Body mass index percentiles and elevated blood pressure among children and adolescents.

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P < 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P < 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P < 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P < 0.001), 1.55 (95% CI, 1.42-1.69; P < 0.001), and 1.80 (95% CI, 1.62-2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years.

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization. RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort.

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

Environmental variation in the prevalence of hypertension in children and adolescents - is blood pressure higher in children and adolescents living in rural areas?

INTRODUCTION: Despite considerable progress in diagnostic methods and treatment options, cardiovascular diseases constitute a serious health issue in Poland, and hypertension is considered one of the main risk factors in the incidence of the diseases. OBJECTIVES: The aim of this study is to assess the values of arterial blood pressure among adolescents in the context of urban and rural environments. MATERIALS AND METHOD: The study was carried out on a representative, randomly selected group of youths aged 10-18 years, participating in the ADOPOLNOR project. Prior to blood pressure measurement, each pupil was assessed according to anthropomorphic principles. The BP measurements strictly followed the guidelines of the Fourth Protocol of the American Working Group of High Blood pressure in Children and Adolescents. RESULTS: Mean values of systolic blood pressure (SBP) in boys in rural areas were higher in every age group than in the boys in urban areas. Higher values of systolic and diastolic blood pressure were observed also in girls in rural areas. BP values sufficiently high for the diagnosis of hypertension were observed in 12.8% of the rural boy population but only in 6.7% of the boys from the urban environment. The difference is statistically significant. The girls in rural areas (13.3%) had twice the incidence of elevated BP values in comparison with the girls in urban areas (7.2%) and, as in boys, the difference is statistically significant. CONCLUSIONS: The high proportion of pupils with elevated arterial blood pressure observed in the rural areas of Wielkopolska calls for regularly performed BP assessment and monitoring in this populatio.

Prevalence of incorrect body posture in children and adolescents with overweight and obesity.

The ever increasing epidemics of overweight and obesity in school children may be one of the reasons of the growing numbers of children with incorrect body posture. The purpose of the study was the assessment of the prevalence of incorrect body posture in children and adolescents with overweight and obesity in Poznan, Poland. The population subject to study consisted of 2732 boys and girls aged 3-18 with obesity, overweight, and standard body mass. The assessment of body mass was performed based on BMI, adopting Cole's cutoff values. The evaluation of body posture was performed according to the postural error chart based on criteria complied by professor Dega. The prevalence rates of postural errors were significantly higher among children and adolescents with overweight and obesity than among the group with standard body mass. In the overweight group, it amounted to 69.2% and in the obese group to 78.6%. CONCLUSION:  The most common postural deviations in obese children and adolescents were valgus knees and flat feet. Overweight and obesity in children and adolescents, predisposing to higher incidence of some types of postural errors, call for prevention programs addressing both health problems. What is Known: • The increase in the prevalence of overweight and obesity among children and adolescents has drawn attention to additional health complications which may occur in this population such as occurrence of incorrect body posture. What is New: • The modified chart of postural errors proved to be an effective tool in the assessment of incorrect body posture. • This chart may be used in the assessment of posture during screening tests and prevention actions at school.

Trends in the Incidence Rates of Chronic Hepatitis B in Poland in the Years 2005 - 2013.

BACKGROUND: The prevalence of newly-diagnosed cases of chronic hepatitis is decisive for the overall incidence rate of hepatitis B observed in Poland. OBJECTIVES: We aimed to determine the chronic hepatitis B incidence trends in Poland, taking into consideration the ages, genders, and environments of the patients. METHODS: The study is based on aggregated data from Polish descriptive epidemiological studies for the period of 2005 to 2013 (i.e., hepatitis B incidence numbers and ratios, including mixed HBV and HCV infections) as published in the annual bulletins Choroby zakazne i zatrucia w Polsce (Infectious diseases and poisonings in Poland] drawn up by the laboratory for the monitoring and analysis of epidemiological status of the department of epidemiology at the national institute of public health - national institute of hygiene (NIPH-NIH). Poland, a central European country situated in the humid continental climate zone, is classified as a highly developed country. In the analyzed period, the Polish population consisted of about 38 million people, more than 19 million of whom were women, and more than 18 million of whom were men. Among European countries, Poland has the smallest number of national and ethnic minorities. For the purposes of epidemiological supervision, a special definition of acute hepatitis B was adopted in Poland in 2005, which facilitated separate registration of acute and chronic cases. RESULTS: A significantly increasing chronic hepatitis B incidence trend was observed in the population of Poland, with considerable increases in incidence rates for both men and women alike. The incidence rates for inhabitants of both urban and rural areas also showed an increasing tendency. Chronic hepatitis B occurred more frequently in men and in urban areas. For each of the five-year age groups encompassing patients between 20 and 54 years of age, the increase in the incidence rate proved to be significant. CONCLUSIONS: The registered increase in the incidence rate of chronic hepatitis B in Poland is a consequence of the new registration of cases of chronic hepatitis B acquired in the past. The problem of chronic hepatitis B can be solved by improving epidemiological supervision, enhancing the detection of frequently asymptomatic infections, and by providing easier access to optimized therapies.

