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Xu M, Wang HX, Zu P, Jiang N, Bian JF, Xu JR, Luo W, Zhu P. Association Between Preeclampsia and Blood Pressure in Offspring: A Systematic Review and Meta-Analysis. Curr Hypertens Rep 2024:10.1007/s11906-024-01306-3. [PMID: 38780756 DOI: 10.1007/s11906-024-01306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW Pregnancy-induced preeclampsia is a severe pregnancy complication and preeclampsia has been associated with an increased risk of chronic hypertension for offspring. However, the magnitude of the overall effect of exposure to preeclampsia in pregnancy on blood pressure (BP) in offspring is unknown. This systematic review and meta-analysis was sought to systematically assess the effects of preeclampsia on the BP of the offspring. RECENT FINDINGS Of 2550 publications identified, 23 studies were included. The meta-analysis indicated that preeclampsia increases the potential risk of hypertension in offspring. Systolic blood pressure (SBP) was 2.0 mm Hg (95% CI: 1.2, 2.8) and diastolic blood pressure (DBP) was 1.4 mm Hg (95% CI: 0.9, 1.9) higher in offspring exposed to pre-eclampsia in utero, compared to those born to normotensive mothers. The correlations were similar in stratified analyses of children and adolescents by sex, geographic area, ages, and gestational age. During childhood and young adulthood, the offspring of pregnant women with preeclampsia are at an increased risk of high BP. It is crucial to monitor their BP.
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Affiliation(s)
- Min Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
- Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China
| | - Hai-Xia Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ping Zu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Nan Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Jing-Feng Bian
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ji-Rong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Wei Luo
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China.
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China.
- Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China.
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Fleur RS, Tanofsky-Kraff M, Yanovski J, Horton N, Reich L, Chavarro J, Hirschhorn J, Ziobrowski H, Field A. Associations Between Phenotypes of Childhood and Adolescent Obesity and Incident Hypertension in Young Adulthood. RESEARCH SQUARE 2024:rs.3.rs-4113605. [PMID: 38562761 PMCID: PMC10984016 DOI: 10.21203/rs.3.rs-4113605/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objectives We investigated whether empirically derived childhood obesity phenotypes were differentially associated with risk of hypertension in young adulthood, and whether these associations differed by sex. Methods Data came from 11,404 participants in the Growing Up Today Study, a prospective cohort study in the US established in 1996. We used a childhood obesity phenotype variable that was previously empirically derived using latent class analysis. The childhood obesity phenotypes included an early puberty phenotype (females only), a mothers with obesity phenotype, a high weight concerns phenotype, and a mixed phenotype. Participants without overweight or obesity in childhood or adolescence were the reference group. We then used logistic regression models with generalized estimating equations to examine associations of childhood obesity phenotypes with incident hypertension between ages 20-35 years. All analyses were stratified by sex. Results Among females, participants in all of the empirically derived childhood obesity phenotypes were more likely than their peers without childhood overweight/obesity to develop hypertension in young adulthood (early puberty subtype odds ratio (OR) = 2.52; 95% confidence interval (CI) = 1.75, 3.62; mothers with obesity (MO) subtype OR = 2.98; 95% CI = 1.93, 4.59; high weight concerns (WC) subtype OR = 2.33; 95% CI = 1.65, 3.28; mixed subtype OR = 1.66; 95% CI = 1.25, 2.20). Among males, the childhood obesity phenotypes were associated with a higher risk of developing hypertension, although males in the MO (OR = 2.65; 95% CI = 1.82, 3.87) and WC phenotypes (OR = 3.52; 95% CI = 2.38, 5.20) had a greater risk of developing hypertension than the mixed subtype (OR = 1.51; 95% CI = 1.23, 1.86) (p = 0.004). Conclusion Risk for incident hypertension in young adulthood varied by childhood obesity phenotypes, as well as by biological sex. If replicated, these results may suggest that increased surveillance of specific childhood obesity phenotypes might help in targeting those at highest risk for hypertension.
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Longitudinal Predictive Curves of Health Risk Factors for American Adolescent Girls. J Adolesc Health 2022; 70:322-328. [PMID: 34756642 DOI: 10.1016/j.jadohealth.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/31/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is to compare age-variant 18 health risk factors by constructing longitudinal predictive curves between African-American (AA) and Caucasian American (CA) adolescent girls. METHODS A total of 2,379 girls (51% AA) from ages 9 to 10 were recruited in the National Heart, Lung, and Blood Institute Growth and Health Study. The various health indicators and dietary habits of these girls were assessed annually for 10 years. We model 2nd, 5th, 95th, and 98th percentile values of the health risk factors to compare trajectories between AA and CA adolescents by employing novel kernel smoothing regression and global tests of equality for regression curves. Health risk factors such as dietary fiber, intake of sodium, sugar, and total calories, systolic blood pressure, weight, body fat percentage, and high-density lipoprotein levels were compared. RESULTS Trajectories of sugar, sodium, and total calories intake and systolic blood pressure, weight, body fat percentage, and high-density lipoprotein among AA girls were significantly higher than those of CA girls throughout their adolescence. CONCLUSIONS AA girls exhibit several health risk factors that are significantly higher than those of CA adolescent girls at the 95th and 98th percentile. Interventions may be warranted for the purposes of ensuring access to health risk information as well as a greater ease of access to healthier food choices within the educational food system.
