Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China.
Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital, Dalian Medical University, Dalian, 116033, China.
BMC Pediatr. 2022 Jan 4;22(1):19. doi: 10.1186/s12887-021-03062-8.
Childhood obesity is more likely to increase the chance of many adult health problems. Numerous studies have shown obese children to be more prone to elevated blood pressure (BP) and hypertension. It is important to identify an obesity anthropometric index with good discriminatory power for them in pediatric population.
MEDLINE/PubMed, Web of Science, and Cochrane databases were retrieved comprehensively for eligible studies on childhood obesity and hypertension/elevated BP through June 2021. The systematic review and meta-analysis of studies used receiver operating characteristics (ROC) curves for evaluating the discriminatory power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in distinguishing children with elevated BP and hypertension.
21 cross-sectional studies involving 177,943 children and 3-19 years of age were included in our study. Meta-analysis showed that the pooled area under the reporting receiver-operating characteristic curves (AUC) and 95% confidence intervals (CIs) for BMI, WC, and WHtR to detect hypertension of boys were 0.68 (0.64, 0.72), 0.69 (0.64, 0.74), 0.67 (0.63, 0.71), for elevated BP, the pooled AUCs and 95% CIs were 0.67 (0.61, 0.73), 0.65 (0.58, 0.73), 0.65 (0.61, 0.71). The pooled AUCs and 95% CIs for BMI, WC and WHtR of predicting hypertension were 0.70 (0.66, 0.75), 0.69 (0.64, 0.75), 0.67 (0.63, 0.72) in girls, the pooled AUCs and 95% CIs of predicting elevated BP were 0.63 (0.61, 0.65), 0.62 (0.60, 0.65), 0.62 (0.60, 0.64) respectively. There was no anthropometric index was statistically superior in identifying hypertension and elevated BP, however, the accuracy of BMI predicting hypertension was significantly higher than elevated BP in girls (P < 0.05). The subgroup analysis for the comparison of BMI, WC and WHtR was performed, no significant difference in predicting hypertension and elevated BP in pediatric population.
This systematic review showed that no anthropometric index was superior in identifying hypertension and elevated BP in pediatric population. While compared with predicting elevated BP, all the indicators showed superiority in predicting hypertension in children, the difference was especially obvious in girls. A better anthropometric index should be explored to predict children's early blood pressure abnormalities.
儿童肥胖更有可能增加许多成年健康问题的机会。许多研究表明肥胖儿童更容易出现血压升高（BP）和高血压。为儿科人群识别具有良好区分能力的肥胖人体测量指数非常重要。
通过 2021 年 6 月，全面检索 MEDLINE/PubMed、Web of Science 和 Cochrane 数据库，以获取有关儿童肥胖和高血压/血压升高的合格研究。使用受试者工作特征（ROC）曲线对系统评价和荟萃分析评估 BMI、腰围（WC）和腰高比（WHtR）在区分血压升高和高血压儿童方面的区分能力。
本研究纳入了 21 项横断面研究，涉及 177943 名 3-19 岁儿童。荟萃分析显示，男孩高血压的 BMI、WC 和 WHtR 的报告接收者操作特征曲线（ROC）下面积（AUC）和 95%置信区间（CI）的汇总值分别为 0.68（0.64、0.72）、0.69（0.64、0.74）、0.67（0.63、0.71），血压升高的 AUC 和 95%CI 分别为 0.67（0.61、0.73）、0.65（0.58、0.73）、0.65（0.61、0.71）。预测高血压的 BMI、WC 和 WHtR 的 AUC 和 95%CI 汇总值分别为 0.70（0.66、0.75）、0.69（0.64、0.75）、0.67（0.63、0.72），预测血压升高的 AUC 和 95%CI 汇总值分别为 0.63（0.61、0.65）、0.62（0.60、0.65）、0.62（0.60、0.64）。在识别高血压和血压升高方面，没有一种人体测量指标具有统计学优势，然而，BMI 预测高血压的准确性明显高于女孩的血压升高（P<0.05）。对 BMI、WC 和 WHtR 进行了比较的亚组分析，在儿科人群中，预测高血压和血压升高没有显著差异。
本系统评价表明，在儿科人群中，没有一种人体测量指标在识别高血压和血压升高方面具有优势。与预测血压升高相比，所有指标在预测儿童高血压方面均表现出优势，在女孩中差异尤为明显。应该探索更好的人体测量指标来预测儿童早期血压异常。
