Dietary studies of children from a biracial population: intakes of fat and fatty acids in 10- and 13-year olds.

Dietary intakes of fat and fatty acids were examined in children randomly selected from a biracial community, Bogalusa, LA. Between two 10-yr-old groups examined 3 yr apart, temporal trends of 1) higher intakes of polyunsaturated fatty acids, linoleic and linolenic acids, and 2) lower intakes of animal fat, saturated fatty acids, and palmitic acid were documented. No racial differences were found, and the only difference between sexes was for myristic acid (boys greater than girls). Longitudinal comparisons of a cohort of 148 children examined at both 10 and 13 yr showed higher intakes over time of unsaturated fatty acids, polyunsaturated fatty acids, vegetable fat, oleic, linoleic, and linolenic acids, and lower intakes of cholesterol, saturated fatty acids, animal fat, and myristic acid. The percentage of energy intake from fat, saturated fatty acids and polyunsaturated fatty acids was quite similar to other reports of US children and adults. Few children's intakes of cholesterol, fat, and fatty acids were compatible with current recommendations for prudent diets. Patterns of dietary fat and fatty acid intake of Bogalusa children reflect reported food market trends of increased use of vegetable fats.

Cardiovascular risk factors from birth to 7 years of age: the Bogalusa Heart Study. Serum lipids and lipoproteins.

Serum lipids and lipoprotein cholesterol fractions were examined in a newborn cohort that was followed from birth to 7 years of age. Although white and female infants had higher cord blood levels of high-density lipoprotein cholesterol (HDL-C) than did black and male infants, respectively, these differences did not persist throughout early childhood. Mean levels of all serum lipids and lipoproteins increased greatly in the first 6 months of life, and by 2 years of age, levels approached those seen in adolescents. Infants consuming cow's milk had higher 6-month levels of serum total cholesterol and low-density lipoprotein cholesterol than did formula-fed infants. However, milk source in infancy did not significantly influence total cholesterol or low-density lipoprotein cholesterol levels at age 7 years. Serum lipid and lipoprotein levels at age 7 years were associated with previously measured levels as early as 6 months of age, and infants with unfavorable levels were likely to have similar adverse levels at 7 years of age. In addition, increases in obesity between 6 months and 7 years of age were positively associated with increases in levels of serum triglycerides. These results suggest that certain persons at increased risk for cardiovascular disease can be identified in infancy.

Cardiovascular risk factors from birth to 7 years of age: the Bogalusa Heart Study. Blood pressure.

BP was measured in 440 children followed longitudinally from birth to 7 years of age in Bogalusa, LA. Levels, trends, and determinants of BP were evaluated in this newborn cohort. Both systolic and diastolic BP levels remained relatively constant between the ages of 6 months and 7 years. BP levels varied between the different instruments, and differences were also noted between measures obtained using the same instrument before and after venipuncture. White children were noted to have slightly higher levels of systolic and diastolic BP pressure at 6 months and 1 year of age, even after adjustment for body size. Significant prediction of year 7 BP rank occurred as early as 6 months of age for systolic and at 1 year of age for diastolic BP levels. Body size was inconsistently related to BP levels from ages 6 months through 4 years, but the relationship was stronger and more consistent with changes in body size. Of interest is the relatively constant levels of indirect BP during this period of rapid growth, as measured by currently available instruments. These data emphasize the importance of cardiovascular risk factor measurement during early life and of the need to improve methods of indirect BP measurement in infancy.

Cardiovascular risk factors from birth to 7 years of age: the Bogalusa Heart Study. Dietary intakes.

