Screening for risk factors for chronic disease in children from fifteen countries

ExPRSweb: An online repository with polygenic risk scores for common health-related exposures

Complex traits are influenced by genetic risk factors, lifestyle, and environmental variables, so-called exposures. Some exposures, e.g., smoking or lipid levels, have common genetic modifiers identified in genome-wide association studies. Because measurements are often unfeasible, exposure polygenic risk scores (ExPRSs) offer an alternative to study the influence of exposures on various phenotypes. Here, we collected publicly available summary statistics for 28 exposures and applied four common PRS methods to generate ExPRSs in two large biobanks: the Michigan Genomics Initiative and the UK Biobank. We established ExPRSs for 27 exposures and demonstrated their applicability in phenome-wide association studies and as predictors for common chronic conditions. Especially the addition of multiple ExPRSs showed, for several chronic conditions, an improvement compared to prediction models that only included traditional, disease-focused PRSs. To facilitate follow-up studies, we share all ExPRS constructs and generated results via an online repository called ExPRSweb.

Differences in Health Behavior Profiles of Adolescents in Urban and Rural Areas in a Korean City

Through a latent class analysis approach, we can classify individuals and identify subgroups according to health behavior patterns, and find evidence for the development of customized intervention programs to target high-risk groups. Our study aimed to explore differences in latent classes of health behaviors in adolescents by region (urban vs. rural areas) in a Korean city. This cross-sectional secondary analysis utilized data collected from all first graders' student health checkups in middle school and high school in a city of the largest island in Korea in 2016 (n = 1807). Health behavior indicators included both healthy (consuming breakfast regularly, consuming vegetables daily, consuming milk daily, consuming fast food on a limited basis, engaging in vigorous physical activities, brushing teeth, and practicing hand hygiene) and unhealthy (drinking, smoking, and overusing the internet) behaviors. Nutritional and diet behaviors were important factors for classifying healthy and unhealthy adolescents in both regions. Approximately 11% of rural students belonged to the risky group, which was characterized by a high level of drinking alcohol and smoking. These results suggest that when developing health policies for adolescents, customized policy-making and education based on the targeted groups' behavioral patterns could be more effective than a uniform approach.

Cardiometabolic risk factor levels in Norwegian children compared to international reference values: The ASK study

OBJECTIVE

To investigate cardiometabolic risk factor levels in a group of Norwegian 10-year-old children compared to international values and examine the association between cardiorespiratory fitness (CRF) and the reference-standardized clustered risk score.

METHODS

913 children (49% girls) were included from the Active Smarter Kids (ASK) study. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C ratio, triglyceride (TG), glucose, insulin, homeostatic model assessment (HOMA) score and CRF, were standardized according to international age-and sex-specific reference values.

RESULTS

The Norwegian children had significantly more favorable WC, DBP, glucose, HDL-C and CRF levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors. CRF was the variable that differed the most from the international values (mean (95% CI) 1.20 (1.16 to 1.24) SD). The clustered risk score (excluding CRF) was higher in the Norwegian children, but decreased to below international levels when including CRF (mean (95% CI) - 0.08 (- 0.12 to -0.05) SD). CRF had a significant inverse association with the clustered risk score (excluding CRF) (β - 0.37 SD, 95% CI -0.43 to -0.31).

CONCLUSIONS

Norwegian children have substantially higher CRF levels than international standards, and including CRF in clustered risk scores reduces overall risk in Norwegian children below that of international levels. CRF is associated with improved cardiometabolic health in children.

Cardiovascular disease risk factors in a population-based sample of Norwegian children and adolescents

OBJECTIVE

The objective of the study was to describe the distribution of cardiovascular disease (CVD) risk factors, and to evaluate the extent of clustering of CVD risk factors in Norwegian children and adolescents.

MATERIAL AND METHODS

A randomly selected cohort of 9-year-olds and 15-year-olds from all regions of the country was sampled. Of 2,818 subjects invited to participate, 2,299 accepted, giving an overall participation rate of 82%.

RESULTS

Mean (SD) values for the main risk factors for 9-year-old and 15-year-old girls and boys were: total cholesterol (TC) (mmol/L) 4.49 (0.73), 4.37 (0.68), 4.19 (0.76) and 3.80 (0.69), respectively; triglycerides (TG) (mmol/L) 0.72 (0.33), 0.63 (0.32), 0.79 (0.32) and 0.82 (0.47), respectively; high density lipoprotein cholesterol (HDL-c) (mmol/L) 1.70 (0.35), 1.79 (0.40), 1.61 (0.34) and 1.42 (0.30), respectively; systolic blood pressure (mmHg) 102.6 (7.7), 103.3 (7.7), 109.0 (8.8) and 115.3 (9.0), respectively; and homeostasis model assessment score (HOMA) 1.29 (0.83), 1.19 (0.78), 2.10 (1.37) and 2.14 (1.49), respectively. At least five risk factors were found in 11.1 (95% confidence interval (CI) 8.76 to 13.44) times as many participants as expected. A significant degree of clustering of CVD risk factors was found in 11.4% (95% CI, 9.8 to 13.0) of the study population, and these had mean Z scores of 1.24 (0.06) and 1.04 (0.08) for the 9-year-olds and 15-year-olds, respectively.

CONCLUSION

This study presents national reference data on selected CVD risk factors in children and adolescents.

Serum total cholesterol, HDL cholesterol and blood pressure levels in 13-year-old children in Eastern Finland. The North Karelia Youth Project

North Karelia Youth Project is a community and school-based intervention study of 13-year-old schoolchildren in Eastern Finland. This paper deals with serum total cholesterol, HDL cholesterol and blood pressure levels with some important background variables in the baseline survey in 1978. A total of 966 children were studied. A high mean serum serum cholesterol level (5.1 mmol/l) among both boys and girls was an outstanding finding. The cholesterol level was higher in the rural than urban areas. Different diet can explain this difference. Mean blood pressure was 117/67 mmHg among girls and 117/63 among boys. The high risk factor levels at this age support strongly the idea that the prevention of cardiovascular diseases should be started already in childhood.

