Gerald S. Berenson

The contribution of childhood obesity to adult carotid intima-media thickness: the Bogalusa Heart Study

Objective:Although obese children are at increased risk for coronary heart disease in later life, it is not clear if the association results from the persistence of childhood obesity into adulthood. We examined the relation of both childhood and adult levels of body mass index (BMI, kgu2009m−2) to carotid intima-media thickness (IMT) measured at the (mean) age of 36 years.Design and Subjects:Prior to the determination of adult IMT, the 1142 participants had been examined 7 (mean) times in the Bogalusa Heart Study.Measurements:In addition to BMI, levels of lipids, lipoproteins and blood pressure were measured at each examination. Cumulative levels of each risk factor were based on the areas under the individual growth curves calculated using multilevel models for repeated (BMI) measurements. We then examined the relation of these cumulative levels to adult IMT.Results:Carotid IMT was associated with cumulative levels of BMI in both childhood and adulthood (P<0.001 for each association). Furthermore, the association between childhood BMI and adult IMT persisted, but was reduced, after controlling for adult BMI. Although childhood levels of lipids, lipoproteins and blood pressure were also associated with adult IMT, these associations were not independent of adult levels of these risk factors.Conclusions:These results emphasize the adverse effects of elevated childhood BMI levels. In addition to the strong tracking of BMI levels from childhood to adulthood, there appears to be a modest, independent effect of childhood BMI on adult IMT. The prevention of childhood obesity should be emphasized.

Body fat patterning and blood pressure in children and young adults. The Bogalusa Heart Study.

The relationship of central body fat (measured by subscapular skinfold) and peripheral body fat (measured by triceps skinfold) to blood pressure was investigated in 3784 subjects aged 5 to 24 years old from the biracial community of Bogalusa, Louisiana. After adjustment for height, age, sex, and race, significant relationships were found for both central body fat (r = 0.19 and 0.14, p less than 0.0001) and peripheral body fat (r = 0.15 and 0.12; p less than 0.0001) with systolic and diastolic (fourth phase) blood pressure, respectively. However, the relationship between peripheral body fat and blood pressure, after controlling for the level of central body fat, was negligible (r = 0.00 and 0.01 for systolic and diastolic blood pressure, respectively). In contrast, the central body fat-blood pressure relationship remained statistically significant even after controlling for the peripheral body fat level. For central body fat, the partial correlations with systolic blood pressure were highest in young children (r = 0.15), dropped slightly during adolescence (r = 0.12), and became nonsignificant only in 18- to 24-year-old female subjects; correlations remained high in both black and white 18- to 24-year-old male subjects (r = 0.18 and 0.16, respectively). Mean levels of systolic blood pressure from the lowest to the highest quartile of central body fat ranged from 100.4 to 108.9 mm Hg. The adult hypertension-central body fat relationship, which has been shown by others, appears to exist in children. Continued efforts at early identification and prevention of obesity in children are warranted.

BMI rebound, childhood height and obesity among adults: the Bogalusa Heart Study.

OBJECTIVE: The beginning of the post-infancy rise in the body mass index (BMI, kg/m2) has been termed the adiposity rebound, and several studies have found that an early rebound increases the risk for overweight in adulthood. We examined whether this relation is independent of childhood BMI levels.DESIGN: A longitudinal study of 105 subjects who examined at ages 5, 6, 7, 8 and 19–23 y.RESULTS: Subjects with an age at the BMI rebound (agemin) of ≤5 y were, on average, 4–5 kg/m2 heavier in early adulthood than were subjects whose agemin was ≥7 y. Agemin, however, was also correlated with childhood BMI levels (r∼−0.5), and we found that agemin provided no additional information on adult overweight if the BMI level at age 7 y (or 8 y) was known. In contrast, childhood height, which was also correlated with agemin (r=−0.47), was independently related to adult BMI. Among relatively heavy (BMI=16.0 kg/m2) 5-y-olds, a child with a height of 120 cm was estimated to be 1.2 kg/m2 heavier in adulthood than would a 104 cm tall child.CONCLUSIONS: Although an early BMI rebound was related to higher levels of relative weight in adulthood, this association was not independent of childhood BMI levels. The relation of childhood height to adult BMI needs to confirmed in other cohorts, but it is possible that childhood height may help identify children who are likely to become overweight adults.International Journal of Obesity (2001) 25, 543–549

Racial contrasts in cardiovascular response tests for children from a total community.

