Larry S. Webber

Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study.

Abstract We assessed the relation of risk factors for cardiovascular disease to early atherosclerotic lesions in the aorta and coronary arteries in 35 persons (mean age at death, 18 years). Aortic involvement with fatty streaks was greater in blacks than in whites (37 vs. 17 percent, P<0.01). However, aortic fatty streaks were strongly related to antemortem levels of both total and low-density lipoprotein cholesterol (r = 0.67, P<0.0001 for each association), independently of race, sex, and age, and were inversely correlated with the ratio of high-density lipoprotein cholesterol to low-density plus very-low-density lipoprotein cholesterol (r = -0.35, P = 0.06). Coronary Artery fatty streaks were correlated with very-low-density lipoprotein cholesterol (r=0.41, P = 0.04). Mean systolic blood-pressure levels also tended to be higher in the four subjects with coronary-artery fibrous plaques than in those without them: 112 mm Hg as compared with 104 (P = 0.09). These results document the importance of risk-fa...

Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (the Bogalusa Heart Study)

Race and sex differences in aorta and coronary atherosclerotic lesions were studied in 150 persons aged 6 to 30 years. The intimal surface involvement with aorta fatty streaks was extensive, 0 to 71%, and greater in blacks than in whites (32 vs 20%, p less than 0.001). Coronary artery fatty streaks were more extensive in male than in female subjects (range 0 to 22%). Fibrous plaque lesions were present but not extensive in either the aorta (0 to 12%) or the coronary artery (0 to 24%) specimens. Lesions were more prevalent in male than in female persons, particularly white male subjects. The relation of fatty streaks to fibrous plaques was greater in the coronary vessels than in the aorta. In male subjects, aorta fatty streaks were strongly related to antemortem levels of total cholesterol, low-density lipoprotein cholesterol and ponderal index in white male subjects. Coronary artery fatty streaks in white male persons were significantly associated with serum triglycerides, very low density lipoprotein cholesterol, systolic and diastolic blood pressure and ponderal index. These results link antemortem risk factors to the development of atherosclerotic lesions and emphasize the need for preventive cardiology in early life.

Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group.

OBJECTIVE To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease. DESIGN A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994). PARTICIPANTS A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas. INTERVENTION Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education. MAIN OUTCOME MEASURES At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures. RESULTS In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed. CONCLUSION The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.

Studies of blood pressures in children, ages 5-14 years, in a total biracial community: the Bogalusa Heart Study.

SUMMARY Blood pressure, height, weight, maturation, triceps skinfold thickness, serum lipids, and hemoglobin were measured as risk factors for coronary artery disease in 3,524 children (93% of the eligible population) in Bogalusa, Louisiana. Nine blood pressures were taken on each child by trained observers with mercury sphygmomanometers (Baumanoneter) and Physomerics automatic recorders in a rigid randomized design in a relaxed atmosphere with other children present. The pressures observed were low compared to reported data. Black children had significantly higher blood pressures than white childre.i. This difference, starting before age 10, was largest in the children in the upper five percent of the pressure ranks. Stepwise multiple regression analysis revealed that this racial difference was significant when measured by an automatic recorder. Body size, expressed by height and by weight/height3 index, was a strong determinant of blood pressure level. Other positive determinants were blood hemoglobin and external maturation.

Promoting Physical Activity in Middle School Girls Trial of Activity for Adolescent Girls

BACKGROUND Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. DESIGN Group randomized controlled trial. SETTING/PARTICIPANTS Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). INTERVENTION A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. MAIN OUTCOME MEASURES The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. RESULTS After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. CONCLUSION A school-based, community-linked intervention modestly improved physical activity in girls.

Serum lipoprotein profile in children from a biracial community: the Bogalusa Heart Study.

SUMMARY Serum lipoprotein profiles in 3182 children, ages 5-14 years, were studied in a biracial community as part of the Bogalusa Heart Study to describe the early natural history of atherosclerosis. White and black children showed similar mean levels of β-lipoproteins. Pre-β-lipoprotein levels, however, were significantly higher in white children, while significantly higher levels of α-lipoprotein were found in black children. Girls had generally higher levels of beta;- and pre-α-lipoprotein and lower levels of α-lipoprotein than boys, although the differences were not significant at each age group. With age there was little change in α-lipoprotein levels, a significant increase in pre-β-lipoprotein levels and a slight but significant decrease between 11 and 14 years in β-lipoprotein levels. The correlation of α-lipoprotein was negative with α-lipoprotein and, to a greater extent, with pre-β-lipoprotein. The above inverse relationships were significantly greater in white children than in black children, suggesting differences in lipoprotein profiles in the two groups. Lipoprotein values from a total community study are now available for comparison with the currently recommended upper normal limits for lipoproteins. Since only a very small percentage of children could be considered as hyperlipoproteinemic by those specific levels in this community, we suggest that distributions and percentiles be used to evaluate children for hyperlipoproteinemia.