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Zhang W, Wu CO, Ma X, Tian X, Li Q. Analysis of multivariate longitudinal data using dynamic lasso-regularized copula models with application to large pediatric cardiovascular studies. J Appl Stat 2021; 50:631-658. [PMID: 36819071 PMCID: PMC9930767 DOI: 10.1080/02664763.2021.1937581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The National Heart, Lung and Blood Institute Growth and Health Study (NGHS) is a large longitudinal study of childhood health. A main objective of the study is to estimate the joint distributions of cardiovascular risk outcomes at any two time points conditioning on a large number of covariates. Existing multivariate longitudinal methods are not suitable for outcomes at multiple time points. We present a dynamic copula approach for estimating an outcome's joint distributions at two time points given a large number of time-varying covariates. Our models depend on the outcome's time-varying distributions at one time point, the bivariate copula densities and the functional copula parameters. We develop a three-step procedure for variable selection and estimation, which selects the influential covariates using a machine learning procedure based on spline Lasso-regularized least squares, computes the outcome's single-time distribution using splines, and estimates the functional copula parameter of the dynamic copula models. Pointwise confidence intervals are constructed through the resampling-subject bootstrap. We apply our procedure to the NGHS cardiovascular risk data and illustrate the clinical interpretations of the conditional distributions of a set of risk outcomes. We demonstrate the statistical properties of the dynamic models and estimation procedure through a simulation study.
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Affiliation(s)
- Wei Zhang
- Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Colin O. Wu
- Office of Biostatistics Research, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA,Colin O. Wu Office of Biostatistics Research, Division of Intramural Research, National Heart, Lung and Blood Institute, 6705 Rockledge Drive, Bethesda, MD20892-7913, USA
| | - Xiaoyang Ma
- Hematology Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Xin Tian
- Office of Biostatistics Research, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Qizhai Li
- Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, People's Republic of China
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Cossio-Bolaños M, Vidal-Espinoza R, de Campos FCC, Sulla-Torres J, Cossio-Bolaños W, Andruske CL, Albornoz CU, Campos RG. Establishing percentiles for blood pressure based on absolute height for children and adolescents. BMC Pediatr 2021; 21:26. [PMID: 33413191 PMCID: PMC7792128 DOI: 10.1186/s12887-020-02489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evaluating blood pressure (BP) is one element for diagnosing and preventing disease in student populations. The objectives of this research were to (a) identify the range of height for measuring BP adjusted for student populations and (b) propose percentiles for evaluating BP based on height. Methods A cross-sectional study was carried out with 3,013 students. Weight, height, and diastolic (DBP) and systolic (SBP) blood pressure were evaluated. Body Mass Index (BMI) was calculated. Height ranges of 5 and 10 cm were generated. Results R2 values for height ranges of 5 cm consisted of [normotensive: DBP (R2 = 10 to 13%) and SBP (R2 = 14 to 20%), and for hypertensive: DBP (R2 = 0.07 to 15%) and for SBP (R2 = 29 to 32%)]. For height ranges of 10 cm, values included: [normotensive: DBP (R2 = 10 to 15%), and SBP (R2 = 15 to 21%) and for hypertensive: DBP (R2 = 0.07 to 16%) and SBP (R2 = 29 to 35%)]. For 5 cm height ranges, diferences occurred between both sexes for DBP (in 5 height ranges from 123 to 148 cm and 158 to 168 cm) and for the SBP (in 6 height ranges from 128 to 148 cm and from 158 to 168 cm). In the 10 cm categories, diferences appeared in DBP (from 138 to 148 cm) and in the SBP (from 158 to 168 cm). Conclusions Height is a determinant for evaluating blood pressure, and height ranges of 10 cm are more suitable for children and adolescents. The proposed percentiles based on height ranges allowed assessment of the DBP and SBP suggest their use in epidemiological and educational contexts.
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Affiliation(s)
| | | | | | | | | | | | - Camilo Urra Albornoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
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ahmadi N, Mahdieh Namayandeh S, Bafghi SMS, Mohammadi MR, Mirzaei M, Sarebanhassanabadi M, Mehrparvar AH, Faraji R, Nilforoshan N, Karimi A. Age-, sex-, and height-based blood pressure reference charts, Yazd children 6-18 years, Iran. Clin Exp Pediatr 2020; 63:321-328. [PMID: 32689764 PMCID: PMC7402986 DOI: 10.3345/cep.2019.00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations. PURPOSE To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile. METHODS The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6-18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling. RESULTS Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated. CONCLUSION Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.
