Heart disease is a pediatric problem: New guidelines point to lifestyle 'training' in childhood

July 01, 2002

DALLAS, July 2 - Helping children visualize a "healthy plate," be physically active and remain smoke-free are key parts of establishing life-long heart health, the American Heart Association says in its new comprehensive guidelines on cardiovascular health in children. The guidelines were published in today's Circulation: Journal of the American Heart Association.

"People know that heart disease is the No. 1 killer of Americans, but they don't fully realize that it's a silent process that begins in childhood," says lead author Christine L. Williams, M.D., M.P.H., immediate past chair of the American Heart Association's Committee on Atherosclerosis, Hypertension, and Obesity in the Young.

Initiating healthful lifestyle "training" in childhood can reduce the risk of coronary heart disease in both the individual child and the population at large, write the authors.

The "super-sizing" of America's children

Rates of obesity have doubled among U.S. young people during the past two decades, with the highest rates among African-American and Latino youth.

Obese children experience the same risk factors associated with heart disease in adults such as high blood pressure, high cholesterol levels and type 2 diabetes (once so uncommon in children it was known as "adult-onset" diabetes). They also develop the beginnings of atherosclerotic lesions, called fatty streaks. These deposits have been found in the body's central artery, called the aorta, as early as age 3, and in the coronary arteries, which supply blood to the heart, after age 10.

"We must act now or these overweight young people could be at risk of developing heart disease at an earlier age than their parents' generation has," says Williams, director of the Children's Cardiovascular Health Center at Columbia University's Babies and Children's Hospital in New York City.

Essentially all children, adolescents and families can benefit from counseling to prevent excess weight gain. This counseling should include strategies on how the entire family can eat a healthy diet and be more physically active, the statement says.

"Physicians must ask parents to look at their patterns and how they can change their whole family's diet and increase physically active play," says Williams. "You can't get the kids to change if the parents won't."

A good place to start is by helping children visualize a "healthy plate." That's a plate half-filled with salad and vegetables, one-fourth with starch such as potatoes or rice and one-fourth with protein such as meat, poultry, fish or soy. This emphasis on portion control and including several food groups can get the whole family involved in balancing calories, says Williams.

Physical activity means turning off the tube

Parents are encouraged to set time limits for sedentary activities such as video games and television, and use planned physical activities instead of food to reward children's accomplishments.

When addressing physical activity with children, parents and physicians are advised to emphasize play and activities rather than "exercise." Healthcare providers are encouraged to assess physical activity levels as early as preschool.

Participation in school physical education is one way parents can work activity into a child's regular schedule, and summer camp is a good way for children to stay active during the often idle break between school years, says Williams.

"In addition, emphasizing sports or activities that can be enjoyed throughout life can equip children with habits that will help keep them healthier in adulthood. Ultimately, a major national campaign is needed to promote heart healthy behaviors," she says.

Cigarette smoking: the best place to start is not to

Cigarette smoking has been called the chief single avoidable cause of death in America. "Many children are, in effect, already smoking on a regular basis by breathing the residual smoke from cigarettes lit and inhaled by their parents," the statement continues. Exposure to second-hand smoke increases the risk of asthma, respiratory illness and ear infections in children.

If all smoking were eliminated in the United States, it's estimated that there would be 22 percent fewer infants born with low birth weights, 33 percent less heart disease, 41 percent fewer childhood deaths between one month and five years of age, 50 percent less bladder cancer and 90 percent less lung cancer, according to the statement.

Ironically, cigarette smoking also has a link to obesity. Some adolescent girls start smoking, thinking it will help them slim down, Williams explains.

The guidelines suggest that anti-smoking messages should be age specific. Intervention for infants could include helping the parents quit smoking. For young children, encourage them to stay out of smoky environments, and to avoid trying "even a puff."

More than one in five adolescents smoke daily by the time they are high school seniors. They overlook the long-term health consequences because they consider the dangers remote compared to the immediate benefits of fitting into a group or appearing more mature.

Because of adolescents concern with their appearance, messages should emphasize immediate consequences like bad breath, smelling like smoke and nicotine-stained fingers, Williams says. "Learning to say no to peer pressure is critical," she adds.
Co-authors are Laura Hayman, Ph.D., R.N.; Stephen Daniels, M.D., Ph.D.; Thomas Robinson, M.D., M.P.H.; Julia Steinberger, M.D.; Stephen Paridon, M.D.; and Terry Bazzarre, Ph.D.

CONTACT: For journal copies only,
please call: (214) 706-1396
For other information, call:
Maggie Francis: (214) 706-1397
Bridgette McNeill: (214) 706-1135

American Heart Association

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