|Year : 2018 | Volume
| Issue : 3 | Page : 187-190
Relationship between body mass index and blood pressure in school students
Sunil Kumar Jena1, Madhuchhanda Pattnaik2
1 Department of Physiology, VIMSAR, Burla, Odisha, India
2 Department of Physiology, SCB Medical College, Cuttack, Odisha, India
|Date of Web Publication||17-Jul-2018|
Department of Physiology, SCB Medical College, Cuttack, Odisha
Source of Support: None, Conflict of Interest: None
Background: Children of school age group in developing countries are facing the problem of overweight and obesity because of lifestyle change, playing video games, watching television as well as consuming energy rich diet. Childhood obesity continues as obesity in adulthood. The chance of high blood pressure (BP) in overweight and obese children is more than healthy weight children. Objectives: (i) Effect of body mass index (BMI) on BP. (ii) Association of overweight and obesity with hypertension (HTN). Materials and Methods: This study included 580 students of age group 6–12 years of both boys and girls. All students were from English medium school. Measurement of height and weight was done by standard procedure. BMI was calculated by weight and height. BP measurement was done by auscultatory method. Statistical analysis was done by SPSS 16. Results: Overweight and obesity were more in boys than girls. There was significantly more BP in overweight and obese participants than healthy weight individuals. There was positive correlation between BMI and BP both systolic and diastolic BP. Prevalence of HTN in boys is more than the girls. Odds ratio suggested that overweight and obesity was associated with HTN. Conclusion: This study concludes that overweight and obese school students were prone to develop elevated BP and HTN and hence were prone to cardiovascular risk.
Keywords: Hypertension, obesity, overweight, school students
|How to cite this article:|
Jena SK, Pattnaik M. Relationship between body mass index and blood pressure in school students. CHRISMED J Health Res 2018;5:187-90
|How to cite this URL:|
Jena SK, Pattnaik M. Relationship between body mass index and blood pressure in school students. CHRISMED J Health Res [serial online] 2018 [cited 2020 Aug 7];5:187-90. Available from: http://www.cjhr.org/text.asp?2018/5/3/187/236884
| Introduction|| |
Previously, obesity was considered as a problem of the affluent countries. But nowadays, this problem spreads to developing countries in the world. Various studies have reported that the prevalence of overweight among adolescents varies from 10% to 30%. Differences in the lifestyle, dietary pattern, and physical activities are the principal contributors of overweight and obesity, responsible for variation in prevalence within the country. Nearly 50%–80% of obese children continue as obese in adulthood. The prevalence of hypertension (HTN) varies from 3.8% to 24.8% in youth with overweight and obesity. Children with obesity and HTN may be accompanied by additional cardiometabolic risk factors such as dyslipidemia and disordered glucose metabolism,, which may contribute their effects on BP or may represent comorbid conditions arising from the same adverse lifestyle behaviors., Some researchers suggested, that the presence of multiple risk factors along with obesity and HTN increases the cardiovascular (CV) risk to great extent than by the individual risk factor alone. Although this phenomenon has been hard to demonstrate definitively, the strong heart study did show that American-Indian adolescents with multiple cardiometabolic risk factors had a higher prevalence of left ventricular hypertrophy, left atrial dilation and reduced left ventricular systolic and diastolic function compared with those without multiple cardiometabolic risk factors. With this background, this study was proposed find the effect of body mass effect on blood pressure (BP) in school going children. Students of today are the future of the nation and a healthy child is always a supportive hand to nation. Therefore, we the parents are responsible to provide a healthy life to our children and a wealthy nation.
| Materials and Methods|| |
The proposed study was conducted in physiology department of an educational health institution in Eastern India. This cross-sectional study was completed between January 2016 and December 2016 after getting approval by the Institutional Ethical Committee. This study was a school based study and the students selected for this study were from English medium schools. Totally 580 school students including both boys and girls of age group 6–12 years were selected. All were apparently healthy. Screening was done by face-to-face interview and general examination to select the students. Those were suffering from any systemic disease were excluded from the study. Informed written consent was taken from their parents as well as all the students participated in study were agreed for this study.
