Abstract
Abstract
The aim of this study was to estimate the relationship between body mass index (BMI) and blood pressure (BP) in a Chinese population with 26 year follow-up. The study included 4211 schoolchildren aged 6–17 years in Hanzhong, Shaanxi Province, China. Body weight, height, waist circumference, and BP were measured in 1987, 1989, 1992, 1995 and 2013. Cox proportional hazards model were fitted to examine the effect of BMI on BP. At the 26 year follow-up, 6.93% of male and 3.43% of female subjects had high SBP, and 12.8% of male and 4.56% of female had high DBP. The average age of subjects with high SBP was 40.3 years in males and 41.4 years in females; while the average age with high DBP was 38.1 years in males and 38.9 years in females. Obese subjects were 2.96 times and 2.88 times more likely to have high SBP and high DBP than normal weight counterparts, respectively; while overweight subjects were 1.81 times and 2.03 times more likely to have high SBP and high DBP, respectively. These findings underscore the urgent need to prevent increasing body weight. Targeting intervention in adolescence may be a critical method for preventing high BP in later life.
Introduction
Hypertension remains a major public health problem. In the past few decades, several studies have provided ample evidence that hypertension in adults has its onset in childhood, resulting in increasing concern with monitoring arterial blood pressure (BP) in children.[1,2] Unfortunately, the prevalence of high BP has been increasing in children and adolescents.[3,4] Based on these observations, early detection and intervention in children with elevated BP may be beneficial in preventing hypertension in adults.
Overweight and obesity are associated with high BP in children and adolescents.[5,6] Elevated BP during childhood and adolescence is associated with increased cardiovascular risk in later life.[7] Thus, the recognition and management of elevated BP at an early age may be an important strategy for limiting the overall disease burden caused by hypertension.[8,9] Furthermore, obesity in children has increased considerably over the past few decades. The rates of obesity and overweight in US children are 16% and 31%, respectively.[10] Some studies have indicated that hypertension early in life can predict adult hypertension, a condition that is associated with shorter lifespan owing to higher cardiovascular mortality.[10–13] However, the relationship between BP and weight status, especially in childhood and adolescents, remains unclear. Importantly, few studies have documented time-dependent corrections to analyse the relationship between BP and increments of body mass index (BMI) in children and adolescents. In this article, we report the relationship of the BMI time-dependent distribution to BP levels and the prevalence of relatively high BP among children and adolescents in Hanzhong, Shaanxi Province, China.
Participants and methods
Study design and population
Of the 5043 participating individuals from Qili, Shayan, Laojun of Hanzhong in Shaanxi Province, China, in 1987, 832 (16.5%) schoolchildren were excluded because they either were living in urban areas or lacked relative information. We included only subjects living in rural areas to eliminate possible differences such as dietary habits. Thus, a total sample of 4211 children underwent anthropometry. The children in the baseline survey were divided into three age ranges: > 6 and ≤9 years, > 10 and ≤13 years, and >14 and ≤17 years. The subsequent follow-up lasted for 26 years, and was conducted in 1989, 1992, 1995 and 2013. The response rate was 74.6% (n = 3141) in 1989, 86.0% (n = 3620) in 1992, 84.7% (n = 3567) in 1995 and 69.2% (n = 2915) in 2013. Reasons for loss to follow-up include emigration, studying, joining the army, interracial marriage and death.
Anthropometric measurements
Body weight was determined to the nearest 0.1 kg on standard physician’s beam scales with the participants wearing only underwear. Height was measured to the nearest 0.1 cm on standardized, wall-mounted height boards according to the following protocol: no shoes, and the student’s buttocks, shoulders and head touching the vertical wall surface, with the line of sight aligned horizontally.
