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Adult hypertension risk quadrupled for obese children
Overweight children are twice as likely and obese children are four times as likely to develop hypertension as adults compared with normal-weight children, new data suggest.
At the American Heart Association High Blood Pressure Research 2013 Scientific Sessions, Sara E. Watson, MD, and colleagues presented results of a cohort study started in 1986 that included 1,117 healthy children in Indianapolis.
Participants with BMI percentile values less than 85% were classified as normal weight, those with BMI percentile values of 85% to 94% were classified as overweight, and those with BMI percentile values of at least 95% were classified as obese.
Based on mean or maximum childhood BMI percentile values, 68% of participants were normal-weight children, 16% were overweight and 16% were obese.
Through active follow-up and review of medical records, the researchers identified 119 cases of adult hypertension among the participants.
Adult hypertension was present in 6% of participants who were classified as normal weight in childhood compared with 14% who were classified as overweight and 26% who were classified as obese (P<.0001). Overweight children had a two times greater risk for adult hypertension compared with normal-weight children (OR=2.2; 95% CI, 1.3-3.6) and obese children had a four times greater risk (OR=4.4; 95% CI, 2.8-6.9), as classified by BMI percentile values. Similar associations were observed when obesity was classified by waist circumference or tricep skinfold.
The researchers also found an association between hypertension risk and overweight or obesity in childhood as assessed by maximum BMI percentile values (OR=1.3; 95% CI, 0.7-2.3 for overweight children; OR=2.3; 95% CI, 2.4-5.7 for obese children).
“This [association] has significant implications for early prevention of childhood obesity and public health,” Watson, of Riley Hospital for Children at Indiana University, and colleagues wrote in the abstract.
For more information:
Watson SE. Abstract #36. Presented at: the American Heart Association High Blood Pressure Research 2013 Scientific Sessions; Sept. 11-14, 2013; New Orleans.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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This is an important study for a few reasons. First, there are relatively few long-term follow-up studies of obese children looking at them through their development and into adulthood. It’s a major effort to track the children into adulthood and follow them. Also, this is a study in which the follow-up assessments were done in 2013. Some studies that have looked at this issue before have been done in prior decades. The follow-up is examined in the context of the modern food environment and the modern physical activity/sedentary environment.
The results are fascinating and clinically important. They are important from a public health perspective because they are linking early childhood obesity to a significant adult health concern — hypertension. It also fits with other emerging science on the health consequences of childhood obesity. These findings suggest that there could be potential longer-term CV health benefits to addressing childhood obesity through treatment or prevention if addressed earlier in life. There are also studies showing that treating childhood and adolescent obesity has benefits for BP. When you treat childhood obesity, weight is lost and BP improves.
This is not a treatment study, but it’s important to note that there are interventions for childhood obesity that involve family members working together using a family treatment model. Those have been shown to be effective for child adiposity.
The abstract makes the case for the importance of knowing your child’s BMI. This has been an important emphasis in primary care pediatrics in recent years. There are a number of BMI calculators for children and adolescents on the Web, including from the CDC.
We know that childhood obesity tracks over time, meaning that if you’re an obese child, you’re more likely to be an obese adolescent and, subsequently, an obese adult. One part to this study that we can’t entirely be sure about is how much of the adult hypertension is due to the childhood obesity per se. It might be that the adult obesity is driving the hypertension. This issue has been hard to tease apart and disaggregate in prior studies.