Hypertensive Measures In Schoolchildren: Risk Of Central Obesity And Protective Effect Of Moderate-To-Vigorous Physical Activity

Tozo, Tatiana Affornali; Pereira, Beatriz Oliveira; Menezes Junior, Francisco José de; Montenegro, Cristianne Morgado; Moreira, Carla Marisa Maia; Leite, Neiva

doi:10.36660/abc.20180391

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Original Article • Arq. Bras. Cardiol. 115 (1) • July 2020 • https://doi.org/10.36660/abc.20180391 copy

Hypertensive Measures In Schoolchildren: Risk Of Central Obesity And Protective Effect Of Moderate-To-Vigorous Physical Activity

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

The proportion of arterial hypertension (AH) has increased in children and adolescents and is associated with several comorbidities.

Objective

To verify the association of arterial hypertension with central and general obesity as well as according to the level of physical activity in schoolchildren.

Methods

336 children and adolescents aged 11 to 17 participated in the study. Height, body weight, waist circumference (WC) and blood pressure (BP) were measured. The body mass index z-score (BMI-z) was calculated. The level of physical activity was assessed by the short form of the International Physical Activity Questionnaire (IPAQ) according to the practice of moderate-to-vigorous physical activities (AF-mv). Students with systolic (SBP) and/or diastolic blood pressure (DBP) higher than the 95^thpercentile according to sex, age and height or ≥120/80 were considered hypertensive. Statistical tests of t-Student, Chi-square, Mann-Whitney and binary logistic regression model were used, considering the significance level of p<0.05.

Results

It was found that 40.5% of the students had AH, 35.11% were overweight (12.5% obese), 13.39% had high WC and 40.2% were considered insufficiently active in AF-mv. The chances of AH were related to high WC (OR = 6.11; 95% CI: 2.59¬–14.42) and overweight (OR = 2.91; 95% CI: 1.76–4.79). In addition, adolescents who practiced AF-mv had a lower risk of high DBP (OR = 0.33; 95% CI: 0.15–0.72).

Conclusion

Central obesity was the best predictor of AH in children and adolescents, as well as general obesity and males. The practice of AF-mv demonstrated a protective effect on high DBP in schoolchildren. (Arq Bras Cardiol. 2020; 115(1):42-49)

Child; Adolescent; School Children; Physical Activity; Waist Circumference; Body Mass Index; Hipertension; Blood Pressure

Age range (years)	Male (n)	Female (n)
12	33	29
13	38	29
14	34	36
15	23	36
16	21	29
17	14	15

	Total (n=336)	Female (n=173)	Male (n=163)	W
Age (years)#	14.50[13.35–15.88]	14.74[13.52–15.99]	14.35[13.16-15.54]	0.103
Body weight (kg)#	56.25[47.90-64.60]	54.70[46.90-62.00]	58.90[49.35-70.50]	0.001
Stature (cm)	1.62[0.10]	1.59[0.07]	1.66[0.10]	<0.001
Stature -z#	0.49[0.29-0.78]	0.44[0.26-0.71]	0.57[0.34-0.82]	0.003
WC (cm) #	68.00[62.50-74.00]	65.00[60.00-70.00]	71.00[65.50-78.00]	<0.001
BMI (kg/m ² )#	21.29[19.00-24.09]	21.55[19.17- 24.01]	20.79 [18.87. 24.80]	1.000
BMI-Z	0.51[1.22]	0.37[1.16]	0.65[1.27]	0.034
SBP (mmHg)#	124.00[113.50-132.50]	120.00[111.00-131.00]	127.00[118.00-135.25]	<0.001
DBP (mmHg)#	69.50[63.38-75.00]	70.00[65.00-76.50]	68.00[61.75-74.00]	0.009
PA-light (min/day)#	19.29[2.50-42.86]	14.29[0.00-38.57]	25.71[8.57-48.21]	0.007
PA- Moderate (min/day)#	17.14[6.43-34.64]	12.86[6.43-34.29]	17.14[6.79-37.14]	0.282
PA- Vigorous (min/day)#	7.14[0.00-17.14]	5.71[0.00-14.29]	8.57[0.00-25.71]	0.009

