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Association between body composition and blood pressure in a contemporary cohort of 9-year-old children

Abstract

Elevated blood pressure (BP) in children is an early risk factor for cardiovascular disease and is positively associated with body mass index (BMI). However, BMI does not distinguish between fat and lean masses, and the relationship of BP in children to different elements of body composition is not well established. BP, BMI and body composition were measured in 6863 children enrolled in the Avon Longitudinal Study of Parents and Children. Fat mass, lean mass and trunk fat were assessed using dual-energy X-ray absorptiometry. After full adjustment for confounders, total body fat and BMI were positively associated with systolic blood pressure (SBP) (β=3.29, 95% confidence interval CI 3.02, 3.57 mm Hg/standard deviation (s.d.) and β=3.97, 95% CI 3.73, 4.21 mm Hg/s.d., respectively) and diastolic blood pressure (DBP) (β=1.26, 95% CI 1.05, 1.46 mm Hg/s.d. and β=1.37, 95% CI 1.19, 1.54 mm Hg/s.d., respectively). SBP was also positively associated with lean mass (β=3.38, 95% CI 2.95, 3.81 mm Hg/s.d.), and weakly associated with trunk fat (β=1.42, 95% CI −0.06, 2.90 mm Hg/s.d., independent of total fat mass), which was robust in girls only. The association between lean mass and SBP remained even after accounting for fat mass. SBP in 9-year-old children is independently associated with fat mass and lean mass and, to a lesser extent, trunk fat in girls. In this analysis, because both fat and lean masses are associated with BP, BMI predicts BP at least as well as these components of body composition.

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References

  1. 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: 2277–2283.

    Article  CAS  Google Scholar 

  2. Berenson GS, Srinivasan SR, Bao W, Newman III 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: 1650–1656.

    Article  CAS  Google Scholar 

  3. Al-Sendi AM, Shetty P, Musaiger AO, Myatt M . Relationship between body composition and blood pressure in Bahraini adolescents. Br J Nutr 2003; 90: 837–844.

    Article  CAS  Google Scholar 

  4. Chen Y, Rennie DC, Reeder BA . Age-related association between body mass index and blood pressure: the humboldt study. Int J Obes Relat Metab Disord 1995; 19: 825–831.

    CAS  PubMed  Google Scholar 

  5. Leccia G, Marotta T, Masella MR, Mottola G, Mitrano G, Golia F et al. Sex-related influence of body size and sexual maturation on blood pressure in adolescents. Eur J Clin Nutr 1999; 53: 333–337.

    Article  CAS  Google Scholar 

  6. Paradis G, Lambert M, O'Loughlin J, Lavallee C, Aubin J, Devlin E et al. Blood pressure and adiposity in children and adolescents. Circulation 2004; 110: 1832–1838.

    Article  Google Scholar 

  7. Reich A, Muller G, Gelbrich G, Deutscher K, Godicke R, Kiess W . Obesity and blood pressure – results from the examination of 2365 schoolchildren in Germany. Int J Obes Relat Metab Disord 2003; 27: 1459–1464.

    Article  CAS  Google Scholar 

  8. Ellis KJ . Selected body composition methods can be used in field studies. J Nutr 2001; 131: 1589S–1595S.

    Article  CAS  Google Scholar 

  9. Wells JC . A critique of the expression of paediatric body composition data. Arch Dis Child 2001; 85: 67–72.

    Article  CAS  Google Scholar 

  10. Freedman DS, Wang J, Maynard LM, Thornton JC, Mei Z, Pierson Jr RN et al. Relation of BMI to fat and fat-free mass among children and adolescents. Int J Obes (London) 2005; 29: 1–8.

    Article  CAS  Google Scholar 

  11. Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, Siervogel RM . Childhood body composition in relation to body mass index. Pediatrics 2001; 107: 344–350.

    Article  CAS  Google Scholar 

  12. Daniels SR, Morrison JA, Sprecher DL, Khoury P, Kimball TR . Association of body fat distribution and cardiovascular risk factors in children and adolescents. Circulation 1999; 99: 541–545.

    Article  CAS  Google Scholar 

  13. He Q, Horlick M, Fedun B, Wang J, Pierson Jr RN, Heshka S et al. Trunk fat and blood pressure in children through puberty. Circulation 2002; 105: 1093–1098.

    Article  Google Scholar 

  14. Wilks RJ, Farlane-Anderson N, Bennett FI, Reid M, Forrester TE . Blood pressure in Jamaican children: relationship to body size and composition. West Indian Med J 1999; 48: 61–68.

    CAS  PubMed  Google Scholar 

  15. Mueller WH, Chan W, Meininger JC . Utility of different body composition indicators: demographic influences and associations with blood pressures and heart rates in adolescents (Heartfelt Study). Ann Hum Biol 2003; 30: 714–727.

    Article  CAS  Google Scholar 

  16. Daniels SR, Kimball TR, Khoury P, Witt S, Morrison JA . Correlates of the hemodynamic determinants of blood pressure. Hypertension 1996; 28: 37–41.

