Colín-Ramírez E, et al. J Am Diet Assoc. 2009; 109 (June).

Waist circumference and fat intake are associated with high blood pressure in

Mexican children aged 8-10 years

Eloisa Colín-Ramírez, MSc: Instituto Nacional de Ciencias Médicas y Nutrición SZ (INCMNSZ) Asociación Mexicana para la Prevención de

Insuficiencia Cardiaca A.C. (AMEPPIC)Lilia Castillo-Martínez, MSc.: INCMNSZ, AMEPPIC

Arturo Orea-Tejeda, MD: INCMNSZ, AMEPPICAntonio R Villa Romero, MD: INCMNSZ

Arely Vergara Castañeda, MSc.: AMEPPICEnrique Asensio Lafuente, MD: INCMNSZ

Colín-Ramírez E, et al.J Am Diet Assoc. 2009; 109 (June).

JOURNAL OF THEAMERICAN DIETETICASSOCIATION


Colín-Ramírez E, et al. J Am Diet Assoc. 2009; 109 (June).

Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8-10 years

Background

• Elevated blood pressure at a young age predicts blood pressure elevation later in life and is associated with being overweight

at all ages.• There are other factors related to hypertension in childhood.




Objective

• To determine the anthropometric, physical activity and dietary factors associated with both systolic and diastolic hypertension in a group of Mexican school-aged children.




Design

• In this cross-sectional descriptive study, blood pressure, anthropometric, physical activity and dietary intake (assessed with a multiple-pass 24-hour dietary recall) evaluations were performed on school-aged children from September, 2005 to July, 2006.




Subjects

• Children aged 8-10 years (626 males and 613 females) from a convenience sample of 23 public schools of low socioeconomic status in Mexico City were included.




Statistical Analysis

• Descriptive statistics, X2 tests, analysis of variance, post hoc analysis with Bonferroni method, and logistic regression analysis were performed.

• Continuous variables are presented as mean ± standard deviation, categorical variables as percentages, and the association measures as adjusted odds ratios (OR).

• A p-value <0.05 was considered statistically significant, and 95% confidence intervals (CI95%) were calculated for adjusted OR.




Results• Dietary assessment showed that both boys and girls had a low fiber

intake (<25 g/d) as well as an excessive mean consumption of total and saturated fat (>35.0% and >10.0% of the daily energy, respectively).

• Based on the total cohort, 3.6% had systolic hypertension, 14.2% diastolic hypertension, and 22.8% mixed hypertension.

• The higher values of weight, body mass index (BMI), waist circumference, and prevalence of overweight and obesity, were more common among children with mixed hypertension, followed by children in the systolic group.




Results

• Subjects with diastolic and mixed hypertension reported increased intake of dietary total fat (37.7% and 38.2% of the daily energy intake, respectively).

• Adjusted OR=1.06 (CI95% 1.01 - 1.11) for systolic hypertension per increase of 1 cm in waist diameter

• Total fat intake >35.0% of the daily energy (kcal) showed an adjusted OR=2.61 (CI95% 1.27 - 5.36) for diastolic hypertension.




Results: Anthropometric and blood pressure variables according to gender for Mexican children aged 8-10 years

Variable Boys(n=626)

Girls(n=613)

Age (years) 9.4 + 0.7 9.4 + 0.7

Weight (kg) 34.2 + 8.6 33.8 + 8.4

Height (cm) 134.2 + 6.9 134.2 + 7.0

Body mass index (kg/m2) 18.8 + 3.5 18.6 + 3.4

Waist circumference (cm) 67.4 + 10.6 66.1 + 9.5

Systolic blood pressure (mmHg) 109.0 + 17.5 106.6 + 17.9

Diastolic blood pressure (mmHg) 75.5 + 14.8 74.5 + 14.5




Results: Dietary intake variables assessed with a single 24-hour recall according to gender for Mexican children aged 8-10 years

Variable Boys(n=626)

Girls(n=613)

