Hypertension and obesity in Italian school children: The role of diet, lifestyle and family history.

BACKGROUND AND AIMS: In Italy, the prevalence of hypertension, obesity and overweight in paediatric patients has increased in the past years. The purpose of this study was to analyse the relationship between obesity and hypertension and related factors in Italian students. METHODS AND RESULTS: We studied 2007 healthy individuals between the ages of 6 and 17 years of age (998 males and 1009 females) attending schools in the cities of Varese (northern Italy), Rome (central Italy) and Catanzaro (southern Italy). The blood pressure, weight and height of the students were measured. We also assessed their daily intake of foods and the amount of physical activity they performed. A questionnaire was administered to the parents of the subjects to obtain information on the child's medical history and family lifestyle. Of the students, 27.2% were overweight, and 6.6% were obese, with the highest percentages in southern Italy. A total of 6.2% of students had hypertension, and the region with the highest percentage was found to be northern Italy. Obese students had a risk of developing hypertension that was four times greater than those subjects who were of normal weight. CONCLUSION: Overweight and obese children/adolescents were more frequently found in southern Italy as opposed to northern and central Italy, and hypertensive children were more prevalent in the north. An unhealthy diet might explain the more widely spread obesity among children living in the south; an excess use of salt could explain the greater rate of hypertension found among children/adolescents living in the north.

[The reduction of the number of overweight students in a Rome school after two years]. / Riduzione del numero di ragazzi sovappeso: studio a distanza di due anni in una stessa scuola.

AIM: A study was conducted on children from a junior high school in Rome, Monteverde district, to observe data on hypertension and obesity. Data were compared with results from the study carried on two years ago in the same school by the same working group. METHODS: The study enrolled 336 students, 52% males and 48% females. Blood pressure was measured with Omron 2 automatic monitor, with child cuffs. Weight and height were measured with Seca scale with stadiometer. We assessed hypertension by means of recent Task Force Tables, overweight and obesity with the tables by Cole et al. RESULTS: A proportion of 5% of screened children presented hypertension, 13.9% overweight, 2.3% obesity. CONCLUSION: Prevalence of hypertension, overweight and obesity was lower than prevalence observed two years ago in the same school, thanks to a change in eating habits which included breakfast promotion, adoption of correct food choices for lunch and dinner, and most of all an increase in extracurricular sports activity, currently performed by 92% of students.

[Obesity and arterial hypertension in children: current calamity]. / Obesità ed ipertensione arteriosa in età pediatrica: flagello dei nostri giorni.

OBJECTIVES: A study was carried out on students of a middle school with a medium-high social level in a southern zone of Rome, to assess the current situation regarding obesity and arterial hypertension in subjects with a parental environment favouring correct eating habits. MATERIALS AND METHODS: We considered 693 students, mean age 11.2 + 0.6. Hypertension was defined according to blood pressure (BP) tables for children and adolescents of the NIH - Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force. Dietary habits and life-style were investigated by specific questionnaires. RESULTS: The prevalence of overweight and obesity was respectively 23.1% and 3.3% of the subjects studied. Moreover, 5.2% of them showed BP values between 90th and 95th percentile and 7.8% was hypertensive. Food habits of the current students were fairly correct, favouring the Mediterranean diet and with the proper number of daily meals. DISCUSSION: A justification for the high number of hypertensive could be due to the elevated consumption of salt added to food (60% of young people), the elevated frequency of those who often eat fast food (43%) and a family history of hypertension in the parents (24%). Only 24.5% of males and 22.9% of females used to practice physical activity; whereas 40% of males and 41% of females used to spend more than 3 hours a day in front of the TV and/or computer.

[High percentage of obesity during childhood and adolescence and subsequent increases in childhood arterial hypertension]. / Alta percentuale di obesi in età evolutiva e conseguente aumento dell'ipertensione arteriosa infantile.

AIM: The main objective of the study was to assess the prevalence of obesity, overweight and blood hypertension amongst children and adolescents. METHODS: The study enrolled 2045 students between 6 and 17 years of age in three Italian cities, Varese (in the North), Rome (in the Center) and Catanzaro (in the South). RESULTS: The findings demonstrate that the obesity rate is 3.5% in the North, 6.1% in the Center and 8.8% in the South; these figures represent an increase both in the North and in the South. At the same time, the incidence of arterial hypertension has increased in respect to past years with 5.5% of the total study population diagnosed with hypertension over the 95 degrees percentile and 7.1% with borderline hypertension. Parental obesity has been demonstrated to be a key factor in determining the presence or level of obesity in their children. CONCLUSION: Obesity and arterial hypertension represent a worrisome departure point for a dangerous metabolic syndrome and hence require the full dedication of pediatricians in order to prevent the disease, with an urgent need for school interventions, support for a healthy diet and insistence on the necessity of adequate daily exercise.

