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Background: An understanding of the relation in adolescents between serum homocysteine and foods rich in vitamin B-6, vitamin B-12, and folate is important because high homocysteine concentrations in childhood and adolescence may be a risk factor for later cardiovascular disease. However, little is known about the relation between food intake and homocysteine in adolescents. Objective: Five years after national folic acid fortification of enriched grain products, cross-sectional relations between food intake and sernm homocysteine concentrations were examined in 2695 adolescents [barx] age: 18.3 (range: 15-20) y] enrolled in the Child and Adolescent Trial for Cardiovascular Health. Design: A nonfasting blood specimen was analyzed for serum homocysteine, folate, and vitamins B-6 and B-12. Dietary intake was assessed by using a food-frequency questionnaire. Multiple regression analyses were used to evaluate the relation of intakes of whole grains, refined grains, fruit, vegetables, dairy products, red and processed meats, and poultry with serum homocysteine concentrations after adjustment for demographic characteristics, lifestyle factors, and food intake. Results: Serum homocysteine concentrations were lower with greater intakes of whole grains (P for trend = 0.002), refined grains (P for trend = 0.02), and dairy foods (P for trend Conclusion: These observational findings suggest a beneficial effect of whole-grain, refined-grain, and dairy products on serum homocysteine concentrations in an adolescent population. KEY WORDS Homocysteine, serum folate, cardiovascular disease, adolescents, food groups, whole grain

The goal of the study was to determine whether overweight or overfatness were predicted from sex, race or ethnicity, school site, and intervention or control status for children who were 9 y old at the outset of the Child and Adolescent Trial for Cardiovascular Health (CATCH). In this ethnically and geographically diverse group of 5106 students, height, weight, and triceps skinfold thickness were measured at 9 (baseline) and 11 y (follow-up) of age. The strongest predictors of status at follow-up were baseline overweight (odds ratio: 69.0; 95% CI: 54.9, 96.3) and overfatness (odds ratio: 27.4; 95% CI: 22.4, 33.4); site, African American race or ethnicity, and male sex were also significant independent associations. Children in the overweight ([is greater than] 85th percentile for body mass index) group had significantly higher adjusted means for total blood cholesterol, higher apolipoprotein B concentrations, lower mean HDL-cholesterol concentrations, and lower performance on the 9-min run than those in other groups ([is less than] 15th, 15-49th, or 50-85th body mass index percentiles). Similar results were found for these factors for those subjects with greater triceps skinfold-thickness measurements. Groups of children who were overweight and overfat at baseline were more likely to be overweight and overfat at follow-up and to have more cardiovascular risk factors than their peers. Am J Clin Nutr 1998;67:602-10.

Objective: To assess whether circulating insulin is a major contributor to adverse lipid profiles during the transition from adolescence to young adulthood. Methods: The association between fasting insulin levels and serum lipid and lipoprotein levels was examined in a cross-sectional survey of 4136 young individuals aged 5 to 30 years from a biracial community. Results: Fasting insulin levels were strongly and positively correlated with serum triglyceride and very-low-density lipoprotein cholesterol levels and negatively correlated with high-density lipoprotein cholesterol levels in all age groups (5 to 11, 12 to 17, 19 to 24, and 25 to 30 years). An increasing impact of insulin level on low-density lipoprotein cholesterol level was observed in young adults aged 25 to 30 years. In multivariate analysis, fasting insulin level was associated with very-low-density lipoprotein cholesterol level for most of the age groups in both races independently of age, sex, glucose levels, obesity, cigarette smoking, and alcohol intake. The independent relationship to low-density lipoprotein cholesterol level persisted in young adults aged 25 to 30 years. The independent and negative association with high-density lipoprotein cholesterol level remained in whites aged 5 to 24 years and blacks aged 19 to 24 years. When individuals were divided into tertiles according to insulin concentration and subscapular skinfold thickness, the independent effect of insulin level and obesity on lipoprotein fractions was also noted. Furthermore, a stronger association of insulin level with lipoprotein fractions was observed in obese than in lean white males. Conclusions: These data indicate that an increasing association of insulin levels with adverse lipoprotein levels in young adults, especially obese individuals, may have adverse consequence for adult cardiovascular diseases.

