Comparisons of tri-ponderal mass index and body mass index in discriminating hypertension at three separate visits in adolescents: A retrospective cohort study

Jia Hu; Yi Zhong; WenXin Ge; Huiling Lv; Ziyao Ding; Di Han; Bo Hai; Hui Shen; Jieyun Yin; Aihua Gu; Haibing Yang

doi:10.3389/fnut.2022.1028861

Comparisons of tri-ponderal mass index and body mass index in discriminating hypertension at three separate visits in adolescents: A retrospective cohort study

Front Nutr. 2022 Oct 17:9:1028861. doi: 10.3389/fnut.2022.1028861. eCollection 2022.

Authors

Jia Hu^{1

2

3}, Yi Zhong⁴, WenXin Ge⁴, Huiling Lv¹, Ziyao Ding^{3

5}, Di Han³, Bo Hai³, Hui Shen^{2

3}, Jieyun Yin⁴, Aihua Gu¹, Haibing Yang^{1

2

3}

Affiliations

¹ State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.
² Suzhou Institute of Advanced Study in Public Health, Gusu School, Nanjing Medical University, Suzhou, China.
³ Suzhou Center for Disease Prevention and Control, Suzhou, China.
⁴ Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China.
⁵ Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.

Abstract

Objective: To estimate whether the new obesity indicator tri-ponderal mass index (TMI) has a better capacity to predict adolescent hypertension (HTN) and HTN subtypes at three separate blood pressure (BP) visits than the conventionally used body mass index (BMI).

Methods: A total of 36,950 adolescents who had initial normal BP from 2012 to 2019 were included in Suzhou, China. HTN was defined as having three separate visits of elevated BP in 2020. The area under the receiver-operating characteristic curve (AUC), false-positive rate, false-negative rate, total misclassification rates, net reclassification improvement (NRI), and integrated discrimination improvement were calculated to compare the discriminative ability of HTN between BMI and TMI.

Results: TMI had better predictive abilities than BMI among all of the participants when predicting HTN (difference in AUC = 0.019, 95% CI = 0.007-0.031; NRI = 0.067, 95% CI = 0.008-0.127) and isolated systolic hypertension (difference in AUC = 0.021, 95% CI = 0.005-0.036; NRI = 0.106, 95% CI = 0.029-0.183). The difference in prediction abilities between BMI and TMI was more obvious in the subgroup of age ≥16. Also, TMI outperformed BMI in predicting adolescent HTN in girls but not in boys.

Conclusion: Compared with BMI, TMI may have a better predictive capacity for HTN, particularly in girls and older adolescents. TMI has the potential to be used as an effective predictor for HTN in clinic practice. Further studies are needed to verify the utility of TMI.

Keywords: adolescents; body mass index; hypertension; pediatric; tri-ponderal mass index.