Dietary patterns and racial differences in nutrient intake were observed in children 6 months to 4 years of age in the Bogalusa Heart Study. Even in this sample of young children, the composition of the intakes of the majority of children was not compatible with prudent recommendations of less than 35% and 10% of energy from total and saturated fat, respectively. Mean cholesterol intake of the 4-year-old children (390 mg) was approximately one half of the average daily adult levels. The polyunsaturated to saturated fatty acid ratio ranged from 0.41 to 0.53 and sucrose to starch ratio from 1.32 to 1.57, reflecting a high saturated fat and sucrose intake. White children had greater intakes of sucrose than black children; however, total fat and cholesterol intakes were greater in black children. Gender differences were noted among the 2, 3, and 4-year-old children: energy, sugar, and starch intakes were greater in boys, and cholesterol intake per 1,000 kcal was greater in girls. Mean intakes per 1,000 kcal in Bogalusa were higher for fat and carbohydrate and lower for protein than reported in the Second Health and Nutrition Examination Survey. However, when the National Research Council recommended dietary allowances for protein and energy are used for comparison, a more than adequate intake was noted in these children. The data found in this newborn-infant cohort contribute information regarding the early development of dietary habits that likely influence eating behavior in later childhood and adolescence.

Cluster of five children with acute encephalopathy associated with cat-scratch disease in south Florida.

Between August 12 and September 27, 1994, five children in South Florida were hospitalized at a single hospital because of encephalopathy, presenting as status epilepticus, associated with cat-scratch disease (CSD). Diagnoses were confirmed by using an indirect fluorescent antibody test to detect antibody to Bartonella henselae, the causative agent of CSD. These cases represent the first cluster of CSD encephalopathy cases to be recognized in the United States. The patients lived within 7 miles of each other and all reported contact with pet or stray cats before developing regional lymphadenopathy and encephalopathy. All recovered fully. A high proportion of 124 cats from the local area were seropositive (62%) or bacteremic (22%). This study suggests that B. henselae can be associated with geographically focal clusters of CSD encephalitis and should be considered in the evaluation of children with acute encephalopathy.

Longitudinal serum lipoprotein changes in white males during adolescence: the Bogalusa Heart Study.

Determinants of follow-up levels of low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and the ratio of LDL-C to HDL-C were analyzed in a longitudinal study. White boys (n = 81) aged 11 to 12 years, when examined in 1973-1974 (year 1) were reexamined in 1978-1979 (year 6) at ages 16 to 17 years. During follow-up, mean levels of LDL-C increased from 87.6 mg/dL to 89.8 mg/dL, mean levels of HDL-C decreased from 67.0 mg/dL to 48.4 mg/dL and the mean LDL-C/HDL-C ratio increased from 1.45 to 2.12. Cross-sectional associations between the serum lipoproteins and weight, triceps skinfold thickness, and ponderosity (wt/ht3) were stronger in year 6 than in year 1. A persistence of ranks was observed between year 1 and year 6 for LDL-C (r = 0.61), HDL-C (r = 0.51), and LDL-C/HDL-C (r = 0.50). Multiple linear regression indicated that year 6 LDL-C levels were positively related to year 1 LDL-C, year 1 Tanner stage (an indication of sexual maturation), and the change in skinfold thickness during follow-up. Follow-up LDL-C/HDL-C was related both to change in height (negatively) and to change in weight (positively), after controlling for year 1 LDL-C/HDL-C. These longitudinal findings were similar to those obtained from earlier cross-sectional analyses and were further verified on an independent cohort of white boys also followed for five years (1976-1977 through 1981-1982).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular health promotion in children: "Heart Smart" and the changing role of physicians.

Despite encouraging reductions in mortality rates from coronary heart disease (CHD), it remains a major public health problem and the leading cause of death in the United States. Although various explanations have been proposed for declining death rates, a consensus exists regarding the importance of lifestyle alterations for risk factor reduction. Because cardiovascular (CV) risk-related behavioral patterns are acquired during childhood, numerous school-based CV health promotion programs have been implemented. The effectiveness of CV research studies for children during the last decade are reviewed. Intervention strategies to prevent heart disease include (1) the population or public health approach and (2) the high-risk approach. The "Heart Smart" model intervention project is utilized to describe these two main strategies. Policy, position statements, and initiatives on CV risk factors from major professional societies and associations, in addition to governmental organizations and offices, are also provided. Primary care physicians, particularly pediatricians and family practitioners, as well as cardiologists can play a crucial role in the prevention of CHD and essential hypertension through efforts and practices in their offices, the schools, and the community at large. The changing and expanding role of physicians interested in preventive child health care is emphasized, including involvement in school- and community-based CV health promotion programs. More comprehensive CV model projects such as "Heart Smart," which intervene on the total school environment, are critical to the reduction of CV disease in the United States and abroad.