Dietary intakes of 10-y-old children were examined in six cross-sectional surveys to observe secular trends in energy, macronutrient, cholesterol, sodium, and fatty acid intakes. Total energy intake remained unchanged from 1973 to 1988; however, when expressed as energy/kg body wt, intake decreased from 275.1 kJ (65.5 kcal) in 1973 to 254.9 kJ (60.7 kcal) in 1988 because children's weight increased. Linear trends over this time period were also noted for total fat (negative), saturated fatty acid (negative), polyunsaturated fatty acid (positive), dietary cholesterol (negative), and sodium intake (positive). There was a significant increase in percent energy from protein and carbohydrate and a significant decrease in percent energy from fat, primarily saturated and monounsaturated fatty acids. An apparent increase over time is noted in the percent of children meeting dietary recommendations for total fat, saturated fatty acid, and cholesterol. Yet, few children meet the prudent diet recommendations.

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

An ongoing study of young people in Bogalusa, Louisiana, is assessing at what ages various heart disease risks appear. Since both obesity and high blood cholesterol levels are associated with an increase in the risk of heart disease, the study subjects were followed over several years, with attention focused on their weights and the blood levels of cholesterol. The ages studied were 5 to 10 years, 11 to 16, 17 to 22, and 23 to 26. A significant number of young people in each age group were found to be overweight, when compared with standard suggested weights for their heights. White males were more overweight than black males, and black females were more overweight than white females. Blood cholesterol levels were found to increase with age. Cholesterol is composed of several subgroups, including high density lipoprotein, HDL, which is protective against heart disease, and low density lipoprotein and very low density lipoprotein (LDL and VLDL), both of which are associated with greater risk of heart disease, when present at elevated levels. Increasing levels of obesity were associated with increasing levels of LDL and VLDL cholesterol, particularly in the older age groups. HDL levels dropped with increasing obesity. Thus, risk factors for cardiovascular disease that are associated with obesity appear to begin in childhood, reinforcing the need to reduce the rate of obesity among children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Elevation of low-density lipoprotein cholesterol (LDL-C) is a major risk factor for cardiovascular disease in adults. Decreases in LDL-C levels resulting from behavioral changes correlate with decreased deaths from cardiovascular disease; this is the rationale for cholesterol screening. Childhood LDL-C levels also correlate well with the subsequent development of cardiovascular disease. Total cholesterol is used as a marker for LDL-C levels in adults, but is less effective in screening children. An alternative to measuring total cholesterol is measuring apolipoprotein B (apo B), which is the major protein contained in LDL-C. The value of apo B measurement as a screening tool was evaluated a study of 2,850 children aged 5 to 17 years. Half of the children were female, and 36 percent were black. Apo B levels correlated well to LDL-C levels for all race and gender groups, and inaccurate results similar to those from total cholesterol screenings were not observed. Although the apo B test might cost more, it would still be a less expensive screening strategy for children than measuring total cholesterol level because it is more accurate. With further study, measurement of apo B and other apolipoproteins could become superior screening tests for children who are at risk for cardiovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

A study was conducted to assess girls' physical activity in middle school physical education relating to field site, lesson context and location, teacher gender and class composition. This identified the areas where improvement is needed and possible in conduct of physical education including modifying curricular content, allocating additional lesson time to more activity promoting fitness, improving managerial efficiency and increasing teacher promotion of physical activity.