	EUTHROPHIC			OVERWEIGHT

	Total (n=218)	Female (n=119)	Male (n=99)	Total (n=118)	Female (n=54)	Male (n=64)	pt	p ♀	p ♂
Age (years)#	14.66[13.41-15.90]	14.80[13.68-16.01]	14.49[13.16-15.48]	14.25[13.14-15.83]	14.62[13.14-15.86]	14.07[13.21-15.61]	0.232	0.356	0.573
Body weight (kg)#	51.60[43.92-57.77]	51.10[43.30-55.90]	52.20[45.65-59.15]	67.45[61.12-78.62]	64.00[59.70-71.15]	74.10[64.75-83.15]	<0.001	<0.001	<0.001
Stature (cm)	1.61[0.10]	1.58[0.08]	1.65[0.11]	1.63[0.09]	1.60[0.06]	1.66[0.10]	0.062	0.230	0.380
Stature z#	0.43[0.27- 0.73]	0.41[0.23-0.64]	0.54[0.32- 0.79]	0.57[0.35- 0.83]	0.52[0.35-0.74]	0.71[0.42-0.87]	0.005	0.027	0.083
WC (cm)#	64.50[60.00-69.00]	61.00[58.00-66.00]	66.50[63.75-70.20]	76.50[72.00-86.00]	72.50[67.25-76.50]	83.00[75.25-91.12]	<0.001	<0.001	<0.001
BMI (kg/m ² )#	19.54[18.07-21.26]	19.69[18.18-21.65]	19.33[17.81-20.49]	25.34[23.88-27.91]	24.93[24.08-27.08]	26.04[23.64-29.03]	<0.001	<0.001	<0.001
BMI- Z	-0.18[0.85]	-0.19[0.90]	-0.17[0.78]	1.78[0.64]	1.60[0.56]	1.93[0.68]	<0.001	<0.001	<0.001
SBP (mmHg)#	121.00[111.50-130.50]	117.00[108.50-129.00]	124.00[116.50-132.00]	129.00[120.00-136.50]	124.00[116.62-136.25]	130.25[122.38-138.75]	<0.001	0.001	0.003
DBP (mmHg)#	68.50[62.50-74.00]	70.00[64.50-75.25]	67.50[61.25-73.25]	70.00[64.50-76.50]	70.50[66.12-77.88]	69.50[62.38-74.62]	0.075	0.255	0.096
PA-L (min/day) #	17.14[0.00-42.32]	11.43[0.00-36.43]	25.71[8.57-51.43]	24.29[6.96-51.43]	24.29[1.43-64.29]	23.57[8.57-43.39]	0.090	0.042	0.910
PA-Mod (min/day) #	14.29[6.43-34.29]	12.86[6.07-31.07]	17.14[6.79-37.14]	17.14[8.57-35.36]	13.57[8.57-35.36]	19.29[8.04-35.36]	0.532	0.768	0.734
PA-Vig (min/day) #	5.71[0.00-17.14]	4.29[0.00-13.57]	8.57[0.00-29.29]	8.57[2.14-17.14]	8.57[3.21-17.14]	10.71[1.39-17.14]	0.120	0.010	0.603