Trends in fatty acid intakes of 10-year-old children, 1973 to 1982.

Diets of four groups of 10-year-old children (no. = 871, 30% black, 70% white) were examined over 10 years with 24-hour dietary recalls to study temporal trends in cholesterol, fat, and fatty acid intakes in a community. Boys had higher intakes per day and per kilogram body weight than girls for all nutrients (p less than .0001), but there were no sex differences in nutrients per 1,000 kcal. The only racial difference detected was a higher myristic acid intake in whites (p less than .02). There was a 16% decline in dietary cholesterol intake between 1978 and 1982. Three shifts in fatty acid intake increased the P:S ratio from 0.29 in 1973 to 0.45 in 1978: (a) a 5% decline in oleic acid, coupled with a 5% rise in linoleic acid; (b) a quadrupling of linolenic acid; and (c) less stearic and more myristic acid, with palmitic acid unchanged. Total fat intake provided 38% of the calories in each survey, but the changes in proportions of fatty acids paralleled trends in food consumption patterns and nutrient sources. Despite the changes, few children met prudent diet recommendations, and serum total cholesterol and very-low-density-lipoprotein cholesterol levels did not change over time.

Macronutrient intakes of 10-year-old children, 1973 to 1982.

Diets of four groups of 10-year-old children (no. = 871) from a biracial community were examined to document eating patterns and to note temporal trends in energy, protein, fat, and carbohydrate intakes. A 24-hour dietary recall method, incorporating numerous quality controls, was adapted for interviewing children. Protein provided 13%, fat 38%, and carbohydrate 49% of calories. Few racial differences in eating patterns were detected. Boys had higher energy intakes than girls, but after diets were adjusted per 1,000 kcal, no other sex differences in intake were found. Snacks yielded roughly one-third of daily energy intake, one-fifth of the day's protein, one-third of the fat, and two-fifths of the total carbohydrate intake. Density of macronutrients within the children's diets was consistent over time. Diets of children in the Bogalusa study typify the American eating pattern and are comparable with those found in major national surveys.

Cardiovascular risk factors and their modification in children.

Normal levels and trends of cardiovascular disease risk factors in childhood have been well documented by numerous epidemiologic surveys. Expected levels of blood pressure, lipids and lipoproteins, and body size can be determined by the child's physician using race- and gender-specific grids. These grids allow for the identification and follow-up of children with high-risk profiles. Evidence of increased left ventricular mass and vascular changes in renal arteries in association with childhood blood pressure level along with atherosclerotic fatty streak and fibrous plaque development in the aorta and coronary arteries shows that children with elevated risk factors are at risk for early target organ damage. These data demonstrate the potential importance of early intervention on the natural history of cardiovascular disease. Based on our own data from the Bogalusa population, as well as evidence from other epidemiologic investigations in children, the following recommendations can be made, regardless of the risk factor variable under consideration: Cardiovascular disease risk factor variables should be measured carefully and in a serial manner to classify a child as abnormal. Serial measurements serve to reduce the effect of regression to the mean and increase the predictive value of the measurements. The misclassification of normal children into the high-risk category can be avoided by serial and replicate observations. Interventions that have attendant side effects (for example, pharmacologic therapy for high blood pressure) have to be measured against the effectiveness of diet, exercise, and other aspects of primary prevention. Risk factor levels consistently greater than the ninetieth percentile deserve medical attention. Care should be taken prior to using specific grids of normal levels of cardiovascular disease risk factors in children. The measurement techniques employed on individuals should be similar to those used by the epidemiologic study to generate the grids in a reference population. The grids should become part of the child's permanent medical record, as they provide a rapid visual assessment of the cardiovascular disease risk profile over time. High-risk trackers may require more intensive follow-up and will allow for early intervention and an assessment of the efficacy of the intervention program. In conclusion, cardiovascular disease risk factor screening in childhood is quick, effective, and inexpensive. The potential payoff in prevention of adult cardiovascular disease is enormous and allows the physician to provide more comprehensive care to a pediatric population.

