Family Based Prevention of Cardiovascular Disease Risk Factors in Children by Lifestyle Change: The PEP Family Heart Study.

Abstract

AIM\nThe 14\xa0years Prevention Education Program PEP was started 1994 among first graders, their siblings and parents living in the half million city Nuremberg (Germany). The aim of prospective family-based observational study was early detection and lifestyle intervention of traditional cardiovascular risk factors.\n\n\nSUBJECTS AND METHODS\nOut of 3370 families 24,927 adults and 23,740 children participated in the PEP Family Heart study. Anthropometric parameters including blood pressure and fasting lipids were measured. Because these variables change specifically because of natural growth and development in 3-18\xa0years old children we had to calculate age-and gender-specific growth curves using the LMS method. Non-overweight (normal weight) is defined as BMI < 85th percentile (pctl), overweight as BMI 85th to <95th percentile, obesity as BMI ≥ 95th percentile and severe obesity as ≥ 120% of the 95th pctl. Prehypertension is categorized as the ≥90th to <95th pctl or ≥120/80 mm Hg and hypertension as ≥95th pctl on ≥3 occasions.\n\n\nMAIN RESULTS\n1. Cardiovascular risk (CVD) factor screening in school children predicted CVD risk in parents. 2. The growths curves for auscultatory systolic (SBP) and diastolic (DBP) blood pressure of non-overweight 8713 boys and 8138 girls nearly identical with the percentile curves of all 11,328 boys and 10,723 girls. 3. The shapes of the 10 lipid percentile curves between the 3rd and 97th pctl differ considerably by age and gender. 4. The wais-to-height ratio (WHtR) percentiles as a measure for abdominal adiposity vary substantially by age and gender 5. Among overweight and obese ≥85th pctl the percentile curves of body fat increase steeply until age 10\xa0years and then decrease slowly in boys whereas the BF% percentile curves in girls increase continuously until age 18\xa0years 6. The prevalence of hypertension increased strongly in severe obesity at the 99th pctl, more steeply beyond 120% of the 95th pctl to 59.1% in boys and 56% in girls. 7. The association between hypertension and normal weight, overweight and obesity increased in boys from 0,5, via 2,7 to 4,3 and in girls from 0,4 via 2,1 to 5,9. 8. Between 2000 and 2007 mean blood pressure decreased from 138.3\xa0±\xa018.5 mm Hg to 124.0\xa0±\xa013.8 mm Hg in fathers and from 119.1\xa0±\xa02.8 mm Hg to 110.4\xa0±\xa011.2 mm Hg in mothers. 9. After 1\xa0year weighed dietary protocols demonstrate in 166 fathers a decrease of all six nutrional components like daily energy consumption from 2423 to 2307\xa0Kcal, from 98\xa0g to 91\xa0g fat, from 260\xa0g to 252\xa0g carbohydrates, from 88\xa0g to 84\xa0g protein, cholesterol from 362 mg to 339 mg and alcohol from 19\xa0g to 17\xa0g per day and in 237 mothers from 1915\xa0Kcal to 1830\xa0Kcal, from 79\xa0g to 73\xa0g total fat, from 216\xa0g to 212\xa0g carbohydrates, from 66\xa0g to 64\xa0g protein, from 299\xa0g to 244 mg cholesterol. 10. Sustained intensive individual and family-based lifestyle counseling in daily life in terms of healthy diet, less sedentary behavior and more leisure time physical activity slightly improved the CVD risk factor profiles in parents and their children already after 1\xa0year.