Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Influence of blood pressure and body mass index on retinal vascular caliber in preschool-aged children

Journal of Human Hypertension volume 27, pages 523–528 (2013)Cite this article

Subjects

Abstract

We assessed the associations between body mass index (BMI) and blood pressure (BP) with the retinal microvasculature among preschool-aged children. Three hundred and seventy-nine children aged 3–<6 years old had gradable retinal photographs, and quantifiable retinal vascular caliber using validated computer-based methods. Weight, height, BMI, waist circumference and BP were obtained using standardized protocols. Mean (±s.d.) BMI and systolic BP in preschool-aged children were 16.0 (±1.8) kg m−2 and 93.2 (±9.9) mm Hg, respectively. After multivariable adjustment, each kg m−2 increase in BMI was associated with a 1.06 μm narrowing of retinal arteriolar caliber (P=0.01) and 1.12 μm widening of retinal venular caliber (P=0.02). Children in the ⩾95th percentile (obese) compared with those in the <85th percentile (healthy weight) had narrower retinal arteriolar caliber (∼6.1 μm, Ptrend=0.01) and wider retinal venular caliber (∼6.4 μm, Ptrend=0.01). Each 10 mm Hg increase in systolic BP was associated with a 1.70 μm narrower retinal arteriolar caliber (multivariable-adjusted P=0.02). We show that BMI and systolic BP have inverse linear associations with retinal arteriolar caliber, and BMI has a positive linear association with retinal venular caliber during early childhood. These findings suggests that the influence of BP and BMI on small vessels are continuous and commence early in life.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lobstein T, Baur L, Uauy R . Obesity in children and young people: a crisis in public health. Obes Rev 2004; 5 (Suppl 1): 4–104.

    Article  Google Scholar 

  2. Gopinath B, Baur LA, Teber E, Liew G, Wong TY, Mitchell P . Effect of obesity on retinal vascular structure in pre-adolescent children. Int J Pediatr Obes 2011; 6 (2-2): e353–e359.

    Article  Google Scholar 

  3. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003; 290 (17): 2277–2283.

    Article  CAS  Google Scholar 

  4. Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA . Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338 (23): 1650–1656.

    Article  CAS  Google Scholar 

  5. Brion MA, Ness AR, Davey SG, Leary SD . Association between body composition and blood pressure in a contemporary cohort of 9-year-old children. J Hum Hypertens 2007; 21 (4): 283–290.

    Article  CAS  Google Scholar 

  6. Gopinath B, Baur LA, Wang JJ, Teber E, Liew G, Cheung N et al. Blood pressure is associated with retinal vessel signs in preadolescent children. J Hypertens 2010; 28 (7): 1406–1412.

    Article  CAS  Google Scholar 

  7. Wong TY, Mitchell P . The eye in hypertension. Lancet 2007; 369: 425–435.

    Article  Google Scholar 

  8. Wang JJ, Mitchell P, Leung H, Rochtchina E, Wong TY, Klein R . Hypertensive retinal vessel wall signs in a general older population: the Blue Mountains Eye Study. Hypertension 2003; 42 (4): 534–541.

    Article  CAS  Google Scholar 

  9. Wang JJ, Taylor B, Wong TY, Chua B, Rochtchina E, Klein R et al. Retinal vessel diameters and obesity: A population-based study in older persons. Obesity (Silver Spring) 2006; 14 (2): 206–214.

    Article  Google Scholar 

  10. Wong TY, Duncan BB, Golden SH, Klein R, Couper DJ, Klein BE et al. Associations between the metabolic syndrome and retinal microvascular signs: the Atherosclerosis Risk In Communities study. Invest Ophthalmol Vis Sci 2004; 45 (9): 2949–2954.

    Article  Google Scholar 

  11. McGeechan K, Liew G, Macaskill P, Irwig L, Klein R, Klein BE et al. Meta-analysis: retinal vessel caliber and risk for coronary heart disease. Ann Intern Med 2009; 151 (6): 404–413.

    Article  Google Scholar 

  12. Taylor B, Rochtchina E, Wang JJ, Wong TY, Heikal S, Saw SM et al. Body mass index and its effects on retinal vessel diameter in 6-year-old children. Int J Obes (Lond) 2007; 31 (10): 1527–1533.

    Article  CAS  Google Scholar 

  13. Li LJ, Cheung CY, Chia A, Selvaraj P, Lin XY, Mitchell P et al. The relationship of body fatness indices and retinal vascular caliber in children. Int J Pediatr Obes 2011; 6 (3-4): 267–274.

    Article  Google Scholar 

  14. Li LJ, Cheung CY, Liu Y, Chia A, Selvaraj P, Lin XY et al. Influence of blood pressure on retinal vascular caliber in young children. Ophthalmology 2011; 118 (7): 1459–1465.

    PubMed  Google Scholar 

  15. Mitchell P, Cheung N, de Haseth K, Taylor B, Rochtchina E, Islam FM et al. Blood pressure and retinal arteriolar narrowing in children. Hypertension 2007; 49 (5): 1156–1162.

    Article  CAS  Google Scholar 

  16. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z et al. CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002; 246: 1–190.

    Google Scholar 

  17. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005; 45 (1): 142–161.

    Article  CAS  Google Scholar 

  18. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (2 Suppl 4th Report): 555–576.

    Article  Google Scholar 

  19. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002; 109 (1): 45–60.