Prevention of atherosclerosis in childhood.

Atherosclerosis begins in infancy, with fatty streaks appearing at the age of 3 years and fibrous plaques appearing during adolescence. Fatty streaks and fibrous plaques are related to serum total cholesterol, LDL-C, and systolic blood pressure levels. Children with elevated levels of cholesterol and blood pressure track (i.e., maintain elevated levels over time) and are candidates for premature coronary artery and cerebrovascular disease, especially if there is a positive family history of premature CVD. Screening for CVD risk factors in children is rapid, simple, inexpensive, and effective, with tremendous potential to prevent future adult CVD. At their annual physical examinations, children 5 years of age or older should have careful blood pressure measurements by two observers, and determinations of serum total cholesterol levels. Levels should be plotted on standard percentile grids (Figs. 5-7) in the child's permanent medical record. Those with persistently elevated levels of blood pressure and/or serum LDL-C require nonpharmacologic intervention initially, but may require antihypertensive or antilipid medication if unresponsive to behavioral modification for diet, physical activity, and cigarette smoking. Pediatric health professionals can play vital roles in primary prevention and reduction of adult CVD.

The interaction of alcohol and tobacco use in adolescents and young adults: Bogalusa Heart Study.

Alcohol and tobacco usage patterns were assessed in 1,811 children and young adults, 12-24 years of age. The prevalence of cigarette smoking and alcohol consumption increased with age in all race and sex groups. Smokeless tobacco use (chewing tobacco and snuff) was primarily seen in white males with the highest prevalence rates in 12-15 year olds. Among white males who reported smokeless tobacco usage, 44% of the 12-17 year olds and 80% of the 18-24 year olds reported concurrent alcohol use. There was a significant interaction between alcohol consumption and cigarette smoking in all four race-sex groups (p less than 0.001). Given the potential synergistic relationship between ethanol and tobacco products on oral and upper gastrointestinal tract cancer, as well as between smoking and cardiovascular disease, the long term effects from these behaviors could be troublesome. Since healthy lifestyles are established in youth, early intervention on alcohol and tobacco use is needed to prevent the future morbidity and mortality from cancer and cardiovascular disease.

Epidemiology of cancer in the United States.

Malignant neoplasms are responsible for more than half a million deaths annually and 22.5% of all deaths in the United States. Cancer is the second leading cause of death overall and the leading cause of death among Americans aged 35-64. Within the next decade it may become the leading cause of death. Cancers of digestive and respiratory organs are responsible for 53% of all cancer deaths. Certain subgroups are at elevated risk for various cancers. For example, sun-sensitive or excessively sun-exposed young white adults, young black women, and elderly patients are at increased risk for cutaneous melanoma, breast cancer, and colon cancer, respectively. Black men have the greatest risk for both lung cancer and cancer of the prostate. Acute lymphoblastic leukemia and solid tumors of the brain and nervous system are the most frequent forms of malignancy occurring among children less than or equal to 14 years. Office screening is the traditional method for identifying cancer victims as early as possible. A suitable screening test should be rapid, simple, inexpensive, and impose minimal discomfort. There must be a window of opportunity available to identify the cancer during a detectable preclinical phase, and therapeutic modalities must be available to alter progression. An office screening test for cancer may have any one of four outcomes, and three of them are bad. False negatives are the worst adverse outcome because cancer remains undetected despite screening. An epidemic of lung cancer, caused by cigarette smoking, is occurring in all race and sex groups. If Americans stopped smoking, 87% of lung cancer deaths could be prevented. Tobacco abuse also is a major risk factor for cancer of the esophagus, larynx, and oral cavity. Cigarette smoking is a contributing factor for cancer of the bladder, kidney, and pancreas, and it has been associated with both cervical cancer and cancer of the stomach. Smoking and smokeless tobacco cessation endorsements, messages, and programs must be part of routine disease prevention and health promotion activities in every primary care practice. More than 1 million Americans became new cancer victims last year, and more than 1 million additional cases will be detected this year. Because of the striking variability in state and regional patterns of various forms of cancer, geographic location of a practice may influence the frequency of cancers seen. Four sites (breast, prostate, lung, colon, and rectum) were responsible for 55% of cancer mortality and 56% of all new cases of cancer detected during 1991.(ABSTRACT TRUNCATED AT 400 WORDS)

