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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 1  |  Page : 174-175
Prevalence of hypertension in healthy school children in Pakistan and its relationship with body mass index, proteinuria and hematuria


Professor in Pediatrics and Child Health, Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

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Date of Web Publication7-Jan-2014
 

How to cite this article:
Al-Mendalawi MD. Prevalence of hypertension in healthy school children in Pakistan and its relationship with body mass index, proteinuria and hematuria. Saudi J Kidney Dis Transpl 2014;25:174-5

How to cite this URL:
Al-Mendalawi MD. Prevalence of hypertension in healthy school children in Pakistan and its relationship with body mass index, proteinuria and hematuria. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 12];25:174-5. Available from: http://www.sjkdt.org/text.asp?2014/25/1/174/124564
To the Editor,

I presume that the following two limitations might cast suspicion on the conclusions made by Rahman et al [1] in their interesting study.

First, Rahman et al [1] stated that among many factors, obesity was strongly correlated with hypertension (HTN), and they recommended that body mass index (BMI) assessment should be incorporated in the community-based scree­ning programs for children and approach high-risk groups for early detection of HTN. Their conclusion was based on defining their over­weight studied children according to the World Health Organization (WHO) classification of BMI (calculated as weight in kg/height in m 2 ). The children were defined as overweight if their BMI ranged between 25 and 30 and obese if their BMI was >30. [2] It is well known that the growth of Pakistani school children signi­ficantly differs from the WHO references. A recently published study has compared age-and gender-specific height, weight and BMI percentiles and nutritional status relative to the international WHO growth references among Pakistani school children. The study revealed that height, weight and BMI percentiles ten­ded to increase with age among both boys and girls, and both had approximately the same height and a lower weight and BMI as com­pared with the WHO references. The mean differences from zero for height-, weight- and BMI-for-age Z score values relative to the WHO references were significant (P <0.001). The means of height-for-age (Pakistani study:0.00, WHO: -0.19), weight-for-age (Pakistani study: 0.00, WHO: -0.22) and BMI-for-age (Pakistani study: 0.00, WHO: -0.32) Z score values relative to the WHO reference were closer to zero. Mean differences between weight-for-age (0.19, 95% CI 0.10-0.30) and BMI-for-age (0.21, 95% CI 0.11-0.30) Z scores relative to the WHO were significant. However, over-nutrition estimates were higher (P <0.001) by the WHO reference, while underweight and thinness/wasting were lower (P <0.001) by the WHO reference. Also, the mean difference between the height-for-age Z scores and the difference in the stunting prevalence relative to the WHO references was not significant. [3]

Accordingly, I presume that the reliance of Rahman et al [1] on the WHO classification of BMI [2] to evaluate the contributory effect of BMI to HTN in their studied cohort was not so accurate. Constructing new growth charts for Pakistani children based on a nationally repre­sentative sample should be achieved. Reliance upon these national charts could better eva­luate the potential correlation of BMI to HT among Pakistani children.

Second, to the best of my knowledge, The Pakistani population is not homogenized, with various ethnic subgroups like Muhajir, Punjabi, Sindhi, Pashtun and Baluchi. Rahman et al [1] did not consider the ethnic subgroup of their studied cohort. This should be seriously considered as it has been noticed that a three­fold difference in the prevalence of HTN exists between the aforementioned ethnic descendants, and this cannot be accounted for by the modified risk factors. [4]

 
   References Top

1.Rahman AJ, Qamar FN, Ashraf S, Khowaja ZA, Tariq SB, Naeem H. Prevalence of hyper­tension in healthy school children in Pakistan and its relationship with body mass index, proteinuria and hematuria. Saudi J Kidney Dis Transpl 2013;24:408-12.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Fuiano N, Luciano A, Pilotto L, Pietrobelli A. Overweight and hypertension: Longitudinal study in school-aged children. Minerva Pediatr 2006;58:451-9.  Back to cited text no. 2
[PUBMED]    
3.Mushtaq MU, Gull S, Mushtaq K, et al. Height, weight and BMI percentiles and nutri­tional status relative to the international growth references among Pakistani school-aged chil­dren. BMC Pediatr 2012;12:31.  Back to cited text no. 3
[PUBMED]    
4.Jafar TH, Levey AS, Jafary FH, et al. Ethnic subgroup differences in hypertension in Pakistan. J Hypertens 2003;21:905-12.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Professor in Pediatrics and Child Health, Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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DOI: 10.4103/1319-2442.124564

PMID: 24434408

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