	ADEQUATE			CENTRAL OBESITY

	Total (n=291)	Female (n=163)	Male (n=128)	Total (n=45)	Female (n=10)	Male (n=35)	pt	p ♀	p ♂
Idade (anos)#	14.64[13.39-15.94]	14.74[13.64-16.01]	14.49[13.23-15.63]	13.81[12.99-15.52]	13.50[12.95-15.48]	13.94[13.02-15.31]	0.065	0.170	0.326
Peso corporal (kg)#	54.50[46.80-61.35]	53.80[46.45-60.80]	55.20[47.58-61.62]	78.40[68.90-89.30]	81.75[70.65-89.38]	78.40[68.80-88.20]	<0.001	<0.001	<0.001
Estatura (cm)	1.62[0.10]	1.59[0.07]	1.65[0.11]	1.66[0.08]	1.64[0.03]	1.67[0.09]	0.005	0.038	0.543
Estatura-z#	0.45[0.28-0.74]	0.43[0.24-0.68]	0.55[0.32-0.80]	0.74[0.49-0.89]	0.77[0.61-0.90]	0.73[0.46-0.89]	<0.001	0.005	0.064
CC (cm)#	66.00[61.00-71.50]	64.00[59.00-69.50]	69.50[64.50-72.50]	88.50[84.00-95.00]	81.00[79.00-88.50]	90.00[86.00-97.25]	<0.001	<0.001	<0.001
IMC (kg/m2)#	20.56[18.54-22.77]	21.40[19.13-23.38]	20.11[18.37-21.60]	28.67[26.40-31.40]	29.80[26.30-33.16]	28.67[26.66-30.23]	<0.001	<0.001	<0.001
IMC-z	0.22[1.02]	0.25[1.07]	0.17[0.95]	2.39[0.52]	2.35[0.53]	2.40[0.53]	<0.001	<0.001	<0.001
PAS (mmHg)#	122.50[112.75-131.00]	119.00[111.00-129.75]	124.25[117.50-132.88]	132.00[127.00-139.50]	136.25[129.00-138.25]	131.00[126.75-141.75]	<0.001	0.026	0.002
PAD (mmHg)#	68.50[62.50-74.50]	70.00[65.00-75.75]	67.00[61.00-73.50]	73.00[68.00-78.00]	76.50[68.88-84.38]	72.50[68.25-74.75]	0.009	0.101	0.003
AF-leve (min/dia)#	19.29[0.00-42.86]	14.29[0.00-38.57]	25.71[8.57-46.61]	21.43[5.71-51.43]	23.57[9.29-57.86]	21.43[5.00-47.14]	0.609	0.432	0.527
AF-moderada (min/dia) #	14.29[6.43-35.00]	12.86[6.43-33.21]	17.14[6.43-36.43]	17.14[8.57-34.29]	19.29[6.96-33.75]	17.14[9.64-34.29]	0.377	0.779	0.619
AF-vigorosa (min/dia)#	6.43[0.00-17.14]	5.71[0.00-14.29]	8.57[0.00-26.43]	10.71[2.86-17.14]	6.43[0.71-11.79]	12.86[3.57-22.14]	0.271	0.928	0.607

	SUFFICIENTLY ACTIVE			INSUFFICIENTLY ACTIVE

	Total (n=201)	Female (n=93)	Male (n=108)	Total (n=135)	Female (n=80)	Male (n=55)	pt	p ♀	p ♂
Age (years)#	14.39[13.17-15.96]	14.48[13.28-15.99]	14.27[13.08-15.88]	14.64[13.56-15.80]	14.84[13.94-15.95]	14.45[13.38-15.10]	0.504	0.442	0.854
Body weight(kg)#	58.10[50.50-65.80]	57.40[50.70-63.40]	59.15[50.40-72.30]	53.70[43.90-62.05]	51.60[43.08-60.83]	58.50[48.45- 66.65]	0.002	0.005	0.300
Stature (cm)	1.63[0.10]	1.60[0.07]	1.67[0.11]	1.60[0.09]	1.58[0.08]	1.64[0.10]	0.002	0.048	0.114
Stature z#	0.56[0.34-0.80]	0.48[0.34-0.73]	0.68[0.35- 0.84]	0.41[0.23- 0.70]	0.38[0.22-0.62]	0.48[0.27-0.71]	0.001	0.016	0.025
WC (cm)#	69.50[64.00-75.00]	67.00[61.00-72.00]	71.25[66.38-79.25]	65.00[61.00-72.00]	63.00[59.00-67.00]	70.00[64.00-75.50]	0.001	0.015	0.226
BMI (kg/m ² ) #	21.58[19.40-24.50]	22.27[19.69-24.26]	20.98[19.17-24.80]	20.35[18.23-23.56]	20.10[18.25-23.34]	20.39[18.29-24.62]	0.020	0.009	0.530
BMI _{- Z}	0.64[1.11]	0.59[1.01]	0.67[1.19]	0.31[1.34]	0.11[1.26]	0.61[1.41]	0.016	0.005	0.748
SBP (mmHg)#	124.50[115.50-132.50]	120.50[112.50-131.00]	129.00[119.12-136.62]	123.00[111.50-130.75]	117.50[108.50-130.62]	124.00[118.00-130.75]	0.067	0.365	0.205
DBP (mmHg)#	69.00[62.50-74.00]	70.50[64.50-75.00]	67.75[61.38-73.00]	70.00[64.50-77.75]	70.00[65.00-77.62]	70.00[62.50-77.75]	0.046	0.599	0.063
PA-L (min/day) #	34.29[12.86-64.29]	34.29[14.29-64.29]	34.29[12.86-64.29]	8.57[0.00-17.14]	0.00[0.00-12.86]	12.86[2.86-25.71]	<0.001	<0.001	<0.001
PA-Mod (min/day) #	25.71[12.86-60.00]	25.71[12.86-60.00]	25.71[12.86-53.57]	8.57[0.00-12.93]	8.57[0.00-12.86]	8.57[0.71-17.14]	<0.001	<0.001	<0.001
PA-Vig (min/day) #	14.29[5.71-32.14]	12.86[5.71-25.71]	15.71[8.04-39.64]	0.00[0.00-5.71]	0.00[0.00-4.64]	1.86[0.00-5.71]	<0.001	<0.001	<0.001

