High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity

Quadros, Teresa Maria Bianchini de; Gordia, Alex Pinheiro; Andaki, Alynne Christian Ribeiro; Mendes, Edmar Lacerda; Mota, Jorge; Silva, Luciana Rodrigues

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 22 • 2019 • https://doi.org/10.1590/1980-549720190017 copy

High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To determine the predictive power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and their respective cut-off points for high blood pressure (BP) screening in Brazilian children and adolescents.

Method:

Cross-sectional study conducted with 1,139 students aged 6 to 17years. Body weight, height, WC, and BP were measured. High BP was classified as systolic or diastolic ≥ 95^th percentile. Receiver Operating Characteristic (ROC) curves were constructed, and the area under the curve, sensitivity, and specificity were calculated.

Results:

The prevalence of high BP was 27.0%. Anthropometric indices showed a significant association with high BP (accuracy ranging from 0.62 - 0.81), except for WHtR among male adolescents.Sensitivity was low, regardless of the anthropometric index, gender, and age group.

Conclusion:

BMI, WC, and WHtR were associated with high BP, but the cut-off points tested showed low sensitivity. Determining specific cut-off points for each population can enable the use of anthropometric indices in high BP screening.

Keywords:
Arterial pressure; Obesity; Body mass index; Waist circumference; Child

	n	Systolic BP^a (mmHg)	Diastolic BP^a (mmHg)	BMI^a (kg/m²)	WC^a (cm)	WHtR^a
Gender
Male	506	114 (104; 122)	65 (60; 71)	17 (16; 19)	63 (56; 70)	0.44 (0.42; 0.46)
Female	633	115 (106; 124)	68 (62; 74)	18 (16; 21)	67 (59; 73)	0.46 (0.43; 0.49)
p-value^b		0.048	0.001	0.001	0.001	0.001
Age group (years)
Children (6 - 9)	363	106 (99; 115)	62 (57; 67)	16 (15; 17)	56 (53; 60)	0.45 (0.43; 0.48)
Adolescents (10 - 17)	776	117 (109; 126)	69 (63; 74)	19 (17; 21)	69 (63; 75)	0.45 (0.42; 0.48)
p-value^b		0.001	0.001	0.001	0.001	0.041
Total	1,139	114 (105; 123)	66 (61; 73)	17 (16; 20)	65 (58; 72)	0.45 (0.42; 0.48)

Anthropometric indices	Male	Female
Anthropometric indices	AUC (95%CI)	AUC (95%CI)
Children
BMI	0.81 (0.74 - 0.87)^a,b	0.78 (0.71 - 0.83)^a
WC	0.78 (0.71 - 0.84)^a,b	0.71 (0.64 - 0.77)^a
WHtR	0.62 (0.54 - 0.69)^a,b,c	0.74 (0.67 - 0.80)^a
Adolescents
BMI	0.67 (0.62 - 0.72)^a	0.63 (0.59 - 0.68)^a
WC	0.65 (0.60 - 0.70)^a	0.63 (0.58 - 0.68)^a
WHtR	0.51 (0.46 - 0.57)	0.62 (0.57 - 0.63)^a

