Rademacher Erin R, Jacobs David R, Moran Antoinette, Steinberger Julia, Prineas Ronald J, Sinaiko Alan
Department of Pediatrics, University of Rochester, New York 14642, USA.
J Hypertens. 2009 Sep;27(9):1766-74. doi: 10.1097/HJH.0b013e32832e8cfa.
Adult obesity and hypertension are leading causes of cardiovascular morbidity/mortality. Although childhood BMI and blood pressure (BP) track into adulthood, how they influence adult cardiovascular risk independent of each other is not well defined.
Participants were from two longitudinal studies with a baseline evaluation at mean age of 13 years and a follow-up at mean age of 24 years. Regression models using childhood BP and BMI to predict young adult cardiovascular risk factors were performed.
In univariate analysis, childhood BMI predicted young adult BP, lipids, glucose, insulin and insulin resistance, whereas childhood BP predicted young adult BP, lipids and glucose. In a multivariable regression model (adjusted for age, sex and race), which included change in BMI and BP from age 13 to 24 years, BMI predicted all young adult risk factors except BP and glucose. Baseline SBP predicted young adult BP, cholesterol, triglycerides and glucose whereas baseline DBP predicted young adult BP, BMI and glucose.
The results from this study show that BP and BMI act independently in children to influence future cardiovascular risk factors and the combination of high BP and BMI in childhood has an additive effect in predicting the highest levels of young adult cardiovascular risk. Thus, there should be a focus on treating hypertension in overweight and obese children, in addition to attempting to reduce weight.
成人肥胖和高血压是心血管疾病发病/死亡的主要原因。尽管儿童期体重指数(BMI)和血压(BP)会持续到成年期,但它们如何相互独立地影响成人心血管风险尚不清楚。
参与者来自两项纵向研究,基线评估平均年龄为13岁,随访平均年龄为24岁。使用儿童期血压和BMI预测年轻成人心血管危险因素的回归模型。
在单变量分析中,儿童期BMI可预测年轻成人的血压、血脂、血糖、胰岛素和胰岛素抵抗,而儿童期血压可预测年轻成人的血压、血脂和血糖。在多变量回归模型(根据年龄、性别和种族进行调整)中,包括从13岁到24岁的BMI和血压变化,BMI可预测除血压和血糖外的所有年轻成人危险因素。基线收缩压可预测年轻成人的血压、胆固醇、甘油三酯和血糖,而基线舒张压可预测年轻成人的血压、BMI和血糖。
本研究结果表明,血压和BMI在儿童期独立起作用,影响未来心血管危险因素,儿童期高血压和高BMI的组合在预测年轻成人心血管风险的最高水平方面具有累加效应。因此,除了试图减轻体重外,还应关注超重和肥胖儿童的高血压治疗。