Cardiac risk evaluation for elementary school children

Relationships between Dietary Patterns and Indices of Arterial Stiffness and Central Arterial Wave Reflection in 9-11-Year-Old Children

Arterial stiffness is an important marker of vascular damage and a strong predictor of cardiovascular diseases (CVD). Given that pathophysiological processes leading to an increased arterial stiffness begin during childhood, the aim of this clustered observational study was to determine the relationship between modifiable factors including dietary patterns and indices of aortic arterial stiffness and wave reflection in 9–11-year-old children. Data collection was conducted between April and December 2015 in 17 primary schools in Dunedin, New Zealand. Dietary data were collected using a previously validated food frequency questionnaire and identified using principal component analysis method. Arterial stiffness (carotid-femoral pulse wave velocity, PWV) and central arterial wave reflection (augmentation index, AIx) were measured using the SphygmoCor XCEL system (Atcor Medical, Sydney, Australia). Complete data for PWV and AIx analyses were available for 389 and 337 children, respectively. The mean age of children was 9.7 ± 0.7 years, 49.0% were girls and 76.0% were classified as “normal weight”. The two identified dietary patterns were “Snacks” and “Fruit and Vegetables”. Mean PWV and AIx were 5.8 ± 0.8 m/s and −2.1 ± 14.1%, respectively. There were no clinically meaningful relationships between the identified dietary pattern scores and either PWV or AIx in 9–11-year-old children.

Cardiovascular risk factor investigation: a pediatric issue

OBJECTIVES

To correlate cardiovascular risk factors (e.g., hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, sedentariness) in childhood and adolescence with the occurrence of cardiovascular disease.

SOURCES

A systematic review of books and selected articles from PubMed, SciELO and Cochrane from 1992 to 2012.

SUMMARY OF FINDINGS

Risk factors for atherosclerosis are present in childhood, although cardiovascular disease arises during adulthood. This article presents the main studies that describe the importance of investigating the risk factors for cardiovascular diseases in childhood and their associations. Significant rates of hypertension, obesity, dyslipidemia, and sedentariness occur in children and adolescents. Blood pressure needs to be measured in childhood. An increase in arterial blood pressure in young people predicts hypertension in adulthood. The death rate from cardiovascular disease is lowest in children with lower cholesterol levels and in individuals who exercise regularly. In addition, there is a high prevalence of sedentariness in children and adolescents.

CONCLUSIONS

Studies involving the analysis of cardiovascular risk factors should always report the prevalence of these factors and their correlations during childhood because these factors are indispensable for identifying an at-risk population. The identification of risk factors in asymptomatic children could contribute to a decrease in cardiovascular disease, preventing such diseases as hypertension, obesity, and dyslipidemia from becoming the epidemics of this century.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

Food Away from Home, Sugar-Sweetened Drink Consumption and Juvenile Obesity

OBJECTIVE

To identify if particular foods or food groups may be associated with obesity in children and adolescents and to determine if consuming food away from home (FAFH) has an effect on the nutritional quality of their diets.

DESIGN

One-year cross-sectional study.

SETTING/SUBJECTS

The obese subjects (n = 91) were on the waiting list for a hospital-based weight control treatment program. The non-obese subjects (n = 90) were recruited from community advertisements.

MEASURES OF OUTCOME

Information on food intake was obtained using the dietary history method by a Registered Dietitian. Body fat was determined by bioelectrical impedance analysis.

RESULTS

Obese children and adolescents consumed significantly more servings of meat and alternatives, grain products, FAFH, sugar-sweetened drinks and potato chips which contributed to a higher calorie, fat and sugar intake compared to non-obese children and adolescents. Sugar-sweetened drinks were only significantly greater in boys. The consumption of meat servings, sugar-sweetened drinks and FAFH was positively correlated with percent body fat. The frequency of food consumed outside of the Canada's Food Guide To Healthy Eating was not different between the two groups.

CONCLUSIONS

Obese children and adolescents need to limit their access to food consumed away from home and sugar-sweetened drinks as there is a relationship between these foods and body fatness.

Role of food prepared away from home in the American diet, 1977-78 versus 1994-96: changes and consequences

OBJECTIVE

To examine changes, between 1977-78 and 1994-96, in the quantity and quality of food Americans consumed that was prepared at home versus away from home.

DESIGN

Data were obtained from nationwide surveys of food consumption conducted by the US Department of Agriculture (USDA) in 1977-78 and 1994-96. To maximize comparability, we used "day 1" dietary data, which both surveys collected via 24-hour recall.

