Associations Between Weight Status Change From Birth To Childhood And High Blood Pressure,Dyslipidemia,Metabolic Syndrome In Childhood

BackgroundCardiovascular diseases,with their high rates of disability and mortality,have become a serious public issue.Among the many risk factors of cardiovascular disease,hypertension,dyslipidemia and metabolic syndrome(MetS)are often used as indicators to predict early cardiovascular disease.Hypertension,dyslipidemia and MetS are all latent chronic diseases that have a long course and prolonged recovery,and many studies show that the roots of related diseases can be traced back to earlier periods of life.Therefore,it is of great significance to explore the childhood influencial factors of high blood pressure,dyslipidemia and MetS for the early prevention and control of cardiovascular diseases.With the changes of lifestyle,the prevalence of childhood obesity in China remains high.Previous studies have shown that childhood obesity is not only important risk factors for hypertension,dyslipidemia and MetS in childhood,but also has a negative impact on blood pressure,blood lipids and other health indicators in adults.Childhood is a critical period of growth and development,and the weight status of children is always in a state of dynamic change.Therefore,only focusing on the association of birth weight or childhood weight with hypertension,dyslipidemia and MetS is not able to reflect the dynamic state of childhood health.Although there are many studies on the association between childhood weight status or birth weight status and hypertension,dyslipidemia and MetS,but there are few reports on the association between dynamic changes from birth weight to childhood weight status and childhood high blood pressure,dyslipidemia and MetS.Therefore,based on the "Huantai Childhood Cardiovascular Health Cohort Study",this study aimed to explore the association of weight status change from birth to childhood with high blood pressure,dyslipidemia and metabolic syndrome,so as to provide a scientific basis for a more comprehensive early prevention of cardiovascular diseases.Objectives1.To examine the association of overweight and obesity in childhood with high blood pressure,dyslipidemia and MetS.2.To examine the association of weight status change from birth to childhood with high blood pressure,dyslipidemia and MetS.MethodsThe participants were from the "Huantai Childhood Cardiovascular Health Cohort Study"that carried out in Huantai County,Zibo City,Shandong Province.Using convenient cluster sampling method,1515 children aged 6-11 from a primary school in Huantai County were selected as baseline survey objects from the end of 2017 to the beginning of 2018.Birth information(including whether the child was preterm,duration of breastfeeding,etc.)and baseline information(including age,sex,intake of fruits and vegetables,consumption of carbonated beverages,daily physical activity time,sleep time,parents’ highest education level,etc.)were collected.Blood pressure was measured by electronic sphygmomanometer,and total cholesterol(TC),total triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG)were measured by blood biochemical analyzer.After excluding missing data of relevant variables(including questionnaire information and blood biochemical markers),and children with underweight(BMI<the fifth quantile by age and sex of the population),a total of 1384 subjects were included to explore the association between childhood weight status and high blood pressure,dyslipidemia,and MetS.After further excluding those with low birth weight(<2500 g)and those with missing data on maternal and infant information(including duration of breastfeeding,preterm birth information,birth weight),a total of 1323 subjects were included in the study to investigate the association of changes in weight status from birth to childhood with high blood pressure,dyslipidemia and MetS.After adjusting for various covariates,covariance analysis was used to investigate the SBP,DBP,TC,TG,HDL-C,LDL-C and FBG levels in children with different weight status(normal,overweight and obese)and weight status changes from birth to childhood(persistent normal weight,weight loss,weight gain and persistent overweight).Multivariate logistic regression model was used to analyze the association of overweight and obesity in childhood with high blood pressure,dyslipidemia and MetS,as well as the association of weight status change from birth to childhood with high blood pressure,dyslipidemia,MetS,high TC,high TG,low HDLC,high LDL-C and hyperglycemia.Results1.The association between overweight and obesity in childhood and high blood pressure,dyslipidemia and metabolic syndromeCompared with children who had normal weight,those who were overweight and obese had higher prevalence of high SBP(17.6%vs.28.5%vs.39.2%),high DBP(9.4%vs.15.3%vs.26.1%),high TC(7.2%vs.9.9%vs.12.7%),high