The relationship between physical activity and cholesterol levels in children and adolescents

OBJECTIVES: to describe total cholesterol (TC) plasma levels according to age and sex; to determine the contribution of sex, age, body mass index and physical activity (PA) to TC variation; to determine the odds ratio for high total cholesterol (HTC) plasma levels of the subjects in the first PA quartile (lower PA) in comparison to the fourth PA quartile. METHODS: the sample comprised 799 white children and adolescents, 353 males and 446 females. Body height and body weight were determined by standard anthropometric methods. Subject's capillary blood samples were taken from the earlobe after at least 12 hours fasting in order to obtain values of plasmatic TC. To calculate physical activity index (PAI) a PA questionnaire was used. RESULTS: the logistic regression of HTC for males and females showed that girls in the lower quartile of PAI, are 3.0 times (p <0.05; 95%CI: 1.3-6.8) as likely to belong at HTC group in relation to girls in the fourth PAI quartile. No significant influence was found in boys. CONCLUSIONS: the results of the present study suggested that the higher TC values could be found even in early ages.

Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme

The effectiveness of a health and nutrition education programme, in changing certain chronic disease risk factors, was assessed after the 6 years intervention period was completed. The school-based intervention programme was applied to all children registered in the first grade (age 5.5-6.5 years) in 1992 in two counties of Crete, while the children from a third county served as a control group. In order to assess the effectiveness of the intervention, a variety of biological and behavioural parameters were measured before and following completion of the intervention in a randomly selected school-based sample of 602 intervention group (IG) and 444 control group (CG) pupils. At the end of the 6-year period, it was found that biochemical indices generally improved significantly more in the IG compared with the CG (mean change for IG v. CG was -0.27 v. -0.12 mmol/l for total cholesterol (TC); -0.07 v. +0.24 for TC:HDL and -0.13 v. +0.14 for LDL:HDL). Similarly, the changes observed in the anthropometric variables in the two groups were in favour of the IG (+3.68 v. +4.28 kg/m2 for BMI; +2.97 v. +4.47 mm for biceps skinfold). Total energy intake and consumption of total fat and saturated fat increased significantly less in the IG compared with the CG (+747.7 v. 1534.7 kJ (+178.7 v. +366.8 kcal); +5.9 v. +18.8 g and +0.8 v. +5.1 g respectively), while time devoted to leisure time physical activity and cardiovascular run test performance increased significantly more in the IG (+281 v. +174 min/week and +2.5 v. +1.2 stages respectively). The findings of the present study underline the importance of such programmes in health promotion and disease prevention. Although the long-term effects of these programmes can only be assessed by tracking this population through to adolescence and adulthood, these programmes seem to have the potential to lead to a healthier lifestyle and thus a reduction in risk factor levels.

Prevalence of plasma lipid abnormalities in Saudi children

BACKGROUND

Lipid levels in children vary in different populations. Due to a close association between high lipid levels and development of atherosclerosis, considerable interest has been directed to investigating lipid levels in children.

MATERIALS AND METHODS

We conducted this study on 2914 children with ages ranging from 1 year to <15 years, randomly selected during a national household screening program. Fasting blood samples were used for estimation of triglyceride and cholesterol levels.

RESULTS

The overall range for cholesterol was 2.0-5.7 mmol/L and for triglyceride the overall range was 0.1-1.7 mmol/L. The children were separated into 14 groups depending on age, and the cholesterol and triglyceride levels were calculated in each age group. Using published guidelines for estimating "borderline" and "high risk" for coronary artery disease from cholesterol and triglyceride levels, the prevalence of borderline and high-risk groups was calculated. 7.72% of the children fell in the borderline risk group and 1.55% in the high-risk group using cholesterol values, while using triglyceride values, 1.4% and 0.55% fell in the borderline and high-risk groups, respectively. The prevalence of abnormality varied in the different age groups.

CONCLUSION

The paper discusses the need for a lipid awareness program in Saudi children in an attempt to decrease the complications associated with dyslipidemias during adulthood.

Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period

BACKGROUND

No national policy for health education in schools exists to date in Greece. The first attempt to apply a school-based health education intervention program was launched in 1992 on all 4,171 pupils registered in the first grade in two counties of Crete. The 1,510 pupils registered in a third county served as controls.

METHODS

The school-based intervention and the seminars organized for parents were primarily aimed at improving children's diet, fitness, and physical activity. Pupils in the first grade in a representative sample of 40 schools were examined prior to the intervention program on a variety of health knowledge, dietary, physical activity, fitness, anthropometric, and biochemical indices. The same measurements were taken after 3 years of the program on 288 intervention group and 183 control group pupils.

RESULTS

Positive serum lipid level changes occurred to a greater extent in the intervention group than the control group. BMI increased less in the intervention group than for controls. The increase in health knowledge and physical activity and fitness levels occurred to a higher extent in the intervention group compared to controls.

CONCLUSIONS

The short-term changes observed in the present study are markedly encouraging and indicate great potential for progressive improvement. Continuation and expansion of such a program may prove to be beneficial in initiating long-term changes.

Exercise training induced alterations in prepubertal children's lipid-lipoprotein profile

PURPOSE

This study examined the effect of exercise training on prepubertal children's (ET, N = 28) lipid-lipoprotein profile, relative to a maturity matched control group (CON, N = 20).

METHODS

Training for ET involved stationary cycling for 30 min, 3 times.wk-1 for 12 wk, at 79.3 +/- 1.2% (mean +/- SD) peak heart rate (HR). Controls maintained their usual lifestyle pattern. Plasma concentrations of total triacylglycerol (TG), total cholesterol (TC), and high-density lipoprotein (HDL)-cholesterol (HDL-C) were determined pre- and postintervention. Low-density lipoprotein (LDL)- cholesterol (LDL-C) was subsequently estimated from these concentrations, and the ratios TC/HDL-C and LDL-C/HDL-C were also calculated. There were no pretest differences (P > 0.05) for any of these blood analytes between groups. The following, potentially, confounding variables were also measured: peak VO2, percent body fat (%BF), dietary composition, and habitual physical activity. These variables, with pretest HDL-C, were included as covariates in two-way split plot ANCOVA analyses. Dietary variables were not included as covariates as they were not related to any of the blood analytes.