SUMMARY Cardiovascular risk factors In childhood were assessed by re-examining a random sample of 278 children stratified by diastolic blood pressure (BP), obtained from 3524 children aged 7-15 years in an entire geographic biraclal community (Bogalusa). Re-examination included plasma renin and serum electrolytes, 24-hour urine electrolytes, heart rates, and BP at rest and in response to standardized physical stresses (orthostatic, isometric handgrip, and cold pressor tests). The BP responses in these tests were not increased in the high BP strata, which argues against a prevailing labile phase In early essential hypertension. Black children tended toward larger BP responses than whites. In black boys of the high BP stratum (n = 25), systolic supine or stressed BP were higher than for other race-sex groups; these pressures were associated negatively with plasma renin activity, which was low. White children in the high BP strata had increased heart rates, possibly indicating hyperkinetic circulation. These findings indicate that multiple mechanisms operate to control BP at different intensities for black and white children.

Comparison of two automatic blood pressure recorders and the mercury sphygomomanometer.

The Physiometrlcs automatic blood pressure recorder was compared with the mercury sphygmomanometer in 2200 children aged 5–14 years, each reexamined after 3 and 5 years; the Physiometrics recorder produced higher intrachild correlations. In trials we could transfer what were essentially Physiometrics readings into levels similar to mercury sphygmomancmetric readings by filtering out the infrasonlc frequency band. The Physiometrics USM-105 was compared with its successor, the Physiometrics SR-2, on 378 children aged 10–17 years. The SR-2 measured lower than the USM-105: 4.1 mm Hg systolic and 8.5 mm Hg diastolic; differences were larger in the younger children. Both in mean levels and correlations, SR-2 readings were closer to the mercury sphygmomanometers than were USM-105 readings, except or diastolic SR-2 readings, which were farther below the mercury sphygmomanometer 4th-phase readings than the USM-105. However, the SR-2 readings are likely doser to the true diastolic pressure in children 13 years and older, although we did not measure pressures intraarterially. Disc readings for systolic pressures showed coefficients of correlation averaging 0.96 among (n = 168) and 0.98 within (n - 40) readers for both models, but diastolic readings showed marked improvement from USM-105 (0.73, 0.81) to SR-2 (0.91,0.97). In many of the parameters observed, SR-2 constitutes an improvement over USM-105. Automatic recorders offer certain advantages for measuring blood pressure in large-scale epidemiologic studies. (Hypertension 4: 329–336, 1982)

Persistence of high diastolic blood pressure in thin children. The Bogalusa Heart Study.

Relationships between initial anthropometric variables and subsequent diastolic blood pressure (fourth phase) were examined in children identified as being in the upper quintile for diastolic blood pressure at Year 1. Of 156 white children, aged 10 to 14 years, with diastolic blood pressure levels in the upper age-race-sex-specific quintile at Year 1, 38% remained in the upper quintile at Year 4. However, there was a definite trend for leaner children, defined by ponderosity (weight/height3) to remain in the highest diastolic blood pressure quintile (p less than 0.001). Of white children originally identified in the highest quintile for diastolic blood pressure and the lowest quintile for ponderosity (lean group), 67% (18 of 27) remained in the upper quintile at Year 4. In contrast, only 21% (11 of 52) of white children identified as being in the highest quintile for both diastolic blood pressure and ponderosity (obese group) at Year 1 were in the upper diastolic blood pressure quintile at Year 4. Similar results were seen in children examined 5 years later. Pearson correlation coefficients and linear regression analyses confirmed the negative relationship between initial ponderosity and subsequent diastolic blood pressure, especially in older children. A similar relationship was noted in black children. Potential differences in the etiological process of obesity-related and non-obesity-related high blood pressure were examined. These observations indicate that characteristics other than obesity can contribute to high blood pressure in late childhood.