		BLOOD PRESSURE			p	SYSTOLIC BLOOD PRESSURE			p	DIASTOLIC BLOOD PRESSURE			p

		Adequate (n=158)	Pre (n=42)	Hypertensive (n=136)		Adequate (n=164)	Pre (n=40)	Hypertensive (n=132)		Adequate (n=287)	Pre (n=18)	Hypertensive (n=31)
Sex (%)	Female	91(52.6%)	15(8.7%)	67(38.7%)	0.033	93(53.8%)	15(8.7%)	65(37.6%)	0.075	145(83.8%)	11(6.4%)	17(9.8%)	0.633
Sex (%)	Male	67(41.1%)	27(16.6%)	69(42.3%)	0.033	71(43.6%)	25(15.3%)	67(41.1%)	0.075	142(87.1%)	7(4.3%)	14(8.6%)	0.633
PA-mv (%)	Suff. Active	91(45.3%)	27(13.4%)	83(41.3%)	0.685	93(46.3%)	27(13.4%)	81(40.3%)	0.412	179(89.1%)	11(5.5%)	11(5.5%)	0.015
PA-mv (%)	Insuff. Active	67(49.6%)	15(11.1%)	53(39.3%)	0.685	71(52.6%)	13(9.6%)	51(37.8%)	0.412	108(80.0%)	7(5.2%)	20(14.8%)	0.015
WC (%)	Appropriate	151(51.9%)	34(11.7%)	106(36.4%)	<0.001	155(53.3%)	32(11.0%)	104(35.7%)	<0.001	252(86.6%)	16(5.5%)	23(7.9%)	0.103
WC (%)	Central Obes.	7(15.6%)	8(17.8%)	30(66.7%)	<0.001	9(20.0%)	8(17.8%)	28(62.2%)	<0.001	35(77.8%)	2(4.4%)	8(17.8%)	0.103
BMIz (%)	Eutrophic	121(55.5%)	25(11.5%)	72(33.0%)	<0.001	125(57.3%)	22(10.1%)	71(32.6%)	<0.001	190(87.2%)	13(6.0%)	15(6.9%)	0.114
BMIz (%)	Overweight	37(31.4%)	17(14.4%)	64(54.2%)	<0.001	39(33.1%)	18(15.3%)	61(51.7%)	<0.001	97(82.2%)	5(4.2%)	16(13.6%)	0.114

	HA OR (CI 95%)	PAS elevada OR (CI 95%)	PAD elevada OR (CI 95%)
Sex=Boys	1.40(0.88-2.22)	1.35(0.85-2.14)	0.84(0.40-1.77)
PA-mv= sufficiently active	1.15(0.72-1.84)	1.21(0.76-1.93)	0.33(0.15-0.72)
WC= Central obesity	6.11(2.59-14.42)	4.64(2.10-10.23)	2.50(1.04-6.03)
BMI-z= General obesity	2.91(1.76-4.79)	2.75(1.68-4.52)	2.09(0.99-4.40)

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