Cardiovascular Health In Children Research Articles

Like Parent, Like Child: Intergenerational Patterns of Cardiovascular Risk Factors at Midlife

PurposeWe aimed to assess the prevalence of four cardiovascular risk factors (obesity, diabetes, excessive alcohol intake, and cigarette smoking) for parents and their adult children at the same approximate midlife age. We also evaluated associations of parents' cardiovascular risk factors, childhood health exposures, and social contexts (i.e., family, school, and neighborhood) during adolescence with adult children's cardiovascular health at midlife. MethodsWe used data from respondents at Wave V of the National Longitudinal Study of Adolescent to Adult Health who had corresponding parent (mostly mothers) data from Wave I. The final sample included 10,466 adult children with a mean age of 37.8 years. Descriptive statistics and logistic regression models were estimated, accounting for the National Longitudinal Study of Adolescent to Adult Health sampling design. ResultsAt similar ages (i.e., 35–45 years) to their parents, adult children had higher rates of excessive drinking and obesity than their parents, lower rates of diabetes, and similar rates of smoking. Adult children's health largely converged and correlated with their parents' health at similar ages. Cardiovascular risks for adult children were also significantly associated with their childhood health exposures and social contexts during adolescence. Some associations varied with respect to the health status of parents at Wave I. ConclusionsThe cardiovascular risk of parents at midlife is strongly associated with the cardiovascular risk of their adult children at midlife. The status of parents' health during adolescence can also modify the significance and magnitude of associations between childhood health exposures or adolescent social contexts and adult children's cardiovascular risk factors.

Association Between Arterial Stiffness, Body Mass Index And Cardiorespiratory Fitness In 7-to-17 Years Old Children

Excess adiposity is a risk factor for cardiovascular disease, however, the obesity paradox suggests the existence of a subpopulation of obese individuals that do not suffer from those cardiovascular risks. Cardiorespiratory fitness (CRF) is a strong indicator of cardiovascular health in children and adults. Both obesity and low CRF have shown to independently increase the risk of cardiovascular diseases. PURPOSE: The aim of this study was to investigate how central arterial stiffness is associated with aerobic capacity and body fat percentage and body mass index (BMI) in children aged 7-to-17-years. METHODS: Seventy healthy children, 34 boys and 36 girls (age 7-17 years; BMI 21.5±5.4 kg/m2; fat mass 23.4±11.5%), participated in this study. Percentage of fat mass (FM%) and fat free mass (FFM) were assessed using air displacement plethysmography (Bod Pod COSMED). Arterial stiffness was assessed measuring carotid-femoral PWV (cfPWV) with the SphygmoCor XCEL (AtCor Medical, Inc.). CRF was assessed through breath-by-breath gas analysis (K5, COSMED) using a 15 watts per minute graded exercise test on a cycle ergometer. The VO2 at the first ventilatory threshold (VT1) was identified using the V-slope technique and as the lowest respiratory equivalent for oxygen. Differences in cfPWV between quartiles of VO2 at VT1, %BF, and BMI were assessed using a multivariate general linear model. RESULTS: cfPWV was higher in the first VO2 at VT1 quartile compared to the fourth when VO2 is normalized by FFM (4.99±0.73 vs 4.24±0.69 m/s, p<0.05). No differences in cfPWV were observed between first and fourth VO2 at VT1 quartiles when VO2 is normalized by body mass (5.05±0.92 vs 4.34±0.71 m/s). cfPWV was higher in the fourth and third BMI quartile compared to the first (4.26±0.53 and 4.90±0.66 vs 5.09±0.89, p<0.05) but no differences in cfPWV were observed between fourth, third and first BF% quartiles (5.06±1.04, 4.57±0.54, 4.61±0.64). CONCLUSION: Low central arterial stiffness in children is associated with high CRF expressed as VO2 at VT1, and with low BMI.

