The contribution of childhood obesity to adult carotid intima-media thickness: the Bogalusa Heart Study.

OBJECTIVE: Although obese children are at increased risk for coronary heart disease in later life, it is not clear if the association results from the persistence of childhood obesity into adulthood. We examined the relation of both childhood and adult levels of body mass index (BMI, kg m(-2)) to carotid intima-media thickness (IMT) measured at the (mean) age of 36 years. DESIGN AND SUBJECTS: Prior to the determination of adult IMT, the 1142 participants had been examined 7 (mean) times in the Bogalusa Heart Study. MEASUREMENTS: In addition to BMI, levels of lipids, lipoproteins and blood pressure were measured at each examination. Cumulative levels of each risk factor were based on the areas under the individual growth curves calculated using multilevel models for repeated (BMI) measurements. We then examined the relation of these cumulative levels to adult IMT. RESULTS: Carotid IMT was associated with cumulative levels of BMI in both childhood and adulthood (P<0.001 for each association). Furthermore, the association between childhood BMI and adult IMT persisted, but was reduced, after controlling for adult BMI. Although childhood levels of lipids, lipoproteins and blood pressure were also associated with adult IMT, these associations were not independent of adult levels of these risk factors. CONCLUSIONS: These results emphasize the adverse effects of elevated childhood BMI levels. In addition to the strong tracking of BMI levels from childhood to adulthood, there appears to be a modest, independent effect of childhood BMI on adult IMT. The prevention of childhood obesity should be emphasized.

Relation of BMI to fat and fat-free mass among children and adolescents.

OBJECTIVE: Although the body mass index (BMI, kg/m2) is widely used as a surrogate measure of adiposity, it is a measure of excess weight, rather than excess body fat, relative to height. We examined the relation of BMI to levels of fat mass and fat-free mass among healthy 5- to 18-y-olds. METHODS AND PROCEDURES: Dual-energy X-ray absorptiometry was used to measure fat and fat-free mass among 1196 subjects. These measures were standardized for height by calculating the fat mass index (FMI, fat mass/ht2) and the fat-free mass index (FFMI, fat-free mass/ht2). RESULTS: The variability in FFMI was about 50% of that in FMI, and the accuracy of BMI as a measure of adiposity varied greatly according to the degree of fatness. Among children with a BMI-for-age > or =85th P, BMI levels were strongly associated with FMI (r=0.85-0.96 across sex-age categories). In contrast, among children with a BMI-for-age <50th P, levels of BMI were more strongly associated with FFMI (r=0.56-0.83) than with FMI (r=0.22-0.65). The relation of BMI to fat mass was markedly nonlinear, and substantial differences in fat mass were seen only at BMI levels > or =85th P. DISCUSSION: BMI levels among children should be interpreted with caution. Although a high BMI-for-age is a good indicator of excess fat mass, BMI differences among thinner children can be largely due to fat-free mass.

The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study.

OBJECTIVE: Although obese children are at increased risk for coronary heart disease in later life, it is not clear if this association results from the persistence of childhood obesity into adulthood. We examined the relation of adiposity at various ages to the carotid intima-media thickness (IMT) at age 35 y. DESIGN: Prior to the determination of IMT by B-mode ultrasound, subjects (203 men, 310 women) had, on average, six measurements of body mass index (BMI) and triceps skinfold thickness (TSF) between the ages of 4 and 35 y. Mixed regression models for longitudinal data were used to assess the relation of these characteristics to adult IMT. RESULTS: Overall, adult IMT was associated with levels of both BMI and TSF (P<0.001), with the magnitudes of the associations with childhood adiposity comparable to those with adult levels of BMI and TSF. Furthermore, adult obesity modified the association between childhood adiposity and IMT: high IMT levels were seen only among overweight (BMI > or =95th percentile) children who became obese (BMI > or =30 kg/m2) adults (P<0.01 for linear trend). In contrast, IMT levels were not elevated among (1) overweight children who were not obese in adulthood, or among (2) thinner children who became obese adults. CONCLUSIONS: These results emphasize the adverse, cumulative effects of childhood-onset obesity that persists into adulthood. Since many overweight children become obese adults, the prevention of childhood obesity should be emphasized.

Inter-relationships among childhood BMI, childhood height, and adult obesity: the Bogalusa Heart Study.

