Association between maternal education and blood pressure: mediation evidence through height components in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Ann Hum Biol. 2017 May;44(3):243-251. doi: 10.1080/03014460.2016.1188983. Epub 2016 Jun 1.


Background: Maternal education influences skeletal growth and offspring adult blood pressure (BP). Height components are negatively associated with BP in high-income countries.

Aim: To evaluate the association between maternal education and offspring adult systolic and diastolic BP (SBP/DBP), assessing whether different height components might mediate such an association.

Subjects and methods: Simple mediation modelling was used to evaluate the maternal education-offspring SBP/DBP association, estimating the contribution of offspring height components, in a cross-sectional sample of 13 571 Brazilians aged 34-75 from the ELSA-Brasil study.

Results: After full adjustment for confounders, and compared to participants whose mothers received low education, those whose mothers received high education had, on average, 0.2 mm Hg lower SBP (95% CI = -0.274, -0.132), as result of the link between maternal education and offspring adult height which, in turn, influenced SBP. Thus, 18-26% of the maternal education-SBP association occurred indirectly, through height, trunk and leg length, alternatively.

Conclusions: Better maternal education might influence higher leg and trunk lengths in offspring, which, in turn, might contribute to prevent higher BP in adults. The negative height-BP association reported in high-income countries is also present in a middle-income country with more recent economic development.

Keywords: Maternal education; blood pressure; height components; mediation modelling; transitioning populations.

MeSH terms

  • Adult
  • Aged
  • Blood Pressure*
  • Body Height*
  • Brazil
  • Cross-Sectional Studies
  • Educational Status*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mothers*