Commitment to Heart Health Must Start in Childhood

Heart association offers tips to help kids avert later problems

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HealthDay Reporter

SATURDAY, May 31, 2003 (HealthDayNews) -- When should people start taking the steps necessary to ward off heart disease?

Try childhood.

So says the American Heart Association, which has just released a comprehensive summary of heart disease prevention guidelines for pediatricians to use with their patients.

"Many studies have shown an association between atherosclerosis and high cholesterol, high blood pressure and obesity beginning in children as young as 5 years old," says Dr. Rae-Ellen Kavey, lead author of the guidelines.

But while guidelines have existed for preventive care for adults at risk for heart disease, there were no similar, overall guidelines for children, adds Kavey, who is chairwoman of cardiology at the Children's Memorial Hospital, Northwestern University-Feinberg School of Medicine in Chicago.

"There are pre-existing guidelines for children about cholesterol, blood pressure and weight, and now we have put all the information together into one place for pediatricians -- it is aimed at primary-care providers," Kavey says.

Preventing heart disease can't begin too early. The guidelines, a year in the making, reflect the latest information that suggests that early intervention in adopting a healthy lifestyle can be enormously effective in delaying the onset of heart disease.

The guidelines, contained in a simple format that pediatricians can stick to their bulletin board, are divided into three sections:

  • recommendations for heart-healthy behavior for all children and teens;
  • information on how to identify those children at risk for future heart problems due to factors like excess weight, high blood pressure or cholesterol;
  • and recommendations for intervention for children and adolescents with identified risk factors.

For otherwise healthy children and teens, the guidelines suggest regularly assessing a child's heart health by checking weight, blood pressure and lipid levels, if necessary. The guidelines also ask doctors to recommend healthy food choices, such as eating more fruits and vegetables, to restrict intake of saturated fats to less than 10 percent of a child's daily caloric consumption, and to keep sugar intake low.

The guidelines also emphasize the importance of daily physical activity and limiting sedentary activity -- for instance, no more than two hours of television and/or sitting at a computer each day. The dangers of smoking are also discussed.

The second part of the guidelines identifies those children or teens already at high risk of cardiovascular disease. These include kids with a Body Mass Index (BMI) above the 85th percentile for their age, height and weight; a blood pressure reading in the 90th percentile for age, sex and height; and a cholesterol reading of 170 or higher.

Other factors that put children at higher risk is a family history of heart disease, particularly if male relatives had heart disease before age 55 and female relatives before 65.

Finally, the guidelines recommend treatments for those children already at risk for heart disease, including dietary changes such as lowering salt intake, losing weight or prescribing medications if needed.

Dr. Nancy Halnon is a pediatric cardiologist at the University of California, Los Angeles Medical Center. She says that while the guidelines are helpful, it may prove hard for pediatricians to introduce another layer of information into their already crowded agendas.

"Doctors have a five-minute visit where they have to cover toilet training, allergies, using seat belts and treating ear infections," she says, remembering her residency in pediatrics. "This is another thing on their plate."

But Kavey says the guidelines were written with time constraints in mind.

"These things can be integrated with the normal practice," she says.

For example, she says, "Parents have major questions about food, when to start solids, what are good snacks, which kinds of formula, so the doctors are giving advice about diet. With these guidelines, they have an opportunity to give specific information about low-fat diets at the get-go."

"It's much easier to establish healthy eating and physical activity patterns than to change unhealthy patterns," she adds.

More information

More information about the children's heart disease prevention guidelines can be found at the American Heart Association. Visit the U.S. Food and Drug Administration for a suggested heart-healthy diet for all ages.

SOURCES: Rae-Ellen Kavey, M.D., chairwoman, cardiology, Children's Memorial Hospital, Northwestern Medical School, Chicago; Nancy Halnon, M.D., clinical instructor, pediatrics, Division of Pediatric Cardiology, David Geffen School of Medicine, University of California, Los Angeles

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