Cardiovascular risk factors and anthropometric measurements of adolescent body composition: a cross-sectional analysis of the Third National Health and Nutrition Examination Survey

Clinical characteristics of two groups commonly referred to an Irish hypertension service-patients with resistant hypertension and young adults with hypertension

BACKGROUND

The management of hypertension is primarily performed in primary care settings in many health systems. However, two groups of patients often require specialist input: patients with resistant hypertension (RH) and young adults with hypertension.

AIMS

To elucidate these groups by examining the characteristics of patients attending an Irish hypertension service, thus informing future management of hypertension.

METHODS

Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Following patient consent, patient data were recorded to identify patient characteristics as well as the results of investigations, blood pressure (BP) measurements and the anti-hypertensive treatment of the study participants which were then analysed.

RESULTS

Two hundred thirty-six patients were included in the study. Compared to those without RH, the RH group were more likely to be obese (OR 2.59 [95% CI 1.06 to 6.33]), to have cardiovascular disease (OR 3.07 [95% CI 1.56 to 6.02]) and to have a non-dipping BP pattern (OR 3.86 [95% CI 1.57 to 9.47]). Young adults comprised 27% of the cohort. Forty-seven percent of these patients were obese, 15.9% had hypertension in pregnancy and 22.2% had chronic headaches. Despite being prescribed less anti-hypertensives (1.41 vs 2.28; p < 0.05), the majority of young patients had a BP less than 140/90 mmHg, comparing favourably with older patients (OR 2.25 [95% CI 1.20 to 4.27]).

CONCLUSION

This contemporary study highlights the high prevalence of obesity among RH patients and young adults with hypertension. Findings suggest that programs to combat hypertension must include interventions to address obesity.

Reference values for lipid profile in Iranian children and adolescents: the CASPIAN-V study

BACKGROUND

We aimed to develop the age- and sex-specific reference values for lipid profile of Iranian pediatric population.

METHODS

Fasting lipid profiles of 3843 participants, aged 7 to 18 years, were extracted from a surveillance survey on Iranian children and adolescents living in 30 provinces across the country.

RESULTS

The mean (SD) age of participants was 12.3(3.1) years, and 52.3% of them were boys. Significant differences were observed between genders comparing the levels of triglyceride (TG) (P = 0.04), total cholesterol (TC) (P = 0.02), low-density lipoprotein- cholesterol (LDL-C) (P = 0.01), and non-high-density lipoprotein cholesterol (non-HDL-C) (P = 0.03). In both genders, TG levels increased with age in the 75th and higher percentiles. Among boys, TC showed a decreasing trend at all percentiles and all age groups. In girls, TC levels increased with age at all percentiles except for the 75th and 90th percentiles. Among boys, the levels of LDL-C and HDL-C decreased with age in all percentiles. However, LDL-C and HDL-C concentrations increased up to the 50th percentile in girls and then decreased with age. The non-HDL-C level decreased in the 50th and higher percentiles among boys and in the 90th and 95th percentiles among girls. The TG/HDL-C ratio increased with age at all percentiles in boys. In girls, TG/HDL-C ratio increased with age in the 50th and higher percentiles.

CONCLUSIONS

Based on the observed differences, it seems necessary to determine age- and sex-specific cut-off values for lipid parameters of children and adolescents in different populations.

Breakfast Consumption Frequency and Its Relationships to Overall Diet Quality, Using Healthy Eating Index 2010, and Body Mass Index among Adolescents in a Low-Income Urban Setting

The aim of this study was to describe the relationship of breakfast frequency to diet quality and BMI among low-income, predominantly African American adolescents aged 9-15 (n = 239). Mean frequency of breakfast consumption was 5.0 ± 0.15 times per week. A significant, positive relationship was seen between HEI scores and frequency of breakfast consumption (p = .01). Dairy (p = .02) and whole grains (p < .01) HEI component scores were significantly related to breakfast frequency. No relationship was seen between breakfast frequency and BMI. Research with more rigorous designs should be conducted to assess the potential effects of breakfast consumption on diet quality in this population.

