Association between BMI z-score and body composition indexes with blood pressure and grip strength in school-age children: a cross-sectional study

Abstract

Childhood obesity is linked to diverse health outcomes, including elevated blood pressure (EBP). Emerging evidence showed that excess fat mass (FM) may have a deleterious impact on blood pressure even in normal-weight children. The primary objective of this study was to assess the association between body weight status by BMI z-score and body composition parameters by conventional bioelectrical impedance analysis (BIA) and bioelectrical impedance vector analysis (BIVA). Also, we aimed to explore the performance of BMI z-score, %FM, and FM index (FMI) in discriminating EBP in a sample of school-age Mexican children. Children were classified as having normal weight, overweight or obesity according to WHO criteria for BMI z-score. FMI was considered high when above 75th percentile, and fat free mass index (FFMI) was considered low when below 25th percentile of the reference population. Body composition was also classified according to the BIVA method and EBP was determined when systolic and/or diastolic blood pressure ≥ 90th percentile. BMI z-score groups were compared by Student´s t-test or the Mann-Whitney U test, or by the chi-square test or Fisher exact test. Receiving operating characteristic (ROC) analysis was performed. 61 children were included (52.5% boys, median age 9.8 (25th, 75th percentiles: 8.5, 11.0)) years. High FMI was observed in 32.3% of children with normal weight. Low FFMI was present in 93.5% of children with normal weight and 53.3% of those with overweight/obesity. According to BIVA, 58.1% and 43.3% of children with normal weight and overweight/obesity were classified as having cachexia. All the three adiposity indicators showed significant areas under the ROC curve (AURC) greater than 0.775 for EBP, with the largest one displayed for FM% (0.794). Hight FMI and low FFMI are common in children with normal weight. Identifying deficiency of FFM might be limited by using solely BMI indicators. Cachexia by BIVA was present in a high proportion of children with either normal weight or overweight/obesity. Both BMI z-score and FM (% and FMI) performed well at discriminating EBP, with a numerically greater AURC observed for FM%. Body composition in pediatric population is relevant for identifying body composition abnormalities at early age.

Keywords: Adiposity; Cardiovascular risk; Childhood obesity; Elevated blood pressure; Lean mass.

Figure 1

Distribution of FMI > 75th percentile and FFMI < 25th percentile between Z-BMI weight status categories in school-age children. *p value by Chi² test for comparison of FMI categories between BMI z-score categories. **p value by Chi² test for comparison of FFMI categories between BMI z-score categories.

Figure 2

Distribution of FMI and FFMI categories in school-age children by sex. *p value by Chi2 test for comparison of categories between boys and girls.

Figure 3

Distribution of BIVA body composition categories between BMI z-score weight status categories in school-age children. *p value by Chi2 test for comparison of BIVA categories between BMI z-score categories.

Figure 4

RXc z score graph showing group impedance vectors for hand-grip strength split at 25th percentile for age and sex: ≥ 25th percentile in black and < 25th percentile blue. *p value for comparing mean group vectors by the Hotelling´s t-squared test.