Advertisement

European Journal of Pediatrics

, Volume 178, Issue 7, pp 1069–1074 | Cite as

The triglycerides and glucose index is associated with elevated blood pressure in apparently healthy children and adolescents

  • Luis E. Simental-Mendía
  • Gabriela Hernández-Ronquillo
  • Claudia I. Gamboa-Gómez
  • Rita Gómez-Díaz
  • Martha Rodríguez-Morán
  • Fernando Guerrero-RomeroEmail author
Original Article

Abstract

Prevalence of elevated blood pressure in pediatric population has been increasing worldwide. Thus, the aim of this study was to examine whether the triglycerides and glucose (TyG) index is associated with the presence of prehypertension or hypertension in children and adolescents. Apparently healthy children aged 6 to 15 years were enrolled in a population-based cross-sectional study. Participants were allocated into groups with normal blood pressure (NBP), prehypertension, and hypertension. Smoking, alcohol intake, pregnancy, previous diagnosis of diabetes, kidney, hepatic, or endocrine diseases were exclusion criteria. NBP was defined by systolic and/or diastolic blood pressure < 90th percentile, prehypertension by systolic and/or diastolic blood pressure ≥ 90th < 95th percentile, and hypertension by systolic and/or diastolic blood pressure ≥ 95th percentile, according to age, sex, and height percentiles. A total of 3589 children were enrolled, 1748 (49%) girls and 1841 (51%) boys, and allocated into groups with NBP (n = 2874), prehypertension (n = 271), and hypertension (n = 444). The multiple logistic regression analysis stratified by age and adjusted by the Z-score/SDS of body mass index and waist circumference showed that elevated TyG index was significantly associated with prehypertension (OR = 1.48; 95% CI: 1.08–2.05) and hypertension (OR = 1.63; 95% CI: 1.26–2.11).

Conclusion: The results of the present study shows that the elevated TyG index is significantly associated with the presence of prehypertension and hypertension in children and adolescents.

What is Known:

Prevalence of elevated blood pressure in children and adolescents has been increasing worldwide.

Insulin resistance plays a key role in the pathogenesis of hypertension.

What is New:

The elevated TyG index is significantly associated with the presence of prehypertension in children aged 6–9 years and adolescents aged 10–15 years.

The elevated TyG index is significantly associated with the presence of hypertension in children aged 6–9 years and adolescents aged 10–15 years.

Keywords

TyG index Triglycerides Glucose Blood pressure Children 

Abbreviations

TyG

triglycerides and glucose

NBP

normal blood pressure

Notes

Authors’ contribution

Luis E. Simental-Mendía conceptualized and designed the study, drafted the initial manuscript, and approved the final version as submitted. Gabriela Hernández-Ronquillo contributed to conception, critically reviewed the manuscript, and approved the final version as submitted. Claudia I. Gamboa-Gómez contributed to conception, critically reviewed the manuscript, and approved the final version as submitted. Rita Gómez-Díaz contributed to conception, critically reviewed the manuscript, and approved the final version as submitted. Martha Rodríguez-Morán contributed to conception, critically reviewed the manuscript, and approved the final version as submitted. Fernando Guerrero-Romero contributed to conception and study design, drafted the manuscript, critically revised the manuscript, and gave final approval.

Funding

No financial assistance was received in support of this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The written informed consent from at least one of each participant’s parents and the informed assent from the participants were obtained.

