Abstract
OBJECTIVE: To develop a machine learning (ML) model utilizing transfer learning (TL) techniques to predict hypertension in children and adolescents across South America. METHODS: Data from two cohorts (children and adolescents) in seven South American cities were analyzed. A TL strategy was implemented by transferring knowledge from a CatBoost model trained on the children's sample and adapting it to the adolescent sample. Model performance was evaluated using standard metrics. RESULTS: Among children, the prevalence of normal blood pressure was 88.9% (301 participants), while 14.1% (50 participants) had elevated blood pressure (EBP). In the adolescent group, the prevalence of normal blood pressure was 92.5% (284 participants), with 7.5% (23 participants) presenting with EBP. Random Forest, XGBoost, and LightGBM achieved high accuracy (0.90) for children, with XGBoost and LightGBM demonstrating superior recall (0.50) and AUC-ROC (0.74). For adolescents, models without TL showed poor performance, with accuracy and recall values remaining low and AUC-ROC ranging from 0.46 to 0.56. After applying TL, model performance improved significantly, with CatBoost achieving an AUC-ROC of 0.82, accuracy of 1.0, and recall of 0.18. CONCLUSION: Soft drinks, filled cookies, and chips were key dietary predictors of elevated blood pressure, with higher intake in adolescents. Machine learning with transfer learning effectively identified these risks, emphasizing the need for early dietary interventions to prevent hypertension and support cardiovascular health in pediatric populations.