Child And Adolescent Trial For Cardiovascular Health Research Articles

Serum homocysteine and folate concentrations among a US cohort of adolescents before and after folic acid fortification

We assessed serum homocysteine (tHcy) and folate concentrations among US adolescents before and after fortification of cereal-grain products with folic acid, and associations with demographic, behavioural and physiological factors. Observational study conducted among participants of a randomized trial. The Child and Adolescent Trial for Cardiovascular Health (CATCH) study. Adolescents (n 2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years). Average serum concentrations of tHcy, folate and vitamin B6 increased by 17 %, 16 % and 14 %, respectively, while serum concentrations of vitamin B12 decreased by 11 % post-fortification. Folic acid fortification provided, on average, an additional intake of 118 μg folate/d. Male sex (P < 0.0001) and white race (P = 0.0008) were associated with significantly greater increases in tHcy concentration, while increases in BMI (P = 0.006) and serum folate concentration (P < 0.0001) were associated with significant decreases in tHcy concentration. Female sex (P < 0.0001), non-smoking (P < 0.0001), use of multivitamins (P < 0.0001) and higher dietary intake of folate (P = 0.001) were associated with significantly greater increases in serum folate concentrations. From grade 8 to grade 12, the upward age trend in serum tHcy concentration was uninterrupted in its course (P > 0.50); whereas serum folic acid concentration showed a downward trend that incurred a discrete jump upward (17 % higher; P < 0.0001) with fortification. These trends differed significantly for males v. females (P < 0.001 for interaction). Fortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.

The interaction of childhood height and childhood BMI in the prediction of young adult BMI.

The purpose of this study was to examine the interaction of childhood height and childhood BMI in the prediction of young adult BMI. The 2,802 subjects in this study were from the Child and Adolescent Trial for Cardiovascular Health (CATCH). The subjects' heights and weights were measured in 3rd grade (mean age 8.7 years) and again in 12th grade (mean age 18.3 years). The associations and interactions between height (cm) and BMI (kg/m(2)) were assessed using mixed linear regression models with adult BMI as the dependent variable. We found a significant interaction between childhood height and childhood BMI in the prediction of adult BMI (P < 0.0001). Stratification by Centers for Disease Control and Prevention (CDC) reference quintiles revealed that a positive association between childhood height and adult BMI existed only for those subjects in the top quintile of childhood BMI, within whom predicted adult BMI ranged from 27.5 (95% confidence interval = 26.4-28.6) for those in the shortest height quintile to 30.2 (95% confidence interval = 29.7-30.6) for those in the highest height quintile. Among children with high BMI levels, those who were taller, as compared to those who were shorter, had significantly higher young adult BMI levels. This pattern seems primarily due to the positive association of childhood height and childhood BMI. Clinicians should recognize the risk of excess body weight in young adulthood for all children who have a high BMI, and pay special attention to those who are tall, because their childhood height will not protect them from subsequent weight gain and elevated BMI.

Neuroimaging for paediatric minor closed head injuries

It is clear that paediatric minor head injuries are common and that most cases may be observed without neuroimaging. However, with easier access to computed tomography scans, there has been an increase in its use. In the present article, clinical decision rules for neuroimaging of paediatric minor head injuries, such as the Child and Adolescent Trial for Cardiovascular Health (CATCH) study, will be discussed. Risk factors that should trigger concern are persistently low Glasgow coma scale, suspected open or basilar skull fracture, worsening headache, irritability, large and boggy scalp hematomas and dangerous mechanism of injury. An update on recent recommendations and evidence-based changes are provided.

Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth

Cardiovascular disease (CVD) is a leading cause of morbidity and premature mortality in women and men in the United States, most of the industrialized world, and many developing countries.1 Data accumulated over the past 3 decades indicate that atherosclerotic-CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposures. Taken together, these data provide compelling evidence for primary prevention of CVD beginning early in childhood. Within the pediatric healthcare community, this evidence has prompted and informed the development of science-based guidelines with recommendations for individual/high-risk and population-based approaches to primary prevention of CVD in children and youth. The purpose of this statement is to provide an overview of the evidence and current science-based recommendations and to emphasize the role of advanced practice nurses in the implementation of strategies consistent with population-based and individual/high-risk approaches to CVD prevention in children and youth. Evidence-based guidelines for primary and secondary prevention of CVD in adults are informed by the results of randomized controlled trials. The existing evidence (discussed below) argues convincingly for prevention of CVD beginning early in childhood. It is noteworthy that data from randomized controlled trials documenting the effect of risk reduction in childhood on the development of CVD in adulthood are nonexistent. Similarly, no long-term longitudinal studies have been conducted to determine the absolute levels of risk factors measured in childhood that predict CVD in adult life. However, evidence from laboratory, clinical, and epidemiological studies supports the need for primary prevention of CVD beginning early in life and has prompted and informed existing guidelines for children and adolescents. ### Laboratory/Pathology and In Vivo/Clinical Studies Autopsy studies conducted as part of the Bogalusa Heart Study2,3 and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study4,5 demonstrate significant positive associations between potentially modifiable …