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Affiliation(s)
- Nastaran ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyedeh Mahdieh Namayandeh
- Yazd Cardiovascular Research Center, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Mahmood Sadr Bafghi
- Yazd Cardiovascular Research Center, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Reza Faraji
- Krmanshah Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ahmad Karimi
- Research Center of Prevention and Epidemiology of Non-Communicable Disease, Departments of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Communicable Disease Surveillance, Abadeh Health Center, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Nonparametric estimation of conditional distribution functions with longitudinal data and time-varying parametric models. METRIKA 2017. [DOI: 10.1007/s00184-017-0634-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Kwak M. Estimation and inference on the joint conditional distribution for bivariate longitudinal data using Gaussian copula. J Korean Stat Soc 2017. [DOI: 10.1016/j.jkss.2016.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1839] [Impact Index Per Article: 262.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Chowdhury M, Wu C, Modarres R. Local Box–Cox transformation on time-varying parametric models for smoothing estimation of conditional CDF with longitudinal data. J STAT COMPUT SIM 2017. [DOI: 10.1080/00949655.2017.1347656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohammed Chowdhury
- Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, GA, USA
| | - Colin Wu
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - Reza Modarres
- Department of Statistics, The George Washington University, Washington, DC, USA
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12
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Kwak M. Estimation and inference of the joint conditional distribution for multivariate longitudinal data using nonparametric copulas. J Nonparametr Stat 2017. [DOI: 10.1080/10485252.2017.1324966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Minjung Kwak
- Department of Statistics, Yeungnam University, South Korea
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13
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Cheung EL, Bell CS, Samuel JP, Poffenbarger T, Redwine KM, Samuels JA. Race and Obesity in Adolescent Hypertension. Pediatrics 2017; 139:peds.2016-1433. [PMID: 28557717 PMCID: PMC5404724 DOI: 10.1542/peds.2016-1433] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The overall prevalence of essential hypertension in adolescents may be growing. Differences in blood pressure (BP) are well established in adults, but are less clear in adolescents. We hypothesize that the prevalence of hypertension differs by race/ethnicity among adolescents at school-based screenings. METHODS We performed school-based BP screening in over 20 000 adolescents from 2000 to 2015. Race/ethnicity was self-reported. Height and weight were measured to determine BMI, and BP status was confirmed on 3 occasions to diagnose sustained hypertension according to Fourth Working Group Report criteria. RESULTS We successfully screened 21 062 adolescents aged 10 to 19 years (mean, 13.8 years). The final prevalence of sustained hypertension in all subjects was 2.7%. Obesity rates were highest among African American (3.1%) and Hispanic (2.7%) adolescents. The highest rate of hypertension was seen in Hispanic (3.1%), followed by African American (2.7%), white (2.6%), and Asian (1.7%) adolescents (P = .019). However, obese white adolescents had the highest prevalence of sustained hypertension (7.4%) compared with obese African American adolescents (4.5%, P < .001). At lower BMI percentiles (<60th percentile), Hispanic adolescents actually had the lowest predicted prevalence of hypertension among the 4 groups. CONCLUSIONS The prevalence of hypertension varies among different race/ethnicities. Although obesity remains the strongest predictor of early hypertension, the strength of this relationship is intensified in Hispanic and white adolescents, whereas it is lessened in African American adolescents.
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Affiliation(s)
- Eric L. Cheung
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, Texas; and
| | - Cynthia S. Bell
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, Texas; and
| | - Joyce P. Samuel
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, Texas; and
| | - Tim Poffenbarger
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, Texas; and
| | - Karen McNiece Redwine
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, Texas; and,Division of Children’s Nephrology, St. Luke’s Health System, Boise, Idaho
| | - Joshua A. Samuels
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, Texas; and
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Adherence to a healthy lifestyle and a DASH-style diet and risk of hypertension in Chinese individuals. Hypertens Res 2016; 40:196-202. [DOI: 10.1038/hr.2016.119] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/08/2022]
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Banker A, Bell C, Gupta-Malhotra M, Samuels J. Blood pressure percentile charts to identify high or low blood pressure in children. BMC Pediatr 2016; 16:98. [PMID: 27430884 PMCID: PMC4950817 DOI: 10.1186/s12887-016-0633-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/09/2016] [Indexed: 12/23/2022] Open
Abstract
Background The goal was to develop familiar blood pressure (BP) charts representing BP percentile curves similar to CDC growth charts to improve screening of both high and low BP in children. Methods Since height accounts for substantially more BP variability than age and is a more direct measure of body size and maturation in children, height-specific BP percentile curves were drawn separately for males and females. We used the 2004 Fourth Report data source and equations to calculate the BP threshold value for each gender and 5 cm height group. By slightly underestimating a child’s BP percentile for high BP and slightly overestimating a child’s BP percentile for low BP, these charts guarantee 100 % sensitivity in detecting abnormal BP. Sensitivity and specificity of the chart cut-offs were confirmed in a sample of 1254 healthy children from a school-based blood pressure screening program. Results The 1st, 5th, 25th, 50th, 75th, 90th, 95th, and 99th BP percentile curves are depicted in the chart for each corresponding gender and height from 85 to 190 cm, mimicking the ubiquitous CDC “growth charts”. Shaded areas of the chart differentiate abnormal BP status categories: hypotension, normal BP, prehypertension, Stage 1 hypertension, and Stage 2 hypertension. Sensitivity was confirmed to be 100 % with specificity above 94 %. Conclusions These simplified BP charts improve upon currently available BP screening reference with the following features: (a) tracking BP longitudinally in an individual child, (b) full physiological range of BP percentiles represented in percentile curve format for rapid identification both high and low BP, (c) easy to use with absolute height alone avoiding the additional step of determining height percentile, (d) incorporation of adult threshold for pre-hypertension to assist in accurate transition from adolescence into adulthood, (e) high sensitivity and specificity to ensure all children at risk are identified with very few false positives.
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Affiliation(s)
- Ashish Banker
- Division of Pediatric Cardiology, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, TexasMedical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA
| | - Cynthia Bell
- Divisions of Pediatric Nephrology & Hypertension, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, Texas Medical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA
| | - Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, TexasMedical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA
| | - Joshua Samuels
- Divisions of Pediatric Nephrology & Hypertension, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, Texas Medical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA.
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Staley JR, Bradley J, Silverwood RJ, Howe LD, Tilling K, Lawlor DA, Macdonald-Wallis C. Associations of blood pressure in pregnancy with offspring blood pressure trajectories during childhood and adolescence: findings from a prospective study. J Am Heart Assoc 2015; 4:JAHA.114.001422. [PMID: 25994439 PMCID: PMC4599398 DOI: 10.1161/jaha.114.001422] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertensive disorders of pregnancy are related to higher offspring blood pressure (BP), but it is not known whether this association strengthens or weakens as BP changes across childhood. Our aim was to assess the associations of hypertensive disorders of pregnancy and maternal BP changes during pregnancy with trajectories of offspring BP from age 7 to 18 years. Methods and Results In a large UK cohort of maternal–offspring pairs (N=6619), we used routine antenatal BP measurements to derive hypertensive disorders of pregnancy and maternal BP trajectories. These were related to offspring BP trajectories, obtained from research clinic assessments, using linear spline random-effects models. After adjusting for maternal and offspring variables, including body mass index, offspring of women who had existing hypertension, gestational hypertension, or preeclampsia during pregnancy had on average higher BP at age 7 years compared to offspring of normotensive pregnancies (mean difference [95%CI] in systolic BP: 1.67 mm Hg [0.48, 2.86], 1.98 mm Hg [1.32, 2.65], and 1.22 mm Hg [−0.52, 2.97], respectively). These differences were consistent across childhood to age 18 years, as the patterns of BP change did not differ between offspring of hypertensive pregnancies and normotensive pregnancies. Maternal BP at 8 weeks’ gestation was also positively associated with offspring BP in childhood and adolescence, but changes in BP across pregnancy were not strongly associated. Conclusions The differences in BP between offspring of hypertensive pregnancies and offspring of normotensive pregnancies remain consistent across childhood and adolescence. These associations appear to be most contributed to by higher maternal BP in early pregnancy rather than by pregnancy-related BP changes.