Definition of body mass index
BMI was computed by dividing the weight (kg) by the height squared (m2). The age- and gender-specific BMI cut-offs newly developed by the Working Group on Obesity in China (WGOC) were used to define overweight and obesity.[14,15] Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children and adolescents of the same age and gender. Obesity is defined as a BMI greater than the 95th percentile. Adults were classified by BMI into three groups: < 24 kg/m2 (non-overweight/obese), ≥24 kg/m2 and <28 kg/m2 (overweight), and ≥28 kg/m2 (obese).[16]
Measurements of blood pressure
BP was measured by two trained physicians using a standard mercury sphygmomanometer. Measurements were taken with participants in a seated position after at least 5 min of rest, with the cuff around the upper right arm according to recommended guidelines. The cuff size was based on the length and circumference of the upper arm and was chosen to be as large as possible without having the elbow skin crease obstruct the stethoscope.[17] Three cuffs with different bladder sizes (8–13 cm, 9–23 cm and 12–22 cm) were used. The BP value was approximated to the nearest 2 mmHg. Systolic blood pressure (SBP) was defined by the onset of the first Korotkoff sound (appearance of sounds) and diastolic blood pressure (DBP) was indicated by the fifth Korotkoff sound (disappearance of Korotkoff sounds). To ensure the accuracy of measurements, all subjects were assessed in a relaxed environment.
Definition of high blood pressure and prehypertension
According to National High Blood Pressure Education Program in USA, hypertension was defined by using percentiles of SBP and DBP values on the basis of height percentile, age and gender. In this study, hypertension is defined as SBP and/or DBP that is ≥ 95th percentile and prehypertension between the 90th and 95th percentiles for gender, age and height.[18] Adult BP standards are as follows: optimal (SBP <120 mmHg and DBP <80 mmHg), normal (SBP 120–129 mmHg or DBP 80–84 mmHg), prehypertension (SBP 130–139 mmHg or DBP 85–89 mmHg) or hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg), as defined by the Sixth Report of the Joint National Committee (JNCVI).[19]
Statistical analyses
All data analyses were performed using the SAS 10.0 statistical software package. Data were analysed using the chi-squared test. Then, Cox proportional hazards regression models were used to estimate possible relationships among BMI categories and BP level. The assumption of proportional hazards was examined by testing the cross-product terms between covariate variables and the log function of survival time. We used the BMI time-dependent increment as a continuous covariate in the models. Survival analyses were used to examine possible trends in the increment of BMI changing with age and BP levels. A p value of less than 0.05 was considered statistically significant.
Ethical approval
All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Results
Blood pressure and body mass index by gender and age
The percentiles of pre-high systolic blood pressure (pre-HSBP), high systolic blood pressure (HSBP), pre-high diastolic blood pressure (pre-HDBP), high diastolic blood pressure (HDBP) and BMI for children and adolescents during the 26 year follow-up stages are shown in Table 1. Children with pre-HSBP accounted for 2.04% of male and 2.4% of female participants at baseline, while adults with pre-HSBP accounted for 21.48% of males and 10.29% of females after the 26 year follow-up. Similarly, children with pre-HDBP accounted for 2.69% of males and 2.0% of females at baseline, whereas after 26 years the adults with pre-HDBP accounted for 15.92% of males and 8.37% of females. The percentages of subjects with pre-HSBP or pre-HDBP were significantly higher in males than in females at the 26 year follow-up compared with the baseline. At baseline, none of the subjects had high BP. However, the proportion of HSBP at the 26 year follow-up was 6.93% of male and 3.43% of female subjects, while the proportion of HDBP was 12.8% of male and 4.56% of female subjects. The prevalence of high BP was significantly higher in males than in females in all stages. The prevalence of overweight and obesity in males was higher than in females in all follow-up stages, although no significant differences were found.
Table 1. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) of the study population by gender and age.
Prevalence of systolic and diastolic blood pressure by body mass index and gender
The effects of different BMI categories on SBP and DBP from childhood to adulthood are presented in Table 2. The prevalence of pre-HDBP for males was slightly higher than for females in the three BMI subgroups, especially in the overweight and obese groups. From baseline to 8 year follow-up, the BP changed little. After the 8 year follow-up, the prevalence of hypertension increased in both male and female subjects, although there was no statistically significant difference.
Table 2. Prevalence and 95% confidence intervals (CI) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) by body mass index (BMI) and gender.
