High Blood Pressure and Obesity: Is not-breastfeeding an added risk for children with Benign Congenital Heart Disease

High Blood Pressure and Obesity: Is not-breastfeeding an added risk for children with Benign Congenital Heart Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High Blood Pressure and Obesity: Is not-breastfeeding an added risk for children with Benign Congenital Heart Disease Azza Abul-Fadl, Sameh Zaki AbdulSamae, Maha Mourad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4768722/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The rising burden of cardiovascular disease (CVD) risk factors of obesity and elevated blood pressure (EBP) from early childhood can aggravate consequences congenital heart defects (CHDs). The aim was to study status and associations of early feeding, systolic (SBP) and diastolic (DBP) elevations, obesity with CHD. Methods : A sample of 150 children randomized into 50 breastfed, 50 non-breastfed and 50 mixed fed children aged 3-5 years examined for early feeding practices, BP and nutritional assessment through anthropometric measurements for estimating Body mass index (BMI) and hemoglobin. Doppler studies were carried out to detect congenital heart disease. Findings DBP, but not SBP, was higher in non-breastfed vs. fully Breastfed. Obesity was positively associated with elevated SBP and DBP in either sex. Early breastfeeding was protective, while not breastfeeding, bottle feeding with additives, pacifiers, unhealthy food intake (UFI) were associated with EBP. Doppler studies detected 16 cases (10.67%) with CHDs, mostly mitral valve prolapse (MVP) in 7(43.7%) followed by tricuspid regurge (TR) in 3 (18.75%), atrial-septal defect (ASD) in 1(6.25%) and ventricular-septal defects (VSD) in 1(6.25%). Although there were no direct associations between CHDs with early feeding, BMI or EBP, however risk factors for EBP by high intake of unhealthy foods was common. Conclusions: Obesity and EBP start from early childhood; this could affect future cardiac dynamics. Breastfeeding may be physiologically and developmentally beneficial for these children by protection against CVD risk factors as obesity and EBP. Close watch of patients with CHD from an early age is recommended to detect cardiac hemodynamic changes especially among children who are obese, hypertensive. Promoting breastfeeding and healthy food intake is important to prevent the build of EBP from UFI into CVD. congenital heart defects obesity hypertension breastfeeding bottle-feeding mitral valve prolapse. Introduction Cardiovascular diseases (CVD) are recognized to emerge from early childhood. The focus on pediatric cardiology has been on congenital heart disease (CHD). CHD affects approximately one in every one hundred infants worldwide, making it one of the most prevalent birth abnormalities global. Hypertension or elevated blood pressure (EBP), is a global public health problem, as it is a risk factor for CVD and chronic renal disease (CRD). It affects approximately 1.3 billion people and is responsible for 7.5 million deaths a year. Egypt has the highest prevalence of hypertensive disease (26.3%) which is higher than USA (24%) [ 1 ] and has increased over the past 2 decades to 29% ranging from 12.1–56% [ 2 ]. Findings of EBP in preschool children are rarely reported. In school students EBP ranged from 5.1% in Kuwait [ 3 ] and 4.30% among preparatory school children in Alexandria [ 4 ] to 3.6% among school children in Jordan [ 5 ]. Childhood obesity has emerged as a novel global epidemic, becoming a major public health issue. Obesity can have profound effects on cardiac hemodynamics and morphology accentuating the effects of CHD. However the link between the combined effect of the presence of CHD and the dynamic disturbances caused by obesity, EBP which are starting to appear from early childhood need to be verified. Moreover, early suboptimal feeding practices (by not breastfeeding) have been shown to be associated with HBP and obesity. Hence the importance of addressing early feeding practices leading to obesity which can influence cardiovascular health. [ 6 ]. Obesity-induced alterations in cardiac function and EBP are interlinked and can both have significant implications for cardiovascular health and may contribute to the increased risk of heart-related complications and renal disease especially among individuals with CHD. Nutritional status is influenced by early feeding practices including breastfeeding, intake of commercial milk formula (CMF) and adequate, diverse healthy complementary food intake. Unhealthy foods high in salt can burden the kidney, interfere with aldosterone-angoitensin-renin maturation predisposing to EBP and renal disease. CMF and high salt in weaning foods can lead to obesity. Although children with CHD tend to be underweight especially younger children under 5 years old with severe CHD (9.8%) versus 4.9%, but the difference is normalized in children over 6 years of age. However, obesity rates are increasing even in children with more severe CHD such as Fontan, Tetralogy of Fallot, transposition of the great arteries showing a percentage of overweight children in the excess of 29% [ 7 ]. Doppler studies are useful in detecting mild lesions of CHD to prevent later cardiac problems. However, although literature is monitoring the climbing rates of obesity and EBP and their effect on the cardiac function, there is still much to be discovered in this field. The aim of this study is to identify status, determinants and any associations of findings of CHD by Doppler studies with EBP, obesity and in relation to early feeding practices in children under-five years of age. This could impact future management, preventive health strategies and country policies that can minimize the high economic costs in managing these conditions. Materials and Methods Study sample included 150 children (males and females) attending in the outpatient department of Damanhur Teaching Hospital in Behira, Egypt were selected and randomized into fully breastfed from birth (50), fully commercially milk formula fed (CMF) from birth (50) and mixed fed (50). The study was carried out over period from June, 2023 to March in 2024. Inclusion criteria included aged 3-5 years of either sex, apparently healthy and whose mothers were willing to participate. Exclusion criteria included freedom from any severe malnutrition, anemia, acute infectious disease, dehydration or chronic disease or exposure to parents who were heavy smokers. They were interviewed via a structured questionnaire about their socio-demographic background, perinatal history, early feeding practices, current feeding practices and family history of cardiovascular disease or diabetes mellitus. The children were subjected to a thorough clinical examination. Anthropometric measurements were taken for standing height to nearest cm, weight in grams, mid-arm (MAC) and waist circumference (WC) to the nearest mm. The Body mass index (BMI) was calculated from the weight and height using the WHO methods and BMI tables [8]. These were recorded and plotted on the standard growth charts for children 0-5 years of the World Health Organization [9]. Hemoglobin levels (Hb) were assessed to exclude significant anemia. Blood pressure (BP) measurements were taken for systolic and diastolic blood pressure using a standard sphygmomanometer and under standard conditions [10] The BP values are interpreted using the BP nanograms centile curves developed for Egyptian children by El-Shafie et al (2018) [11]. Echocardiographic assessment was carried out using standard methods as M-mode, 2D echocardiogram in different views, and Doppler, both pulsed (PW) and continuous wave (CW) in the parasternal (in short and long axis views), apical and subcostal views which are most suitable for children as described by others [12; 13] for detecting valvular lesions as mitral valve prolapse (MVR), tricuspid regurge (TR) and endocardial cushion defects (atrial or ventricular septal defects (ASD/VSD). Ethical approvals : An approval by the local ethical committee was obtained before the study by Benha Faculty of Medicine. A verbal informed consent was obtained from all participants (parents) before participation in the study, since most of them were illiterate or limited education. The objectives of the study, the expected benefits and types of information to be obtained were explained to them. Statistical Analysis : Data were fed to the computer and analyzed using IBM SPSS software package version 26.0. (Armonk, NY: IBM Corp) Quantitative data were described using mean and standard deviation Analysis was done by Chi square-test (x²) for comparison of qualitative data of frequency distribution. Student's "T"- test was used for comparison of quantitative data of 2 independent sample with normal distribution variables and one way ANOVA test for comparison of quantitative data of more than 2 independent samples with normal distribution variables. Correlation between groups were done using Pearson correlation test. The coefficient interval was set to 95%. The level of significance following probability (p) values of P<0.05 was used as a cut off for being statistically significant. Results The findings are presented in the tables below: The socio-demographic showed no differences with a mean age of around 4–5 years and no sex differences mostly living in slum areas. Two thirds of the parents had some kind of CVD and all children were highly exposed to tobacco from a smoking parent. Wasting with BMI-for-age 0.05. BMI for age > 97th centile indicative of obesity was 12% ranging from 8% in the breastfed to 18% in the mixed fed with no significant difference between the groups (P > 0.05). No differences were noted in WC. MAC was significantly higher in the fully breastfed (16.6 ± 2) compared to CMFF (15.9 ± 2.1) and mixed fed (15.3 ± 2.8) at (P = 0.01). Hemoglobin levels < 11 gm/dl was 10% with no significant differences between the groups and no significant clinical pallor requiring further investigation. Clinical data related to BP showed elevated DBP in the girls who were