Energy (Kcal/d) 2009.3 + 728.1 2019 + 680.4

Fiber (g/d) 6.6 + 3.6 6.3 + 3.4

Carbohydrate (g/d) 254.5 + 126.6 257.7 + 116.6

Energy from carbohydrate (%) 49.3 + 10.0 50.2 + 10.1

Protein (g/d) 67.8 + 21.3 66.7 + 20.5

Energy from protein (%) 13.9 + 2.9 13.6 + 2.8

Total fat (g/d) 81.6 + 30.5 82.8 + 31.7

Energy from total fat (%) 37.3 + 8.6 37.2 + 8.4

Saturated fat (g/d) 25.8 + 10.4 26.6 + 11.2

Energy from saturated fat (%) 11.7 + 3.3 11.89 + 3.48

Polyunsaturated fat (g/d) 13.0 + 8.1 13.1 + 8.1

Energy from polyunsaturated fat (%) 6.0 + 3.0 5.8 + 2.8

Monounsaturated fat (g/d) 26.8 + 11.9 27.0 + 12.7

Energy from monounsaturated fat (%) 12.2 + 4.0 12.0 + 4.0

Cholesterol (mg/d) 281.8 + 234.5 277.0 + 250.3

Sodium (mg/d)a 1441.1 + 929.0 1496.2 + 1003.6

Calcium (mg/d) 1043.6 + 434.8 1056.9 + 415.7

Magnesium (mg/d) 152.9 + 65.9 144.0 + 58.9

Potassium (mg/d) 2111.6 + 1072.5 2049.4 + 972.4

a.Excluding salt used in cooking




Results: Anthropometric and blood pressure variables according to type of hypertension for Mexican children aged 8-10 years

Variable Normal systolic and diastolic

BPn=606

Systolic hypertension

n=45

Diastolic hypertension

n=176

Mixed hypertension

n=283

p valueab

Gender [Male (%)] 48.7 44.4 42 54.1 0.080

Age (years) 9.4 + 0.7d 9.3 + 0.6e 9.7 + 0.7def 9.5 + 0.7f 0.000***d

0.046*e

0.016*f

Weight (kg) 30.2 + 5.8gdh 36.6 + 7.3gi 34.9 + 6.9df 41.7 + 9.1hif 0.000***gdhif

Body mass indexc (kg/m2) 17.1+2.3gdh 20.1 + 3.3gei 18.7 + 2.9def 21.9 + 3.7hif 0.000***gdhf

0.015*e

0.001**i

Overweight (%) 16.2 31.1 27.8 36.0 0.000***

Obesity (%) 1.8 24.4 7.4 36.7 0.000***

Waist circumference (cm) 62.4 + 7.3gdh 70.1 + 8.5gi 66.9 + 8.1df 76.0 + 10.5hif 0.000***gdhif

Systolic blood pressure (mmHg) 95.6 + 9.7gdh 123.4 + 7.8gei 106.1 + 5.3def 131.4 + 13.8hif 0.000***gdheif

Diastolic blood pressure (mmHg) 64.5 + 7.7dh 68.09 + 8.39ei 83.7 + 5.3def 92.4 + 12.4hif 0.000***dheif

a.After post hoc analysis using the Bonferroni method for variables with p<0.05 in analysis of variance for continuous variables.b.Based on Pearson’s Chi2 test for categorical variables. c.Mean difference based on analysis of variance. d.Difference between normal and diastolic hypertension

groups. e.Difference between systolic and diastolic hypertension groups. f.Difference between diastolic and mixed hypertension groups. g.Difference between normal and systolic hypertension

groups. h.Difference between normal and mixed hypertension groups. i.Difference between systolic and mixed hypertension groups. *Statistically significant difference at p<0.05 **Statistically significant difference at p<0.01 ***Statistically significant difference at p<0.001




Results: Dietary intake variables according to type of hypertension for Mexican children aged 8-10 years

Variable Normal systolic and diastolic BP

n=606

Systolic hypertension

n=45

Diastolic hypertension

n=176

Mixed hypertensionn=283

p valuea

Fiberb (g) 6.2 + 3.4 5.7 + 2.7 7.0 + 4.6 6.5 + 3.1

Energyb (Kcal/d) 1976.8 + 724.3 2118.3 + 524.7 1860.1 + 578.4 2140.8 + 738.3

From carbohydrateb (%) 49.7 + 10.6 55.5 + 9.3 48.9 + 8.8 49.4 + 10.1

From proteinb (%) 13.9 + 2.8 12.7 + 2.8 14.0 + 2.7 13.4 + 2.9

From total fatb (%) 31.1 + 9.0 32.1 + 7.8 37.7 + 7.6 38.2 + 8.1

From saturated fatb (%) 11.9 + 3.4 9.8 + 3.3 11.6 + 3.6 12.1 + 3.1

From polyunsatyrated fatb (%) 5.8 + 3.0 5.2 + 2.5 6.4 + 2.6 6.2 + 3.1

From monounsaturated fatb (%) 11.9 + 4.3 10.2 + 3.7c 12.1 + 3.6 12.9 + 3.7c 0.04*c

Cholesterolb (mg) 290.5 + 285.2 236.8 + 218.2 270.4 + 173.4 254.2 + 180.8

Sodiumbd (mg) 1382.5 + 922.8e 1388.1 + 767.7 1317.1 + 964.1f 1715.3 + 1040.2ef 0.03*e

