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Trajectories of systolic blood pressure in children: risk factors and cardiometabolic correlates

Trajectories of systolic blood pressure in children: risk factors and cardiometabolic correlates
Trajectories of systolic blood pressure in children: risk factors and cardiometabolic correlates
Objective: to identify systolic blood pressure (SBP) percentile trajectories in children and to describe the early-life risk factors and cardiometabolic correlates of those trajectories.

Study design: using age-, sex-, and height-specific SBP percentiles based on the American Academy of Pediatrics reference, we examined SBP trajectories using latent class mixed models from ages 3 to 8 years (n = 844) from the Growing Up in Singapore Towards healthy Outcomes-study, a Singaporean mother–offspring cohort study. We analyzed associations between SBP trajectories and early-life risk factors using multinomial logistic regression and differences across trajectories in cardiometabolic outcomes using multiple linear regression.

Results: children were classified into 1 of 4 SBP percentile trajectories: “low increasing” (15%), “high stable” (47%), “high decreasing” (20%), and “low stable” (18%). Maternal hypertension during early pregnancy was a predictor of the “high stable” and “low increasing” SBP trajectories. Rapid child weight gain in the first 2 years of life was only associated with the “high stable” trajectory. Compared with children in the “low stable” trajectory, children in the “high stable” SBP trajectory had greater body mass index z scores, sum of skinfold thicknesses, waist circumference from ages 3 to 8 years, and abdominal adipose tissue (milliliters) at 4.5 years (adjusted mean difference [95% CI]: superficial and deep subcutaneous abdominal adipose tissue: 115.2 [48.1-182.3] and 85.5 [35.2-135.8]). Their fat mass (kilograms) (1.3 [0.6-2.0]), triglyceride levels (mmol/L) (0.10 [0.02-0.18]), and homeostasis model assessment of insulin resistance (0.28 [0.11 0.46]) at age 6 years were also greater but not their arterial thickness and stiffness.

Conclusions
Reducing maternal blood pressure during pregnancy and infant weight gain in the first 2 years of life might help to prevent the development of high SBP.
GUSTO, adiposity, latent class mixed model, maternal hypertension, rapid weight gain
0022-3476
86-94.e6
Yuan, Wen Lun
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Kramer, Michael S.
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Michael, Navin
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Sadananthan, Suresh
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Mya, Tint
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Chen, Ling-Wei
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Pang, Wei Wei
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Velan, Sendhil
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Godfrey, Keith
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Chong, Yap-Seng
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Chong, Mary Foong-Fong
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Choo, Jonathan TL
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Ling, L.H.
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Eriksson, Johan G.
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Lee, Yung Seng
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Yuan, Wen Lun
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Kramer, Michael S.
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Michael, Navin
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Sadananthan, Suresh
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Mya, Tint
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Chen, Ling-Wei
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Pang, Wei Wei
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Velan, Sendhil
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Godfrey, Keith
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Chong, Yap-Seng
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Chong, Mary Foong-Fong
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Choo, Jonathan TL
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Ling, L.H.
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Eriksson, Johan G.
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Lee, Yung Seng
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Yuan, Wen Lun, Kramer, Michael S., Michael, Navin, Sadananthan, Suresh, Mya, Tint, Chen, Ling-Wei, Pang, Wei Wei, Velan, Sendhil, Godfrey, Keith, Chong, Yap-Seng, Chong, Mary Foong-Fong, Choo, Jonathan TL, Ling, L.H., Eriksson, Johan G. and Lee, Yung Seng (2021) Trajectories of systolic blood pressure in children: risk factors and cardiometabolic correlates. Journal of Pediatrics, 236, 86-94.e6. (doi:10.1016/j.jpeds.2021.05.027).

Record type: Article

Abstract

Objective: to identify systolic blood pressure (SBP) percentile trajectories in children and to describe the early-life risk factors and cardiometabolic correlates of those trajectories.

