Atherosclerosis: a nutritional disease of childhood

doi:10.1016/S0002-9149(98)00719-X

The American Journal of Cardiology

Volume 82, Issue 10, Supplement 2, 26 November 1998, Pages 22-29

https://doi.org/10.1016/S0002-9149(98)00719-X Get rights and content

Abstract

The development of coronary atherosclerosis begins in childhood. A clear relation between diet and cardiovascular disease risk has been demonstrated. Findings from the Bogalusa Heart Study indicate that most children still exceed national recommendations for intake of total and saturated fat. In addition, children’s mean total energy intake is greater than energy expenditure, contributing to the high prevalence of obesity beginning in childhood. Even in childhood, obesity often occurs with other risk factors for cardiovascular disease, such as increased blood pressure, adverse changes in serum lipoproteins, and hyperinsulinemia. This clustering of risk factors has been linked to acceleration of atherosclerotic lesions in the coronary arteries of young individuals. Decreasing the incidence of coronary artery disease in mid and late life necessitates healthy habits in nutrition and lifestyle in early life. Public health measures to favorably alter lifestyle can have a major impact on heart disease prevention and should be pursued vigorously.

Section snippets

Diet and potential impact on early cardiovascular risk

Dietary intake is a major determinant of cardiovascular risk. Experimental studies in humans and animals show a clear relation between diet and cardiovascular risk. Variations in diets of different cultures correspond with the prevalence of coronary artery disease and its risk factors, according to international and crosscultural studies. In contrast, studies within populations show only a weak association between diet and risk factors, underscoring a genetic basis for interindividual

Epidemiology of obesity

Excess caloric intake and sedentary behavior contribute to the high prevalence of obesity beginning in childhood in the US population.20 At an individual level, the onset of obesity appears to be related to both a genetic predisposition and an imbalance between energy expenditure and energy intake. Studying obesity in childhood is complex because it entails differentiating changes in obesity from the changes of normal growth and redistribution of body fat. In general, white children have more

Anatomic studies of coronary artery disease and risk factors

Coronary arteriography has contributed considerably to our understanding of the relation between the severity of coronary artery disease and clinical risk factors, but these studies are more limited than actual anatomic studies.28 Furthermore, coronary arteriography is not practical in an asymptomatic young population. An important question is whether multiple risk factors influence substantial coronary atherosclerosis in youth.

Autopsy studies

Autopsy studies show an impressive relation between

Background

Cardiovascular disease, atherosclerotic coronary artery disease, hypertension, and diabetes mellitus are major public health problems. Two epidemiologic approaches for prevention of heart disease are possible: the high-risk clinical model and the public health or general population approach. Currently, cardiologists focus primarily on high-risk individuals who have already demonstrated clinical coronary artery disease. Reduction of LDL cholesterol levels has been effective in decreasing

Summary

Cardiovascular risk factors begin in childhood and are associated with accelerated coronary atherosclerosis, a truly silent disease. Unhealthy lifestyles and behaviors also begin in childhood and include excessive intake of calories, saturated fat, and cholesterol; inactivity; obesity; and cigarette smoking. The appearance of these behaviors in youth indicates the need for preventive programs, not only for individuals identified at high risk, but also for children and young adults in general.

Acknowledgements

The Bogalusa Heart Study represents the collaborative efforts of many people whose cooperation is gratefully acknowledged. We especially thank Donna Lee for work as Community Coordinator. We also thank the children and young adults of Bogalusa without whom this study would not be possible.

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^☆: This research is supported by funds from the National Heart, Lung, and Blood Institute of the US Public Health Service, grants HL38844, and HD32194.

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Original ArticlesAtherosclerosis: a nutritional disease of childhood☆

Abstract

Section snippets

Diet and potential impact on early cardiovascular risk

Epidemiology of obesity

Anatomic studies of coronary artery disease and risk factors

Autopsy studies

Background

Summary

Acknowledgements

Am J Cardiol

Am J Cardiol

J Am Diet Assoc

Am J Clin Nutr

J Am Diet Assoc

J Pediatr

Am J Cardiol

Am J Cardiol

Lancet

Am J Med Sci

Am J Prev Med

Am J Acad Sci

Cardiovascular diseases as a growing health problem in developing countriesthe role of nutrition in the epidemiologic transition

Public Health Rev

Juvenile arteriosclerosis

Arch Pathol

Pathogenesis of coronary disease in American soldiers killed in Korea

JAMA

The natural history of atherosclerosisthe early aortic lesions as seen in New Orleans in the middle of the 20th century

Am J Pathol

Coronary artery disease in combat casualties in Vietnam

JAMA

Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis

N Engl J Med

Relationship of arteriosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking

JAMA

Original Articles
Atherosclerosis: a nutritional disease of childhood☆