You Can Fix The Fat From Childhood promotes family-focused comprehensive knowledge and behaviors with an eye toward preventing early disability and death from heart disease. Heart disease risk factors "show" in early childhood. Learning to adopt healthy lifestyles - that's prevention! Health doesn't come in a bottle, and you cannot buy it in a drug store or at the supermarket! You have to work at it. Slim, trim, toned, and fit - desired "look" not easy but achievable! Decide to tackle the fat: prevent it, control it, exercise it. We can fix the fat! Dr. Shiriki Kumanyika, associate dean at University of Pennsylvania School of Medicine, said on the acclaimed HBO special, "The weight of the nation is out of control, but we can fix that"
YOU CAN FIX THE FAT FROM CHILDHOOD & Other Heart Disease Risks, Too
By Gerald S. Berenson NancyKay Sullivan WessmanAuthorHouse
Copyright © 2012 Gerald S. Berenson, MD
All right reserved.ISBN: 978-1-4772-5785-2Contents
Preface............................................................................xiiiIntroduction.......................................................................xvChapter One The Bogalusa Heart Study..............................................1Chapter Two Heart disease starts in childhood – really!.....................7Chapter Three What we know about risk factors.....................................16Chapter Four Obstacles to achieving good health...................................39Chapter Five Your roadmap to better health........................................45Chapter Six Positive choices pay big rewards......................................57Chapter Seven Feasting on nutritious food – or not..........................63Chapter Eight Kid Fit: Engage and enjoy physical activity.........................76Chapter Nine How to cope, like yourself, manage stress............................86Chapter Ten Arnold's story: learn from him........................................93Chapter Eleven Pitfalls can hamper good intent, behavior..........................99Conclusion.........................................................................103Appendix About Health Ahead/Heart Smart...........................................105About the authors..................................................................127Glossary...........................................................................131Resources..........................................................................135
Chapter One
The Bogalusa Heart Study
In 1972, the Bogalusa Heart Study (BHS, Bogalusa, Louisiana) was identified at Louisiana State University (LSU) Medical Center as a national Specialized Center of Research (SCOR). The United States Congress had mandated the National Institutes of Health to establish SCORs to investigate major causes of cardiovascular disease: atherosclerosis — a generic term for heart and vascular changes, hypertension, pulmonary disease, strokes, and thrombosis.
Bogalusa Heart Study is the only long-term, cardiovascular, community research program in the world in which both African-American and Caucasian individuals have consistently participated from early childhood through adulthood and middle life. The Study encompassed clinical, epidemiologic, and experimental programs on atherosclerosis, essential hypertension, and diabetes as they related to later coronary and hypertensive heart diseases – and also how these begin in childhood. Before, no comprehensive examination of all children in a total biracial (black and white) community had been undertaken with this detail.
Louisiana and Washington Parish
The Study – which began at LSU School of Medicine in 1972 and moved to become the flagship Tulane University Center for Cardiovascular Health, Disease, and Prevention in 1991 – brought together a highly skilled and trained, multi-disciplinary team of anthropologists, biochemists, cardiologists, epidemiologists, geneticists, nurses, nutritionists, psychologists, sociologists, statisticians, and – finally – school teachers. They worked together to study hereditary and environmental aspects of early coronary artery disease (CAD), hypertension, and diabetes. Funding for the research came from the National Heart, Lung, and Blood Institute, the National Institute for Child Health and Human Development, the National Institute of Aging, and the American Heart Association – basically from taxpayers like you and volunteers.
The Bogalusa Heart Study focus was to understand the early natural history of coronary artery disease (atherosclerosis or hardening of the arteries), essential hypertension (high blood pressure), and diabetes mellitus (abnormally high glucose levels in the blood). Our researchers aimed to address these questions in designing and beginning the Study of children five to 17 years. As time allowed in the research, the ages were extended to both and recently to 45 years of age to look at aging and longevity. More information is available at www.tulane.edu/som/ cardiohealth.
Researchers had four fundamental questions that guided the beginning of the BHS.
• What is the distribution and prevalence of cardiovascular risk factors in children? How are risk factors defined in childhood? What levels of risk factor variables in children are abnormal? We now know a lot about the normal and abnormal levels, how they are measured, and how they produce a life-long burden on the cardiovascular system, importantly beginning in childhood.
• What are the interrelationships of risk factors during childhood? Are the relationships similar to those in adults – for example, does obesity relate to hypertension? How do the risk factor observations relate to a child's family history? We now know the risk factors interrelate; obesity is the main culprit, and a family history is very important, as are lifestyles and health behaviors. As you will see, this interrelation is the basis of the metabolic syndrome – the apple, poor body configuration.
• What are the time-course changes of risk factors in children? What are trends during children's growth phases? Are the risk factor levels during childhood predictive of future levels? First of all, risk factors in children do predict those in adulthood; they "track" – high and low levels tend to persist, and they change with growth periods of early childhood, at puberty and adolescence, and in adulthood. Thus, we look at percentiles at different ages and for boys and girls – like the 5th percentile or 95th percentile, which can be abnormal. "Cut points," specific or selected high or low levels from adult heart disease studies, don't apply to growing children. Now we are looking at aging and longevity, and some of our children (500) have died.