Performance of Eleven Simplified Methods for the Identification of Elevated Blood Pressure in Children and Adolescents.

The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84-0.98), high sensitivity (0.69-1.00), high specificity (0.87-1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child's absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.

Malignant testicular tumour incidence and mortality trends.

AIM OF THE STUDY: In Poland testicular tumours are the most frequent cancer among men aged 20-44 years. Testicular tumour incidence since the 1980s and 1990s has been diversified geographically, with an increased risk of mortality in Wielkopolska Province, which was highlighted at the turn of the 1980s and 1990s. The aim of the study was the comparative analysis of the tendencies in incidence and death rates due to malignant testicular tumours observed among men in Poland and in Wielkopolska Province. MATERIAL AND METHODS: Data from the National Cancer Registry were used for calculations. The incidence/mortality rates among men due to malignant testicular cancer as well as the tendencies in incidence/death ratio observed in Poland and Wielkopolska were established based on regression equation. The analysis was deepened by adopting the multiple linear regression model. A p-value < 0.05 was arbitrarily adopted as the criterion of statistical significance, and for multiple comparisons it was modified according to the Bonferroni adjustment to a value of p < 0.0028. Calculations were performed with the use of PQStat v1.4.8 package. RESULTS: The incidence of malignant testicular neoplasms observed among men in Poland and in Wielkopolska Province indicated a significant rising tendency. The multiple linear regression model confirmed that the year variable is a strong incidence forecast factor only within the territory of Poland. A corresponding analysis of mortality rates among men in Poland and in Wielkopolska Province did not show any statistically significant correlations. CONCLUSIONS: Late diagnosis of Polish patients calls for undertaking appropriate educational activities that would facilitate earlier reporting of the patients, thus increasing their chances for recovery. Introducing preventive examinations in the regions of increased risk of testicular tumour may allow earlier diagnosis.

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

BACKGROUND: Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). METHODS AND RESULTS: Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. CONCLUSIONS: These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study.

UNLABELLED: In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10-18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent's sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES. CONCLUSION: The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments.

Prevalence of selected risk factors for cardiovascular diseases in adolescents with overweight and obesity.

AIM OF THE STUDY: The aim of the study was to assess the prevalence of elevated blood pressure values and significant family history with respect to the incidence of cardiovascular diseases in overweight and obese adolescents. MATERIAL AND METHODS: Our study encompassed 4904 adolescents from randomly selected schools from the Wielkopolska province of Poland. Measurements of body height and mass were performed in all the school pupils. The adolescents were qualified to be included in the overweight and obese groups based on the BMI value, using the cut-off points according to Cole's method. Blood pressure measurements were conducted according to the methodology and recommendations of the Fourth Report, with the application of the Polish blood pressure standards. Within the group of students with normal body mass, overweight and obesity, the frequency of higher systolic and diastolic blood pressure and significant family history were calculated, and the relationship between the variables was calculated by means of chi2 test, assuming p<0.05. In order to calculate the odds ratio and the probability of incidence of higher systolic and diastolic blood pressure, the variables significant in the logistic regression model were taken into consideration. RESULTS: Overweight and obesity was observed in 845 subjects, which made up 17.2% of the population included in the study. Overweight and obesity were significantly more often observed in boys (485 - 22,2%) than in girls (362 - 17.0%) (p<0.05). In boys, the significant family history increases the odds ratio of prevalence of higher systolic blood pressure 1.90 times, obesity - 8.86 times and significant family history combined with obesity - 16.85 times, in comparison with the boys who have normal body mass and no significant family history. Obesity in girls increases the odds ratio of prevalence of higher systolic blood pressure by 9.24 times. Obesity in boys increases the odds ratio of prevalence of higher diastolic blood pressure by 5.88 and in obese girls the odds ratio of elevated diastolic blood pressure are 4.17 times higher. CONCLUSIONS: 1. Obesity and positive family history in pupils of both genders considerably increased the probability of elevated systolic and diastolic blood pressure occurrence. This obliges to: - perform further medical diagnostics, towards identification of other risk-factors of cardiovascular diseases; - to qualify such adolescents to "groups of increased risk" (this information should be entered in the school medical records).

Blood pressure references for Polish children and adolescents.