OBJECTIVE: Although the body mass index (BMI, mass index, kg/m2) is widely used as a surrogate measure of adiposity, it is moderately associated (r approximately 0.3) with height among children. We examined whether the resulting preferential classification of taller children as overweight is appropriate. DESIGN: Cross-sectional analyses of children (ages, 3-17 y) examined the relation of height to adiposity (as assessed by BMI and skinfold thicknesses) and fasting levels of insulin. Longitudinal analyses examined the relation of childhood height and weight-height indices to adult (mean age, 25 y) levels of adiposity and fasting insulin. SUBJECTS: Children (n=11,406) and adults (n=2911) who had participated in the Bogalusa Heart Study. MEASUREMENTS: We constructed three weight-height indices: BMI, W/H3, and W/Hp. The triceps and subscapular skinfolds, as well as fasting levels of insulin, were also measured. RESULTS: The classification of children as overweight (BMI-for-age > or =95th percentile) varied markedly by height, with a 10-fold difference in the prevalence of overweight across quintiles of height between the ages of 3 and 10 y. Childhood height, however, was also related to skinfold thicknesses and insulin levels, and all associations were modified in a similar manner by age. Furthermore, childhood height was related to adult adiposity, and of the three childhood weight-height indices, BMI showed the strongest associations with adult adiposity. CONCLUSIONS: Because BMI reflects the positive association between height and adiposity among children, it is a better weight-height index than is either W/H3 or W/Hp.

Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study.

BACKGROUND: Childhood obesity is related to adult levels of lipids, lipoproteins, blood pressure, and insulin and to morbidity from coronary heart disease (CHD). However, the importance of the age at which obesity develops in these associations remains uncertain. OBJECTIVE AND DESIGN: We assessed the longitudinal relationship of childhood body mass index (BMI, kg/m(2)) to adult levels of lipids, insulin, and blood pressure among 2617 participants. All participants were initially examined at ages 2 to 17 years and were reexamined at ages 18 to 37 years; the mean follow-up was 17 years. RESULTS: Of the overweight children (BMI >/=95th percentile), 77% remained obese (>/=30 kg/m(2)) as adults. Childhood overweight was related to adverse risk factor levels among adults, but associations were weak (r ~ 0.1-0.3) and were attributable to the strong persistence of weight status between childhood and adulthood. Although obese adults had adverse levels of lipids, insulin, and blood pressure, levels of these risk factors did not vary with childhood weight status or with the age (/=18 years) of obesity onset. CONCLUSIONS: Additional data are needed to assess the independent relationship of childhood weight status to CHD morbidity. Because normal-weight children who become obese adults have adverse risk factor levels and probably will be at increased risk for adult morbidity, our results emphasize the need for both primary and secondary prevention.

High prevalence of postpartum anemia among low-income women in the United States.

OBJECTIVE: To determine the prevalence of anemia from 4 to 26 weeks post partum and to examine prenatal predictors of postpartum anemia. STUDY DESIGN: Retrospective cohort analysis of 59,428 participants in the Special Supplemental Nutrition Program for Women, Infants, and Children in 12 US states. RESULTS: The prevalence of postpartum anemia was 27%. Anemia rates were higher among minority women, reaching 48% among non-Hispanic black women. Of 9129 women who had normal hemoglobin in the third trimester, 21% had postpartum anemia. Prenatal anemia was the strongest predictor of postpartum anemia (adjusted odds ratio, 2.7; 95% confidence interval, 2.5-2.8). Maternal obesity, multiple birth, and not breast-feeding also predicted postpartum anemia. CONCLUSION: The high prevalence of post partum anemia among low-income women highlights the importance of anemia screening at 4 to 6 weeks post partum. These data suggest that screening should not be limited, as it is at present, to women considered at high risk.

BMI rebound, childhood height and obesity among adults: the Bogalusa Heart Study.

OBJECTIVE: The beginning of the post-infancy rise in the body mass index (BMI, kg/m2) has been termed the adiposity rebound, and several studies have found that an early rebound increases the risk for overweight in adulthood. We examined whether this relation is independent of childhood BMI levels. DESIGN: A longitudinal study of 105 subjects who examined at ages 5, 6, 7, 8 and 19-23 y. RESULTS: Subjects with an age at the BMI rebound (age(min)) of < or =5 y were, on average, 4-5 kg/m2 heavier in early adulthood than were subjects whose age(min) was > or =7 y. Age(min), however, was also correlated with childhood BMI levels (r approximately -0.5), and we found that age(min) provided no additional information on adult overweight if the BMI level at age 7 y (or 8 y) was known. In contrast, childhood height, which was also correlated with age(min) (r=-0.47), was independently related to adult BMI. Among relatively heavy (BMI=16.0 kg/m2) 5-y-olds, a child with a height of 120 cm was estimated to be 1.2 kg/m2 heavier in adulthood than would a 104 cm tall child. CONCLUSIONS: Although an early BMI rebound was related to higher levels of relative weight in adulthood, this association was not independent of childhood BMI levels. The relation of childhood height to adult BMI needs to confirmed in other cohorts, but it is possible that childhood height may help identify children who are likely to become overweight adults.