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Affiliation(s)
- James R Staley
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.R.S.)
| | - John Bradley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom (J.B.)
| | - Richard J Silverwood
- Department of Medical Statistics and Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, United Kingdom (R.J.S.)
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.) School of Social and Community Medicine, University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.)
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.) School of Social and Community Medicine, University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.)
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.) School of Social and Community Medicine, University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.)
| | - Corrie Macdonald-Wallis
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.) School of Social and Community Medicine, University of Bristol, United Kingdom (L.D.H., K.T., D.A.L., C.M.W.)
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Howe LD, Parmar PG, Paternoster L, Warrington NM, Kemp JP, Briollais L, Newnham JP, Timpson NJ, Smith GD, Ring SM, Evans DM, Tilling K, Pennell CE, Beilin LJ, Palmer LJ, Lawlor DA. Genetic influences on trajectories of systolic blood pressure across childhood and adolescence. ACTA ACUST UNITED AC 2013; 6:608-14. [PMID: 24200906 DOI: 10.1161/circgenetics.113.000197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blood pressure (BP) tends to increase across childhood and adolescence, but the genetic influences on rates of BP change are not known. Potentially important genetic influences could include genetic variants identified in genome-wide association studies of adults as being associated with BP, height, and body mass index. Understanding the contribution of these genetic variants to changes in BP across childhood and adolescence could yield understanding into the life course development of cardiovascular risk. METHODS AND RESULTS Pooling data from 2 cohorts (the Avon Longitudinal Study of Parents and Children [n=7013] and the Western Australian Pregnancy Cohort [n=1459]), we examined the associations of allelic scores of 29 single-nucleotide polymorphisms (SNPs) for adult BP, 180 height SNPs, and 32 body mass index SNPs, with trajectories of systolic BP (SBP) from 6 to 17 years of age, using linear spline multilevel models. The allelic scores of BP and body mass index SNPs were associated with SBP at 6 years of age (per-allele effect sizes, 0.097 mm Hg [SE, 0.039 mm Hg] and 0.107 mm Hg [SE, 0.037 mm Hg]); associations with age-related changes in SBP between 6 and 17 years of age were of small magnitude and imprecisely estimated. The allelic score of height SNPs was only weakly associated with SBP changes. No sex or cohort differences in genetic effects were observed. CONCLUSIONS Allelic scores of BP and body mass index SNPs demonstrated associations with SBP at 6 years of age with a similar magnitude but were not strongly associated with changes in SBP with age between 6 and 17 years. Further work is required to identify variants associated with changes with age in BP.
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Affiliation(s)
- Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol
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Wu CO, Tian X. Nonparametric Estimation of Conditional Distributions and Rank-Tracking Probabilities With Time-Varying Transformation Models in Longitudinal Studies. J Am Stat Assoc 2013. [DOI: 10.1080/01621459.2013.808949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Wu CO, Tian X. Nonparametric Estimation of Conditional Distribution Functions and Rank-Tracking Probabilities With Longitudinal Data. JOURNAL OF STATISTICAL THEORY AND PRACTICE 2013. [DOI: 10.1080/15598608.2013.771598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Blood pressure distribution in Indian children. Indian Pediatr 2010; 47:477-85. [PMID: 19736371 DOI: 10.1007/s13312-010-0089-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/21/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine blood pressure distribution in schoolchildren and to derive population specific reference values appropriate for age, gender and height status. DESIGN Cross sectional observational study. SETTING Schools in Ernakulam district, Kerala, India, during 2005-06. METHODS Stratified random cluster sampling method was used to select the children. Blood pressure and anthropometric data were collected from 20,263 students of 5-16 years age. Three readings of blood pressures of each child were taken by mercury sphygmomanometer and mean was taken for analysis. Blood pressure percentiles in relation to gender, age and height were estimated from a non-overweight population of 18,931 children using polynomial regression models. RESULTS Children from study population have higher diastolic pressures for both sexes than international standard across all age groups. For systolic blood pressure, girls showed higher values than the international standard while for boys, the difference appears to be minimal. CONCLUSIONS Blood pressure distribution in children from our study population demonstrates a different pattern in comparison to existing international reference. Higher blood pressure values in the study population are of considerable public health significance.