Prevalence of systolic and diastolic blood pressure by body mass index and age
The prevalence of high SBP and high DBP increased in parallel with the percentage of overweight or obesity in all age groups (Table 3). The rates of pre-HSBP, HSBP, pre-HDBP and HDBP were all markedly higher in overweight and obese subjects than in the normal-weight group.
Table 3. Prevalence (95% CI) in SBP and DBP by BMI and age.
Cox regression model of the effect of blood pressure value with body mass index time-dependent covariate
Overweight and obese subjects who maintained their body composition showed a higher risk of high SBP [overweight: hazard ratio (HR) = 1.811; obese: HR = 2.96] compared to subjects who maintained a normal BMI (Table 4 and Figure 1). Obese subjects were also at increased risk of pre-HDBP (HR = 1.194) compared to subjects who maintained a normal BMI. We did not find any association with pre-HSBP in subjects with increased body weight. An increase in BMI by 1 unit increases the risk of high SBP 1.811 times and 2.96 times for overweight and obese subjects, respectively.
Published online:
03 May 2016Figure 1. Survival curve for (A) high systolic blood pressure (SBP), (B) pre-high SBP, high diastolic blood pressure (DBP), and (D) pre-high DBP.
![]({"type":"image","src":"/na101/home/literatum/publisher/tandf/journals/content/iblo20/2016/iblo20.v025.i05/08037051.2016.1168969/20160802/images/medium/iblo_a_1168969_f0001_c.jpg"})
Figure 1. Survival curve for (A) high systolic blood pressure (SBP), (B) pre-high SBP, high diastolic blood pressure (DBP), and (D) pre-high DBP.
Table 4. Cox-regression model of the effect of BP value with BMI-time dependent covariate.
Discussion
The results from this population-based longitudinal–sectional study show a strong positive association between long-term change in BMI and the prevalence of high SBP and high DBP from childhood to adulthood. Obese subjects were 2.96 times and 2.88 times more likely to have high SBP and high DBP than normal weight counterparts, respectively; while overweight subjects were 1.81 times and 2.03 times more likely to have high SBP and high DBP than normal weight counterparts, respectively. Gender differences exist in the average age of obese subjects with high SBP and high DBP. The average age of patients with high SBP was 40.3 years in males, while in females it was 41.4 years. The average age of patients with high DBP was 38.1 years in males, while in females it was 38.9 years. Our results suggest that in subjects with obesity, the average age of subjects with high SBP and DBP was lower in males than in females. The risk of hypertension is increased in subjects with overweight or obesity at a younger age. Therefore, healthcare for overweight or obese young people is necessary. Our results support the necessity of monitoring and highlighting the need for early intervention for high BP in the overweight to obese population.
A positive association between BP and obesity in children and adolescents has been reported.[20] Cao et al. reported that BP increased in parallel with BMI in children and adolescents in Changsha city, China.[21] Dong et al. revealed that the prevalence of high BP rose with increasing BMI percentile in all age groups.[22] So far, few long-term longitudinal, large-scale studies have aimed to track the changes in BMI and BP from childhood to adulthood for overweight and obese subjects compared with subjects with normal weight in a Chinese population.[5] Our findings are consistent with the findings of previous studies, which indicated that BP, as well as the prevalence of high BP, increased with increasing BMI. To the best of our knowledge, the present study is the first to investigate the relationship between variation in 26 year follow-up of the stratification of BMI and high BP in a rural population of northern China. Comparing baseline with 26 year follow-up, obvious increases were found in the proportion of overweight and obesity (33.54% vs 9.41%; 11.47% vs 4.42%), and the proportion of high SBP and high DBP (10.36% vs 0%; 17.36% vs 0%), without appreciable linear growth. Our findings are very similar to a recent international review documenting population-based studies with a minimum of 2000 participants in the US population (including the resident Hispanic population).
