The prevalence of childhood obesity and high blood pressure has increased dramatically in the past two decades, so understanding the factors related to increased risk for obesity and high blood pressure is critical, especially in a fast-growing population of immigrants. Our study results suggest that a lower maternal acculturation level and unhealthy food choices are risk factors for increased BMI in Chinese American children. Additionally, making unhealthy food choices is also a risk factor for increased SBP, whereas a low level of physical activity and older age are risk factors for increased diastolic blood pressure in Chinese American children.
Studies have suggested that low level of maternal acculturation is associated higher BMI in children [31
]. It is possible that mothers with higher levels of acculturation are more sensitive about their own child’s weight status because they are more aware of the health issues associated with childhood obesity and therefore are more likely to provide healthy food and encourage active lifestyle [32
]. In addition, acculturated mothers may also have better access to healthier food than those who are less acculturated as higher acculturation is associated with higher level of household income [34
]. Future study need to examine the mechanisms by which mothers’ acculturation may affect proximal determinants of energy balance and overweight risk in children, including dietary intake, and physical activity.
Another important factor associated with obesity and high blood pressure is children’s food choices. Our study indicates that choosing unhealthy foods is a risk factor for increased BMI and high SBP. This is consistent with other study that suggests unhealthy dietary intake, especially sugar-sweetened beverage, is associated with increased blood pressure in children [35
]. In addition, increased fruit and vegetable intake is related to lower waist to hip ratio in Chinese Americans. An important aspect of children’s health behaviors is dietary behavior [36
]. Overweight children and children at risk for becoming overweight report a higher preference for high-fat foods and more patterns of overeating than do normal-weight children [35
]. Several studies that used dietary interventions have demonstrated successful weight reduction in overweight and obese children [39
]. Additionally, a meta-analysis of eight randomized controlled trials in a recent systematic review of the effectiveness of dietary interventions in overweight children indicated that interventions that contain a dietary component are effective in weight management in overweight children and adolescents (standardized mean difference −1.82 with 95% confidence interval [CI] = −2.4 to −1.23) [41
]. Therefore, a critical element of a program for preventing overweight and cardiovascular disease in Chinese American children should incorporate healthy eating.
Our results indicate that decreased physical activity and older age are risk factors for increased diastolic blood pressure. Regular physical activity may decrease the prevalence of overweight, death from cardiovascular diseases, diabetes, and high cholesterol [42
]. A lower level of physical activity is related to increase the risk for a higher level BP in children [45
]. A low physical activity level and high BMI were independently associated with a high BP and risk of having hypertension in both genders [45
]. Our results are consistent with the above mentioned studies and suggest that low lever of physical activity put children at higher risk for high blood pressure and CVD risks. Thus, increased physical activity is critical in CVD risk reduction in children.
However, Asian children engage in lower levels of physical activity than do white and African American children [47
]. The lower level of physical activity and high inactive level may reflect a cultural difference. The low levels of activity may be related to the emphasis placed on academic achievement of children in Asian cultures; as a result, these children spend more time studying or reading than being physically active [48
]. Moreover, new immigrant families may also be unaware of the health benefits of physical activity and thus may not promote physical activity.
A study indicated that children’s levels of physical activity decline with age (at about age 13), that girls’ levels of physical activity decline with age more rapidly than do boys’ levels of physical activity, and that boys spend more time engaging in physical activity than do girls [49
]. Healthy People 2010 emphasizes the importance of regular participation in moderate physical activity as an essential component of a lifestyle that promotes health and has identified physical activity as a leading health indicator [50
]. Therefore, physical activity could be an integral component of children’s health behaviors and of the prevention of overweight and cardiovascular disease in children, especially in Chinese Americans.
The results of this study of factors contributing to obesity and high blood pressure in Chinese American children should be interpreted carefully. Because of the cross-sectional design of this analysis, no causal relationship can be established. A longitudinal study is needed to examine the change in children’s body composition and blood pressure and the factors contributing to these changes. Moreover, because the study involved many self-reported measures, errors in measurement such as under or estimate food consumption may have occurred. Because the children and families who participated in this study are well educated, results can be generalized only to a similar population. Future studies should include children and families who are from different locations and educational backgrounds.
Although results indicated that a small to moderate percentage of variance was explained by the factors we examined in this study, a larger amount of variance was still unexplained. Future studies should incorporate other important factors, such as parental BMI, health perception regarding obesity and cardiovascular disease, and barriers to a healthy lifestyle.