A Study on The Relationship of Somatotype and Anthropometric Variables with Blood Pressure levels among Urban Adolescents in Howrah District, West Bengal, India
Swastika Roy1, Jayita Roy (Ghoshal)2*, JyotiRatan Ghosh3
1Department of Anthropology, Visva-Bharati University, Santiniketan731235, West Bengal, India
2Department of Anthropology, NarasinhaDutt College, Howrah711101, West Bengal, India
3Department of Anthropology, Visva-Bharati University, Santiniketan731235, West Bengal, India
*Corresponding Author’s Email: jayitagroy@gmail.com
Abstract
Introduction: Somatotype is depiction of human body build as manifested in configuration of human external morphology and the body shape and body composition can be depicted as it highlights the different components of the body constitution. Findings from some investigations have thrown light on the fact specific somatotype are associated with specific life style diseases. Objective: Keeping above contentions in mind, the present study was carried out among urban Bengali adolescents of West Bengal, India with the following objectives 1. Study therelationship of age and sex variation in somatotype with blood pressure.2. Assessment of the relationship between the somatotype with hyper and hypotension of the subjects. 3. To ascertain theassociation of anthropometric variables and somatotype. Methods: The cross-sectional investigation was undertaken to evaluate association of somatotype and anthropometric variables and blood pressure of adolescent boys and girls aged 10 to 17 years. Relationship of somatotype and anthropometric indicators with physiological marker like blood pressure in adolescent boys and girls was investigated. In order to investigate such association, study participants were chosen from two schools of Howrah Municipal Corporation, the district city of Howrah, West Bengal. Descriptive analysis and partial correlation, regression and regression analysis (logistic) were considered for inferential statistics. Results: The mean values of endomorphy, mesomorphy and ectomorphyare found to be higher in boys than girls. Results of partial correlation coefficient of somatotype components with SBP and DBP in boys and girls revealed that both endomorphy and mesomorphy show significant (p<0.01) and positive correlation with both SBP and DBP. Regression analysis using somatotype components showed that all somatotype components are significant (p<0.01) predictors of both SBP and DBP. Conclusion: All anthropometric variables had statistically significant positive association with both SBP and DBP irrespective of sex. Somatotypes were also significantly correlated with blood pressure in both sexes.
Keywords: Adolescents; Anthropometric Variables; Blood Pressure; Somatotype; Variables
Introduction
Leko Bankole (2017) defined Somatotype as “the present morphological configuration of the human body build” and it is the most apt representation for the human body shape and composition throwing a detailed insight into the various components of the body constitution (Leko Bankole et.al., 2017).
In 2012, Rahmawati et.al reported that anthropometric measurements and somatotypic components are very important in the assessment of overall growth and development and may exhibit variation in children and adolescents. It is also revealed that individuals with high endomorphic scores are more susceptible to hypertension in later adulthood.
It has been reported in some research findings that somatotype profiles of adolescents during growth and development period for cardiovascular risk factors, diabetes and hypertension, and older frail adults still need to be assessed (Yang et.al., 2020; Price et.al.,2022; Sachdev et.al., 2021; Makgae et al., 2017; Malina et al., 1997; Baltadjiev, 2012; Baltadjiev & Vladeva,2014). In 2000, William et al found that in persons suffering from coronary heart disease, the endomorphic component was significantly correlated to increased circumference of the waist circumference and increased ratio of waist: hip.
Burgos et.al in 2013 reported from his study on children aged 7-18 years that a significant relationship exists between blood pressure and ectomorphic somatotype component. In 2004 Herrera et.al also found a negative association between ectomorphic components and blood pressure.
Review of Literature World Perspective
Study in Tianjin children revealed that both BMI and WC were superior to WSR and WHR(waist hip ratio) in predicting increased blood pressure among subjects comprising of children and adolescents (Lu et al., 2018). In a study among Brazilian adolescents Madruga et al. (2016) demonstrated that adolescents with higher WSR were 2.4 times more susceptible to hypertension than those with lower WSR. Guilherme et al. (2015) indicated that WC was a fitter predictor for arterial hypertension than BMI in adolescents. The prevalence of elevated blood pressure increased with the ascending trend of WC, WSR, and BMI (Yi et al., 2015). Ellisras longitudinal growth and health study in rural South African children demonstrated that not only BMI, ectomorphy components was also significantly associated with blood pressures (Makgae et al., 2007). Another study in school children of Nigeria demonstrated that endomorphy correlated positively with SBP while ectomorphy correlated negatively with SBP (Leko Bankole et al., 2017). Overweight/obese students were 2.7 times more likely to have elevated blood pressure than normal weight students in Nassau (Conliffe et al., 2015). The findings are in accordant with the results of Kalichman et al. (2004), which also displayed similar positive association of blood pressure with endomorphy and mesomorphy and negative association with ectomorphy. Leko Bankole et al. (2017) in a study among school children of Nigeria also demonstrated positive association of mesomorphy and endomorphy with SBP and negative association of ectomorphy with SBP. However, in that study (Leko Bankole et al., 2017) endomorphywas negatively correlated, while ectomorphy was positively correlated with DBP. A trend of higher blood pressure in endomorphic boys was also observed by Badenhorst et al. (2003) among South African children.