References

  1. 1.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program Coordinating Committee. Seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252CrossRefGoogle Scholar
  2. 2.
    de Moraes AC, Carvalho HB, Siani A, Barba G, Veidebaum T, Tornaritis M, Molnar D, Ahrens W, Wirsik N, De Henauw S, Mårild S, Lissner L, Konstabel K, Pitsiladis Y, Moreno LA, IDEFICS consortium (2015) Incidence of high blood pressure in children - effects of physical activity and sedentary behaviors: the IDEFICS study: High blood pressure, lifestyle and children. Int J Cardiol 180:165–170.  https://doi.org/10.1016/j.ijcard.2014.11.175 CrossRefGoogle Scholar
  3. 3.
    Fernández JR, Redden DT, Pietrobelli A, Allison DB (2004) Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 145(4):439–444CrossRefGoogle Scholar
  4. 4.
    Guerrero-Romero F, Rodríguez-Morán M, Hernández-Ronquillo G, Gómez-Díaz R, Pizano-Zarate ML, Wacher NH, Mondragón-González R, Simental-Mendia LE, Network of Childhood Obesity of the Mexican Social Security Institute (2016) Low serum magnesium levels and its association with high blood pressure in children. J Pediatr. 168:93–98.e1.  https://doi.org/10.1016/j.jpeds.2015.09.050
  5. 5.
    Haffner SM, Miettinen H, Gaskill SP, Stern MP (1996) Metabolic precursors of hypertension. The San Antonio heart study. Arch Intern Med 156(17):1994–2001CrossRefGoogle Scholar
  6. 6.
    Horita S, Seki G, Yamada H, Suzuki M, Koike K, Fujita T (2011) Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens 2011:391762.  https://doi.org/10.4061/2011/391762 CrossRefGoogle Scholar
  7. 7.
    Jian S, Su-Mei N, Xue C, Jie Z, Xue-Sen W (2017) Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults. Clin Exp Hypertens 39(8):732–739.  https://doi.org/10.1080/10641963.2017.1324477 CrossRefGoogle Scholar
  8. 8.
    Koebnick C, Black MH, Wu J, Martinez MP, Smith N, Kuizon BD, Jacobsen SJ, Reynolds K (2013) The prevalence of primary pediatric prehypertension and hypertension in a real-world managed care system. J Clin Hypertens (Greenwich) 15(11):784–792.  https://doi.org/10.1111/jch.12173 CrossRefGoogle Scholar
  9. 9.
    Lastra G, Dhuper S, Johnson MS, Sowers JR (2010) Salt, aldosterone, and insulin resistance: impact on the cardiovascular system. Nat Rev Cardiol 7(10):577–584.  https://doi.org/10.1038/nrcardio.2010.123 CrossRefGoogle Scholar
  10. 10.
    Modan M, Halkin H, Almog S, Lusky A, Eshkol A, Shefi M, Shitrit A, Fuchs Z (1985) Hyperinsulinemia. A link between hypertension obesity and glucose intolerance. J Clin Invest 75(3):809–817CrossRefGoogle Scholar
  11. 11.
    Mohd Nor NS, Lee S, Bacha F, Tfayli H, Arslanian S (2016) Triglyceride glucose index as a surrogate measure of insulin sensitivity in obese adolescents with normoglycemia, prediabetes, and type 2 diabetes mellitus: comparison with the hyperinsulinemic-euglycemic clamp. Pediatr Diabetes 17(6):458–465.  https://doi.org/10.1111/pedi.12303 CrossRefGoogle Scholar
  12. 12.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 114(2 Suppl 4th Report):555–576CrossRefGoogle Scholar
  13. 13.
    Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 109(1):45–60CrossRefGoogle Scholar
  14. 14.
    Reaven GM, Hoffman BB (1987) A role for insulin in the aetiology and course of hypertension? Lancet. 2(8556):435–437CrossRefGoogle Scholar
  15. 15.
    Riley M, Bluhm B (2012) High blood pressure in children and adolescents. Am Fam Physician 85(7):693–700Google Scholar
  16. 16.
    Rodríguez-Morán M, Simental-Mendía LE, Guerrero-Romero F (2017) The triglyceride and glucose index is useful for recognising insulin resistance in children. Acta Paediatr 106(6):979–983.  https://doi.org/10.1111/apa.13789 CrossRefGoogle Scholar
  17. 17.
    Sánchez-Íñigo L, Navarro-González D, Pastrana-Delgado J, Fernández-Montero A, Martínez JA (2016) Association of triglycerides and new lipid markers with the incidence of hypertension in a Spanish cohort. J Hypertens 34(7):1257–1265.  https://doi.org/10.1097/HJH.0000000000000941 CrossRefGoogle Scholar
  18. 18.
    Scherrer U, Randin D, Vollenweider P, Vollenweider L, Nicod P (1994) Nitric oxide release accounts for insulin's vascular effects in humans. J Clin Invest 94(6):2511–2515CrossRefGoogle Scholar
  19. 19.
    Schulman IH, Zhou MS (2009) Vascular insulin resistance: a potential link between cardiovascular and metabolic diseases. Curr Hypertens Rep 11(1):48–55CrossRefGoogle Scholar
  20. 20.
    Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F (2008) The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 6(4):299–304.  https://doi.org/10.1089/met.2008.0034 CrossRefGoogle Scholar
  21. 21.
    Simental-Mendía LE, Hernández-Ronquillo G, Gómez-Díaz R, Rodríguez-Morán M, Guerrero-Romero F (2017) The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents. Pediatr Res 82(6):920–925.  https://doi.org/10.1038/pr.2017.187 CrossRefGoogle Scholar
  22. 22.
    Thackeray JT, Radziuk J, Harper ME, Suuronen EJ, Ascah KJ, Beanlands RS, Dasilva JN (2011) Sympathetic nervous dysregulation in the absence of systolic left ventricular dysfunction in a rat model of insulin resistance with hyperglycemia. Cardiovasc Diabetol 10:75.  https://doi.org/10.1186/1475-2840-10-75 CrossRefGoogle Scholar
  23. 23.
    Velloso LA, Folli F, Perego L, Saad MJ (2006) The multi-faceted cross-talk between the insulin and angiotensin II signaling systems. Diabetes Metab Res Rev 22(2):98–107CrossRefGoogle Scholar
  24. 24.
    Zheng R, Mao Y (2017) Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis 16(1):175.  https://doi.org/10.1186/s12944-017-0562-y CrossRefGoogle Scholar
  25. 25.
    Zhou MS, Wang A, Yu H (2014) Link between insulin resistance and hypertension: what is the evidence from evolutionary biology. Diabetol Metab Syndr 6(1):12.  https://doi.org/10.1186/1758-5996-6-12 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Luis E. Simental-Mendía
    • 1
  • Gabriela Hernández-Ronquillo
    • 1
  • Claudia I. Gamboa-Gómez
    • 1
  • Rita Gómez-Díaz
    • 2
  • Martha Rodríguez-Morán
    • 1
  • Fernando Guerrero-Romero
    • 1
    Email author
  1. 1.Unidad de Investigación Biomédica, Delegación DurangoInstituto Mexicano del Seguro SocialDurangoMexico
  2. 2.Unidad de Investigación Médica en Epidemiología ClínicaUMAE Hospital de Especialidades del CMN Siglo XXI del Instituto Mexicano del Seguro SocialMexico CityMexico

Personalised recommendations