| Object(1) To compare the predictive effect of different obesity-related indicators (Body mass index, Waist circumference and waist-to-height ratio) on child hypertension.(2) To explore the predictive effect of BPHR on child hypertension.Subjects and methods1. SubjectsThe research subjects were students aged6-17years from middle-level schools in Jinan City. It requires that their residence is Jinan or they live in Jinan at least one year. We used the convenience cluster sampling method to select students from four Jinan urban middle-level schools, it includes two primary school, one junior middle school and one senior middle school. The total number of research subjects is8783, it includes4245male students and4133female students, the gender ratio is close to1:1.2. Research MethodsWe conduct questionnaire survey and physical examination on subjects, the questionnaire includes their basic information and birth information, dietary habits and family history of disease. The physical examination include height, weight, WC, SBP, DBP, heart rate, and we calculate the BMI, WHt R, SBPHR, DBPHR. To use " the BMI cutoff points of overweight and obesity among children aged2-18years screening criteria"," the waist cutoff point of obesity among Chinese children and adolescents aged7-18years screening criteria " and the international WHtR screening criteria (the cutoff point is0.5) to divide obese type. To use "the diagnostic criteria of hypertension among Chinese children" to divide child hypertension. All instruments were calibrated before use. Investigators have unified training before the research. The dedicated quality control staff conducted the quality control process during the entire survey to ensure the accuracy of the measurement results.3. Statistical AnalysisWe use Epidata software for Data entry. SPSS13.0software and MedCalc software were used for statistical analysis.T-test was used to compare the mean of quantitative indicators between genders. Pearson correlation analysis was used to analyze the correlation between different indicators. Partial correlation analysis and multiple linear regression analysis were used to analyze the relationship between obesity-related indicators and blood pressure. Multivariate logistic regression and ROC curve analysis were used to analysis the predictive effects of obesity-related indicators on child hypertension. ROC curve analysis was also used to analysis the predictive effects of BPHR on child hypertension.Results1. The prevalence of different types of child obesity(1) When diagnosed by the "BMI cutoff points of overweight and obesity among children aged2-18years ", the total prevalence of overweight was19.1%, for male students20.0%, female students18.2%.The total prevalence of obesity was18.9%,23.9%for male students and13.8%for female students, and the prevalence of both overweight and obesity, the male students is higher than female students(P<0.05).(2) When diagnosed by "the waist cutoff point of obesity among Chinese children and adolescents aged7-18years", the total prevalence of abdominal obesity is28.3%,32.5%for male students, and24.1%for female students, and the prevalence of abdominal obesity of male students is higher than female students(P<0.001).(3) When diagnosed by "the international WHtR screening criteria", the total prevalence of abdominal obesity is19.1%,26.2%for male students and11.9%for female students, and the prevalence of abdominal obesity of male students is higher than female students(P<0.001).2. The prevalence of child hypertensionBased on "the diagnostic criteria of hypertension among Chinese children", the total prevalence of child hypertension is16.7%,20.1%for male students, and13.1%for female students, and the prevalence of male students is higher than female students (P<0.001).3. The predictive effect of different obesity-related indicators on child hypertension(1) The partial correlation analysis showed that, after adjusted for ages, the obesity-related indicators were positively associated with SBP and DBP (P<0.001). The partial correlation coefficient is descending with the order of BMI, WC and WHtR. To conduct subgroup analysis by gender, the trend remains unchanged.(2) The multiple linear regression analysis showed that, after adjusted for ages, the obesity-related indicators were closely associated with SBP and DBP (P<0.001).The regression coefficients of obesity-related indicators on blood pressure were descending with the order of WHtR, BMI, WC. To conduct subgroup analysis by gender, the trend remains unchanged.(3) Logistic regression analysis showed that, after adjusted for ages, the risk of hypertension, elevated SBP and elevated DBP all increased with the rise of obesity-related indicators, and the odd ratios of obesity-related indicators on hypertension were descending with the order of WHtR, BMI, WC. To conduct subgroup analysis by gender, the trend remains unchanged.(4)The area under the ROC curve of obesity-related indicators on hypertension, elevated SBP and elevated DBP were higher than0.7(except for the identification on elevated DBP), it suggest that the prediction of obesity-related indicators was good. In general, the prediction of BMI is more or less better than WC and WHtR. To conduct subgroup analysis by gender, the trend remains unchanged.4. The predictive effect of BPHR on hypertension(1) The correlation analysis showed that SBPHR was highly positively associated with SBP and DBPHR was highly positively associated with DBP.(2) To use SBPHR to predict elevated SBP, for male students, the area under the ROC curve was0.943-0.995, the sensitivity was0.818-0.976, the specificity was0.828-0.930; for female students, the area under the ROC curve was0.941-0.982, the sensitivity was0.886-1, the specificity was0.761-0.930. To use DBPHR to predict elevated DBP, for male students, the area under the ROC curve was0.979-0.995, the sensitivity was0.957-1, the specificity was0.873-0.989; for female students, the area under the ROC curve was0.975-0.998, the sensitivity was0.875-1, the specificity was0.919-0.992.(3) To predict overall hypertension with SBPHR and DBPHR together, the sensitivity was0.956, the specificity was0.848. It is showed that BPHR has excellent predictive effect on hypertension.Conclusions1. The prevalence of various types of obesity and hypertension among students aged6-17years in Jinan City may be at a relatively high level in China.2. BMI, WC and WHtR have good predictive effect on hypertension, the predictive effect of BMI was slightly better than WC and WHtR, they can be used for early warning of child hypertension. 3. SBPHR and DBPHR have excellent predictive effect on child hypertension, they were simple and accurate indicators for the screening of child hypertension. |
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