Effects of family-oriented risk-based prevention on serum cholesterol and blood pressure values of children and adolescents

Diagnosis and treatment of hypertension in children

Hypertension is a global problem, affecting both developed and developing nations. In children and adolescents, hypertension has gained ground in cardiovascular medicine, thanks to the progress made in several areas of pathophysiologic and clinical research. Childhood hypertension is often asymptomatic and is easily missed, even by health professionals. Target organ damage is detectable in children and adolescents. Management of hypertension includes lifestyle changes and pharmacologic treatment. In the case of secondary hypertension, pharmacologic treatment usually is required. In essential hypertension, assessment of early organ damage provides a useful tool for treatment decisions.

Interventions that involve parents to improve children's weight-related nutrition intake and activity patterns - what nutrition and activity targets and behaviour change techniques are associated with intervention effectiveness?

Parent involvement is an important component of obesity prevention interventions. However, the best way to support parents remains unclear. This review identifies interventions targeting parents to improve children's weight status, dietary and/or activity patterns, examines whether intervention content and behaviour change techniques employed are associated with effectiveness. Seventeen studies, in English, 1998-2008, were included. Studies were evaluated by two reviewers for study quality, nutrition/activity content and behaviour change techniques using a validated quality assessment tool and behaviour change technique taxonomy. Study findings favoured intervention effectiveness in 11 of 17 studies. Interventions that were considered effective had similar features: better study quality, parents responsible for participation and implementation, greater parental involvement and inclusion of prompt barrier identification, restructure the home environment, prompt self-monitoring, prompt specific goal setting behaviour change techniques. Energy intake/density and food choices were more likely to be targeted in effective interventions. The number of lifestyle behaviours targeted did not appear to be associated with effectiveness. Intervention effectiveness was favoured when behaviour change techniques spanned the spectrum of behaviour change process. The review provides guidance for researchers to make informed decisions on how best to utilize resources in interventions to support and engage parents, and highlights a need for improvement in intervention content reporting practices.

An activity-based intervention for obese and physically inactive children organized in primary care: feasibility and impact on fitness and BMI A one-year follow-up study

OBJECTIVE

To investigate the feasibility and impact on BMI and physical fitness of an intervention for obese and inactive children, based on physical activity and carried out in primary health care.

DESIGN

A prospective, longitudinal one-year follow-up study.

SETTING

The community of Kristiansand, Norway (80 000 inhabitants).

INTERVENTION

A 40-week structured intervention based on physical training with some lifestyle advice for the obese child and one parent. Subjects. A total of 62 physically inactive children aged 6-14 years with iso-BMI ≥ 30 kg/m².

MAIN OUTCOME MEASURES

Body mass index (BMI), maximum oxygen uptake, and physical fitness in tests of running, jumping, throwing, and climbing assessed at baseline and after six and 12 months as well as number of dropouts and predicting factors.

RESULTS

A total of 49 out of 62 children completed the first six months and 37 children completed 12 months. Dropout rate was higher when parents reported being physically inactive at baseline or avoided physical participation in the intervention. The children's maximum oxygen uptake increased significantly after 12 months from 27.0 to 32.0 ml/kg/min (means), as did physical fitness (endurance, speed, agility, coordination, balance, strength) and BMI was significantly reduced.

CONCLUSION/IMPLICATIONS

This one-year activity-based intervention for obese and inactive children performed in primary health care succeeded by increasing cardiovascular capacity and physical fitness combined with reduced BMI in those who completed. Dropout was substantial and depended on the attendance and compliance with physical activity by the parents.

Leucine 7 to proline 7 polymorphism in the neuropeptide Y gene and changes in serum lipids during a family-based counselling intervention among school-aged children with a family history of CVD

OBJECTIVE

To compare whether serum lipids and their changes during a health education intervention are associated with the Leu7Pro polymorphism in the signal peptide part of neuropeptide Y (NPY) in children with normal weight and in those with overweight.

DESIGN

An intervention study.

SETTING

A family-based intervention of risk factors for prevention of CHD in Finland.

SUBJECTS

Subjects were 443 children with a family history of CVD participating in family-based health education. The children were divided into two groups according to NPY genotype: children with Leu7/Pro7 or Pro7/Pro7 genotype (n 50) and children with Leu7/Leu7 genotype (n 393). The final sample of the follow-up study included 353 (80 %) children (Pro7 allele carriers, n 43; Leu7/Leu7, n 310).

RESULTS

At baseline, the Leu7Pro polymorphism was not associated with serum lipid values after adjustment for body weight in boys or girls. There was a significant interaction of NPY genotype group by time and body weight (P = 0.043 for three-way interaction: time x NPY genotype x body weight) in LDL-cholesterol (LDL-C) concentration among boys. LDL-C decreased among boys with normal weight in both NPY groups and in overweight boys with the Leu7/Leu7 genotype, whereas it increased in overweight boys with the Pro7 allele. Two-way interaction (time x NPY genotype) showed no significant differences in changes of serum lipids between the NPY genotype groups among boys or girls.

CONCLUSIONS

The Leu7Pro polymorphism may be associated with dietary response to LDL-C concentration in overweight boys with a family history of early-onset CVD.

Apolipoprotein E polymorphism and changes in serum lipids during a family-based counselling intervention

OBJECTIVE

To compare serum lipids and their changes during a family-based health education in children aged 6-17 years with or without the epsilon4 allele of the gene encoding apolipoprotein E (apoE).

DESIGN

An intervention study.

SETTING

A family-based prevention of risk factors of coronary heart disease in Eastern Finland. The programme consisted of two counselling meetings at children's schools and three at children's homes.

SUBJECTS

Four hundred and thirty-nine children with a family history of cardiovascular diseases (CVD) participated in a family-based health education. The children were divided into two groups according to apoE genotype. The risk group consisted of 143 children having apoE epsilon4 allele (genotype epsilon3/4 or epsilon4/4) and the non-risk group of 296 children without apoE epsilon4 allele (epsilon2/3 or epsilon3/3). The final sample of the follow-up study included 354 (81%) children (114 and 240, respectively).

RESULTS

Baseline differences were found in low-density lipoprotein cholesterol (LDL-C) (P=0.007) and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (P=0.030) among boys and in total cholesterol (TC)/HDL-C (P=0.008) and LDL-C/HDL-C ratios (P=0.006) among girls. Differences between groups in changes during the follow-up were observed only for TC/HDL-C ratio (P-value adjusted for age=0.049) among boys.

CONCLUSIONS

At baseline, children with apoE epsilon4 allele had on average a more unfavourable lipid profile than those without apoE epsilon4 allele. However, the effect of about 33 months' family-based health education on plasma lipids did not depend on apoE genotype in children with a family history of CVD.