The development of overweight and obesity had obvious age and gender characteristics. We found that the percentage of overweight or obese subjects increased with age, with male subjects having higher BMI than females, especially after the year 1995. On the other hand, significant differences were found in the prevalence of hypertension by comparing baseline with 26 year follow-up. For example, the prevalence of pre-HSBP was 50.55% [95% confidence interval (CI) 43.05–58.03] at the 26 year follow-up and 3.88% (95% CI 1.07–9.65) at baseline for obese males, and 41.49% (95% CI 31.41–52.12) at the 26 year follow-up and 10.99% (95% CI 5.4–19.28) at baseline for obese females. The prevalence of pre-HDBP was 40.04% (95% CI 35.68–44.52) at the 26 year follow-up and 6.8% (95% CI 2.78–13.5) at baseline for males, and 31.91% (95% CI 22.67–42.33) at the 26 year follow-up and 6.59% (95% CI 2.46–13.8) at baseline for females. The results for high SBP and high DBP were similar. This indicates that hypertension increases sharply with BMI and age.
It was also concluded that the increase in hypertension in youth in the USA is largely driven by an increased BMI. As shown by our study and others, the prevalence of prehypertension and hypertension is much higher in obese than in normal-weight young people. The results of the present study could inform future decisions between a general population-wide screening and a targeted screening or closer follow-up strategies in high-risk populations to identify children and adolescents with high BP.
There are several strengths of the present study. Its major strength is the large longitudinal cohort, based on the data from 26 year long-term follow-up. We were able to analyse the association between BP and BMI distribution in various gender- and age-specific subgroups from childhood to adulthood. Furthermore, we quantified the effect of obesity and overweight on the prevalence of relatively high BP, which helped to determine the effect of weight control on the prevention of high BP. However, one limitation of the present study is that we did not consider eating behaviour, salt intake or physical activity, all of which may contribute to BP trends.
In summary, the distribution of BMI has obvious effects on BP in children and adults. Children and adults with elevated BMI may have an increased risk of hypertension. Our findings clearly emphasize the importance and necessity of preventing overweight and obesity early in life in order to prevent future sequelae of overweight- and obesity-related diseases such as hypertension in children and adults.
| SBP | DBP | BMI | |||||
|---|---|---|---|---|---|---|---|
| Pre-high | High | Pre-high | High | Normal | Overweight | Obese | |
| Baseline | |||||||
| Male | 86 (2.04) | 0 | 113 (2.69) | 0 | 1919 (45.57) | 205 (4.87) | 103 (2.26) |
