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      Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid

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          Abstract

          Over the past 60 years there has been a dramatic increase in the prevalence of overweight in children and adolescents, ranging from 4% in 1975 to 18% in 2016. Recent estimates indicate that overweight or obese children and adolescents are more than 340 million. Obesity is often associated with hypertension, which is an important cardiovascular risk factor. Recent studies show that the presence of hypertension is a frequent finding in the pediatric age. Hypertensive children easily become hypertensive adults. This phenomenon contributes to increasing cardiovascular risk in adulthood. Primary hypertension is a growing problem especially in children and adolescents of western countries, largely because of its association with the ongoing obesity epidemic. Recently, it has been hypothesized that a dietary link between obesity and elevated blood pressure (BP) values could be simple carbohydrate consumption, particularly fructose, both in adults and in children. Excessive intake of fructose leads to increased serum uric acid (SUA) and high SUA values are independently associated with the presence of hypertension and weaken the efficacy of lifestyle modifications in children. The present review intends to provide an update of existing data regarding the relationship between BP, simple carbohydrates (particularly fructose), and uric acid in pediatric age. In addition, we analyze the national policies that have been carried out over the last few years, in order to identify the best practices to limit the socio-economic impact of the effects of excessive sugar consumption in children.

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          Most cited references48

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          Childhood obesity: public-health crisis, common sense cure

          The Lancet, 360(9331), 473-482
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            Global burden of hypertension: analysis of worldwide data

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              Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.

              To our knowledge, no single investigation concerning the long-term effects of overweight status on the risk for hypertension, hypercholesterolemia, diabetes mellitus, and cardiovascular sequelae has been reported. Relations between categories of body mass index (BMI), cardiovascular disease risk factors, and vascular disease end points were examined prospectively in Framingham Heart Study participants aged 35 to 75 years, who were followed up to 44 years. The primary outcome was new cardiovascular disease, which included angina pectoris, myocardial infarction, coronary heart disease, or stroke. Analyses compared overweight (BMI [calculated as weight in kilograms divided by the square of height in meters], 25.0-29.9) and obese persons (BMI > or =30) to a referent group of normal-weight persons (BMI, 18.5-24.9). The age-adjusted relative risk (RR) for new hypertension was highly associated with overweight status (men: RR, 1.46; women: RR, 1.75). New hypercholesterolemia and diabetes mellitus were less highly associated with excess adiposity. The age-adjusted RR (confidence interval [CI]) for cardiovascular disease was increased among those who were overweight (men: 1.21 [1.05-1.40]; women: 1.20 [1.03-1.41]) and the obese (men: 1.46 [1.20-1.77]; women: 1.64 [1.37-1.98]). High population attributable risks were related to excess weight (BMI > or =25) for the outcomes hypertension (26% men; 28% women), angina pectoris (26% men; 22% women), and coronary heart disease (23% men; 15% women). The overweight category is associated with increased relative and population attributable risk for hypertension and cardiovascular sequelae. Interventions to reduce adiposity and avoid excess weight may have large effects on the development of risk factors and cardiovascular disease at an individual and population level.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                03 May 2018
                2018
                : 6
                : 129
                Affiliations
                [1] 1Department of Medicine and Surgery, University of Milano-Bicocca , Milan, Italy
                [2] 2Family Pediatrician, Azienda Sanitaria Locale della Provincia di Milano , Milan, Italy
                [3] 3Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano , Milan, Italy
                Author notes

                Edited by: Sumantra Ray, NNEdPro Global Centre in Cambridge, United Kingdom

                Reviewed by: Roberto Pontremoli, Università di Genova, Italy; Iain Stephen Pratt, Cancer Council Western Australia, Australia

                *Correspondence: Antonina Orlando, antonina.orlando@ 123456unimib.it

                Specialty section: This article was submitted to Public Health Policy, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2018.00129
                5943632
                29774210
                99a35a17-e874-4376-90a8-763f5e866e71
                Copyright © 2018 Orlando, Cazzaniga, Giussani, Palestini and Genovesi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 23 October 2017
                : 16 April 2018
                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 72, Pages: 7, Words: 5089
                Categories
                Public Health
                Mini Review

                obesity,cardiovascular disease,hypertension,fructose,uric acid

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