Population-based references for waist and hip circumferences, waist-to-hip and waist-to-height ratios for children and adolescents, and evaluation of their predictive ability

Current etiology of hypertension in European children - factors associated with primary hypertension

BACKGROUND

While hypertension (HT) in pediatric patients is often secondary (SH), recent trends show a rise in primary hypertension (PH), which is associated with an increasing global prevalence of obesity. A relationship between serum uric acid and PH has also been suggested. Our study aimed to assess the etiology of HT and factors associated with PH in a large European cohort of children referred for HT based on office blood pressure (BP) measurements.

METHODS

We performed a retrospective analysis of 2008 children aged 0-18 years (12.3 ± 4.9 years) diagnosed with HT. Patients were classified into white coat hypertension (WCH), PH, or SH groups based on office BP, 24-h ambulatory BP monitoring (ABPM) and clinical evaluation. Anthropometric, hemodynamic, and biochemical data were collected.

RESULTS

Out of 2008 patients included in the analysis, 200 (10%) were excluded due to multifactorial HT diagnosis after kidney transplantation (KTx). Among the remaining patients HT was confirmed in 1260 (548 were classified as WCH). Of 1260 patients with HT: 49.3% had PH, while 50.7% SH, mainly secondary to renal parenchymal disease (43.5% of SH patients), aortic coarctation (20.7%), and renovascular HT (18%). Age > 12.5 years, obesity (BMI SDS (standard deviation score) ≥ 1.65), and serum uric acid > 4.8 mg/dL were identified as significant factors associated with PH.

CONCLUSIONS

Our study provides valuable insights into the current etiology of pediatric HT and highlights the role of age, obesity, and uric acid level in the diagnosis of PH in children.

Impact of Different Metabolic Indicators on Ventricular Repolarization Indices in Obese Children: A Case Control Study

Background

Obesity, insulin resistance, and dyslipidemia may impact ventricular repolarization in children.

Objectives

The study aimed to identify the relationship between various metabolic indicators and ventricular repolarization indices among obese children compared to healthy ones.

Methods

A case-control study included 90 children, divided into two groups: 45 obese children (cases) and 45 children with normal weight (controls). Electrocardiogram (ECG) readings were analyzed to calculate several parameters, including corrected QT (QTc), QTc dispersion (QTcd), JTc dispersion, and the TpTe interval, using 12-lead surface ECGs. Both groups were also assessed for lipid profiles, fasting plasma glucose (FPG), and serum insulin to calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).

Results

Obese children had significantly higher serum levels of triglycerides, cholesterol, LDL, fasting insulin, and HOMA-IR compared to controls. Also, they significantly had longer mean values of QTcd and JTcd with no significant difference in TpTe interval between both groups. A significant positive correlation was detected between QTc and JTc dispersion and the following variables: waist circumference, body mass index (BMI), blood pressure, fasting insulin, HOMA-IR index, and LDL. Additionally, no significant difference was revealed between obese children with and without metabolic syndrome regarding ventricular repolarization ECG parameters.

Conclusion

Greater JTc dispersion (ms) and QTc dispersion (ms) were observed in obese children with a positive correlation to waist circumference, BMI, and insulin resistance.

Evaluating waist-to-hip ratio in youth using frequency-modulated continuous wave radar and machine learning

Waist-to-hip ratio (WHR) is an essential predictor of cardiometabolic diseases, but traditional tape-based WHR measurements in children and adolescents can cause discomfort due to direct contact and are prone to measurer variation. This study aimed to develop a non-invasive, precise, and convenient alternative for WHR measurement and central obesity assessment using frequency modulated continuous wave (FMCW) radar, and to evaluate its accuracy by comparing it with traditional measurement methods. We included 100 participants aged 7-18 and radar data were analyzed using point cloud generation processed through convolutional neural networks for estimating WHR. The radar-based WHR measurements were compared to conventional clinician measurements. Participants were classified into low (WHR < 0.86), moderate (≥ 0.86, < 0.91) and high WHR (≥ 0.91) groups, and the classifications were compared. Strong agreement was observed between the two methods, with an intraclass correlation coefficient of 0.83 (p = 0.023995). The radar system achieved 82% accuracy in classifying participants into the correct abdominal obesity risk groups. Our findings demonstrate that FMCW radar can be a reliable tool for routine monitoring of central obesity. This technology addresses concerns about privacy and discomfort, making it suitable for widespread application in both clinical and non-clinical settings.

