Search

Between August 12 and September 27, 1994, five children in South Florida were hospitalized at a single hospital because of encephalopathy, presenting as status epilepticus, associated with cat-scratch disease (CSD). Diagnoses were confirmed by using an indirect fluorescent antibody test to detect antibody to Bartonella henselae, the causative agent of CSD. These cases represent the first cluster of CSD encephalopathy cases to be recognized in the United States. The patients lived within 7 miles of each other and all reported contact with pet or stray cats before developing regional lymphadenopathy and encephalopathy. All recovered fully. A high proportion of 124 cats from the local area were seropositive (62%) or bacteremic (22%). This study suggests that B. henselae can be associated with geographically focal clusters of CSD encephalitis and should be considered in the evaluation of children with acute encephalopathy.

Cardiovascular (CV) risk factors change over time with the emergence of clinically recognizable abnormalities (obesity, hypertension and hyperlipoproteinemia) in the second and third decades of life. A cohort of 286 subjects, aged 11-15 in 1973-74 were reexamined 6 years later to observe changes in height, weight, blood pressure, lipids and lipoproteins between adolescence and adulthood. During the 6 years of follow-up, 10-11 year-old males increased 30 cm in height and 32 kg in weight. Among 10-11 year-old girls, height increased 12-15 cm and weight increased 15 kg in whites and 20 kg in blacks. Mean systolic BP increased 16-23 mmHg in black males and 11-15 mmHg in white males. Mean serum total cholesterol levels increased with age such that levels in 20 year olds were 160-190 mg/dl, about 10 to 15 mg/dl higher than 18 year olds. In white males beta-lipoprotein cholesterol increased (13 mg/dl) with age; however, there was a simultaneous decrease in alpha-lipoprotein cholesterol (11 mg/dl), resulting in a dramatic rise in the beta-LPC/alpha-LPC ratio. These adverse changes in LPC may be related to the early development of atherosclerosis and risk for coronary heart disease of young white men. Early identification of hypertension and hyperlipoproteinemia should help to predict and prevent future CV disease.

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

Alcohol and tobacco usage patterns were assessed in 1,811 children and young adults, 12-24 years of age. The prevalence of cigarette smoking and alcohol consumption increased with age in all race and sex groups. Smokeless tobacco use (chewing tobacco and snuff) was primarily seen in white males with the highest prevalence rates in 12-15 year olds. Among white males who reported smokeless tobacco usage, 44% of the 12-17 year olds and 80% of the 18-24 year olds reported concurrent alcohol use. There was a significant interaction between alcohol consumption and cigarette smoking in all four race-sex groups (p less than 0.001). Given the potential synergistic relationship between ethanol and tobacco products on oral and upper gastrointestinal tract cancer, as well as between smoking and cardiovascular disease, the long term effects from these behaviors could be troublesome. Since healthy lifestyles are established in youth, early intervention on alcohol and tobacco use is needed to prevent the future morbidity and mortality from cancer and cardiovascular disease.

Serum lipids and lipoproteins were measured three times over 6 years in a total-community study of children in Bogalusa, Louisiana. Interrelationships and changes in the distributions of serum lipoprotein cholesterol levels were examined in terms of variability and precision of the laboratory measurements. Although distributions of serum lipoprotein cholesterol variables shifted among the three surveys, precision increased markedly as indicated by a decrease in the coefficient of variation for measurement error for total cholesterol, alpha-lipoprotein cholesterol, and triglycerides between Year 1 and Year 4 and then stabilized. Pre-beta-lipoprotein cholesterol was the most difficult variable to measure. The range and magnitude of correlation coefficients between lipid and lipoprotein variables were very similar. Despite quality controls, efforts to standardize laboratory analyses, and adherence to protocols, fluctuations in distributions of lipids and lipoproteins occurred when the same population was restudied. Long-term studies for coronary artery disease prevention should include laboratory safeguards that help to distinguish modest population changes in serum lipids and lipoproteins from laboratory drift.

A sample of 310 white, ambulatory elderly adults (n = 116 men, n = 194 women, ages 65 to 99 years) from the Dunedin Program in Florida were examined for serum total and lipoprotein cholesterols, weight, and blood pressure. Women had higher age-adjusted mean levels of total cholesterol (p less than .0001), low density lipoprotein cholesterol (p less than .0001), high density lipoprotein cholesterol (p less than .0005), and weight/height (p less than .0001). Systolic blood pressure increased with age in both sexes, but the trend rose more sharply in women (p less than .0001). Both systolic (p less than .05) and diastolic (p less than .025) blood pressure increased with obesity in women but were unrelated to obesity in men. Approximately 70% (218) of the sample had elevated levels of at least one risk factor. This included 12% (38) having elevated levels of two risk factors and 1% (3) with three. The distribution of risk factors for coronary heart disease in this sample indicates a homogeneous population derived through selective survival remains by age 70 years. These results emphasize the need for additional investigations of genetic and environmental variables promoting longevity.