Indian Perspective
In a number of community-based studies it has been proved that there exists a positive association between metric measurements and blood pressure in studied population (Durrani and Waseem, 2011; Ghosh and Bandyopadhyay, 2013; Ahmed et al., 2016; Kumar et al., 2017). However, the staunchest risk factor for primary hypertension in pre-adolescents, irrespective of place of residence, was elevated BMI (Mohan et al., 2004; Kajale et al., 2014; Verma and Sinha, 2014; Madruga et al., 2016). But, a fluctuating BMI has stronger influence than the absolute level of BMI in influencing pediatric blood pressure as showed by a previous cohort study in 12129 children (Raj et al. 2010). In a study among urban Indian school children the adjusted risk ratios of high SBP with WSR, BMI and WC were 2.48, 2.59 and 2.38, respectively. Similar results were seen with high DBP also (Mishra et al., 2015).
The aim of the present study was to determine about the association between somatotype and blood pressure among the 10-17 years of adolescents.
Objective
In view of the above context, the present study among urban Bengali adolescents of West Bengal, India was carried out to find out
the age and sex variation in somatotypic components and blood pressure.
the relationship between somatotypic components and blood pressure.
the association between anthropometric variables and somatotypic components.
Methods
The cross-sectional investigation was attempted to evaluate the association of somatotype and anthropometric variables and blood pressures among adolescents aged 10 to17 years. Relationship between somatotype and anthropometric parameters with blood pressure in adolescents were investigated. In order to examine such relationships, subjects were chosen from two schools of Howrah Municipal Corporation, the industrial district city of Howrah, West Bengal.
A sample size of 1072 (555 boys and 517 girls) adolescents reportedly in good health and without any chronic disease and abnormality since birth, were included in the present investigation. The participating students were aged between 10 and 17 years. Wilful consent was obtained from each of the project volunteer along with their parents’ and permission was taken from the school administration before the study commenced.
Anthropometric measurements were taken on each participant, following Tg et al. (1988) and Carter and Heath (1990). All participants were classified using the Heath–Carter anthropometric somatotype method (Carter and Heath 1990) owing to the applicability irrespective of variation in humans irrespective of age, sex or differences attributed to climate, diet, genetics, race, health or physical activity (Carter and Heath, 1990; Katzmarzyk et al., 1998; Makgae et al., 2007).Resting SBP and DBP were measured following standard techniques (National High Blood Pressure Education Program Working Group on high blood pressure in children and adolescents, 2004). An appropriate calf with sphygmomanometer and a stethoscope were adopted to measure the blood pressure by auscultation method. The first perception of sound was taken as the level of SBP and the DBP was taken as the level at which the sounds disappeared.
All anthropometric and physiological variables were checked for normality and the variables not in normal distributions were log-transformed. Descriptive analysis of anthropometric variables, somatotypic units and blood pressure were calculated by mean and standard deviation (SD). PCA, adjusted for age and HT were utilized to examine the relationship among somatotype components with blood pressures, respectively. Regression analysis was utilized to examine somatotype components as predictor of blood pressure variables. Logistic regression analysis was performed for somatotype components as predictor of hypertension. The data were rechecked for any inadvertent error. The necessary statistical considerations were done with the help of IBM SPSS 22.0. The resultant statistical value considered to be significant (p ≤0.05).
Results
Table-1 &2 shows age specific mean and SD of anthropometric characteristics of boys and girls.
Mean and SD of somatotype components of the studied population are presented in Table-3. It shows that the mean values of the three types of somatotype are found to be higher in boys than girls.
Table-4 demonstrate the mean and SD of SBP and DBP of the studied population. It reveals that the mean values of SBP and DBP are found to be higher in boys than girls.
Results of partial correlation coefficient (adjusted for age and HT) of somatotype components with SBP and DBP in boys are presented in Table-5. The results reveal that both endomorphy and mesomorphy show significant (p<0.01) and positive correlation with both types of blood pressure. Contrary to that, ectomorphy does not show any significant (p<0.01) correlation with both systolic and diastolic blood pressure.
