Objective: To explore the association between the cumulative effect of body mass index (BMI) in childhood and the frequency of elevated blood pressure and cumulative burden of blood pressure, so as to provide a basis for preventing high blood pressure in children. Methods: Data were derived from the "Cardiometabolic Risk Cohort Study" conducted from 2012 to 2018, which included all students from three nine year schools (comprising primary and secondary school) in Zigong City. A total of 1 583 students with normal blood pressure at baseline were included in the study. Questionnaires and physical examinations were administered to collect demographic information, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Follow up surveys were conducted annually. To measure cumulative effects, the total area under the BMI curve (BMI-AUCt), cumulative burden of SBP (CB-SBP), and cumulative burden of DBP (CB-DBP) were calculated using the trapezoidal rule. Multinomial Logistic regression models were employed to analyze the relationship between BMI-AUCt and the frequency of elevated blood pressure during the follow up period. Additionally, multiple linear regression models combined with restricted cubic splines (RCS) were used to explore the dose response relationships of BMI-AUCt with CB-SBP and CB-DBP, respectively. Results: At baseline, the median ( IQR ) values for BMI, SBP and DBP of the students were 15.0(14.2, 16.1) kg/m 2 ，89.0(87.0, 90.0) mmHg and 58.0(54.0, 60.0 ) mmHg, respectively. During follow up, the median( IQR ) BMI, SBP and DBP for students with 0, 1 and ≥2 occurrences of high blood pressure were: 14.8(14.0, 15.9), 15.2(14.3, 16.3), 15.8(14.9, 17.0) kg/m 2; 89.0(87.0, 90.0),89.0(87.0,90.0), 89.0(87.0, 90.0)mmHg; 58.0(54.0, 60.0), 58.0(54.0, 59.5), 59.0(56.0, 59.0) mmHg. Results from the multinomial Logistic regression model, after adjusting for baseline age, sex, school, overweight/obesity status and number of measurements showed that compared to students with 0 occurrence of high blood pressure during follow up, for every 1 unit increase in BMI-AUCt, the risk of having 1 occurrence and ≥2 occurrences of high blood pressure increased by 4%( OR =1.04) and 6%( OR =1.06), respectively(both P <0.05). Multiple linear regression combined with restricted cubic splines(RCS) revealed non linear dose response relationships between BMI-AUCt and both CB-SBP and CB-DBP(all P trend <0.01, all P non linearity <0.01). Specifically, BMI-AUCt was positively correlated with CB-SBP when BMI-AUCt exceeded 30.08 kg/m 2×year( β =0.13) and with CB-DBP when BMI-AUCt exceeded 48.41 kg/m 2×year( β =0.12)(both P <0.01). Conclusions Children with a higher cumulative BMI may face an increased risk of cumulative blood pressure burden. It is necessary to enhance dynamic monitoring of children s BMI and blood pressure for reducing the risk of elevated blood pressure in childhood.

Objective: To assess the association of adverse experiences and subsequent incidence of depressive symptoms among middle school students in Liangshan, so as to provide a basis for preventing the occurrence of depression symptoms among middle school students. Methods: In October 2021, a convenient sampling combined with cluster random sampling method was employed to select 888 students from three high schools (junior first year and second year, senior first year) in Liangshan for a questionnaire survey. In March 2023, a followup survey was conducted to collect data on adverse experiences (such as school bullying, domestic violence, and lack of parental understanding). Depressive symptoms were assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression model analysis was used to examine the relationship between the number of adverse experiences at baseline and the incidence of depressive symptoms during the followup period. Results: The detection rate of depressive symptoms among middle school students was 9.4% at followup. School bullying (OR=2.26, 95%CI=1.37-3.73), domestic violence (OR=2.56, 95%CI=1.55-4.21), and lack of parental understanding (OR=1.91, 95%CI=1.15-3.16) at baseline were positively associated with the incidence of depressive symptoms at followup (P<0.05). Compared with participants with no adverse experiences at both baseline and followup, those with adverse experiences at both baseline and followup were more likely to exhibit depressive symptoms at followup, regardless of the type of adverse experiences (P<0.01). The incidence of depressive symptoms increased with the increase of baseline adverse experiences (P<0.01). Compared to the participants with no adverse experiences at both baseline and followup, those with adverse experiences at baseline but not at followup did not show a statistically significant difference in the likelihood of developing depressive symptoms at followup (OR=0.78, 95%CI=0.13-4.80, P>0.05). Conclusions Adverse experiences increase the risk of developing depressive symptoms among middle school students. Participants who have reversed adverse experiences show no increased risk of depressive symptoms compared to those with no adverse experiences. Measures should be taken to prevent the occurrence of depression symptoms among middle school students based on their adverse experiences during their middle school years.