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In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Context No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. Objective To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. Design and Setting We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). Main Outcome Measure WC measured based on recommendation by the World Health Organization. Results We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). Conclusion The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6–17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th–24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14–1.41; P

Waist circumference (WC) and WC-based indicators are often used as simple measures of abdominal obesity (AO) and an essential component of the metabolic syndrome (MetS). However, in the case of pediatric subjects, access to current and appropriate reference systems (usually in the form of tables or percentile curve distributions) is often difficult and their interpretation—complicated for the user. The concept of a web-based calculator supporting AO and MetS diagnostics in children and adolescents has been presented. The calculator enables selection of different criteria for the assessment of both MetS and its individual components (AO, blood pressure, lipids, and glucose/insuline). An extensive database of pediatric reference systems allows for quick diagnostics of the child's cardiometabolic profile and may be useful in personal comparative epidemiological studies.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

Background Obesity particularly affects young people with disabilities, whose ability to participate in health promotion programs is reduced. Objective The aim of the study is to determine the prevalence of abdominal obesity among students with visual impairment in Poland according to waist-to-height ratio, including indicators such as gender, age or certain additional coexisting disabilities or disorders. Methods A total of 238 students who were blind or partially-sighted, aged 7.35–23.35 years (mean age 15.5; ±3.9 years), were included in the study. Abdominal obesity was estimated using waist-to-height ratio; a cutoff point of ≥0.50 was determined as central obesity. Results Abdominal obesity was identified among 26.9% [N = 64] of the participants: 33.1% [N = 41] of male students and 20.2% [N = 23] of female students (ch2 = 5.02; p = 0.025; Phi = 0.145). Of all the students, the multivariate logistic regression showed that abdominal obesity was one and a half times more likely to be detected in the 7–9 year age group (OR = 1.56; 95% CI 0.58–4.18; P = 0.376) than the 19–23 year age group. However, among the female subjects, abdominal obesity was over six times more common in the 7–9 year group (OR = 6.48; 95% CI 1.29–32.5; P = 0.022) than in the group of early adults. Central obesity was detected almost three times more frequently among students with visual impairment and additional intellectual disability (OR = 2.99; 95% CI 0.52–17.1; P = 0.215) than those with only visual impairment. Conclusion Prevention programs aimed at reducing abdominal obesity among pupils with visual impairment from special schools are needed.

The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84–0.98), high sensitivity (0.69–1.00), high specificity (0.87–1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child’s absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.

Streszczenie Nadciśnienie tetnicze moze miec swoj początek w wieku rozwojowym. Przy niedostatecznej jego kontroli powiklania narządowe mogą wystąpic bardzo wcześnie. Dlatego bardzo waznym elementem badania fizykalnego jest wlaściwa kontrola ciśnienia tetniczego u dzieci i mlodziezy. Trudności pomiarowe i interpretacyjne uzyskanych wartości ciśnienia mogą byc związane z brakiem sfigmomanometrow z wymienialnymi mankietami oraz norm wlaściwych dla danej populacji. Celem pracy jest zaprezentowanie przypadku z obciązającym wywiadem nefrologicznym oraz brakiem kontroli ciśnienia tetniczego. W opisywanym przypadku obciązający wywiad (nawracające zakazenia ukladu moczowego, refluksy pecherzowo-moczowodowe), niepelna diagnostyka oraz niedostateczna kontrola ciśnienia tetniczego przyczynily sie do powstania zmian narządowych. Po zastosowanym leczeniu obserwowano normalizacje wartości ciśnienia tetniczego. Zarowno nadciśnienie tetnicze utrwalone, jak i towarzyszące zmiany narządowe zostaly zbyt poźno rozpoznane, co ma związek z niedostateczną kontrolą ciśnienia tetniczego w wieku rozwojowym. W prewencji, a takze w terapii nadciśnienia tetniczego podstawowego znaczenia nabiera wlaściwa kontrola ciśnienia tetniczego, prowadzona od jak najwcześniejszych lat zycia. Umozliwia to wczesną identyfikacje osob ze zmianami subklinicznymi oraz pozwala na pierwotną prewencje powiklan chorob ukladu krązenia w wieku doroslym.