SUBJECTS/SETTINGS

Individuals 2 years of age and over were selected. USDA sampling weights were used to generate nationally representative estimates.

VARIABLES MEASURED

We categorized foods by preparation at home or at restaurants, fast-food establishments, schools/day care, and other non-home locations. We assessed percent calories from total fat and saturated fat, and the cholesterol, sodium, fiber, calcium, and iron densities of foods prepared at home versus those prepared away from home.

STATISTICAL ANALYSES

T tests were calculated using accepted procedures to adjust for survey design effects.

RESULTS

Between 1977-78 and 1994-96, consumption of food prepared away from home increased from 18% to 32% of total calories. Meals and snacks based on food prepared away from home contained more calories per eating occasion, and "away" food was higher in total fat and saturated fat on a per-calorie basis than at-home food. "Away" food contained less dietary fiber, calcium, and iron on a per-calorie basis. Among adults but not children, food prepared away from home was more sodium and cholesterol dense.

IMPLICATIONS

When developing intervention messages and strategies, nutrition educators need to be aware of the increasing role of "away" food in Americans' diets.

The effect of cardiovascular health promotion on health behaviors in elementary school children: an integrative review

This report provides on an integrative review of health promotion studies relevant to elementary school children published between 1986 and 1998. The 22 research articles represented several disciplines including public health and nursing. The studies varied in research design, sample characteristics, and approaches to health education. The most common interventions targeted behavioral risk factors for cardiovascular disease, but it also was evident from the literature that family and community involvement both played a significant role in health behaviors of children. Health promotion studies were under-represented in the nursing literature, a gap that creates an impetus to study children and families to identify the ways they learn primary preventive behaviors.

Effectiveness of a cardiovascular health promotion education intervention on the attitudes of urban African American school-age children

African American children are at risk for high rates of morbidity and mortality associated with cardiovascular (CV) disease as they become adults, yet little is known about the effectiveness of CV risk-reduction interventions in African American children. This study explored the effectiveness of a concentrated CV health promotion educational program on health-related attitudes of 76 African American children enrolled in a mid-southern school system. The Children's Cardiovascular Health Promotion Attitude Scale was used to examine differences in attitude prior to and 2 weeks following a focused health education intervention. Results demonstrate that children have preconceived attitudes regarding practice of health behaviors and that these attitudes are modifiable with age and developmental level specific educational interventions. Findings indicate the need for health care providers to assume more active roles in reducing the risk of future CV disease and death in African Americans through health promotion education of individuals who influence the development of children's attitudes.

Perfil lipídico de dietas e sua relação com os níveis de colesterolemia em escolares de uma escola pública de Campinas, São Paulo, (Brasil)

Este estudo foi conduzido com 194 escolares com o objetivo de identificar o perfil lipídico de suas dietas, relacionando-os com o colesterol plasmático. Foi realizado um inquérito alimentar de 24 horas e a dosagem de colesterol e HDL-colesterol. Associação entre lipídios da dieta e do sangue foi analisada por correlação bivariada e regressão logística. A dieta consumida pelos escolares mostrou diferença significativa (teste t), entre os sexos, para a quantidade de carboidratos e de fibra alimentar. Os carboidratos contribuíram com 52,7% das calorias totais, as proteínas com 14,0%, os triglicérides com 33,3%, sendo que os ácidos graxos monoinsaturados com 12,0%, os poliinsaturados com 8,5% e os saturados com 12,5%. A quantidade de colesterol na dieta foi 176mg e de fibra alimentar 15g. O valor do colesterol plasmático foi 150mg/dl e do HDL-colesterol 36mg/dl. Observou-se associação direta entre colesterolemia e percentual de calorias proveniente de triglicerídeos, de ácidos graxos monoinsaturados e poliinsaturados. Encontrou-se associação positiva entre colesterolemia e porcentagem de calorias proveniente de ácidos graxos monoinsaturados. Concluiu-se que o método utilizado neste estudo não foi apropriado ao objetivo proposto devido à baixa prevalência de hipercolesterolemia (4,8%) entre os escolares estudados. Fatores de respostas individuais devem ser considerados no estudo de associação entre colesterol dietético e plasmático.

Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents' homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m2). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI > or = 20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13-3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64-3.59), allergy (OR = 1.89, 95% CI: 1.34-2.66), and Environmental Tobacco Smoke (OR = 1.54; 95% CI: 1.05-2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43-1.00) when compared with children from households where coal or gas was used for home heating.