| Female | 101 (2.4) | 0 | 84 (2) | 0 | 1701 (40.39) | 192 (4.54) | 91 (2.16) |
| 6–9 years | 63 (1.5) | 0 | 64 (1.52) | 0 | 1130 (26.83) | 127 (3.01) | 64 (1.52) |
| 10–13 years | 76 (1.81) | 0 | 88 (2.09) | 0 | 1415 (33.60) | 164 (3.89) | 73 (1.73) |
| 14–17 years | 48 (1.14) | 0 | 45 (1.07) | 0 | 1075 (25.52) | 107 (2.54) | 56 (1.33) |
| 2 year follow-up | |||||||
| Male | 98 (3.12) | 1 (0.03) | 83 (2.64) | 1 (0.03) | 1395 (44.41) | 188 (5.99) | 85 (2.71) |
| Female | 74 (2.36) | 1 (0.03) | 68 (2.16) | 0 | 1248 (39.73) | 156 (4.97) | 69 (2.20) |
| 8–11 years | 65 (2.07) | 0 | 64 (2.03) | 0 | 999 (31.80) | 167 (5.32) | 75 (2.39) |
| 12–15 years | 73 (2.32) | 0 | 88 (2.8) | 0 | 1144 (36.42) | 137 (4.36) | 55 (1.75) |
| 16–19 years | 34 (1.08) | 2 (0.06) | 45 (1.43) | 0 | 500 (15.92)** | 40 (1.27) | 24 (0.76) |
| 5 year follow-up | |||||||
| Male | 360 (9.94) | 40 (1.09) | 184 (5.08) | 39 (1.08) | 1623 (44.83) | 182 (5.02) | 96 (2.65) |
| Female | 199 (5.50) | 10 (0.27) | 126 (3.48) | 16 (0.44) | 1457 (40.25) | 171 (4.72) | 91 (2.51) |
| 11–14 years | 62 (1.71) | 0 | 55 (1.52) | 0 | 1034 (28.56) | 151 (4.17) | 80 (2.21) |
| 15–18 years | 67 (1.85) | 0 | 64 (1.77) | 0 | 1181 (32.62) | 154 (4.25) | 104 (2.87) |
| 19–22 years | 430 (11.8) | 50 (1.38) | 191 (5.28) | 55 (1.5) | 865 (23.90)** | 48 (1.33) | 3 (0.08) |
| 8 year follow-up | |||||||
| Male | 606 (16.99) | 104 (2.92) | 350 (9.81) | 79 (2.22) | 1683 (47.18) | 136 (3.81) | 44 (1.23) |
| Female | 339 (9.5) | 30 (0.84) | 241 (6.76) | 27 (0.76) | 1496 (41.94)* | 164 (4.60) | 44 (1.04) |
| 14–17 years | 73 (2.05) | 0 | 81 (2.27) | 0 | 1007 (28.23)** | 129 (3.62) | 63 (1.77) |
| 18–21 years | 432 (12.11) | 63 (1.77) | 264 (7.4) | 45 (1.26) | 1215 (34.06)** | 114 (3.2) | 19 (0.53) |
| 22–25 years | 440 (12.34) | 71 (1.99) | 246 (6.9) | 61 (1.71) | 957 (26.83)** | 57 (1.60) | 6 (0.17) |
| 26 year follow-up | |||||||
| Male | 626 (21.48) | 202 (6.93) | 464 (15.92) | 373 (12.80) | 886 (30.42) | 596 (20.45) | 221 (7.56) |
| Female | 300 (10.29) | 100 (3.43) | 244 (8.37) | 133 (4.56) | 716 (24.56)** | 382 (13.09) | 114 (3.91) |
| 32–35 years | 260 (8.92) | 83 (2.85) | 198 (6.79) | 149 (5.11) | 501 (17.17)** | 278 (9.52) | 101 (3.45) |
| 36–39 years | 349 (11.97) | 110 (3.77) | 252 (8.64) | 183 (6.28) | 608 (20.86)** | 367 (12.6) | 134 (4.61) |
| 40–43 years | 387 (13.28) | 130 (4.46) | 257 (8.82) | 174 (6.0) | 494 (16.96)** | 333 (11.43) | 99 (3.41) |
Data are shown as n (%).
*p < 0.05, **p < 0.01, Chi-squared test.
| BMI | HSBP | Pre-HSBP | HDBP | Pre-HDBP | |||||
|---|---|---|---|---|---|---|---|---|---|
| % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | ||
| Baseline | |||||||||
| Male | NW | – | – | 3.65 | (2.86, 4.59) | – | – | 4.49 | (3.61, 5.52) |