Breaking the Cycle: Enhancing Cardiovascular Health in the Elderly Through Group Exercise

The global increase in aging populations underscores the urgency of addressing cardio-kidney metabolic health indicators, particularly among sedentary elderly individuals. This study investigates the impact of an 8-month structured group exercise program on cardiovascular health indicators among 320 women aged 60 and older living independently in Rijeka. Participants engaged in biweekly sessions designed to improve mobility, balance, and strength. Key metrics, including blood pressure (BP), body mass index (BMI), waist-to-hip (WHR) and waist-to-height ratio (WHtR), and hand grip strength, were measured before and after the intervention. Results revealed significant reductions in systolic blood pressure (mean -3.4 mmHg) and pulse pressure among hypertensive participants, highlighting improved cardiovascular function. BP control significantly improved (7.2%), and 19% of untreated hypertensive subjects at the start become normotensive at the end of follow-up. Although BMI changes were minimal, WHtR improvements indicated reductions in central obesity and muscle fat redistribution. Hand grip strength increased significantly on both arms, correlating with physical capacity. The results underline the benefits of group training for improving health even in the elderly population through an organized exercise program. While these preliminary results demonstrate promising health improvements, further research with longer follow-up and inclusion of diverse participant groups is recommended to validate these outcomes and refine intervention strategies.

Sport participation, weight status, and physical fitness in French adolescents

The primary objective of this study was to investigate the associations between sport participation and weight status with physical fitness among French adolescents. The secondary aim was to establish sex- and age-specific physical fitness percentiles for French adolescents. The sample comprised 8084 adolescents (4126 boys, 3958 girls), aged 10-14 years. Participants were tested on cardiorespiratory fitness and muscular strength using the following tests: 20-m shuttle run test and handgrip strength test. A questionnaire on organized sport participation was completed. Physical fitness levels were better in boys (P < 0.005). Handgrip strength increased with age whereas 20-m shuttle run performance decreased with age. Overweight and obese adolescents had significantly lower cardiorespiratory fitness levels than their normal-weight peers (P < 0.005), whereas normal-weight adolescents had lower cardiorespiratory fitness than thin adolescents (P < 0.005). Sport participation was higher for boys (57.2% boys vs. 52.8% girls) (P < 0.001). Adolescents who participated in at least one organized sport (either through a club or at school) were fitter than those who did not participate in organized sports (P < 0.005). Adolescents who engaged in organized sports were more active and physically fit than those who did not participate. The fitness benefits of club sports are greater than those provided by school-based sports, highlighting the potential of sports clubs as a key setting for promoting health. What is Known: • Physical fitness is a strong marker of health in children and adolescents. • The last French Report Card highlighted the lack of fitness data and the need for nationwide programs, while showing a significant decline in cardiorespiratory fitness among youth in recent decades.. What is New: • This study reveals that adolescents participating in organized sports have better physical fitness compared to their peers who do not, emphasizing the potential advantages of club sports over school-based activities. • We highlight the need for targeted strategies, particularly for overweight or obese adolescents and girls, to increase participation in organized sports and enhance health outcomes. • The study emphasizes the need to develop policies that improve access to organized sports clubs and expand physical education in schools, aiming to improve CRF in adolescents.

Association between body roundness index and psoriasis among US adults: a nationwide population-based study

BACKGROUND

In clinical practice, psoriasis is a prevalent chronic inflammatory cutaneous disease featured with the development of red plaque with silvery scales, which considerably affects cutaneous health and quality of life of those afflicted.

OBJECTIVE

This research aimed to examine the association between the body roundness index (BRI) and psoriasis, using data sourced from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Our study used a cross-sectional design, including 8,479 adults, of whom 234 were diagnosed with psoriasis. Multivariable logistic regression was used to analyze the relationship between BRI and psoriasis, with stepwise adjustments for covariables.

RESULTS

Results from multivariable logistic regression analyses indicated a significant positive relationship between BRI and the risk of developing psoriasis; specifically, after comprehensive adjustment for covariables, per 1 unit increase in BRI was linked to an 11% rise in psoriasis risk (OR = 1.11, 95% CI = 1.05-1.17). Furthermore, psoriasis patients exhibited higher average BRI compared to non-psoriasis patients and a greater prevalence of comorbidities such as hypertension and smoking.