Effects of Nigella sativa oil with a low-calorie diet on cardiometabolic risk factors in obese women: a randomized controlled clinical trial

Obesity is typically associated with increased risk factors of cardiovascular diseases (CVDs). Therefore, a therapeutic approach that aims to control body weight and metabolic profile might be effective in preventing CVDs. We aimed to determine the effects of Nigella Sativa (NS) oil with a low-calorie diet on cardiometabolic risk factors in obese women. In this double-blind randomized controlled clinical trial, 90 obese women were recruited. Participants were females aged 25-50 years old with body mass index (BMI) between 30 and 35 kg m(-2). They were randomly assigned to receive a low-calorie diet with 3 g per day (1 g before each meal) NS oil or placebo for 8 weeks. Anthropometric indices, dietary intake and biochemical parameters were measured at the baseline and after the intervention. Eighty-four females completed the trial (intervention n = 43, placebo n = 41). Two groups were similar in the baseline characteristics. After the intervention, dietary intake was changed in both groups compared to the baseline, but the differences were not significant between the two groups. In the NS group, weight (-6.0 vs. -3.6%; p < 0.01) and waist circumference (-6.9 vs. -3.4%; p < 0.01) decreased significantly compared with the placebo group at the end of the trial. Comparison of biochemical parameters presented a significant decline in triglyceride (-14.0 vs. 1.4%; p = 0.02) and very low density lipoprotein (-14.0 vs. 7%; p < 0.01) levels in the NS group compared to the placebo group. NS oil concurrent with a low-calorie diet can reduce cardiometabolic risk factors in obese women. However, more clinical trials are needed to elucidate efficacy of NS as a complementary therapy in obese subjects.

Physical activity, screen time, and school absenteeism: self-reports from NHANES 2005-2008

OBJECTIVE

The purpose of this study was to examine how lifestyle behaviors in the context of physical activity levels and screen time are associated with school absenteeism.

METHODS

We analyzed 2005-2008 NHANES data of proxy interviews for 1048 children aged 6-11 years and in-person self-reports of 1117 adolescents aged 12-18 years. Missing 10% of school days during the past school year was defined as severe school absenteeism (SSA).

RESULTS

Watching TV ≥2 hours a day was significantly associated with SSA among both children (OR = 3.51 [1.03-12.0]) and adolescents (OR = 3.96 [1.84-8.52]) compared with their peers watching <2 hours a day. A U-shaped association was identified between the level of physical activity and SSA among children. Both inactive children (OR = 12.4 [1.43-108]) and highly active children (14.8 [2.82-77.7]) had higher odds of SSA compared with children with medium levels of physical activity. No associations were observed for either children 0.57 ([0.16-1.99]) or adolescents (0.94 [0.44-2.03]) using a computer ≥3 hours a day.

LIMITATIONS

Cross-sectional study involving self-reports. Transportation to and from school not included in physical activity assessment. Absenteeism was not validated with report cards. Unable to account for the absence type or frequency of illness or injury. No psychometric properties provided for subjective measures regarding participants' attitudes and characteristic traits towards physical activity, TV viewing, and school attendance.

CONCLUSIONS

Excessive TV watching among children and adolescents, and inactivity and high activity levels (≥7 times per week) among children are independently associated with severe school absenteeism.

Hypertension in Young People: Epidemiology, Diagnostic Assessment and Therapeutic Approach

High blood pressure (BP) still remains one of the most relevant cardiovascular risk factors, also due to its persistently high prevalence and growing incidence in the general adult and elderly population. Since almost all hypertension-related cardiovascular complications, mostly including coronary artery disease, myocardial infarction, ischemic stroke, and congestive heart failure, occurred in adult and elderly individuals, evidence on both prevalence and clinical management of hypertension in young individuals are lacking. Therefore, the clinical impact of high BP levels in young populations remains to be explored. In the recent years, the attitude of the scientific community has changed and more attention was devoted to young individuals with hypertension, also in view of the fact that early identification of these subjects may prevent developing of established hypertension in adulthood. In addition, unhealthy lifestyle habits have progressively involved children and adolescents worldwide, thus contributing to further increase the risk of developing hypertension in young individuals. On the basis of these considerations, the present review is aimed at providing a brief reappraisal of the major aspects of hypertension in the young age, as well as at promoting interest and discussion on this important issue.

Obesity, hyperglycemia and endothelial function in inner city Bronx adolescents: a cross-sectional study

Background

Along with the rise in obesity, cardiovascular disease (CVD) has become the major cause of death in developed countries. Although overt coronary heart disease rarely manifests during childhood, atherosclerosis can begin by the second decade of life. Therefore, identifying reliable risk markers of early vascular disease in childhood could be important. Alteration in endothelial function (EF) is an early preclinical marker of the atherosclerotic process and can be assessed non-invasively using reactive hyperemia peripheral arterial tonometry (RH-PAT). The purpose of this study was to investigate if obesity in children is associated with lower EF as measured with RH-PAT, and if obese children with impaired glucose regulation have further impairment in RH-PAT measured EF compared to obese children with normal glucose tolerance.