    Article  Google Scholar 

  20. Wong TY, Knudtson MD, Klein R, Klein BE, Meuer SM, Hubbard LD . Computer-assisted measurement of retinal vessel diameters in the Beaver Dam Eye Study: methodology, correlation between eyes, and effect of refractive errors. Ophthalmology 2004; 111 (6): 1183–1190.

    Article  Google Scholar 

  21. Li LJ, Cheung CY, Gazzard G, Chang L, Mitchell P, Wong TY et al. Relationship of ocular biometry and retinal vascular caliber in preschoolers. Invest Ophthalmol Vis Sci 2011; 52 (13): 9561–9566.

    Article  Google Scholar 

  22. Knudtson MD, Lee KE, Hubbard LD, Wong TY, Klein R, Klein BE . Revised formulas for summarizing retinal vessel diameters. Curr Eye Res 2003; 27 (3): 143–149.

    Article  Google Scholar 

  23. Leung H, Wang JJ, Rochtchina E, Tan AG, Wong TY, Hubbard LD et al. Computer-assisted retinal vessel measurement in an older population: Correlation between right and left eyes. Clin Experiment Ophthalmol 2003; 31 (4): 326–330.

    Article  Google Scholar 

  24. Hitzenberger CK . Optical measurement of the axial eye length by laser Doppler interferometry. Invest Ophthalmol Vis Sci 1991; 32 (3): 616–624.

    CAS  PubMed  Google Scholar 

  25. Wong TY, Islam FM, Klein R, Klein BE, Cotch MF, Castro C et al. Retinal vascular caliber, cardiovascular risk factors, and inflammation: the multi-ethnic study of atherosclerosis (MESA). Invest Ophthalmol Vis Sci 2006; 47 (6): 2341–2350.

    Article  Google Scholar 

  26. Klein R, Klein BEK, Knudtson MD, Wong TY, Tsai MY . Are inflammatory factors related to retinal vessel caliber? The Beaver Dam Eye Study. Arch Ophthalmol 2006; 124 (1): 87–94.

    Article  Google Scholar 

  27. Oren S, Grossman E, Frohlich ED . Arterial and venous compliance in obese and nonobese subjects. Am J Cardiol 1996; 77 (8): 665–667.

    Article  CAS  Google Scholar 

  28. Serre K, Sasongko MB . Modifiable lifestyle and environmental risk factors affecting the retinal microcirculation. Microcirculation 2012; 19 (1): 29–36.

    Article  Google Scholar 

  29. Sonta T, Inoguchi T, Tsubouchi H, Sekiguchi N, Kobayashi K, Matsumoto S et al. Evidence for contribution of vascular NAD(P)H oxidase to increased oxidative stress in animal models of diabetes and obesity. Free Radic Biol Med 2004; 37 (1): 115–123.

    Article  CAS  Google Scholar 

  30. Nagaoka T, Kuo L, Ren Y, Yoshida A, Hein TW . C-reactive protein inhibits endothelium-dependent nitric oxide-mediated dilation of retinal arterioles via enhanced superoxide production. Invest Ophthalmol Vis Sci 2008; 49 (5): 2053–2060.

    Article  Google Scholar 

  31. Watts K, Bell LM, Byrne SM, Jones TW, Davis EA . Waist circumference predicts cardiovascular risk in young Australian children. J Paediatr Child Health 2008; 44 (12): 709–715.

    Article  Google Scholar 

  32. Kraemer-Aguiar LG, Maranhao PA, Cyrino FZ, Bouskela E . Waist circumference leads to prolonged microvascular reactive hyperemia response in young overweight/obese women. Microvasc Res 2010; 80 (3): 427–432.

    Article  Google Scholar 

  33. Sun C, Wang JJ, Mackey DA, Wong TY . Retinal vascular caliber: systemic, environmental, and genetic associations. Surv Ophthalmol 2009; 54 (1): 74–95.

    Article  Google Scholar 

  34. Sasongko MB, Wong TY, Wang JJ . Retinal Arteriolar Changes: Intermediate Pathways Linking Early Life Exposures to Cardiovascular Disease? Microcirculation 2010; 17: 1–11.

    Article  Google Scholar 

  35. Cheung N, Saw SM, Islam FM, Rogers SL, Shankar A, de Haseth K et al. BMI and retinal vascular caliber in children. Obesity (Silver Spring) 2007; 15 (1): 209–215.

    Article  Google Scholar 

Download references

Acknowledgements

The Sydney Pediatric Eye Disease Study was supported by the Australian National Health and Medical Research Council (NHMRC) grant number 402425 and 529923, and the National Heart Foundation of Australia grant number G11S6106.

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Westmead Millennium Institute, Centre for Vision Research, University of Sydney, Westmead, New South Wales, Australia

    B Gopinath, J J Wang, A Kifley, A G Tan & P Mitchell

  2. Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia, Victoria

    J J Wang & T Y Wong

  3. Singapore Eye Research Institute, National University of Singapore, Singapore

    T Y Wong

Authors
  1. B Gopinath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J J Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Kifley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A G Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T Y Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Mitchell.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gopinath, B., Wang, J., Kifley, A. et al. Influence of blood pressure and body mass index on retinal vascular caliber in preschool-aged children. J Hum Hypertens 27, 523–528 (2013). https://doi.org/10.1038/jhh.2013.15

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.15

Keywords

This article is cited by

Search

Advanced search

Quick links