Vitamin Supplement Intake Is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

Objective To explore the relationship of multiple-vitamin supplement use with selected food groups, physical activity, lifestyle behaviors, and weight status. Subjects and Methods Two thousand seven hundred sixty-one adolescents in the 12th grade who participated in the fourth Child and Adolescent Trial for Cardiovascular Health study had height and weight measured and completed health behavior survey and food frequency questionnaires. Logistic regression models were used to determine the likelihood of supplement use with health and activity behaviors and dietary intake. Results Prevalence of multiple-vitamin supplement use among adolescents was 25% and varied by sex and race/ethnicity. Supplement users had higher mean daily intakes of most food groups, but lower intakes of total fat and saturated fat than nonusers. Higher food index scores were positively associated with the likelihood of using multiple-vitamin supplements. Supplement users were more likely to be physically active, participate in team and organized sports, and less likely to be overweight and to watch more than an hour of television per day. Conclusions Adolescents who use multiple vitamin supplements have more healthful dietary and lifestyle behaviors than nonusers. Further study on supplement use by adolescents, including other types of supplements used and reasons for use, is warranted.

School-based health education programs can be maintained over time: results from the CATCH Institutionalization study

Background. Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation. Methods. The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention ( n = 56) and former comparison ( n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics. Results. Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias ( P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools ( P < 0.001). Training had the greatest impact on maintenance of CATCH. Conclusions. Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.

Maintenance of a health promotion program in elementary schools: results from the CATCH-ON study key informant interviews.

To better understand the institutionalization process in Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention and control schools, 199 key informant interviews were conducted with school food service staff, physical education teachers, classroom teachers, and administrators at the four CATCH-ON field centers. School personnel were asked to talk about the degree of CATCH program implementation, who at the school or school district was instrumental in promoting CATCH, and the conditions that facilitated or impeded the institutionalization of CATCH activities and philosophies. The CATCH Physical Education (PE) component appeared to have the highest level of institutionalization, and the CATCH classroom curriculum and family components appeared to have the lowest levels of institutionalization. The primary barriers expressed included the low priority for health promotion activities and time constraints of schools: lack of mechanisms for training of school staff; and lack of sufficient funds for materials, equipment, and lower fat vendor products.

How the CATCH eat smart program helps implement the USDA regulations in school cafeterias.

This article describes the implementation of the U.S. Department of Agriculture's National School Lunch Program (NSLP) standards in school lunch menus in 56 intervention and 20 control schools from the Child and Adolescent Trial for Cardiovascular Health (CATCH) 5 years after the main trial, compared with 12 schools previously unexposed to CATCH. School food service personnel completed questionnaires to assess CATCH guideline implementation, demographic data, behavioral constructs, training, program material use, and participation in competing programs. Five days of menus and recipes were collected from school cafeteria staff, averaged, and compared to USDA School Meal Initiative (SMI) standards. Significant differences between intervention and unexposed schools were found for training and knowledge of CATCH and in mean percentage energy from fat and carbohydrates. Intervention schools most closely met USDA SMI recommendations for fat. Thus, the CATCH Eat Smart Program assisted school cafeterias in meeting USDA guidelines 5 years postimplementation.

School Climate and the Institutionalization of the Catch Program

School climate refers to various physical and psychosocial structures that shape schools' social and physical environments. The Child and Adolescent Trial for Cardiovascular Health (CATCH) study provided an opportunity to study how aspects of school climate are associated with continued implementation of the CATCH program. Nutrient analysis of menus, observations of physical education (PE) classes, and teacher and staff self-reports were used to measure CATCH program components. Results of this study indicate that aspects of school climate were associated with continued implementation of the CATCH classroom component but not the CATCH food service or PE components. These findings have implications for how we plan for the progression of innovative school health promotion programs from the initial trial stage to institutionalization. Measures of school climate may be useful in determining a school's readiness to adopt and implement an innovative health promotion curriculum.