exposed to CMF and not breastfed. Table (1) Overall cases with ESBP in girls were 4 (5.1%) and none in boys (0%) with no ESBP in either sex. Pre-ESBP (> 90-95th centile) was detected in one quarter of the cases (22.2% in boys and 26.9% in girls) and Pre-EDBP in one third of the cases (29.2% in boys and 35.9% in girls) as shown in Table (1). On echocardiographic examination, Doppler studies showed a preponderance of mitral valve prolapse (MVP) with no differences by pattern of feeding in children aged 2–5 years of age as presented in table (1). There was no statistically significant association between echocardiographic findings and different parameters among studied children as presented in table (2). However, the breastfed tended to breastfeed longer and more cases with mild lesions appeared as normal healthy children were detected in the breastfeeding group. Also, none of those who had lesions showed elevated BP compared to the normotensive cases. It raises possibility that the presences of these lesions had a physiological function in preventing the rise in resistance i.e. the diastolic BP. The patterns of feeding among the groups who were breastfed, non-breastfed and mixed fed during their infancy are presented in table (3). Early breastfeeding, full breastfeeding and other practices related to optimal breastfeeding were significantly higher in the breastfed, while suboptimal practices were more common among the non-breastfed. Early, breastfeeding, skin to skin, cue feeding, night feeding and full breastfeeding were physiologically adapted to the needs of hemodynamic stabilization and thereby prevention of elevation of BP. The correlation between systolic and diastolic blood pressure in children and among the children of the groups who were breastfed and non-breastfed by feeding practices is presented in table (4) and shows that optimal breastfeeding practices were associated with optimal BP and suboptimal formula feeding practices were associated with suboptimal BP. Table (1) Sociodemographic, anthropometric and clinical data related to blood pressure and echo findings by pattern of feeding in children aged 2–5 years of age Fully breastfed Never breastfed Mixed** Total P value N = 50 N = 50 N = 50 (150) Age in months Sex Male 25(50%) 23(46%) 24(48%) 72 (48%) 0.92 Female 25 (50%) 27 (54%) 26 (52%) 78(52%) Residence Urban 13 (26%) 19 (38%) 12 (24%) 44 (29.33%) 0.56 Rural 16 (32%) 15 (30%) 18 (36%) 49 (32.67%) Slum 21 (42%) 16 (32%) 20 (40%) 57 (38%) Family history Hypertension 18(36%) 19(38%) 19(38%) 56 (37.33%) 0.99 Heart disease 15(30%) 16(32%) 15(30%) 46 (30.67%) Diabetes mellitus 17(34%) 15(30%) 16(32%) 48 (32%) Exposure to smoking Father 20(40%) 27(54%) 24(48%) 71 (47.3%) 0.16 Mother 0 0 0 0 (0%) No exposure 30(60%) 23(46%) 26(52%) 79 (52.67%) Boys SBP on Egyptian standards by percentile (T = 72) 95th 0(0%) 0(0%) 0(0%) 0 (0%) Boys DBP on Egyptian standards by percentiles 95th 0(0%) 0 (0%) 0(0%) 0 (0%) Girls SBP on Egyptian standards by percentile (T = 78) 95th 0(0%) 0(0%) 0(0%) 0 (0%) Girls DBP on Egyptian standards by percentiles** 95th 0(0%) 3(11.1%) 1(3.8%) 4 (5.1%) BMI-for-age interpreted using WHO Percentile for age (0–5 years) < 3rd 5(10%) 3 (6%) 2 (4%) 10 (6.67%) 0.5 3rd to < 15th 8(16%) 7 (14%) 5 (10%) 20 (13.3%) 15th to < 50th 9(18%) 8(16%) 7(14%) 24 (16%) 50th to < 85th 14(28%) 15(30%) 13(26%) 42 (28%) 85th to < 97th 10(20%) 12 (24%) 14 (28%) 36 (24%) ≥ 97th 4(8%) 5(10%) 9(18%) 18 (12%) Echocardiographic Doppler findings of cases with Congenital Heart Defects Total cases 5 (10.0%) 6 (12%) 5 (10%) 16 (10.67%) 0.9 Mild mitral valve prolapse 4(8%) 4(8%) 3(6%) 11 (7.3%) Mild TR 1(2%) 1(2%) 1(2%) 3 (5.3%) Small ASD 0 0 1(2%) 1 (0.67%) Small VSD 0 1(2%) 0 1 (0.67%) Nutritional indices among patients with mitral valve prolapse Wasted 2 (50%) 0 (0%) 1 (33.3%) 3 (5.3%) 0.80 Underweight 1 (25%) 1 (25%) 0 (0%) 2 (1.3%) Average 1 (25%) 2 (50%) 2 (66.7%) 5 (3.3%) Overweight 0 (0%) 0 (0%) 0 (0%) 0 (0%) Obese 0 (0%) 1 (25%) 0 (0%) 1(0.67%) Mean ± SD of Waist circumference (WC) and Mid arm circumference of groups under study WC 54 ± 3.6 55.3 ± 4 54.6 ± 4.2 0.24 MAC 16.6 ± 2 15.9 ± 2.1 15.3 ± 2.8 0.01* Hemoglobin 11gm/dl 45 (90%) 44 (88%) 46 (92%) NS *Cut off of significance is P < 0.05 **Mixed fed means was fed breast-milk but also formula milk in bottle with or without added sugar and starch. MVP: mild mitral valve prolapse, TR: tricuspid regurgitation, ASD: atrial septal defect, VSD: ventricular septal defect, VSD: ventricular septal defect. Table (2): Association between echocardiographic findings and different parameters among children (3–5 years of age) Variables Normal Mild MVP Mild TR ASD/VSD P value N = 136 N = 11 N = 3 N = 2 SBP > 95 th percentile 90–95 th percentile 95 th percentile 90–95 th percentile < 90 th percentile 3 (2.2%) 3 (2.2%) 128 (95.5%) 0 (0%) 0 (0%) 3 (100%) 0 (0%) 0 (0%) 11 (100%) 0 (0%) 0 (0%) 2 (100%) 1.00 Breastfeeding duration 1:6 months 6:12 months More than one year 51 (38.1%) 43 (32.1%) 40 (29.9%) 2 (66.7%) 1 (33.1%) 0 (0%) 4 (36.4%) 4 (36.4%) 3 (27.3%) 1 (50%) 1 (50%) 0 (0%) 0.94 Bottle fed duration* 1:6 months 6:12 months More than one year 42 (31.3%) 28 (20.9%) 19 (21.3%) 1 (50%) 1 (50%) 0 (0%) 3 (42.9%) 3 (42.9%) 1 (14.3%) 1 (50%) 1 (50%) 0 (0%) 0.97 * Assessed only in group of breastfed and non-breastfed. MVP: mild mitral valve prolapse, TR: tricuspid regurgitation, ASD: atrial septal defect, VSD: ventricular septal defect, VSD: ventricular septal defect. Table (3) Patterns of feeding among the groups who were breastfed, non-breastfed and mixed fed during their infancy Infant feeding practice Fully breastfed Never breastfed Mixed** P value N = 50 N = 50 N = 50 Early initiation of Breastfeeding: 24 hours 12 (24%) 8 (16%) 9 (18%) Early initiation by skin to skin contact Taken away 7 (14%) 25 (50%) 12 (24%) 0.001* 24 hours 13 (26%) 7 (14%) 6 (12%) Frequency of feedings per day (breast or formula) 2 times 0 40 (80%) 22 (44%) 3 times 50 (100%) 0 14 (28%) Frequency of feeding per night (breast or formula) One time 11 (22%) 45 (90%) 17 (34%) 2 times 24 (48%) 0 17 (34%) Rooming in From birth 34 (68%) 28 (56%) 30 (60%) 0.32 At home 16 (32%) 22 (44%) 20 (40%) Pattern of feeding Scheduled 23 (46%) 50(100%) 13 (26%) < 0.001* On crying 16 (32%) 0 15 (30%) Cue led Feeds 11 (22%) 0 22 (44%) Age of stopping Breastfeeding 1–6 months 11 (22%) 31 (62%) 16 (32%) 1 year 29 (58%) 0 14 (28%) *Cut off of significance is P < 0.05 **Mixed fed means was fed breastmilk but also commercial milk formula (CMF) in bottle with or without added sugar and starch. Table (4): Correlation between systolic and diastolic blood pressure in children and among the children of the groups who were breastfed and non-breastfed by feeding practices Blood pressure of children vs. variables Systolic Blood Pressure Diastolic Blood Pressure R P value R P value Breastfeeding practices Full breastfeeding -0.16 0.02* -0.15 0.03* Early initiation of Breastfeeding < 1 hour -0.18 0.04* -0.13 0.08 Early initiation of skin to skin contact 0.02 0.81 -0.09 0.2 Prenatal education about infant feeding -0.15 0.05* -0.16 0.04* Frequency of Breastfeeding per day -0.22 0.01* -0.13 0.05* Age of stopping breastfeeding -0.32 0.03* -0.12 0.04* Frequency of night breastfeeds -0.19 0.02* -0.17 0.03* Supplements given -0.01 0.90 0.12 0.44 Frequency of supplements other than breast-milk -0.05 0.53 0.18 0.02* Pacifiers given 0.03 0.66 -0.22 0.005* Age of start pacifier 0.02 0.72 -0.18 0.02* Age of stopping pacifier 0.004 0.95 -0.20 0.01* Non breastfed (formula fed groups) Frequency of formula feeding 0.14 0.04* 0.13 0.05* Addition of sugar to formula 0.13 0.05* 0.15 0.01* Age of start additives of sugar or starch to formula -0.18 0.01* -0.22 0.009* How cleaned bottle (non-hygienic) 0.18 0.04* 0.21 0.03* Quality of complementary feeding meals Preparation of food 6-12m (salt ) 0.27 0.001* 0.24 0.009* Preparation of food(salt)12–24 0.16 0.04* 0.18 0.03* Dietary diversity (high) -0.07 0.28 -0.05 0.6 High intake of unhealthy diet 0.25 0.008* 0.21 0.01* *Cut off of significance P < 0.05. Discussion Although EBP in this age group appears to be minimal yet EDBP was detected in girls (5.1%) and not in boys (0%) with no ESBP in either sex. Moreover, it was detected in the girls exposed to CMFF in their infancy but not in those who were fully breastfed. Prehypertension or pre-ESBP (> 90-95th centile) was detected in one quarter of the cases (22.2% in boys and 26.9% in girls) and pre-EDBP in one third of the cases (29.2% in boys and 35.9% in girls). Such findings coincide with the findings of other studies who reported that the pooled global prevalence of EBP among children was 4.00% [ 14 ]. However, studies for EBP in preschoolers have not been reported in Egypt. A cross-sectional study of 1500 adolescents (11–19 years) in Alexandria in Egypt reported that prevalence rates of prehypertension and hypertension (HTN) were 5.7% and 4.0% [ 15 ]. The Demographic health survey in 2008 reported that HTN in the 11–19 females was (3.8%) and males (4.9%) [ 16 ]. Findings from analysis of demographic surveys conducted in 2015 indicate that overall prevalence of HTN in Egypt is 26% and that more than half of Egyptian adults who meet criteria for HTN are unaware of their BP status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status [ 17 ]. Our cases with Doppler findings of CHD did not show any significant elevations in BP. It is ideal to compare our results with standards developed from our own locality. The trend of Egyptian SBP and DBP nanograms, differ from Turkish [ 18 ] and American nanograms[ 19 ]. The latter Task Force values were based on nine different populations, including African and Mexican Americans. They used the first BP reading and not the average of two readings as in the Egyptian study. The rise in BP with increasing age is most probably caused by the growth of the child. It is accepted that the most influential determinants of normal BP are chronological age and body size as determined by height, weight and BMI [ 20 ]. This study showed that early breastfeeding and full breastfeeding was associated with lower