Results of partial correlation coefficient (adjusted for age and HT) of somatotype components with SBP and DBP in girls are presented in Table-6. The results also show that both endomorphy and mesomorphy show significant (p<0.01) positive correlation with both systolic and diastolic blood pressure. But, ectomorphy has significant (p<0.01), but negative correlation with both SBP and DBP.
Results of regression analysis using somatotype components as predictors of adjusted (age and HT) SBP and DBP in boys are presented in Table-7. It seems that all somatotype components are significant (p<0.01) predictors of both SBP and DBP. It also appears that ectomorphy explain 16.6% of variance of SBP, follows by mesomorphy (16.2% of variance) and endomorphy (12.5% of variance). On the other hand, mesomorphy explain 9.9% of variance of DBP, follows by ectomorphy (9.8% of variance) and endomorphy (7.3% of variance).
Table 1: Age Specific Mean and Standard Deviation of Anthropometric Characteristics of Boys
Age (Year) | BMI (kg/m2) | WHR | WSR | CI | |
10 | Mean | 18.72 | 0.90 | 0.50 | 1.24 |
SD | 3.71 | 0.03 | 0.05 | 0.04 | |
11 | Mean | 20.47 | 0.90 | 0.51 | 1.25 |
SD | 4.69 | 0.03 | 0.06 | 0.04 | |
12 | Mean | 20.62 | 0.89 | 0.51 | 1.25 |
SD | 4.53 | 0.05 | 0.07 | 0.05 | |
13 | Mean | 20.53 | 0.88 | 0.49 | 1.23 |
SD | 4.11 | 0.05 | 0.06 | 0.06 | |
14 | Mean | 21.41 | 0.87 | 0.48 | 1.22 |
SD | 3.43 | 0.04 | 0.056 | 0.05 | |
15 | Mean | 21.61 | 0.87 | 0.48 | 1.23 |
SD | 3.96 | 0.04 | 0.06 | 0.05 | |
16 | Mean | 21.69 | 0.86 | 0.48 | 1.22 |
SD | 4.06 | 0.04 | 0.05 | 0.05 | |
17 | Mean | 21.97 | 0.86 | 0.48 | 1.22 |
SD | 4.76 | 0.04 | 0.06 | 0.05 | |
SD= standard deviation; BMI=body mass index; WHR=waist hip ratio; WSR=waist stature ratio; CI=conicity index
Results of regression analysis using somatotype components as predictors of adjusted (age and HT) SBP and DBP in girls are presented in Table-8. It seems that all somatotype components are significant (p<0.01) predictors of both SBP and DBP. It also appears that ectomorphy explains 20% of variance of SBP, follows by mesomorphy (18.6% of variance) and endomorphy (17.1% of variance). On the other hand, endomorphy explains 13% of variance of DBP, follows by ectomorphy (12.0% of variance) and mesomorphy (11.0% of variance).
The results of logistic regression analysis using somatotype components for hypertension in boys are shown in Table-9. It appears that all somatotype components are statistically significant (p<0.01) predictors of hypertension. The OR associated with one unit increase in endomorphy is 1.82 (95% confidence interval,1.23-2.70). The OR for one unit increase in mesomorphy is 1.63 (95% confidence interval,1.37-1.95), follows by ectomorphy (OR=0.64; 95% confidence interval, 0.52-0.79).
The results of logistic regression analysis using somatotype components for hypertension in boys are shown in Table-10. It appears that all somatotype components are statistically significant (p<0.01) predictor of hypertension. The OR associated with an unit increase in endomorphy is 4.30 (95% confidence interval, 2.41-7.64). The value for an unit increase in mesomorphy is 1.59 (95% confidence interval,1.33-1.89), follows by ectomorphy (OR=0.48; 95% confidence interval, 0.35-0.64).
