Diagnostic accuracy of anthropometric indices for discriminating elevated blood pressure in pediatric population: a systematic review and a meta-analysis

Background Childhood obesity is more likely to increase the chance of many adult health problems. Numerous studies have shown obese children to be more prone to elevated blood pressure (BP) and hypertension. It is important to identify an obesity anthropometric index with good discriminatory power for them in pediatric population. Methods MEDLINE/PubMed, Web of Science, and Cochrane databases were retrieved comprehensively for eligible studies on childhood obesity and hypertension/elevated BP through June 2021. The systematic review and meta-analysis of studies used receiver operating characteristics (ROC) curves for evaluating the discriminatory power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in distinguishing children with elevated BP and hypertension. Results 21 cross-sectional studies involving 177,943 children and 3–19 years of age were included in our study. Meta-analysis showed that the pooled area under the reporting receiver-operating characteristic curves (AUC) and 95% confidence intervals (CIs) for BMI, WC, and WHtR to detect hypertension of boys were 0.68 (0.64, 0.72), 0.69 (0.64, 0.74), 0.67 (0.63, 0.71), for elevated BP, the pooled AUCs and 95% CIs were 0.67 (0.61, 0.73), 0.65 (0.58, 0.73), 0.65 (0.61, 0.71). The pooled AUCs and 95% CIs for BMI, WC and WHtR of predicting hypertension were 0.70 (0.66, 0.75), 0.69 (0.64, 0.75), 0.67 (0.63, 0.72) in girls, the pooled AUCs and 95% CIs of predicting elevated BP were 0.63 (0.61, 0.65), 0.62 (0.60, 0.65), 0.62 (0.60, 0.64) respectively. There was no anthropometric index was statistically superior in identifying hypertension and elevated BP, however, the accuracy of BMI predicting hypertension was significantly higher than elevated BP in girls (P < 0.05). The subgroup analysis for the comparison of BMI, WC and WHtR was performed, no significant difference in predicting hypertension and elevated BP in pediatric population. Conclusions This systematic review showed that no anthropometric index was superior in identifying hypertension and elevated BP in pediatric population. While compared with predicting elevated BP, all the indicators showed superiority in predicting hypertension in children, the difference was especially obvious in girls. A better anthropometric index should be explored to predict children’s early blood pressure abnormalities.

The Threshold of Visceral Adipose Tissue Areas Measured With QCT On Cardiometabolic Risk Factors In A Nationwide Study In China

Background: Abdominal adiposity is associated with increased cardiometabolic risk and visceral adipose tissue (VAT) area obtained from computed tomography (CT) is a key anthropometric index. The present study investigated the VAT criteria on cardiometabolic risk factors in a large-scale nationwide Chinese population.Method: A total of 21,772 adults who underwent a low dose chest CT (LDCT) for lung cancer screening at one of 13 health checkup centers throughout China and had complete ancillary health records were evaluated. Abdominal VAT area at the center of L2 vertebra was measured with Mindways quantitative CT software using the existing LDCT dataset. Relevant anthropometric, serum and blood pressure measurements were obtained from the participants’ records. The VAT distribution of the LDCT cohort was age-adjusted using the Chinese national census. Results: The prevalence of metabolic syndrome based on the Chinese national guidelines was 29.5% and 10.5% in men and women respectively. Using ROC curves, the optimum threshold values for VAT area to identify metabolic syndrome were 213 cm2 in men, and 136 cm2 in women. For participants with VAT area above threshold, the odds ratio (95% confidence interval) for metabolic syndrome was 6.15 (5.65, 6.69) and 9.25 (7.58, 11.4) for men and women respectively. A further analysis of population attributable risk showed that VAT above threshold was significantly associated with an increased risk for metabolic syndrome.Conclusion: In this large-scale nationwide population of China, sex-specific threshold values for VAT area measured by CT were established to identify the risk of metabolic syndrome. VAT area is a key anthropometric index of interventions to control cardiometabolic risk.