TG(0.1%vs.3.3%vs.7.6%),low HDLC(2.9%vs.6.9%vs.13.4%),high LDL-C(4.0%vs.5.8%vs.8.6%),high FBG(5.5%vs.6.9%vs.8.0%),high blood pressure(21.7%vs.33.9%vs.47.1%),dyslipidemia(10.2%vs.19.3%vs.29.0%)and MetS(0.5%vs.1.1%vs.7.0%)(all P<0.05).After adjusting for the relevant covariates,covariance analysis shows that children who were overweight or obese had higher SBP(105.21 vs.108.51 vs.111.51 mmHg),DBP(62.10 vs.64.63 vs.66.45 mmHg),TC(4.18 vs.4.23 vs.4.32 mmol/L),TG(0.67 vs.0.76 vs.0.96 mmol/L),LDL-C(2.33 vs.2.45 vs.2.58 mmoI/L),FBG(4.72 vs.4.79 vs.4.80 mmol/L)and lower HDL-C(1.62 vs.1.47 vs.1.33 mmol/L)than those with normal weight group(P<0.05).Multivariate logistic regression analysis showed that compared with children who had normal weight,overweight children had higher risk of high SBP(Odds ratio[OR]=1.72,95%Confidence interval[CI]=1.24-2.40),high DBP(OR=1.81,95%CI=1.18-2.76),high TG(OR=20.47 95%CI=2.52-166.10),low HDL-C(OR=2.78,95%CI=1.45-5.36),high blood pressure(OR=1.77,95%CI=1.30-2.42)and dyslipidemia(OR=2.06,95%CI=1.39-3.04).Obese children also had higher risk of high SBP(OR=2.72,95%CI=l.95-3.79),high DBP(OR=2.41,95%CI=2.29-5.09),high TC(OR=1.87,95%CI=1.21-2.88),high TG(OR=57.12,95%CI=7.48-436.25),low HDL-C(OR=6.16,95%CI=3.42-11.09),high LDL-C(OR=2.22,95%CI=1.24-3.99),high blood pressure(OR=2.98,95%CI=2.17-4.09),dyslipidemia(OR=3.30,95%CI=2.30-4.75)and MetS(OR=15.26,95%CI=4.96-46.94)The results were similar in the subgroup analysis by gender.2.The association between weight change status and high blood pressureCompared with children who had persistent normal weight,the prevalence of high SBP(17.8%vs.34.1%vs.37.5%),high DBP(9.5%vs.21.0%vs.26.3%)and high blood pressure(9.1%vs.24.9%vs.24.7%)in weight gain group and persistent overweight group were higher(P<0.05).After adjusting for relevant covariates,covariance analysis showed that children with weight gain and persistent overweight from birth to childhood had higher levels of SBP(104.70 vs.109.35 vs.109,16 mmHg)and DBP(62.23 vs.65.63 vs.66.24 mmHg)than those with persistent normal weight(P<0.001).Multivariate logistic regression analysis showed that both weight gain and persistent overweight children were associated with high blood pressure compared with those with persistent normal weight,with OR(95%CI)of 2.28(1.72-3.01)and 2.95(1.79-4.86),respectively.However,the association of children with weight loss and high blood pressure was not obvious(OR=1.15,95%CI:0.63-2.13).And the results were similar in the gender subgroup analysis.3.Association between body weight change status and dyslipidemiaCompared with children who had persistent normal weight,the prevalence of high TC(6.9%vs.10.8%vs.13.8%),high TG(0%vs.5.2%vs.6.3%),low HDL-C(3.0%vs.11.2%vs.8.8%),high LDL-C(3.9%vs.7.5%vs.8.8%)and dyslipidemia(24.4%vs.31.9%vs.38.4%)in children with weight gain and persistent overweight were higher than those with persistent normal weight(P<0.05).After adjusting for the relevant covariates,covariance analysis showed that those who had weight gain owned higher levels of TG(0.83 vs.0.64 mmol/L)and LDL-C(2.51 vs.2.32 mmol/L),lower level of HDL-C(1.41 vs.1.63 mmol/L)than those who maintained normal weight(P<0.05).Children with persistent overweight had higher levels of TC(4.32 vs.4.30 mmol/L),TG(0.84 vs.0.64 mmol/L)and LDL-C(2.55 vs.2.32 mmol/L),lower level of HDL-C(1.44 vs.1.63 mmol/L)than those with persistent normal weight(P<0.05).Multivariate logistic regression model showed that children with weight gain and persistent overweight was associations with higher risk of dyslipidemia compared with those with persistent normal weight,with OR(95%CI)of 2.89(2.05-4.07)and 2.46(1.35-4.49),respectively.However,the association of children with weight loss and dyslipidemia was not obvious(OR=1.37,95%CI:0.62-3.01).And the results were similar in the gender subgroup analysis.4.Association between body weight change status and metabolic syndromeCompared with children with persistent normal weight,the prevalence of high FBG(5.3%vs.6.7%vs.10.0%)and MetS(0.8%vs.3.9%vs.2.7%)in children with weight gain and persistent overweight were higher(P<0.05).Multivariate logistic regression analysis showed that children with weight gain and persistent overweight were associated with MetS compared with persistent normal weight,with OR(95%CI)of 10.23(2.92-35.79)and 7.02(1.30-37.92),respectively.However,the association of children with weight loss and MetS was not obvious(OR=3.40,95%CI:0.33-35.15).The results were similar to the gender subgroups analysis.Conclusions1.Childhood overweight and obesity showed significant association with high blood pressure,dyslipidemia,and MetS.2.Compared with those who maintained normal weight,the risk of high blood pressure,dyslipidemia,and MetS increased in those who gained weight and with persistent abnormal weight from birth to childhood,but not in those who lost weight.