Low vitamin D status is associated with obesity but no other cardiovascular risk factors in Chinese children and adolescents

Background and aimsEvidence on relationship between vitamin D status and cardiovascular health in childhood remains inconsistent. This study aimed to investigate vitamin D status and its relationship with cardiovascular risk factors in Chinese children and adolescents. Methods and resultsCross-sectional data were obtained from 2680 children and adolescents aged 7-18 y in Guangzhou, South China. Anthropometric and socioeconomic characters, concentration of serum 25-hydroxyvitamin D [25(OH)D], fasting blood glucose and lipids, as well as information about diet and physical activity were measured and collected. Logistic regression model was adopted to analyze the associations between 25(OH)D levels and cardiovascular risk factors including obesity, high blood pressure, dyslipidemia, hyperglycemia, and metabolic syndrome. Overall, median level of 25(OH)D was 19.74 ng/mL. The prevalence rates of vitamin D deficiency and inadequacy were 7.5% and 44.4%, both of which were highest among adolescents aged 14-18 y (14.5% and 51.6%, respectively). As vitamin D level increased, an upward trend in fasting glucose concentrations was observed in subjects with normal fasting glucose level, but not in subjects with hyperglycemia. Among the assessed cardiovascular risk factors, vitamin D status was only inversely associated with general obesity, and the adjusted odds ratio was 1.95 (95% CI: 1.08–3.49), comparing the lowest 25(OH)D quartile with the highest one. ConclusionsVitamin D deficiency and inadequacy remain a concern among school-aged children and adolescents in Guangzhou, South China, particularly in adolescents aged 14-18 y. However, low vitamin D status was found only associated with general obesity but no other cardiovascular risk factors.

Abstract P288: Parent-child Associations In Cardiovascular Health

Introduction: Shared genetics may explain some of the strong heritability of cardiovascular (CV) disease, however, excess risk is largely due to intergenerational transmission of poor lifestyles leading to the increased presence of cardiovascular risk factors. We examined the association between parental and child CV health (CVH), including behavioral and clinical factors. Methods: Participants of the Multidimensional Assessment of Preschoolers Study (MAPS) and a parent (predominantly mothers) were recruited for a CVH exam when the child was 9-11 yrs (in 2018-19). Five CVH metrics were collected in children and parents: BMI and blood pressure via standardized measurements, and diet, physical activity and smoking via questionnaire. CVH was defined as the sum of ideal (2 points), intermediate (1 point) and poor (0 points) levels of the 5 metrics, as defined by the AHA. The overall CVH score (range: 0-10) was stratified into high (9-10), moderate (5-8) and low (0-4). Logistic regression was used to examine relationships between ideal CVH in children and various predictors, including parental employment, income, and ideal CVH. Results: Among 185 participants (53% female, 12% Non-Hispanic White, 52% non-Hispanic Black and 30% Hispanic; mean age 11) 5% had low, 75% moderate and 20% had high CVH. Looking at the metrics individually, poor diet was the most common (43%), followed by BMI (22%), physical activity (18%), smoking (2%), and BP (1%). Among the parents, 19% were in low, 71% moderate and 10% high CVH. After adjusting for race, age, and sex, the strongest predictor of a child’s CVH score was parental CVH score (p=0.007). If a parent had high CVH, the child was 5 times more likely to have high CVH (OR: 5.03, 95% CI: 1.55-16.33). Conclusions: In this MAPS cohort, there was an association between ideal CVH in parents and ideal pre-adolescence CVH in children. These results suggest that interventions to preserve and restore CVH must be family-based.

Systematic Review on the Associations between Objectively Measured Breaks in Sitting Time and Cardiovascular Health in Youth

The aim of this systematic review was to summarize the literature on the associations between breaks in sitting time and cardiovascular health, in children and adolescents. The search was conducted using five databases (MEDLINE, SCOPUS, WEB OF SCIENCE, PSYCINFO and CINAHL) through to 01 October 2019. Due to heterogeneity of the data, meta-analyses were not possible. We screened 2577 studies, and 15 studies were included, representing 9116 participants, from six different countries. Five observational studies and four experimental studies showed associations between breaks in sitting time and cardiovascular health, i.e. an increased number of breaks in sitting time was negatively associated with a cardiovascular health outcome. No associations between number of breaks in sitting time and cardiovascular health outcomes were found in the six remaining studies. Studies examining associations between breaks in sitting time and cardiovascular health in children have shown some favorable associations. More epidemiological evidence is required, to inform lifestyle interventions and public health policies, which could translate into long-term implications on population health.