RESULTS

There were no differences over time or between groups for TG and TC (P > 0.05). LDL-C decreased in ET (-10.2%) but remained unchanged in CON (0.3%) over the intervention period (P < 0.05). HDL-C increased in ET (9.3%) but decreased in CON (-8.9%) (P < 0.01). A similar, but inverted, pattern of change (P < 0.01) was revealed for both ratios, TC/HDL-C (-11.6% vs 6.3%, ET and CON, respectively), and LDL-C/HDL-C (-17.2% vs 8.0%, ET and CON, respectively). The favorable alterations in the lipid-lipoprotein profile for ET were independent of alterations in peak VO2 (group x time interaction, P < 0.05), %BF (main effect time, P < 0.01), and habitual physical activity (group x time interaction, P < 0.01).

CONCLUSIONS

In conclusion, the favorable alterations in the lipoprotein profile seen in this study would suggest that it is possible to influence the prepubertal lipoprotein profile independent of alterations in confounding variables such as body composition, cardiorespiratory fitness, and habitual physical activity.

Worldwide distribution of blood lipids and lipoproteins in childhood and adolescence: a review study

Review and pooled analysis of the relevant worldwide literature was investigated from 1975 to 1996. Eighteen surveys out of 54 were suitable for analysis according to the selection criteria. This represents a total of 60494 observations from 26 countries all over the world. Data suggests differences as great as 76 mg/dl when comparing northern European countries to black African children. The overall curve of cholesterol with age observed in the pooled population indicates a pre-adolescent peak and then a slightly inverse change is observed for both boys and girls, from 3 to 12 years old being almost coincident absolute values. Beyond age 12, values for boys continue to slightly decrease to age 16, while for girls values tend to increase through this age-range. The curve in the late teens (16-18 years) tends to reach pre-teen levels for both sexes, although girls have consistently higher absolute values than boys. There is a great variation in the specific age-sex and race levels of cholesterol among different populations or even in the same populations over a period of time. However, an apparently universal pattern of an early rise, a fall, and a subsequent rise in mean values of total cholesterol by age from the preadolescence to late teens is observed. More data are needed on total cholesterol and lipid fractions between late school age and mid-adulthood.

Evaluation of lifestyle, food consumption and nutrient intake patterns among Irish teenagers

Lifestyle, food consumption and nutrient intake patterns from a randomly selected group of 390 secondary pupils aged between 12-18 were evaluated. Demographic information and anthropometric measurements included weight, height, and skinfold thickness were taken. Nutrient intake was assessed using the 7-day dietary history method, using a photographic atlas as an aid. Mean energy intakes for boys and girls aged 12-15 and 15-18 were 11.3MJ and 14MJ and 9.1MJ and 8.9MJ respectively. As percentage energy, protein fat and carbohydrate intakes varied little between the different age-sex groupings and were approximately 13.7-14.5, 35.4-37 and 46.8-50 per cent respectively. For boys micronutrient intake for iron and folate achieving only 83 and 78 per cent and 98 and 90 per cent of the recommended nutrient intake (R.N.I.) for ages 12-15 and 15-18 respectively. Mean dietary fibre intakes were approximately 19.6-25g/day for boys aged 12-18 and 17g/day for girls of a similar age. The main sources of energy were bread, meat and meat products, potatoes/chips, confectionery and preserves. Fruit and vegetable consumption was low for all groups. The majority of those surveyed consumed the traditional main meals. Snacking was also common practice. The snack foods consumed were generally of a high fat/high sugar content. 1.1 per cent boys and 2.6 per cent of girls aged 12-15 and 5.5 per cent and 8.2 per cent of boys and girls aged 15-18 respectively had a BMI greater than 26 indicating a risk of overweight. Greater than 68 per cent of girls and 79.5 per cent of boys surveyed participated in some form of sport. Boys were more physically active than girls and older girls less active than younger. In conclusion, changes from present day practices would be beneficial to reduce incidence of chronic disease for present day teenagers.

Parent and physician response to children's cholesterol values of 200 mg/dL or greater: the Child and Adolescent Trial for Cardiovascular Health Experiment

OBJECTIVE

To determine parental actions and concerns and physician responses to parental notification that a child's cholesterol value was 200 mg/dL or greater, a value recommended by the National Cholesterol Education Program to warrant physician follow-up and evaluation.

METHODOLOGY

A telephone survey of parents (n = 784) and physicians (n = 117) was carried out after parental notification of a total blood cholesterol value obtained as part of measurement done while participating in the Child and Adolescent Trial for Cardiovascular Health in 96 schools located in California, Louisiana, Minnesota, and Texas.

RESULTS

Only 20% of parents contacted physicians. Factors associated with this action included whether the parent was notified once or twice, the level of the cholesterol, previous cholesterol testing in the parent, and medical insurance that covered the visit. Family history of cardiovascular disease, when other factors were considered, did not increase the likelihood that a physician contact would be made. After contact with the physician, 59% of physicians reported evaluating children for cholesterol; about half reported repeating the cholesterol determination.

CONCLUSION

Parental knowledge of a child's cholesterol value of 200 mg/dL or greater did not result in substantially further seeking of health care.

Cholesterol screening in childhood: results of a 9-year follow-up study in Swiss and Italian children in Switzerland

Mass screening for blood cholesterol as part of routine preventive health care of children continues to be discussed in several countries. Results of longitudinal studies underline the importance of the predictive value of cholesterol levels assessed during childhood. Some countries have changed their recommendations during the past years to blood cholesterol screening for obese children only or for children of high risk families. In the Kindergarten-study Basel, a follow-up study on somatic, psychic and social development of Swiss and immigrant schoolchildren, cardiovascular risk factors were assessed at the ages of 5, 10 and 14 years. The age-specific levels of total and LDL-cholesterol found in our study were slightly higher and HDL-cholesterol lower than, for example, those found in the Bogalusa Heart Study. For total cholesterol no significant tracking correlations over the 5 and 9 year periods were found. Tracking of LDL- and HDL-cholesterol differed between nationalities and sexes. The total cholesterol/HDL-cholesterol index tracked slightly better. Italian girls showed the best 9-year tracking for HDL-cholesterol (r = 0.56). The differences between this and other studies can only partially be explained by different sampling and laboratory methods. Individual changes in cholesterol levels between the ages of 5 and 14 were marked. Sexual maturation was found to be of minor influence. Body mass index was the most consistent risk factor in our population. Changes of sex or growth hormone levels during puberty, but also changes of nutritional habits or physical activity might influence the individual cholesterol levels. Before recommendations on mass screening of cholesterol in children are made, the different longitudinal patterns of changes in cholesterol levels, and subpopulation-specific changes of nutritional habits and physical activity, should be discussed. The results of the Kindergarten study Basel suggest that attention should be paid to screening for obesity and to health education regarding nutrition and physical activity.