• What determines risk factors in children? Simply, why do some children have high levels of risk factors while others have low levels? What is the extent of genetic and environmental determinants? We suffer through or are gratified by having a good genetic (familial) background, but we all have to relate to our environment and respond by lifestyles we choose.
The basis of our Study is genetics versus environment – read on.
The BHS took a look at increasing obesity and "superobesity" (morbid obesity) among youngsters in the early 1980s – two decades before most people observed the bulge. Even then, America's children were growing fatter, not fitter.
Now CDC calls the problem "common, serious, and costly," about $150 million a year by 2010. That's a hefty price to pay – a huge part of the country's public health and medical dollars going to a human difficulty that can be both predicted and prevented.
We know – we have observed and we have proved in the BHS – that obesity and other major causes of adult heart disease begin in childhood. And we know from a Dutch philosopher's proclamation some 500 years ago and restated by Benjamin Franklin in the 18th century that prevention costs less than cure.
Think back to your own child's earliest days – or infants in general.
Do you remember your child's birth – how absolutely amazed you were to hold such a tiny creature, complete with 10 fingers and 10 toes? Suddenly, the rest of the world simply stopped. That special moment included only you and your baby.
Time could not freeze that moment, however; so you and your child began a journey of teaching and learning from each other. Your child was as risk-free then as he or she would ever be – and we can help children stay that way if we start heart-healthy training from the cradle.
Most newborn babies come into the world healthy.
More than four million infants are born each year, and only a very small percentage suffers heart defects or other diseases. Even so, a staggering 90 percent will develop some aspect of heart and vascular disease.
Using research findings and the closely related comprehensive health promotion program called "Health Ahead/Heart Smart," this book focuses on helping families avoid heart disease. You and individual family members can choose to take responsibility for your own good health and for the health of your children.
Books and other material resources about health and growing up to live healthy abound. Many physicians, scientists, public health experts, pop-culture authors, and would-be authorities write books and articles on nutrition and dietary recommendations. The Internet continues to offer ever more options on how individuals can avoid unhealthy risk factors. Advertisers tempt with quick fixes, often including special diets, nutrition plans, and "the magic bullet." Many people believe that information is accurate and will work. But that is not always the case.
If risk factors are uncontrollable, then the doctors need to address the problem. We now have marvelous drugs, and we are learning how to use them for children, if needed. The focus should be not only on adults but also on pre-school, kindergarten, and school-age children.
Observations made over the past 40 years in the BHS clearly show that children manifest "silent" evidence of adult heart disease. Believe it; it's real. Kids with hypertensive heart disease is common – not just a special occurrence but part of early life, maybe 5 to 10 percent. High serum total cholesterol, high blood pressure, obesity, and tobacco use occur in the early years of life and are predictive of future adult illnesses. By the year 2030, unless drastic lifestyle changes occur in homes across the country, heart disease will claim 1.5 million of today's children in the U.S. each year.
The idea that cardiovascular risk factors are detectable in childhood and, therefore, predictive of future risk clearly sets the stage for developing prevention programs at young ages. Yes, prevention programs.
Serious risk factors include high cholesterol, the various lipoprotein cholesterols (the good and the bad), high blood pressure, obesity, and aberrations of sugar and insulin metabolism.
Arteriosclerosis includes atherosclerosis (coronary, cerebral, and other vessels in the body) and the cardiovascular system changes related to high blood pressure, with diabetes accelerating both. Diabetes involves changes on very small blood vessels, even in the eyes and kidneys. All these diseases have different and some overlapping changes in the heart and blood vessels, which keep scientists busy and trying to understand how they occur. We are learning more all the time; your concern is to achieve a lifestyle that will prevent or delay them from occurring and also to help your children to grow up healthy.
Atherosclerosis refers to the cholesterol, good and bad lipoproteins, clotting, and causing fibrous changes to occur in blood vessels – coronary vessels that supply the heart, the kidney, the brain, and special vessels or arteries all over the body. Hypertension is the pressure inside blood vessels – not hyper-tension, excitement, or anxiety under usual day-to-day conditions but rather tension or blood vessel physical stress that occurs with each heartbeat. Diabetes is an imbalance of sugar being metabolized by cells and how insulin and other hormones work.
And all this begins in childhood, especially with obesity and a family history of diabetes. This is serious, demanding attention and action now.
Chapter Two
Heart disease starts in childhood – really!
After 40 years of heart-related research focused on the people in one small community, the question often comes: "What have you learned?" This is it!
Almost everyone has heard a variation on the story of a man who goes for a physical examination, passes with flying colors, and then dies of a heart attack on his way home.
And women? Heart diseases claim women, too – more than 35 percent of American women's deaths link to cardiovascular disease. At older ages, women suffer more heart attacks than men, in part because more men have died off.
