Overweight, hypertension and microalbuminuria in urban and rural Bangladeshi schoolchildren
Background The prevalence of childhood overweight and obesity has increased over the last two decades due to high caloric intake and decreased physical activity. The dramatic increase in the prevalence of overweight children occurred in conjunction with increasing prevalence of hypertension. Microalbuminuria is an early sign of damage to the kidney and cardiovascular system. Hypertensive, overweight children have an increased chance of microalbuminuria.
Objectives To assess the prevalence of overweight, hypertension, and microalbuminuria in urban and rural school going children and contributing risk factors and associations.
Methods This cross-sectional study was done in schoolchildren aged 6 to 16 years, from urban and rural areas, in Bangladesh, from September 2015 untill August 2016. Subjectsâ€™ weights, heights, and blood pressures (BP) were measured. Overweight and hypertension (HTN) statuses were determined with age-appropriate standardized charts. Subjects were divided into overweight and normoweight groups to evaluate risk factors for overweight such as family history (F/H) of obesity, F/H of HTN, daily physical outdoor activities, and monthly family income by comparative analysis. All overweight children were divided into hypertensive and normotensive groups in order to compare their fasting lipid profiles, urine microalbumin, serum creatinine, and random blood sugar.
Results A total of 976 schoolchildren from urban (471, 48.3%) and rural (505, 51.7%) areas were included. Overweight was observed in 22.3% of the urban group and in 8.1% of the rural group (P<0.001). Hypertension was observed in 24.7% of overweight children and in 2.5% of normal weight children (P<0.001). Contributing risk factors for overweight were less physical outdoor activities, F/H of obesity, F/H of HTN, and higher family income (P<0.001). Microalbuminuria and random blood sugar were significantly increased in the overweight with hypertension group compared to the normotensive group (P <0.005).
Conclusion Overweight is a health problem, noted especially in urban areas. Hypertension is also significantly increased in overweight children. Factors like F/H of hypertension, obesity, sedentary lifestyle, and higher socioeconomic status are significantly associated with overweight. Microalbuminuria and increased random blood sugar are also significantly higher observed in hypertensive overweight children compared to normotensive overweight children.
World Health Organization. Preventing chronic diseases: a vital investment: WHO Global Report. Geneva: WHO; 2005. p. 44.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350:2362-74. https://doi.org/10.1056/NEJMoa031049 PMid:15175438
Sharma AM. Is there a rationale for angiotensin blockade in the management of obesity hypertension? Hypertension. 2004;44:12-9. https://doi.org/10.1161/01.HYP.0000132568.71409.a2 PMid:15173127
Whelton PK, He J, Muntner P. Prevalence, awareness, treatment and control of hypertension in North America, North Africa and Asia. J Hum Hypertens. 2004;18:545-51. https://doi.org/10.1038/sj.jhh.1001701 PMid:15269704
Ogden CL, Troiano RP, Briefel RR, Kuczmarski Rj, Flegal KM Johnson CL. Prevalence of overweight among preschool children in the United States, 1971 through 1994. Pediatrics. 1997;99:E1. https://doi.org/10.1542/peds.99.4.e1 PMid:9099776
Elcarte LR, Villa EI, Sada GJ, Gasco EM, Oyarzabal IM, Sola MA, et al. Prevalence of arterial hypertension, hyperlipidemia and obesity in the infant-child population of Navarra. Association of risk factors. An Esp Pediatr. 1993;38:428-36.
Burke V, Beilin LJ, Dunbar D, Kevan M. Associations between blood pressure and overweight defined by new standards for body mass index in childhood. Prev Med. 2004;38:558-64. https://doi.org/10.1016/j.ypmed.2003.09.023 PMid:15066358
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217-23. https://doi.org/10.1016/S0140-6736(05)70151-3
Murray CJL, Lopez AD. Global comparative assessment in the health sector. Geneva: WHO; 1994. p. 21-55. PMid:8148568
Raj M. Obesity and cardiovascular risk in children and adolescents. Indian J Endocrinol Metab. 2012:16:13-9. https://doi.org/10.4103/2230-8210.91176 PMid:22276248 PMCid:PMC3263181
Aucott L, Poobalan A, Smith WC, Avenell A, Jung R, Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension. 2005;45:1035-41. https://doi.org/10.1161/01.HYP.0000165680.59733.d4 PMid:15897373
Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8:iii-iv. https://doi.org/10.3310/hta8210 PMid:15147610
Dong J, Guo XL, Lu ZL, Cai XN, Wang HC, Zhang JY, et al. Prevalence of overweight and obesity and their associations with blood pressure among children and adolescents in Shandong, China. BMC Public Health. 2014;14:1080. https://doi.org/10.1186/1471-2458-14-1080 PMid:25326029 PMCid:PMC4216350