How Well Does Body Mass Index (BMI) Predict Undiagnosed Hypertension and Diabetes in Indonesian Adults Community Population?

BACKGROUND: Previous studies have reported that Body Mass Index (BMI) cut-off was related to non-communicable diseases. This study aimed to give the latest evidence related to the accuracy of BMI cut-off towards undiagnosed hypertension and diabetes in the Indonesian population. METHODS: This was A cross-sectional study that involved data of the 2018 national population-based health survey, with the samples were 15,516 male and female populations aged between 19 years old and above. This study only included those claimed to have never been diagnosed as suffering from diabetes and hypertension by health workers. Receiver operating characteristic (ROC) analysis was conducted to assess the optimal BMI cut-off. The logistic regression was performed to assess the association of BMI on undiagnosed hypertension and diabetes controlled by several variables. RESULTS: The average BMI sample was 24 kg/m2 (SD = 4.6 kg/m2. The proportion of undiagnosed hypertension was 36.9%, and 12.3% for the proportion of undiagnosed diabetes. According to the ROC, the result shows BMI was more sensitive to hypertension conditions compared to diabetes. BMI cut-off points at 23.9 kg/m2 (AUC=0.59;Se=64.3%;Sp=53.4%) was the optimum value to predict hypertension and 24.9 kg/m2 (AUC=0.55;Se=53.1%;Sp=56.4%) was the optimum for diabetes. CONCLUSIONS: Based on the optimal AUC cut-off points for BMI which is around 0.5, BMI needs to be reconsidered as an anthropometric index in predicting undiagnosed hypertension and diabetes. And an assessment can be made using other anthropometric indices, such as waist circumference to predict undiagnosed hypertension and diabetes.

Diagnostic Accuracy of Anthropometric Indices for Discriminating Elevated Blood Pressure in Pediatric Population: A Systematic Review and a Meta-Analysis

Background: Childhood obesity is more likely to increase the chance of many adult health problems. Numerous studies have shown obese children to be more prone to elevated blood pressure (BP) and hypertension. It is important to identify an obesity anthropometric index with good discriminatory power for them in pediatric population.Methods: MEDLINE/PubMed, Web of Science, and Cochrane databases were retrieved comprehensively for eligible studies on childhood obesity and hypertension/elevated BP through June 2021. The systematic review and meta-analysis of studies used receiver operating characteristics (ROC) curves for evaluating the discriminatory power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in distinguishing children with elevated BP and hypertension. Results: 21 cross-sectional studies involving 177,943 children and 3–19 years of age were included in our study. Meta-analysis showed that the pooled area under the reporting receiver-operating characteristic curves (AUC) and 95% confidence intervals (CIs) for BMI, WC, and WHtR to detect hypertension of boys were 0.68 (0.64, 0.72), 0.69 (0.64, 0.74), 0.67 (0.63, 0.71), for elevated BP, the pooled AUCs and 95% CIs were 0.67 (0.61, 0.73), 0.65 (0.58, 0.73), 0.65 (0.61, 0.71). The pooled AUCs and 95% CIs for BMI, WC and WHtR of predicting hypertension were 0.70 (0.66, 0.75), 0.69 (0.64, 0.75), 0.67 (0.63, 0.72) in girls, the pooled AUCs and 95% CIs of predicting elevated BP were 0.63 (0.61, 0.65), 0.62 (0.60, 0.65), 0.62 (0.60, 0.64) respectively. There was no anthropometric index was statistically superior in identifying hypertension and elevated BP, however, the accuracy of BMI predicting hypertension was significantly higher than elevated BP in girls (P< 0.05). The subgroup analysis for the comparison of BMI, WC and WHtR was performed, no significant difference in predicting hypertension and elevated BP in pediatric population. Conclusions: This systematic review showed that no anthropometric index was superior in identifying hypertension and elevated BP in pediatric population. while compared with predicting elevated BP, all the indicators showed superiority in predicting hypertension in children, the difference was especially obvious in girls. A better anthropometric index should be explored to predict children’s early blood pressure abnormalities.