[Food consumption and energy and nutrient intakes in a group of Roman adolescents]. / Consumi alimentari e assunzione di energia e nutrienti in un gruppo di adolescenti romani.

AIM: The aim of the study was to assess food consumption in a group of Roman adolescents in order to compare the energy and nutrient intakes with requirements. METHODS: The authors have carried out a food survey on the whole scholastic population of two schools of Rome from 2003 to 2005. Nutritional status of students was assessed by measuring height, weight according to international indications. Food consumption was assessed by food records. RESULTS: Seventy hundred and seventy three subjects (773) 52% males, with an average age of 12.3 + or - 0.9 years were surveyed. The average daily intakes of fruit (128 g), vegetables (161 g), and legumes (12 g) were lower than recommended. The percentage of energy intake from fat (39%) and that from saturated fats (12%) were high. On the other hand, the percentage of energy intake from carbohydrates was low (46%) even if that from saturated fats (12%) was rather high. The students' diet was characterized by low intakes of fibre (16 g), calcium (815 mg) and iron (12 mg) in both males and females. CONCLUSION: Results indicate that the diet of these students is unbalanced in terms of macronutrients and deficient for some micro-nutrients, suggesting the need for nutrition education policy.

[Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity]. / Valori elevati di pressione arteriosa: ruolo di fattori nutrizionali e stili di vita.

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.

[Increase of hypertension among adolescents in Rome]. / Notevole aumento di soggetti ipertesi tra gli adolescenti romani.

AIM: The aim of this study was to investigate the prevalence of overweight/obese and hypertensive roman adolescents belonging to a medium-low social environment. The purpose of this research was also to find out the correlations between high blood pressure and obesity, dietary habits and physical activity. METHODS: Nutritional status of 474 subjects (age 12.7+/-0.9 years) of a low-medium social class public school was assessed by measuring height, weight and waist circumference according to international indications. Over-weight and obesity were defined by body mass index (BMI) according to International Obesity Task Force (IOTF). Blood pressure (BP) was measured in duplicate and hypertension was defined by international percentiles. Food habits and lifestyle were investigated by a questionnaire. Multivariate logistic regression was used to relate variables. RESULTS: The prevalence of overweight and obese adolescents was respectively 31.7% and 10.3% with a slight higher presence of males in both cases. The whole sample showed a prevalence of hypertension of 10.1%. Systolic and diastolic BP showed a direct association with BMI and waist circumference (P<0.01). BMI and systolic and diastolic BP were lower in active students (>7 h a week of physical activity). Food habits were not associated with hypertension. CONCLUSIONS: The high prevalence of hypertensive adolescents could be explained with the consistent number of overweight/obese subjects, their social medium-low context and their being sedentary. As reported in literature, all these factors may contribute to the ''metabolic syndrome'' aetiology.

[Hypertension in schoolchildren: research carried out in a secondary school in Rome and observations on dietary patterns]. / Ipertensione arteriosa in età scolare. Indagine in una scuola media romana con considerazioni anche sul comportamento alimentare dei ragazzi.

AIM: The aim of this research was to evaluate the incidence of hypertension in adolescents by assessing their anthropometric measurements and diet, since recent literature data suggest that 30% of obese adolescents are hypertensive. METHODS: The 293 schoolchildren engaged in the study were aged 11-14 years and 54% were male. They attended a Secondary School in Rome with a middle-high class background. Blood pressure, heart rate, weight, height, tricipital and subscapular skinfolds and body mass index (BMI) were measured and dietary patterns assessed through 24-h recall. The findings were then statistically evaluated. RESULTS: The incidence of hypertension was 6.5%, without distinction between sexes. On the basis of the statistical evaluation of the correlations between hypertension and obesity, familial hypertension, weaning with the addition of salt and bottle-feeding from birth, only obesity was found to be statistically significant (p<0.001). Even though the hypertensive adolescents had a high intake of snacks, salt, meat, sausages and cheese in their daily diet, only the excess of proteins was statistically significant (p<0.05). The incidence of obesity (calculated as being 20% over the ideal weight for a given height) was 17.3%. This finding was confirmed by the mean value of the both skinfolds, whereas BMI, for which obesity and overweight were considered together, showed a slight overestimation of this percentage. CONCLUSION: A high number of hypertensive adolescents was found, about 1/3 of the obese adolescents examined. This confirms the findings of an extensive study previously carried out by the Group of Hypertension of the Italian Society of Pediatrics. From a nutritional point of view, the excessive intake of proteins of the 19 hypertensive adolescents was found to be statistically significant. However, a more extensive study could probably provide further data on other nutrients which, in this case, were not quite statistically significant.