| OW | 5.37 | (2.71, 9.4) | – | – | 9.76 | (6.06, 14.67) | |||
| OB | – | – | 3.88 | (1.07, 9.65) | – | – | 6.8 | (2.78, 13.5) | |
| Female | NW | – | – | 4.35 | (3.43, 5.43) | – | – | 4 | (3.12, 5.04) |
| OW | – | – | 8.9 | (5.27, 13.87) | – | – | 5.24 | (2.54, 9.42) | |
| OB | 10.99 | (5.4, 19.28) | – | 6.59 | (2.46, 13.8) | ||||
| 2 year follow-up | |||||||||
| Male | NW | 0.08 | (0, 0.42) | 5.24 | (4.13, 6.56) | 0.07 | (0, 0.41) | 4.49 | (3.47, 5.7) |
| OW | – | – | 7.45 | (4.13, 12.18) | – | – | 5.85 | (2.96, 10.23) | |
| OB | – | – | 8.24 | (3.38, 16.23) | – | – | 10.59 | (4.96, 19.15) | |
| Female | NW | – | – | 3.23 | (1.06, 7.37) | – | – | 4.15 | (3.14, 5.37) |
| OW | – | – | 4.68 | (3.61, 5.96) | – | – | 6.45 | (3.14, 11.54) | |
| OB | – | – | 10.14 | (4.18, 19.79) | – | – | 4.35 | (0.91, 12.18) | |
| 5 year follow-up | |||||||||
| Male | NW | – | – | 4.17 | (1.15, 10.33) | – | – | 7.14 | (3.86, 11.9) |
| OW | 1.69 | (0.35, 4.85) | 10.99 | (6.8, 16.3) | 2.04 | (1.41, 2.86) | 7.29 | (2.98, 14.45) | |
| OB | 2.25 | (1.59, 3.09) | 19.99 | (18.06, 22.01) | 2.2 | (0.6, 5.53) | 9.84 | (8.43, 11.4) | |
| Female | NW | – | – | 8.79 | (3.87, 16.59) | – | – | 6.59 | (2.46, 13.8) |
| OW | 0.53 | (0.23, 1.05) | 11.03 | (9.49, 12.73) | 0.8 | (0.42, 1.4) | 6.95 | (5.72, 8.36) | |
| OB | 1.17 | (0.14, 4.16) | 15.2 | (10.18, 21.48) | 2.34 | (0.64, 5.88) | 9.36 | (5.44, 14.75) | |
| 8 year follow-up | |||||||||
| Male | NW | – | – | 15.91 | (6.64, 30.07) | 2.27 | (0.06, 12.02) | 18.18 | (8.19, 32.71) |
| OW | 5.88 | (2.57, 11.26) | 27.21 | (19.93, 35.5) | 5.88 | (2.57, 11.26) | 18.38 | (12.26, 25.93) | |
| OB | 5.71 | (4.65, 6.93) | 33.41 | (31.16, 35.72) | 4.16 | (3.26, 5.23) | 18.86 | (17.01, 20.81) | |
| Female | NW | – | – | 9.09 | (2.53, 21.67) | 2.27 | (0.06, 12.02) | 9.09 | (2.53, 21.67) |
| OW | 1.54 | (0.98, 2.3) | 19.57 | (17.59, 21.67) | 1.47 | (0.92, 2.22) | 14.03 | (12.31, 15.89) | |
| OB | 4.27 | (1.73, 8.6) | 25.61 | (19.12, 33) | 2.44 | (0.67, 6.13) | 16.46 | (11.14, 23.04) | |
| 26 year follow-up | |||||||||
| Male | NW | 8.78 | (6.83, 11.07) | 38.67 | (35.14, 42.29) | 16.8 | (14.17, 19.7) | 28.22 | (24.98, 31.64) |
| OW | 16.06 | (12.92, 19.6) | 50.61 | (46.10, 55.11) | 30.89 | (26.84, 35.18) | 31.87 | (25.17, 39.17) | |
| OB | 32.42 | (25.68, 39.74) | 50.55 | (43.05, 58.03) | 53.3 | (45.77, 60.71) | 40.04 | (35.68, 44.52) | |
| Female | NW | 6.6 | (4.73, 8.91) | 24.37 | (20.96, 28.03) | 7.8 | (5.76, 10.26) | 22.37 | (19.07, 25.95) |
| OW | 12.46 | (9.01, 16.64) | 37.38 | (32.00, 43.00) | 19.17 | (14.96, 23.97) | 26.2 | (21.41, 31.44) | |
| OB | 23.4 | (15.29, 33.26) | 41.49 | (31.41, 52.12) | 28.72 | (19.86, 38.98) | 31.91 | (22.67, 42.33) | |
HSBP: high systolic blood pressure; HDBP: high diastolic blood pressure; NW: normal weight; OW: overweight; OB: obese.