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Obarzanek E, Wu CO, Cutler JA, Kavey REW, Pearson GD, Daniels SR. Prevalence and incidence of hypertension in adolescent girls. J Pediatr 2010; 157:461-7, 467.e1-5. [PMID: 20488454 DOI: 10.1016/j.jpeds.2010.03.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 02/26/2010] [Accepted: 03/26/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate the prevalence and incidence of hypertension and prehypertension and associated factors in adolescent girls. STUDY DESIGN A total of 2368 girls (49% Caucasian, 51% African-American) aged 9 or 10 years enrolled in the National Heart, Lung, and Blood Institute Growth and Health Study had blood pressure, height, and weight measured at annual visits through age 18 to 19 years. Prevalence and incidence of hypertension and prehypertension were calculated. RESULTS On the basis of 2 visits, hypertension prevalence was approximately 1% to 2% in African-American girls and 0.5% in Caucasian girls. Incidence in 8 years was 5.0% and 2.1%, respectively. Obese girls had higher prevalence (approximately 6-fold higher) and incidence (approximately 2- to 3-fold higher) compared with girls of normal weight. Similar patterns were found for prehypertension, except that prehypertension occurred more in older girls than younger girls. Dietary factors (lower intake of fiber, potassium, magnesium, and calcium, and higher intake of caffeine and calories) were each associated with hypertension incidence (all P<.05). In multivariate analysis, higher body mass index (P<.001) and lower potassium intake (P=.023) were independently associated with incidence of hypertension. CONCLUSIONS Hypertension occurred early in childhood and was related to obesity and other modifiable lifestyle factors. Clinicians should monitor blood pressure during childhood and provide focused diet and physical activity guidance to minimize the development of hypertension.
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Affiliation(s)
- Eva Obarzanek
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD 20892-7913, USA
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22
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Abstract
Diagnosis of hypertension in adolescents is complicated because blood pressure values vary with age, gender and height. How can we simplify the diagnostic criteria for hypertension in adolescents? In 2006, anthropometric measurements were assessed in a cross-sectional population-based study of 3136 Han adolescents aged 13-17 years. Hypertension was defined according to the 2004 National High Blood Pressure Education Program Working Group definition. The following equations for blood pressure-to-height ratio (BPHR) were used: systolic BPHR (SBPHR)=SBP (mm Hg)/height (cm) and diastolic BPHR (DBPHR)=DBP (mm Hg)/height (cm). Receiver-operating characteristic curve analyses were performed to assess the accuracy of SBPHR and DBPHR as diagnostic tests for elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. After the cutoff points were determined, hypertension was defined by SBPHR/DBPHR, and the sensitivity and specificity were calculated. The accuracy of SBPHR and DBPHR (assessed by area under the curve) for identifying elevated SBP and DBP was >0.85 (0.989-1.000). The optimal thresholds of SBPHR/DBPHR for defining hypertension (stages 1 and 2) were 0.75/0.48 for boys and 0.78/0.51 for girls, and for defining hypertension (stage 2) were 0.81/0.57 for boys and 0.84/0.63 for girls. In identifying hypertension, the sensitivity and specificity were both >90% (91.0-99.1%). In identifying stage 2 hypertension, when the sensitivity was 100%, the specificity was 98.6% for boys and 99.1% for girls. BPHR is a simple, accurate and non-age-dependent index for screening hypertension in Han adolescents, especially for stage 2 hypertension.
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23
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Wu CO, Tian X, Yu J. Nonparametric estimation for time-varying transformation models with longitudinal data. J Nonparametr Stat 2010. [DOI: 10.1080/10485250903160988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Klesges RC, Obarzanek E, Klesges LM, Stockton MB, Beech BM, Murray DM, Lanctot JQ, Sherrill-Mittleman DA. Memphis Girls health Enrichment Multi-site Studies (GEMS). Contemp Clin Trials 2008; 29:42-55. [PMID: 17588824 DOI: 10.1016/j.cct.2007.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 04/23/2007] [Accepted: 05/04/2007] [Indexed: 10/23/2022]
Abstract
Obesity prevalence is increasing in the U.S., especially among children and minority populations. This report describes the design and baseline data of the ongoing Girls health Enrichment Multi-site Studies (GEMS) trial (Memphis site), which is testing the efficacy of a 2-year family-based intervention to reduce excessive increase in body mass index (BMI). This randomized, controlled trial conducted at community centers in Memphis, Tennessee requires major measurements at baseline and at 12 and 24 months post-randomization. The participants are healthy African-American girls and one parent/caregiver of each girl. Participating girls are of ages 8-10 years, with BMI>or=25th percentile of the CDC 2000 growth charts or with one overweight or obese parent/caregiver (BMI>or=25 kg/m(2)). The active intervention is designed to prevent excessive weight gain by promoting healthy eating habits and increasing physical activity. An alternative intervention (comparison group) promotes general self-esteem and social efficacy. The main outcome measure is the difference between the two treatment groups in the change in BMI at 2 years. Three hundred and three girls have been randomly assigned to receive the test intervention (n=153) or the alternative intervention (n=150). The two groups do not differ in baseline characteristics. At the time of enrollment, the mean age was 9 years, the mean BMI was 22 kg/m(2) (mean BMI percentile=77 th), and 41% were overweight (BMI>/=95th percentile using CDC 2000 growth charts). Participants' intake of fruits and vegetables (1.3 serving/day) and fats (36% kcal), and their participation in moderate-to-vigorous physical activity (20 min/day), did not meet national recommendations. The GEMS obesity prevention intervention targets improved diet and increased physical activity to reduce excessive weight gain in healthy African-American girls of ages 8-10.
