Temporal Associations between Tri-Ponderal Mass Index and Blood Pressure in Chinese Children: A Cross-Lag Analysis

Abstract

Background: No longitudinal studies have explored the relationship between tri-ponderal mass index (TMI) and blood pressure (BP) in children. This study is aimed to investigate the temporal associations between TMI and BP among children in China. Methods: A longitudinal study was carried out with Chinese children from 2014 to 2019. Data of the anthropometric examination and blood pressure were collected annually. TMI was calculated by dividing weight by the cube of height. BP was measured using a standard mercury sphygmomanometer. We investigated temporal associations between TMI and BP with a cross-lagged panel model using repeated measure data from 2014 (Wave 1), 2016 (Wave 2), and 2018 (Wave 3). Results: Results of the cross-lagged panel model showed that TMI was associated with subsequent BP. Participants with higher levels of TMI presented higher levels of BP (Wave 1: β = 0.737 for systolic blood pressure (SBP) and β = 0.308 for diastolic blood pressure (DBP), Wave 2: β = 0.422 for SBP and β = 0.165 for DBP, p < 0.01). In addition, children with higher BP could also present higher TMI (Wave 1: β = 0.004 for SBP and β = 0.006 for DBP, Wave 2: β = 0.003 for SBP and β = 0.005 for DBP, p < 0.01), but the cross-lag path coefficient indicated that the influence of TMI on BP was stronger than the influence of BP on TMI. Conclusions: There was a temporal association between TMI and BP in Chinese children. Higher TMI predicted higher subsequent BP rather than the reverse relationship.

Keywords: blood pressure; children; cross-lagged panel model; tri-ponderal mass index.

Figure 1

Mean values of BMI, TMI, SBP, and DBP with age: (a) BMI and TMI with age; (b) SBP and DBP with age; BMI, body mass index; TMI, tri-ponderal mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 2

Stability model with TMI and BP among children at three time points: (a) stability model with TMI and SBP; (b) stability model with TMI and DBP. ** p < 0.001; TMI, tri-ponderal mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 3

Cross-lagged model with TMI and BP among children at three time points: (a) cross-lagged model with TMI and SBP; (b) cross-lagged model with TMI and DBP; ** p < 0.001; TMI, tri-ponderal mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.