Influence of puberty on relationships between body composition and blood pressure: a cross-sectional study

Esther A. Kwarteng, Lisa M. Shank, Loie M. Faulkner, Lucy K. Loch, Syeda Fatima, Suryaa Gupta, Hannah E. Haynes, Kaitlin L. Ballenger, Megan N. Parker, Sheila M. Brady, Anna Zenno, Marian Tanofsky-Kraff, Jack A. Yanovski*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Fat mass (FM) and fat-free mass (FFM) are positively associated with blood pressure (BP) in youth. Yet, how puberty, independent of age, affects these relationships remains unclear. Given puberty may be a crucial period for cardiometabolic health, we examined how pubertal development moderates the associations of FM/FFM with BP. Methods: Pubertal development, resting BP, and body composition were assessed in a convenience sample of youth (5.5–17 years). General linear models were conducted to assess if pubertal development moderated the relationships between FM/FFM and systolic/diastolic BP standardized for age, sex, and height (SBPz/DBPz). Results: Among participants (N = 1405; age: M = 13.3 ± 2.9 years; 65.4% female; 53.2% racial/ethnic minority), FM/FFM were positively associated with SBPz and DBPz (ps ≤ 0.02). Pubertal development moderated the associations between FFM and BPz (ps ≤ 0.01), but not FM (ps > 0.43). For early/mid and late pubertal participants, there were positive associations between FFM and BP (DBPz: βs = 0.10–0.18, ps ≤ 0.01; SBPz: βs = 0.33–0.43, ps < 0.001); however, these relationships were attenuated, especially for prepubertal DBPz (DBPz: β = 0.01, p = 0.91; SBPz: β = 0.24, p = 0.001). Conclusions: Puberty moderated the relationships between FFM and SBPz/DBPz in analyses that separately modeled the contributions of age and sex. These data suggest that the FFM-DBPz association may potentially be impacted by increasing sex hormone concentrations during puberty. Impact: Fat mass (FM) and blood pressure (BP) were positively associated throughout puberty.Fat-free mass (FFM) and BP were positively associated throughout puberty; however, puberty moderated the FFM-BP relationship, such that there was a positive relationship in early/mid and late puberty, but the relationship was attenuated for prepubertal children.These findings contribute further insight into physiological and cardiometabolic changes occurring during puberty.Changes in hormone concentrations may explain the impact puberty has on the FFM-BP relationship.Understanding predictors of BP are important as childhood BP is associated with future cardiometabolic outcomes.

Original languageEnglish
Pages (from-to)781-788
Number of pages8
JournalPediatric Research
Issue number2
StatePublished - Aug 2023
Externally publishedYes


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