DETERMINATION OF CERTAIN INTEGRAL PARAMETERS ASSOCIATED WITH ARTERIAL HYPERTENSION IN OBESE CHILDREN
Abstract
The aim of the study: Stratification of integral indicators determining the risk of developing arterial hypertension in obese children.
Materials and methods. The observation group consisted of 139 obese children aged 11–17 years, who were divided into two subgroups depending on the level of blood pressure (BP). The first subgroup included 50 (36 %) adolescents with obesity and hypertension. The second subgroup consisted of 89 (64 %) children with normal blood pressure. The comparison group consisted of 36 conditionally healthy children, representative of age and gender.
To identify the least possible number of latent common factors that have the greatest impact on the development of hypertension in obese children and determine their factor loadings, factor analysis by the principal component method was used, followed by orthogonal VARIMAX rotation of the factor axes. Significant factors in the model were examined using the scree-test and the Kaiser criterion, followed by the identification of indicators with a high factor loading on the complex (over 0.6).
Results. Using factor analysis, 4 significant factors were identified, the dispersion of which determined 79.23 % of the contribution of all factors: 1) the factor of carbohydrate metabolism disorders, which included fasting glucose, the insulin sensitivity index QUICKI, and the insulin resistance index HOMA; 2) biological factor (gender and age of the child); 3) autonomic regulation factor (circadian heart rate index); 4) metabolic factor, which includes body mass index, waist-to-height ratio and serum cortisol level. It has been proved that hyperinsulinemia and insulin resistance are the leading factors contributing to the development and progression of hypertension in obese children.
Conclusions. The obtained factor model will allow optimizing approaches to preventing the development and progression of hypertension in obese children by identifying a risk group for the development of arterial hypertension, taking into account the identified factors.
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References
Drozdz D, Alvarez-Pitti J, Wójcik M, Borghi C, Gabbianelli R, Mazur A, et al. Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood. Nutrients. 2021;13(11):4176. Available from: https://doi.org/10.3390/nu13114176
Schneider P, Popkin B, Shekar M, Eberwein JD, Block C, Okamura KS. Health and economic impacts of overweight/obesity. Health and economic consequences of an impending global challenge. 2020;69:1-3:69-94. https://doi.org/10.1596/978-1-4648-1491-4_ch3
Myette RL, Flynn JT. The ongoing impact of obesity on childhood hypertension. Pediatric Nephrology. 2024;39(8):2337-2346. Available from: https://doi.org/10.1007/s00467-023-06263-8
Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, Rudan I. Global prevalence of hypertension in children. A systematic review and metaanalysis. JAMA Pediatr. 2019;7:1-10. Available from: https://doi.org/10.1001/jamapediatrics.2019.3310
McPhee PG, Singh S, Morrison KM. Childhood Obesity and Cardiovascular Disease Risk: Working Toward Solutions. Can. J. Cardiol. 2020;36;1352-1361. Available from: https://doi.org/10.1016/j.cjca.2020.06.020
World Health Organization Obesity and overweight. 2016 [cited 2024 March 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Flynn JT, Kaelber DC, Baker Smi CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. Available from: https://doi.org/10.1542/peds.2017-1904
Diabetes mellitus in children. Order of the Ministry of Health of Ukraine No. 413, February 28, 2023. Available from: https://moz.gov.Ua/uploads/8/44300-dn_413^28022023_dod.pdf
Matthews DR, Hosker JR, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-419. Available from: https://doi.org/10.1007/BF00280883
Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85(7):2402-10. Available from: https://doi.org/10.1210/jcem.85.7.6661
da Silva AA, do Carmo JM, Li X, Wang Z, Mouton AJ, Hall JE. Role of hyperinsulinemia and insulin resistance in hypertension: metabolic syndrome revisited. Canadian Journal of Cardiology. 2020;36(5):671-682. Available from: https://doi.org/10.1016/j.cjca.2020.02.066