Measurement of height was done by a measuring tape with bare foot to nearest 0.5 cm. Weight was measured by an analog weighing machine to nearest 0.5 kg. The weighing machine was standardized by a 10 kg weight. Body mass index (BMI) was calculated as weight in kilometer divided by height in m 2 (BMI = Kg/m 2). Recording of BP was done between 8 am and 9 am by auscultatory method using Elko meter sphygmomanometer. Recording of BP was done in the sitting position, back supported, feet rest on floor and uncrossed, in the right arm and 5-min rest. Appropriate cuff size was used to record BP, i.e., length should be 80%–100% and width at least 40% of arm circumference. First and fifth Korotkoff sound was considered for systolic BP (SBP) and diastolic BP (DBP), respectively.
Students were classified into four groups based on BMI percentiles specific to age and sex  as shown in [Table 1]. BP categories were classified based on specific to age, sex, and height percentile  as shown in [Table 2].
Analysis of data was done by statistical software SPSS (Statistical Package for the Social Sciences, IBM Corporation, Armonk, New York) version 16. Statistical tests implemented were one way ANOVA, Pearson correlation, and Odd's ratio. P < 0.05 was considered to be statistically significant. Generation of tables and graphs were done by Microsoft word and Excel.
| Results|| |
[Table 3] shows frequency distribution of students in different group of weight status. Nearly 20% boys and 17.14% girls were overweight, respectively; over all overweight, among all students was 18.79%. Similarly, 23.88% boys and 11.42% girls were obese respectively, over all obesity among all students was 18.62%. This data suggested that the prevalence of overweight and obesity is more in boys than girls in this study. [Table 4] shows the variation of SBP and DBP among different study group of boys. There was gradual increase in SBP as well as DBP with respect to increasing weight status. The rise in SBP was at significant level where as that of DBP was not significant. [Table 5] shows the variation of SBP and DBP among different study group of girls. There was gradual increase in SBP as well as DBP with respect to increasing weight status. The rise in SBP and DBP is at significant level. [Table 6] shows the correlation between BMI and BP. In boys, there was a significant positive correlation between SBP and BMI and also DBP and BMI. However, in girls, there was a significant positive correlation between DBP and BMI, the correlation between SBP and BMI was negative but not significant. [Table 7] shows the prevalence of HTN among overweight and obese subjects. In boys, HTN prevalence was 7.84% where as in girls 4.47% and among all overweight and obese students it was 6.45%. [Table 8] shows the association between overweight obesity and HTN. Odds ratio 8.27 suggested that HTN was associated with overweight and obesity students at significant level.
|Table 3: Frequency distribution of students in different groups of weight status|
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| Discussion|| |
This study was a school-based study and planned to include the students of different English medium school in Western Odisha, India. This study suggested that 18.79% students were overweight and 18.62% were obese which is higher in comparison to the study by Jain et al. in 2016 in Rajasthan shown their study 12.5% overweight and 5.6% obese. This result is also higher in comparison to the study on school children in 2000 by Kapil et al. in Delhi, India where the overall prevalence of obesity was 7.4%. In this study, overweight and obesity are more in boys than girls, and similar result was found by Goyal et al. in 2010 in the city Ahmadabad.
This study reported that overweight and obese subjects both in boys and girls experience more BP (both SBP and DBP) in comparison to healthy weight individuals. The findings of this study was similar with the data in standard guideline of updated 4th report for screening and management of high BP in children and adolescents.
This study suggested that there was a positive correlation between BMI with SBP and DBP in boys; but in girls, BMI was positive correlation with SBP, but negative correlation with DBP though negative correlation is not significant. If this nonsignificant negative correlation is ignored, overall, there was positive correlation between BMI with SBP and DBP. Our report is agreed with Also et al., they reported a significant correlation between BMI with SBP and DBP in both sex in primary school children of Nigeria. Significant positive correlation between BMI and BP (both SBP and DBP) has also been suggested by other studies by Taksande et al. and Raj et al., Analysis the data with implementation of odds ratio, our study suggested that overweight and obesity were associated with HTN. Berkey et al. in their study suggested that greater BMI in adolescence is associated with elevated BP. Sorof and Daniels confirmed that obesity has become an increasingly important medical problem in children and adolescents. They suggested that obese children are at a 3-fold higher risk for development of HTN than nonobese children. This study reported that the hypertensive students were in the overweight and obese category. None of the underweight and healthy weight students had HTN. The prevalence of HTN among overweight and obese subjects was 7.84% and 4.47% in boys and girls, respectively and overall 6.45%. The prevalence of HTN among overweight and obese students is within the range as reported in updated 4th report for screening and management of high BP in children and adolescents. In our study, we found HTN in students of older age group which is similar to the report suggested by Mahyar et al. and Einterz et al., However, this finding contradicts the finding of Chiolero et al. where higher prevalence of HTN was found among younger children. In obesity, there is abnormal renal tubular dysfunction in which tubular reabsorption of sodium is increased which is responsible for the expansion of extracellular fluid volume, blood volume and hence BP. Also in obesity, there is activation of the sympathetic nervous system, renin-angiotensin-aldosterone system. Thus, all these mechanisms contribute to high BP in overweight and obese participants.