Table 2: Age Specific Mean and Standard Deviation of Anthropometric Characteristics of Girls
Age (Year) | BMI (kg/m2) | WHR | WSR | CI | |
10 | Mean | 18.14 | 0.86 | 0.47 | 1.19 |
SD | 4.24 | 0.04 | 0.06 | 0.05 | |
11 | Mean | 18.65 | 0.84 | 0.45 | 1.15 |
SD | 3.74 | 0.03 | 0.05 | 0.04 | |
12 | Mean | 19.75 | 0.83 | 0.45 | 1.13 |
SD | 4.38 | 0.03 | 0.06 | 0.04 | |
13 | Mean | 20.92 | 0.84 | 0.46 | 1.15 |
SD | 4.42 | 0.04 | 0.05 | 0.05 | |
14 | Mean | 22.24 | 0.84 | 0.47 | 1.14 |
SD | 4.77 | 0.04 | 0.06 | 0.05 | |
15 | Mean | 22.61 | 0.86 | 0.50 | 1.21 |
SD | 4.22 | 0.05 | 0.06 | 0.08 | |
16 | Mean | 22.53 | 0.86 | 0.51 | 1.23 |
SD | 4.23 | 0.04 | 0.06 | 0.07 | |
17 | Mean | 22.75 | 0.85 | 0.51 | 1.22 |
SD | 3.68 | 0.04 | 0.05 | 0.07 | |
SD= standard deviation; BMI=body mass index; WHR=waist hip ratio; WSR=waist stature ratio; CI=conicity index
Table 3: Mean and Standard Deviation of Somatotype Components of the Studied Population
Variables | Boys | Girls | ||
Mean | SD | Mean | SD | |
Endomorphy | 6.02 | 0.97 | 5.87 | 0.93 |
Mesomorphy | 3.75 | 1.70 | 3.53 | 1.77 |
Ectomorphy | 2.55 | 1.75 | 2.35 | 1.72 |
SD= standard deviation
Figure 1: Somatotype Components of the Studied Group
Table 4: Mean and Standard Deviation of Systolic and Diastolic Blood Pressure of the Studied Population
Variables | Boys | Girls | ||
Mean | SD | Mean | SD | |
SBP(mmHg) | 109.10 | 12.63 | 101.11 | 10.68 |
DBP(mmHg) | 65.37 | 8.34 | 62.14 | 8.30 |
SD= standard deviation; SBP=systolic blood pressure; DBP=diastolic blood pressure
Figure 2: Systolic and Diastolic Blood Pressure of the Studied Group
Table 5: Results of Partial Correlation Coefficient of Somatotype Components with Systolic and Diastolic Blood Pressure in Boys
Variables* | SBP(mmHg) | DBP(mmHg) | ||
r | p | R | p | |
Endomorphy | 0.353 | <0.01 | 0.271 | <0.01 |
Mesomorphy | 0.402 | <0.01 | 0.315 | <0.01 |
Ectomorphy | -0.407 | <0.01 | -0.313 | <0.01 |
*Adjusted for age and height; SBP=systolic blood pressure; DBP=diastolic blood pressure
Table 6: Results of Partial Correlation Coefficient of Somatotype Components with Systolic and Diastolic Blood Pressure in Girls
Variables* | SBP(mmHg) | DBP(mmHg) | ||
r | p | R | p | |
Endomorphy | 0.414 | <0.01 | 0.361 | <0.01 |
Mesomorphy | 0.431 | <0.01 | 0.331 | <0.01 |
Ectomorphy | -0.447 | <0.01 | -0.347 | <0.01 |
*Adjusted for age and height; SBP=systolic blood pressure; DBP=diastolic blood pressure
Table 7: Results of Regression Analysis Using Somatotype Components as Predictors of Systolic and Diastolic Blood Pressure in Boys
Variables* | SBP(mmHg) | DBP(mmHg) | ||||||
r2 | β | T | p | r2 | β | t | p | |
Endomorphy | 0.125 | 0.30 | 8.85 | <0.01 | 0.073 | 0.26 | 6.60 | <0.01 |
Mesomorphy | 0.162 | 0.35 | 10.30 | <0.01 | 0.099 | 0.30 | 7.78 | <0.01 |
Ectomorphy | 0.166 | -0.35 | -10.46 | <0.01 | 0.098 | -0.30 | -7.72 | <0.01 |
*adjusted for age and height; SBP=systolic blood pressure; DBP=diastolic blood pressure
Table 8: Results of Regression Analysis Using Somatotype Components as Predictors of Systolic and Diastolic Blood Pressure in Girls
Variables* | SBP(mmHg) | DBP(mmHg) | ||||||
r2 | β | T | p | r2 | β | t | p | |
Endomorphy | 0.171 | 0.40 | 10.28 | <0.01 | 0.130 | 0.35 | 8.75 | <0.01 |
Mesomorphy | 0.186 | 0.41 | 10.81 | <0.01 | 0.110 | 0.32 | 7.93 | <0.01 |
Ectomorphy | 0.200 | -0.44 | -11.33 | <0.01 | 0.120 | -0.34 | -8.38 | <0.01 |
*adjusted for age and height; SBP=systolic blood pressure; DBP=diastolic blood pressure
Table 9: Results of Logistic Regression Analysis Using Somatotype Components as Predictors of Hypertension in Boys
Variables* | β | p | OR | 95% CI | |
Lower | Upper | ||||
Endomorphy | 0.60 | <0.01 | 1.82 | 1.23 | 2.70 |
Mesomorphy | 0.49 | <0.01 | 1.63 | 1.37 | 1.95 |
Ectomorphy | -0.45 | <0.01 | 0.64 | 0.52 | 0.79 |
*adjusted for age and height; OR=odds ratio; CI=confidence interval
Table 10: Results of Logistic Regression Analysis Using Somatotype Components as Predictors of Hypertension in Girls
Variables* | β | P | OR | 95% CI | |
Lower | Upper | ||||
Endomorphy | 1.46 | <0.01 | 4.30 | 2.41 | 7.64 |
