Obesity and Metabolic Syndrome as Risk Factors for Hypertension in Children

Öz

Hypertension (HT) is an increasingly important health problem in children. Changes in environmental and social factors in the last 20 years, less physical activity, fast eating habits, obesity and metabolic syndrome directly affect the development of HT. The aim of our study is to determine whether the prevalence of obesity and metabolic syndrome has increased over the years in children followed up with a diagnosis of HT over a period of 18 years. Between January 2001 and December 2018, 377 patients who were admitted to the Pediatric Nephrology Outpatient Clinic due to HT and diagnosed with HT were evaluated retrospectively. The patients were divided into two groups, patients admitted between 2001-2009 (Group I) and patients admitted between 2010-2018 (Group II), and the two groups were compared in terms of obesity and metabolic syndrome. The mean age at presentation was 11.4±4.5 years. 64% of the patients were male. The patients in Group 2 had higher age, BMI, metabolic syndrome and family history of hypertension than Group 1. There was no difference in obesity between the two groups (p>0.05). The results of our study showed that there has been an increase in the rate of both BMI and metabolic syndrome in patients followed up with a diagnosis of hypertension in recent years compared to 2009 and before. These changes are particularly pronounced in adolescents. Reducing sodium intake in children and adolescents and preventing obesity with lifestyle change recommendations constitute the first step in the prevention and treatment of HT development.

Anahtar Kelimeler

• child
• hypertension
• metabolic syndrome
• obesity

Çocuklarda Hipertansiyon Risk Faktörü Olarak Obezite ve Metabolik Sendrom

Öz

Hipertansiyon (HT), çocuklarda giderek artan önemli bir sağlık sorunudur. Son 20 yıl içinde çevresel ve sosyal faktörlerdeki değişiklikler, daha az fiziksel aktivite, hızlı beslenme alışkanlıkları, obezite ve metabolik sendrom, HT gelişimini doğrudan etkilemektedir. Çalışmamızın amacı, 18 yıllık bir süreçte HT tanısıyla izlenen çocuklarda yıllar içinde obezite ve metabolik sendrom sıklığının artıp artmadığını belirlemektir. Ocak 2001-Aralık 2018 tarihleri arasında Çocuk Nefroloji Polikliniği’nde HT nedeni ile başvuran ve HT tanısı kesinleşen 377 hasta retrospektif olarak değerlendirildi. Hastalar, 2001-2009 döneminde başvuran hastalar (Grup I) ve 2010-2018 döneminde başvuran hastalar (Grup II) olmak üzere iki gruba ayrıldı ve iki grup obezite ve metabolik sendrom açısından karşılaştırıldı. Ortalama başvuru yaşı 11,4±4,5 yıldı. Hastaların %64’ü erkekti. Grup 2’deki hastaların yaş, VKİ, metabolik sendrom ve ailede hipertansiyon olma öyküsü Grup 1’den yüksekti. İki grup arasında obezite açısından fark yoktu (p>0,05). Çalışmamızın sonuçları, hipertansiyon tanısıyla izlediğimiz hastalarda son yıllarda 2009 ve öncesine göre hem VKİ’de hem de metabolik sendrom görülme oranında artış olduğunu göstermiştir. Bu değişiklikler, özellikle ergenlerde belirgindir. Çocuk ve ergenlerde sodyum alımının azaltılması ve yaşam tarzı değişikliği önerileriyle obezitenin önlenmesi, HT gelişiminin engellemesi ve tedavisinde ilk aşamayı oluşturur.

Anahtar Kelimeler

• çocuk
• hipertansiyon
• metabolik sendrom
• obezite

Kaynakça

1. 1. Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, et al. Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(12):1154-63.
2. 2. Sharma AK, Metzger DL, Rodd CJ. Prevalence and Severity of High Blood Pressure Among Children Based on the 2017 American Academy of Pediatrics Guidelines. JAMA Pediatr. 2018;172(6):557-65.
3. 3. Duzova A, Yalçinkaya F, Baskin E, Bakkaloglu A, Soylemezoglu O. Prevalence of hypertension and decreased glomerular filtration rate in obese children: results of a population-based field study. Nephrol Dial Transplant. 2013;28(4):iv166–71.
4. 4. Becton LJ, Shatat IF, Flynn JT. Hypertension and obesity: Epidemiology, mechanisms and clinical approach. Indian J Pediatr. 2012;79(8):1056-61.
5. 5. Flynn JT. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol. 2013;28(7):1059-66.
6. 6. Herouvi D, Karanasios E, Karayianni C, Karavanaki K. Cardiovascular disease in childhood: the role of obesity. Eur J Pediatr 2013;172(6):721–32.
7. 7. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627-42.
8. 8. Atay Z, Turan S, Guran T, Haliloglu B, Bereket A. The change in obesity prevalence in 8 year-interval in 6-16 years old girls living in Istanbul. Proceedings of XIV. National Pediatric Endocrinology Congress. P54, Sarigerme-Mugla 2010.