Maintenance of effects of the CATCH physical education program: results from the CATCH-ON study.

Long-term maintenance effects of physical education (PE) curriculum and staff development programs have not been studied. The authors assessed the sustainability of the Child and Adolescent Trial for Cardiovascular Health (CATCH) PE intervention using direct observations of 1,904 PE lessons in former intervention and control schools in four U.S. states 5-years postintervention. Student physical activity levels, lesson contexts, and level of CATCH PE training of teachers were analyzed. Student energy expenditure levels and proportion of PE time in moderate-to-vigorous physical activity in intervention schools were maintained 5 years later, but vigorous activity declined sharply. Meanwhile, postintervention gains in former control schools, influenced by delayed program implementation and secular trends, resulted in a convergence of activity levels in intervention and control schools. Use of CATCH PE curricula was associated with increased levels of teacher training and school support for PE in both former intervention and control schools.

Adoption and institutionalization of the Child and Adolescent Trial for Cardiovascular Health (CATCH) in El Paso, Texas.

One goal of national health-promotion research is to disseminate and institutionalize experimentally tested programs in local communities. In 1997, the national Child and Adolescent Trial for Cardiovascular Health (CATCH) was chosen by the Paso del Norte Health Foundation as their first community-wide preventive health initiative for the El Paso, Texas/Juárez, México border region. With help from researchers at the University of Texas at Houston, evaluators from the University of Texas at El Paso, and the Region 19 Educational Services Center, CATCH was implemented in 18 Title I pilot schools. Known as the Coordinated Approach to Child Health 5 years later, the El Paso CATCH program has been embraced by the border community and reaches 108 elementary schools from New Mexico to West Central Texas. There are also plans to implement CATCH in Juárez. This article describes the institutionalization of CATCH in a predominately Hispanic, low income border region.

Assessing the dietary environment: examples from school-based nutrition interventions.

The objectives of this paper are to (1) introduce the concept of upstream and downstream public health approaches and discuss diet assessment issues in that context, and (2) provide examples of diet assessment methods and challenges in assessing environmental factors influencing eating patterns. Dietary assessment of environmental factors is discussed as they relate to nutrition interventions for school-aged children, although the issues transcend population characteristics. Examples of assessment challenges in measuring 'dietary environments' are drawn from the Child and Adolescent Trial for Cardiovascular Health (CATCH), Teens Eating for Energy and Nutrition at School (TEENS) and Trying Alternative Cafeteria Options in Schools (TACOS) studies. The healthfulness of our 'dietary environments' (which may include food availability, social norms around food choice and the effect of pricing, policy and promotion on food choice) may be more important in determining what people consume than their individual decision-making about food choice. There is a dearth of published information to inform us on how to assess these 'dietary environments'.

Tracking of Physical and Physiological Risk Variables among Ethnic Subgroups from Third to Eighth Grade: The Child and Adolescent Trial for Cardiovascular Health Cohort Study

Background. The Child and Adolescent Trial for Cardiovascular Health (CATCH), a multisite field trial, tested the effectiveness of multiple interventions for cardiovascular disease risk behaviors in children in third through fifth grades. This paper reports the tracking of physiologic variables through eighth grade.Methods. The cohort began with 5,106 third grade students from diverse ethnic backgrounds: 69% Caucasian, 14% Hispanic, 13% African American, and 4% other. Seventy-two percent of students were remeasured. Measures described are serum lipids, blood pressure, and body anthropometrics. Tracking was examined across three time points (third, fifth, and eighth grades) with a scaled Kendall concordance coefficient and percentage retention within quintiles across time.Results. For the overall sample, tacking was strongest for body mass index (BMI) (Kendall coefficient = 0.86) and weight (0.86), followed by skinfold thicknesses (0.72–0.78), serum lipids (0.67–0.72), and blood pressure (0.45–0.51). For BMI, 96% of students stayed within ±1 quintile from third to fifth grades; 90% stayed within this range from third to eighth grades.Conclusions. There were small but noticeable gender and ethnic differences: tracking was stronger among boys and African American students. These results demonstrate that the children's relative level of cardiovascular risk remained stable over a 6-year period.