Anthropometric indices	Male			Female
Anthropometric indices	Obesity prevalence (%)	SE (%)	SP (%)	Obesity prevalence (%)	SE (%)	SP (%)
Children
BMI
IOTF¹⁹19. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320(7244): 1240-3.	13.5	42.9	89.2	19.3	45.0	83.6
WHO²⁰20. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85(9): 660-7.	18.1	42.9	84.1	23.4	55.0	80.1
CDC²¹21. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, etal. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002; (246): 1-190.	16.4	42.9	86.0	18.8	45.0	84.2
Conde and Monteiro²²22. Conde WL, Monteiro CA. Body mass index cutoff points for evaluation of nutritional status in Brazilian children and adolescents. J Pediatr (Rio J) 2006; 82(4): 266-72. https://doi.org/doi:10.2223/JPED.1502 https://doi.org/doi:10.2223/JPED.1502...	14.6	42.9	87.9	25.0	55.0	78.4
WC
Taylor etal.²⁴24. Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19 y. Am J Clin Nutr 2000; 72(2): 490-5. https://doi.org/10.1093/ajcn/72.2.490 https://doi.org/10.1093/ajcn/72.2.490...	11.2	35.7	91.0	20.3	50.0	83.0
Katzmarzyk etal.²⁵25. Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 2004; 114(2): e198-205.	38.0	57.1	63.7	49.0	65.0	52.6
CDC (75^th)²⁷27. Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007-2010. Vital Health Stat 11 2012; (252): 1-48.	8.2	8.3	92.9	14.1	20.0	92.9
CDC (90^th)²⁷27. Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007-2010. Vital Health Stat 11 2012; (252): 1-48.	1.2	3.1	100.0	4.2	10.0	96.5
Fernández etal. (75^th)²⁶26. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145(4): 439-44. https://doi.org/10.1016/j.jpeds.2004.06.044 https://doi.org/10.1016/j.jpeds.2004.06....	14.0	21.4	81.5	20.8	25.0	83.6
Fernández etal. (90^th)²⁶26. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145(4): 439-44. https://doi.org/10.1016/j.jpeds.2004.06.044 https://doi.org/10.1016/j.jpeds.2004.06....	4.7	7.1	95.5	8.3	25.0	93.6
WHtR
0.5²⁸28. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2005; 56(5): 303-7. https://doi.org/10.1080/09637480500195066 https://doi.org/10.1080/0963748050019506...	14.1	35.7	87.8	24.0	55.0	79.5
Kelishadi etal.⁹9. Kelishadi R, Ardalan G, Gheiratmand R, Adeli K, Delavari A, Majdzadeh R, etal. Paediatric metabolic syndrome and associated anthropometric indices: the CASPIAN Study. Acta Paediatr 2006; 95(12): 1625-34. https://doi.org/10.1080/08035250600750072 https://doi.org/10.1080/0803525060075007...	38.2	50.0	62.8	49.5	70.0	52.6
Zhou etal.²⁹29. Zhou D, Yang M, Yuan ZP, Zhang DD, Liang L, Wang CL, etal. Waist-to-Height Ratio: a simple, effective and practical screening tool for childhood obesity and metabolic syndrome. Prev Med 2014; 67: 35-40. https://doi.org/10.1016/j.ypmed.2014.06.025 https://doi.org/10.1016/j.ypmed.2014.06....	27.6	35.7	73.1	62.0	90.0	40.9
Adolescents
BMI
IOTF¹⁹19. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320(7244): 1240-3.	13.1	18.0	89.2	17.5	24.7	86.7
WHO²⁰20. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85(9): 660-7.	16.7	23.4	86.5	20.6	27.2	83.2
CDC²¹21. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, etal. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002; (246): 1-190.	13.7	18.0	88.3	16.6	23.5	87.5
Conde and Monteiro²²22. Conde WL, Monteiro CA. Body mass index cutoff points for evaluation of nutritional status in Brazilian children and adolescents. J Pediatr (Rio J) 2006; 82(4): 266-72. https://doi.org/doi:10.2223/JPED.1502 https://doi.org/doi:10.2223/JPED.1502...	17.0	24.3	86.5	21.8	30.2	83.2
WC
Taylor etal.²⁴24. Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19 y. Am J Clin Nutr 2000; 72(2): 490-5. https://doi.org/10.1093/ajcn/72.2.490 https://doi.org/10.1093/ajcn/72.2.490...	14.0	22.5	90.1	25.9	37.0	80.3
Katzmarzyk etal.²⁵25. Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 2004; 114(2): e198-205.	37.6	45.0	65.9	55.3	64.2	49.8
CDC (75^th)²⁷27. Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007-2010. Vital Health Stat 11 2012; (252): 1-48.	6.3	11.7	92.4	8.6	9.3	91.0
CDC (90^th)²⁷27. Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007-2010. Vital Health Stat 11 2012; (252): 1-48.	0.9	0.9	99.1	2.3	4.3	98.9
Fernández etal. (75^th)²⁶26. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145(4): 439-44. https://doi.org/10.1016/j.jpeds.2004.06.044 https://doi.org/10.1016/j.jpeds.2004.06....	15.2	22.5	85.7	20.0	19.7	84.0
Fernández etal. (90^th)²⁶26. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145(4): 439-44. https://doi.org/10.1016/j.jpeds.2004.06.044 https://doi.org/10.1016/j.jpeds.2004.06....	5.4	9.0	96.4	6.6	13.6	97.5
WHtR
0.5²⁸28. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2005; 56(5): 303-7. https://doi.org/10.1080/09637480500195066 https://doi.org/10.1080/0963748050019506...	-	-	-	25.0	34.6	80.6
Kelishadi etal.⁹9. Kelishadi R, Ardalan G, Gheiratmand R, Adeli K, Delavari A, Majdzadeh R, etal. Paediatric metabolic syndrome and associated anthropometric indices: the CASPIAN Study. Acta Paediatr 2006; 95(12): 1625-34. https://doi.org/10.1080/08035250600750072 https://doi.org/10.1080/0803525060075007...	-	-	-	61.4	69.1	43.2
Zhou etal.²⁹29. Zhou D, Yang M, Yuan ZP, Zhang DD, Liang L, Wang CL, etal. Waist-to-Height Ratio: a simple, effective and practical screening tool for childhood obesity and metabolic syndrome. Prev Med 2014; 67: 35-40. https://doi.org/10.1016/j.ypmed.2014.06.025 https://doi.org/10.1016/j.ypmed.2014.06....	-	-	-	60.9	67.9	43.2

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[1] Corresponding author: Teresa Maria Bianchini de Quadros. Centro de Formação de Professores. Universidade Federal do Recôncavo da Bahia. Avenida Nestor de Melo Pita, 535, Centro, CEP: 45300-000, Amargosa, BA, Brasil. E-mail: tetemb@gmail.com