tendency towards EBP. There were no significant echocardiographic studies. However, a study on which echocardiographic studies were conducted for 76 healthy infants aged 6 to 24 months of life of whom 38 were fed only breast-milk and 38 who were CMFF in the first six months of life showed some differences in right ventricular (RV) studies. Percent fractional shortening (%FAC) for right side was significantly higher in fully breastfed infants compared to the CMFF (P < 0.05). There was a significant increase in the mean RV Velocity time integral (VTI) values in EBF infants (17.2 ± 2.73) than CMFF infants (15.9 ± 1.94) P < 0.01; the cardiac output (COP) and the Tricuspid Annular Plane Systolic Excursion (TAPSE) were significantly higher in breastfed infants (5.81 ± 1.01) than CMFF infants (5.26 ± 1.18), (1.56 ± 0.18) and (1.46 ± 0.20) respectively at P < 0.05. Their findings suggested that early feeding patterns in infancy may influence functions and structures of right side of the heart in infancy and that fully breastfeeding supports higher performance and may explain their higher resilience to cardiac insults later in life [ 21 ]. This study revealed that not breastfeeding was associated with increased tendency towards obesity. Breastfeeding reduced the odds of overweight or obesity as indicated by many workers [22; 23; 24; 25]. Studies involving autopsies, ultrasounds, and cardiac magnetic resonance imaging (cMRI) have demonstrated that obesity may influence cardiac morphology [ 26 ]. One of the most frequently observed alterations is left ventricular (LV) hypertrophy, often eccentric, particularly in the absence of concurrent HTN. Chahal et al. [ 27 ] in a study that involved 4127 patients revealed that the right ventricular mass was 15% greater in overweight/obese patients compared to lean patients and right ventricular volumes were 26% larger in overweight/obese subjects compared to lean patients (p < 0.001 for the trend) [ 27 ]. A cross-sectional study was conducted for 76 healthy infants aged 3 to 12 months of life (38 breastfed and 38 CMFF, BMI percentiles were significantly higher in CMFF infants compared to breasted infants (P < 0.05). BMI was positively correlated with structural dimensions in CMFF but not breastfed. BMI correlated with RV function in breastfed but not CMF fed infants [ 28 ]. This study also indicated that not breastfeeding was associated with EBP. However there is limited evidence that suggests that never versus ever being fed human milk is associated with EBP within a normal range at 6–7 y of age. Moderate evidence suggests there is no association between the duration of any human milk feeding and childhood BP. Limited evidence suggests there is no association between the duration of exclusive human milk feeding and BP or metabolic syndrome in childhood. Additional evidence about intermediate outcomes for the 4 systematic reviews was scant or inconclusive [ 29 ]. None the less Metabolic syndrome (MetS) which is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, were found to increase risks of developing future CVD and type 2 diabetes mellitus (T2D) [ 30 ]. On the other hand Doppler findings suggested no relationship between the findings of MVP, TR, ASD or VSD and early feeding, BP or obesity. MVP was the commonest lesion detected in 11 cases (7.3%). MVP is s generally considered a benign condition often associated with a leaky valve causing blood to flop back into the atrium; however, at times, it may present with sudden cardiac death, endocarditis, arrhythmias or cerebrovascular accident. It is more associated with leaness rather than obesity. It ranges from 4–8%. MVP usually occurs as a primary disorder and is commonly, but not invariably, associated with myxomatous proliferation of the mitral valve and chordae tendineae. The absence of any relationship between obesity and even morbid obesity on the progression or complication associated with mitral regurge is in agreement with many other workers who studied MR after reconstructive surgery [ 31 ]. In addition MVP in association with EBP was not an issue in this study. Low BP is reported by others as a common feature in patients with MVP, and association between the two entities was found in population-based studies [ 32 ]. MVP individuals demonstrate increased beta-adrenergic receptor responsiveness associated with a hyperkinetic circulation [ 33 ]. The latter research team showed that in patients with MVP giving propranolol increased BP, and decreased heart rate, and depends, namely, on β1 receptors blockade. Increase in BP is an unusual response to adrenergic beta-blockade in normal conditions, and this finding supports the preponderance of β2 receptors on the BP control in patients with MVP. Breastfeeding through practices as early initiation, cue feeding, night feeding and tactile stimulation may assist in stabilizing the hyper-responsiveness of adrenergic responses preventing the sudden disturbances in BP and HR shown in individuals with MVP. However this may need further investigation. A study conducted in Cairo University Children’s Hospital on infants with CHD and heart failure (HF) showed that breastfeeding and skin-to-skin contact (SSC) resulted in a sustained improvement in their oxygen saturations and vital signs when compared to the artificially fed infants with CHD and HF [ 34 ]. Another study in Sweden showed that immediate SSC versus incubator care had beneficial effects on the cardiorespiratory stabilisation of very preterm infants. SSC stimulates oxytocin release in mother and infant which is a hormone and neuropeptide, is associated with calmness, bonding, and stress reduction [ 35 ]. Inappropriate foods introduced early in life that include adding sugar and starch to bottles and salt to weaning foods are shown to be linked with higher BP. A study in Egypt showed that high BP prevalence in young school children and youth was associated with adding table salt, regular consumption of certain energy dense foods, and certain types of salty foods and foods with high sodium content (OR 2.6) [ 36 ]. In another study snacking, high intakes of sugary beverages and less physical activity among children had a higher risk for HBP (OR 2.5) [ 37 ] and especially when children were obese [38; 15] In Qalyuibiya, school-aged children with prehypertension or EBP were 4 times less likely to practice sports [ 39 ]. EBP was more prevalent in private than in public schools [ 38 ]. EBP was more prevalent in obese versus overweight (22% vs. 6.4%) and WC was reported to be a good indicator of elevated BP [ 40 ]. A study conducted for primary school children in Menoufia in Egypt showed that prehypertension was 2.8% in males and 5.2% in females who were overweight and obese and increase in age in both sexes [ 41 ]. The risk of EBP has been associated with disturbed lipid metabolism and other biomarkers of CVD. A study by Attia (2017) showed that biomarkers of CVD were higher in non-breastfed children and their mothers who did not breastfeed compared to mothers and children who were exposed to breastfeeding [ 42 ]. Obese and hypertensive youth had lipid profiles of atherosclerosis and high-risk patterns of impaired glucose homeostasis (pre-diabetes) and when the research team conducted Doppler studies for these obese youth they found increased risk of diastolic dysfunction [ 43 ]. Left ventricular diastolic function (LVDF) is an important marker of early cardiovascular remodelling, which has not been well summarized in young people with overweight/obesity. Increased BMI was associated with worse LVDF in all measures except early mitral inflow deceleration time, with septal early diastolic tissue peak velocity to late diastolic tissue peak velocity ratio having the strongest association ( n = 13 studies, 1824 individuals; r = − 0.69; P < 0.001). Elevated HOMA-IR was also associated with worse LVDF [ 44 ]. Hence obesity and EBP results in a combination of disturbed metabolism of glycemic homeostasis and renal dysfunction apparently emerging from the young age probably triggered by poor early feeding practices of not breastfeeding and exposure to CMFF. The study has a number of limitations related to its small size and limited representation, although cases were taken from Damanhur Teaching hospital which is a referral hospital for one of the largest governorates in Egypt, still conclusive findings cannot be made on such a sample. However, it is a definite eye open to the pending holocaust caused by the inappropriate early feeding practices that have invaded the lives and eating behavior of young children. The detection of EBP in this age group and high prevalence of pre-HTN and obesity is a disturbing finding. Moreover CHD, although mild and predominantly encompassing MVP in almost one half of the cases, which is a benign condition, yet could develop into complications if associated with untreated high BMI and EBP on the long run. Breastfeeding is by far the most suitable and safe feeding practice for children and should be promoted and supported in addition with strict laws to regulate salt intake in marketed foods [ 45 ]. Regular monitoring of young children for EBP in nurseries, especially among the obese children is recommended. Future studies that examine these findings through demographic surveys are needed not only in Egypt but in other countries in the region. Preventive actions through early detection and campaigns for increasing awareness of the public about the importance of tracking their child’s feeding behavior and checking their BP and physical health status beginning as early as preschool age is recommended. Declarations Disclosures: none Disclaimers: none Acknowledgements to Pediatric department in Damanhour Teaching hospital for facilitating collection of data and screening studies by echocardiogram. Role of the investigators: Sameh Zaki Abdulsamea was involved in the conceptualization, literature review, statistical re-analysis of data and interpretation, presentation and research writing. Azza Abul-Fadl was involved in organizing the team, planning of the work, literature review, supervising collection of data, statistical analysis, interpreting data, writing the discussion and revising paper. Maha Mourad, expert in cardiology, reviewer and supervisor. References Ibrahim, M. Mohsen. Epidemiology of Hypertension in Egypt. 