Mesomorphy | 0.46 | <0.01 | 1.59 | 1.33 | 1.89 |
Ectomorphy | -0.74 | <0.01 | 0.48 | 0.35 | 0.64 |
* adjusted for age and height; OR=odds ratio; CI=confidence interval
Discussion
Somatotype characteristics of the studied population revealed that the mean values of endomorphy, mesomorphy and ectomorphy were more in boys than girls and there was significant (p<0.05) age and sex differences in all somatotype components. Similarly, Katzmarzyk et al. (1998) also demonstrated significant age and sex variation in somatotype components. Contrary to that, a recent study in school children of Nigeria demonstrated higher mean values of endomorphy and ectomorphy in girls compared to boys (Leko Bankole et al., 2017). Ellisras longitudinal study demonstrated higher endomorphic ratings in girls compared to boys, while mesomorphy rating was higher in boys compared to girls (Makgae et al., 2007).
The present study also demonstrated a strong association of BMI with blood pressures in both boys and girls. In accordance with the present study a number of studies also demonstrated stronger association of BMI with blood pressure (Guimaraes et al., 2008; Hosseini et al., 2010; Moser et al.,2013; Kapil et al.,2013; Hardy et.al., 2021; Mphekgwana et.al., 2020; Konlan et.al; 2023). Moreover, BMI was also positively associated with body fat (Katzmarzyk et al., 2015), dyslipidemia (Furtado et al., 2018), fasting blood glucose (Mehdad et al., 2012), junk food consumption (Azemati et al., 2018) and screen time (Sourtiji et al.,2019), but negatively associated with physical activity (Van Zant and Toney, 2012) and sleeping time (Doherty et al.,2015) in children and adolescents.
Results of regression analysis using somatotype components as predictors of adjusted blood pressure in the studied population revealed that all somatotype components are significant (p<0.01) predictors of both systolic and diastolic blood pressure. However, ectomorphy and mesomorphy explained highest amount of variance of SBP (16.6%) and DBP (9.9%) in boys and in girls highest amount of variance of SBP (20%) and DBP (13%) was explained by ectomorphy and endomorphy.
Similar inverse association between ectomorphy and both SBP and DBP was also observed in young adults (Herrera et al.,2004). Positive correlation between blood pressure and endomorphy, and negative correlation between blood pressure and ectomorphy in adults were also observed by Rahmawati (2012). Koleva et al. (2002) demonstrated that adults with higher ratings of endomorphy and mesomorphy and the lower rating of ectomorphy were suffered most frequently from arterial hypertension.
Conclusion
The present study was conducted among adolescent boys and girls aged between 10-17 years from two schools of Howrah Municipal Corporation, in the state of West Bengal, India. The studied population comprising of 1072 apparently healthy adolescents including 555 boys and 517 girls were included in the present study. The (Body Mass Index (BMI), Waist Hip Ratio (WHR), Waist Stature Ratio (WSR) and Conicity Index (CI)) indices, ratio etc were derived by using different anthropometric measurements Somatotype characteristics of the studied population revealed that the mean values of endomorphy, mesomorphy and ectomorphy were more in boys than girls and there was significant (p<0.05) age and sex variations in all somatotype components.
Blood pressure characteristics of the studied group revealed that the mean values of SBP and DBP were more in boys than girls. However, significant (p<0.05) age and sex difference exists only in SBP.
Somatotype components were also significant (p<0.01) predictors of both SBP and DBP. However, ectomorphy and mesomorphy explained highest amount of variance of SBP (16.6%) and DBP (9.9%) in boys, respectively and in girls’ highest amount of variance of SBP (20%) and DBP (13%) was explained by ectomorphy and endomorphy, respectively.
All anthropometric variables were significantly and positively correlated with both SBP and DBP without sex bias. Somatotypes were also significantly correlated with blood pressure in both sexes.