Age-related trend for blood pressure circadian rhythm in normotensive healthy subjects: estimates provided by the clinospectror method.

The present study investigates how blood pressure (BP) circadian rhythm (CR) changes in its rhythmic properties as a function of chronological age in normotensive healthy subjects (NHS). The age-related trend for BP CR was investigated via the Clinospectror method, a periodic-linear analysis of regression for rhythmic parameters. The study was performed on 437 NHS (219 males and 218 females, ranging in age from 1 year to 102 years), who were monitored in their 24-h BP via a noninvasive automated recorder. An age-related trend was detected for the three properties of BP CR, i.e., mesor (M), amplitude (A) and acrophase (cent). Such a trend was positive for M and A, and negative for cent. According to the clinospectrometric formula, the BP CR can be classified as a "dianaclinous rhythm", i.e., a rhythm which increases in its oscillatory level and extent with advancing years. The documented age-related trend for the rhythmic properties suggests that the biological clock which regulates the BP CR in human beings undergoes a resetting of its mechanisms of tonic, amplitude and phasic modulation as a function of chronological age. The readjustment of the pressure clock may be regarded as one of the physiological features which characterize the aging process in human beings.

Blood pressure in childhood and adolescence: the Italian normal standards. Study Group on Hypertension' of the Italian Society of Pediatrics'.

OBJECTIVES: To develop a national standard level of blood pressure (BP) for Italian children on the basis of a large sample of the population. DESIGN: We analyzed data available from 21 Italian studies conducted according to the recommendations of the American Task Force between 1988 and 1994. Percentile curves of systolic and diastolic BP were constructed by fitting a third-order polynomial model of BP on age and height using multiple regression analysis. PARTICIPANTS: BP was measured in 11 519 healthy individuals (6258 boys and 5261 girls) aged 5-17 years in various locations throughout Italy. All measurements were performed at school. RESULTS: Percentile curves (5th, 10th, 25th, 50th, 75th, 90th and 95th) of systolic and diastolic BP are reported by age and by height for males and females. CONCLUSIONS: With respect to the American standards, the levels in Italy for the 90th and 95th percentiles were 3-8 mmHg higher for systolic and diastolic BP in both sexes between 5 and 12 years of age, and 2-3 mmHg higher in older males. With respect to Northern Europe, in the lower ages, levels in Italy were quite similar, although slightly higher, whereas in late adolescence, the Northern European levels were much higher, especially in males, with differences of 4-5 mmHg for the mean values and 8-12 mmHg for the 95th percentile.

24 hour monitoring of blood pressure in premature and full-term new born babies.

Using a 24 hour monitoring of the systo-diastolic blood pressure, 127 new born babies were studied in the first five days of life. 45 of these new born babies were premature (35 +/- 1 week) and 82 full-term. The results showed an overlap in the systo-diastolic blood pressure in the 2 groups of subjects with a rise and fall in pressure in the 24 hour period and no fall in pressure during the night typical to a healthy adult.

[Determination of the arterial pressure in premature and term newborns via 24-hour monitoring]. / Conoscenza della pressione arteriosa del pretermine e del neonato a termine attraverso un monitoraggio per 24 ore.

During the first five days of life, 102 babies, 41 premature births (35 +/- 1 weeks) and 61 in time have been studied, through a 24 hours monitoring of the systo-diastolic arterial pressure. The results show that the systo-diastolic arterial pressure is overlap in both groups of subjects, with an "intermittent" trend during the 24 hours, without falling of night-pressure typical in the healthy grown-up. In the research also mono and biovular twins have been included who showed a pressure trend, during the 24 hours, very much alike in the two subjects.

Variability in the arterial pressure of newborns as compared to that of adults and old men.