The objective of this study was to develop age- and gender-specific reference ranges for blood pressure in a large national database on blood pressure levels throughout childhood and adolescence in young Poles. A prospective cross-sectional study was performed in 2002-2005 in the representative sampling sites, selected randomly from the entire Poland. Altogether, 6,447 school pupils, aged 7-18 years, were involved in the study of which 3,176 were boys and 3,271 were girls. Statistical analysis was performed using STATISTICA for Windows 7.1. The normal range of blood pressure, determined by age and the category of body height percentiles, revealed percentiles values which might serve as reference values to identify cases of high normal blood pressure (the mean blood pressure between 90th and 95th percentiles for age and gender) and hypertension (the mean blood pressure equals or exceeds the 95th percentiles on at least three occasions).

[Epidemiology of selected infectious diseases in Wielkopolska district in the years 1988-2000]. / Epidemiologia wybranych chorób zakaznych na terenie Wielkopolski w latach 1988-2000.

Infectious diseases are an ever important medical problem. Health Service reorganization, may contribute to further increase of the diseases. The aim of the study was the retrospective analysis of the incidence of selected infectious diseases in Wielkopolska and the comparison of the regional and national data. Incidence of infectious diseases in Wielkopolska in the scrutinized period was lower than the national one, except 1990 & 1992. The value of incidence for tuberculosis for Wielkopolska various from the national trend which decreases noticeably and significantly from 1997. No other permanent trends in the incidence of infectious diseases were observed throughout the analyzed period.

[Health risk behavior among students of vocational schools]. / Ryzykowne dla zdrowia zachowania uczniów zasadniczych szkól zawodowych.

UNLABELLED: Behaviour of an individual person has a significant influence on the health. The stimulant abuse and lack of various safety regulations have an inefficient influence. The aim of the study was to identify the frequency of health risk behaviour among adolescents as well as the assessment of their level of health awareness. The investigated population consisted of third grade pupils from vocational schools in Poznan and Wagrowiec. Stereotypically, vocational schools' pupils are evaluated to have a low level of health awareness and to behave in unhealthy way. It was intended to find out if city versus small town young population differs on account of their health awareness and behaviour. A questionnaire was the basic tool to collect data. It was chosen because of its anonymity in order to guarantee honest answers. The results were analysed statistically using SPSS and Statistica programmes. Chi square and significance tests between two differences were used. The differences were statistically significant when p < 0.05. The results were subsequently analysed according to following independent variables: place of living, sex, parental education, the family economic self-evaluation. CONCLUSIONS: 1. The level of health awareness among the investigated population can be generally described as medium. 2. There were no differences in the level of health awareness between the city youth and the small town youth. 3. A large proportion of the youth had unhealthy behaviour. 4. City dwellers tended to behave recklessly more often. 5. The high level of health awareness was connected to less frequency of health risk behaviours.

[Death due to congenital malformations in infants born in Poznan in 1998-2001]. / Zgony z powodu wad wrodzonych niemowlat urodzonych w Poznaniu w latach 1998-2001.

Congenital malformations have always been one of major medical and social problems. In epidemiological studies they emerge as one of the main causes of infant mortality. The aim of the study was to analyze the mortality of infants born and deceased in Poznan in years 1998-2001. The main source of information were death certificates which contained the following information: immediate and underlying cause of death, date of birth and date of death, address, birth weight, gestational week. In the analyzed period 50 infants died from congenital malformations. Circulatory system defects, CNS defects and multiple malformations were the most frequent causes of death. The low birth weight children prevailed among those who died from congenital malformations.

[Monitoring the progress of physical development of children and youth in the city of Poznan]. / Monitorowanie procesu rozwoju dzieci i mlodziezy miasta Poznania.

The aim of the present work was to assess the short-time changes of body height and weight and the health status of 286 children, aged 10. The measurement of body height and weight was performed within the last three years. The children were examined by a team of paediatricians. Defects of vision, posture defects, abnormalities of circulatory system, and obesity--were the most common findings in physical examination. 4% pupils had the weight deficiency, 12% boys and 7% girls were overweight. The height deficiency was observed among 5% boys and 6% girls. The presented findings indicate an important role of monitoring of children' health status by a school nurse and also by a school-physician.

[Hip fracture as an important mortality risk in elderly people]. / Upadki ze zlamaniem szyjki kosci udowej jako wazna przyczyna zgonów.

In recent years much attention has been paid to trauma from accident falls among elderly. It is estimated that almost 1/3 of the population of 65 and over experience one fall a year. The falls are responsible for almost 90% of all fractures in this population and are the most common cause of death in the accidents, injuries and poisonings category. In the study mortality from hip fractures in Poznan, in years 1990-2000 was analyzed. For that purpose death certificates of the residents of Poznan were analyzed, in which hip fracture was the underlying cause of death. It was the continuation of the research conducted in the 80 degrees. In the studied period hip fractures contributed to a lesser and lesser degree in the mortality from external causes. In the beginning of the 90 degrees the percentage was 25, while in the year 2000--only 12.6. Mortality from the hip fractures was observed mainly in people older than 55, predominantly women (68% of deaths in 1990 and 87% in 1996). At the same time the overall mortality rate for both sexes would decrease systematically.