| HSBP | Pre-HSBP | HDBP | Pre-HDBP | ||||||
|---|---|---|---|---|---|---|---|---|---|
| % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | ||
| Baseline | |||||||||
| 6–9 year | Normal weight | – | – | 3.9 | (2.85, 5.21) | – | – | 4.8 | (3.62, 6.21) |
| Overweight | – | – | 11.8 | (6.76, 18.7) | – | – | 7.09 | (3.29, 13.03) | |
| Obesity | – | – | 4.69 | (0.98, 13.09) | – | – | 1.56 | (0.04, 8.4) | |
| 10–13 year | Normal weight | – | – | 3.07 | (1, 7.01) | – | – | 4.59 | (3.56, 5.82) |
| Overweight | – | – | 4.44 | (3.43, 5.64) | – | – | 9.2 | (5.24, 14.72) | |
| Obesity | – | – | 10.96 | (4.85, 20.46) | – | – | 10.96 | (4.85, 20.46) | |
| 14–17 year | Normal weight | 100 | (99.66, 100) | 3.44 | (2.43, 4.71) | 100 | (99.66, 100) | 3.26 | (2.28, 4.5) |
| Overweight | – | – | 5.36 | (1.12, 14.87) | – | – | 7.14 | (1.98, 17.29) | |
| Obesity | – | – | 7.48 | (3.28, 14.2) | – | – | 5.61 | (2.09, 11.81) | |
| 2-year-follow-up | |||||||||
| 8–11 year | Normal weight | – | – | 5.23 | (3.93, 6.8) | – | – | 4.62 | (3.4, 6.12) |
| Overweight | – | – | 4.19 | (1.7, 8.45) | – | – | 5.99 | (2.91, 10.74) | |
| Obesity | – | – | 4 | (0.83, 11.25) | – | 6.37 | (3.1, 11.4) | ||
| 12–15 year | Normal weight | – | – | 4.45 | (3.34, 5.79) | – | – | 3.62 | (2.61, 4.88) |
| Overweight | – | – | 8.09 | (4.11, 14.01) | – | – | 7.3 | (3.56, 13.01) | |
| Obesity | – | – | 18.18 | (9.08, 30.9) | – | – | 14.55 | (6.5, 26.66) | |
| 16–19 year | Normal weight | 0.2 | (0.01, 1.13) | 2.56 | (0.06, 13.48) | – | – | 2.56 | (0.06, 13.48) |
| Overweight | – | – | 4.17 | (0.11, 21.12) | – | – | 12.5 | (2.66, 32.36) | |
| Obesity | – | – | 5.76 | (3.97, 8.03) | 0.18 | (0.1, 2.25) | 5.4 | (3.67, 7.61) | |
| 5-year-follow-up | |||||||||
| 11–14 years | Normal weight | – | – | 4,45 | (3.28, 5.9) | – | – | 4.26 | (3.13, 5.67) |
| Overweight | – | – | 7.95 | (4.17, 13.47) | – | – | 3.97 | (1.47, 8.45) | |
| Obesity | – | 8.16 | (4.29, 13.83) | – | 5 | (1.38, 12.31) | |||
| 15–18 years | Normal weight | – | – | 4.36 | (3.27, 5.67) | – | – | 3.69 | (2.69, 4.92) |
| Overweight | – | – | 4.55 | (1.85, 9.14) | – | – | 7.79 | (4.09, 13.22) | |
| Obesity | – | – | 7.69 | (3.38, 14.6) | – | – | 7.69 | (3.38, 14.6) | |
| 19–22 years | Normal weight | – | – | 33.33 | (0.84, 90.57) | – | – | 19.7 | (17.1, 22.5) |
| Overweight | 5.00 | (3.67, 6.63) | 44.67 | (41.39, 47.98) | 5.22 | (3.86, 6.88) | 22.9 | (12.0, 37.3) | |
| Obesity | 10.42 | (3.47, 22.66) | 56.25 | (41.18, 70.52) | 16.67 | (7.48, 30.22) | 33.3 | (0.84, 90.57) | |
| 8-year-follow-up | |||||||||
| 14–17 years | Normal weight | – | – | 5.36 | (4.05, 6.94) | – | – | 6.45 | (5.02, 8.15) |
| Overweight | – | – | 9.52 | (3.58, 19.59) | 6.98 | (3.24, 12.83) | |||
