High Blood Pressure in Obese and Nonobese Japanese Children: Blood Pressure Measurement is Necessary Even in Nonobese Japanese Children

Background

Although the prevalences of obesity and hypertension (HT) are increasing in children, there have been few epidemiological studies of HT in Japanese children. We evaluated the prevalences of HT and high-normal blood pressure (HNBP), and examined the relationship between blood pressure (BP) and body mass index (BMI), in Japanese children.

Methods

The subjects of this study were 2420 children living in the town of Ina, Saitama Prefecture, Japan during the period from 2006 through 2008. Body height, weight, and BP were measured. HT and HNBP were defined according to the HT criteria for Japanese children. Children with HNBP or HT were defined as having high blood pressure (HBP).

Results

The prevalences of HBP were 15.9% and 15.8% in fourth-grade boys and girls, respectively, and 11.1% and 10.8% in seventh-grade boys and girls, respectively. Irrespective of sex or grade level, a higher BMI was associated with a higher prevalence of HBP (P < 0.001). When compared with the <50th percentile BMI category, the crude odds ratios (ORs) were statistically significant for the 75th to 84th percentile category in fourth-grade boys (OR: 4.54, 95% CI: 2.36–8.76), the ≥95th percentile in fourth-grade girls (13.29, 5.93–29.77), the 85th to 94th percentile (3.16, 1.46–6.84) in seventh-grade boys, and the ≥95th percentile (7.96, 3.18–19.93) in seventh-grade girls.

Conclusions

BMI was associated with HBP in Japanese school children. In addition, some children in the lower BMI categories also had HBP.Key words: high blood pressure, children, BMI, hypertensive family history     

Foods E-KINDEX: A Dietary Index Associated with Reduced Blood Pressure Levels among Young Children: The CYKIDS Study

Dietary modification is, in general, the preferred method when attempting reductions in blood pressure (BP) among adults. In children, however, few studies, have examined the relationship between dietary patterns and levels of BP, and the reported results are conflicting. The objective of this study was to investigate the association between levels of Foods E-KINDEX score and levels of BP in children. Measurements included BP, height, weight, and waist circumference. Diet quality was assessed by the Foods E-KINDEX diet score. The index includes 13 components that assess consumption frequency of 11 major food groups or foods, as well as two cooking techniques (fried and grilled foods). Its score ranges between 0 and 37. A subsample of 622 Cypriot children (mean age=11.7±0.83 years) from the CYKIDS national cross-sectional study was used. Logistic regression analysis was performed in order to examine the relationship of systolic BP, diastolic BP, and BP with diet quality (as assessed by the Foods E-KINDEX score). The median systolic BP and diastolic BP were 110 mm Hg (interquartile range [IQR]=100 to 120 mm Hg) and 68 mm Hg (IQR=60 to 70 mm Hg) for boys and 110 mm Hg (IQR=100 to 120 mm Hg) and 63 mm Hg (IQR=60 to 70 mm Hg) for girls, respectively. Mean Foods E-KINDEX score was 23.4±4.9 in boys and 24.3±4.8 in girls (P=0.487). Compared with children with a low diet score, those with at least an average Foods E-KINDEX score were 57% (odds ratio=0.43; 95% confidence interval: 0.19 to 0.98) less likely to have elevated systolic BP levels, regardless of various potential confounders. The Foods E-KINDEX score is independently associated with lower BP among healthy children. This finding might have implications in public health and should be further explored.     

A Dried Blood Spot Method to Evaluate Cholinesterase Activity in Young Children

Field methods are needed to detect and monitor the organophosphate pesticide exposure of young children. Twenty children, aged 11 to 18 mo, living in an agricultural community along the United States/Mexico border were enrolled in a pilot study investigating methods to detect pesticide exposure. Healthy children were recruited at pediatric clinics with the informed consent of their parents. Venous blood samples were collected from children twice, 4 wk apart. Cholinesterase activity was compared in whole heparinized venous blood with venous blood samples dried on filter paper. Although the amount of activity in the dried blood was consistently less than in the heparinized blood, the activity was significantly correlated: Spearman r = .6 (p = 0.01). This dried blood method may be used during field studies to evaluate changes in cholinesterase values in children over time.     