| Conclusion|| |
Nowadays, because of various abnormal habits and behavior, the children of school age group are getting overweight and obese. Overweight and obesity contributes to elevated BP and development of HTN in some of them. Thus, there is the chance that overweight and obese students are more prone to CV risk. Hence, all parents should be very careful for the healthy life of their children.
For the evaluation of prevalence, a larger group of students is more appropriate. Socioeconomic status of the parents is lacking here which is a contributing factor of overweight and obesity. Dietary habit of the students may be considered for overweight and obesity. Further study may be done considering all these aspects for a better output.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Jain A, Jain A, Pankaj JP, Sharma BN, Paliwal A. The study of obesity among children aged 5-18 years in Jaipur, Rajasthan. Muller J Med Sci Res 2016;7:125-30. [Full text]
Kotian MS, Kumar SG, Kotian SS. Prevalence and determinants of overweight and obesity among adolescent school children of South Karnataka, India. Indian J Community Med 2010;35:176-8.
] [Full text]
Styne DM. Childhood and adolescent obesity. Prevalence and significance. Pediatr Clin North Am 2001;48:823-54, vii.
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al.
Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140. pii: e20173035.
Yip J, Facchini FS, Reaven GM. Resistance to insulin-mediated glucose disposal as a predictor of cardiovascular disease. J Clin Endocrinol Metab 1998;83:2773-6.
Kashyap SR, Defronzo RA. The insulin resistance syndrome: Physiological considerations. Diab Vasc Dis Res 2007;4:13-9.
Zhang T, Zhang H, Li S, Li Y, Liu Y, Fernandez C, et al.
Impact of adiposity on incident hypertension is modified by insulin resistance in adults: Longitudinal observation from the Bogalusa Heart Study. Hypertension 2016;67:56-62.
Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, et al.
Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents. Hypertension 2008;51:635-41.
Chinali M, de Simone G, Roman MJ, Best LG, Lee ET, Russell M, et al.
Cardiac markers of pre-clinical disease in adolescents with the metabolic syndrome: The strong heart study. J Am Coll Cardiol 2008;52:932-8.
Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatr 2002;39:449-52.
Goyal RK, Shah VN, Saboo BD, Phatak SR, Shah NN, Gohel MC, et al.
Prevalence of overweight and obesity in Indian adolescent school going children: Its relationship with socioeconomic status and associated lifestyle factors. J Assoc Physicians India 2010;58:151-8.
Also U, Asani M, Ibrahim M. Prevalence of elevated blood pressure among primary school children in Kano Metropolis, Nigeria. Niger J Cardiol 2016;13:57-61.
Taksande A, Chaturvedi P, Vilhekar K, Jain M. Distribution of blood pressure in school going children in rural area of Wardha District, Maharashtra, India. Ann Pediatr Card 2008;1:101-6.
] [Full text]
Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: Time trends and relationship with hypertension. Natl Med J India 2007;20:288-93.
Berkey CS, Gardner J, Colditz GA. Blood pressure in adolescence and early adulthood related to obesity and birth size. Obes Res 1998;6:187-95.
Sorof J, Daniels S. Obesity hypertension in children: A problem of epidemic proportions. Hypertension 2002;40:441-7.
Mahyar A, Ebrahemi M, Shahsavari A, Rahmani Y. Blood pressure of primary-school children of Eghbalieh city, Islamic Republic of Iran. East Mediterr Health J 2009;15:1449-54.
Einterz EM, Hutchinson T, Flegel K. Survey of blood pressure in Nigerian children. Trop Doct 1982;12:172-5.
Chiolero A, Madeleine G, Gabriel A, Burnier M, Paccaud F, Bovet P, et al.
Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing country. J Hum Hypertens 2007;21:120-7.
Nanawarel NL, Gavkare AM, Surdi AD. Study of Correlation of Body Mass Index (BMI) with blood pressure in school going children and adolescents. Int J Recent Trends Sci Technol 2011;1:20-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]