From the discovery of risk factors for coronary artery disease to the application of preventive measures

Hyperlipidemia and high blood pressure have clearly evolved as major risk factors for cardiovascular diseases. High fat intake, obesity, and cigarette smoking have been shown to be root causes of such risk. Ecologic correlations and case-control studies have provided evidence that hyperlipidemia and obesity certainly have their beginnings during childhood, and that the onset of cigarette smoking at a young age escalates the risk for coronary artery disease. Thus, preventive measures will have the greatest impact when applied at an early age. In fact, several fine comprehensive school health education programs (eg, Health Ahead/Heart Smart, Know Your Body) have demonstrated that behavior can be changed and that the risk factors for heart disease can be reduced. Such programs are most cost effective when they are multifactorial in nature and address health promotion on a broad scale. Therefore, comprehensive school health education programs should be a component of national health-care reform. The investment in early health education will pay off by deterring chronic diseases in adulthood and will thus contribute to a healthier nation.

Lipid levels in schoolchildren in north east England: effects of feeding and age

Serum total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, apolipoprotein (apo) A-I and apoB concentrations were estimated and low-density lipoprotein (LDL) cholesterol levels were calculated in 132 children aged 11.4-17.3 years. The effect of feeding was investigated by estimating postprandial values and also by studying the effects of a test meal. The distribution of all data was consistent with Gaussian apart from triglycerides which was log normal. Overall fasting values were [mean (standard deviation; SD)] cholesterol 4.5 (0.8) mmol/L, HDL cholesterol 1.5 (0.4) mmol/L, LDL cholesterol 2.6 (0.8) mmol/L, apoA-I 1.5 (0.3) g/L, apoB 1.0 (0.4) g/L and triglycerides 0.76 (0.38-1.51) mmol/L, the values for triglycerides being mean (95% confidence intervals). Girls had higher triglycerides than boys [0.82 (0.43-1.54) versus 0.70 (0.36-1.33)] and different effects of age on lipids were found, HDL cholesterol being negatively correlated with age in boys (r = -0.37; P < 0.001), but not in girls, and apoA-I being negatively correlated with age in boys (r = -0.31; P = 0.006), but positively correlated with age in girls (r = 0.32; P = 0.008). Triglycerides rose and HDL cholesterol fell following feeding and inconsistent effects were seen on apoA-I and apoB.

Nutritional and genetic contributions to serum cholesterol concentration in a children's follow-up study

In the Finnish multicentre study of cardiovascular risk in young Finns in 1980, 1983 and 1986, 2429, 2052 and 1841 9 to 18-year-old children and adolescents participated. In 1980, subjects of eastern origin living in the west had, despite their western diet, higher serum cholesterol concentrations than subjects both residing in and originating from the west. In males, eastern origin increased the east/west difference in serum cholesterol concentrations. Between 1980 and 1986 the mean serum total cholesterol of the study cohorts decreased by 5.5% and simultaneously the east/west differences in serum cholesterol concentrations disappeared in boys. The study suggests that genetic background is a separate factor determining serum total cholesterol level, but with declining serum cholesterol concentrations the effect of the genetic factor does not become manifest.

Childhood origins of lifestyle-related risk factors for coronary heart disease in adulthood

Research over the past 40 years clearly points to childhood as a critical period when dietary and lifestyle patterns are initiated which have longterm implications for coronary heart disease risk in adult life. Smoking, high habitual dietary intake of total fat and saturated fat, low exercise level, and excessive alcohol consumption often occur in family aggregates. They are correlated with elevated serum cholesterol, obesity, and hypertension in children, as well as with a predisposition to premature death from coronary heart disease. Intervention studies in children and adolescents show, however, that these lifestyle-risk factors are controllable through education and dietary counselling of the affected individual and their family. Equally important are the emerging data in adults showing that vigorous longterm intervention involving reduction of dietary fat and work-related stress, increased exercise, and elimination of smoking all contribute to a significant improvement in coronary perfusion. Hence, effective dietary and lifestyle management of coronary heart disease can occur at early or later stages of the disease and needs better support from health authorities at the national and international level.

Coronary risk factors in schoolchildren

Death rates from coronary heart disease (CHD) in Northern Ireland are among the highest in the world. However, no data have been available to test the hypothesis that the high prevalence of CHD is reflected by the risk status of the childhood population. A randomly selected 2% population sample of 1015 children aged 12 and 15 years was studied to obtain baseline information on blood pressure, lipid profile, cigarette smoking, family history, physical activity, cardiorespiratory fitness, and dietary fat intake. Using available criteria thresholds, 15-23% displayed increased blood pressure, 12-25% had unfavourable lipid profiles, and 18-34% were overfat. In 15 year old children, 16-21% admitted being regular smokers, 26-34% displayed poor cardiorespiratory fitness, and 24-29% reported little physical activity in the previous week. Dietary analysis revealed relatively low polyunsaturated to saturated fatty acid ratios and high mean fat intakes, accounting for approximately 40% total daily energy. Despite the exclusion of family history from the analysis, 16% of the older children exhibited three or more risk factors. These results justify major concern about the level of potential coronary risk in Northern Ireland schoolchildren. Broadly based primary prevention strategies aimed at children are essential if future adult CHD mortality is to be reduced.