Effects of the CATCH physical education intervention: teacher type and lesson location

Background: Substantial differences exist in how and where physical education (PE) is conducted in elementary schools throughout the United States. Few effectiveness studies of large-scale interventions to improve PE have been reported. Design: Multicenter randomized trial. Setting/ participants: The Child and Adolescent Trial for Cardiovascular Health (CATCH) was implemented in PE classes in 96 schools (56 intervention, 40 control) in four study centers: California, Louisiana, Minnesota, and Texas. Intervention: The 2.5-year PE intervention consisted of professional development sessions, curricula, and follow-up consultations. Main Outcome Measures: Intervention effects on student physical activity and lesson context in PE were examined by teacher type (PE specialists and classroom teachers) and lesson location (indoors and outdoors). Results: Differential effects by teacher type and lesson location were evidenced for both physical activity and lesson context. Observations of 2016 lessons showed that intervention schools provided more moderate-to-vigorous physical activity ( p=0.002) and vigorous physical activity ( p=0.02) than controls. Classroom teachers improved physical activity relatively more than PE specialists, but PE specialists still provided longer lessons and more physical activity. Classroom teachers increased lesson length ( p=0.02) and time for physical fitness ( p=0.03). Conclusions: The intervention improved PE of both specialists’ and classroom teachers’ lessons. States and districts should ensure that the most qualified staff teaches PE. Interventions need to be tailored to meet local needs and conditions, including teacher type and location of lessons.

Adolescents’ Eating Patterns Influence their Nutrient Intakes

Eating patterns established during adolescence shape diet later in life ( (1) Kemm J.R Eating patterns in childhood and adult health. Nutr Health. 1987; 4: 205-215 Google Scholar , (2) Nicklas T.A Farris R.P Smoak C.G Frank G.C Srinivasan S.R Webber L.S Berenson G.S Dietary factors relate to cardiovascular risk factors in early life Bogalusa Heart Study. Arterioscler. 1988; 8: 193-199 Google Scholar ). Compared with younger children, adolescents have more control over their eating habits and more access to food outside the home, experiment more with food choices, deviate more from 3-meal-a-day eating patterns, and are more likely to snack ( (3) Bull N.L Dietary habits, food consumption, and nutrient intake during adolescence. J Adolesc Health. 1992; 13: 384-388 Google Scholar , (4) Court J.M Nutrition and adolescents an overview of concerns in western society. Med J Aust. 1988; 148: S2-S7 Google Scholar , (5) DiPietro L Physical activity, body weight, and adiposity an epidemiologic perspective. Exerc Sport Sci Rev. 1995; 23: 275-303 Google Scholar , (6) Epstein L.H Valoski A.M Vara L.S McCurley J Wisniewski L Kalarchian M.A Klein K.R Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol. 1995; 14: 109-115 Google Scholar , (7) Farthing M.C Current eating patterns of adolescents in the United States. Nutrition Today. 1991; 26: 35-39 Google Scholar , (8) Johnson R.K Johnson D.G Wang M.Q Smiciklas-Wright H Guthrie H.A Characterizing nutrient intakes of adolescents by sociodemographic factors. J Adolesc Health. 1994; 15: 149-154 Google Scholar , (9) Leon G.R et al. Adolescent nutritional and psychological patterns and risk for the development of an eating disorder. Journal of Youth Adolescent. 1989; 18: 273-282 Google Scholar , (10) Siega-Riz A.M Carson T Popkin B Three squares or mostly snacks—what do teens really eat? A sociodemographic study of meal patterns. J Adolesc Health. 1998; 22: 29-36 Google Scholar ). Eating patterns influence nutrient intakes because food choices vary by eating occasion. This paper describes a) the associations of type and number of eating occasions with nutrient intakes, b) the influence of overweight status and prior participation in the intervention or control groups in the Child and Adolescent Trial for Cardiovascular Health (CATCH) on them, and c) patterns and sources of meals and snacks by sex and race/ethnicity among these students. Supported by cooperative agreement grants from the National Heart, Lung, and Blood Institute, National Institutes of Health (U01-HL-39880, U01-HL-39906, U01-HL-39852, U01-HL-39927, U01-HL-39870).

