Waist circumference and waist-hip ratio as screening tools for hypertension in children aged 6–11 years

Main Article Content

Esti Istiqomah
Dida A. Gurnida
Dany Hilmanto
Dzulfikar Djalil Lukmanul Hakim
Prima Nanda Fauziah

Abstract

Background Hypertension in children is associated with obesity. 7 The renin-angiotensin-aldosterone system has been associated with intra-abdominal fat tissue. Anthropometric parameters for determining nutritional status include waist circumference and waist-hip ratio. Many studies have shown that waist circumference and waist-hip ratio are more precise to determine overweight or obese.


Objective To determine the usefulness of waist circumference and waist-hip ratio as hypertensive screening tools for children aged 6-11 years.


Methods This analytical study with cross-sectional design and multistage cluster sampling method was conducted in August-September 2017 at a primary school in Bandung, West Java, Indonesia. Subjects underwent height, weight, waist circumference, hip circumference, and blood pressure measurements. Receiver operating characteristic (ROC) curve analysis was done to obtain the area under curve (AUC), cut-off point, sensitivity, specificity, and prevalence ratio.


Results Subjects were 325 children consisting of 187 males and 138 females. Hypertension was diagnosed in 47 children (37 males and 10 females). Mean waist circumference and waist-hip circumference ratio were significantly higher in the hypertensive group than in the normotensive group. The hypertensive group had a mean waist circumference of 72.6 (SD 12.8) cm, AUC 0.779 (95%CI 0.730 to 0.823; P<0.001), cut-off point >65 cm, sensitivity 66.0%, specificity 76.3%, and prevalence ratio 4.55. This group had mean waist-hip ratio of 0.94 (SD 0.10), AUC 0.724 (95%CI 0.672 to 0.772; P<0.001), waist-hip ratio cut-off >0.91, sensitivity 59.6%, specificity 77.0%, and prevalence ratio 3.73.


Conclusion Waist circumference >65 cm or waist-hip ratio >0.91 can be used to screen for hypertension in children aged 6-11 years with negative predictive values of 92.0% and 91.8%, respectively.


 

Article Details

How to Cite
1.
Istiqomah E, Gurnida D, Hilmanto D, Hakim D, Fauziah P. Waist circumference and waist-hip ratio as screening tools for hypertension in children aged 6–11 years. PI [Internet]. 11Oct.2019 [cited 11Dec.2019];59(5):265-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2185
Section
Pediatric Nephrology
Received 2019-04-14
Accepted 2019-10-11
Published 2019-10-11

References

1. Supartha M, Suarta IK, Winaya IDA. Hipertensi pada anak. MKI. 2009;59221-30.
2. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298:874-9.
3. Fujita Y, Kouda K, Nakamura H, Nishio N, Takeuchi H, Iki M. Relationship between height and blood pressure in Japanese schoolchildren. Pediatr Int. 2010;52:689-93.
4. Ejike C. Blood pressure to height ratios as simple, sensitive, and specific diagnostic tools for adolescent (pre)hypertension in Nigeria. Ital J Pediatr. 2011;37:30.
5. Garnet SP, Baur LA, Srinivasan S, Lee JW, Cowell CT. Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence. Am J Clin Nutr 2007;86:549-55.
6. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015;4:187-92.
7. Salman Z, Kirk GD, Deboer MD. High rate of obesity-associated hypertension among primary schoolchildren in Sudan. Int J Hypertens. 2010:2011:629492.
8. Ramoshaba NE, Monyeki KD, Zatu MC, Hay L, Mabata LR. The relationship between blood pressure and anthropometric indicators in rural South African children: Ellisras Longitudinal Study. J Obes Weight Loss Ther. 2015;5:243.
9. Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010;33:386-93.
10. Davy KP, Hall JE. Obesity and hypertension: two epidemics or one?. Am J Physiol Regul Integr Comp Physiol. 2004;286:803-13.
11. Aregullin-Eliqio EO, Alcorta-Garza MC. Prevalence and risk factors of high blood pressure in Mexican school children in Sabinas Hidalgo. Salud Publica Mex. 2009;51:14-8.
12. Dulskiene V, Kuciene R, Medzioniene J, Benetis R. Association between obesity and high blood pressure among Lithuanian adolescent: a cross-sectional study. Ital J Pediatr. 2014;40:102.
13. Chen B, Li HF. Waist circumference as an indicator of high blood pressure in preschool obese children. Asia Pac J Clin Nutr. 2011;20:557-62.
14. The National Center for Health Statistics in Collaboration with The National Center for Chronic Diasease Prevention and Health Promotion (2000). Available from: http:www.cdc.gov/growthcharts.
15. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555-76.
16. Lubis G, Oyong N. Hubungan lingkar pinggang dengan faktor risiko penyakit kardiovaskular pada anak obesitas usia sekolah dasar. Sari Pediatri. 2006;8:147-53.
17. Liu A, Hills AP, Hu X, Li Y. Waist circumference cut-off values for the prediction of cardiovascular risk factors clustering in Chinese school-aged children: a cross-sectional study. BMC Public Health. 2010;10:82.
18. Choy CS, Chan WY, Chen TL, Shih CC, Wu LC, Liao CC. Waist circumference and risk of elevated blood pressure in children: a cross-sectional study. BMC Public Health. 2011;11:613.
19. Allamanda E, Prawirohartono EP, Mulyani NS. Predicting hypertension using waist circumference in obese Indonesian adolescents. Paediatr Indones. 2010;50:300-4.
20. Dwivedi GN, Sethi S, Singh R, Singh S. Association of blood pressure with body mass index and waist circumference in adolescents. Int J Contemp Pediatr. 2016;3:3971-6.
21. Xiao YQ, Liu Y, Zheng SL, Yang Y, Fan S, Yang C, et al. Relationship between hypertension and body mass index, waist circumference and waist-hip ratio in middle aged and elderly resident. Zhongua Liu Xing Bing Xue Za Zhi. 2016;37:1223–7.
22. Zhang YX, Wang SR. Comparison of blood pressure levels among children and adolescents with different body mass index and waist circumference: study in a large sample in Shandong, China. Eur J Nutr. 2014;53:627-34.