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa heart study. Pediatrics. 1999;103:1175-82. https://doi.org/10.1542/peds.103.6.1175 PMid:10353925
Li YP, Yang XG, Zhai FY, Piao JH, Zhao WH, Zhang J, et al. Disease risks of childhood obesity in China. Biomed Environ Sci. 2005;18:401-10. PMid:16544522
Le, S, Bacha F, Arslanian SA. Waist circumference, blood pressure and lipid components of the metabolic syndrome. J Pediatr. 2006;149:809-16. https://doi.org/10.1016/j.jpeds.2006.08.075 PMid:17137898
Mohan B, Kumar N, Aslam N. Rangbulla A, Kumbkarni S, Sood NK, et al. Prevalance of Sustained hypertension and obesity in urban and rural school going children in Ludhiona. Indian Heart J. 2004;56:310-4. PMid:15586739
Kaur S, Sachdev HPS, Dwivedi SN, Lakshmi R, Kapil U, Sareen N, Association of obesity with hypertension amongst school-age children belonging to lower income group and middle income group in national capital territory of Delhi. Indian J Community Med. 2013;38:175-9. https://doi.org/10.4103/0970-0218.116355 PMid:24019604 PMCid:PMC3760327
Diercks GF, van Boven AJ, Hillege HL, Janssen WM, Kors JA, de Jong PE, et al. Microalbuminuria is independently associated with ischemic electrocardiographic abnormalities in a large non-diabetic population. The PREVEND Study. Eur Heart J. 2000;21:1922-7. https://doi.org/10.1053/euhj.2000.2248 PMid:11071797
Mogensen CE, Keane WF, Bennett PH, Jerums G, Parving HH, Passa P, et al. Prevention of diabetic renal disease with special reference to microalbuminuria. Lancet. 1995;346:1080-4. https://doi.org/10.1016/S0140-6736(95)91747-0
Okpere AN, Anochie IC, Eke FU. Prevalence of microalbuminuria among secondary school children. Afr Health Sci. 2012;12:140-7. https://doi.org/10.4314/ahs.v12i2.10
Duzova A, YalÃ§Ä±nkaya F, Baskin E, Bakkaloglu A, Soylemezoglu O. Prevalence of hypertension and decreased glomerular filtration rate in obese children: results of a population-based field study. Nephrol Dial Transplant. 2013;28:166-71. https://doi.org/10.1093/ndt/gft317 PMid:24179010
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States. Adv Data. 2000;314:1-27.
National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555-76. https://doi.org/10.1542/peds.114.2.S2.555 PMid:15286277
Rowe DJ, Dawnay A, Watts GF. Microalbuminuria in diabetic mellitus: review and recommendations for the measurement of albumin in urine. Ann Clin Biochem. 1990;27:297-312. https://doi.org/10.1177/000456329002700404 PMid:2206092
Adrogue HE, Sinaiko AR. Prevalence of hypertension in junior high school-aged children: effect of new recommendations in the 1996 Updated Task Force Report" American journal of hypertension. 2001;14:412â€“4. https://doi.org/10.1016/S0895-7061(00)01277-2
Muntner P, He J, Cutler JA, Wildman RP, Whelton PK. Trends in blood pressure among children and adolescents. JAMA. 2004;291:2107-13. https://doi.org/10.1001/jama.291.17.2107 PMid:15126439
Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation. 2007;116:1488-96. https://doi.org/10.1161/CIRCULATIONAHA.106.683243 PMid:17846287
Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475-8. https://doi.org/10.1542/peds.113.3.475 PMid:14993537
Jung FF, Ingelfinger JR. Hypertension in childhood and adolescence. Pediatr Rev. 1993;14:169-79. https://doi.org/10.1542/pir.14-5-169
Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH. Family (parental) history and prevalence of hypertension. Results of a nationwide screening program. JAMA. 1979:241:43-6. https://doi.org/10.1001/jama.1979.03290270033016 https://doi.org/10.1001/jama.241.1.43 PMid:758494
Longini IM Jr., Higgins MW, Hinton PC, Moll PP, Keller JB. Environmental and genetic sources of familial aggregation of blood pressure in Tecumseh, Michigan. Am J Epidemiol. 1984;120:131-44. https://doi.org/10.1093/oxfordjournals.aje.a113862
Pardee PE, Norman GJ, Lustig RH, Preud'homme D, Schwimmer JB. Television viewing and hypertension in obese children. Am J Prev Med. 2007;33:439-43. https://doi.org/10.1016/j.amepre.2007.07.036 PMid:18022058
Cleroux J, Feldman RD, Petrella RJ. Lifestyle modifications to prevent and control hypertension. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999;160:S21-8. PMid:10333850 PMCid:PMC1230336
Assadi F. Relation of left ventricular hypertrophy to microalbuminuria and C-reactive protein in children and adolescents with essential hypertension. Paediatr Cardiol. 2008;29:580-4. https://doi.org/10.1007/s00246-007-9153-4 PMid:18046596
Nguyen S, McCulloch C, Brakeman P, Portale A, Hsu CY. Being overweight modifies the association between cardiovascular risks factors and micro albuminuria in adolescents. Pediatrics. 2008;121:37-45. https://doi.org/10.1542/peds.2007-3594 PMid:18166555 PMCid:PMC3722048
Lubrano R, Travasso E, Raggi C, Guido G, Masciangelo R, Elli M. Blood pressure load, proteinuria and renal function in pre-hypertensive children. Pediatr Nephrol. 2009;24:823-31. https://doi.org/10.1007/s00467-008-1077-6 PMid:19096881
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