Every year, 450,000 seemingly healthy Americans die suddenly from massive heart attacks that strike with no warning. In 2004, some 654,000 U.S. citizens – 222.7 per 100,000 people – died of heart disease. Many of the victims never had any inkling that their arteries were clogged and their hearts in mortal danger. Some 50 percent are classified as "sudden death" victims because they do not get to the hospital before dying. Fortunately, emergency programs, CPR training, and emergency defibrillators even at airports and in classrooms are becoming available to address this problem.
Some people worry needlessly about heart trouble when the real cause of their chest pain might be nothing more than indigestion or a pulled muscle. Chest pain might also signal another condition – gall bladder disease or pleurisy, with inflammation of the lining of the lung that can follow a viral infection.
Absent a set of definitive guidelines for diagnosing heart disease, few if any can predict precisely when, how, and why heart attacks occur. No single "thing" causes heart disease. No bacteria, no virus can be directly charged as responsible for atherosclerosis or hypertension. Heart attacks remain non-contagious. But they happen so oft en, heart disease is epidemic — and the subtle process begins in childhood. Heart disease has replaced infectious diseases as the whole world's number one killer.
Additionally, research shows that many victims of heart disease experience low blood flow to the heart – called ischemia – and might feel no pain.
While one episode of ischemia can cause little or no damage to the heart muscle, repeated episodes can lead to fatal heart attacks. Ischemia can occur at any time – when an individual is reading, talking, or even just sitting on the front porch petting the dog. The chest pain called angina pectoris, which might equate with heart disease, appears to be a relatively late sign of coronary artery disease. Classically, it does occur with physical activity, a heavy meal, or anxiety and disappears with rest. We BHS researchers learned that autopsies of young individuals dying from traumatic events – mostly, automobile crashes – already show the atherosclerotic disease in coronary vessels, but chest pain does not occur until after significant blockage of the coronary vessel has happened or from blood clotting in the vessel initiated by an atherosclerotic lesion.
Individuals should not begin to worry that their hearts are having a heart attack in silence. One should pay more attention to health and have a profile by professionals.
Bad choices cost too much
A popular news magazine, reporting results of yet another university study, announced that the top killer in America is individuals making dumb decisions to "engage in self-destructive behavior." Such decisions as drinking and driving can result in vehicular deaths; refusing to curb spending and sinking into ever deeper debt can lead to stress, strokes, and lifelong disability; over-eating, not exercising, and consuming non-nutritious food can lead to obesity, diabetes, and heart disease.
Such huge numbers of people related to chronic disease strain the brain's comprehension of the cost. Health organizations estimated in 2008 that the cost of cardiovascular diseases and stroke in the United States was near to $448.5 billion; diabetes alone costs the nation $218 billion a year. Beyond, consider the cost for emotional pain to families.
Those numbers fail to consider the human costs: the pain and suffering from the disease itself plus the social stigmatization and depression often associated with poor health, particularly obesity and cardiovascular disease. What a challenge!
Positive choices pay big rewards
Researchers believed that by studying an entire free-living young population, before disease becomes obvious, we could learn how to influence the early natural course of various forms of heart disease. Our findings show the early natural histories of essential hypertension and coronary artery disease vary with both race and gender, and those variations account for some of the differences observed in clinical heart disease in adults.
Hypertension, for example, occurs much more frequently and more severely in black people, yet white males experience more coronary heart disease events (heart attacks) at an earlier age. Black people tend to have more diabetes, and black females experience more severe obesity and more diabetes, beginning even before adolescence.
While social and cultural differences play a role, clues about black people's having more hypertension and white men's having more coronary artery disease obviously relate to underlying genetic susceptibility influenced by environmental factors. Diet and physical activity or cigarette smoking, to which individuals are exposed over time, interact with an individual's intrinsic makeup.
The environmental factors affect clinical risk factors in adults, but do they influence the development of risk factors from childhood? Can we diagnose coronary atherosclerotic lesions in childhood? Can we diagnose hypertension in childhood — can we diagnose hypertensive disease of target organs affected by high blood pressure, such as an enlarged heart, changes in kidney or blood vessels?
Yes – yes to all those questions.
We also know diet and socioeconomic factors are important and need to be considered. Social diversity also plays a part. Attitudes toward health and lifestyles of healthy or unhealthy behaviors affect risk, so encourage your family to develop good attitudes early!
The concept that cardiovascular risk factors can be detected in childhood and, therefore, might predict future risk clearly sets the stage childhood and, therefore, might predict future risk clearly sets the stage for developing prevention programs at young ages. Although medical and clinical consequences appear only later in life, the mechanisms that lead to atherosclerosis, hypertension, diabetes, and the metabolic syndrome of insulin resistance become obvious in childhood. Don't give up; we will explain some of the terms, and we provide a glossary.
Scientists still do not know the precise initiating factors, but because physicians can identify the earliest determining factors that establish the characteristics of the disease, young people can come closer to actually delaying or preventing heart disease.
(Continues...)
Excerpted from YOU CAN FIX THE FAT FROM CHILDHOOD & Other Heart Disease Risks, Tooby Gerald S. Berenson NancyKay Sullivan Wessman Copyright © 2012 by Gerald S. Berenson, MD. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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