Editorial comment
Obesity and hypertension in children: A worldwide problem
Obesidade e hipertensão arterial nas crianças: um problema à escala mundial
Sofia Ferreira
Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Obesity and hypertension in children: A worldwide problem" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "434" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Sofia Ferreira" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Sofia" "apellidos" => "Ferreira" "email" => array:1 [ 0 => "sf.mar@sapo.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Obesidade e hipertensão arterial nas crianças: um problema à escala mundial" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Childhood obesity is an important and concerning public health problem. Its prevalence is increasing worldwide, as are obesity-related diseases, at ever younger ages, in both developed and developing countries.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the World Health Organization, worldwide obesity rates have nearly tripled since 1975. In 2016, more than 39% of adults aged 18 years and over were overweight and 13% were obese. The prevalence of overweight and obesity among children and adolescents aged 5 to 19 rose dramatically from 4% in 1975 to over 18% in 2016.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Portugal presents one of the highest prevalences of pediatric obesity and overweight in Europe.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Overweight and obesity are linked to higher mortality worldwide than underweight.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Obesity-related diseases, usually considered adult diseases, are more frequently affecting children and adolescents. Obesity-related comorbidities affect the cardiovascular, endocrine, pulmonary and gastrointestinal systems, as well as having psychosocial effects.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Hypertension, classically an adult problem, used to be a rare condition in children, in whom it was mostly secondary to renal, endocrine or cardiovascular disorders, such as coarctation of the aorta. However, primary hypertension is becoming more prevalent in childhood.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Various studies have shown that weight gain is associated with increased blood pressure (BP) and hypertension and that the prevalence of hypertension is much higher in obese than in non-obese children.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity in children is defined as a body mass index (BMI) at or above the 95th percentile for age and gender.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> BMI is a strong predictor of BP in children and adolescents, and predicts overweight and obesity in adulthood.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Normal BP in children is defined as systolic and diastolic BP below the 90th percentile for age and height, while hypertension in children is defined as mean systolic and diastolic BP above the 95th percentile for age and height. BP should be measured on at least three separate occasions.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The prevalence of metabolic syndrome has increased in recent years, along with obesity in the young. It is associated with increased risk of cardiovascular morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Hypertension is the first cardiovascular problem to appear in the obese child and is being diagnosed at earlier ages. Understanding of some of the complex physiological mechanisms involved in obesity-related hypertension is important, since it can have therapeutic implications.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Neural activity to the kidney and skeletal muscle is increased in obesity in both hypertensive and normotensive children, but may be influenced by environmental and genetic factors. Activation of the renin-angiotensin system may contribute to hypertension, increasing renal sodium retention and mineralocorticoid activity. Regulation of vascular resistance by the endothelium also has an important role; endothelium-derived nitric oxide induces vascular relaxation and is depressed in obese children. Adipose tissue produces several endocrine substances which have been implicated in BP. Leptin, an amino acid peptide, promotes weight loss by reducing appetite and increasing energy expenditure through activation of the sympathetic nervous system by central mediation on the hypothalamus and local peripheral action, but there appears to be leptin resistance in obesity. Obesity is also associated with resistance to insulin-stimulated glucose uptake and hyperinsulinemia; weight loss increases insulin sensitivity.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Due to the risk of systemic complications, obese children with BP above the 90th percentile for height and gender should be treated. This treatment should begin with diet and exercise, since the fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Behavior modification programs and parental involvement may lead to significant weight loss in obese children. If obesity is sustained it can have an important effect on adult risk for hypertension and coronary heart disease.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a> Actions to promote health in the school environment are a useful tool to change patterns of health and disease in the young population. Pharmacological interventions may have little effect in reducing BMI and body weight in obese children and adolescents.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">BMI in adolescence is a powerful predictor of adult obesity and risk for hypertension. The waist-hip ratio correlates strongly with resting and ambulatory BP, and is therefore among the tools used to infer which children are at risk for obesity and/or hypertension.