Commenced in January 2007
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Understanding the Nature of Blood Pressure as Metabolic Syndrome Component in Children

Authors: Mustafa M. Donma, Orkide Donma

Abstract:

Pediatric overweight and obesity need attention because they may cause morbid obesity, which may develop metabolic syndrome (MetS). Criteria used for the definition of adult MetS cannot be applied for pediatric MetS. Dynamic physiological changes that occur during childhood and adolescence require the evaluation of each parameter based upon age intervals. The aim of this study is to investigate the distribution of blood pressure (BP) values within diverse pediatric age intervals and the possible use and clinical utility of a recently introduced Diagnostic Obesity Notation Model Assessment Tension (DONMA tense) Index derived from systolic BP (SBP) and diastolic BP (DBP) [SBP+DBP/200]. Such a formula may enable a more integrative picture for the assessment of pediatric obesity and MetS due to the use of both SBP and DBP. 554 children, whose ages were between 6-16 years participated in the study; the study population was divided into two groups based upon their ages. The first group comprises 280 cases aged 6-10 years (72-120 months), while those aged 10-16 years (121-192 months) constituted the second group. The values of SBP, DBP and the formula (SBP+DBP/200) covering both were evaluated. Each group was divided into seven subgroups with varying degrees of obesity and MetS criteria. Two clinical definitions of MetS have been described. These groups were MetS3 (children with three major components), and MetS2 (children with two major components). The other groups were morbid obese (MO), obese (OB), overweight (OW), normal (N) and underweight (UW). The children were included into the groups according to the age- and sex-based body mass index (BMI) percentile values tabulated by WHO. Data were evaluated by SPSS version 16 with p < 0.05 as the statistical significance degree. Tension index was evaluated in the groups above and below 10 years of age. This index differed significantly between N and MetS as well as OW and MetS groups (p = 0.001) above 120 months. However, below 120 months, significant differences existed between MetS3 and MetS2 (p = 0.003) as well as MetS3 and MO (p = 0.001). In comparison with the SBP and DBP values, tension index values have enabled more clear-cut separation between the groups. It has been detected that the tension index was capable of discriminating MetS3 from MetS2 in the group, which was composed of children aged 6-10 years. This was not possible in the older group of children. This index was more informative for the first group. This study also confirmed that 130 mm Hg and 85 mm Hg cut-off points for SBP and DBP, respectively, are too high for serving as MetS criteria in children because the mean value for tension index was calculated as 1.00 among MetS children. This finding has shown that much lower cut-off points must be set for SBP and DBP for the diagnosis of pediatric MetS, especially for children under-10 years of age. This index may be recommended to discriminate MO, MetS2 and MetS3 among the 6-10 years of age group, whose MetS diagnosis is problematic.

Keywords: Blood pressure, children, index, metabolic syndrome, obesity.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.2702851

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References:


