Body mass index and waist-to-height ratio cut-offs as predictors of high blood pressure in adolescents

Kurnia Febriana, Neti Nurani, Madarina Julia



DOI: https://doi.org/10.13181/mji.v24i1.1200

Abstract


Background: Obesity is associated with increased risk for high blood pressure (BP). Although a routine BP measurement is indicated for all children visiting pediatric practice, recognition of children particularly at risk may save times. The aim of this study was to assess the cut-off point for body mass index (BMI) and waist-to-height ratio (WHtR) to predict high BP in adolescents.

Methods: We conducted a cross-sectional study on 928 children aged 11 to 16 years in Yogyakarta. BP were measured using standard technique described by The Fourth Report on The Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. BMI was adjusted for age and sex using the WHO 2007 growth reference. WHtR was ratio of waist circumference related to height in centimeters. Receiver operating characteristic (ROC) curves were used to estimate the best cut-offs.

Results: The best cut-off point for BMI-for-age Z-score (BMIZ) to predict high BP was 0.51 with sensitivity and specificity of 82% (95% CI = 78-86) and 76% (95% CI = 67-78) for systolic BP and sensitivity and specificity of 82% (95% CI = 78-86) and 72% (95% CI = 68-76) for diastolic BP. The best cut-off point for WHtR was 0.45, with sensitivity of 76% (95% CI = 67-78) and specificity of 74% (95% CI = 71-79) for systolic BP and sensitivity of 76% (95% CI = 72-80) and specificity of 70% (95% CI = 61-75) for diastolic BP.

Conclusion: BMIZ of 0.51 and WHtR of 0.45 are the best cut-off point to predict high BP in adolescents.


Keywords


adolescents; BMI-for-age Z-score; blood pressure; waist-to-height ratio

Full Text:

PDF

References


  1. Luma GB, Spiotta RT. Hypertension in children and adolescents. Am Fam Physician. 2006;73(9):1558-68.
  2. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th report):555-76.
  3. Falkner B, Gidding SS, Portman R, Rosner B. Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics. 2008;122(2):238-42. http://dx.doi.org/10.1542/peds.2007-2776
  4. Freedman D, Kahn HS, Mei Z, Grummer-Strawn LM, Dietz WH, Srinivasan SR, et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 2007;86(1):33-40.
  5. Aeberli I, Gut-Knabenhans I, Kusche-Ammann RS, Molinari L, Zimmermann MB. Waist circumference and waist-to-height ratio percentiles in a nationally representative sample of 6-13 year old children in Switzerland. Swiss Med Wkly. 2011;141:1-6. http://dx.doi.org/10.4414/smw.2011.13227
  6. Moore WE, Stephens A, Wilson T, Wilson W, Eichner JE. Body mass index and blood pressure screening in a rural public school system: the Healthy Kids Project. Prev Chronic Dis. 2006;3(4):1-10.
  7. Ribeiro RC, Coutinho M, Bramorski MA, Giuliano IC, Pavan J. Association of the waist-to-height ratio with cardiovascular risk factors in children and adolescents: the three cities heart study. Int J Prev Med. 2010;1(1):39-49.
  8. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb. 2002;9(3):127-32. http://dx.doi.org/10.5551/jat.9.127
  9. M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb. 2002;9(3):127-32. http://dx.doi.org/10.5551/jat.9.127
  10. Hu YH, Reilly KH, Liang YJ, Xi B, Liu JT, Xu DJ, et al. Increase in body mass index, waist circumference and waist-to-height ratio is associated with high blood pressure in children and adolescents in China. J Int Med Res. 2011;39(1):23-32. http://dx.doi.org/10.1177/147323001103900103
  11. He Q, Ding ZY, Fong DY, Kalberg J. Blood Pressure is associated with body mass index in both normal and obese children. Hypertension. 2000;36(2):165-70. http://dx.doi.org/10.1161/01.HYP.36.2.165
  12. National Health and Nutrition Examination Survey. Anthropometry Procedures Manual [Internet]. Atlanta: Centers for Disease Control and Prevention; 2007 [cited 2013 November 1]. Available from: http://www.cdc.gov/
  13. Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J, editors. Development of a WHO growth reference for school-aged children and adolescents [Internet]. Geneva: World Health Organization; 2007 [cited 2013 November 1]. Available from: http://www.who.int/bulletin/volumes/85/9/07-043497/en/
  14. Julia M. Number of blood pressure measurement needed for screening of hypertension in children and adolescents. Paediatr Indones. 2009;49(4):229-33.
  15. Kim HI, Kim JT, Yu SH, Kwak SH, Jang HC, Park KS, et al. Gender differences in diagnostic values of visceral fat area and waist circumference for predicting metabolic syndrome in Koreans. J Korean Med Sci. 2011;26(7):906-13. http://dx.doi.org/10.3346/jkms.2011.26.7.906
  16. Elizondo-Montemayor L, Serrano-González M, Ugalde-Casas PA, Bustamante-Careaga H, Cuello-García C. Waist-to-height: cutoff matters in predicting metabolic syndrome in Mexican children. Metab Syndr Relat Disord. 2011;9(3):183-90. http://dx.doi.org/10.1089/met.2010.0116
  17. Motswagole BS, Kruger HS, Faber M, van Rooyen JM, de Ridder JH. The sensitivity of waist-to-height ratio in identifying children with high blood pressure. Cardiovasc J Afr. 2011;22(4):208-11. http://dx.doi.org/10.5830/CVJA-2010-062





Copyright (c) 2015 Kurnia Febriana, Neti Nurani, Madarina Julia

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All articles and issues in Medical Journal of Indonesia have unique DOI number registered in Crossref.
 
Romeo