Serum lipids and blood pressure in relation to age and sexual maturity

This study was designed to examine serum lipid profile and blood pressure in relation to age and sexual maturity. Written informed consent to participate was obtained from 42% of the eligible population of two Devon communities. The blood pressure of 343 boys and 336 girls, aged 11-16 years, was recorded and sufficient blood for analysis was obtained from 320 boys and 301 girls. Of these, sexual maturity of 221 boys and 209 girls was visually assessed using the indices developed by Tanner. In girls there was a significant (p less than 0.05) correlation between age and serum triglyceride level (r = 0.16) and in boys both serum cholesterol and HDL-cholesterol were significantly (p less than 0.01) and negatively correlated with age (r = -0.25 and -0.18 respectively). Girls had significantly higher (p less than 0.05) levels of HDL-cholesterol than boys but neither sex demonstrated significant changes (p greater than 0.05) in serum lipids or lipoproteins with sexual maturity. No significant differences (p greater than 0.05) were detected between the mean diastolic blood pressures of boys and girls but older boys had significantly higher (p less than 0.05) systolic blood pressures than similarly aged girls. Age was positively and significantly correlated (p less than 0.01) with blood pressure in both boys (systolic, r = 0.49; diastolic, r = 0.30) and girls (systolic, r = 0.28; diastolic, r = 0.29). More mature children were demonstrated to have both higher systolic and diastolic blood pressures than less mature children (p less than 0.05) but when allowance was made for school year group through analysis of co-variance the relationship for diastolic blood pressure in boys no longer remained significant. Blood pressures observed in this study do not raise general cause for concern but the data indicate that unfavourable serum lipid and lipoprotein profiles are common.

Effects of developmental changes and early nutrition on cholesterol metabolism in infancy: a review

Plasma cholesterol levels usually range between 50 and 100 mg/dl at birth, with the cholesterol approximately equally distributed between low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Plasma cholesterol increases rapidly over the first days after birth, predominantly due to an increase in cholesterol with LDL, irrespective of whether the infant is breast fed or fed with infant formulas. With continued feeding, plasma cholesterol becomes progressively, and significantly, higher in infants who are breast fed compared to those fed low-cholesterol, polyunsaturated fatty acid-rich infant formula. Studies in the developing young of other species have suggested that up-regulation of cholesterol synthesis, or turnover and excretion, at stages when these pathways are acquiring functional maturity may have lasting effects on cholesterol metabolism. The information available, however, indicates the diet-related differences in plasma cholesterol of the more mature human newborn are temporal in nature and probably not of significance to adult cardiovascular disease. Infants born early in the third trimester of gestation, however, are at risk for marked elevations in plasma cholesterol, with stimulation of endogenous cholesterol biosynthesis, as a result of the intravenous nutrition required to sustain life. Whether this has long-term consequences for this group of infants is unknown. There is presently no reason to advocate diet modification to alter the plasma cholesterol of normal infants under the age of 2 years.

Association of apolipoprotein E and B polymorphisms with serum lipids

Genetic polymorphism of apolipoprotein E (apoE) and the Xbal restriction-fragment-length polymorphisms (RFLP) of the gene for apolipoprotein B (apoB) have both been shown to be associated with plasma lipid concentration. We studied the combined effect of these gene polymorphisms on serum cholesterol concentrations in 300 subjects aged nine to 18 years. In three way ANOVA, there was a statistically significant interaction between the effects of apoE phenotype and gender on serum cholesterol (P = 0.009). Therefore, males and females were analysed separately by two way ANOVA: there was no interaction between the effects of apoE phenotype and apoB Xbal polymorphism in either gender. In females, there were independent effects of both the apoE phenotype (P = 0.020) and the apoB Xbal genotype (P = 0.037) on serum cholesterol, but in males these effects were not statistically significant. These data suggest that variations at the apolipoprotein B and E gene locus play a role in the determination of serum cholesterol concentration in young female Finns.

Reflotron cholesterol measurements in 1112 Australian children aged 10-12 years

OBJECTIVE

To study the distribution of blood cholesterol concentration in a sample of Western Australian schoolchildren.

DESIGN

The Reflotron dry-chemistry system (Boehringer Mannheim, Germany) was used to measure cholesterol in finger-prick blood samples obtained from Year 6 children aged 10-12 years attending government schools in metropolitan Perth. Recruitment methods ensured that children from different socioeconomic strata were represented.

PARTICIPANTS

For the 1239 children enrolled in Year 6 in 30 government schools, parental consent to participate was obtained for 1144; of these cholesterol concentration was measured in 1112.

RESULTS

The measurement method proved practicable and was generally well accepted. Cholesterol levels were somewhat lower than those obtained using a laboratory reference method and a bias, relative to national quality assurance standards, was estimated to be -0.32 mmol/L. Mean cholesterol level in boys (4.28 mmol/L, SD 0.69) was not significantly different from that in girls (4.35 mmol/L, SD 0.72). Allowing for measurement bias, 52% of boys and 57% of girls had cholesterol levels exceeding the National Heart Foundation's designated "desirable" level of 4.5 mmol/L for children.

CONCLUSIONS

The distribution of cholesterol levels in Australian children compares unfavourably with distributions in children in countries with low rates of cardiovascular disease and indicates a need for widespread, appropriate diet and lifestyle changes.

The Minnesota Heart Health Program. Education for youth and parents

Within the Minnesota Heart Health Program, all schools have participated in these programs and most have been incorporated as part of the regular school curriculum. The involvement of parents in youth programs has been challenging, but we view it as essential to making significant changes. Further, a program with appropriate underlying behavioral theory and community involvement can be successful. Such efforts seem critical to primary prevention of cardiovascular disease risk and subsequent disease in a culture where these diseases are common.

The North Karelia Youth Programs

Two family-based and two community- and school-based studies have been done in the province of North Karelia in eastern Finland. In the two family-based studies it was possible to decrease serum cholesterol level among children by 15%, showing that to a great extent the extremely high blood cholesterol level among Finnish children can be explained mainly by the typical Finnish diet high in saturated fat. In the first North Karelia Youth Project it was possible to affect the onset of smoking among adolescents. Two years after the program, smoking was about 30% less common in the intervention school than in the reference schools. In the eighth-year follow up survey the effect of the teacher-delivered program was still seen. In the second North Karelia Youth Project it was possible to delay the onset of smoking during the seventh grade but no permanent effect was seen. Diet was changed more among the program school students than in the reference school. These studies, done during the last 10 years, show the cardiovascular risk factors can be reduced among children and adolescents. The next main question is how to use these findings in the normal school and health care system. We have started the National Healthy School Program in Finland to assess the extent to which these programs can be implemented on the national level.