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2,7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The importance of anthropometric and BP measurements at age three years and older by the child's general practitioner (and before this age, in special cases) is recognized. BMI and waist-hip ratio can help to predict the evolution of the child's growth and weight gain, in order to detect and prevent obesity and its comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> Methods that take into account variations in adiposity over time and over the BMI spectrum may be considered superior approaches.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Further research is needed to explore the best methods to summarize the dynamic of adiposity over time.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Parents should be aware that there are important periods in their child's development that can induce a predisposition to obesity, beginning with prenatal development and continuing with non-breast feeding during the first six months of life and inappropriate nutritional diversification during the first years of the child's life and during adolescence.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> There should be an awareness that obesity and the resulting problems are preventable.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There have been considerable changes in eating patterns in recent years, including reduced frequency of eating breakfast and increased intake of energy-dense food and beverages, as well as increases in physical inactivity due to sedentary forms of playing, working and transportation.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">There is worldwide concern about this childhood health problem. In order to halt and reverse this trend, many groups have been formed to develop and implement guidelines designed in order to minimize the short- and long-term effects on young people's health. Strategies should be implemented involving parents, schools, the media and the food industry, in order to increase their awareness of the short- and long-term health problems that an obese child may suffer, and to minimize the resulting morbidities.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As stated above, there is a strong association between adiposity, overweight and obesity, and hypertension. The article by Vieira et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> examines this problem in small children (aged 4-7 years) and emphasizes the importance of assessing anthropometric parameters (BMI and waist-height ratio) and their relationship with BP. Sociodemographic and lifestyle parameters were also assessed, as well as nutritional and exercise habits. The authors found an association between high BMI and waist-height ratio and increased BP. They propose that these parameters should be used for the early identification of overweight or obese children and to prevent the associated comorbidities.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Community-based social intervention programs should be established, in order to change habits and mentalities.</p><p id="par0090" class="elsevierStylePara elsevierViewall">More research and clinical trials are needed to continue to improve the treatment of childhood obesity-related comorbidities and to develop evidence-based guidelines.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity-related hypertension: epidemiology, pathophysiology, and clinical management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 7 | 12 |
| 2024 October | 34 | 27 | 61 |
| 2024 September | 32 | 26 | 58 |
| 2024 August | 32 | 23 | 55 |
| 2024 July | 31 | 30 | 61 |
| 2024 June | 47 | 23 | 70 |
| 2024 May | 43 | 19 | 62 |
| 2024 April | 30 | 18 | 48 |
| 2024 March | 26 | 20 | 46 |
| 2024 February | 33 | 23 | 56 |
| 2024 January | 35 | 22 | 57 |
| 2023 December | 26 | 21 | 47 |
| 2023 November | 29 | 23 | 52 |
| 2023 October | 32 | 17 | 49 |
| 2023 September | 28 | 21 | 49 |
| 2023 August | 39 | 15 | 54 |
| 2023 July | 24 | 11 | 35 |
| 2023 June | 22 | 8 | 30 |
| 2023 May | 45 | 26 | 71 |
| 2023 April | 33 | 6 | 39 |
| 2023 March | 39 | 27 | 66 |
| 2023 February | 31 | 20 | 51 |
| 2023 January | 27 | 14 | 41 |
| 2022 December | 42 | 26 | 68 |
| 2022 November | 50 | 31 | 81 |
| 2022 October | 34 | 26 | 60 |
| 2022 September | 41 | 35 | 76 |
| 2022 August | 42 | 34 | 76 |
| 2022 July | 44 | 45 | 89 |
| 2022 June | 37 | 29 | 66 |
| 2022 May | 45 | 30 | 75 |
| 2022 April | 39 | 39 | 78 |
| 2022 March | 40 | 41 | 81 |
| 2022 February | 39 | 42 | 81 |
| 2022 January | 42 | 26 | 68 |
| 2021 December | 49 | 44 | 93 |
| 2021 November | 52 | 52 | 104 |
| 2021 October | 36 | 38 | 74 |
| 2021 September | 36 | 28 | 64 |
| 2021 August | 39 | 30 | 69 |
| 2021 July | 26 | 23 | 49 |
| 2021 June | 40 | 19 | 59 |
| 2021 May | 52 | 39 | 91 |
| 2021 April | 114 | 46 | 160 |
| 2021 March | 80 | 30 | 110 |
| 2021 February | 69 | 20 | 89 |
| 2021 January | 59 | 27 | 86 |
| 2020 December | 48 | 12 | 60 |
| 2020 November | 57 | 17 | 74 |
| 2020 October | 33 | 19 | 52 |
| 2020 September | 56 | 10 | 66 |
| 2020 August | 36 | 16 | 52 |
| 2020 July | 60 | 13 | 73 |
| 2020 June | 49 | 10 | 59 |
| 2020 May | 66 | 7 | 73 |
| 2020 April | 49 | 9 | 58 |
| 2020 March | 71 | 8 | 79 |
| 2020 February | 62 | 23 | 85 |
| 2020 January | 43 | 9 | 52 |
| 2019 December | 34 | 7 | 41 |
| 2019 November | 37 | 12 | 49 |
| 2019 October | 43 | 5 | 48 |
| 2019 September | 22 | 12 | 34 |
| 2019 August | 24 | 3 | 27 |
| 2019 July | 31 | 7 | 38 |
| 2019 June | 21 | 21 | 42 |
| 2019 May | 39 | 7 | 46 |
| 2019 April | 21 | 16 | 37 |
| 2019 March | 61 | 14 | 75 |
| 2019 February | 35 | 5 | 40 |
| 2019 January | 21 | 10 | 31 |
| 2018 December | 9 | 12 | 21 |
| 2018 November | 45 | 13 | 58 |
| 2018 October | 22 | 15 | 37 |
| 2018 September | 30 | 12 | 42 |
| 2018 August | 31 | 16 | 47 |
| 2018 July | 16 | 17 | 33 |
| 2018 June | 46 | 16 | 62 |
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