comparison of some cardiometabolic risk factors in peri-urban adolescent school learners in mthatha,...
DESCRIPTION
Prevalence of hypertension in adolescents Hypertension. 2013; 62: Children whose BMI or WC were in the top 25% for their age group were about twice as likely to have elevated blood pressure as children with measurements in the bottom 25%. African-American children had a 28% higher risk of elevated blood pressure than CaucasiansTRANSCRIPT
Comparison of some cardiometabolic risk factors in peri-urban adolescent school
learners in mthatha, South Africa.
Presented by
BN Nkeh-Chungag
Cardiometabolic risk factors in adolescents
• There is no universal consensus on the definition of cardiometabolic risk factors in children• The International Diabetes Federation attempted to standardize the definition
of these risk factors however the National Cholesterol Education Program and Adult Treatment Panel III (NCEP-ATP III) covers children better• Hypertension is an important risk factor which tends to be neglected in
children and adolescents• Described by African Union as Africa’s second challenge only after AIDS
Prevalence of hypertension in adolescents
Hypertension. 2013; 62: 247-254
• Children whose BMI or WC were in the top 25% for their age group were about twice as likely to have elevated blood pressure as children with measurements in the bottom 25%.• African-American children had a 28% higher risk of elevated
blood pressure than Caucasians
• Were low HT rates due to low prevalence or poor diagnostic methods?
• The use of percentiles for age, sex and height has been a challenge• However there is a trend for higher HT prevalence rates in South
African children
Hypertension in South African adolescents
http://www.hypertension.org.za/monthly-theme/hypertension-in-adolescents-the-race-against-time
http://www.health24.com/Diet-and-nutrition/Weight-loss/Obesity-are-our-children-doomed-20130725
South African Demographic and Health Survey 2004.
www.gov.za/documents/download.php?f=90139
Prevalence of hypertension in rural South African children – 2005
Ellisras study. Monyeki et al, 2005. International Journal of Epidemiology. 2006;35:114–120
Prevalence of hypertension in rural South African children/adolescents – 2012
Limpopo locations. Moselakgomo et al 2012, Rev Paul Pediatr. 30:562-9
• In the current study we investigated the risk factors for cardiometabolic diseases in a peri-urban adolescent population.
Cohort Females Males
N 410 283 127
Age 15±0.07 15±0.08 15.3±0.1
Weight 64±0.8 65±0.9 62.4±1.4
Height 161±0.4 159±0.4 166.2±0.8*
BMI 25±0.3 26±0.4* 22.5±0.5
WC 77±0.6 79±0.7* 73.8±1
HC 98±0.7 101±10.8* 91±1
Demographic and general information on participants
Males Females
Total Lean OW/OB Total Lean OW/OB
N 127 97 30 283 137 146
MSBP 121.9±1 120±1.3 125.6±1.7* 118±0.6 114.6±1.1 120.3±0.9*
MDBP 72±0.7 71.3±1 74.7±1.3* 72±1.4 70.9±0.8 72.9±0.5*
Note: Total = all males or females, lean= BMI<85th percentile for age and gender; - overweigh/obese (OW/OB)= BMI ≥85th
percentile, BMI- Body mass index, *p<0.05.