Reliability and Validity of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist: A Self-report Instrument to Measure Fat and Sodium Intake by Middle School Students

Objective To develop a scoring algorithm and evaluate the reliability and validity of scores from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist (CFC) as measures of total fat, saturated fat, and sodium intake in middle school students.Design Randomized, controlled trial in which participants were assigned to 1 of 3 study protocols that varied the order of CFC and 24-hour dietary recall administration. Criterion outcomes were percent energy from total fat, percent energy from saturated fat, and sodium intake in milligrams.Subjects/setting A multiethnic sample (33% ethnic and racial minorities) of 365 seventh-grade students from 8 schools in 4 states.Statistical analyses Multivariable regression models were used to calibrate the effects of individual food checklist items; bootstrap estimates were used for cross-validation; and kappa statistics, Pearson correlations, t tests, and effect sizes were employed to assess reliability and validity.Results The median same-day test-retest reliability kappa for the 40 individual CFC food items was 0.85. With respect to item validity, the median kappa statistic comparing student choices to those identified by staff dietitions was 0.54. Test–retest reliability coefficients ranged from 0.84 to 0.89 for CFC total nutrient scores. Correlations between CFC scores and 24-hour recall values were 0.36 for total fat, 0.36 for saturated fat, and 0.34 for sodium; CFC scores were consistent with hypothesized gender differences in nutrient intake.Applications/conclusions The CFC is a reliable and valid tool for measuring fat, saturated fat, and sodium intake in middle school students. Its brevity and ease of administration make the CFC a cost-effective way to measure middle school students’ previous day’s intake of selected nutrients in school surveys and intervention studies. J Am Diet Assoc. 2001;101:635-642,647.

National Nutrition Summit, May 30, 2000: Results of the Obesity Discussion Groups

National Nutrition Summit, May 30, 2000: Results of the Obesity Discussion Groups

Dissemination and adoption of the Child and Adolescent Trial for Cardiovascular Health (CATCH): a case study in Texas.

The total impact of a health promotion program can be measured by the efficacy of the intervention multiplied by the extent of its implementation across the target population. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was a school-based health promotion project designed to decrease fat, saturated fat, and sodium in children's diets, increase physical activity, and prevent tobacco use. This article describes the dissemination of CATCH in Texas, including the theoretical framework, strategies used, and lessons learned. To date (Fall 2000), CATCH materials have been adopted by more than 728 elementary schools in Texas.

Prevalence of Marked Overweight and Obesity in a Multiethnic Pediatric Population: Findings From the Child and Adolescent Trial for Cardiovascular Health (CATCH) Study

Objective Determine the prevalence of marked overweight and obesity among children in the Child and Adolescent Trial for Cardiovascular Health (CATCH), identify high risk groups, and compare findings to other recent studies. Design Cohort study. Subjects/setting Five thousand one hundred-six school children who were participants in CATCH at baseline (age approximately 9 years) during 1991 and 4,019 of those children who had follow-up data from 1994 (age approximately 11 years) available. Methods Body mass index (BMI), triceps and subscapular skinfolds, subscapular to triceps skinfold (S/T) ratio, and an estimate of body fat distribution from skinfolds was calculated. Findings were compared to population-based reference data from the First National Health and Nutrition Examination Survey, 1971 to 1973 (NHANES I), to data from the Bogalusa Heart Study, and to data from the Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III). Results Children in CATCH were markedly heavier and fatter than the NHANES I population and more comparable to the NHANES III population, especially those in the upper percentiles. The prevalence of obesity based on BMI and triceps skinfolds >95th percentile among CATCH children was higher in boys than in girls at both baseline (boys 9.1%, girls 8.6%) and follow-up (boys 11.7%, girls 7.2%). It was higher among African-Americans and Hispanics than whites for both sexes. S/T ratios did not differ appreciably from those observed in the NHANES I reference population, suggesting that body fat distribution was more stable over time than BMI and skinfolds. Applications Our findings support other recent reports that American children, especially African-American and Hispanic children, are becoming heavier and fatter. Preventive measures are warranted, especially for high-risk youth. J Am Diet Assoc. 2000; 100:1149-1156.

Incorporating Parent Information with the Self-reported Intakes of Seventh Graders has a Statistically Significant, but Small, Effect on Mean Nutrient Intakes

The 24-hour recall is a dietary assessment technique often used to measure nutrient intakes of children and adolescents. Because children often have difficulty accurately describing foods, ingredients, and preparation methods, assessments of their diets frequently include input from a parent or other caretaker (1–9). A variety of methods are used to obtain this additional information, including home visits, the presence of a parent during the interview, and telephoning a parent after the interview (4,5,10). Because these methods can be costly and logistically difficult to implement, it is important to evaluate their relative costs and benefits. The Child and Adolescent Trial for Cardiovascular Health (CATCH) developed a procedure for telephoning the parents of students whose reported intakes were missing information likely to affect the assessment of fat and sodium intake, the nutrients of interest in CATCH. This article examines the effect of incorporating parent information on the estimated nutrient intakes of seventh graders.