Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis.

Yin X, Liu Q, Bovet P, Ma C, Xi B.

J Hum Hypertens. 2016 Mar 3.doi: 10.1038/jhh.2016.12. [Epub ahead of print]

The aim of this study was to assess the performance of the blood pressure-to-height ratio (BPHR) for screening elevated blood pressure (BP) in children and adolescents using a meta-analysis of eligible published studies. We retrieved studies that investigated the performance of the BPHR for identifying elevated BP from Pubmed and other databases. We performed meta-analyses by subgroups of sex, age and ethnicity using a fixed or random effect model based on whether there was between-study heterogeneity. A total of 13 publications including 262 830 children and adolescents aged 6-18 years on BPHR and a total of three publications including 95 343 children on the modified BPHR were included in this meta-analysis. The summary results suggested that BPHR performed well to  identify pre-high BP and high BP for children aged 6-11 years and adolescents aged 12-18 years. The performance of BPHR was perfect for identifying severe high BP in adolescents aged 12-18 years. However, the modified BPHR did not improve accuracy for screening high BP in children aged 6-12 years. In summary, BPHR performed well for identifying elevated BP in children and adolescents, independently of sex, age and ethnicity group. In addition, the modified BPHR performed similarly with BPHR for screening high BP in childhood.Journal of Human

Hypertension advance online publication, 3 March 2016; doi:10.1038/jhh.2016.12.

Weight Gain in Infancy and Vascular Risk Factors in Later Childhood

Michael R. Skilton, PhD^a,^b, 

Guy B. Marks, PhD^c, 

Julian G. Ayer, PhD^b,

Frances L. Garden, MBiostat^b,^c,^d, 

Sarah P. Garnett, PhD^b,^e,^f,

Jason A. Harmer, MBBS^b, 

Stephen R. Leeder, PhD^b,^d,^g, 

Brett G. Toelle, PhD^c, 

Karen Webb, PhD^h, 

Louise A. Baur, PhD^b,^d,^e, and

David S. Celermajer, PhD^b

PEDIATRICS Vol. 131 No. 6 June 1, 2013 pp. e1821 -e1828

(doi: 10.1542/peds.2012-2789)

1. ^aBoden Institute of Obesity, Nutrition, Exercise, and Eating Disorders,
2. ^bSydney Medical School;
3. ^dSydney School of Public Health;
4. ^eThe Children's Hospital at Westmead Clinical School; and
5. ^gMenzies Centre for Health Policy, University of Sydney, Sydney, Australia;
6. ^cWoolcock Institute of Medical Research, Glebe, Australia;
7. ^fInstitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia; and
8. ^hAtkins Center for Weight and Health, Department of Nutritional Sciences and Toxicology and School of Public Health, University of California, Berkeley, California

ABSTRACT

OBJECTIVE: We hypothesized that early weight gain would be associated with incident obesity, higher blood pressure, systemic inflammation, and arterial wall thickening in later childhood.

METHODS: A longitudinal birth cohort was recruited antenatally from 2 maternity hospitals in Sydney, Australia, between September 1997 and December 1999. Three hundred ninety-five nondiabetic children who were followed to age 8 years had complete data for early weight gain and arterial wall thickness.

RESULTS: Independent predictors of excess early weight gain (age 0–18 months; adjusted for height gain) included male gender (0.411 kg [SE: 0.103],P < .001), fewer weeks’ gestation (−0.121 kg [SE: 0.044] per week, P = .006), birth length (0.156 kg [SE: 0.024] per cm, P < .001), and failure to breastfeed to 6 months of age (0.498 kg [SE: 0.108], P < .001). Early height-adjusted weight gain was significantly associated with later childhood overweight (odds ratio [OR]: 1.67 [95% confidence interval (CI): 1.26 to 2.20] per kg) and obesity (OR: 2.07 [95% CI: 1.53 to 2.79] per kg), excess central adiposity (OR: 1.54 [95% CI: 1.20 to 1.98] per kg), higher systolic blood pressure (1.24 mm Hg [SE: 0.33] per kg, P < .001), higher C-reactive protein (0.17 mg/dL [SE: 0.06] per 100% increase in weight gain, P = .006), and greater carotid intima-media thickness (0.012 mm [SE: 0.004] per kg, P = .002).

CONCLUSIONS: Early postnatal weight gain from birth to age 18 months is significantly associated with later childhood overweight and obesity, excess central adiposity, and greater arterial wall thickness.