Increased blood pressure in adolescents of low socioeconomic status with short stature

The nutritional programming hypothesis, which has been studied since the 1970s, proposes that intrauterine undernutrition continuing during the first years of life causes permanent metabolic disorders. These alterations are amplified with time, depending on the quality of the diet and on environmental factors. The aim of this cross-sectional study was to detect blood pressure alterations in teenagers with nutritional deficit. The study sample consisted of 53 adolescents living in shantytowns of Sao Paulo City, Brazil; 27 boys and 26 girls ranging in age from 11 to 16 years were studied. Weight, height, skinfold thickness, and blood pressure were measured during a medical visit. Anthropometric data were compared with the reference values of the National Center for Health Statistics and Frisancho, and arterial pressure data were compared with the reference values of the 1996 Task Force. The adolescents studied are among the 10% poorest stratum of the Brazilian population, with a per capita income of U.S. $45/month. The anthropometric results revealed nutritional deficiencies for the entire sample. The major marker of malnutrition was height, with a mean height deficit of 7 cm among boys and of 5 cm among girls. The overall prevalence of arterial (diastolic) hypertension for the sample was 21% (95% confidence interval 10%-32%). No significant difference was observed between sexes. The prevalence of cases with a systolic or diastolic arterial pressure above the 90th percentile, adjusted for height, was 51% (n=27) (95% confidence interval 37%-65%); 6% (n=3) of these individuals had simultaneous systolic and diastolic arterial hypertension. In conclusion, the prevalence of arterial hypertension was elevated among malnourished adolescents. The mechanisms involved in the genesis of hypertension seem to be related to malnutrition during an early phase of life, supporting the programming hypothesis.