Wstep Centralne rozmieszczenie tkanki tluszczowej stanowi udowodnione ryzyko rozwoju zespolu metabolicznego rowniez u dzieci i mlodziezy. Podstawowego znaczenia nabiera wczesna diagnostyka oparta na aktualnych ukladach odniesienia oraz zaleceniach czolowych towarzystw pediatrycznych i naukowych. Cel Celem badan bylo opracowanie rozkladow centylowych obwodu pasa (WC) dla dzieci lodzkich w wieku szkolnym. Podjeto ponadto probe odpowiedzi na pytanie: czy WC przekraczający polowe wysokości ciala (Ht/2) moze stanowic proste kryterium oceny otylości brzusznej w wieku rozwojowym? Material i metody Badaniami objeto lącznie 26 542 dzieci w tym 13 358 dziewcząt oraz 13 184 chlopcow w wieku 7–19 lat. U wszystkich osob wykonano pomiary podstawowych parametrow antropometrycznych (wysokośc i masa ciala, obwody pasa i bioder). Do konstrukcji siatek centylowych wykorzystano metode LMS opartą na transformacji Boxa-Coxa. Wyniki Średnie wartości WC chlopcow lodzkich we wszystkich kategoriach wiekowych byly wyzsze niz u dziewcząt. Wartości WC odpowiadające poziomowi c95 zarowno u 18-letnich chlopcow, jak i u 18-letnich dziewcząt lodzkich są wyraźnie nizsze w stosunku do przyjetych dla osob doroslych granicznych wartości definiujących otylośc brzuszną (88 cm dla kobiet; 102 cm dla mezczyzn). Wnioski Zaprezentowane rozklady centylowe obwodu pasa (WC) dzieci i mlodziezy lodzkiej powinny byc stosowane lącznie z oceną ogolną otluszczenia dziecka, np. z uzyciem lokalnych rozkladow centylowych wskaźnika BMI. Znajomośc obu wskaźnikow (BMI oraz WC) poglebia ocene potencjalnego ryzyka związanego z nadmiernym otluszczeniem organizmu, dla ktorego istotną role odgrywa tkanka tluszczowa ulokowana centralnie. Metoda LMS zastosowana do konstrukcji rozkladow centylowych, zapewnia optymalne dopasowanie i wygladzenie krzywych, jak rowniez umozliwia latwą transformacje indywidualnych wartości WC w cm na ich percentylową reprezentacje. Jako uproszczone i jednakowe dla obu plci kryterium rozpoznania otylości brzusznej mozna przyjąc za graniczną wartośc WC badanego dziecka, rowną bądź przekraczającą polowe wysokości jego ciala.

Artificial Neural Networks (ANNs) play a vital role in the medical field in solving various health problems like estimating the risk of cardiovascular diseases. The article concerns the process of developing ANNs for estimating the risk of arterial hypertension. ANNs proposed in this article use anthropometrical predictors, easy to control for everybody at home without special equipment. In the article we analyze four different models of ANNs and try to find out which model and set of anthropometrical predictors estimates the risk the most accurately. We use dataset of 2485 real cases of patients from the city of Lodz. The experiment was done in the Matlab environment. The performance of the proposed method in terms of accuracy and facility of use shows that ANNs can be effective tools for preliminary tests of arterial hypertension.