Methods

Cardiovascular risk factors, adipocytokines and EF using RH-PAT were evaluated in lean (n = 14) and obese (n = 37) adolescents (age 12–18 years). Based on an oral glucose tolerance test, the obese group was subdivided into: obese with normal (NGT, n = 22) and obese with impaired glucose regulation (IGR, n = 15).

Results

RH-PAT score was lower in obese subjects compared to lean controls (1.70 ± 0.02 vs. 1.98 ± 0.09, P = 0.02), indicating worse EF. This difference remained significant when adjusted for age, sex and ethnicity (P = 0.02). We observed a pattern of worsening EF with increasing metabolic burden, with RH-PAT scores of 1.98 ± 0.09,1.73 ± 0.08 and 1.65 ± 0.12 in the lean, obese-NGT and obese-IGR groups, respectively, p_trend = 0.03. Obese subjects were more insulin resistant [higher HOMA] (p = 0.03), and had higher levels of leptin (p = 0.004), hsCRP (p = 0.0004), and TNF-α (p = 0.03) compared to lean subjects. Adjusting for insulin resistance and adipocytokines substantially attenuated the obesity association with RH-PAT, suggesting that insulin resistance and inflammation may mediate the association of EF with obesity.

Conclusions

Risk factors for adult cardiovascular disease, including impaired EF, insulin resistance and inflammation, are evident in obese adolescents. Whether early detection of these cardiovascular risk factors will be useful for informing interventions to prevent disease progression needs further study.

Trial registration

Clinical Trials Identifier: NCT01879033

Non-high-density-lipoprotein cholesterol and cardiovascular risk factors among adolescents with and without impaired fasting glucose

To evaluate how non-high-density-lipoprotein (non-HDL) is associated with impaired fasting glucose (IFG) and clustered metabolic risk (MR) factors among adolescents, we pooled 2764 adolescents, aged 12-19 years, from the National Health and Nutrition Examination Survey from 3 time periods (1999-2000, 2001-2002, and 2003-2004) who were free of diabetes and had fasted overnight for this analysis. IFG was defined as 100 <or= glucose <or= 125 mg.dL-1. Age- and sex-specific cut-offs were used for 4 MR factors: higher levels of triglycerides, waist circumference, blood pressure, and lower levels of HDL. Clustered MR was defined as having any 2 of the 4 factors. Overall, approximately 11% of adolescents had IFG. The mean level of non-HDL cholesterol was much higher in those with IFG than in those without IFG, with adjustment for certain confounding variables (121.4 vs. 110.1 mg.dL-1; p < 0.05). This difference could still be observed in adolescents with one or more clustered MR factors. However, there were no statistical differences in low-density-lipoprotein (LDL) level. Compared with those who were without IFG and not at high levels of non-HDL - after adjustment for age, sex, race, current smoking, and body mass index - the odds of having clustered MR factors were 1.08 (95% CI, 0.65-1.82) for those with IFG and low non-HDL cholesterol, 3.55 (2.29-5.48) for those without IFG but with high non-HDL cholesterol, and 10.10 (3.67-27.80) for those with both IFG and high non-HDL cholesterol. Moreover, those with IFG and at increased risk of obesity were more likely to have higher levels of non-HDL cholesterol (odds ratio (95% CI): 4.41 (2.28-8.50)), compared with those without IFG and not at increased risk of obesity. In summary, prediabetic adolescents with IFG and high levels of non-HDL cholesterol are more likely to have clustered MR factors. Thus, the levels of non-HDL cholesterol may be an important indicator in monitoring cardiovascular disease risk among adolescents with IFG.

Preventing childhood obesity and diabetes: is it time to move out of the school?

Childhood obesity interventions in the USA and Europe have predominantly focused on the school environment for over two decades with mixed or modest success. The focus on school--while intuitive, apparently efficient, and convenient--does not address larger upstream environmental factors, which affect obesity among youth. In this article, we examine potential drawbacks and limitations of previous school-based obesity and diabetes prevention programs. The future of school-based obesity and diabetes interventions and potential strategies for improvement is explored. Increased use and reporting of diversified theoretical frameworks, formative research to inform the interventions, and process evaluations to improve programs are recommended. More importantly, addressing the broader issue of the overall food environment and its impact on children's diet with intensified involvement of key stakeholders, including families, supermarkets, and corner stores is essential. We discuss the development of healthy eating zones around schools as a potential tool in the fight to reduce childhood obesity.