Blood pressure by gender and body size
Prevalence of hypertension in adolescents
Hypertension Pre-hypertension Normotensive
Whole cohort (n=391) 83 (21.2%) 48 (12.3%) 260 (66.5%)
Males (n=118) 26 (22.0%) 16 (13.6%) 76 (64.4%)
Females (n=273) 57 (20.9%) 32 (11.7%) 184 (73.4%)
Lean (BMI<85th %) (n=224) 37 (16.5%) 25 (11.1%) 162 (72.3%)
Overweight (BMI≥85th <95th %) (n=84 ) 25 (29.8%) 13 (15.5%) 46 (54.7%)
Obese (BMI≥95th %) (n=78) 13 (16.7%) 16 (20.5%) 49 (62.8%)
Female Male P-valueBMI 25.7±0.3 22.6±0.4 0.001SBP 118.5±0.7 122.1±1 0.003DBP 71.9±0.5 71.8±0.8 0.82Triglycerides 0.77±0.02 0.8±0.03 0.48HDL 1.56±0.02 1.34±0.03 0.001Glucose 4.6±0.04 0.47±0.06 0.13
Risk factors for metabolic syndrome
Number of risk factors for metabolic syndrome
Lean Participants Obese participant
Three or morerisk factors
10 43
Two risk factors 32 59
One risk factor 75 47
No risk factor 101 0
Risk factors or metabolic syndrome in lean vs obese
Metabolic syndrome was defined by the NCEP with modification, Silveira et al, 2013
Cohort Females MalesNumber (n/%) 370 257 (69.5%) 113 (30.5%)Overweight/Obese 112 (30.3%) 94 28 Metabolic Syndrome 53 (14.3%) 33 (12.8%)# 20 (17.7%)#Two risk factors 92 69 24One risk factor 122 86 36No risk factor 103 68 34
Prevalence of the metabolic syndrome
Metabolic syndrome was defined by the NCEP with modification, Silveira et al, 2013
Hs-CRP and Adiponectin levels Cohort
Participant with metabolic syndrome
Without metabolic syndrome
P-value
HS-CRP 2.02 ±0.41 1.72±0.17 0.51Adiponectin 14.33±2.5 16.83±0.9 0.36
Participant with metabolic syndromeFemales Males P-value
Hs-CRP 1.67±0.31 2.68±1.7 0.30Adiponectin 14.5±2.3 13.5±10.8 0.81
Influence of BMI on CVD markersBMI > 5th < 85th % BMI > 85th % p-value
hs-CRP (mg/l) 1.44±0.16 2.42±0.3 0.002**Adiponectin (µg/ml) 17.4±1.8 14.7±1.2 0.16
Influence of WC on CVD markersWC ≤ 80 cm WC > 80 cm p-value
hs-CRP (mg/l) 1.4±0.2 2.8±0.4 0.0001Adiponectin (µg/ml) 17.2±1.1 14.9±1.3 0.2*
Body size effect on CVD markers
Lean Overweight/Obese
P-value
TCh/HDL 2.67±0.05 2.95±0.07 0.001LDL/HDL 1.65±0.13 1.71±0.56 0.71 TRIG/HDL 0.53±0.19 0.58±0.03 0.08
Atherosclerosis indices
TChol/HDL LDL/HDL TGL/HDL
MDBP R 0.038 0.039 0.087
95% CI -0.202 -
0.274
-0.201-0.275 -0.154 -
0.319
p-value 0.751 0.741 0.467
MSBP R 0.232 0.248 0.167
95% CI -0.066 -
0.446
0.0106-0.459 0.074 - 0.390
p-value 0.049 * 0.036* 0.160
hs-CRP R 0.266 0.277 0.039
95% CI 0.030 - 0.483 0.041-0.483 -0.201- 0.275
p-value 0.023* 0.019* 0.74
Pearson correlations between various atherosclerosis indices with BP and Hs-CRP
TChol/HDL LDL/HDL TGL/HDL
MDBP R 0.038 0.039 0.087
95% CI -0.202 - 0.274 -0.201-0.275 -0.154 - 0.319
p-value 0.751 0.741 0.467
MSBP R 0.232 0.248 0.167
95% CI -0.066 - 0.446 0.0106-0.459 0.074 - 0.390
p-value 0.049 * 0.036* 0.160
hs-CRP R 0.266 0.277 0.039
95% CI 0.030 - 0.483 0.041-0.483 -0.201- 0.275
p-value 0.023* 0.019* 0.74
Conclusion• Cardiometabolic risk factors were greater in overweight/obese adolescents• Cardiometabolic risks were greater in males than in females• Hs-CRP was significiantly increased in adolescents with higher BMI• Adiponectin levels were significantly decreased in
overweight /obese adolescents
Thank you