Adequate 25-hydroxyvitamin D levels are inversely associated with various cardiometabolic risk factors in Chinese children, especially obese children

ObjectiveVitamin D deficiency has recently evolved as a major public health issue worldwide. But the relationship between vitamin D and cardiovascular health in children remains unclear. Accordingly, we aimed to...

Cardiorespiratory responses to low-level ozone exposure: The inDoor Ozone Study in childrEn (DOSE)

BackgroundIndoor air pollution has emerged as a significant environmental and public health concern in recent years. However, evidence regarding the cardiorespiratory effects of indoor ozone is limited, and the underlying biological mechanisms are unclear, especially in children. Our study aimed to assess the cardiorespiratory responses to indoor ozone exposure in children. MethodsA repeated-measure study was conducted in 46 middle-school children in Beijing, China. Real-time concentrations of ozone, along with co-pollutants including particulate matter (PM) and black carbon (BC), were monitored in classrooms from Monday to Friday. Three repeated health measurements of cardiorespiratory functions, including ambulatory electrocardiogram (ECG), blood pressure, fractional exhaled nitric oxide (FeNO) and lung function, were performed on each participant. Mixed-effect models were used to evaluate the effects of indoor ozone exposure. ResultsThe mean (SD) indoor ozone concentration was 8.7 (6.6) ppb during the study period, which was largely below the current guideline and standards. However, even this low-level ozone exposure was associated with reduced cardiac autonomic function and increased heart rate (HR) in children. For instance, per interquartile range (IQR) increase in ozone at 2-hour moving average was associated with −7.8% (95% CI: −9.9%, −5.6%) reduction in standard deviation of all normal-to-normal intervals (SDNN), and 2.6% (95% CI: 1.6%, 3.6%) increment in HR. In addition, the associations were stronger at high BC levels (BC ≥ 3.7 μg/m3). No significant associations were found for airway inflammation and pulmonary function. ConclusionsExposure to low-level indoor ozone that is not associated with respiratory effects was significantly related to disturbed cardiac autonomic function and increased HR in children, which suggested a possible mechanism through which ozone may affect cardiovascular health in children, and indicated more protective measures should be taken to alleviate the acute adverse effects of indoor ozone in this susceptible population.

459-P: Risk for Type 2 Diabetes and Cardiovascular Health in Children Treated with Second-Generation Antipsychotics

Background: Second-generation antipsychotics (SGAs) are used to treat mental illness in children but have side effects including weight gain, dyslipidemia, hypertension, and risk for type 2 diabetes. These side effects are well-known risk factors for cardiovascular disease. However, little is known about the cardiovascular health of SGA-treated children. Methods: Cross-sectional study of children (aged 6-18 years) with mental illness that were SGA-treated (n=47) or SGA-naïve (n=37), and control children (n=83, no mental illness). Anthropometrics and a fasting blood sample were collected. Subclinical indicators of atherosclerosis were assessed. Central pulse-wave velocity (PWV) by standard M-mode echocardiography and Doppler tracing, an indicator of arterial stiffness, and carotid intima-media thickness (cIMT) were assessed. Results: SGA-treated children had greater BMI z-scores (p&amp;lt;0.001) and higher (p&amp;lt;0.001) prevalence of overweight/obesity (BMI ≥85th percentile for age and sex) than SGA-naïve and control children. SGA-treated children had higher fasting plasma insulin (p=0.016) and 21.7% had hyperinsulinemia (fasting insulin ≥100pmol/L) compared to 12.9% of SGA-naïve children. No differences in fasting glucose or circulating lipids were observed. Hypertension was observed in 14.9% of SGA-treated children, compared to 5.4% of SGA-naïve and 6.0% of control children. SGA-treated (p=0.002) and SGA-naive children (p&amp;lt;0.001) had higher PWV compared to controls (adjusted for age, sex, BMI, systolic blood pressure). No effect of SGAs or mental health diagnosis on cIMT was observed. Conclusion: Children with mental illness have greater arterial stiffness than control children. Disclosure A.M. Henderson: None. N. Islam: None. G.G. Sandor: None. C. Panagiotopoulos: Advisory Panel; Self; Dexcom, Inc. A.M. Devlin: None. Funding British Columbia Mental Health &amp; Substance Use Services