Study design: using age-, sex-, and height-specific SBP percentiles based on the American Academy of Pediatrics reference, we examined SBP trajectories using latent class mixed models from ages 3 to 8 years (n = 844) from the Growing Up in Singapore Towards healthy Outcomes-study, a Singaporean mother–offspring cohort study. We analyzed associations between SBP trajectories and early-life risk factors using multinomial logistic regression and differences across trajectories in cardiometabolic outcomes using multiple linear regression.

Results: children were classified into 1 of 4 SBP percentile trajectories: “low increasing” (15%), “high stable” (47%), “high decreasing” (20%), and “low stable” (18%). Maternal hypertension during early pregnancy was a predictor of the “high stable” and “low increasing” SBP trajectories. Rapid child weight gain in the first 2 years of life was only associated with the “high stable” trajectory. Compared with children in the “low stable” trajectory, children in the “high stable” SBP trajectory had greater body mass index z scores, sum of skinfold thicknesses, waist circumference from ages 3 to 8 years, and abdominal adipose tissue (milliliters) at 4.5 years (adjusted mean difference [95% CI]: superficial and deep subcutaneous abdominal adipose tissue: 115.2 [48.1-182.3] and 85.5 [35.2-135.8]). Their fat mass (kilograms) (1.3 [0.6-2.0]), triglyceride levels (mmol/L) (0.10 [0.02-0.18]), and homeostasis model assessment of insulin resistance (0.28 [0.11 0.46]) at age 6 years were also greater but not their arterial thickness and stiffness.

Conclusions
Reducing maternal blood pressure during pregnancy and infant weight gain in the first 2 years of life might help to prevent the development of high SBP.

Text
BP_traj_YWL_manuscript_Vf_Jpeds_140421 - Accepted Manuscript
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Accepted/In Press date: 11 May 2021
e-pub ahead of print date: 18 May 2021
Published date: September 2021
Additional Information: Funding Information: Supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC) [Singapore - NMRC/TCR/004-NUS/2008, NMRC/TCR/012-NUHS/2014]; the Singapore Institute for Clinical Sciences , Agency for Science, Technology and Research (A∗STAR), Singapore; the UK Medical Research Council ( MC_UU_12011/4 [to K.G.]); the National Institute for Health Research ( NF-SI-0515-10042 [to K.G.]); and Programme Early Nutrition eAcademy Southeast Asia ( 573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP [to K.G.]). The funder/sponsor did not participate in the work. K.G. received reimbursement for speaking at conferences sponsored by companies selling nutritional products, and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, and Danone. The other authors declare no conflicts of interest. Appendix 1 Appendix 2 Funding Information: Supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC) [Singapore - NMRC/TCR/004-NUS/2008, NMRC/TCR/012-NUHS/2014]; the Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A?STAR), Singapore; the UK Medical Research Council (MC_UU_12011/4 [to K.G.]); the National Institute for Health Research (NF-SI-0515-10042 [to K.G.]); and Programme Early Nutrition eAcademy Southeast Asia (573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP [to K.G.]). The funder/sponsor did not participate in the work. K.G. received reimbursement for speaking at conferences sponsored by companies selling nutritional products, and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, and Danone. The other authors declare no conflicts of interest. Funding and conflicts of interest information available at www.jpeds.com. Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: GUSTO, adiposity, latent class mixed model, maternal hypertension, rapid weight gain

Identifiers

Local EPrints ID: 450137
URI: http://eprints.soton.ac.uk/id/eprint/450137
ISSN: 0022-3476
PURE UUID: 30a92029-9740-491e-b93b-8b2bc56a40df
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

Catalogue record

Date deposited: 13 Jul 2021 16:31
Last modified: 26 Nov 2021 02:35

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Contributors

Author: Wen Lun Yuan
Author: Michael S. Kramer
Author: Navin Michael
Author: Suresh Sadananthan
Author: Tint Mya
Author: Ling-Wei Chen
Author: Wei Wei Pang
Author: Sendhil Velan
Author: Keith Godfrey ORCID iD
Author: Yap-Seng Chong
Author: Mary Foong-Fong Chong
Author: Jonathan TL Choo
Author: L.H. Ling
Author: Johan G. Eriksson
Author: Yung Seng Lee

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