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Childhood Obesity and Congenital Heart Disease: A Lifelong Struggle. Journal of Clinical Medicine . 2023; 12(19):6249. https://doi.org/10.3390/jcm12196249. Agnostopoulou A. The burden of obesity in children with congenital heart disease. Global Pediatrics. 2023. 3:100037, ISSN 2667-0097. WHO. Training course on child growth assessment, WHO child growth standards. Interpreting growth indicators. BMI card. WHO child growth standards: training course on child growth assessment. World Health Organization 2008. WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth among populations in the WHO multicentre growth reference study. Acta Paediatr Suppl. 2006; 450:56–65. Goonasekera CD, Dillon MJ. Measurement and interpretation of blood pressure. Arch Dis Child 2000;82:261–5. El-shafie AM, El-Gendy FM, Allhony DM, et al. Establishment of blood pressure nomograms representative for Egyptian children and adolescents: a cross-sectional study. BMJ Open 2018;8:e020609. doi:10.1136/bmjopen-2017-020609. Bolger AF, Eidenvall L, Ask P, Loyd D, Wranne B. Understanding continuous-wave Doppler signal intensity as a measure of regurgitant severity. J Am Soc Echocardiogr. 1997 Jul-Aug;10(6):613-22. Ahmed I, Sasikumar N. Echocardiography Imaging Techniques. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. (Accessed on 4 July, 2024 from https://www.ncbi.nlm.nih.gov/books/) Song P, Zhang Y, Yu J, et al. Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(12):1154–1163. doi:10.1001/jamapediatrics.2019.3310 Abolfotouh M, Sallam S, Mohammed M, Loutfy A, Hasab A. Prevalence of Elevated Blood Pressure and Association with Obesity in Egyptian School Adolescents. International journal of Hypertension. 2011. 2011. 952537. 10.4061/2011/952537. El-Zanaty, Fatma and Ann Way. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International. 2009. Soliman SSA, Guseman EH, Haile ZT, Ice G. Prevalence and determinants of hypertension unawareness among Egyptian adults: the 2015 EHIS. Journal of Human Hypertension. 2021;35(10):927-934. Tümer N, Yalçinkaya F, Ince E, et al. Kara N, Ozkaya N, Ensari C, Onder S. Blood pressure nomograms for children and adolescents in Turkey. Pediatr Nephrol 1999;13:438–43. Rosner B, Cook NR, Daniels S, et al. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension 2013;62:247–54. Doll S, Paccaud F, Bovet P, et al. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes Relat Metab Disord. 2002;26:48–57. Abul-Fadl AM, Amer EG, Darwish M, Mahfouz D. Echocardiography of the Right Ventricle in Infancy: Do Early Feeding Practices Make a Difference?” EC Paediatrics. 9.8 (2020): 29-37. Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of Breastfeeding and Risk of Overweight: A Meta-Analysis. Am. J. Epidemiol. 2005;162:397–403. Plagemann A, Harder T, Schellong K, Schulz, S, Stupin J.H. Early postnatal life as a critical time window for determination of long-term metabolic health. Best Pract. Res. Clin. Endocrinol. Metab. 2012;26:641–653. Papatesta E.-M, Iacovidou N. Breastfeeding reduces the risk of obesity in childhood and adolescence. J. Pediatr. Neonatal Individ. Med. (JPNIM) 2013;2:e020206. Horta BL, Rollins N, Dias MS, Garcez V, Perez-Escamilla R. Systematic review and meta-analysis of breastfeeding and later overweight or obesity expands on previous study for World Health Organization. Acta Paediatr. 2023;112:34–41 Cabeza JF, Aristizábal-Duque CH, Sánchez IMB, Ortiz MR, Almodóvar AR, Ortega MD, et al. Relationship between overweight and obesity and cardiac dimensions and function in a paediatric population. Eur. J. Pediatr. 2022;181:1943–1949. Chahal H, McClelland R.L, Tandri, H, Jain A, Turkbey E.B, Hundley W.G, Barr, R.G, Kizer J, et al. Obesity and Right Ventricular Structure and Function: The MESA-Right Ventricle Study. Chest 2012, 141:388–395. Bishr NT, Daeweesh M., Amer E, Abul-Fadl AMA, Al-Jawaldeh A. Overweight Increases the Risk of Right Ventricular Dysfunction in the non-Breastfed Infants. (2020). International Journal of Scientific Research and Management (IJSRM), 8(10), 411-420. Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, et al. Infant milk-feeding practices and cardiovascular disease outcomes in offspring: a systematic review. Am J Clin Nutr. 2019 Mar 1;109(Suppl_7):800S-816S. doi: 10.1093/ajcn/nqy332. Wasniewska M, Pepe G, Aversa T, Bellone S, de Sanctis L, Di Bonito P, et al. Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity. Children 2023, 10, 735. EL-Andari R., Bozso SJ, Kang JJH, et al. The effects of body mass index on long-term outcomes and cardiac remodeling following mitral valve repair surgery. Int J Obes 45, 2679–2687 (2021). https://doi.org/10.1038/s41366-021-00933-z Devereux RB, Kramer-Fox R, Brown WT, Shear MK, Hartman N, Kligfield P, et al. Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse. J Am Coll Cardiol 1986; 8: 763-72. da Silva EP, Pedro MM, Varela MG, et al. Heart rate, blood pressure and beta-blockade in MVP. Anatol J Cardiol 2007: 7 Suppl 1; 107-9. Abdelwahed M, Abul-Fadl AM, Lotfy WM, Eltaweel AA. Skin-to-skin care for care for care for managing congestive heart failure in infants. MCFC Egypt J Breastfeed 2012;4:59-71. Linnér A, Lode-Kolz K, Klemming S, Bergman N, Lilliesköld S, Pike H, et al. Immediate skin‐to‐skin contact may have beneficial effects on the cardiorespiratory stabilisation in very preterm infants. Acta Paediatrica. 2022; 111. 10.1111/apa.16371. Abul-Fadl A, Al-Jawaldeh A. An in-depth multi-dimensional review of hypertension in adolescents in relation to obesity: Risk approach management is the solution. Indian J Child Health. 2021; 8:10 DOI: 10.32677/ijch.v8i10.3055 Kamel SG. Hypertension and its Relation to Obesity among Primary CareChildren in Alexandria. Thesis, Master of Science Degree in Forensic Medicine: Faculty of Medicine, Alexandria University, Egypt, 2010. Osman MA. Prevalence of Hypertension among Obese Primary School Children in Some Urban Areas in Qaluibiya Governorate. Thesis Master of Science in Pediatrics. Faculty of Medicine, Benha University, Egypt, 2015. Mohamed MS. Prevalence of Hypertension among Obese Primary School Children in Some Rural Areas in Qaluibiya Governorate. Thesis, Master of Science in Pediatrics. Faculty of Medicine, Benha University,Egypt, 2015. Ismail HA. Assessment of Obesity and Its Relation to Blood Pressure in Primary School Children. Thesis, Master in Pediatrics. Faculty of Medicine, Menoufia University, Egypt, 2012. Aziz AY. Growth Parameters and Blood Pressure Measurements in Primary School Children. Thesis, Master in Pediatrics. Faculty of Medicine, Menoufia University, Egypt, 2019. Attia MA. Influence of early feeding practices on biomarkers of cardiovascular diseases in later life. Master thesis in Pediatrics, Benha Faculty of Medicine. Benha University, Egypt 2017. Shaheen SI. Tissue Doppler Studies for Assessment of Cardiovascular Risk in Obese Adolescents. MD Thesis Pediatrics. Faculty of Medicine, Benha University, Egypt, 2017. Burden S, Weedon B, Whaymand L, Rademaker J, Dawes H, Jones A. The effect of overweight/obesity on diastolic function in children and adolescents: A meta-analysis. Clin Obes. 2021;11(5):e12476. Al-Jawaldeh A, Rafii B, Nasreddine L. Salt intake reduction strategies in the Eastern Mediterranean Region. East Mediterr Health J. 2018;24:1172-80. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4768722","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335926744,"identity":"4f6c9349-2b06-47c5-9273-074f3a33a3f7","order_by":0,"name":"Azza Abul-Fadl","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYDACCQbGAxUMzDL8zMzHP3wACrCxE9bCcOAMAzOPZHtbGuMMkBZmYrUYnDljxswDEiGkhX92j8GBAzXWPAw3Eswe2/zaJs/HzMD44WMOHkvunAFqOZbOwzgjId04t++2YRszA7PkzG14rLmRY3D4A9thHmaJhAPSuT23GYFa2Jh58WiRB2o5cODfYR42icQGacue2/YEtRiAtBxsO8zDw3OYTZrhx+1EgloM7xwrOHCwL51Hgr2N2bC34XZyGzNjM16/yN1u3vjgwDdrOfvD/B8f/Phz23Z+e/PBDx/xeR8FMLaByQZi1YPAH1IUj4JRMApGwUgBAP3yV4/dxGOVAAAAAElFTkSuQmCC","orcid":"","institution":"Benha University","correspondingAuthor":true,"prefix":"","firstName":"Azza","middleName":"","lastName":"Abul-Fadl","suffix":""},{"id":335926745,"identity":"3e3fa428-8fe2-41bf-ae00-5147c03efcf4","order_by":1,"name":"Sameh Zaki AbdulSamae","email":"","orcid":"","institution":"Benha University","correspondingAuthor":false,"prefix":"","firstName":"Sameh","middleName":"Zaki","lastName":"AbdulSamae","suffix":""},{"id":335926746,"identity":"a246c9ba-9ffc-4cab-9d5a-ebcdbcbc1528","order_by":2,"name":"Maha Mourad","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Maha","middleName":"","lastName":"Mourad","suffix":""}],"badges":[],"createdAt":"2024-07-19 17:03:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4768722/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4768722/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61856848,"identity":"9e63fb21-de37-469e-a589-2bf6e0b109e3","added_by":"auto","created_at":"2024-08-06 10:00:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1155099,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4768722/v1/60490873-d69a-4980-b4ba-d9e2bf84efac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High Blood Pressure and Obesity: Is not-breastfeeding an added risk for children with Benign Congenital Heart Disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular diseases (CVD) are recognized to emerge from early childhood. The focus on pediatric cardiology has been on congenital heart disease (CHD). CHD affects approximately one in every one hundred infants worldwide, making it one of the most prevalent birth abnormalities global. Hypertension or elevated blood pressure (EBP), is a global public health problem, as it is a risk factor for CVD and chronic renal disease (CRD). It affects approximately 1.3\u0026nbsp;billion people and is responsible for 7.5\u0026nbsp;million deaths a year. Egypt has the highest prevalence of hypertensive disease (26.3%) which is higher than USA (24%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and has increased over the past 2 decades to 29% ranging from 12.1\u0026ndash;56% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Findings of EBP in preschool children are rarely reported. In school students EBP ranged from 5.1% in Kuwait [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and 4.30% among preparatory school children in Alexandria [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] to 3.6% among school children in Jordan [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildhood obesity has emerged as a novel global epidemic, becoming a major public health issue. Obesity can have profound effects on cardiac hemodynamics and morphology accentuating the effects of CHD. However the link between the combined effect of the presence of CHD and the dynamic disturbances caused by obesity, EBP which are starting to appear from early childhood need to be verified. Moreover, early suboptimal feeding practices (by not breastfeeding) have been shown to be associated with HBP and obesity. Hence the importance of addressing early feeding practices leading to obesity which can influence cardiovascular health. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Obesity-induced alterations in cardiac function and EBP are interlinked and can both have significant implications for cardiovascular health and may contribute to the increased risk of heart-related complications and renal disease especially among individuals with CHD.\u003c/p\u003e \u003cp\u003eNutritional status is influenced by early feeding practices including breastfeeding, intake of commercial milk formula (CMF) and adequate, diverse healthy complementary food intake. Unhealthy foods high in salt can burden the kidney, interfere with aldosterone-angoitensin-renin maturation predisposing to EBP and renal disease. CMF and high salt in weaning foods can lead to obesity. Although children with CHD tend to be underweight especially younger children under 5 years old with severe CHD (9.8%) versus 4.9%, but the difference is normalized in children over 6 years of age. However, obesity rates are increasing even in children with more severe CHD such as Fontan, Tetralogy of Fallot, transposition of the great arteries showing a percentage of overweight children in the excess of 29% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Doppler studies are useful in detecting mild lesions of CHD to prevent later cardiac problems. However, although literature is monitoring the climbing rates of obesity and EBP and their effect on the cardiac function, there is still much to be discovered in this field. The aim of this study is to identify status, determinants and any associations of findings of CHD by Doppler studies with EBP, obesity and in relation to early feeding practices in children under-five years of age. This could impact future management, preventive health strategies and country policies that can minimize the high economic costs in managing these conditions.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eStudy sample included 150 children (males and females) attending in the outpatient department of Damanhur Teaching Hospital in Behira, Egypt were selected and randomized into fully breastfed from birth (50), fully commercially milk formula fed (CMF) from birth (50) and mixed fed (50). The study was carried out over period from June, 2023 to March in 2024. Inclusion criteria included aged 3-5 years of either sex, apparently healthy and whose mothers were willing to participate. Exclusion criteria included freedom from any severe malnutrition, anemia, acute infectious disease, dehydration or chronic disease or exposure to parents who were heavy smokers. They were interviewed via a structured questionnaire about their socio-demographic background, perinatal history, early feeding practices, current feeding practices and family history of cardiovascular disease or diabetes mellitus. The children were subjected to a thorough clinical examination. Anthropometric measurements were taken for standing height to nearest cm, weight in grams, mid-arm (MAC) and waist circumference (WC) to the nearest mm. The Body mass index (BMI) was calculated from the weight and height using the WHO methods and BMI tables [8]. These were recorded and plotted on the standard growth charts for children 0-5 years of the World Health Organization [9]. Hemoglobin levels (Hb) were assessed to exclude significant anemia. Blood pressure (BP) measurements were taken for systolic and diastolic blood pressure using a standard sphygmomanometer and under standard conditions [10] The BP values are interpreted using the BP nanograms centile curves developed for Egyptian children by El-Shafie et al (2018) [11]. Echocardiographic assessment was carried out using standard methods as M-mode, 2D echocardiogram in different views, and Doppler, both pulsed (PW) and continuous wave (CW) in the parasternal (in short and long axis views), apical and subcostal views which are most suitable for children as described by others [12; 13] for detecting \u0026nbsp;valvular lesions as mitral valve prolapse (MVR), tricuspid regurge (TR) and endocardial cushion defects (atrial or ventricular septal defects (ASD/VSD).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approvals\u003c/strong\u003e: An approval by the local ethical committee was obtained before the study by Benha Faculty of Medicine. A verbal informed consent was obtained from all participants (parents) before participation in the study, since most of them were illiterate or limited education. The objectives of the study, the expected benefits and types of information to be obtained were explained to them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e: Data were fed to the computer and analyzed using IBM SPSS software package version 26.0. (Armonk, NY: IBM Corp) Quantitative data were described using mean and standard deviation Analysis was done by Chi square-test (x²) for comparison of qualitative data of frequency distribution. Student's \"T\"- test was used for comparison of quantitative data of 2 independent sample with normal distribution variables and one way ANOVA test for comparison of quantitative data of more than 2 independent samples with normal distribution variables. Correlation between groups were done using Pearson correlation test. The coefficient interval was set to 95%. The level of significance following probability (p) values of P\u0026lt;0.05 was used as a cut off for being statistically significant.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe findings are presented in the tables below: The socio-demographic showed no differences with a mean age of around 4\u0026ndash;5 years and no sex differences mostly living in slum areas. Two thirds of the parents had some kind of CVD and all children were highly exposed to tobacco from a smoking parent. Wasting with BMI-for-age\u0026thinsp;\u0026lt;\u0026thinsp;3rd centile was 6.67% ranging from 10% in the fully breastfed to 6% in the CMFF and 4% in the mixed fed with no significant difference between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05. BMI for age\u0026thinsp;\u0026gt;\u0026thinsp;97th centile indicative of obesity was 12% ranging from 8% in the breastfed to 18% in the mixed fed with no significant difference between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). No differences were noted in WC. MAC was significantly higher in the fully breastfed (16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2) compared to CMFF (15.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1) and mixed fed (15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8) at (P\u0026thinsp;=\u0026thinsp;0.01). Hemoglobin levels\u0026thinsp;\u0026lt;\u0026thinsp;11 gm/dl was 10% with no significant differences between the groups and no significant clinical pallor requiring further investigation.\u003c/p\u003e \u003cp\u003eClinical data related to BP showed elevated DBP in the girls who were exposed to CMF and not breastfed. Table\u0026nbsp;(1) Overall cases with ESBP in girls were 4 (5.1%) and none in boys (0%) with no ESBP in either sex. Pre-ESBP (\u0026gt;\u0026thinsp;90-95th centile) was detected in one quarter of the cases (22.2% in boys and 26.9% in girls) and Pre-EDBP in one third of the cases (29.2% in boys and 35.9% in girls) as shown in Table\u0026nbsp;(1).\u003c/p\u003e \u003cp\u003eOn echocardiographic examination, Doppler studies showed a preponderance of mitral valve prolapse (MVP) with no differences by pattern of feeding in children aged 2\u0026ndash;5 years of age as presented in table (1). There was no statistically significant association between echocardiographic findings and different parameters among studied children as presented in table (2). However, the breastfed tended to breastfeed longer and more cases with mild lesions appeared as normal healthy children were detected in the breastfeeding group. Also, none of those who had lesions showed elevated BP compared to the normotensive cases. It raises possibility that the presences of these lesions had a physiological function in preventing the rise in resistance i.e. the diastolic BP.\u003c/p\u003e \u003cp\u003eThe patterns of feeding among the groups who were breastfed, non-breastfed and mixed fed during their infancy are presented in table (3). Early breastfeeding, full breastfeeding and other practices related to optimal breastfeeding were significantly higher in the breastfed, while suboptimal practices were more common among the non-breastfed. Early, breastfeeding, skin to skin, cue feeding, night feeding and full breastfeeding were physiologically adapted to the needs of hemodynamic stabilization and thereby prevention of elevation of BP. The correlation between systolic and diastolic blood pressure in children and among the children of the groups who were breastfed and non-breastfed by feeding practices is presented in table (4) and shows that optimal breastfeeding practices were associated with optimal BP and suboptimal formula feeding practices were associated with suboptimal BP.