Healthy Body Weights With Corticosteroid-free Immunosuppression Is the Best Predictor of Cardiovascular Health in Children After Liver Transplantation.

Cardiometabolic dysregulation (CMD) influences morbidity and mortality risk in adults post-liver transplantation (LTx). CMD is reported in 10% to 25% of pediatric LTx recipients, but no information regarding the longitudinal expression of CMD is available. The study objective was to examine the longitudinal expression of CMD and associations with body composition and growth in children post-LTx. A retrospective review was conducted in youth (34 F/30 M) who underwent LTx between 1994 and 2015 at the Stollery Children's Hospital. Primary outcomes included serum markers of CMD (insulin, glucose, hemoglobin A1C [A1C], homeostasis model assessment for insulin resistance [abnormal >3], lipid panel triglycerides, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol) and systolic/diastolic blood pressure (BP: absolute/z scores). Mean (±SD) age, weight z, height z, body mass index z was 9.7 ± 3.4 years (3.5-17.9), 0.26 ± 1.03, 0.017 ± 1.2, and 0.41 ± 1.05, respectively. The majority of children had percentage fat mass, percentage fat-free mass within normal reference ranges. Systolic/diastolic BP was within healthy references ranges in 83.1% and 93.5% of children, respectively. Serum insulin (83.4%) and high-density lipoprotein-cholesterol (43.9%) concentrations were low, with abnormal findings of other laboratory markers found in <5% of participants. Abnormal findings for metabolic parameters were independent of weight z, body mass index z, fat mass, and corticosteroids but were positively related to child's age (>9.7 years) and fat-free mass (total, arms). Insulin levels decreased significantly in the first 4 years post-LTx, but no changes in lipid panel, A1C and glucose were noted over 10 years. Pediatric LTx recipients with healthy body weights and corticosteroid-free immunosuppression have a low expression of CMD over 10 years.

Cardiovascular Health in Children and Adolescents With Congenital Adrenal Hyperplasia Due to 21-Hydroxilase Deficiency.

Increasing evidence indicates that adults with Congenital Adrenal Hyperplasia (CAH) may have a cluster of cardiovascular (CV) risk factors. In addition, ongoing research has highlighted that children and adolescents with CAH are also prone to developing unfavorable metabolic changes, such as obesity, hypertension, insulin resistance, and increased intima-media thickness, which places them at a higher risk of developing CV disease in adulthood. Moreover, CAH adolescents may exhibit subclinical left ventricular diastolic dysfunction and impaired exercise performance, with possible negative consequences on their quality of life. The therapeutic management of patients with CAH remains a challenge and current treatment regimens do not always allow optimal biochemical control. Indeed, overexposure to glucocorticoids and mineralocorticoids, as well as to androgen excess, may contribute to the development of unfavorable metabolic and CV abnormalities. Long-term prospective studies on large cohorts of patients will help to clarify the pathophysiology of metabolic alterations associated with CAH. Meanwhile, further efforts should be made to optimize treatment and identify new therapeutic approaches to prevent metabolic derangement and improve long-term health outcomes of CAH patients.

Childhood health motivation and adult cardiometabolic health in the Childhood Determinants of Adult Health (CDAH) study.