High blood pressure in the young.

Essential hypertension begins in early childhood. Current evidence suggests that those children persisting at high levels over time may be considered to have essential hypertension. The evaluation of high levels is best judged from blood pressure percentile grids representing population measurements, as long as the methods used to measure blood pressure and to generate the grids are similar. Resting, basal blood pressure measurements are more reproducible and are better for following the time course of blood pressure levels in children. Measurements should be made in an unhurried, relaxed atmosphere by trained observers using adequately lighted instruments placed at eye level and a cuff size appropriate for the child's arm length and circumference. Repeated observations and serial blood pressure measurements of growing children are necessary for judgments of abnormal levels. There is a progressive rise of approximately 1.5 mm Hg systolic and 1 mm Hg diastolic pressure per year of age, but blood pressure levels in the growing child are more closely related to height. In most instances elevated blood pressure levels in children cannot be attributed to secondary causes. Various hemodynamic and biochemical mechanisms have been identified in the early stages of hypertension, and mechanisms contributing to the development of hypertension may be of different magnitudes in black children and white children. Studies following young adults over many years have shown the predictive value of baseline blood pressure levels for subsequent hypertension. Children tracking at the high percentiles can be identified and are candidates for early intervention. The key to early prevention of essential hypertension is to influence children and adolescents to adopt lifestyles that promote good health and prevent development of cardiovascular risk factors.

Tracking of cardiovascular disease risk factor variables in school-age children.

Persistence in ranks (tracking) for cardiovascular disease risk factor variables was examined in 2236 children who were screened three times over a 5-yr period. As expected, the greatest persistence was noted for height (r = 0.47-0.99) and weight (r = 0.70-0.96). Correlation coefficients for systolic blood pressure and diastolic blood pressure ranged from 0.38 to 0.66 and 0.22 to 0.49 respectively. Among lipids, the correlations were highest for serum beta-lipoprotein cholesterol ranging from 0.62 to 0.78. For those children who were at or above the 90th percentile on a risk factor variable during the first examination, a tendency to retain their ranks in the second and third examinations was noted. For systolic blood pressure, 35% of those initially high remained high in the second examination and 30% in the third examination. Correspondingly, for those initially high for beta-lipoprotein cholesterol, 47 and 41% remained high. A linear discriminant model was used to distinguish characteristics of children who persisted at high rankings and those who did not. The model was effective for total and beta-lipoprotein cholesterol, but only moderately so for systolic blood pressure.

Serum lipid and lipoprotein cholesterol grids for cardiovascular risk screening of children.