[Development of serum cholesterol and frequency of hypercholesterolemia in children and adolescents: results of the Berlin-Pankow cohort study]

The age-related evolution of serum cholesterol has been studied in a cohort of 475 boys and girls born in 1964, living in Berlin-Pankow district; they have been followed up from age 13-14 to 20-21 (response rate after eight years: 66%). At age 13-14, mean total cholesterol was higher among boys (183 +/- 34 mg/dl) as well as among girls (187 +/- 33 mg/dl) as compared with those observed in other populations. About one third of the subjects at this age had values greater than 200 mn/dl. There was a marked decrease in mean total cholesterol around age 14 in both sexes, inversely related to the degree of sexual maturity. Between age 15 and 20 the serum cholesterol rose continuously. After puberty girls had higher mean values than boys. The evolution of serum cholesterol changes during adolescence should be taken into account when assessing preventive measures in children and young people.

Differences in modifiable cardiovascular disease risk factors in Australian schoolchildren: the results of a nationwide survey

Two thousand four hundred schoolchildren ages 9, 12, and 15 years were randomly selected to participate in the Health and Fitness Survey of Australian Schoolchildren in 1985. Data on blood lipids, aerobic fitness, blood pressure, and obesity were obtained through physical measurement. Information on socioeconomic status and ethnic origin was collected via questionnaire. Serum total cholesterol and low and high-density lipoprotein cholesterol were lowest in the oldest age group. Girls had significantly higher serum lipid levels, the difference being greatest at 15 years. However, comparison of the total cholesterol/high-density lipoprotein cholesterol ratio showed a trend in the direction of decreasing risk with increasing age for girls, with the reverse being found in boys. Fifteen-year-old girls were also the fattest and least fit of all the children, but had significantly lower systolic and diastolic blood pressures than their male peers. Children of Asian ethnic origin had significantly lower systolic and diastolic blood pressures and a significantly higher mean high-density lipoprotein cholesterol and were less likely to be overweight compared with other ethnic groups. Children from Mediterranean/Middle-East countries were significantly fatter and had a higher mean diastolic blood pressure than the other ethnic groups. These differences were detectable at age 9 years. Children from lower socioeconomic backgrounds were fatter and had a significantly lower mean high-density lipoprotein cholesterol and higher mean serum triglyceride levels. As with ethnic origin, these differences were detectable at age 9 years. The results demonstrate that age, sex, ethnic origin, and socioeconomic status can be used as variables to describe mean differences in the levels of cardiovascular risk factors in the national population of children. As some elevations in risk factors appear to be present in the youngest age group and these levels correlate with fatty streak and fibrous plaque formation in young adulthood, preventive programs should aim at intervention prior to puberty.

Estimation of coronary risk factors in British schoolchildren: a preliminary report

Surveys from several countries have identified the presence of risk factors known to be associated with coronary heart disease in children. Data on the distribution of coronary risk factor variables in British children are scarce. This study was therefore designed to test the feasibility of collecting coronary risk factor data from British children and to conduct a preliminary examination of the problem. One hundred and seven children (mean age 12.8 yr) had their height, weight, triceps skinfold and blood pressure checked. Blood samples for cholesterol and HDL-cholesterol analysis were obtained from 93 children. Peak VO2 was determined on 48 children, 76 children had their daily activity monitored and 59 children's stage of sexual maturity was assessed. The boys' peak VO2 was significantly higher than the girls, whether expressed in l.min-1 (p less than 0.05) or ml.kg.-1min-1 (p less than 0.01). No other significant differences (p greater than 0.05) between the sexes were detected. The results indicate that children have relatively high serum cholesterol levels (boys 4.58 +/- 0.79; girls 4.72 +/- 0.80 mmol.l-1). The willingness and enthusiasm of the children, parents and schools to take part in the study clearly demonstrated the feasibility of a large scale study being successfully pursued in the United Kingdom.

Insight into a bad omen for white men: coronary artery disease--the Bogalusa Heart Study

Clinical experience of diagnostic and interventional procedures, including cardiac surgery, indicates a greater prevalence of coronary heart disease in white men than in other race-gender groups. Studies of children and young adults in the Bogalusa Heart Study have provided evidence that might account for this race-gender contrast. A variety of anthropometric and metabolic parameters influencing serum lipid and lipoprotein levels places white boys and young white men selectively at high risk for the development of atherosclerotic coronary artery disease. Obesity and greater central body fat, subtle aberrations in carbohydrate-lipid metabolic relations and variability in sex hormone profiles appear to underlie a trend to adverse lipoprotein changes in white men. A lower high-density lipoprotein cholesterol level and apolipoprotein A-l at puberty and a dramatic increase of low-density lipoprotein cholesterol are seen in young white men; such adverse changes identify them to be at greater risk. It is noteworthy that children whose fathers had myocardial infarction tend to be white. These children also have relatively high ratios of apolipoprotein B/apolipoprotein A-l and apolipoprotein B/low-density lipoprotein cholesterol. Studies of risk factors in children emphasize their importance in the early natural history of coronary artery disease. These findings show the need for beginning prevention of adult heart disease in childhood.

Risk factors for cardiovascular disease in 16-19-year-old teenagers

In a representative sample of Danish school children (124 boys and 169 girls), 16-19 years of age, blood pressure, blood lipids, body fat content, maximal aerobic power, alcohol consumption and smoking habits were studied. No systematic variation was noticed within this age in the risk factor profile. The mean values for blood pressure (BP) (systolic/diastolic) were 125/73 mmHg for the boys and 117/71 mmHg for the girls. As much as 14% of the boys and 5% of the girls had either a systolic BP above 140 mmHg or a diastolic BP above 90 mmHg. Total serum cholesterol averaged 4.13 mmol l-1 for the boys and 4.53 mmol l-1 for the girls, which is also high compared with adolescents from other countries. The ratios for high density lipoprotein cholesterol to total serum cholesterol were normal and in the range of 0.25-0.28 for both sexes. Other factors associated with coronary heart disease in adults, such as body fat content, serum triglycerides, physical activity, as well as smoking and alcohol habits were similar to that reported for teenagers in other countries. No correlation was found between aerobic power (ml min-1.kg-1) and the risk factors measured.