This research examined if childhood health motivation was associated with adult health behaviors and objectively measured health outcomes. Data were from the Childhood Determinants of Adult Health study. Children aged 9 to 15 years in 1985 completed a questionnaire with health motivation items. In 2004-2006, when aged 26 to 36, participants completed assessments of health behaviors (smoking, diet, alcohol consumption, and physical activity) and cardiometabolic outcomes (body mass index, carotid intima-media thickness from ultrasound, and HOMA insulin resistance from fasting blood samples). Structural path regression analyses examined pathways from health motivation in childhood to adult cardiometabolic outcomes, mediated via adult health behaviors measured concurrently, controlling for age, sex and socioeconomic position. There were 6,230 (49% female) children with data on health motivation. There were two latent constructs: health motivation (4 items: visiting a dentist, visiting a doctor, knowing about your body, and eating a good diet) and risk motivation (3 items: not being a smoker, not being fat, and not drinking alcohol). Greater health motivation was directly associated with nonsmoking, lower carotid intima-media thickness, and lower body mass index in adulthood. Greater risk motivation was directly associated with smoking, higher alcohol consumption, and poorer diets in adulthood. It was also indirectly associated with higher carotid intima-media thickness and higher HOMA insulin resistance via poorer health behaviors. Health motivation during childhood appears important to maintain health across the life course. It could be a target for interventions to improve cardiovascular health in children and adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Partial Clinical Remission of Type 1 Diabetes Mellitus in Children: Clinical Applications and Challenges with its Definitions

The honeymoon phase, or partial clinical remission (PCR) phase, of Type 1 diabetes mellitus (T1DM) is a transitory period that is marked by endogenous insulin production by surviving β cells following a diabetes diagnosis and the introduction of insulin therapy. It is a critical window in the course of the disease that has short and long-term implications for the patient, such as a significant reduction in the risk of long-term complications of T1DM. To promote long-term cardiovascular health in children with newly diagnosed T1DM, three key steps are necessary: the generation of a predictive model for non-remission, the adoption of a user-friendly monitoring tool for remission and non-remission, and the establishment of the magnitude of the early-phase cardiovascular disease risk in these children in objective terms through changes in lipid profile. However, only about 50% of children diagnosed with T1DM experience the honeymoon phase. Accurate and prompt detection of the honeymoon phase has been hampered by the lack of an objective and easily applicable predictive model for its detection at the time of T1DM diagnosis, the complex formulas needed to confirm and monitor PCR, and the absence of a straightforward, user-friendly tool for monitoring PCR. This literature review discusses the most up-to-date information in this field by describing an objective predictive model for non-remission, an easy tool for monitoring remission or non-remission, and objective evidence for the cardiovascular protective effect of PCR in the early phase of the disease. The goal is to present non-remission as an independent clinical entity with significantly poorer long-term prognosis than partial remission.

Abstract P053: The Frequency of High Glycemic Load Meals is Predictive of Cardiovascular Risk Factors in Children at Risk for Obesity After 2 Years

Introduction: Consuming a daily diet of high glycemic load (GL) carbohydrates has potential long-term effects on obesity and cardiovascular health. However, it is possible that the GL of certain meals (breakfast, lunch and supper) have different effects. Few studies have examined the effect of meal-specific GL and frequency of high GL meals on adiposity and cardiovascular health in children. We hypothesized that the number of high GL meals per day, and secondarily, the meal-specific GL, would predict cardiovascular risk factors in children after two years of follow-up. Methods: We used data from the QUALITY cohort which recruited 630 children, ages 8-10 years at baseline with at least one obese parent. Three separate 24-hour dietary recalls were administered by a dietitian at baseline and individual meal-specific GL scores were calculated using the International table of GI. CV risk factors measured at 2 years of follow-up included continuous values of BMI z-score, percent fat mass, triglycerides, LDL and HDL cholesterol, and systolic (SBP) and diastolic (DBP) blood pressure obtained through direct measurement (blood pressure, blood lipids, anthropometrics) or questionnaires (socio-economic characteristics). Linear regressions between meal-specific GL categorized as high ( 2 33) vs. low (&lt;33) and CV risk factors were estimated, adjusting for important confounders, including underreporting, as well as anthropometric, socio-economic and dietary factors. Secondary analysis consisted of linear regression with number of high GL meals as an ordinal exposure variable. Results: Mean age at baseline was 9.6 years, with 33% of children overweight or obese. Breakfast, lunch and supper glycemic load were positively associated with each other. A higher number of high GL meals was positively associated with BMI z-score (β=0.18, 95%CI: 0.06, 0.30), percent fat mass (β=1.74, 95%CI: 0.52, 2.96) and triglycerides (β=0.08, 95%CI: 0.03, 0.14) and negatively associated with HDL (β=-0.04, 95%CI: -0.07, -0.01). Our secondary analysis revealed that High breakfast GL was positively associated with increased triglycerides (β=0.14, 95%CI: 0.05, 0.23) after 2 years but not adiposity, HDL, LDL and blood pressure. High GL lunch (β=0.27, 95%CI: 0.08, 0.46) and supper (β=0.22, 95%CI: 0.02, 0.41) were associated with higher BMI z-score after 2 years. Conclusion: In conclusion, consuming more than one high GL meal per day is associated with greater BMI and unhealthy lipid profile after 2 years.

