CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
AFRICA
263
general and central fatness in females, such strong relationships
were not seen. This was different from the findings in other
studies where strong relationships existed between BMI, WC
and BP, irrespective of gender.
13,30,32
In keeping with the work of Dobbelsteyn
et al.
33
and Yan
et
al.
34
on Chinese children, BMI was a better indicator of blood
pressure levels when compared with WC. Similarly, among
Nigerian adults who were urban civil servants, central obesity as
assessed by waist:hip ratio made little contribution to elevated
blood pressure levels.
35
However, in Valencia, Spain,
36
the waist-
to-hip ratio of children significantly contributed to SBP levels,
while the relationship between waist-to-hip ratio and DBP was
of borderline significance when compared with weight, height
and ponderal index. The BMI is a measure of total adiposity. It
has the limitation of not been able to distinguish between muscle
mass and fat mass and therefore it is difficult to determine which
is the most significant contributor to blood pressure variability.
According to Stallones
et al.
,
37
weight was more important
than fatness in predicting systolic blood pressure. However,
the mechanism of the relationship between weight and blood
pressure is not fully known. In a lean black population, there was
a threshold above which weight was related to blood pressure.
38
This was also observed in a study on urban schoolchildren in
India where the prevalence of high SBP suddenly increased
beyond a BMI value of 20 kg/m
2
in boys and 21.5 kg/m
2
in
girls.
39
This aspect of the assessment was not carried out in our
own study.
The limitations of this study include use of the BMI-for-age
percentile of the study population to define overweight and
obesity rather than the internationally recommended standards.
These international standards are designed for developed
countries where under-nutrition is not a problem. There is a
need to develop a national BMI classification for paediatric
populations in Nigeria and other African countries.
Conclusion
Overweight and obesity is an emerging health problem among
adolescents in Abeokuta, Nigeria. However, periodic studies
coupled with preventive strategies may be necessary to prevent
childhood overweight and obesity in Abeokuta from rising
at the alarming rate that is presently experienced globally.
Although WC was a more direct measurement of body fat,
in this study, BMI was a better predictor of blood pressure
levels. Future studies are necessary to validate each of these
anthropometric measures against adverse serum lipid profiles
and other cardiovascular and metabolic risk factors.
We thank the Ogun State Ministry of Education for giving us approval to
enter their schools, and the schools, school principals, teachers and students
who participated in this study. We are grateful to the student nurses who
helped with data collection. The Federal Medical Centre, Abeokuta, Nigeria,
funded this work.
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