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Affiliation(s)
- Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Center for Health Sciences and St. Jude Children's Research Hospital, Memphis, TN, USA
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26
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Harding S, Maynard M, Cruickshank JK, Gray L. Anthropometry and blood pressure differences in black Caribbean, African, South Asian and white adolescents: the MRC DASH study. J Hypertens 2006; 24:1507-14. [PMID: 16877952 DOI: 10.1097/01.hjh.0000239285.20315.4d] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES In this first large-scale study of ethnic differences in blood pressure (BP) among British adolescents, we examine the differences in BP levels in adolescence and the extent to which age, sex, body size and stage of maturation affect any observed differences. METHOD A total of 6365 11-13 year olds (including 1189 white, 907 black Caribbeans and 1056 black Africans, 473 Indians, 605 Pakistanis and Bangladeshis, and 548 of mixed ethnicity) had systolic blood pressure (SBP) and diastolic blood pressure (DBP), anthropometry and pubertal stage measured in 2003. RESULTS Compared with their white UK counterparts, black Caribbean and African boys were taller, and black Caribbean and African girls were taller, larger and matured earlier. Except for DBP among Indian girls, BP in minority groups was generally lower than in white UK children. Adjusted for age, height and body mass index, mean SBP was 109.1 mmHg (95% confidence interval 108.4, 109.8) and DBP 65.7 mmHg (65.2, 66.3) among white UK boys. Black Caribbean boys had lower SBP (-2.0; -3.2, -0.9 mmHg) and DBP (-1.5; -2.3, -0.6), and black African (-2.3; -3.4, -1.2) and mixed ethnicity (-1.6; -2.9, -0.3) boys had lower SBP. Adjusted SBP was 108.5 (107.8, 109.3) and DBP was 67.5 mmHg (66.9, 68.1) among white UK girls. Pakistani (-1.8; -3.2, -0.4) and black African (-1.1; -1.9, -0.3) girls had lower SBP and Indian girls (1.2; 0.1, 2.4) had higher DBP. Unlike African American girls, late puberty was not associated with higher BP in minority groups. CONCLUSION At these ages, the ethnic-specific patterns in BP in adulthood were not observed. Apart from higher DBP for Indian girls, BP in minority groups was generally lower than their white UK counterparts. Targeting intervention in adolescence may be a critical opportunity for preventing ethnic differences in BP in later life.
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Affiliation(s)
- Seeromanie Harding
- Social and Public Health Sciences Unit, Medical Research Council, University of Glasgow, Glasgow, Scotland, UK.
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Remsberg KE, Demerath EW, Schubert CM, Chumlea WC, Sun SS, Siervogel RM. Early menarche and the development of cardiovascular disease risk factors in adolescent girls: the Fels Longitudinal Study. J Clin Endocrinol Metab 2005; 90:2718-24. [PMID: 15728207 DOI: 10.1210/jc.2004-1991] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to evaluate the influence of menarcheal age on changes in insulin, glucose, lipids, and blood pressure during adolescence and to assess whether body composition modifies this relationship. We examined 391 girls, a subset of Fels Longitudinal Study female participants (8-21 yr of age). Self-reported menarcheal age was classified based on the National Health and Nutrition Examination Survey III distribution, in which early menarche was at the 25th percentile or less (11.9 yr). Age at menarche was examined in relation to measures of body composition [e.g. fat-free mass (FFM) and percent body fat (PBF)], insulin resistance, blood pressure, and lipid profile. The effects of menarcheal age and body composition on cardiovascular disease risk factor changes were analyzed with serial data mixed models. Median menarcheal age was 12.7 yr (range, 9.8-17.0 yr), with 91 girls (23%) classified as early menarche. Girls with early menarche had more deleterious changes in insulin, glucose, blood pressure, FFM, and PBF levels than girls with average or late menarche. Menarcheal age adversely affected cardiovascular disease risk factor changes independent of age and changes in FFM or PBF. Girls with early menarche exhibited elevated blood pressure and glucose intolerance compared with later maturing girls, independent of body composition.
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Affiliation(s)
- Karen E Remsberg
- Lifespan Health Research Center, Department of Community Health, Wright State University School of Medicine, 3171 Research Boulevard, Kettering, Ohio 45420-4006, USA.
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Vlajinac H, Miljus D, Adanja B, Marinković J, Sipetić S, Kocev N. Blood pressure levels in 7 to 14-year-old Belgrade children. J Hum Hypertens 2004; 17:761-5. [PMID: 14578915 DOI: 10.1038/sj.jhh.1001618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of the work was to study blood pressure and some anthropometric characteristics in children. The study design included the prevalence study at Belgrade, Serbia and Montenegro. The study comprised 1651 subjects (809 boys and 842 girls) aged 7-14 years, that is, 2.6% of all relevant population. The average levels of systolic and diastolic blood pressures (SBP and DBP) were 113.4/70.3 mmHg in boys and 114.6/71.1 mmHg in girls. High SBP was present in 4.7% of boys and in 5.3% of girls. High DBP was found in 5.6% of boys and in 4.8% of girls. According to multivariate regression analysis, in boys SBP and DBP were significantly associated with age, body mass index (BMI) and subscapular skinfold, SBP was also associated with body weight, and DBP with triceps skinfold. In girls, SBP was significantly related to BMI, suprailiac skinfold and body height, and DBP was significantly associated with BMI, suprailiac and subscapular skinfolds. The results of the present study support the opinion that BMI is a significant predictor of blood pressure in children and point out to suprailiac skinfold in girls as a possible predictor of blood pressure.
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Affiliation(s)
- H Vlajinac
- Institute of Epidemiology, School of Medicine, Belgrade University, Belgrade, Serbia and Montenegro.