Distribution and correlates of high-density lipoprotein subclasses among children and adolescents.

Levels of high-density lipoprotein (HDL) cholesterol among children vary by sex and race/ethnicity and are correlated with age, obesity, and other characteristics. Several studies of adults have indicated that atherogenicity of HDL particles may vary by size, but there is little information on the distribution and correlates of HDL subfractions in early life. We used nuclear magnetic resonance (NMR) spectroscopy to determine the mean HDL particle size and levels of 3 HDL subclasses among 10- to 17-year-olds (n = 918). We found the mean HDL particle size to be (1) inversely associated with age among boys, (2) larger among girls than boys, and (3) larger among black children than among white children. These associations with particle size reflected contrasting associations with various HDL subclasses; among boys, for example, levels of large HDL decreased with age, whereas levels of small HDL remained constant (black boys) or tended to increase (white boys). Furthermore, relative weight and levels of both triglycerides and low-density lipoprotein (LDL) cholesterol were associated inversely with levels of large HDL, but positively with levels of small HDL. These contrasting associations suggest that the role of HDLC in coronary heart disease (CHD) may be more complex than previously thought, and that the analysis of HDL subclasses may improve the accuracy of CHD prediction.

Levels and correlates of LDL and VLDL particle sizes among children: the Bogalusa heart study.

Levels of lipids and lipoproteins among children vary by sex and race/ethnicity, and are correlated with age, obesity, and other characteristics. There is, however, little information on the distribution and correlates of low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) subclasses in early life. We used nuclear magnetic resonance (NMR) spectroscopy to determine mean LDL and VLDL particle sizes among 10- to 17-year-olds (n=918) who participated in the 1992-94 examination of the Bogalusa heart study. As compared with girls, boys had a smaller (0.1 nm) mean LDL particle size and a larger (0.9 nm) mean VLDL size; furthermore, the average size of VLDL particles increased with age among white boys but not among other children. Although there were also black/white differences in particle sizes, with black children having larger LDL and smaller VLDL particles, these racial contrasts could be attributed to differences in lipid levels. Levels of triglycerides, insulin, and relative weight were associated with the size of VLDL (positive) and LDL (negative) particles. These results suggest that the analysis of lipoprotein subclasses may provide a better understanding of the role of various risk factors in the development of coronary heart disease

Black/white differences in relative weight and obesity among girls: the Bogalusa Heart Study.

BACKGROUND AND OBJECTIVE: Although black women have a higher prevalence of overweight and obesity than do white women, it is unclear if a similar pattern exists among youths. We therefore examined the development of black/white differences in relative weight and adiposity among 5 to 17-year-old girls. METHODS: Cross-sectional analyses of 4542 black and 4542 white girls who were examined between 1973 and 1994. Quetelet Index (kg/m(2)), Rohrer Index (kg/m;s(3)), and height-adjusted weight were used as measures of relative weight, and subscapular and triceps skinfolds as measures of adiposity. Breast development was used as an index of sexual maturation. RESULTS: On average, black girls were 1 to 3 kg heavier than were similarly aged white girls, and before adolescence, they were 2 to 3 cm taller. After adjusting for differences in height, the mean relative weight of black girls was consistently greater than that of white girls only after age 13; furthermore, sexual maturation was a stronger correlate of relative weight among black girls than among white girls. Comparable differences were seen for the subscapular skinfold thickness, but white girls consistently had a thicker mean triceps skinfold than did black girls. CONCLUSION: Sexual maturation should be considered in comparisons of relative weight and obesity among youths, and as compared with white girls, black girls do not have a higher mean relative weight until adolescence. The use of different indices of overweight and adiposity can lead to contrasting results, with simple comparisons of Quetelet Index tending to overstate the relative weights of taller children.

Secular trends in height among children during 2 decades: The Bogalusa Heart Study.