9. 9. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;14:555-76.
10. 10. Cole TJ, Bellizzi MC, Flegal MC, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240-3.
11. 11. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatrica. 2006;95(2):194-8.
12. 12. Barlow SE. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(suppl 4):S164-92.
13. 13. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet. 2007;369(9579):2059-61.
14. 14. Patton GC, Sawyer SM, Santelli JS, Ross JS, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423-78.
15. 15. Saner C, Simonetti GD, Wühl E, Mullis PE, Janner M. Increased ambulatory arterial stiffness index in obese children. Atherosclerosis. 2015;238(2):185-9.
16. 16. Flechtner-Mors M, Neuhauser H, Reinehr T, Roost HP, Wiegand S, Siegfried W, et al. Blood pressure in 57,915 pediatric patients who are overweight or obese based on five reference systems. Am J Cardiol. 2015;115:1587–94.
17. 17. Flechtner-Mors M, Thamm M, Wiegand S, Reinehr T, Schwab KO, Kiess W, et al. Comorbidities related toBMI category in children and adolescents: German/Austrian/Swiss Obesity Register APV compared to the German KiGGS Study. Horm Res Paediatr. 2012;77:19-26.
18. 18. Obrycki Ł, Feber J, Derezinski T, Lewandowska W, Kułaga Z, Litwin M. Hemodynamic patterns and target organ damage in adolescents with ambulatory prehypertension. Hypertension. 2020;75:826–34.
19. 19. Brambilla P, Antolini L, Street ME, Giussani M, Galbiati S, Valsecchi MG, et al. Adiponectin and hypertension in normal-weight and obese children. Am J Hypertens. 2013;26(2):257-64.
20. 20. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980±2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-81.
21. 21. van Dommelen P, Schonbeck Y, van Buuren S, HiraSing RA. Trends in a life threatening condition: morbid obesity in Dutch, Turkish and Moroccan children in The Netherlands. PLoS One. 2014;9(4):e94299.
22. 22. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmarker SL, Swinburn BA, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385(9986):2510–20.
23. 23. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627-42.
24. 24. Sun H, Ma Y, Han D, Pan CW, Xu Y. Prevalence and trends in obesity among China's children and adolescents, 1985-2010. PLoS One. 2014;9(8):e105469.
25. 25. Chiolero A, Bovet P, Paradis G, Paccaud F. Has blood pressure increased in children in response to the obesity epidemic? Pediatrics. 2007;119:544-53.
26. 26. Chiolero A, Paradis G, Madeleine G, Hanley JA, Paccaud F, Bovet P. Discordant secular trends in elevated blood pressure and obesity in children and adolescents in a rapidly developing country. Circulation. 2009;119:558–65.
27. 27. Khang YH, Lynch JW. Exploring determinants of secular decreases in childhood blood pressure and hypertension. Circulation. 2011;124:397-405.
28. 28. Hosseini F, Mousavi A, Mirmiran P, Ghanbarian A, Azizi F. Trends in risk factors for cardiovascular disease among Iranian adolescents: the Tehran Lipid and Glucose Study, 1999-2008. J Epidemiol. 2011;21:319-28.
29. 29. Shirasawa T, Ochiai H, Nishimura R, Morimoto A, Shimada N, Ohtsu T, et al. Secular trends in blood pressure among Japanese school children: a population-based annual survey from 1994 to 2010. J Epidemiol. 2012;22:448-53.
30. 30. Xi B, Zhang T, Zhang M, Liu F, Zong X, Zhao M, et al. Trends in Elevated Blood Pressure Among US Children and Adolescents: 1999-2012. Am J Hypertens. 2016;29:217–25.
31. 31. Dong Y, Ma J, Song Y, Ma Y, Dong B, Zou Z, et al. Secular trends in blood pressure and overweight and obesity in Chinese boys and girls aged 7 to 17 years from 1995 to 2014. Hypertension. 2018;72(2):298-305.
32. 32. Krawczyk M, Rumińska M, Witkowska-Sędek E, Majcher A, Pyrżak B. Usefulness of the triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) in prediction of metabolic syndrome in Polish obese children and adolescents. Acta Biochim Pol. 2018;65:605-11.
33. 33. Litwin M, Sladowska J, Antoniewicz J, Niemirska A, Wierzbicka, Daszkowska J, et al. Metabolic abnormalities, insulin resistance, and metabolic syndrome in children with primary hypertension. Am J Hypertens. 2007;20:875-82.
34. 34. Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Janas R, Wawer ZT, et al. Regression of target organ damage in children and adolescents with primary hypertension. Pediatr Nephrol. 2010;25:2489-99. 35. Ostrihoňová T, RimárováK, Bérešová J, Kontrošová S, Dorko E, Diabelková J. Prevalence and trends of metabolic syndrome in Slovakia during the period of 2003-2012. Cent Eur J Public Health. 2017;25:313-20.
35. 36. Mule G, Nardi E, Cottone S, Cusimano P, Volpe V, Piazza G, et al. Influence of metabolic syndrome on hypertension-related target organ damage. J Int Med. 2005;257(6):503-13.