Postnatal growth in children born small for gestational age with and without smoking mother.

Maternal smoking impairs fetal growth; however, if postnatal growth differs between children born small for gestational age (SGA) with smoking and non-smoking mother is unknown. Cohort-study of term born children born appropriate for gestational age with non-smoking mother (AGA-NS, n = 30,561), SGA (birthweight <10th percentile) with smoking mother (SGA-S, n = 171) or SGA with non-smoking mother (SGA-NS, n = 1761). Means of height and weight measurements, collected at birth, 1.5, 3, 4, and 5 years, were compared using a generalized linear mixed effect model. Relative risks of short stature (<10th percentile) were expressed as adjusted risk ratios (aRR). At birth, children born SGA-S were shorter than SGA-NS, but they did not differ in weight. At 1.5 years, SGA-S had reached the same height as SGA-NS. At 5 years, SGA-S were 1.1 cm taller and 1.2 kg heavier than SGA-NS. Compared with AGA-NS, SGA-S did not have increased risk of short stature at 1.5 or 5 years, while SGA-NS had increased risk of short stature at both ages; aRRs 3.0 (95% CI 2.6;3.4) and 2.3 (95% CI 2.0;2.7), respectively. Children born SGA-S have a more rapid catch-up growth than SGA-NS. This may have consequences for metabolic and cardiovascular health in children with smoking mothers.

What Do We Know about Diet and Markers of Cardiovascular Health in Children: A Review.

Chronic diseases such as cancer, diabetes, and cardiovascular diseases (CVD) are the main health concerns in the 21st century, with CVD as the number one cause of mortality worldwide. Although CVD hard endpoints such as stroke or heart attack do not usually occur in children, evidence shows that the manifestation of CVD risk factors begins in childhood, preceding clinical complications of CVD in adulthood. Dietary intake is a modifiable risk factor that has been shown to make a substantial contribution to the risk of CVD in adulthood. However, less is known about the association between dietary intake and markers of cardiovascular health in children. This review summarises the current evidence on the relationship between dietary intake and markers of cardiovascular health including traditional CVD risk factors, physical fitness, and indices of arterial stiffness and wave reflection in children. Original research published in English, between January 2008 and December 2018 fulfilling the objective of this review were screened and included. Findings show that adaptation of a healthy lifestyle early in life can be beneficial for reducing the risk of CVD later in life. Furthermore, keeping arterial stiffness low from a young age could be a potential CVD prevention strategy. However, limited studies are available on diet-arterial stiffness relationship in children, and future research is required to better understand this association to aid the development and implementation of evidence-based strategies for preventing CVD-related complications later in life.