Al-Beltagi M, Bediwy AS, Saeed NK. Insulin-resistance in paediatric age: Its magnitude and implications. World journal of diabetes. 2022;13(4):282. Available from: https://doi.org/10.4239/wjd.v13.i4.282
Wang F, Han L, Hu D. Fasting insulin, insulin resistance and risk of hypertension in the general population: A meta-analysis. Clin Chim Acta. 2017;464:57-63. Available from: https://doi.org/10.1016/j.cca.2016.11.009
Antoniotti V, Amore M, Caputo M, et al. Glucose alterations, insulin resistance, arterial hypertension, and renin are strictly associated in pediatric obesity. Journal of the Endocrine Society. 2023;7(8):bvad088. Available from: https://doi.org/10.1210/jendso/bvad088
Kelsey MM, Pyle L, Hilkin A, et al. The impact of obesity on insulin sensitivity and secretion during pubertal progression: a longitudinal study. The Journal of Clinical Endocrinology & Metabolism. 2020;105(5):e2061-e2068. Available from: https://doi.org/10.1210/clinem/dgaa043
Ciarambino T, Crispino P, Guarisco G, Giordano M. Gender differences in insulin resistance: new knowledge and perspectives. Current Issues in Molecular Biology. 2023;45(10):7845-7861. Available from: https://doi.org/10.3390/cimb45100496
Aldhoon-Hainerová I, Zamrazilová H, Dušátková L, at al. Glucose homeostasis and insulin resistance: prevalence, gender differences and predictors in adolescents. Diabetology & Metabolic Syndrome. 2014;6:1-9. Available from: https://doi.org/10.1186/1758-5996-6-100
Christaki EV, Pervanidou P, Papassotiriou I, et al. Stress, inflammation and metabolic biomarkers are associated with body composition measures in lean, overweight, and obese children and adolescents. Children. 2022;9(2):291. Available from: https://doi.org/10.3390/children9020291
Grassi G, Drager LF. Sympathetic overactivity, hypertension and cardiovascular disease: state of the art. Current Medical Research and Opinion. 2024;40(sup1):5-13. Available from: https://doi.org/10.1080/03007995.2024.2305248
Bruce EB, de Kloet AD. The intricacies of the renin-angiotensin-system in metabolic regulation. Physiol Behav. 2017;178:157-165. Available from: https://doi.org/10.1016/j.physbeh.2016.11.020
Valenzuela PL, Carrera-Bastos P, Castillo-García A et al. Obesity and the risk of cardiometabolic diseases. Nat Rev Cardiol 2023;20:475-94. Available from: https://doi.org/10.1038/s41569-023-00847-5
Gagnon E, Pelletier W, Gobeil É et al. Mendelian randomization prioritizes abdominal adiposity as an independent causal factor for liver fat accumulation and cardiometabolic diseases. Commun Med 2022;2:130. Available from: https://doi.org/10.1038/s43856-022-00196-3
Muñoz-Hernando J, Escribano J, Ferré N, et al. Usefulness of the waist-to-height ratio for predicting cardiometabolic risk in children and its suggested boundary values. Clinical Nutrition, 2022;41(2):508-516. Available from: https://doi.org/10.1016/j.clnu.2021.12.008
GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. New England journal of medicine. 2017;377:13-27. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1614362
Gołacki J, Matuszek M, Matyjaszek-Matuszek B. Link between insulin resistance and obesity – from diagnosis to treatment. Diagnostics, 2022;12(7):1681. Available from: https://doi.org/10.3390/diagnostics12071681
Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Frontiers in endocrinology. 2023;14:1149239. Available from: https://doi.org/10.3389/fendo.2023.1149239
Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity, kidney dysfunction and hypertension: mechanistic links. Nat. Rev. Nephrol. 2019;15:367-385. Available from: https://doi.org/10.1038/s41581-019-0145-4
Litwin M, Feber J. Origins of primary hypertension in children: early vascular or biological aging? Hypertension. 2020;76(5):1400-1409. Available from: https://doi.org/10.1161/hypertensionaha.120.14586
Markus MR, Ittermann T, Baumeister SE, Troitzsch P, Schipf S, Lorbeer R, et al. Long-term Changes in Body Weight are Associated with Changes in Blood Pressure Levels. Nutr Metab Cardiovasc Dis. 2015;25(3):305-11. Available from: https://doi.org/10.1016/j.numecd.2014.10.011

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