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1) Sociodemographic, anthropometric and clinical data related to blood pressure and echo findings by pattern of feeding in children aged 2\u0026ndash;5 years of age\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully breastfed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever breastfed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(150)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eAge in months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78(52%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (29.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c7\" namest=\"c6\" rowspan=\"3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (32.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57 (38%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFamily history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (37.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c7\" namest=\"c6\" rowspan=\"3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46 (30.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExposure to smoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (47.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c7\" namest=\"c6\" rowspan=\"3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo exposure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79 (52.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBoys SBP on Egyptian standards by percentile (T\u0026thinsp;=\u0026thinsp;72)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c7\" namest=\"c6\" rowspan=\"5\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50-75th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75-90th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBoys DBP on Egyptian standards by percentiles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4 (5.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c7\" namest=\"c6\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0.03*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50-75th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75-90th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (31.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (43.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGirls SBP on Egyptian standards by percentile (T\u0026thinsp;=\u0026thinsp;78)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c7\" namest=\"c6\" rowspan=\"5\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50-75th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (23.07%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75-90th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGirls DBP on Egyptian standards by percentiles**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3 (3.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c7\" namest=\"c6\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50-75th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75-90th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (35.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;95th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBMI-for-age interpreted using WHO Percentile for age (0\u0026ndash;5 years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3rd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd to \u0026lt;\u0026thinsp;15th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15th to \u0026lt;\u0026thinsp;50th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e24 (16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50th to \u0026lt;\u0026thinsp;85th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e42 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e85th to \u0026lt;\u0026thinsp;97th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e36 (24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;97th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e18 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEchocardiographic Doppler findings of cases with Congenital Heart Defects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e16 (10.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0.9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild mitral valve prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e11 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild TR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall ASD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (0.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall VSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (0.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNutritional indices among patients with mitral valve prolapse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWasted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1(0.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e of Waist circumference (WC) and Mid arm circumference of groups under study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMAC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemoglobin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;11 gm/dl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;11gm/dl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Cut off of significance is P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 **Mixed fed means was fed breast-milk but also formula milk in bottle with or without added sugar and starch. MVP: mild mitral valve prolapse, TR: tricuspid regurgitation, ASD: atrial septal defect, VSD: ventricular septal defect, VSD: ventricular septal defect.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2): Association between echocardiographic findings and different parameters among children (3\u0026ndash;5 years of age)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMild MVP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMild TR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eASD/VSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;136\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;95 th percentile\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e90\u0026ndash;95 th percentile\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;90 th percentile\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (15.7%)\u003c/p\u003e \u003cp\u003e28 (20.9%)\u003c/p\u003e \u003cp\u003e85 (63.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (9.1%)\u003c/p\u003e \u003cp\u003e1 (9.1%)\u003c/p\u003e \u003cp\u003e9 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDBP\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;95 th percentile\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e90\u0026ndash;95 th percentile\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;90 th percentile\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003cp\u003e128 (95.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e3 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e11 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreastfeeding duration\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e1:6 months\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e6:12 months\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMore than one year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (38.1%)\u003c/p\u003e \u003cp\u003e43 (32.1%)\u003c/p\u003e \u003cp\u003e40 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003cp\u003e1 (33.1%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003cp\u003e3 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (50%)\u003c/p\u003e \u003cp\u003e1 (50%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBottle fed duration*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e1:6 months\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e6:12 months\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMore than one year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (31.3%)\u003c/p\u003e \u003cp\u003e28 (20.9%)\u003c/p\u003e \u003cp\u003e19 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50%)\u003c/p\u003e \u003cp\u003e1 (50%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (50%)\u003c/p\u003e \u003cp\u003e1 (50%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e* Assessed only in group of breastfed and non-breastfed. MVP: mild mitral valve prolapse, TR: tricuspid regurgitation, ASD: atrial septal defect, VSD: ventricular septal defect, VSD: ventricular septal defect.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3) Patterns of feeding among the groups who were breastfed, non-breastfed and mixed fed during their infancy\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfant feeding practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully breastfed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever breastfed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEarly initiation of Breastfeeding: \u0026lt; 1 hour\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaken away\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-6hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEarly initiation by skin to skin contact\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaken away\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-6hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFrequency of feedings per day (breast or formula)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFrequency of feeding per night (breast or formula)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (34%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eRooming in\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePattern of feeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScheduled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn crying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCue led Feeds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge of stopping Breastfeeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;12 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Cut off of significance is P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 **Mixed fed means was fed breastmilk but also commercial milk formula (CMF) in bottle with or without added sugar and starch.