Cigarette smoking in Australian schoolchildren

Six thousand, four hundred and fifty-one schoolchildren who were aged nine to 15 years completed a questionnaire about their patterns of cigarette use, as part of the nation-wide Health and Fitness Survey of Australian Schoolchildren which was conducted in 1985. The survey yielded figures for the prevalence of cigarette smoking by age, sex, socioeconomic status and ethnic origin. It also provided data on the relationship between parental smoking and smoking in children. By the age of 15 years, 32.4% of the girls and 26.0% of the boys in the study sample had smoked at least one cigarette in the seven days before they were surveyed. In some of the age-groups, the average number of cigarettes that were consumed by girl smokers equalled or exceeded that of their male counterparts. There were no significant differences in the prevalence of current cigarette smoking with differences in socioeconomic status. This finding contrasts with the pattern of use in adults. Ethnic origin was a statistically-significant predictor of smoking behaviour in children. Significantly-fewer children of Asian ethnic origin were current smokers. Parental smoking status also appeared to be an important determinant of smoking behaviour in schoolchildren. This influence was more important for girls than for boys, particularly when the mother was a smoker. The over-all findings suggest that many features of the adult pattern of cigarette use are established by the age of 15 years. The findings also supported the trend towards increased cigarette consumption by girls compared with boys that was noted by earlier researchers. These findings should encourage a serious reappraisal of the role of cigarette advertising in the promotion of smoking in young persons.

Type A behavior, coping mechanisms and emotions related to somatic risk factors of coronary heart disease in adolescents

Type A behavior, coping mechanisms, emotions and somatic risk factors of coronary heart disease were studied in 208 randomly selected healthy adolescents. Type A behavior was evaluated by the Wolf-Hunter A-B Rating Scale and a questionnaire developed for the present study. Subjects' coping mechanisms and emotions were assessed by interviews. The somatic risk factors used were SBP, DBP, serum total cholesterol, LDL, HDL, triglycerides and body mass index. In boys, type A behavior consistently correlated negatively with somatic risk factors of CHD while in girls, 'traditional' type A components like impatience and a sense of hurry correlated positively with somatic risk. The key finding was that inability to recognize and express negative emotions and the denial of problems correlated with somatic risk.

Health promotion in the family: current findings and directives for nursing research

This paper reviews the current nursing research findings on health promotion within the family and provides directives for future research. The concept of health promotion-the overall enhancement of well being--is contrasted with primary or disease prevention, the specific protection from a health threat. The conceptual parameters of health promotion were used to search the nursing research journals for studies of health promotion in the family. The four major nursing research journals were reviewed and yielded five articles in 105 issues which addressed this phenomenon. The findings from these studies as well as other research literature are used to develop future directives. The directives are presented for both the internal environment of the family and its external environment. Areas for study related to the internal environment include definitions of health and health promotion, descriptions of current health promotion behaviours and those practised over time, decision making, fathering, and methods of intervention. Research of the external environment includes the societal norms, societal interventions, and the effects of societal institutions. This discussion of health promotion in the family describes an agenda for nursing research which is necessary to support nursing practice with families if 'health for all' is to be reached by the year 2000.

Serum cholesterol (total, low-density lipoprotein, and high-density lipoprotein cholesterol), triglyceride levels, and fat consumption among Jerusalem Arab and Jewish schoolchildren

As part of initial health screening for the "Know Your Body" Program-based comprehensive health education program, 841 Jerusalem first- and second-grade schoolchildren were tested for total serum cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. The same population, which included 643 Jewish (76.5%) and 198 Arab children (23.5%), had their nutritional habits evaluated by means of a parent-completed food-frequency questionnaire. Arab schoolchildren had significantly lower total, high-density lipoprotein, and low-density lipoprotein cholesterol levels and higher triglyceride levels than the Jewish children studied (total cholesterol: Arab mean, 153.1 mg/dl, Jewish mean, 170.3 mg/dl; high-density lipoprotein cholesterol: Arab mean, 46.4 mg/dl, Jewish mean, 48.5 mg/dl; low-density lipoprotein cholesterol: Arab mean, 90.7 mg/dl, Jewish mean, 108.5 mg/dl; triglycerides: Arab mean, 77.9 mg/dl, Jewish mean, 66.3 mg/dl). No significant differences in consumption level of foods high in saturated fats and/or cholesterol were found between populations, although the Arab children showed a tendency to eat more of these foods. Significant differences in total cholesterol values were also found among Jewish children of different origins, but no significant differences were found in consumption levels of saturated fats and cholesterol. Further studies are needed to determine the reasons for the differences in total cholesterol and lipoprotein levels found between Jewish and Arab schoolchildren.

Serum total cholesterol, HDL cholesterol and blood pressure levels in 15-year-old adolescents in eastern Finland

Serum total cholesterol, HDL-cholesterol and blood pressure were studied among 15-year-old school children in Eastern Finland. The mean serum total cholesterol was 4.47 mmol/l in boys and 4.86 mmol/l in girls; mean HDL-cholesterol was 1.29 mmol/l and 1.46 mmol/l, respectively. The mean blood pressure was 135/65 mmHg in boys and 126/67 mmHg in girls. Obese children had higher blood pressure and lower HDL-cholesterol levels than others. Among boys sexual maturation decreased the HDL-cholesterol level. Children whose parents had histories of cardiovascular disease did not have higher cholesterol or higher blood pressure levels than other children. Children at high risk apparently cannot be screened on the basis of parents' history of cardiovascular diseases.