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Agyemang C, Bhopal R, Bruijnzeels M. Do variations in blood pressures of South Asian, African and Chinese descent children reflect those of the adult populations in the UK? A review of cross-sectional data. J Hum Hypertens 2004; 18:229-37. [PMID: 15037871 DOI: 10.1038/sj.jhh.1001658] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to assess whether variations in BP in children of UK ethnic minority populations correspond to those seen in adults. A systematic literature review was carried out using MEDLINE 1966-2003 and EMBASE 1980-2003, supplemented by correspondence with expert informants, and citations from references. Five studies were identified. There were important differences between studies in terms of age and sex of samples, definition of ethnic minority children and methods of evaluating BP. Three studies of children of African descent reported lower mean SBP in boys from African descent compared to white boys, the differences being significant only in one study. In African descent girls, the mean SBP was significantly lower in one study, while DBP was significantly higher in one study. Four studies included children of South Asian origin. The Health Survey for England '99 reported on South Asian groups separately. Pakistani boys had a significantly higher age- and height-standardised mean SBP than the general population. The mean DBP was significantly higher in Indian and Pakistani boys than the general population. Pakistani and Bangladeshi girls had a significantly higher mean DBP than the general population. The other three studies, which combined South Asian subgroups found no significant differences in the mean BP between South Asians and white subjects. One study included children of Chinese descent and reported significantly higher mean DBP in Chinese boys and girls compared to the general population. Overall, BP across ethnic groups was similar. These similarities in BP patterns particularly in African, Bangladeshi and Pakistani descent children contrasts with those in the corresponding adult populations in the UK where BP is comparatively high in those of African descent and comparatively low in those of Bangladeshi and Pakistani descent.
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Affiliation(s)
- C Agyemang
- Institute of Health Policy and Management, Erasmus Medical Center, The Netherlands.
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Norman JE, Bild D, Lewis CE, Liu K, West DS. The impact of weight change on cardiovascular disease risk factors in young black and white adults: the CARDIA study. Int J Obes (Lond) 2003; 27:369-76. [PMID: 12629565 DOI: 10.1038/sj.ijo.0802243] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To quantify the relation between weight change and change in blood pressure, lipids and insulin levels, and determine if this relation differs by race or initial level of obesity. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS Community-based sample of 3325 black and white men and women aged 18-30 y from four centers followed for 10 y. Women pregnant at baseline or 10th year exam and persons without a recorded weight at both exams were excluded. Participants whose baseline BMI was >or=25 kg/m(2) were classified as overweight. Height, weight, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), fasting triglycerides, fasting insulin, and blood pressure were measured at baseline and Year 10. RESULTS The mean (s.d.) of weight gained over 10 y was 10.5 (10.0) kg (black men), 11.7 (11.0) (black women), 7.7 (8.0) (white men), and 7.2 (10.0) (white women). An increase in weight was associated with adverse changes in all factors in all race-sex groups. For example, a 9.1 kg (20-lb) weight increase in persons not overweight at baseline predicted an increase in LDL-C ranging from 0.23 mmol/l in black women to 0.28 mmol/l in black men and a decrease in HDL-C from 0.09 mmol/l (white women) to 0.11 mmol/l (white men) (all P<0.0001). The estimated change in triglycerides was greater in white than in black participants (P<0.02); no other racial differences were found. Changes in triglycerides (P<0.00001) and fasting insulin (P=0.004) were greater in men than in women. Only for LDL-C was a weight change-associated increase significantly different (greater, P<0.001) for nonoverweight persons than for those overweight at baseline. None of these associations were highly specific. Mean levels of LDL-C, HDL-C, and systolic blood pressure improved among all those who lost or did not gain weight. CONCLUSIONS A 10 y weight gain in young adults of both races and sexes tends to confer adverse changes in their levels of LDL-C, HDL-C, triglycerides, fasting insulin, and blood pressure. This effect occurs regardless of initial weight, age, race, or gender.
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Affiliation(s)
- J E Norman
- Division of Epiemiology and Clinical Applications, National Heart, Lung and Blood Institute, Bethesda, MD 20892-7938, USA.
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Oren A, Vos LE, Uiterwaal CS, Gorissen WH, Grobbee DE, Bots ML. Adolescent blood pressure does not predict aortic stiffness in healthy young adults. The Atherosclerosis Risk in Young Adults (ARYA) study. J Hypertens 2003; 21:321-6. [PMID: 12569262 DOI: 10.1097/00004872-200302000-00023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased arterial stiffness has been shown to be a good predictor of cardiovascular morbidity and mortality and to be associated with an adverse cardiovascular risk profile. OBJECTIVE To evaluate the relationship between adolescent blood pressure and aortic stiffness in 524 healthy young adults aged 27-30 years, as a means of investigating early determinants of arterial stiffness. SETTING General community. PARTICIPANTS We studied 524 healthy young adults, aged 27-30 years, who attended secondary school in Utrecht, The Netherlands. MEASUREMENTS Data on adolescent weight, height, blood pressure and stage of puberty were available from the original school health records of the Municipal Health Service. At young adulthood, a questionnaire on cardiovascular risk factors was completed and a fasting blood sample was drawn. MAIN OUTCOME MEASURE Arterial stiffness, assessed by carotid-femoral pulse wave velocity (PWV). RESULTS Adolescent blood pressure did not predict aortic PWV at young adulthood (linear regression coefficient 0.03 m/s per 10 mmHg increase in systolic blood pressure; 95% confidence interval 0.09 to 0.14). Repeated analysis in a subgroup (n = 199) for whom two adolescent blood pressure measurements were averaged showed stronger (2-19x) associations with adult PWV, although these were not significant. CONCLUSION Adolescent blood pressure did not predict arterial stiffness in healthy young adults. Measurement error in the baseline blood readings (regression to the mean phenomenon) may partly explain the lack of association in our study. Further studies should confirm our results in order to enable better understanding of the role of adolescent blood pressure in the aetiology of vascular damage.