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(4): Correlation between systolic and diastolic blood pressure in children and among the children of the groups who were breastfed and non-breastfed by feeding practices\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBlood pressure of children vs. variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSystolic Blood Pressure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDiastolic Blood Pressure\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eBreastfeeding practices\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly initiation of Breastfeeding\u0026thinsp;\u0026lt;\u0026thinsp;1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly initiation of skin to skin contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal education about infant feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of Breastfeeding per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of stopping breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of night breastfeeds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupplements given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of supplements other than breast-milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePacifiers given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of start pacifier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of stopping pacifier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon breastfed (formula fed groups)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of formula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddition of sugar to formula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of start additives of sugar or starch to formula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow cleaned bottle (non-hygienic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuality of complementary feeding meals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreparation of food 6-12m (salt )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreparation of food(salt)12\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietary diversity (high)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh intake of unhealthy diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e*Cut off of significance P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/b\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough EBP in this age group appears to be minimal yet EDBP was detected in girls (5.1%) and not in boys (0%) with no ESBP in either sex. Moreover, it was detected in the girls exposed to CMFF in their infancy but not in those who were fully breastfed. Prehypertension or pre-ESBP (\u0026gt;\u0026thinsp;90-95th centile) was detected in one quarter of the cases (22.2% in boys and 26.9% in girls) and pre-EDBP in one third of the cases (29.2% in boys and 35.9% in girls). Such findings coincide with the findings of other studies who reported that the pooled global prevalence of EBP among children was 4.00% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, studies for EBP in preschoolers have not been reported in Egypt. A cross-sectional study of 1500 adolescents (11\u0026ndash;19 years) in Alexandria in Egypt reported that prevalence rates of prehypertension and hypertension (HTN) were 5.7% and 4.0% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The Demographic health survey in 2008 reported that HTN in the 11\u0026ndash;19 females was (3.8%) and males (4.9%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Findings from analysis of demographic surveys conducted in 2015 indicate that overall prevalence of HTN in Egypt is 26% and that more than half of Egyptian adults who meet criteria for HTN are unaware of their BP status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur cases with Doppler findings of CHD did not show any significant elevations in BP. It is ideal to compare our results with standards developed from our own locality. The trend of Egyptian SBP and DBP nanograms, differ from Turkish [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and American nanograms[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The latter Task Force values were based on nine different populations, including African and Mexican Americans. They used the first BP reading and not the average of two readings as in the Egyptian study. The rise in BP with increasing age is most probably caused by the growth of the child. It is accepted that the most influential determinants of normal BP are chronological age and body size as determined by height, weight and BMI [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study showed that early breastfeeding and full breastfeeding was associated with lower tendency towards EBP. There were no significant echocardiographic studies. However, a study on which echocardiographic studies were conducted for 76 healthy infants aged 6 to 24 months of life of whom 38 were fed only breast-milk and 38 who were CMFF in the first six months of life showed some differences in right ventricular (RV) studies. Percent fractional shortening (%FAC) for right side was significantly higher in fully breastfed infants compared to the CMFF (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was a significant increase in the mean RV Velocity time integral (VTI) values in EBF infants (17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73) than CMFF infants (15.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94) P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; the cardiac output (COP) and the Tricuspid Annular Plane Systolic Excursion (TAPSE) were significantly higher in breastfed infants (5.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01) than CMFF infants (5.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18), (1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18) and (1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20) respectively at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Their findings suggested that early feeding patterns in infancy may influence functions and structures of right side of the heart in infancy and that fully breastfeeding supports higher performance and may explain their higher resilience to cardiac insults later in life [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study revealed that not breastfeeding was associated with increased tendency towards obesity. Breastfeeding reduced the odds of overweight or obesity as indicated by many workers [22; 23; 24; 25]. Studies involving autopsies, ultrasounds, and cardiac magnetic resonance imaging (cMRI) have demonstrated that obesity may influence cardiac morphology [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. One of the most frequently observed alterations is left ventricular (LV) hypertrophy, often eccentric, particularly in the absence of concurrent HTN. Chahal et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] in a study that involved 4127 patients revealed that the right ventricular mass was 15% greater in overweight/obese patients compared to lean patients and right ventricular volumes were 26% larger in overweight/obese subjects compared to lean patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for the trend) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A cross-sectional study was conducted for 76 healthy infants aged 3 to 12 months of life (38 breastfed and 38 CMFF, BMI percentiles were significantly higher in CMFF infants compared to breasted infants (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). BMI was positively correlated with structural dimensions in CMFF but not breastfed. BMI correlated with RV function in breastfed but not CMF fed infants [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also indicated that not breastfeeding was associated with EBP. However there is limited evidence that suggests that never versus ever being fed human milk is associated with EBP within a normal range at 6\u0026ndash;7 y of age. Moderate evidence suggests there is no association between the duration of any human milk feeding and childhood BP. Limited evidence suggests there is no association between the duration of exclusive human milk feeding and BP or metabolic syndrome in childhood. Additional evidence about intermediate outcomes for the 4 systematic reviews was scant or inconclusive [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. None the less Metabolic syndrome (MetS) which is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, were found to increase risks of developing future CVD and type 2 diabetes mellitus (T2D) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand Doppler findings suggested no relationship between the findings of MVP, TR, ASD or VSD and early feeding, BP or obesity. MVP was the commonest lesion detected in 11 cases (7.3%). MVP is s generally considered a benign condition often associated with a leaky valve causing blood to flop back into the atrium; however, at times, it may present with sudden cardiac death, endocarditis, arrhythmias or cerebrovascular accident. It is more associated with leaness rather than obesity. It ranges from 4\u0026ndash;8%. MVP usually occurs as a primary disorder and is commonly, but not invariably, associated with myxomatous proliferation of the mitral valve and chordae tendineae. The absence of any relationship between obesity and even morbid obesity on the progression or complication associated with mitral regurge is in agreement with many other workers who studied MR after reconstructive surgery [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition MVP in association with EBP was not an issue in this study. Low BP is reported by others as a common feature in patients with MVP, and association between the two entities was found in population-based studies [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. MVP individuals demonstrate increased beta-adrenergic receptor responsiveness associated with a hyperkinetic circulation [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The