The systolic and diastolic blood pressure was monitored on healthy subjects of different ages, spanning from newborns (24-48 hs old, to elderly age (70-80 years old). Each subject was monitored for 15 minutes, and the pressure values collected every minute. This protocol allowed a statistical evaluation of both inter- and intraindividual variabilities among and within different class ages. As expected, increasing age is paralleled by a marked increase in the average values of systolic blood pressure; the trend of variabilities around the average, however, as traced by standard deviations, is just the opposite: a marked decrease going from newborns to adults is accompanied--in most cases--by a statistically significant difference in the same direction also between adults and old men. This can be rationalized, in the light of recent findings on the role of deterministic chaos in the functional behaviour of complex biological systems, in terms of decreased functional flexibility characteristic of the aging process.

[Dietetic counseling of obese school child. Study in an elementary school]. / Suggerimenti dietetici per lo scolaro obeso. Indagine nella scuola elementare.

We controlled, after nine months, 29 obese children, who attended the primary school, and to whom it was advised a good balanced base diet of 1200 kcal. One child wasn't obese anymore, and in 13 cases there was a sensible reduction of overweight percentage. We consider these results positively, because our aim was to obtain a gradual resolution of the overweight, trying to avoid some very dangerous relapses for the young's future. Finally, we underline the necessity to begin some conferences about the young's and family's alimentary education, as soon as possible. These conferences have to be addressed to all the teachers, parents and pupils, from the primary school.

[Obesity and hypercholesterolemia in a primary school in Rome]. / Obesità ed ipercolesterolemia in una scuola elementare romana.

The research in particular the incidence of obesity, hypertension and hyperlipemia was evaluated involved 201 primary school children. The results show an obesity percentage equal to 28%; 23% of the young were hypercholesterolic and 21% had hypertriglyceridemia. Nobody was hypertensioned. The high percentage of obese and hjperlipemic subjects suggest the immediate needs of Courses of alimentary education in schools, as well as to resort to sound daily sporting activity.

Early detection by non-invasive monitoring of abnormally elevated systolic blood pressure in newborns with a positive familiarity for hypertension.

This study investigates 263 full-term clinically healthy newborn babies: subdivided into two groups depending on a positive (113 individuals) or negative (150 subjects) family history for hypertension. The babies were comparable for body weight and statural height and equipartitioned into males and females. The infants underwent a non-invasive, automated monitoring of blood pressure during the first three days of their life, according to protocol in which the systolic and diastolic measurements were performed at 1 min intervals over 15 minutes. The babies of the two groups showed superimposable mean values for systolic and diastolic blood pressure. However, the neonates with a positive familiarity for hypertension showed a higher number of systolic readings above the reference limit of 90 mmHg. The higher incidence of the abnormally-elevated systolic values (> 13%) in babies with a positive familiarity for hypertension was seen to be significant, suggesting that their blood pressure pattern is characterized by a larger variability at least in the systolic component. Such a wider variability may be regarded as a phenotypic expression of the genetic predisposition to hypertension, whose risk can be detected by a short-term monitoring of BP soon after the birth.

Follow-up of obese child.

A long-term follow-up which is still being carried out was started in the school-year 1985-86 in a Primary School of Rome and we suggested a written diet of 1300 calories and correct physical exercises. During this long follow-up we studied the changes in percentage of obesity of these subjects, considering their familiarity with obesity. It resulted that after a starting benefit due to the diet and the sport activity, which lasted till 1989, the youngsters with familiarity have subsequently regained the initial situation in 62.5% of cases, unlike those without familiarity who have kept themselves slim in 75% of cases. Even many other facts have been considered, as for example the psychologic approach, blood-tests for cholesterol, triglycerides etc, arterial pressure and above all a very careful feeding recall that has shown as the now obese subjects intake more calories than not obese one, with and excess of calories from fats to the detriment of carbon hydrates.

[Individual arterial pressure variability in newborn infants, adults, and the elderly]. / Osservazioni sulla variabilità individuale della pressione arteriosa in neonati, adulti e anziani.

The complexity of the cardiovascular function is related to a wide interindividual variability (VA) that changes with age. The aim of our study was to investigate the spontaneous blood pressure (BP) VA in 3 groups of 20 healthy subjects (S) each, 10 M and 10 F: Group I newborns 24 hours old; Group II 30-40 yrs; Group III 70-80 yrs. Each S underwent BP monitoring in a comfortable condition for 15'. Our data show an increase, with age, of both the average systolic and diastolic BP, paralleled by a simultaneous decrease of their standard deviations. Furthermore, the three distributions show a reasonably gaussian behaviour (maximum absolute value of the skewness was 0.21). These results emphasize the age-dependent reduction in functional flexibility of the cardiovascular system. A major pool of subjects is required to confirm our preliminary data.