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Affiliation(s)
- Anath Oren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Dekkers JC, Snieder H, Van Den Oord EJCG, Treiber FA. Moderators of blood pressure development from childhood to adulthood: a 10-year longitudinal study. J Pediatr 2002; 141:770-9. [PMID: 12461492 DOI: 10.1067/mpd.2002.128113] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the effect of ethnicity on the development of blood pressure (BP) from childhood into early adulthood within the context of height, sex, adiposity, and socioeconomic status (SES). STUDY DESIGN Individual growth curves of systolic BP (SBP) and diastolic BP (DBP) were created for 745 black and white male and female youths, with annual assessments over a 10-year period (age range, 4.9-27.5 years). RESULTS Blacks had higher SBP levels (P <0.01) than whites, respectively. Moreover, black female subjects showed a greater SBP increase over time (P <.05) than white female subjects. Black male and female subjects also showed higher DBP levels (P <.001) than white male and female subjects, respectively, but the rate of change of DBP did not differ. Ethnic differences in BP trajectories persisted after adjusting for SES and/or changes in height and/or adiposity in both male and female subjects. CONCLUSIONS Ethnic differences in SBP become manifest in childhood in girls, in early adolescence in boys, and tend to increase with age. Ethnic differences in DBP become manifest in childhood in both boys and girls and remain stable over time. The ethnic differences cannot be entirely explained by individual differences in SES, growth, or adiposity. Identification of mechanisms responsible for increase of BP in childhood will improve prevention of hypertension in adulthood.
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Affiliation(s)
- J Caroline Dekkers
- Georgia Prevention Institute, Medical College of Georgia, Augusta 30912, USA
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Abstract
Childhood obesity may be seen as a marker for high-risk dietary and physical inactivity practices. Recent increases in the prevalence of overweight and obesity among American children are not limited to one age, gender, or ethnic group, which suggests that unique behaviors of the members of various racial or ethnic subgroups of the population are unlikely to be the major contributing factors. Rather, it seems that environmental changes promoting increased energy intake and decreased energy output are occurring and have widespread impact on children from various backgrounds. Although no ethnic group is immune from the current shift in energy balance, differential rates of overweight seem to exist among ethnic groups. National probability samples of African-American, Hispanic, and white children in the United States provide clear evidence that white children are at lower risk for childhood overweight than are African-American or Hispanic children. Of concern is the lack of national data on the prevalence of overweight and obesity for Native-American and Asian-American groups. Also of concern is the aggregation of racial and ethnic subgroups, which may render prevalence rates meaningless. This possibility is clearly true with some surveys of weight status that combine diverse populations, such as Asians and Pacific Islanders, into one group. The high rates of obesity in African-American, Hispanic, and Native-American children are of concern. Although parental SES is associated inversely with childhood obesity among whites, higher SES does not seem to protect African-American and Hispanic children against obesity. In these groups, childhood obesity does not seem to be associated significantly with parental income and education. Health consequences of childhood obesity include a higher prevalence of type 2 diabetes and an increased risk for adverse levels of lipids, lipoproteins, and blood pressure. The effects of recently reported unprecedented levels of childhood overweight on subsequent risk for obesity in middle age are not known until future longitudinal data can be collected. It seems likely, however, that future health consequences of current early and severe childhood obesity will be staggering. Funding for adult follow-up of longitudinal studies of high-risk African American, Hispanic, and Native-American children is needed urgently to provide information on the long-term effects of childhood obesity. Halting the obesity epidemic is a formidable task, but the success in recent decades of drastically reducing childhood undernutrition offers hope and should spur similar action and leadership efforts. Promotion of efforts to reduce excess caloric intake with efforts to increase energy expenditure should receive paramount attention in the design of health programs. Given the relatively few published obesity-prevention and treatment studies that are designed to address specific cultural issues, it is important to promote the development of culturally appropriate intervention strategies that are shown to be effective among youth of diverse backgrounds. Although the dietary and activity goals will be similar, parental, family, and community messages and techniques grounded in cultural traditions and norms will be different for each ethnic group. This approach is crucial in the United States, a country with an increasingly diverse population.
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Affiliation(s)
- P B Crawford
- Center for Weight and Health, Department of Nutritional Sciences, University of California, Berkeley, Berkeley, California, USA.
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Abstract
This study investigates sexual maturity as a predictor of resting blood pressures independent of other known predictors, in 179 boys and 204 girls 11-16 years of age from the Heartfelt Study. The sample included youth of African (n = 140), Mexican (n = 117), and European and "other" (n = 126) backgrounds. Sexual maturity was assessed during clinical examination of three standard indicators for each sex. Systolic and diastolic blood pressures were higher in children of maturity stages IV and V, compared to stages I-III, in each gender/ethnic group (P < 0.01 in almost all groups). Boys and girls advanced in sexual maturity for their age group, had significantly higher systolic blood pressures (but not diastolic) than the less advanced in linear models that included height, body mass index (BMI), ethnicity, and age as co-predictors. Diastolic blood pressures were predicted by height in boys and by age and the BMI in girls. This analysis, using a very conservative approach, suggests that sexual maturity provides important and independent information on systolic blood pressure in adolescents. Further investigation of its role in 24-hr blood pressures and in blood pressures taken during physical and emotional stress, is recommended.
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Affiliation(s)
- S D Cho
- University of Texas-Houston, Health Science Center, School of Public Health, 77225, USA
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Abstract
The prevalence and severity of obesity are increasing in children and adolescents. This raises concerns about the accompanying cardiovascular complications. Such complications include hypertension, dyslipidemia, type II diabetes which may accelerate vascular disease, left ventricular hypertrophy and pulmonary hypertension due to obstructive sleep apnea. The evaluation of an obese child or adolescent should include careful consideration of these possible cardiovascular complications. If they are present, treatment should be directed at both obesity and the risk factor abnormality. This treatment may be important for prevention of future cardiovascular morbidity and mortality. In addition, research is necessary to better understand the mechanisms by which obesity increases the risk of cardiovascular disease.
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Affiliation(s)
- S R. Daniels
- Division of Cardiology, Department of Pediatrics, University of Cincinnati, College of Medicine and the Children's Hospital Medical Center, OH 45229, Cincinnati, USA
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