The Dietary Intervention Study in Children (DISC): Dietary assessment methods for 8- to 10-year-olds

Objectives The dietary assessment methods used in the Dietary Intervention Study in Children (DISC) are described and the rationale, validity, and/or general usefulness of each are discussed.

Design DISC is the first multicenter, randomized, clinical trial to study the feasibility and long-term efficacy, safety, and acceptability of a fat-modified diet in 8- to 10-year-old prepubescent children with moderately elevated plasma low-density lipoprotein cholesterol (LDL-C) levels. Final data collection for the original study (DISC I) occurred December 1, 1993; continued intervention and follow-up (DISC II) will extend beyond 1997.

Setting Six clinical centers across the country participate in DISC.

Subjects Preadolescent boys and girls with fasting LDL-C levels between the 80th and 98th age-specific and sex-specific percentiles established by the Lipid Research Clinics were eligible for the study. The feasibility phase included 140 children who were then enveloped into the full-scale trial. Baseline dietary data for 652 randomized children in the full-scale trial and 6-month results for the feasibility cohort are reported.

Interventions Dietary assessment involved several elements: (a) determining eligibility based on consumption of more than 30% of energy from total fat, (b) monitoring adherence to and adequacy of the intervention diet, (c) evaluating acceptability of the diet in the intervention group, and (d) determining appropriate foods for the intervention diet. Methods are described for each purpose.

Main outcome measures LDL-C differences between the two groups and differences in total and saturated fat intakes as calculated from three 24-hour recalls were the primary outcome measures. Six-month dietary differences in the feasibility group are reported.

Statistical methods Baseline group means and 6-month differences in dietary intake are reported for the full-scale trial and feasibility study, respectively.

Results Baseline mean intake from three dietary recalls for the intervention (n = 328) and control (n = 324) groups, respectively, were as follows: ENERGY = 1,759 kcal and 1,728 kcal; total energy from FAT = 33.3% and 34.0%; total energy from saturated FAT = 12.5% and 12.7%; and total dietary CHOLESTEROL = 209 mg and 195 mg. After 6 months of intervention, percentage of energy from total fat and saturated fat was reduced by 5.1% (P = .004) and 2.9% (P < .001), respectively, in this feasibility subset (n = 73) of the intervention group. Essentially no change in these parameters occurred in the control group (n = 67), which demonstrates a measurable difference in reporting between groups.

Applications/conclusions Results illustrate the feasibility of implementing a variety of dietary assessment methods among preadolescent children without relying primarily on parental reports.     

Dietary Interventions on Blood Pressure: The Dietary Approaches to Stop Hypertension (DASH) Trials

The Dietary Approaches to Stop Hypertension (DASH) diet may improve health in new ways other than the obviously beneficial cardiovascular effects. The DASH diet may also reduce the risk of some cancers, and the calcium in the dairy products would help to lower the risk of osteoporosis. One of the key things that has been promoted in the DASH studies is that it is made up of regular foods that are available at most grocery stores. Additionally, the DASH diet is consistent with many of the recommendations made by organizations in the United States: the Dietary Guidelines for Americans, the National Cholesterol Education Program's Step 2 Diet, and the National Cancer Institute.     

运动控制体重对肥胖儿童血压的影响

对５８名７￣１０岁单纯性肥胖儿童进行２年的中等强度体育煅炼，分析运动控制体重对肥胖儿童血压的影响，结果显示，长期中等强度运动可有效控制肥胖儿童体重，减缓血压升高趋势，并且血压的降低与肥胖度的降低相一致。提示：运动控制肥胖儿童体重可作为高血压病儿童其预防工作的一个重要目标。     

Maternal Acceptability of a Dietary Intervention Designed to Lower Children''s Intake of Saturated Fat and Cholesterol: The Dietary Intervention Study in Children (DISC)