CONCLUSION

These findings suggest that higher BRI is positively correlated with the risk of psoriasis in the adult population in the US. BRI could potentially act as a practical anthropometric index for more accurately predicting the risk of developing psoriasis.

Application of a Body Shape Index as an Anthropometric Predictor of Cardiometabolic Risks in Children and Adolescents (Systematic Review)

A body shape index (ABSI) is a novel anthropometric measure associated with body obesity. However, the research on the relationship between the new anthropometric risk index and metabolic disorders and cardiovascular alterations in the pediatric population is limited. The aim of the study was to perform a systematic review and meta-analysis of the associations between cardiometabolic risk and ABSI and evaluate its discrimination capacity.

Materials and Methods

A systematic search and analysis of the available scientific literature were conducted to identify relevant articles published up to March 2024 in Web of Science, Science Direct, Scopus, ResearchGate, and PubMed. All full-text publications reporting an association between cardiometabolic risk and ABSI in children and adolescents were considered eligible and reviewed in detail. The reported results and statements were summarized using meta-analysis methods.

Results

A systematic review of 17 cross-sectional studies involving 31,849 children and adolescents, predominantly from Asian countries, was conducted. Nine studies included fewer than 1,000 subjects, raising questions about the representativeness of the samples and the reliability of the reported results. The data regarding the relationship between ABSI and cardiometabolic risk remain controversial. Even when applying age- and sex-adjusted ABSI, and when compared with other established or newly introduced anthropometric measurements, the discriminatory capacity of ABSI remains uncertain.

Conclusions

The findings to date highlight the variable discriminating capacity of ABSI as a predictor of cardiometabolic risk in children and adolescents.

Obesity and hypertension in children and adolescents

As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.

Evidence for central obesity risk-related thresholds for adolescents aged 11 to 18 years in England using the LMS method

INTRODUCTION

Central obesity has been shown to better indicate health risks compared to general obesity. Measures of central obesity include waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and waist circumference (WC). The National Institute of Health and Care Excellence (NICE) recently recommended the use of WHtR alongside body mass index (BMI) to identify risks in adults and children, whilst recognising the need for more evidence relating to WHtR in children. This study explores risk thresholds for central obesity measures throughout adolescence. It compares these with those currently recommended in England and discusses whether these thresholds are age- and sex-specific.

METHODS

Data on adolescents aged 11 to 18 years from the Health Survey for England (HSE) during 2005 to 2014 was used to calculate WHtR, WHR and WC percentiles. Next, smoothed lambda-mu-sigma (LMS) curves were created and the percentiles which align with the adult thresholds at age 18 years identified. This allows the most appropriate risk related thresholds for each measure during adolescence to be determined.

RESULTS

WHtR LMS curves are stable and flat throughout adolescence. WHR decreases in girls and WC increases in both boys and girls, during adolescence. Across all measures, there is slightly more fluctuation in higher percentiles, and in girls' WHR.

DISCUSSION

In practice, WHtR thresholds are simple to use to identify central obesity related risks. In particular, they are recommended because the same thresholds can be used for males and females and for adolescents and adults. The results support NICE guidance to use WHtR thresholds alongside BMI thresholds to identify individual risk.

IMPLICATIONS AND CONTRIBUTION

This study uses central obesity measures, including waist-to-height and waist-to-hip ratios, to investigate risk-related thresholds for adolescents. It is the first to do so using English data. It provides support for current NICE recommendations to use adult waist-to-height thresholds in adults and children, alongside BMI measures in clinical and non-clinical settings.

Impact of Covid-19 lockdowns on the anthropometric development in primary school children in the Rhein-Neckar Region, Germany

BACKGROUND

Published data suggests that lockdowns during the COVID-19 pandemic may have negatively affected children's weight development. This study aims to assess the prevalence of overweight and obesity after the COVID-19 lockdowns as well as anthropometric development among primary school children in the Rhein-Neckar Region, Germany.

