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| Year : 2014 | Volume
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| Issue : 1 | Page : 174-175 |
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| Prevalence of hypertension in healthy school children in Pakistan and its relationship with body mass index, proteinuria and hematuria |
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Mahmood Dhahir Al-Mendalawi
Professor in Pediatrics and Child Health, Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq
Click here for correspondence address and email
| Date of Web Publication | 7-Jan-2014 |
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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 2023 Feb 5];25:174-5. Available from: https://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 | |  |
| 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. 
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| 2. | Fuiano N, Luciano A, Pilotto L, Pietrobelli A. Overweight and hypertension: Longitudinal study in school-aged children. Minerva Pediatr 2006;58:451-9.
[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.
[PUBMED] |
| 4. | Jafar TH, Levey AS, Jafary FH, et al. Ethnic subgroup differences in hypertension in Pakistan. J Hypertens 2003;21:905-12.
[PUBMED] |
Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Professor in Pediatrics and Child Health, Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-2442.124564
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