Objective: To assess differences through grade 8 in diet, physical activity, and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) school and family intervention from grades 3 through 5. Design: Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools. Participants: We studied 3714 (73%) of the initial CATCH cohort of 5106 students from ethnically diverse backgrounds in California, Louisiana, Minnesota, and Texas at grades 6, 7, and 8. Results: Self-reported daily energy intake from fat at baseline was virtually identical in the control (32.7%) and intervention (32.6%) groups. At grade 5, the intake for controls remained at 32.2%, while the intake for the intervention group declined to 30.3% (P[is less than] .001). At grade 8, the between-group differential was maintained (31.6% vs 30.6%, P =.01). Intervention students maintained significantly higher self-reported daily vigorous activity than control students (P = .001), although the difference declined from 13.6 minutes in grade 5 to 11.2, 10.8, and 8.8 minutes in grades 6, 7, and 8, respectively. Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions, but not for social support for physical activity. No impact on smoking behavior or stages of contemplating smoking was detected at grade 8. No significant differences were noted among physiologic indicators of body mass index, blood pressure, or serum lipid and cholesterol levels. Conclusion: The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors. This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors. Arch Pediatr Adolesc Med. 1999;153:695-704, Increasing school-based exercise, improving the nutritional value of school cafeteria food, and teaching young students about healthy habits can effectively and persistently improve the diet and reduce cardiovascular disease risk factors in children. Researchers compared 3,714 students in grades 6-8 in 56 schools that participated in the student health intervention and 40 schools that did not (control group). Prior to the intervention, students ate about 33% of their daily calories as fat. By grade 8, students in the intervention schools ate only about 31% calories as fat, while students in the control schools did not significantly change their eating. Students in the intervention schools also vigorously exercised more often than students in the control schools.

The latest research on health effects of obesity shows that the location and distribution of fat in an overweight person is important; risk for certain diseases is higher with specific fat patterns. Regardless of the total degree of overweight, truncal (upper-body) obesity has been linked to diabetes and coronary heart disease in adults. But few studies have examined fat distribution in children and adolescents. A group of 361 children aged 6 to 18 who had either unusually low or unusually high levels of very-low- density-lipoprotein (VLDL) cholesterol and low-density-lipoprotein (LDL) cholesterol were studied. Measurements included waist circumference and skinfold thicknesses on the back, abdomen, arms and legs; skinfolds are measured with a caliper that pinches the fat under the skin. Regardless of how obese they were, children with greater fat deposits in the trunk and less fat in the limbs had higher blood levels of both types of cholesterol than children with the opposite fat pattern. A truncal fat distribution was also linked to lower levels of high-density-lipoprotein (HDL) cholesterol; studies have suggested that low HDL levels may increase the risk for coronary heart disease. Thus assessment of body fat distribution in children and adolescents may help predict their risk of developing hyperlipidemia (elevated blood lipids such as cholesterol) in later life. The authors noted that the results are most likely applicable to the general population, even though the subjects were not randomly selected.

Hypercholesterolemia, high blood cholesterol, can cause cardiovascular disease. Abnormal lipid (fat) and lipoprotein levels found during childhood often persist into adulthood. However, if these risk factors are identified during childhood, early intervention may help prevent cardiovascular disease. To determine whether family history of heart disease is related to abnormal lipid and lipoprotein values in children and whether such a history can reliably predict the presence of abnormal values, 3,313 children were evaluated. It was found that older children (11 to 17 years old) born of white parents that had experienced a heart attack or had diabetes were 4.3 to 5.6 times more likely to have high total blood cholesterol values and two times more likely to have high low-density lipoprotein (LDL) levels. Information obtained about black parents was inadequate, but it did indicate that older children were about five times more likely to have low levels of high density lipoprotein (HDL). It was also found that offspring of the parents who reported having cardiovascular disease, 40 percent of the white children and 21 percent of the black children had large concentrations of LDL. It is suggested that although family history is associated with abnormal levels of lipids and lipoproteins, the risk factors are not the same in black (low-HDL) and white (high-LDL) children. It is important to have the children with family cardiovascular disease history evaluated for lipid abnormalities.