METHODS

In this cross-sectional study, schools were selected in cooperation with the local health authority to include different socioeconomic backgrounds. Participation was voluntary at school and individual level, requiring written informed consent from legal guardians. Study visits in schools were conducted between October 2021 and July 2022. Anthropometric data from nationally recommended medical examinations at 4 years (U8) and 5 years (U9), data on nutrition, physical activity, and socioeconomic data was collected using questionnaires. zBMI and weight category were calculated based on German reference data.

RESULTS

256 children with a mean age of 8.0 years (7.1-9.3 years) were included in the study. Most participants were from households with an above average income. 5.1% of the children were overweight, 4.7% were obese, 15.6% were underweight, and 74.6% were normal weight with a mean zBMI of -0.25 (SD 1.10), which is significantly lower than the mean zBMI of the German reference population (p < 0.001). No significant changes in zBMI were observed between U8 and U9 (p = 0.16). The mean zBMI decreased by 0.17 (SD 0.72) between U9 and the study visit (p = 0.02). A zBMI decrease of 0.5 was documented for the subgroup of overweight and obese children (p = 0.028) as well as a decrease of 0.23 (SD 0.63) for the normal-weight children subgroup (p < 0.001).

CONCLUSIONS

Contrary to previous reports mean zBMI decreased significantly in the children studied. No significant changes in zBMI were observed between U8 and U9 examinations, which supports the hypothesis that the decrease in zBMI could be attributed to lockdown measures. The study was registered at clinicaltrials.gov on September 21st 2021 under the registration number NCT05077059.

High prevalence of impaired glucose metabolism among children and adolescents living with HIV in Ghana

BACKGROUND

Antiretroviral therapy (ART)-associated metabolic abnormalities, including impairment of glucose metabolism, are prevalent in adults living with HIV. However, the prevalence and pathogenesis of impaired glucose metabolism in children and adolescents living with HIV, particularly in sub-Saharan Africa, are not well characterized. We investigated the prevalence of impaired glucose metabolism among children and adolescents living with perinatally infected HIV in Ghana.

METHODS

In this multicentre, cross-sectional study, we recruited participants from 10 paediatric antiretroviral treatment clinics from January to June 2022 in 10 facilities in Greater Accra and Eastern regions of Ghana. We determined impaired glucose metabolism in the study sample by assessing fasting blood sugar (FBS), insulin resistance as defined by the homeostatic model assessment for insulin resistance (HOMA-IR) index and glycated haemoglobin (HbA1c) levels. The prevalence of impaired glucose metabolism using each criterion was stratified by age and sex. The phenotypic correlates of glucose metabolism markers were also assessed among age, sex, body mass index (BMI) and waist-to-hip ratio (WHR).

RESULTS

We analysed data from 393 children and adolescents living with HIV aged 6-18 years. A little over half (205/393 or 52.25%) of the children were female. The mean age of the participants was 11.60 years (SD = 3.50), with 122/393 (31.00%) aged 6-9 years, 207/393 (52.67%) aged 10-15 years, and 62/393 (15.78%) aged 16-18 years. The prevalence rates of glucose impairment in the study population were 15.52% [95% confidence interval (CI): 12.26-19.45], 22.39% (95% CI: 18.54-26.78), and 26.21% (95% CI: 22.10-30.78) using HbA1c, HOMA-IR, and FBS criteria, respectively. Impaired glucose metabolism detected by FBS and HOMA-IR was higher in the older age group, whereas the prevalence of abnormal HbA1c levels was highest among the youngest age group. Age and BMI were positively associated with FBS and HOMA-IR (p < 0.001). However, there was negative correlation of WHR with HOMA-IR (p < 0.01) and HbA1c (p = 0.01).

CONCLUSION

The high prevalence of impaired glucose metabolism observed among the children and adolescents living with HIV in sub-Saharan Africa is of concern as this could contribute to the development of metabolic syndrome in adulthood.

A differentiated approach to the diagnosis of overweight and obesity in children based on bioimpedance analysis of body composition

OBJECTIVE

Aim: The current study introduces a novel diagnostic algorithm employing bioimpedance analysis to comprehensively evaluate body composition in children, assessing fat content, skeletal muscle content, and fat distribution.

PATIENTS AND METHODS

Materials and Methods: Bioelectrical impedance measurements were obtained using the TANITA MC-780 MA analyzer. Indicators such as body weight, BMI, total fat content, absolute limb muscle mass, skeletal muscle strength, and waist-to-hip ratio (WHR) were assessed. A sample of 101 children aged 9 to 14 were studied using the proposed algorithm, refining BMI-based classifications.