Cardiovascular health in urban Chinese children and adolescents

Introduction: Cardiovascular diseases remain the leading cause of death and disease burden in China and worldwide. We aimed to evaluate the status of cardiovascular health among urban Chinese children and adolescents.Methods: We conducted a cross-sectional study comprising 12,618 children and adolescents aged 6–18 years, who were recruited from Chinese urban areas during 2013–2015. The poor, intermediate, and ideal levels of 7 cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, blood glucose, and total cholesterol were defined according to revised American Heart Association criteria.Results: Ideal smoking status was the most prevalent health component (overall, 90.7%; males, 86.3% and females, 95.4%), whereas ideal health diet score (overall, 8.7%; males, 9.1% and females, 8.3%) was the least prevalent among urban Chinese children and adolescents. The majority (overall, 84.9%; males, 82.6% and females, 87.4%) of participants had 3–5 ideal metrics. The overall prevalence of ideal cardiovascular health (i.e. meeting all 7 ideal components) was extremely low (overall, 0.5%; males, 0.5% and females, 0.4%).Conclusions: The prevalence of ideal cardiovascular health in urban Chinese children and adolescents is extremely low, particularly for physical activity and healthy dietary intake. Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk.Key messagesIdeal health diet score was the least prevalent health component among urban Chinese children and adolescentsThe prevalence of ideal cardiovascular health in urban Chinese children and adolescents was extremely lowEffective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk

Preserving Optimal Cardiovascular Health in Children.

The origins of cardiovascular disease are at the beginning of life, and national guidelines recommend evaluation for cardiovascular risk factors such as obesity and hypertension as part of general pediatric care. In this review, a simple plan is proposed for clear and consistent monitoring and messaging throughout childhood, based on the American Heart Association's "cardiovascular health" construct. A framework is provided for age-appropriate scoring of the cardiovascular health components, including diet, physical activity and screen time, sleep, smoking exposure, body mass index, blood pressure, cholesterol, and glucose. Guidance is provided for evidence-based, efficient intervention by pediatric clinicians to preserve or restore cardiovascular health. Finally, anticipated near-term advances in pediatric cardiovascular health promotion are previewed. [Pediatr Ann. 2018;47(12):e479-e486.].

Secular trends of cardiovascular health in children and adolescents in Germany (KiGGS Study)

Secular trends of cardiovascular health in children and adolescents in Germany (KiGGS Study)

Secular trends of cardiovascular health in children and adolescents in Germany (KiGGS Study)

Secular trends of cardiovascular health in children and adolescents in Germany (KiGGS Study)

Impact of Ideal Cardiovascular Health in Childhood on the Retinal Microvasculature in Midadulthood: Cardiovascular Risk in Young Finns Study

BackgroundThis study examined the association between ideal cardiovascular health (CVH) and the retinal microvasculature in midadulthood.Methods and ResultsThe Cardiovascular Risk in Young Finns Study included children from 5 Finnish University cities, who were chosen randomly from the national population register. Participants ranged from 12 to 18 years in childhood (1986) and from 37 to 43 years in midadulthood (2011). Ideal CVH was defined according to the American Heart Association criteria. Retinal microvascular measures included diameters, lengths, length:diameter ratio, and tortuosity. From childhood to adulthood, fasting plasma glucose and blood pressure were significantly higher in those with impaired fasting glucose or diabetes mellitus. Childhood ideal CVH was negatively associated with adult arteriolar tortuosity (β=−0.008; 95% confidence interval [CI], −0.01 to −0.003; P=0.001). Improved ideal CVH from childhood to adulthood was positively associated with adult arteriolar diameter (β=0.122; 95% CI, 0.01–0.24; P=0.033) and negatively associated with adult length:diameter ratio (β=−0.666; 95% CI, −1.25 to −0.08; P=0.026). When stratified by glucose metabolism, among those with diabetes mellitus and impaired fasting glucose, there was a negative association between childhood ideal CVH and adult venular diameter (diabetes mellitus: β=−2.75; 95% CI, −5.46 to −0.04; P=0.047; impaired fasting glucose: β=−2.13; 95% CI, −4.18 to −0.08; P=0.042).ConclusionsThis study is the first to comprehensively examine the impact of CVH from childhood to midadulthood on quantitative measures of the retinal microvasculature. Ideal CVH in childhood and improvement in CVH from childhood to adulthood appears to have a protective effect on the retinal microvasculature in those with, without, and at risk of diabetes mellitus.