OBJECTIVE: To examine trends in height among 5- to 17-year-old children between 1973 and 1992. DESIGN: A panel design consisting of 7 cross-sectional surveys. PARTICIPANTS: All schoolchildren residing in Bogalusa, La, were eligible. A total of 24 070 examinations were performed. RESULTS: During the study period, the mean height of schoolchildren increased by 0.70 cm per decade independently of race, sex, and age. Trends were most pronounced among preadolescents, blacks, and boys, with 9- to 12-year-old black boys showing a height increase of 1.8 cm per decade. We observed a decrease in the number of relatively short children (<10th percentile of height) and an increase in the number of tall children (>90th percentile of height). Because a secular trend was not seen among the 15- to 17-year-old children, our findings likely reflect an acceleration of maturation. CONCLUSIONS: It has generally been assumed that secular increases in height among schoolchildren in the United States ceased by the mid-1900s. Our findings, which may be due to various environmental factors, demonstrate that care must be taken when using nonconcurrent reference data to assess the growth of children. Additional study is needed to determine if these secular trends are continuing and to examine possible explanations and consequences of these trends.

The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study.

BACKGROUND: Although overweight and obesity in childhood are related to dyslipidemia, hyperinsulinemia, and hypertension, most studies have examined levels of these risk factors individually or have used internal cutpoints (eg, quintiles) to classify overweight and risk factors. OBJECTIVE: We used cutpoints derived from several national studies to examine the relation of overweight (Quetelet index, >95th percentile) to adverse risk factor levels and risk factor clustering. DESIGN: The sample consisted of 9167 5- to 17-year-olds examined in seven cross-sectional studies conducted by the Bogalusa Heart Study between 1973 and 1994. RESULTS: About 11% of examined schoolchildren were considered overweight. Although adverse lipid, insulin, and blood pressure levels did not vary substantially with the Quetelet index at levels <85th percentile, risk factor prevalences increased greatly at higher levels of the Quetelet index. Overweight schoolchildren were 2.4 times as likely as children with a Quetelet index <85th percentile to have an elevated level of total cholesterol. Odds ratios for other associations were 2.4 (diastolic blood pressure), 3.0 (low-density lipoprotein cholesterol), 3.4 (high-density lipoprotein cholesterol), 4.5 (systolic blood pressure), 7.1 (triglycerides), and 12.6 (fasting insulin). Several of these associations differed between whites and blacks, and by age. Of the 813 overweight schoolchildren, 475 (58%) were found to have at least one risk factor. Furthermore, the use of overweight as a screening tool could identify 50% of schoolchildren who had two or more risk factors. CONCLUSIONS: Because overweight is associated with various risk factors even among young children, it is possible that the successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease.

Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study.

BACKGROUND: Although body fat patterning has been related to adverse health outcomes in adults, its importance in children and adolescents is less certain. OBJECTIVE: We examined the relation of circumference (waist and hip) and skinfold-thickness (subscapular and triceps) measurements to lipid and insulin concentrations among 2996 children and adolescents aged 5-17 y. DESIGN: This was a community-based, cross-sectional study conducted in 1992-1994. RESULTS: A central or abdominal distribution of body fat was related to adverse concentrations of triacylglycerol, LDL cholesterol, HDL cholesterol, and insulin; these associations were independent of race, sex, age, weight, and height. These associations were observed whether fat patterning was characterized by using 1) waist circumference alone (after adjustment for weight and height), 2) waist-to-hip ratio, or 3) principal components analysis. Compared with a child at the 10th percentile of waist circumference, a child at the 90th percentile was estimated to have, on average, higher concentrations of LDL cholesterol (0.17 mmol/L), triacylglycerol (0.11 mmol/L), and insulin (6 pmol/L) and lower concentrations of HDL cholesterol (-0.07 mmol/L). These differences, which were independent of weight and height, were significant at the 0.001 level and were consistent across race-sex groups. CONCLUSIONS: These findings emphasize the importance of obtaining information on body fat distribution, waist circumference in particular, in children. Waist circumference, which is relatively easy to measure, may help to identify children likely to have adverse concentrations of lipids and insulin.

Relation of cigarette smoking to non-Hodgkin's lymphoma among middle-aged men.