| Obesity | – | – | 10.08 | (5.48, 16.62) | – | – | 11.11 | (4.59, 21.56) | |
| 18–21 years | Normal weight | – | – | 21.05 | (6.05, 45.57) | 3.13 | (2.22, 4.27) | 10.53 | (1.3, 33.14) |
| Overweight | 4.44 | (3.36, 5.76) | 32.2 | (29.58, 34.9) | 4.39 | (1.44, 9.94) | 19.75 | (17.55, 22.1) | |
| Obesity | 7.89 | (3.67, 14.46) | 32.46 | (23.99, 41.86) | 10.5 | (1.3, 33.14) | 19.3 | (12.51, 27.75) | |
| 22–25 years | Normal weight | – | – | 16.67 | (0.42, 64.12) | – | – | 23.25 | (20.6, 26.06) |
| Overweight | 6.79 | (5.28, 8.58) | 42.84 | (39.68, 46.05) | 5.65 | (4.27, 7.31) | 36.84 | (24.45, 50.66) | |
| Obesity | 10.53 | (3.96, 21.52) | 50.88 | (37.29, 64.37) | 12.28 | (5.08, 23.68) | 50.00 | (11.81, 88.19) | |
| 26-year-follow-up | |||||||||
| 32–35 years | Normal weight | 6.55 | (4.36, 9.39) | 28.16 | (23.86, 32.77) | 11.38 | (8.48, 14.84) | 23.73 | (19.7, 28.1) |
| Overweight | 12.72 | (8.69, 17.75) | 45.61 | (39.02, 52.32) | 28.07 | (22.34, 34.38) | 32.02 | (26.01, 38.5) | |
| Obesity | 32.53 | (22.65, 43.7) | 46.99 | (35.93, 58.26) | 43.37 | (32.53, 54.71) | 32.53 | (22.65, 43.7) | |
| 36–39 years | Normal weight | 7.34 | (5.22, 9.98) | 31.35 | (27.32, 35.6) | 11.33 | (8.7, 14.43) | 23.80 | (20.1, 27.78) |
| Overweight | 15.18 | (11.33, 19.73) | 44.22 | (38.55, 50.01) | 27.39 | (22.45, 32.78) | 30.36 | (25.24, 35.88) | |
| Obesity | 24.32 | (16.68, 33.38) | 51.35 | (41.68, 60.95) | 38.74 | (29.64, 48.45) | 36.94 | (27.97, 46.62) | |
| 40–43 years | Normal weight | 9.54 | (6.87, 12.8) | 37.65 | (32.94, 42.55) | 15.65 | (12.26, 19.54) | 30.07 | (25.67, 34.77) |
| Overweight | 15.69 | (11.6, 20.55) | 46.72 | (40.69, 52.81) | 23.72 | (18.81, 29.21) | 24.39 | (15.58, 35.12) | |
| Obesity | 32.93 | (22.94, 44.19) | 42.68 | (31.82, 54.09) | 54.88 | (43.49, 65.9) | 41.61 | (35.71, 47.69) | |
| HR | 95%CI | p | ||
|---|---|---|---|---|
| Pre-HSBP | Boy-girl | 1.68 | (1.452, 1.944) | <0.000 |
| OW-NW | 1.108 | (0.953, 1.287) | 0.1815 | |
| OB-NW | 1.103 | (0.887, 1.371) | 0.3785 | |
| HSBP | Boy-girl | 1.663 | (1.246, 2.22) | <0.0001 |
| OW-NW | 1.811 | (1.337, 2.454) | <0.0001 | |
| OB-NW | 2.96 | (2.077, 4.22) | <0.0001 | |
| Pre-HDBP | Boy-girl | 1.309 | (1.12, 1.53) | <0.005 |
| OW-NW | 1.165 | (0.916, 1.482) | <0.005 | |
| OB-NW | 1.194 | (1.014, 1.406) | <0.005 | |
| HDBP | Boy-girl | 1.928 | (1.504, 2.472) | <0.0001 |
| OW-NW | 2.023 | (1.575, 2.597) | <0.0001 | |
| OB-NW | 2.888 | (2.128, 3.92) | <0.0001 |
HR: hazard ratio; CI: confidence interval; NW: normal weight; OW: overweight; OB: obese.
Disclosure statement
No potential conflict of interest was reported by the authors.
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