Determinants of blood pressure in 7th grade Jerusalem school children

The determinants of blood pressure level were analyzed in a group of 1154 Jerusalem school children aged 12. After controlling for age, significant differences in blood pressure measurements were found between three groups: boys, pre-menarche girls and post-menarche girls. A comparison of the means of selected biological variables showed that girls who have reached menarche have levels of systolic blood pressure, weight, height and Quetelet's index higher than boys and pre-menarche girls. However, levels of triceps skinfold thickness and pulse rate were similar in the two groups of girls and higher than in boys. Using multiple regression analysis, we found that much of the variance (boys 29%, post-menarche girls 21% and pre-menarche girls 15%) of systolic blood pressure could be explained by a combination of biological variables (Quetelet, pulse rate, triceps skinfold thickness and height) while these variables explained a much smaller proportion (boys 12%, post-menarche girls 17% and pre-menarche 9%) of diastolic blood pressure variance. The predictive power of systolic blood pressure by the measured biological variables was higher in boys than in girls. However, diastolic blood pressure was better predicted by the biological variables in the group of girls with menarche than in other groups. Elevated blood pressure was observed in 3.2% of the examined children. High values for Quetelet's index were observed in 6.4%. The prevalence of elevated measurements of blood pressure and Quetelet's index were significantly higher in girls with menarche. Among children aged 12, the association between sociodemographic characteristics and blood pressure level was weak, as measured in multiple regression analysis.

Physical activity and its relationship to blood pressure in school children

The present report analyzes the relationship between physical activity and blood pressure in 1341 school children aged 7-14 years (girls = 598, boys = 743) participating in a screening for cardiovascular risk factors that took place in the suburban area of Naples. During the baseline examination, systolic (SBP) and diastolic (DBP) blood pressure, height, weight, and resting pulse rate (PR) were measured. The Harvard-Modified Step Test was also performed in order to score both a crude recovery index (RI) and an index corrected for the initial resting pulse rate (RI-PR) used as measures of the level of habitual physical activity. Significant differences have been found between the quartiles of distribution of both the crude recovery index and the corrected index in girls and boys with regard to systolic blood pressure but not diastolic. In both sexes, better responders to the Harvard-Modified Step Test showed on the average lower systolic blood pressure than poorer responders. In boys, the inverse association between systolic blood pressure and the recovery index was independent of the effect of age, body mass index, height, and resting pulse rate, while in girls the same association did not reach statistical significance. Our results support the hypothesis that systolic blood pressure is independently related to the level of habitual physical activity in children.

The concept of health promotion and the prevention of adolescent drug abuse

A three-dimensional conceptual model for health promotion interventions to prevent adolescent drug abuse is elaborated. The model is based on an analysis of the concept of health into four domains--physical, psychological, social, and personal; an analysis of intervention approaches to change behavior into two major strategies--introducing/strengthening health-enhancing behavior, and weakening/eliminating health-compromising behavior; and an analysis of the foci of interventions into three levels--environmental, personality, and behavior. Components of a specific health promotion program, the Minnesota Heart Health Program, that are designed to prevent adolescent drug abuse are described. These include health behavior campaigns, educational interventions, and community organization. The theoretical content of the components is shown to be linked logically to the health promotion model.

Assessing needs for youth health promotion

Children and adolescents recently have become a group targeted for health promotion efforts. It is argued that early behavioral intervention will alter patterns of behavior that might place young people at increased risk for chronic diseases later in life. The Minnesota Heart Health Program is a longitudinal, community-based research and demonstration project to improve cardiovascular health in three north central communities. Reductions in cigarette smoking, improved eating and exercise patterns, and hypertension management are targeted objectives. To design educational interventions for children and adolescents in these areas as part of this program, a behavioral needs assessment was conducted in the communities prior to program implementation. This needs assessment focused on existing behavior patterns, skills related to the targeted behaviors, and environmental influences. This article describes that needs assessment, the results from two of the communities, differences due to gender and age of student, and the implications of the results for designing intervention activities for children and adolescents.

Screening by nurse clinicians in cancer prevention and detection

Cancer screening by definition as an organized effort to detect cancer at an early stage when reduced mortality is possible. Cancer screening should not be the exclusive responsibility of comprehensive cancer centers or large urban medical centers. Rather, every health professional should play a significant role in the early detection and education of patients with cancer. As seen here, some of the most common and life-threatening forms of cancer are the most preventable. Practical and inexpensive steps exist for thorough and effective screening. Nurses educated in the early detection of cancer are in a unique position; they are on the front line of patient care in the promotion and education of patients to the many benefits of early detection. Preventive efforts, such as screening and early detection, coupled with vastly improved treatment modalities, provide a very real and potent weapon against diseases that only 20 years ago were considered incurable.

Atherosclerosis precursors in Finnish children and adolescents. XII. Smoking behaviour and its determinants in 12-18-year-old subjects

The cross-sectional study of 1980 for atherosclerosis precursors in Finnish children and adolescents aimed at a wide coverage of the relevant relationships of the smoking behaviour to socioeconomic and psychosocial factors. The initiation and establishment of the smoking habits were primarily viewed as a function of the youngsters' main socializing agents: the peer group and the family. A subpopulation comprising 1,790 children and adolescents aged 12, 15 and 18 years of the total sample was included in the study on smoking behaviour. The information on smoking habits was collected in connection with the medical examination in a solitary room where the youngsters could respond undisturbed. Data on the children's families were obtained by means of a general questionnaire filled out by the parents. The prevalence of daily smoking was 1% in the 12-year-old, 10% in the 15-year-old, and 30% in the 18-year-old subjects. The best friend's behaviour was the best predictor of an adolescent's smoking behaviour, although the family had retained its role as an important model as regards the learning of smoking behaviour. Quitting school turned out to be a major event leading to an increased risk of becoming a habitual smoker. No clear associations between socioeconomic status of the family and daily smoking were found, except that farmers' children had generally lower rates of daily smoking than children from other socioeconomic groups. First contacts with tobacco formed part of a normal behaviour pattern at a certain age, and this experimentation was unrelated to a later regular habit.(ABSTRACT TRUNCATED AT 250 WORDS)

Atherosclerosis precursors in Finnish children and adolescents. III. Blood pressure

In connection with the Finnish Multicentre Study on the precursors of atherosclerosis in 3-, 6-, 9-, 12-, 15- and 18-year-old children and adolescents, blood pressure was measured in 3,596 subjects in the five university hospital areas. Blood pressure was measured with an ultrasound device (Arteriosonde 1020, Roche) in the 3-year-old children, and an ordinary mercury sphygmomanometer was used in the rest of the subjects. The systolic and diastolic values increased with age as has been shown earlier. There were no significant differences in the values between boys and girls except that the 15- and 18-year-old boys had values a little higher than girls of the same age. Weight and height correlated well to both systolic and diastolic blood pressures. Physical maturation also correlated to blood pressure.