Original ArticlesAtherosclerosis: a nutritional disease of childhood☆
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.