However, the main limitation of the present study was the cross-sectional studied population, which allowed determining only the associations of somatotype and anthropometric variables with blood pressure in adolescent. Moreover, the present study was conducted on a relatively small group and was not representative of the pan Indian population. Because of enormous ethnic and cultural heterogeneity in Indian population, it is imperative to conduct comparative study on other ethnic groups to see if the trends observed in the present study also exist among them.
Conflict of Interest
The authors declare that they have no conflict of interests.
Acknowledgement
The authors are grateful to all participants. The authors are also grateful to the Department of Anthropology, Visva-Bharati for providing all the facilities for conducting this study.
References
Ahmed, A., Ali, S.W., Massodi, S. and Bhat, M.A., 2016. Blood pressure-to-height ratio as a screening tool for hypertension in children. Indian Pediatr, 53, pp.137-139. https://www.indianpediatrics.net/feb2016/137.pdf
Azemati, B., Kelishadi, R., Ahadi, Z., Shafiee, G., Taheri, M., Ziaodini, H., ... & Heshmat, R. (2020). Association between junk food consumption and cardiometabolic risk factors in a national sample of Iranian children and adolescents population: the CASPIAN-V study. Eating
and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 25, 329-335. https://doi.org/10.1007/s40519-018-0591-1
Badenhorst, L., De Ridder, J. H., & Underhay, C. (2003). Somatotype, blood pressure and physical activity among 10-to 15-year old south African boys: the THUSA BANA study. African Journal for Physical Activity and Health Sciences, 9(3), 184-195.
Baltadjiev, A. G. (2012). Somatotype characteristics of male patients with type 2 diabetes mellitus. Folia Medica, 54(2), 40.
Baltadjiev, A. G., & Vladeva, S. V. (2014). Correlations between human somatotype components and some anthropometric parameters in male patients with type 2 diabetes mellitus. Folia Medica, 56(3), 175. https://10.2478/folmed-2014-0025
Burgos, M. S., Burgos, L. T., Camargo, M. D., Franke, S. I. R., Prá, D., Silva, A. M. V. D., ... & Reuter, C. P. (2013). Relationship between anthropometric measures and cardiovascular risk factors in children and adolescents. Arquivos Brasileiros de Cardiologia, 101, 288-296. https://doi.org/10.5935/abc.20130169
Carter, J. L., & Heath, B. H. (1990). Somatotyping: Development and Applications (Vol. 5). Cambridge university press.
Conliffe, C., Frankson, M., Smith, F., Hanna-Mahase, C., & Oriakhi, M. (2015). The prevalence of elevated blood pressure in adolescents in Nassau, The Bahamas. The West Indian Medical Journal, 64(1), 17. https://doi.org/10.7727%2Fwimj.2015.114
Doherty, M., Santiago-Torres, M., Cui, Y., Schoeller, D., LaRowe, T., Adams, A., & Carrel,A. (2015). The association between screen time and weight status in Hispanic children. BAOJ Obesity & Weight Loss Management, 1(1).
Durrani, A. M., & Waseem, F. (2011). Blood pressure distribution and its relation to anthropometric measurements among school children in Aligarh. Indian Journal of Public Health, 55(2), 121-124. https://doi.org/10.4103/0019-557X.85246
Furtado, J. M., Almeida, S. M., Mascarenhas, P., Ferraz, M. E., Ferreira, J. C., Vilanova, M., ... & Ferraz, F. P. (2018). Anthropometric features as predictors of atherogenic dyslipidemia and cardiovascular risk in a large population of school-aged children. PLoS One, 13(6), e0197922. https://doi.org/10.1371/journal.pone.0197922
Ghosh, J. R., & Bandyopadhyay, A. R. (2013). Central adiposity and the risk of hypertension in Asian Indian girls. World Journal of Pediatrics, 9, 256-260. https://doi.org/10.1007/s12519- 013-0424-2
Guilherme, F. R., Molena-Fernandes, C. A., Guilherme, V. R., Fávero, M. T. M., Reis, E. J. B. D., & Rinaldi, W. (2015). Body mass index, waist circumference, and arterial hypertension in students. Revista Brasileira de Enfermagem, 68, 214-218. https://doi.org/10.1590/0034- 7167.2015680205i
Guimarães, I. C. B., Almeida, A. M. D., Santos, A. S., Barbosa, D. B. V., & Guimarães, A. C. (2008). Blood pressure: effect of body mass index and of waist circumference on adolescents. Arquivos Brasileiros de Cardiologia, 90, 426-432. https://doi.org/10.1590/S0066- 782X2008000600007
Hardy, S. T., Sakhuja, S., Jaeger, B. C., Urbina, E. M., Suglia, S. F., Feig, D. I., & Muntner, P. (2021). Trends in blood pressure and hypertension among US children and adolescents, 1999- 2018. JAMA Network Open, 4(4), e213917-e213917.