Because of previous inconsistencies in the observed relation of cigarette smoking to non-Hodgkin's lymphoma, this association was investigated in the Selected Cancers Study, a population-based case-control study of 1,193 non-Hodgkin's lymphoma cases and 1,903 controls, conducted between 1984 and 1988. Study subjects were men, and the median age of non-Hodgkin's lymphoma cases was 50 years (range, 32-60 years). As compared with the risk among men who had never smoked cigarettes, the risk among ever smokers was not increased (odds ratio (OR) = 1.05, p approximately 0.50), but the risk was significantly elevated among men who reported smoking > or = 2 1/2 packs per day and among men who had smoked for 30-39 years (OR = 1.45 in each group, p < 0.05). The estimated odds ratio among the 350 heavy smokers (> or = 50 pack-years) was 1.41 (95% confidence interval 1.08-1.85) after controlling for educational achievement, various occupational and medical exposures, and other potential confounders. The observed associations, however, tended to vary by age, with the odds ratio among heavy smokers decreasing from 2.8 among 32- to 44-year-olds to 1.1 among men over 55 years of age. These age-related differences, which may account for some of the inconsistencies seen in previous studies of cigarette smoking and non-Hodgkin's lymphoma, should be considered in future investigations.

Occupational chlorophenol exposure and soft tissue sarcoma risk among men aged 30-60 years.

To evaluate the association of chlorophenol exposure with soft tissue sarcoma risk independent of phenoxyherbicide exposure, the authors analyzed data from the Selected Cancers Study, a population-based case-control study that included 295 male soft tissue sarcoma cases, aged 32-60 years, from eight population-based cancer registries and 1,908 male controls. Chlorophenol exposure was assigned using both an intensity and a confidence estimate by an industrial hygienist based on verbatim job descriptions. Seventeen percent of the jobs rated as high intensity involved wood preservation, while 82% involved cutting oils. Soft tissue sarcoma risk, modeled using conditional logistic regression, was significantly associated with ever having high-intensity chlorophenol exposure (odds ratio = 1.79, 95% confidence interval 1.10-2.88). A duration-response trend was evident among more highly exposed subjects (p for trend < 0.0001). For subjects with 10 or more years of substantial exposure, the odds ratio was 7.78 (95% confidence interval 2.46-24.65). These results suggest that chlorophenol exposure independent of phenoxyherbicides may increase the risk of soft tissue sarcoma. Because of the large number of machinists in the exposed group and the complex composition of cutting fluids, it is possible that another exposure involved in machining is responsible for the observed excess risk.

Relation of lipoprotein subclasses as measured by proton nuclear magnetic resonance spectroscopy to coronary artery disease.

Although each of the major lipoprotein fractions is composed of various subclasses that may differ in atherogenicity, the importance of this heterogeneity has been difficult to ascertain owing to the labor-intensive nature of subclass measurement methods. We have recently developed a procedure, using proton nuclear magnetic resonance (NMR) spectroscopy, to simultaneously quantify levels of subclasses of very low density (VLDL), low density (LDL), and high density (HDL) lipoproteins; subclass distributions determined with this method agree well with those derived by gradient gel electrophoresis. The objective of the current study of 158 men was to examine whether NMR-derived lipoprotein subclass levels improve the prediction of arteriographically documented coronary artery disease (CAD) when levels of lipids and lipoproteins are known. We found that a global measure of CAD severity was positively associated with levels of large VLDL and small HDL particles and inversely associated with intermediate size HDL particles; these associations were independent of age and standard lipid measurements. At comparable lipid and lipoprotein levels, for example, men with relatively high (higher than the median) levels of either small HDL or large VLDL particles were three to four times more likely to have extensive CAD than were the other men; the 27 men with high levels of both large VLDL and small HDL were 15 times more likely to have extensive CAD than were men with low levels. In contrast, adjustment for levels of triglycerides or HDL cholesterol greatly reduced the relation of small LDL particles to CAD. These findings suggest that large VLDL and small HDL particles may play important roles in the development of occlusive disease and that their measurement, which is not possible with routine lipid testing, may lead to more accurate risk assessment.

Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults.

