Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 25  |  Issue : 1  |  Page : 175--176

Author's reply


Arshalooz Jamila Rahman, Farah Naz Qamar 
 Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan

Correspondence Address:
Arshalooz Jamila Rahman
Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi
Pakistan




How to cite this article:
Rahman AJ, Qamar FN. Author's reply.Saudi J Kidney Dis Transpl 2014;25:175-176


How to cite this URL:
Rahman AJ, Qamar FN. Author's reply. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Dec 14 ];25:175-176
Available from: http://www.sjkdt.org/text.asp?2014/25/1/175/124566


Full Text

To the Editor,

In reply to the honorable Prof. Mahmood Dhahir Al-Mendalawi's comments, I agree with my respected colleague that our study has limitations, so have the studies cited in his comment; they have mentioned limitations in their conclusions as well. Very little is known about BMI, height and weight parameters in the Asian population. The fact that obesity is a strong contributing factor for HTN and diabetes in adults cannot be denied, and the question remains whether it has its roots in the childhood? Our concern is the population with normal BMI and pre-hypertensive readings systolic BP 90-95 th percentile with BMI <25, which represented 84% of our study patients.

Are these children at a higher risk of deve­loping hypertension as adults needs to be followed closely? The Asian pediatric group has not so far been able to come up with their consensus regarding cutoffs for normal versus overweight individuals. In the west, BMI = 27 is considered as the cutoff; however, according to the recent recommendations, 23.9 is consi­dered a cutoff for the Asian population. We have to rely on the WHO/USA CDC charts till we have our authenticated and approved stan­dards for Asian children. Community screening programs should be doable in order to standar­dize to one scale and make comparison easier among different populations. Generalizability of the screening tools is essential, which may have some limitations in comparison due to ethnicity, genetics, and environment. Having only Pakistani population charts will make us isolated across the globe; however, having Asian standards for growth sound as better and stronger criteria for our part of the world. [1]

Secondly, the question about ethnicity and the study quoted by Tazeen Jaffar et al is on the population over 15 years of age, which may reflect body compositions and regulatory mechanisms different from children. This study cannot be applied to the fit pre-adolescent and adolescent pediatric populations. One has to keep in mind the location of our study cohort, which is Karachi, a cosmopolitan city with a mix of all ethnic groups that makes this cohort a little different from the rest of the Pakistani groups, as the representative popu­lation is reflective of genetic mingling and sharing of urban lifestyles. A more detailed and larger group with modifiable variables such as diet, exercise and environment needs to be studied to take us beyond the concept of physical parameters in relation to HTN. [2]

References

1Khadilkar V, Hakhadilkar A. Growth charts: A diagnostic tool. Indian J Endocrinol Metab 2011;15(Suppl 3):S166-71.
2Aziz S, Noor-Ul-Ain W, Majeed R, et al. Growth centile charts (anthropometric measurement) of Pakistani pediatric population. J Pak Med Assoc, Vol. 62, No. 4, April 2012, 368-377.