RESULTS

Results: The algorithm comprises three steps, categorizing children based on fat content, presence of sarcopenia, and central fat distribution. It identified diverse somatotypes within the groups classified by BMI. Notably, it revealed prognostically unfavorable somatotypes, such as sarcopenic obesity with central fat distribution, highlighting potential health risks. Current BMI-centric diagnoses may misclassify cardiometabolic risks, making early detection challenging. The algorithm enables a detailed evaluation, unmasking metabolically unfavorable conditions like sarcopenic obesity. The incorporation of functional tests, such as a standardized hand-grip test, enhances diagnostic accuracy. The proposed WHR indicator for characterizing fat distribution provides a practical method for determining somatotypes in children.

CONCLUSION

Conclusions: This comprehensive algorithm offers an alternative to BMI-based classifications, enabling early detection of obesity and associated risks. Further validation through large-scale epidemiological studies is essential to establish correlations between somatotypes and cardiometabolic risks, fostering a more nuanced and individualized approach to pediatric obesity management.

Nutrition-Related Knowledge, Diet Quality, Lifestyle, and Body Composition of 7-12-Years-Old Polish Students: Study Protocol of National Educational Project Junior-Edu-Żywienie (JEŻ)

Increasing students' nutrition knowledge is an important goal of school education which may improve their lifestyle and consequently reduce the incidence of non-communicable chronic diseases, including obesity. This research aimed at assessing the dietary habits, nutrition-related knowledge and attitudes, and nutritional status of Polish students aged 7-12 years. Additional objectives included recognizing nutrition-related knowledge among their parents and teachers as well as the school food and nutrition environment. The final goal was to develop a nutrition education program. This study protocol presents a general and detailed approach for realizing the above-mentioned issues, including conducting quantitative and qualitative research. The study was designed as cross-sectional, covering primary school students from all over Poland, including rural, town, and metropolitan areas. Data on eating habits, lifestyle, nutrition-related knowledge, and attitudes were collected with questionnaires. Measurements of body weight, height, waist and hip circumferences, and handgrip strength were performed in accordance with the International Standards for Anthropometric Assessment (ISAK) recommendations. Body composition was assessed with bioelectrical impedance analysis. Ultimately, 2218 schools from all 16 voivodeships in Poland registered for the project. In total, quantitative data were collected among 27,295 students, 17,070 parents, and 2616 teachers. Anthropometric measurements were taken among 18,521 students. The results allow us to develop a multifaceted educational program based on knowledge and adapted to the perception of students. Our research may contribute to the identification of subpopulations of children and adolescents at risk of excessive body weight and define the predictors of obesity risk in Poland.

Comparison of Several Anthropometric Indices Related to Body Fat in Predicting Cardiorespiratory Fitness in School-Aged Children-A Single-Center Cross-Sectional Study

Body fat (BF) and cardiorespiratory fitness (CRF) are important health markers that ought to be considered in screening exams. The aim of this study was to assess the value of six indicators, i.e., tri-ponderal mass index (TMI), relative fat mass (RFM), waist-BMI ratio, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and body mass index (BMI) in predicting CRF in school-aged children. The analysis was based on the data coming from the examination of 190 children participating in school physical education (PE) classes. Their body weight (BW) and height (BH), waist and hip circumference (WC; HC) and percentage of body fat (%BF) were measured; the CRF test was performed with the use of the 20 m shuttle run test (20 mSRT); peak heart rate (HRpeak) was measured; TMI, relative fat mass pediatric (RFMp), waist-BMI ratio, WHtR, BMI and WHR were calculated. Statistical analysis was mainly conducted using regression models. The developed regression models, with respect to the sex and age of the children, revealed RFMp as the strongest CRF indicator (R2 = 51.1%) and WHR as well as waist-BMI ratio as the weakest ones (R2 = 39.2% and R2 = 40.5%, respectively). In predicting CRF in school-aged children, RFMp turned out to be comparable to body fat percentage obtained by means of the bioimpedance analysis (BIA) (R2 = 50.3%), and as such it can be used as a simple screening measure in prophylactic exams of school children. All of these models were statistically significant (p < 0.001).