The authors compared interview reports with hospitalization records of participants in a nationally representative survey to determine the accuracy of self-reports of ischemic heart disease, stroke, gallbladder disease, ulcers, cataract, hip fracture, colon polyps, and cancers of the colon, breast, prostate, and lung. The study cohort consisted of 10,523 participants from the First National Health and Nutrition Examination Survey in 1971-1975 who were aged 25-74 years at the baseline examination and who completed a follow-up interview in 1982-1984. Self-reports of hospitalization for breast cancer were confirmed as accurate for 100% of cases where a hospital record was available. Self-report accuracy was also high for ischemic heart disease (84%), cataract (83%), and hip fracture (81%); it was moderate for lung cancer (78%), prostate cancer (75%), gallbladder disease (74%), colon cancer (71%), and stroke (67%); but it was low for ulcers (54%) and colon polyps (32%). Some of the self-reports of ulcers (20%), hip fracture (9%), ischemic heart disease (7%), and stroke (7%) were found to reflect diagnoses of other conditions of anatomic proximity. Accuracy of self-reports improved with higher levels of education, but was not generally related to age, gender, race, alcohol use, or smoking. The results suggest that self-reports of some diseases can be taken as accurate, but self-reports of other conditions might require medical record verification in epidemiologic follow-up studies.

Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention pediatric nutrition surveillance, 1983 to 1995.

OBJECTIVE: To determine whether the prevalence of overweight in preschool children has increased among the US low-income population. DESIGN: Analysis using weight-for-height percentiles of surveillance data adjusted for age, sex, and race or ethnicity. SETTING: Data from 18 states and the District of Columbia were examined. SUBJECTS: Low-income children <5 years of age who were included in the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. RESULTS: The prevalence of overweight increased from 18.6% in 1983 to 21.6% in 1995 based on the 85th percentile cutoff point for weight-for-height, and from 8.5% to 10.2% for the same period based on the 95th percentile cutoff point. Analyses by single age, sex, and race or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) all showed increases in the prevalence of overweight, although changes are greatest for older preschool children. CONCLUSION: Overweight is an increasing public health problem among preschool children in the US low-income population. Additional research is needed to explore the cause of the trend observed and to find effective strategies for overweight prevention beginning in the preschool years.

Risk factors for coronary heart disease among Navajo Indians: findings from the Navajo Health and Nutrition Survey.

Coronary heart disease was uncommon among the Navajo in the past, but appears to have increased substantially over the last few decades. The 1991-1992 Navajo Health and Nutrition Survey, which included interviews and examinations of 303 men and 485 women between the ages of 20 and 91 y, is the first population-based examination of coronary heart disease risk factors in this tribe. Coronary heart disease risk characteristics were common, particularly overweight (men, 35%; women, 62%), hypertension (men, 23%; women, 14%) and diabetes mellitus (men, 17%; women, 25%). Among 20- to 39-y-olds, a large proportion of men reported that they currently smoked cigarettes (23%); use of chewing tobacco or snuff was also prevalent among these 20- to 39-y-old men (37%) and women (31%). Although serum concentrations of total cholesterol were fairly comparable to those seen in the general U.S. population, fasting serum triglyceride concentrations were high (median: men, 132 mg/dL; women, 137 mg/dL), and concentrations of HDL cholesterol were low, particularly among women (median: men, 42 mg/dL; women, 44 mg/dL). Body mass index was associated with levels of most risk factors, and, independently of the level of overweight, a truncal pattern of body fat was related to adverse lipid levels among men. A large proportion of men (20%) and women (30%) reported not having participated in physical activity during the preceding month. Lessons learned from past intervention activities among the Navajo, particularly those for diabetes, may be useful in managing these risk factors to reduce the future burden of coronary heart disease.

Prevalence of hypertension among Navajo Indians: findings from the Navajo Health and Nutrition Survey.

Hypertension and other chronic diseases are becoming increasingly important health problems for many Native American people, including the Navajo. A community-based survey that included three standardized measurements of blood pressures, was conducted during 1991-92 on the Navajo Reservation. Among the 780 adults examined, the overall age-standardized prevalence of hypertension, defined as an elevated systolic (> or = 140 mm Hg) or diastolic (> or = 90 mm Hg) blood pressure, or possession of prescription antihypertensive medications, was 19% (24% among men and 15% among women). The prevalence of hypertension increased with age and relative weight, and among men, was associated with diabetes mellitus. Among women, hypertension was associated with a central distribution of body fat, cigarette smoking, self-reported diabetes mellitus and impaired glucose tolerance. Although only 50% of the persons found to have elevated blood pressure at the examination reported they had been previously told that they had hypertension, persons who had been previously diagnosed with hypertension had a slightly higher rate (approximately 60%) of blood pressure control than that seen in the general U.S. population. On the basis of these results, the prevalence of hypertension among the Navajo appears to have substantially increased since the 1930s. Improved prevention and management of hypertension, especially for overweight and diabetic individuals, may reduce morbidity and mortality from cardiovascular and renal disease.