latter research team showed that in patients with MVP giving propranolol increased BP, and decreased heart rate, and depends, namely, on β1 receptors blockade. Increase in BP is an unusual response to adrenergic beta-blockade in normal conditions, and this finding supports the preponderance of β2 receptors on the BP control in patients with MVP. Breastfeeding through practices as early initiation, cue feeding, night feeding and tactile stimulation may assist in stabilizing the hyper-responsiveness of adrenergic responses preventing the sudden disturbances in BP and HR shown in individuals with MVP. However this may need further investigation. A study conducted in Cairo University Children\u0026rsquo;s Hospital on infants with CHD and heart failure (HF) showed that breastfeeding and skin-to-skin contact (SSC) resulted in a sustained improvement in their oxygen saturations and vital signs when compared to the artificially fed infants with CHD and HF [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Another study in Sweden showed that immediate SSC versus incubator care had beneficial effects on the cardiorespiratory stabilisation of very preterm infants. SSC stimulates oxytocin release in mother and infant which is a hormone and neuropeptide, is associated with calmness, bonding, and stress reduction [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInappropriate foods introduced early in life that include adding sugar and starch to bottles and salt to weaning foods are shown to be linked with higher BP. A study in Egypt showed that high BP prevalence in young school children and youth was associated with adding table salt, regular consumption of certain energy dense foods, and certain types of salty foods and foods with high sodium content (OR 2.6) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In another study snacking, high intakes of sugary beverages and less physical activity among children had a higher risk for HBP (OR 2.5) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] and especially when children were obese [38; 15] In Qalyuibiya, school-aged children with prehypertension or EBP were 4 times less likely to practice sports [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. EBP was more prevalent in private than in public schools [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. EBP was more prevalent in obese versus overweight (22% vs. 6.4%) and WC was reported to be a good indicator of elevated BP [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A study conducted for primary school children in Menoufia in Egypt showed that prehypertension was 2.8% in males and 5.2% in females who were overweight and obese and increase in age in both sexes [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe risk of EBP has been associated with disturbed lipid metabolism and other biomarkers of CVD. A study by Attia (2017) showed that biomarkers of CVD were higher in non-breastfed children and their mothers who did not breastfeed compared to mothers and children who were exposed to breastfeeding [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Obese and hypertensive youth had lipid profiles of atherosclerosis and high-risk patterns of impaired glucose homeostasis (pre-diabetes) and when the research team conducted Doppler studies for these obese youth they found increased risk of diastolic dysfunction [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Left ventricular diastolic function (LVDF) is an important marker of early cardiovascular remodelling, which has not been well summarized in young people with overweight/obesity. Increased BMI was associated with worse LVDF in all measures except early mitral inflow deceleration time, with septal early diastolic tissue peak velocity to late diastolic tissue peak velocity ratio having the strongest association (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13 studies, 1824 individuals; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.69; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Elevated HOMA-IR was also associated with worse LVDF [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Hence obesity and EBP results in a combination of disturbed metabolism of glycemic homeostasis and renal dysfunction apparently emerging from the young age probably triggered by poor early feeding practices of not breastfeeding and exposure to CMFF.\u003c/p\u003e \u003cp\u003eThe study has a number of limitations related to its small size and limited representation, although cases were taken from Damanhur Teaching hospital which is a referral hospital for one of the largest governorates in Egypt, still conclusive findings cannot be made on such a sample. However, it is a definite eye open to the pending holocaust caused by the inappropriate early feeding practices that have invaded the lives and eating behavior of young children. The detection of EBP in this age group and high prevalence of pre-HTN and obesity is a disturbing finding. Moreover CHD, although mild and predominantly encompassing MVP in almost one half of the cases, which is a benign condition, yet could develop into complications if associated with untreated high BMI and EBP on the long run. Breastfeeding is by far the most suitable and safe feeding practice for children and should be promoted and supported in addition with strict laws to regulate salt intake in marketed foods [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Regular monitoring of young children for EBP in nurseries, especially among the obese children is recommended. Future studies that examine these findings through demographic surveys are needed not only in Egypt but in other countries in the region. Preventive actions through early detection and campaigns for increasing awareness of the public about the importance of tracking their child\u0026rsquo;s feeding behavior and checking their BP and physical health status beginning as early as preschool age is recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDisclosures: none\u003c/p\u003e\n\u003cp\u003eDisclaimers: none\u003c/p\u003e\n\u003cp\u003eAcknowledgements to Pediatric department in Damanhour Teaching hospital for facilitating collection of data and screening studies by echocardiogram.\u003c/p\u003e\n\u003cp\u003eRole of the investigators:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSameh Zaki Abdulsamea was involved in the conceptualization, literature review, statistical re-analysis of data and interpretation, presentation and research writing.\u003c/p\u003e\n\u003cp\u003eAzza Abul-Fadl was involved in organizing the team, planning of the work, literature review, supervising collection of data, statistical analysis, interpreting data, writing the discussion and revising paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMaha Mourad, expert in cardiology, reviewer and supervisor.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eIbrahim, M. 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East Mediterr Health J. 2018;24:1172-80.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"congenital heart defects, obesity, hypertension, breastfeeding, bottle-feeding, mitral valve prolapse.","lastPublishedDoi":"10.21203/rs.3.rs-4768722/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4768722/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The rising burden of cardiovascular disease (CVD) risk factors of obesity and elevated blood pressure (EBP) from early childhood can aggravate consequences congenital heart defects (CHDs).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe aim\u003c/strong\u003e was to study status and associations of early feeding, systolic (SBP) and diastolic (DBP) elevations, obesity with CHD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A sample of 150 children randomized into 50 breastfed, 50 non-breastfed and 50 mixed fed children aged 3-5 years examined for early feeding practices, BP and nutritional assessment through anthropometric measurements for estimating Body mass index (BMI) and hemoglobin. Doppler studies were carried out to detect congenital heart disease. \u003cstrong\u003eFindings\u003c/strong\u003e DBP, but not SBP, was higher in non-breastfed vs. fully Breastfed. Obesity was positively associated with elevated SBP and DBP in either sex. Early breastfeeding was protective, while not breastfeeding, bottle feeding with additives, pacifiers, unhealthy food intake (UFI) were associated with EBP. Doppler studies detected 16 cases (10.67%) with CHDs, mostly mitral valve prolapse (MVP) in 7(43.7%) followed by tricuspid regurge (TR) in 3 (18.75%), atrial-septal defect (ASD) in 1(6.25%) and ventricular-septal defects (VSD) in 1(6.25%). Although there were no direct associations between CHDs with early feeding, BMI or EBP, however risk factors for EBP by high intake of unhealthy foods was common.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Obesity and EBP start from early childhood; this could affect future cardiac dynamics. Breastfeeding may be physiologically and developmentally beneficial for these children by protection against CVD risk factors as obesity and EBP. Close watch of patients with CHD from an early age is recommended to detect cardiac hemodynamic changes especially among children who are obese, hypertensive. Promoting breastfeeding and healthy food intake is important to prevent the build of EBP from UFI into CVD.\u003c/p\u003e","manuscriptTitle":"High Blood Pressure and Obesity: Is not-breastfeeding an added risk for children with Benign Congenital Heart Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-06 09:52:06","doi":"10.21203/rs.3.rs-4768722/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cfc29d4a-1324-4168-8c3a-81f7e5888243","owner":[],"postedDate":"August 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-06T09:52:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-06 09:52:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4768722","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4768722","identity":"rs-4768722","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}