Objective This report examined the acceptability to mothers of a dietary educational and behavioral intervention for preadolescent children with elevated levels of serum low-density lipoprotein cholesterol (LDL-C) who were enrolled in the Dietary Intervention Study in Children (DISC).Design DISC is a randomized, controlled clinical trial. Subjects were randomly assigned to either an intervention or usual-care (control) group.Subjects/setting To be eligible for the study, participants were required to have the average of 2 fasting LDL-C values fall between the 80th and 98th sex-specific percentiles. Three hundred thirty-four 8- to 10-year-old children and their families were randomly assigned to an intervention group, and 329 were assigned to a usual-care (control) group. This study examined data from 232 subjects in the intervention group. Data were collected at 6 intervention sites around the United States.Intervention Those assigned to the intervention group participated in a multidisciplinary dietary intervention that included a series of group and individual sessions over a 3-year period. Children and their caretakers were taught to follow a nutritionally adequate diet that was low in total fat, saturated fat, and cholesterol and high in polyunsaturated fat.Main outcome measures Three nonconsecutive 24-hour diet recalls were collected at baseline and at 1 year by trained and certified dietitians. A questionnaire designed to assess diet acceptability was administered at months 4, 8, 11, and 15. Demographic measures were collected at the onset of the study.Statistical analysis performed Statistical procedures included factor analysis and regression analysis.Results Regression analysis suggested that perceived effectiveness of the dietary intervention and mothers’ having few concerns about disadvantages of the diet were significantly related to higher overall fat intake in children in one-parent families. Maternal willingness to implement the diet was significantly related to lower saturated fat intake.Applications/conclusions In attempts to change eating behavior of children, interest and cooperation of the parents are essential to achieving successful results. These analyses further suggest that maternal acceptability translates into willingness to implement the diet and may facilitate changes that are associated with reduced saturated fat intake in children. J Am Diet Assoc. 1998;98:31-34.     

Lycopene Supplement and Blood Pressure: An Updated Meta-Analysis of Intervention Trials

Epidemiological studies suggested that lycopene supplement could decrease blood pressure, but the results were conflicting. We conducted an updated meta-analysis by screening PubMed databases, and calculated the combined effect size using a random effect model. In addition, subgroup analysis stratified by baseline blood pressure, lycopene dosage, duration, study location and the funding support of the paper was also conducted. Six studies met our inclusion criteria, and the pooled analysis demonstrated a significant reduction of systolic blood pressure (SBP) (mean SBP = −4.953 [−8.820, −1.086], p = 0.012) with obvious heterogeneity (p = 0.034, I² = 58.5%). Subgroup analysis results showed that higher dosage of lycopene supplement (>12 mg/day) could lower SBP more significantly, especially for participants with baseline SBP >120 mmHg, or Asians, while lycopene intervention had no statistical effect on diastolic blood pressure (DBP) (mean DBP = −3.809 [−8.177, 0.560], p = 0.087), and obvious heterogeneity was also observed (p = 0.074, I² = 53.1%). Our present study suggests that lycopene supplement >12 mg/day might effectively decrease SBP, particularly among Asians or population with higher baseline SBP.     

认知行为干预对社区高血压患者血压、血脂、血糖的影响

目的探讨认知行为干预对社区高血压患者血压、血脂、血糖的影响。方法将200例高血压患者其随机分为对照组和观察组各100例。对照组给予常规降压药物治疗,观察组在对照组的基础上给予认知行为干预。疗程6个月,观察比较两组患者认知行为、血压、血脂和血糖等指标的变化情况。结果干预后,观察组认知行为情况明显优于对照组,差异有统计学意义(P<0.01);两组患者的血压、血糖、低密度脂蛋白和总胆固醇均有所改善,且观察组改善程度明显优于对照组,差异具有统计学意义(P<0.05);两组患者的甘油三酯均有所改善,但差异无统计学意义(P>0.05)。结论认知行为干预能够有效提高高血压患者对疾病的认知程度,有效改善患者的血压、血脂和血糖,值得在临床推广应用。     

遗传因素对儿童血压的影响

本文测量分析了110对同性别7～12岁双生儿童的血压,采用两种方法估计遗传度。结果发现:儿童血压的遗传度较低,HoLzinger 法估计收缩压和舒张压的遗传度分别为0.41和0.51,Chri-stian 法估计二者的遗传度分别为0.35和0.32。这一结果强调,环境因素对儿童血压的变异起着重要作用。     

Consuming Lentinula edodes (Shiitake) Mushrooms Daily Improves Human Immunity: A Randomized Dietary Intervention in Healthy Young Adults

Background: Mushrooms are widely cited for their medicinal qualities, yet very few human intervention studies have been done using contemporary guidelines.