    Article  CAS  Google Scholar 

  17. Brandon LJ, Fillingim J . Body composition and blood pressure in children based on age, race, and sex. Am J Prev Med 1993; 9: 34–38.

    Article  CAS  Google Scholar 

  18. Julius S, Majahalme S, Nesbitt S, Grant E, Kaciroti N, Ombao H et al. A ‘gender blind’ relationship of lean body mass and blood pressure in the Tecumseh study. Am J Hypertens 2002; 15: 258–263.

    Article  Google Scholar 

  19. Golding J, Pembrey M, Jones R . ALSPAC – the avon longitudinal study of parents and children. I. study methodology. Paediatr Perinat Epidemiol 2001; 15: 74–87.

    Article  CAS  Google Scholar 

  20. Bolling K . The Dinamap 8100 Calibration Study: A survey carried out by Social Survey Division of OPCS on behalf of the Department of Health 1994. HMSO: London.

    Google Scholar 

  21. Nord RH, Payne RK . Body composition by dual-energy x-ray absorptiometry – a review of the technology. Asia Pacific J Clin Nutr 1995; 4: 167–171.

    CAS  Google Scholar 

  22. Park YW, Heymsfield SB, Gallagher D . Are dual-energy X-ray absorptiometry regional estimates associated with visceral adipose tissue mass? Int J Obes Relat Metab Disord 2002; 26: 978–983.

    Article  Google Scholar 

  23. OPCS. Standard Occupational Classification 1991. HMSO: London.

  24. Tanner JM . Normal growth and techniques of growth assessment. Clin Endocrinol Metab 1986; 15: 411–451.

    Article  CAS  Google Scholar 

  25. Knuiman MW, Divitini ML, Buzas JS, Fitzgerald PE . Adjustment for regression dilution in epidemiological regression analyses. Ann Epidemiol 1998; 8: 56–63.

    Article  CAS  Google Scholar 

  26. Sterne JA, Davey Smith G . Sifting the evidence-what's wrong with significance tests? BMJ 2001; 322: 226–231.

    Article  CAS  Google Scholar 

  27. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  28. Wells JC . A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord 2000; 24: 325–329.

    Article  CAS  Google Scholar 

  29. Weinsier RL, Norris DJ, Birch R, Bernstein RS, Wang J, Yang MV et al. The relative contribution of body fat and fat pattern to blood pressure level. Hypertension 1985; 7: 578–585.

    Article  CAS  Google Scholar 

  30. Berglund G, Ljungman S, Hartford M, Wilhelmsen L, Bjorntorp P . Type of obesity and blood pressure. Hypertension 1982; 4: 692–696.

    Article  CAS  Google Scholar 

  31. Siervogel RM, Roche AF, Chumlea WC, Morris JG, Webb P, Knittle JL . Blood pressure, body composition, and fat tissue cellularity in adults. Hypertension 1982; 4: 382–386.

    Article  CAS  Google Scholar 

  32. Daniels SR, Khoury PR, Morrison JA . The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. Pediatrics 1997; 99: 804–807.

    Article  CAS  Google Scholar 

  33. Deurenberg P, Weststrate JA, Seidell JC . Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr 1991; 65: 105–114.

    Article  CAS  Google Scholar 

  34. Deurenberg P, Yap M, van Staveren WA . Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 1998; 22: 1164–1171.

    Article  CAS  Google Scholar 

  35. Resnicow K, Futterman R, Vaughan RD . Body mass index as a predictor of systolic blood pressure in a multiracial sample of US schoolchildren. Ethn Dis 1993; 3: 351–361.

    CAS  PubMed  Google Scholar 

  36. Haarbo J, Gotfredsen A, Hassager C, Christiansen C . Validation of body composition by dual energy X-ray absorptiometry (DEXA). Clin Physiol 1991; 11: 331–341.

    Article  CAS  Google Scholar 

  37. Kannel WB . Elevated systolic blood pressure as a cardiovascular risk factor. Am J Cardiol 2000; 85: 251–255.

    Article  CAS  Google Scholar 

  38. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.

    Article  Google Scholar 

  39. Strandberg TE, Pitkala K . What is the most important component of blood pressure: systolic, diastolic or pulse pressure? Curr Opin Nephrol Hypertens 2003; 12: 293–297.

    Article  Google Scholar 

  40. Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F . Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 2002; 20: 1995–2007.

    Article  Google Scholar 

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Acknowledgements

We thank to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laborotary technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council, the Wellcome Trust and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors and Marie-Jo Brion and Andy Ness will serve as guarantors for the contents of this paper. Marie-Jo Brion is jointly funded by the Overseas Research Students Awards Scheme and the University of Bristol. None of the authors had any financial or personal interest in any of the companies or organizations sponsoring this research. Contents of this article represent the views of the authors and not necessarily those of the funding bodies.

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Correspondence to M A Brion.

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Brion, M., Ness, A., Davey Smith, G. et al. Association between body composition and blood pressure in a contemporary cohort of 9-year-old children. J Hum Hypertens 21, 283–290 (2007). https://doi.org/10.1038/sj.jhh.1002152

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