[1] V. Higgins, and K. Adeli, “Pediatric metabolic syndrome: pathophysiology and laboratory assessment,” J. Int. Fed. Clin. Chem. Lab. Med., vol. 28, pp. 25-42, March 2017.
[2] T. T. K. Huang, S. S. Sun, and S. R. Daniels, “Understanding the nature of metabolic syndrome components in children and what they can and cannot do to predict adult disease,” J. Pediatr, vol.155, pp. e13-e14, Sept. 2009.
[3] T. T. K. Huang, “Finding thresholds of risk for components of the pediatric metabolic syndrome,” J. Pediatr., vol.152, pp.158-159, Feb. 2008.
[4] E. S. Ford, and C. Li, “Defining the metabolic syndrome in children and adolescents: Will the real definition please stand up?,” J. Pediatr., vol.152, pp. 160-164, Feb. 2008.
[5] R. Weiss, A. A. Bremer, R. H. Lustig, “What is metabolic syndrome, and why are children getting it?,” Ann. N. Y. Acad. Sci., vol.1281, pp.123-140, Apr. 2013.
[6] P. Zimmet, K. G. Alberti, F. Kaufman, N. Tajima, M. Silink, S. Arslanian, G. Wong, P. Bennett, J. Shaw, S. Caprio, and IDF consensus group, “The metabolic syndrome in children and adolescents- an IDF consensus report”, Pediatr. Diabetes, vol. 8, no. 5, pp. 299- 306, Oct. 2007.
[7] C. Koebnick, M. H. Black, J. Wu, M. P. Martinez, N. Smith, B. Kuizon, D. Cuan, D. R. Young, J. M. Lawrence, and S. J. Jacobsen, “High blood pressure in overweight and obese youth: Implications for screening,” J. Clin. Hypertens., vol. 15, pp. 793–805, Nov. 2013.
[8] A. A. Oduwole, T. A. Ladapo, I. B. Fajolu, E. N. Ekure, and O. F. Adeniyi, “Obesity and elevated blood pressure among adolescents in Lagos, Nigeria: A cross-sectional study,” BMC Public Health, vol. 12, pp. 616: 1–6, Aug. 2012.
[9] W. Strojny, D. Drozdz, K. Fijorek, M. Korostynski, M. Piechota, W. Balwierz, J. A. Pietrzyk, P. Kwinta, M. Siedlar, and S. Skoczen, “Looking for a new diagnostic tools and biomarkers of hypertension in obese pediatric patients,” Blood Press. Monit., vol.22, pp.122-130, Jun. 2017.
[10] Harvard Health Publishing, Harvard Medical School, Tips to measure your blood pressure correctly. Available at: https://www.health.harvard.edu, 2010-2019 Harvard University.
[11] Great Ormond Street Hospital for Children, NHS Foundation Trust, Blood pressure monitoring, Available at: https://www.gosh.nhs.uk, 2019.
[12] World Health Organization (WHO). The WHO Child Growth Standards. Available at: http://www.who.int/childgrowth/en/ Accessed on June 10, 2016.
[13] P. Di Bonito, G. Valerio, L. Pacifico, C. Chiesa, C. Invitti, A. Morandi, M. R. Licenziati, M. Manco, E. M. D. Giudice, M. G. Baroni, S. Loche, G. Tornese, F. Franco, C. Maffeis, G. de Simone, CARITALY Study Group; on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology, Diabetology, “Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth,” J. Hypertens., vol.37, pp. 732-738, Apr. 2019.
[14] P. Di Bonito, G. Valerio, L. Pacifico, C. Chiesa, C. Invitti, A. Morandi, C. Maffeis, M. R. Licenziati, M. Manco, E. M. D. Giudice, M. G. Baroni, S. Loche, G. Tornese, M. Tomat, G. de Simone, CARITALY Study Group, “A new index to simplify the screening of hypertension in overweight or obese youth,” Nutr. Metab. Cardiovasc. Dis., vol.27, pp.830-835, Sept. 2017.
[15] R. Kelishadi, M. Bahreynian, R. Heslimat, M. E. Motlagh, S. Djalalinia, F. Naji, G. Ardalan, H. Asayesh, and M. Qorbani, “Accuracy of blood pressure-to-height ratio to define elevated blood pressure in children and adolescents: The CASPIAN-IV Study,” Pediatr. Cardiol., vol.37, pp. 378-385, Feb.2016.
[16] K. Rimarova, E. Dorko, J. Diabelkova, Z. Sulinova, K. Frank, J. Bakova, T. Uhrin, P. Makovicky, N. Pelechova, and N. Konradyova, “Anthropometric predictors of systolic and diastolic blood pressure considering intersexual differences in a group of selected schoolchildren,” Cent. Eur. J. Public Health, vol. 26, pp. S4-S11, Dec. 2018.
[17] M. L. Marcovecchio, A. Mohn, G. Diddi, N. Polidori, F. Chiarelli, and N. Fuiano, “Longitudinal assessment of blood pressure in school-aged children: A 3-year follow-up study,” Pediatr. Cardiol., vol.37, pp.255-261, Feb. 2016.
[18] A. O. Fowokan, Z. Punthakee, C. Waddell, M. Rosin, K. M. Morrison, M. Gupta, K. Teo, S. Rangarajan, and S. A. Lear, “Adiposity measures and their validity in estimating risk of hypertension in South Asian children: a cross-sectional study,” BMJ Open, vol.9, pp.e024087, Feb. 2019.
[19] H. S. Ejtahed, M. Qorbani, M. E. Motlagh, P. Angoorani, S. Hasani-Ranjbar, H. Ziaodini, M. Taheri, Z. Ahadi, S. Beshtar, T. Aminaee, R. Heshmat, and R. Kelishadi, “Association of anthropometric indices with continuous metabolic syndrome in children and adolescents: the CASPIAN-V study,” Eat. Weight Disord., vol.23, p. 597-604, Oct. 2018.
[20] A. E. Al-Agha, and A. O. Mahjoub, “Impact of body mass index on high blood pressure among obese children in the western region of Saudi Arabia,” Saudi Med. J., vol.39, pp.45-51, Jan. 2018.
[21] Y. Huang, Z. Deng, Z. Se, Y. Bai,C. Yan, Q. Zhan, Q. Zeng, P. Ouyang, M. Dai, and D. Xu, “Combined impact of risk factors on the subsequent development of hypertension,” J. Hypertens., vol.37, pp. 696-701, Apr. 2019.