https://doi.org/10.1001/jamanetworkopen.2021.3917
Herrera, H., Rebato, E., Hernandez, R., Hernández-Valera, Y., & Alfonso-Sánchez, M. A. (2004). Relationship between somatotype and blood pressure in a group of institutionalized Venezuelan elders. Gerontology, 50(4), 223-229. https://doi.org/10.1159/000078351
Hosseini, M., Ataei, N., Aghamohammadi, A., Yousefifard, M., Taslimi, S., & Ataei, F. (2010). The relation of body mass index and blood pressure in Iranian children and adolescents aged 7–18 years old. Iranian Journal of Public Health, 39(4), 126.
Kajale, N. A., Khadilkar, A. V., Chiplonkar, S. A., & Khadilkar, V. V. (2014). Body fat indices for identifying risk of hypertension in Indian children. Indian Pediatrics, 51, 555-560. https://doi.org/10.1007/s13312-014-0446-4
Kalichman, L., Livshits, G., & Kobyliansky, E. (2004). Association between somatotypes and blood pressure in an adult Chuvasha population. Annals of Human Biology, 31(4), 466-476. https://doi.org/10.1080/03014460412331281728
Kapil, U., Bhadoria, A. S., Sareen, N., & Kaur, S. (2013). Association of body mass index and waist circumference with hypertension among school children in the age group of 5-16 years belonging to lower income group and middle income group in National Capital Territory of Delhi. Indian Journal of Endocrinology and Metabolism, 17(Suppl1), S345. https://doi.org/10.4103%2F2230-8210.119614
Katzmarzyk, P. T., Barreira, T. V., Broyles, S. T., Chaput, J. P., Fogelholm, M., Hu, G., ... & Church, T. S. (2015). Association between body mass index and body fat in 9–11-year-old children from countries spanning a range of human development. International Journal of Obesity Supplements, 5(2), S43-S46. https://doi.org/10.1038/ijosup.2015.18
Katzmarzyk, P. T., Malina, R. M., Song, T. M. K., Theriault, G., & Bouchard, C. (1998). Physique and echocardiographic dimensions in children, adolescents and young adults. Annals of Human Biology, 25(2), 145-157. https://doi.org/10.1080/03014469800005522
Koleva M., Nacheva A., Boev M. 2002. Somatotype and disease prevalence in adults.Reviews on Environmental Health 17: 65-84. https://doi.org/10.1515/REVEH.2002.17.1.65
Konlan, K. D., Lee, H., & Afaya, A. (2023). Prevalence and risk factors of hypertension among adolescents living in Ghana. International Journal of Environmental Health Research, 1-12. https://doi.org/10.1080/09603123.2023.2218280
Kumar, P., Kumar, D., Ranjan, A., Singh, C. M., Pandey, S., & Agarwal, N. (2017). Prevalence of hypertension and its risk factors among school going adolescents of Patna, India. Journal of Clinical and Diagnostic Research: JCDR, 11(1), SC01. https://doi.org/10.7860%2FJCDR%2F2017%2F23886.9196
Leko Bankole, J., Fawehinmi, H. B., & Oladipo, G. S. (2017). The Relationship between Somatotype and Blood Pressure among Schoolchildren in Port-Harcourt, Nigeria. European Journal of Biomedical, 4(6), 137-142.
Lu, Y., Luo, B., Xie, J., Zhang, X., & Zhu, H. (2018). Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. Journal of Human Hypertension, 32(11), 789-798. https://doi.org/10.1038/s41371-018-0088-4
Madruga, J. G., Silva, F. M., & Adami, F. S. (2016). Positive association between waist-to- height ratio and hypertension in adolescents. Revista Portuguesa de Cardiologia (English Edition), 35(9), 479-484. https://doi.org/10.1016/j.repce.2016.03.006
Makgae, P. J., Monyeki, K. D., Brits, S. J., Kemper, H. C. G., & Mashita, J. (2007). Somatotype and blood pressure of rural South African children aged 6–13 years: Ellisras longitudinal growth and health study. Annals of Human Biology, 34(2), 240-251. https://doi.org/10.1080/03014460601144219
Malina, R. M., Katzmarzyk, P. T., Song, T. M., Theriault, G., & Bouchard, C. (1997). Somatotype and cardiovascular risk factors in healthy adults. American Journal of Human Biology: The Official Journal of the Human Biology Association, 9(1), 11-19. https://doi.org/10.1002/(SICI)1520-6300(1997)9:1%3C11::AID-AJHB3%3E3.0.CO;2-T
Mehdad, S., Hamrani, A., El Kari, K., El Hamdouchi, A., Barakat, A., El Mzibri, M., ... & Aguenaou, H. (2012). Body mass index, waist circumference, body fat, fasting blood glucose in a sample of Moroccan adolescents aged 11–17 years. Journal of Nutrition and Metabolism, 2012. https://doi.org/10.1155/2012/510458
Mishra, P. E., Shastri, L., Thomas, T., Duggan, C., Bosch, R., McDonald, C. M., ... & Kuriyan,(2015). Waist-to-height ratio as an indicator of high blood pressure in urban Indian school children. Indian Pediatrics, 52, 773-778. https://doi.org/10.1007/s13312-015-0715-x
Mohan, B., Kumar, N., Aslam, N., Rangbulla, A., Kumbkarni, S., Sood, N. K., & Wander, G.S (2004). Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart Journal, 56(4), 310-314.
