Weight-Related Hypertension in Youth: Evaluation of Family Nutrition and Physical Activity Tool

Objectives and BackgroundThis study explores the potential moderating influence of Family Nutrition and Physical Activity (FNPA) behavior scores on reducing hypertension incidence associated with overweight changes during childhood. MethodsA longitudinal design was used to explore associations between childrens FNPA scores and overweight status change (when ages 3-9 years) on hypertension during latter childhood and adolescence (ages 9-18 years). Data were obtained from well-child visits. Participants were classified into 3 by 3 subgroups by FNPA score (low, moderate, high) and overweight status (loss, stable, gain). Cox proportional hazards models were used to estimate hazard ratios of hypertension development with the moderate FNPA score X overweight stable reference group. ResultsAmong 3808 participants, 58% were publicly insured. Among participants who gained overweight during childhood, 41.7% developed hypertension compared to 29.9% who were overweight stable and 27.3% who lost overweight (P <0.001). After accounting for confounders, participants who gained vs. maintained overweight had 2.01 (95% CI 1.65-2.44) times higher hypertension risk. Although FNPA scores were not associated with hypertension incidence, the interaction term between a high FNPA and overweight gain was significant (P = 0.01). Among children who gained, hazard ratios for hypertension among low, moderate, and high FNPA groups were estimated at 1.99 (95% CI 0.98-4.05), 2.01 (95% CI 1.64-2.44), 1.54 (95% CI 0.71-3.34), respectively. ConclusionsFNPA screening can inform preventive counseling about healthy home environments. Behaviors associated with high FNPA scores potentially reduce hypertension risk among children who experience overweight gain by approximately 25%. Article SummaryHaving higher, healthier Family Nutrition and Physical Activity behavior scores moderates the incidence of hypertension associated with gain in overweight during early-middle childhood. Whats Known on This SubjectThe AAP Clinical Practice Guidelines for the Screening and Management of High Blood Pressure provides recommendations which naturally accord with those for obesity prevention and management. The FNPA has been used in clinical settings to facilitate implementation of anticipatory guidance. What This Study AddsThe results underscore the novelty and importance of FNPA as a screening tool and in identification of the positive culmination of behaviors, reflected as high FNPA score, in moderating the risk of hypertension among children experiencing gain in overweight status.