Zhu Haiyuan, Yu Lianlong, Wu Qiqi, Zhang Runquan, Zhang Zebang, Feng Yumei, Liu Tao, Liu Dan, Peng Jiewen, Chen Xiongfei, Dong Xiaomei
Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
Health Management Institute, Shandong Center for Disease Control and Prevention, Jinan, China.
Front Endocrinol (Lausanne). 2025 Jul 24;16:1595097. doi: 10.3389/fendo.2025.1595097. eCollection 2025.
The prevalence of hypertension in children is rising globally, with early-onset high blood pressure linked to future cardiovascular risk. Identifying early risk markers beyond obesity and high salt intake is necessary. Although cost-effective indicators of insulin resistance (IR), such as TyG and METS-IR, have been associated with new-onset hypertension in adults, their links with pediatric hypertension, particularly specific phenotypes of hypertension remain unclear.
12,087 individuals aged 7-17 years from the 2017 China National Nutrition and Health Surveillance of Children and Lactating Women were included. Hypertension was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95th percentile for sex, age, and height. Isolated systolic hypertension (ISH), defined as SBP ≥95th and DBP <95th percentile. Isolated diastolic hypertension (IDH), defined as DBP ≥95th and SBP <95th percentile. Systolic-diastolic hypertension (SDH), defined as both SBP and DBP ≥95th percentile. The associations of TyG and METS-IR with hypertension phenotypes were investigated using multivariable logistic regression and restricted cubic spline regression.
TyG and METS-IR were positively associated with hypertension and all its phenotypes after multivariable adjustment. Treated as continuous variables, each 1-unit rise in TyG corresponds to 44%, 47%, and 61% higher chance of ISH, IDH, and SDH, respectively (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.31-1.59; OR: 1.47, 95%CI: 1.21-1.79; OR: 1.61, 95%CI: 1.35-1.91); each 1-unit rise in METS-IR corresponds to 10%, 6%, and 12% higher chance of ISH, IDH, and SDH, respectively (OR: 1.10, 95%CI: 1.09-1.12; OR: 1.06, 95%CI: 1.03-1.08; OR: 1.12, 95%CI: 1.10-1.14). Consistent positive associations were observed across different subgroups for ISH and SDH, whereas this association for IDH was not statistically significant in several subgroups (e.g., age ≥12 years, sufficient sleep, daily exercise). TyG and METS-IR exhibited linear dose-response relationships with all hypertension phenotypes (p-nonlinear >0.10).
TyG and METS-IR show strong relationships with three kinds of hypertension phenotypes. They are promising markers that may contribute to the primary prevention of hypertension in pediatric populations.
全球儿童高血压患病率呈上升趋势，早发性高血压与未来心血管风险相关。识别肥胖和高盐摄入以外的早期风险标志物很有必要。尽管胰岛素抵抗（IR）的成本效益指标，如TyG和METS-IR，已与成人新发高血压相关，但其与儿童高血压，特别是高血压的特定表型之间的联系仍不清楚。
纳入2017年中国儿童与乳母营养与健康监测中12087名7至17岁的个体。高血压定义为收缩压（SBP）和/或舒张压（DBP）≥按性别、年龄和身高划分的第95百分位数。单纯收缩期高血压（ISH）定义为SBP≥第95百分位数且DBP<第95百分位数。单纯舒张期高血压（IDH）定义为DBP≥第95百分位数且SBP<第95百分位数。收缩期-舒张期高血压（SDH）定义为SBP和DBP均≥第95百分位数。使用多变量逻辑回归和受限立方样条回归研究TyG和METS-IR与高血压表型的关联。
多变量调整后，TyG和METS-IR与高血压及其所有表型呈正相关。作为连续变量处理时，TyG每升高1个单位，ISH、IDH和SDH的发生几率分别高出44%、47%和61%（比值比[OR]：1.44，95%置信区间[CI]：1.31-1.59；OR：1.47，95%CI：1.21-1.79；OR：1.61，95%CI：1.35-1.91）；METS-IR每升高1个单位，ISH、IDH和SDH的发生几率分别高出10%、6%和12%（OR：1.10，95%CI：1.09-1.12；OR：1.06，95%CI：1.03-1.08；OR：1.12，95%CI：1.10-1.14）。在ISH和SDH的不同亚组中观察到一致的正相关，而IDH在几个亚组（如年龄≥12岁、充足睡眠、每日锻炼）中的这种关联无统计学意义。TyG和METS-IR与所有高血压表型均呈现线性剂量反应关系（p-非线性>0.10）。
TyG和METS-IR与三种高血压表型关系密切。它们是有前景的标志物，可能有助于儿童人群高血压的一级预防。