Cardiovascular Risk Factors in Children and Coronary-Related Behavior

Publisher Summary The question of how changes in behavior can modify the process of atherosclerosis and hypertension during adolescence is practical and important. However, no uniform answers exist to that question. There is an abundance of studies with animals relating nutritional and psychological states to cardiovascular risk factors, but there is a serious question about how applicable those models are for prescribing intervention in the atherosclerotic/hypertensive process. The atherosclerotic/hypertensive process has apparently evolved so recently that even within the human species, blacks and whites have different mechanisms for the development of this process. Inter- and intra-species differences in non-human primates limit the applicability of these studies to cardiovascular disease in man. Further, the limitation of hospital-based studies to symptomatic individuals in later and complicated stages of the process is well known. There is a great need for an epidemiologic approach to cardiovascular disease in man. This chapter discusses nutritional and other behavior associated with increased risk of coronary artery disease and also considers the following four risk factors — obesity, high blood pressure, blood lipids, and blood insulin-glucose.

Dietary Studies of Infants and Children: The Bogalusa Heart Study

Publisher Summary Certain eating behaviors in early life may represent health risks. Excessive energy intake may predispose a person to obesity. A potential elevation of serum lipids may result from abundant animal protein and fat intakes. Iron deficiency anemia may be aggravated by inadequate iron intakes. Early use of alcohol may increase the likelihood of future dependency. Sodium may predispose to later hypertension, and sucrose can increase the risk of dental caries and obesity. All these eating and drinking behaviors may contribute to disease states. This chapter focuses on these and other eating behaviors and describes the prevalence of excessive or inadequate nutrient intake and/or eating patterns as observed in the Bogalusa Heart Study. The chapter also discusses specific dietary components, such as energy, protein, saturated fat, cholesterol, sodium, sucrose, and iron. Correcting an energy imbalance either by a reduction of energy, protein, sucrose, and saturated fat or by an increase in physical activity or by both is an effective method of weight reduction.

A family approach to cardiovascular risk reduction through diet

We developed a dynamic family approach towards the treatment and preve ntion of cardiovascular risk. The eating behavior component, which is part of our Family Health Promotion program, includes counse ling, instruction, and group activities. A nutritionist and behaviorist conduct the family education and counseling sessions. Families are counseled individually. To provide families with general information and training on cardiovascular health and eating behavior, we developed six instruction modules. Activities are included with each module. The DIN-O-MITE module teaches families how to record their eating behavior. They learn to use household measurements and scales to estimate amounts of food consumed. Families become familiar with describing intake in terms of food preparation, recipe documentation, and food characteristics. They monitor their intake by keeping food records which are computerized using the DINE system (I). Families can profile their intake and monitor achievements of desirable changes using the computerized nutritional reports as a guide. The Shopping Wise module (see Figure I) provides the skills for families to evaluate food labels and to select appropriate

Epidemiology of Essential Hypertension in Children

Cardiovascular diseases, including heart attack and stroke, remain the leading causes of death and disability in the US (1). However, the adult heart diseases begin decades earlier (2). Observations from many well established epidemiologic studies in adults have implicated risk factors such as high blood pressure (BP), hypercholesterolemia, and obesity, along with lifestyles of poor diet, smoking, and sedentary behavior, as related to the development of clinical heart disease (3–5). Unfortunately, hypertension (HTN) is a major public health problem involving as much as 40% of the black adult population (3). Furthermore, a strong relationship has been proven to exist between cardiovascular risk factors and underlying atherosclerotic, hypertensive, vascular abnormalities at autopsy, in adults, children and adolescents (6). The occurrence of anatomic changes at a young age is the most compelling evidence that the adverse effects of risk factors such as HTN are not limited to adult heart disease, but that hypertensive cardiovascular—renal diseases begin in childhood (3,4,7). Epidemiologic studies at a young age now provide considerable understanding of the early natural history of high BP and the hypertensive disease leading to clinical events.