Moser, D. C., Giuliano, I. D. C. B., Titski, A. C. K., Gaya, A. R., Coelho, M. J., & Leite, N. (2013). Anthropometric measures and blood pressure in school children. Jornal de Pediatria, 89(3), 243-249. https://doi.org/10.1016/j.jped.2012.11.006
Mphekgwana, P. M., Monyeki, K. D., Makgopa, H. M., & Makgae, P. J. (2020). Multiple points change in the association of blood pressure subtypes with anthropometric indices of adiposity among children in a rural population. Children, 7(4), 28. https://doi.org/10.3390/children7040028
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 114(Supplement_2), 555-576. https://doi.org/10.1542/peds.114.S2.555
Price, J. J., Urbina, E. M., Carlin, K., Becker, R., Daniels, S. R., Falkner, B. E., ... & Flynn, J.(2022). Cardiovascular risk factorsand target organ damage in adolescents: the SHIP AHOY study. Pediatrics, 149(6), e2021054201. https://doi.org/10.1542/peds.2021-054201
Rahmawati, N. T. (2012). Relationship Between Somatotype and Blood Pressure Among 30-70 Years Old Javanese People in Sleman, Yogyakarta Province. Jurnal Kedokteran YARSI, 20(3), 118-127.
Raj, M., Sundaram, K. R., Paul, M., Sudhakar, A., & Kumar, R. K. (2010). Body mass index trend and its association with blood pressure distribution in children. Journal of Human Hypertension, 24(10), 652-658. https://doi.org/10.1038/jhh.2010.6
Sachdev, H. S., Porwal, A., Sarna, A., Acharya, R., Ramesh, S., Kapil, U., & Kurpad, A. V. (2021). Intraindividual double-burden of anthropometric undernutrition and “metabolic obesity” in Indian children: a paradox that needs action. European Journal of Clinical Nutrition, 75(8), 1205-1217. https://doi.org/10.1038/s41430-021-00916-3
Sourtiji H., Hosseini S A., Rassafiani M., Kohan A., Noroozi M., Motlagh E M. (2019). The associations between screen time, sleep duration, and body mass index (BMI) in under five- year-old children. Archives of Neuroscience 6: e81229.
Tg, L. (1988). Anthropometric standardization reference manual. Human kinetics books, 55- 68.
Van Zant, R. S., & Toney, J. (2012). Negative correlation between body mass index category and physical activity perceptions in children. Physiotherapy Theory and Practice, 28(7), 529- 534. https://doi.org/10.3109/09593985.2011.639851
Verma, V., & Sinah, S. K. (2014). Influence of lean body-mass index versus that of fat mass index on blood pressure of gujarati school going adolescents. Indian J Physiol Pharmacol, 58(1), 39-44.
Williams, S. R., Goodfellow, J., Davies, B., Bell, W., McDowell, I., & Jones, E. (2000). Somatotype and angiographically determined atherosclerotic coronary artery disease in men. American Journal of Human Biology: The Official Journal of the Human Biology Association, 12(1), 128-138. https://doi.org/10.1002/(SICI)1520- 6300(200001/02)12:1%3C128::AID-AJHB14%3E3.0.CO;2-X
Yang, L., Magnussen, C. G., Yang, L., Bovet, P., & Xi, B. (2020). Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension, 75(4), 948-955.
https://doi.org/10.1161/HYPERTENSIONAHA.119.14168
Yi, Z. H. A. I., Li, W. R., Chong, S. H. E. N., Frank, Q. I. A. N., & Shi, X. M. (2015). Prevalence and correlates of elevated blood pressure in Chinese children aged 6-13 years: a nationwide school-based survey. Biomedical and Environmental Sciences, 28(6), 401-409.