Background— Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). Methods and Results— Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. Conclusions— These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

Waist-to-height ratio (WHtR), with a 0.5 threshold (WHtR0.5), is regarded as a simple age- and gender-independent criterion of abdominal obesity (AO) and a better predictor than the 90th percentile of waist circumference (WCP90).An analysis of gender and ethnic differences of WHtR and other AO indices between children and adolescents from southern China (HK: Hong-Kong, China) and Europe (LD: Łódź, Poland).Two large cross-sectional surveys of children and adolescents aged 7-19 years, one from LD (13 172) and one from HK (14 566).The percentile and standardized values of WHtR and other parameters (WC, body mass index (BMI)) were assessed using the LMS method. The WHtR values corresponding to WCP90 and to the BMI definition of global obesity (BMIP95) were evaluated with the polynomial regression model. The compliance of the AO prevalence data, obtained with two criteria (WCP90 vs WHtR0.5) was analyzed using Cohen's kappa index (κC).The WHtR data of Polish subjects were generally higher than those of their HK peers, and the ethic differences increased with age. The WHtR values of HK boys showed a stronger relationship with BMI z-score. WHtR corresponding to WCP90 assumed values0.5. An application of Cohen's kappa coefficient (κC) to Polish subjects showed either 'substantial' (κC0.6) or 'almost perfect' (κC0.8) agreement in the AO prevalence for both criteria (WCP90 and WHtR0.5). For these criteria, either 'fair' (κC0.4) or 'moderate' (κC0.6) AO consistency ratings were observed among HK girls. In HK boys, a significant difference in the prevalence of AO was observed, independent of the criterion used.Our results provide further evidence of the need for developing ethnic-specific WC charts and for recommending that a WHtR cutoff of 0.5 may not be appropriate to predict cardiometabolic risk in children of different ethnic groups.

The article presents the idea of a hybrid system for multiobjective optimization. The system consists of the genetic algorithm and the fuzzy logic driver. The genetic algorithm realizes the process of multiobjective optimization. The fuzzy logic driver uses data aggregated by the genetic algorithm and controls the process of evolution by modifying the probability of selection of individuals to the parental pool. The controlling of the evolution process makes it possible to choose the preferred area with pareto-optimal solution. In experiments we investigated the ability of the proposed system to search solutions in a given area of the search space. We compared the results of the standard genetic algorithm and the proposed system. The experiments showed that the proposed system is able to control the process of evolution toward pareto-optimal solutions in the given area of searching.

The objective of this study was to develop age- and gender-specific reference ranges for blood pressure in a large national database on blood pressure levels throughout childhood and adolescence in young Poles. A prospective cross-sectional study was performed in 2002−2005 in the representative sampling sites, selected randomly from the entire Poland. Altogether, 6,447 school pupils, aged 7−18 years, were involved in the study of which 3,176 were boys and 3,271 were girls. Statistical analysis was performed using STATISTICA for Windows 7.1. The normal range of blood pressure, determined by age and the category of body height percentiles, revealed percentiles values which might serve as reference values to identify cases of high normal blood pressure (the mean blood pressure between 90th and 95th percentiles for age and gender) and hypertension (the mean blood pressure equals or exceeds the 95th percentiles on at least three occasions).

Low physical activity (PA), and often concomitant overweight in the developmental age are well documented risk factors for cardiovascular diseases (CVD) and many other chronic civilization diseases. Regular monitoring of health related physical fitness (H-RF) is an important part of early prevention and school health education. An assessment of components of H-RF is complex and controversial. In the assessment of H-RF components, systems of fuzzy inference based on simple linguistic variables can be used. The paper presents a system intended to support the evaluation of the H-RF components based on the EUROFIT battery tests and the anthropometric measurements. A basis of the system is the EUROFIT calculator which converts absolute results of individual trials to standarized values and the fuzzy inference system for four H-RF components (Morphological, Cardiorespiratory, Musculoskeletal and Motor Fitness). The system is implemented in MS Visual Studio in C# and has a friendly graphical interface for archiving test results. An application of fuzzy inference elements in the evaluation of the H-RF components is a new approach that can be used in monitoring and rational planning of PA dosing in prophylaxis and therapy.