Serum cholesterol and triglyceride levels in 3,446 children from a biracial community: the Bogalusa Heart Study.

SUMMARY Serum lipid profiles of 3,446 (91% of population) children, ages 5-14 years, were determined in a biracial community (Bogalusa, Louisiana) as part of a program investigating the early natural history of atherosclerosis. Black children had significantly higher mean levels of serum cholesterol than white children (170 mg/dl vs 162 mg/dl, P < 0.0001). On the other hand, significantly lower levels of triglycerides were found in blacks than in whites (61 mg/dl vs 73 mg/dl, P < 0.0001). Girls had higher levels of triglycerides than boys in both races (blacks, 64 mg/dl vs 59 mg/dl, P < 0.001; whites, 77 mg/dl vs 69 mg/dl, P < 0.001). The racial differences in serum cholesterol and triglyceride levels were even more apparent at the 95th percentile. The serum cholesterol level remained relatively constant in all children until ages 11 and 12 years, after which a slight reduction occurred. This reduction was more pronounced in boys than in girls. In contrast, a significant increase in the level of triglycerides with age was observed in all children except black girls, the increasing slope being most pronounced in white girls.

Physical and sedentary activity in school children grades 5-8 : the Bogalusa Heart Study

Physical and sedentary activity in children and adolescents has immediate health benefits and can also set a pattern that carries over into adulthood, resulting in long-term health benefits. Activity levels in a free-living biracial sample of children and adolescents, ages 9-15 yr (N = 995), were examined using a 24-h recall instrument, the Self-Administered Physical Activity Checklist. Selected sedentary activities (television watching and video-/computergame playing) were also assessed. Overall, boys were more physically active than girls and engaged in more heavy physical activity, while girls reported a larger percentage of time spent in light and moderate physical activities. Gender and, to a lesser extent, ethnic differences were seen in the types of activities reported. Although most physical activity occurred after school, children who reported no physical education class during school had less physical activity overall. There was a decrease in moderate physical activity with increasing grade levels in school and an increase in sedentary behavior. Black children reported more sedentary activity than white children, and girls reported more than boys. Although this 24-h recall method has limitations, it allows characterization of the activity of groups of children and provides useful data for policy recommendations.

Breakfast consumption affects adequacy of total daily intake in children

Breakfast consumption patterns were assessed for 467 10-year-old children (59% white, 50% girls), who were interviewed in 1984-1985 or in 1987-1988. Consumption patterns were then related to mean daily nutrient intake patterns. More whites (56%) and more girls (46%) ate breakfast at home, whereas more blacks (58%) and more boys (49%) ate breakfast at school. Results indicated that 16% of all children skipped breakfast; the highest percentage was in black girls (24%). Breakfast consumption made a significant contribution to the childs mean daily nutrient intake. The average total energy intake was significantly lower for children who did not consume breakfast (mean = 1,821 kcal) and for children who consumed breakfast at home (mean = 2,098 kcal) compared with children who consumed breakfast at school (mean = 2,326 kcal). A similar pattern was noted for macronutrient contribution. Percentage of total energy from fat was lower in children who did not eat breakfast (34%) compared with those who did (37% to 39%), yet percentage of energy from carbohydrate was higher (53%) in children who did not eat breakfast. Children who skipped breakfast did not make up the differences in dietary intakes at other meals. A higher percentage of children who did not consume breakfast compared with those who ate breakfast did not meet two thirds of the Recommended Dietary Allowance for vitamins and minerals. These data confirm the importance of breakfast to overall dietary quality and adequacy in school-age children.

Tracking of cardiovascular disease risk factor variables in school-age children☆

Persistence in ranks (tracking) for cardiovascular disease risk factor variables was examined in 2236 children who were screened three times over a 5-yr period. As expected, the greatest persistence was noted for height (r = 0.47-0.99) and weight (r = 0.70-0.96). Correlation coefficients for systolic blood pressure and diastolic blood pressure ranged from 0.38 to 0.66 and 0.22 to 0.49 respectively. Among lipids, the correlations were highest for serum beta-lipoprotein cholesterol ranging from 0.62 to 0.78. For those children who were at or above the 90th percentile on a risk factor variable during the first examination, a tendency to retain their ranks in the second and third examinations was noted. For systolic blood pressure, 35% of those initially high remained high in the second examination and 30% in the third examination. Correspondingly, for those initially high for beta-lipoprotein cholesterol, 47 and 41% remained high. A linear discriminant model was used to distinguish characteristics of children who persisted at high rankings and those who did not. The model was effective for total and beta-lipoprotein cholesterol, but only moderately so for systolic blood pressure.