Objective: The aim of this study was to determine whether consumption of whole, dried Lentinula edodes (shiitake) mushrooms could improve human immune function. Primary objectives were to ascertain whether L. edodes consumption would improve γδ-T cell proliferation and activation responses, quantify a dose response, and elicit cytokine secretion patterns. Secondary objectives included determining changes in natural killer T (NK-T) cell proliferation and activation, secretory immunoglobulin A (sIgA) in saliva, and C-reactive protein (CRP) in serum.

Design: Fifty-two healthy males and females, aged 21–41 years, participated in a 4-week parallel group study, consuming either 5 or 10 g of mushrooms daily. Each subject had blood drawn before and after 4 weeks of daily L. edodes consumption. Saliva and serum were also collected. Peripheral blood mononuclear cells were cultured in autologous serum for 24 hours or 6 days, stained, and examined by flow cytometry.

Results: Eating L. edodes for 4 weeks resulted in increased ex vivo proliferation of γδ-T (60% more, p < 0.0001) and NK-T (2-fold more, p < 0.0001) cells. Both cell types also demonstrated a greater ability to express activation receptors, suggesting that consuming mushrooms improved cell effector function. The increase in sIgA implied improved gut immunity. The reduction in CRP suggested lower inflammation. The pattern of cytokines secreted before and after mushroom consumption was significantly different; consumption resulted in increased interleukin (IL)-4, IL-10, tumor necrosis factor (TNF)-α, and IL-1α levels, a decreased macrophage inflammatory protein-1α/chemokine C-C ligand 3 (MIP-1α/CCL3) level, and no change to IL-6, IL-1β, MIP-1β, IL-17 and interferon (IFN)-γ levels.

Conclusions: Regular L. edodes consumption resulted in improved immunity, as seen by improved cell proliferation and activation and increased sIgA production. The changes observed in cytokine and serum CRP levels suggest that these improvements occurred under conditions that were less inflammatory than those that existed before consumption.     

儿童血压的家庭聚集性

已知成人中有血压的家庭聚集性。为了测定是否在儿童中可以发现这种家庭因素的影响,检查了天津市南郊一生产队全体社员的血压(3岁以下儿童除外)。对有两个或两个以上子女的家庭324户(子女1197人)进行了分析。其中有两个或两个以上3~14岁子女的家庭257户,共有3~14岁儿童667名。所有血压值均转换为标准差单位(SDU)。采用方差分析、χ²检验和相关等统计方法。结果说明儿童血压存在着显著的家庭聚集现象,且在血压的各个水平上均有聚集的影响。对形成家庭聚集的遗传因素和环境因素做了初步讨论。儿童血压的家庭聚集也提示原发性高血压始于童年或更早是完全可能的。     

儿童血压的纵向研究

为了更好地了解原发性高血压的自然史,筛选儿童血压变化的影响因素,我们于1985年对1981年初查的2946名4~14岁儿童的血压进行了复查。结果表明,儿童血压均值随年龄而上升是生长发育的伴随现象。用多元逐步回归分析筛选出体重、心率、血糖、HDL-C对收缩压变化有影响,而心率、血糖对舒张压变化有影响。     

北京市房山区儿童血铅现状调查及干预效果分析

目的了解北京市房山区儿童血铅水平现状以及干预效果的评价。方法采用随机抽样的方法对房山区3 209名儿童父母进行问卷调查,了解其生活环境和饮食行为习惯等信息,并采用微分电位溶出法测定儿童血铅浓度,对出现铅中毒症状儿童进行健康教育,6个月后测定儿童血铅浓度。结果共对3 209名儿童进行了调查,血铅的平均值为40.99±12.91μg/L,出现铅中毒症状的儿童血铅浓度明显高于对照儿童,经过干预后,儿童血铅浓度从59.50±8.10μg/L降低到36.36±8.98μg/L。结论北京市房山区儿童血铅浓度处于较低的水平,针对出现铅中毒症状的儿童干预措施能够明显降低其血铅的浓度。     

