Blood Lipids, Blood Pressure, and BMI in Childhood and Adolescence. Background to Project HeartBeat!

TY - JOUR

T1 - Blood Lipids, Blood Pressure, and BMI in Childhood and Adolescence. Background to Project HeartBeat!

AU - Labarthe, Darwin R.

AU - Dai, Shifan

AU - Harrist, Ronald B.

N1 - Funding Information: Leading advocates have recommended taking action in childhood and adolescence to prevent not only atherosclerosis, but also epidemic occurrence of the CVD risk factors themselves. 61,62 Despite these recommendations from such authorities as the WHO, 63 the American Heart Association, 64 the American Academy of Pediatrics, 65 and NIH, 31 investment in public health strategies specifically targeting early prevention of these risk factors has been limited. As a result of the rising prevalence of overweight and obesity in children and adults in the U.S. and elsewhere, increased physical activity and improved nutrition for prevention or management of obesity have received growing public attention. 66–69 Fully effective interventions to address overweight and obesity in childhood and adolescence would be expected to contribute to improved levels of blood lipids and blood pressure as well. But to achieve optimum levels, more than energy balance is at issue. Both nutrient composition of the diet and sodium intake are important in development of these risk factors. 70 Further, growth of lean mass and not fat mass alone is related to increases in blood pressure. 71–73 The main blood lipid components change with age in complex patterns that include a decrease in total cholesterol concentration in the early teenage years. 23,74 It is important to understand how public health efforts to prevent overweight and obesity in childhood and adolescence would be expected to affect development of blood lipids and blood pressure given the close inter-relations of these CVD risk factors with body mass and body composition. Several general lessons follow from this research and lend importance to the work reported here. First, there is a well-established body of knowledge concerning epidemiologic aspects of CVD risk factor development in childhood and adolescence. As a foundation for public health policy, this evidence has been considered sufficient to recommend preventive strategies for more than a decade, while research has continued. Second, the growing prominence of obesity as a public health concern, especially in childhood and adolescence, adds a new dimension to this research. There is need for fuller examination of body size and composition, as reflected in multiple anthropometric indices, in longitudinal studies of risk factor development. Third, the dynamics of risk factor development during growth and maturation demand more intensive monitoring of change than has been customary in population studies in the past, in order to detect transient influences or responses—termed “critical periods” or “sensitive periods” in the context of “life course perspectives”—that may have longer-term impact on further risk factor development. 75 This need for more intensive monitoring should be a prominent consideration in the design of future research aimed at elucidating the relationships among obesity and major CVD risk factors as they develop in childhood and adolescence. The NHLBI Report 76 of the Task Force on Research in Epidemiology and Prevention of Cardiovascular Diseases concluded that the greatest opportunity in prevention of CVD is to prevent the risk factors in the first place. Healthy People 2010, 77 which includes prevention of CVD risk factors as part of the nation's goal for heart disease and stroke prevention, reflects the same principle. Clarifying the process through which the risk factors develop, especially in view of the increasing prevalence of obesity, must be a high priority in pursuing this aim. The authors acknowledge with gratitude the contribution of time and dedication of each Project HeartBeat! participant and family. The cooperation of the Conroe Independent School District and the generous support of The Woodlands Corporation are deeply appreciated. The Woodlands and Conroe Advisory Committees have assisted greatly in the planning and conduct of the project. Cooperative Agreement U01-HL-41166, National Heart, Lung, and Blood Institute, provided major funding for the project. Support of the CDC, through the Southwest Center for Prevention Research (U48/CCU609653), and that of Compaq Computer Corporation is also gratefully acknowledged, as is that of the University of Texas Health Science Center at Houston, School of Public Health. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC. No financial disclosures were reported by the authors of this paper.

PY - 2009/7

Y1 - 2009/7

UR - http://www.scopus.com/inward/record.url?scp=67049096079&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67049096079&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2009.04.015

DO - 10.1016/j.amepre.2009.04.015

M3 - Review article

C2 - 19524153

AN - SCOPUS:67049096079

SN - 0749-3797

VL - 37

SP - S3-S8

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

IS - 1 SUPPL.

ER -