Distinct determinants of systolic and diastolic blood pressure in obese children: A multivariate cluster analysis

Background & aims: This study evaluated the nutritional status and blood pressure of obese children aged 6-15 using multivariate cluster analysis to reveal distinct risk patterns for systolic and diastolic hypertension. Methods: A total of 240 obese children were assessed using anthropometric measurements, 24-h dietary recalls, Mediterranean dietary adherence scale (KIDMED) scores, and blood pressure values. Multivariate cluster analysis, which evaluates all variables collectively, was used to detect interrelated subgroups. Results: The study included 240 obese children (mean age 11.3 f 2.2 years; 51.7 % female). Mean systolic and diastolic blood pressure values were 114.1 f 13.1 and 69.8 f 12.0 mmHg, respectively. Among children aged 13-15 years, 17.9 % had elevated systolic and 23.9 % had elevated diastolic blood pressure. The mean KIDMED score was 7.1 f 3.0, with 46.3 % showing optimal adherence to the Mediterranean diet. Average daily intake was 2132 f 502 kcal, 206.5 f 74.5 g carbohydrates, 85.4 f 14.3 g protein, and 110.3 f 23.4 g fat. Cluster analysis revealed that systolic blood pressure clustered with BMI, waist and neck circumferences, while diastolic blood pressure was associated with protein intake and sleep duration. Conclusion: Multivariate cluster analysis enabled a whole-system view, identifying tailored clinical targets. By differentiating the factors affecting systolic and diastolic pressure, this approach offers a new perspective for personalized interventions in obese children. (c) 2025 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.