Association between body mass index, waist-to-height ratio, and waist circumference with hypertension in a representative sample of elementary school children in Puerto Rico

Puerto Rican children have a higher prevalence of obesity than US children. Hypertension and prehypertension are strongly associated with overweight risk in children. BMI for age is used as an overweight indicator, but some argue its validity in assessing health risks. Other measurements proposed as better indicators include waist circumference and waist-to-height ratio. This study aimed to assess the association between hypertension and these three overweight indicators in a representative sample of children from elementary schools in Puerto Rico. A two-stage stratified cluster sampling design was used (n=250). Information was collected using a personal interview of the child, a self-administered questionnaire to parents, and by taking physical measurements. Odds ratios were calculated to evaluate these associations. Hypertension level was assessed according to the BP percentile for gender, age, and height percentile. High waist-to-height ratio was defined as ≥0.50, and high waist circumference was defined as ≥95th percentile by gender/age. Half of the students were male (52%); mean age was 9±2 years. Approximately 9% children were prehypertensives and 5% were hypertensives. Almost a third (31%) had a high waist-to-height ratio, 23% had a high waist circumference, and 38% were overweight or at risk of overweight. A high waist-to-height ratio (OR=3.1;95%CI=1.5-6.4), a high waist circumference (OR=2.7;95%CI=1.3-5.7), and being overweight (OR=2.5;95%CI=1.2-5.4) were associated with a higher probability of prehypertension/hypertension. Regardless of the weight indicator used, overweight children are at a higher risk of prehypertension/hypertension than non-overweight children. This risk significantly places PR children at high risk for cardiovascular disease and premature death.