Positive and negative likelihood ratios of two anthropometric indices (Waist/Height Index and Waist/Hip Index) in the diagnosis of pathological nutritional situations overweight and obesity

Background and objective. Koch et al., reported that the Waist/Hip Index more accurately predicts cardiovascular risk factors and mortality. Huaman et al., reported that the Waist/Height Index can be used as a diagnostic test for metabolic syndrome, since it has a high significant value. To determine whether two anthropometric indices have sufficient prognostic efficiency or moderate prognostic efficiency by combining sensitivity and specificity using positive and negative likelihood ratios in a single expression. Material and methods. Quantitative epistemological approach. Descriptive observational epidemiological study without directionality and with prospective temporality. Three husband adult patients of both genders who attended the Integral Hospital "Jose Maria Morelos" were studied. As a reference test or Gold Standard was used the Lorentz Equation as a reference test. Results. The results for the positive likelihood ratios corresponded to 13.41 and 1.72 for the anthropometric indices Waist/Height Index and Waist/Hip Index, respectively. The results for the negative likelihood ratios corresponded, respectively, to 0.07 and 0.48 for the anthropometric indices Waist/Height Index and Waist/Hip Index. Conclusions. The best anthropometric index for the diagnosis of overweight and obesity pathological nutritional situations corresponds to the Waist/Height Index, since the results of the positive and negative likelihood ratios report sufficient prognostic efficiencies. On the other hand, the results of the positive and negative likelihood ratios report, respectively, negligible prognostic efficiency and poor prognostic efficiency for the Waist/Hip Index.

Estimated visceral adiposity is associated with risk of cardiometabolic conditions in a population based study

Visceral adiposity is a major risk factor of cardiometabolic diseases. Visceral adipose tissue (VAT) is usually measured with expensive imaging techniques which present financial and practical challenges to population-based studies. We assessed whether cardiometabolic conditions were associated with VAT by using a new and easily measurable anthropometric index previously published and validated. Data (1529 participants) came from the European Health Examination Survey in Luxembourg (2013–2015). Logistic regressions were used to study associations between VAT and cardiometabolic conditions. We observed an increased risk of all conditions associated with VAT. The total adjusted odds ratio (AOR, [95% CI]) for hypertension, prediabetes/diabetes, hypercholesterolemia, and hypertriglyceridemia for the fourth quartile of VAT compared to the lowest were (10.67 [6.95, 16.39]), (6.14 [4.14, 9.10]), (6.03 [3.97, 9.16]) and (9.18 [5.97, 14.12]). We observed higher odds in women than in men for all outcomes with the exception of hypertension. Future studies should investigate the impact of VAT changes on cardiometabolic health and the use of anthropometrically predicted VAT as an accurate outcome when no biomedical imaging is available.

Implementation of the Simple Multi Attribute Rating Technique Method (SMART) in Determining Toddler Growth

Toddler nutritional status is an important factor in efforts to reduce child mortality. The development of community nutrition can be monitored through the results of recording and reporting of community nutrition improvement programs reflected in the results of weighing infants and toddlers every month at the Pos Pelayanan Terpadu (Posyandu/ Integrated Service Post) , where these efforts aim to maintain and improve health and prevent and cope with the emergence of public health problems, especially aimed at toddlers. However, in carrying out the health service activities of Medical Officers, faced with an important problem that is still difficult in providing information related to the results of monitoring the growth and development of infants, because information on growth and development of infants owned is obtained from the data collection done manually such as; make records and calculations to find out the condition of a toddler declared good, less, or bad. Implementation of the SMART method in Toddler's growth and development, this method can be used based on the weights and criteria that have been determined. The criteria used are based on the Anthropometric index assessment criteria. The results of the analysis are the results of ranking the greatest value to be used as the material in the decision-making process.