0.04*f

Calcium (mg) 1037.5 + 445.4 1000.5 + 400.0 1027.4 + 389.6 1087.6 + 414.9

Magnesium (mg) 147.8 + 65.3 122.3 + 54.2 149.6 + 60.0 150.7 + 61.1

Potassium (mg) 2064.3 + 1030.1 2329.3 + 1453.5 1913.5 + 850.5 2183.6 + 1091.7

a.After post hoc analysis using the Bonferroni method for variables with p<0.05 in analysis of variance.b.Mean difference based on analysis of variance. c.Difference between systolic and mixed hypertension groups. d.Excluding salt used in cooking.e.Difference between normal and mixed hypertension groups. f.Difference between diastolic and mixed hypertension groups. *Statistically significant difference at p<0.05




Results: Logistic regression analysis of the association of systolic hypertension with overweight status and diet for Mexican

children aged 8-10 years

Ba S.E.b Wald dfc ORd 95.0% C.I.e for OR

Lower Upper

Age (years) -0.55 0.25 4.82 1 0.58* 0.35 0.94

Gender Male:1 Female: 0

0.10 0.31 0.10 1 1.10 0.60 2.02

Diastolic blood pressure (mm Hg)

0.13 0.02 63.98 1 1.14*** 1.10 1.17

Waist circumference (cm) 0.05 0.02 5.04 1 1.06* 1.01 1.11

a.Beta coefficient b.Standard error c.Degree of freedomd.Odds ratio for the association with the presence of systolic hypertension. e.Confidence interval*Statistically significant difference at p<0.05 ***Statistically significant difference at p<0.001




Results: Logistic regression analysis of the association of systolic hypertension with overweight status and diet for Mexican

children aged 8-10 years (cont’d)

Overweight Overweight and/or obesity:1 Normal weight: 0

0.39 0.43 0.86 1 1.48 0.64 3.41

Energy intake (Kcal/d) 0.00 0.00 0.83 1 1.00 1.00 1.00

Total fat intake >35% of daily energy: 1 <35% of daily energy: 0

-0.50 0.41 1.52 1 0.61 0.27 1.35

Saturated fat (mg/d) -0.03 0.06 0.21 1 0.97 0.86 1.10

Monounsaturated fat (mg/d) 0.04 0.06 0.39 1 1.04 0.93 1.16

Sodium (mg/d) 0.00 0.00 1.45 1 1.00 1.00 1.00

Constant -10.35 2.70 14.76 1 0.00






Results: Logistic regression analysis of the association of diastolic hypertension with overweight status and diet for Mexican

children aged 8-10 years


Lower Upper

Age (years) 0.32 0.22 2.14 1 1.38 0.90 2.11

Gender Male:1 Female: 0

0.14 0.27 0.27 1 1.15 0.68 1.96

Systolic blood pressure (mm Hg) 0.13 0.02 80.78 1 1.14*** 1.11 1.18

Waist circumference (cm) -0.02 0.02 0.43 1 0.99 0.94 1.03

Overweight Overweight and/or obesity:1 Normal weight: 0

0.41 0.40 1.04 1 1.51 0.69 3.31

Energy (Kcal/d) 0.00 0.00 1.24 1 1.00 1.00 1.00

a. Beta coefficient b.Standard error c.Degree of freedom d.Odds ratio for the association with the presence of systolic hypertension. e.Confidence interval*Statistically significant difference at p<0.05 ***Statistically significant difference at p<0.001




Results: Logistic regression analysis of the association of diastolic hypertension with overweight status and diet for Mexican

children aged 8-10 years (cont’d)

Total fat intake >35% of daily energy: 1 <35% of daily energy: 0

0.96 0.37 6.86 1 2.61** 1.27 5.36

Saturated fat (mg/d) -0.05 0.06 0.78 1 0.95 0.85 1.06

Monounsaturated fat (mg/d) 0.02 0.05 0.13 1 1.02 0.92 1.12

Sodium (mg/d) 0.00 0.00 0.20 1 1.00 1.00 1.00

Constant -16.57 2.65 38.98 1 0.00






Results: Prevalence of overweight and obesity in Mexican children aged 8-10 years

23.6

12.3

22.2

13.9

25

10.6

0

5

10

15

20

25

30

%

All Boys Girls

OverweightObesity




Results: Prevalence of hypertension in Mexicanchildren aged 8-10 years

3.6

14.2

22.8

3.2

11.8

24.4

4.1

16.6

21.2

0

5

10

15

20

25

30

%

All Boys Girls

SHDHSDH

SH=Systolic hypertension, DH=Diastolic hypertension, SDH=Systolic and diastolic hypertension.




Conclusions

• In a sample of Mexican children of low socioeconomic status, the prevalence of hypertension was high.

• Waist circumference was the main factor associated with systolic hypertension, and higher intake of total fat was related to diastolic hypertension.

Colín-Ramírez E, et al. J Am Diet Assoc. 2009; 109 (June).

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