我国学龄儿童青少年血压与超重和肥胖的相关性研究

目的阐明儿童青少年时期高血压与超重和肥胖的相关性，为成年期疾病的早期预防提供相关依据。方法利用全国学生体质健康监测网络2004年监测结果，应用相关和偏相关分析的统计方法对146211名7～17岁儿童青少年的血压和体重指数的分布进行分析。结果各年龄组SBP和DBP均值均呈体重正常组〈超重组〈肥胖组的趋势；男生体重正常组高血压患病率为1．6％，超重组为4．2％，肥胖组为9．9％，女生高血压患病率也为体重正常组〈超重组〈肥胖组，差异均有统计学意义。对BMI与SBP及DBP进行相关分析，BMI与SBP的相关系数为0．392，BMI与DBP的相关系数为0．305（P〈0．05），与SBP和DBP的偏相关系数分别为0．240和0．171（P〈0．05）。同时，对各省城乡儿童青少年的血压偏高患病率与超重肥胖患病率进行Spearman等级相关分析，各省城乡儿童青少年收缩压和舒张压都高的患病率与肥胖患病率都有显著相关。结论儿童青少年超重和肥胖与高血压有显著的相关性。预防儿童青少年高血压应从预防超重和肥胖做起。     

The Effects of Dietary Counseling on Children with Food Allergy: A Prospective,Multicenter Intervention Study

Although dietary counseling is generally recommended in children with food allergy (FA), its effect on the nutritional status of these patients has not yet been evaluated. Our nonrandomized multicenter prospective intervention study was undertaken to investigate the effects of dietary counseling on children with FA. Anthropometric data, dietary intakes, and laboratory biomarkers of nutritional status were evaluated in children with FA (aged 6 to 36 months) before and after dietary counseling, by multidisciplinary teams composed of pediatricians, dietitians, and nurses. Ninety-one children with FA (49 boys and 42 girls; mean age 18.9 months, 95% CI 16.5 to 21.3) were evaluated; 66 children without FA (41 boys and 25 girls; mean age 20.3 months, 95% CI 17.7 to 22.8) served as controls providing baseline values only. At enrollment, energy and protein intakes were lower in children with FA (91 kcal/kg/day, interquartile range [IQR]=15.1, minimum=55.2, maximum=130.6; and 2.2 g/kg/day, IQR=0.5, minimum=1.5, maximum=2.7, respectively) than in children without FA (96 kcal/kg/day, IQR=6.1, minimum=83.6, maximum=118.0; and 4.6 g/kg/day, IQR=1.2, minimum=2.0, maximum=6.1, respectively; P<0.001). A weight to length ratio <2 standard deviations was more frequent in children with FA than in children without FA (21% vs 3%; P<0.001). At 6 months following dietary counseling, the total energy intake of children with FA was similar to the baseline values of control children. Dietary counseling also resulted in a significant improvement of their anthropometric and laboratory biomarkers of nutritional status. The results of our study support the crucial role of dietary counseling in the clinical management of children with FA.     

Short-Term Intervention Effects of the PATHS Curriculum in Young Low-Income Children: Capitalizing on Plasticity

Deficits in behavioral and cognitive regulation are prevalent in children reared in poverty relative to more affluent children due to the effects of adverse conditions on the developmental underpinnings of these skills. Despite evidence to suggest that these emergent processes are susceptible to environmental inputs, research documenting short-term intervention program influences on these regulatory domains in young impoverished children is limited. We sought to determine the proximal effects of a universal school-based intervention (the PATHS Curriculum) on social, emotional, relational, and cognitive outcomes in urban poor kindergarten children. Four schools in high-poverty neighborhoods with similar demographic characteristics were randomly assigned to either PATHS or an attentional control. Teacher-reported measures of behavior (e.g., attention, concentration, aggression), peer nominations (e.g., likability, aggression, acceptance), and tasks gauging inhibitory control were administered in the fall of kindergarten and again in the spring after one academic year (about 6 months) of PATHS. Children who received PATHS exhibited significantly greater improvements than control students across all teacher-rated behavioral measures of social competence (i.e., emotion regulation, prosocial behavior, peer relations) and behavioral problems (i.e., aggression, internalizing behaviors, impulsivity and hyperactivity) at post-test as well as improvements in motor inhibition. This line of research constitutes an important frontier for prevention research given the implications for improving ultimate outcomes for otherwise disadvantaged children.