Evaluation of different anthropometric indices and their associations with elevated blood pressure among adolescents in Selangor, Malaysia

A trend of increasing prevalence of hypertension among children and adolescents was observed globally, including Malaysia. Early detection and prompt treatment of hypertension in children and adolescents helps in reducing associated risks and long term effect. Anthropometry indices have been used in several studies to predict hypertension. This cross-sectional study aims to compare the predictive ability of the 7 anthropometric indices: BMI-for-age z-score (BAZ), Waist circumference (WC), Waist-to-height ratio (WHtR), Conicity Index (C-Index), A Body Shape Index (ABSI), Body Roundness Index (BRI), and Triponderal Mass Index (TMI) in identifying elevated blood pressure in adolescents aged 13 to 17 years old in Selangor. Two schools in Selangor state was randomly selected using probability proportionate to size where a total of 934 respondents were recruited. Self-administered questionnaires was used to get data of sociodemographic background, physical activity and sleep quality. Weight, height, waist circumference and blood pressure were measured. Using the receiver operating characteristic curve and established procedures, the prediction power of anthropometric indicators was according to sex. A total 934 children (387 boys and 547 girls) were examined. The prevalence of elevated BP was 19.6%, hypertension stage 1 was 7.7% and hypertension stage 2 was 4.8%. Multiple logistic regression analysis upon controlling sex, age, ethnicity and physical activity level showed WC (AOR=1.274, 95% CI = 0.746, 2.176) and TMI (AOR=1.310, 95% CI = 1.219, 1.407) were significantly associated with elevated BP. Overall, AUCs of BMI-for-age (AUC= 0.752, CI 95%= 0.717, 0.787), WC (AUC=0.767, CI 95%= 0.735, 0.800), WHtR (AUC= 0.701, CI 95%= 0.664, 0.738), TMI (AUC= 0.731, CI 95%= 0.695, 0.767) and BRI (AUC= 0.701, CI 95%= 0.664, 0.738) indicated good predictive power in assessing elevated BP. Considering the results of AUC, sensitivity, specificity and Youden index, WC was considered as the best anthropometric indices in predicting high BP among adolescents in this study cut off values of 71.12 cm in males and 74.27 cm in females. These results suggested that WC may be a helpful signal for assessing the risk of high blood pressure in routine screening for adolescents. Future studies are suggested to include dietary factors and stress factors to investigate the association with BP

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