We determined serum lipid and lipoprotein percentiles from a total community study of 5,250 fasting children (35% black, 65% white), aged 2 to 19 years. A serum turbidity index was used as a rapid, inexpensive screening test for hyper-beta-lipoproteinemia and hyper-pre-beta-lipoproteinemia. Percentile grids for the turbidity index and serum total cholesterol and beta-lipoprotein cholesterol levels may be used for either black or white children. Triglyceride and pre-beta-lipoprotein cholesterol level percentile grids were reported by race because of lower levels in black children, while grids for alpha-lipoprotein cholesterol levels were reported separately by sex for black and white subjects. A five-step method was outlined for screening children for lipid and lipoprotein abnormalities. Those with hyper-beta-lipoproteinemia and hyperpre-beta-lipoproteinemia would be candidates for therapy and indicate screening of other family members, after secondary causes are excluded.

Levels of selected cardiovascular risk factors in a sample of geriatric participants--the Dunedin Program.

A sample of 310 white, ambulatory elderly adults (n = 116 men, n = 194 women, ages 65 to 99 years) from the Dunedin Program in Florida were examined for serum total and lipoprotein cholesterols, weight, and blood pressure. Women had higher age-adjusted mean levels of total cholesterol (p less than .0001), low density lipoprotein cholesterol (p less than .0001), high density lipoprotein cholesterol (p less than .0005), and weight/height (p less than .0001). Systolic blood pressure increased with age in both sexes, but the trend rose more sharply in women (p less than .0001). Both systolic (p less than .05) and diastolic (p less than .025) blood pressure increased with obesity in women but were unrelated to obesity in men. Approximately 70% (218) of the sample had elevated levels of at least one risk factor. This included 12% (38) having elevated levels of two risk factors and 1% (3) with three. The distribution of risk factors for coronary heart disease in this sample indicates a homogeneous population derived through selective survival remains by age 70 years. These results emphasize the need for additional investigations of genetic and environmental variables promoting longevity.

Transitions of cardiovascular risk from adolescence to young adulthood--the Bogalusa Heart Study: II. Alterations in anthropometric blood pressure and serum lipoprotein variables.

Cardiovascular (CV) risk factors change over time with the emergence of clinically recognizable abnormalities (obesity, hypertension and hyperlipoproteinemia) in the second and third decades of life. A cohort of 286 subjects, aged 11-15 in 1973-74 were reexamined 6 years later to observe changes in height, weight, blood pressure, lipids and lipoproteins between adolescence and adulthood. During the 6 years of follow-up, 10-11 year-old males increased 30 cm in height and 32 kg in weight. Among 10-11 year-old girls, height increased 12-15 cm and weight increased 15 kg in whites and 20 kg in blacks. Mean systolic BP increased 16-23 mmHg in black males and 11-15 mmHg in white males. Mean serum total cholesterol levels increased with age such that levels in 20 year olds were 160-190 mg/dl, about 10 to 15 mg/dl higher than 18 year olds. In white males beta-lipoprotein cholesterol increased (13 mg/dl) with age; however, there was a simultaneous decrease in alpha-lipoprotein cholesterol (11 mg/dl), resulting in a dramatic rise in the beta-LPC/alpha-LPC ratio. These adverse changes in LPC may be related to the early development of atherosclerosis and risk for coronary heart disease of young white men. Early identification of hypertension and hyperlipoproteinemia should help to predict and prevent future CV disease.

Racial difference in hemoglobin concentration of young adults.

Hemoglobin concentration was measured in 1,001 young adults (34% black, 66% white), ages 17 to 24 years, in a community survey. Hemoglobin levels were 0.9 g/dl lower in blacks than in whites (P less than 0.001) and 2.0 g/dl lower in females than in males (P less than 0.001). Black females had the highest prevalence of anemia (16%) and the lowest prevalence of polycythemia 3%), while white females had the lowest prevalence of anemia (1%) and highest prevalence of polycythemia (9%). Mean hemoglobin levels in females did not increase after approximately age 12 1/2 years, while those in males continued to increase until age 17 years. Regular cigarette smoking was a potent risk factor for polycythemia in white males. Number of cigarettes smoked per week and number of years as a regular smoker increased hemoglobin concentration. New criteria, based on population distribution of hemoglobin levels, may be needed for defining anemia and polycythemia in black populations and cigarette smokers.