Heart Health Begins to Decline in Childhood

Veronica Hackethal, MD

March 24, 2015

Most US children start life with optimal cardiovascular health (CVH), but it declines substantially over time, suggests a study published online March 18 in Circulation: Cardiovascular Quality and Outcomes.

"Our findings indicate that, in general, children start with pretty good blood pressure. But if they have a horrible diet, it will drive a worsening body mass index (BMI) and cholesterol levels," senior author Donald M. Lloyd-Jones, MD, said in a news release. Dr Lloyd-Jones is professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

"The better we can equip our children to make healthy choices, the more cardiovascular health will be preserved into adulthood. And those who preserve their heart health into middle age live much longer and are much healthier while they live," he added.

Results from the study provide the first comprehensive estimate of CVH among US children, based on the American Heart Association (AHA) 2020 Strategic Impact goal. This goal challenges all Americans to improve their CVH by 20% by 2020.

The study included 8961 children (4443 girls, 4518 boys; 58% non-Hispanic white, 15% black, 15% Mexican-American, and 12% other) between the ages of 2 and 11 years who participated in the National Health and Nutrition Examination Surveys between 2003 and 2010. The researchers looked at four variables of CVH defined by the AHA 2020: BMI, healthy diet, total cholesterol, and blood pressure.

No children had ideal values for all four variables. Compared with children younger than 12 years, adolescents fared worse on ideal BMI levels (67% in girls, 66% in boys), healthy diet score (0% in both girls and boys), and blood pressure (90% in girls, 78% in boys). Approximately 70% of children aged 2 to 11 years had ideal BMI (68.7% in boys, 70% in girls).

Most children had intermediate or poor diets, with less than 1% having an ideal diet score. Diet score did not change significantly across sex and race/ethnic groups.

Children fared the worst on eating fruits, vegetables, fish, and whole grains. Less than 10% ate the recommended amount of fruits and vegetables (≥4.5 cups/day of fruit and vegetables) and fish (two or more 3.5-ounce servings of fish per week). Only 2.4% of girls and 3.0% of boys ate the recommended amount of whole grains (three or more 1-ounce servings/day).

More than 50% drank more than the recommended amount of sugar-sweetened beverages (≤450 kcal per week of added sugar in sugar-sweetened beverages). About 90% ate more sodium than the recommended goal of less than 1500 mg/day.

About 30% struggled with being overweight or obese, and about 40% had intermediate or poor total cholesterol levels.

Children fared best on ideal blood pressure score, which ranged from 88% to 93% across sex and race/ethnicity groups.

Limitations included lack of data on physical activity, blood glucose, smoking, and diabetes and the use of adult measures of dietary intake.

"Without knowing how much physical activity a child is doing, and therefore how many calories are needed, we can't scale the diet metrics to a child's needs," Dr Lloyd-Jones said in the news release. "So we used the adult metrics, but understand that it would be difficult for a 5-year-old to take in as many fruits and vegetables as an adult," he noted.

"The bottom line is that we need even better data," he emphasized, "But what we do see is that we are losing an awful lot of our intrinsic cardiovascular health very early in life, which sets us up to be unhealthy adults."

The authors have disclosed no relevant financial relationships.

Circ Cardiovasc Qual Outcomes. Published online March 18, 2015. Abstract

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