Atherosclerosis begins in infancy, with fatty streaks appearing at the age of 3 years and fibrous plaques appearing during adolescence. Fatty streaks and fibrous plaques are related to serum total cholesterol, LDL-C, and systolic blood pressure levels. Children with elevated levels of cholesterol and blood pressure track (i.e., maintain elevated levels over time) and are candidates for premature coronary artery and cerebrovascular disease, especially if there is a positive family history of premature CVD. Screening for CVD risk factors in children is rapid, simple, inexpensive, and effective, with tremendous potential to prevent future adult CVD. At their annual physical examinations, children 5 years of age or older should have careful blood pressure measurements by two observers, and determinations of serum total cholesterol levels. Levels should be plotted on standard percentile grids (Figs. 5-7) in the child's permanent medical record. Those with persistently elevated levels of blood pressure and/or serum LDL-C require nonpharmacologic intervention initially, but may require antihypertensive or antilipid medication if unresponsive to behavioral modification for diet, physical activity, and cigarette smoking. Pediatric health professionals can play vital roles in primary prevention and reduction of adult CVD.

Determinants of follow-up levels of low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and the ratio of LDL-C to HDL-C were analyzed in a longitudinal study. White boys (n - 81) aged 11 to 12 years, when examined in 1973–1974 (year 1) were reexamined in 1978–1979 (year 6) at ages 16 to 17 years. During follow-up, mean levels of LDL-C increased from 87.6 mg/dL to 89.8 mg/dL, mean levels of HDL-C decreased from 67.0 mg/dL to 48.4 mg/dL and the mean LDL-C HDL-C ratio increased from 1.45 to 2.12. Cross-sectional associations between the serum lipoproteins and weight, triceps skinfold thickness, and ponderosity (wt/ht3) were stronger in year 6 than in year 1. A persistence of ranks was observed between year 1 and year 6 for LDL-C (r= 0.61), HDL-C (r = 0.51), and LDL-C HDL-C (r = 0.50). Multiple linear regression indicated that year 6 LDL-C levels were positively related to year 1 LDL-C, year 1 Tanner stage (an indication of sexual maturation), and the change in skinfold thickness during follow-up. Follow-up LDL-C HDL-C was related both to change in height (negatively) and to change in weight (positively), after controlling for year 1 LDL-C HDL-C . These longitudinal findings were similar to those obtained from earlier cross-sectional analyses and were furtehr verified on an independent cohort of white boys also followed for five years (1976–1977 through 1981–1982). These observations indicate that white boys with elevated LDL-C HDL-C levels who have large weight increases and minimal height increases during adolescence may be at high risk of developing coronary heart disease in adulthood.

Serum total cholesterol and lipoprotein cholesterol (LPC) were measured in a standardized laboratory in 3568 fasting children and youths, age 5–17 yr, in a biracial population of a total community. Between ages 11–15 yr, mean serum total cholesterol declined 3 mg/dl per year from 155 mg/dl to 143 mg/dl. Both α-LPC (7 mg/dl) and β-LPC (7 mg/dl) decreased while pre-β-LPC (2 mg/dl) increased during adolescence. Measurement errors, based upon a 10% blind duplicate random subsample, and race-sex adjustment factors, were determined for each lipid. Measurement errors were 4 mg/dl for serum total cholesterol and 6, 5 and 2 mg/dl for serum α-, β- and pre-β-LPC respectively. Measurement errors generally exceeded race-sex adjustment factors. For each fasting child serum total cholesterol was standardized for race, sex and age. Deciles for these total cholesterol relative deviates were determined. Mean total and lipoprotein cholesterol were calculated for each decile for each of the four race-sex groups. Both α-LPC and β-LPC steadily increased as the total cholesterol relative deviates increased, but the rate of increase in β-LPC exceeded that for α-LPC. As percentages of total cholesterol relative deviates. β-LPC greatly increased while α-LPC markedly decreased at higher deciles in all race-sex groups. Percentile tables for each lipid were listed with recommendations for use by clinicians caring for children in daily office practice. Guidelines were suggested for total cholesterol and LPC determinations in clinical practice. Children with a total cholesterol level greater than 185 mg/dl should have lipoproteins determined which will enable judgement for therapeutic decisions. Lipid data and lipoprotein ratios from nine selected white male adolescents in the study were presented and discussed. The results suggested a biologic link between earlier post-mortem studies of premature coronary atherosclerosis in young white male adults and epidemiologic studies of coronary heart disease in older adults. Because of the remarkable changes in lipoprotein patterns during adolescence, young men are appropriate targets for the study of methods for intervention to prevent coronary heart disease.

A cross-sectional study of 4074 children, ages 5--17 years, in Bogalusa, Louisiana indicated significant changes of serum lipids and lipoproteins occurring during puberty. These changes could be related to both age and maturation and likely reflect the influence of sex hormones on serum lipoprotein metabolism. Considerable differences were observed in the race/sex groups, with boys showing a more marked decrease of serum total cholesterol, reflecting decreases of beta- and alpha- lipoproteins. While the ratio of mean beta-lipoprotein cholesterol/mean alpha-lipoprotein cholesterol for the white girls and black children remained relatively constant over the age span, the ratio beginning around age 11 years rose dramatically in white boys, reflecting an inordinate decrease of alpha-lipoprotein and an earlier beginning rise of beta-lipoprotein. The observations have important implications for earlier coronary artery disease in white men.

Hemoglobin concentration was measured in 1,001 young adults (34% black, 66% white), ages 17 to 24 years, in a community survey. Hemoglobin levels were 0.9 g/dl lower in blacks than in whites (P less than 0.001) and 2.0 g/dl lower in females than in males (P less than 0.001). Black females had the highest prevalence of anemia (16%) and the lowest prevalence of polycythemia 3%), while white females had the lowest prevalence of anemia (1%) and highest prevalence of polycythemia (9%). Mean hemoglobin levels in females did not increase after approximately age 12 1/2 years, while those in males continued to increase until age 17 years. Regular cigarette smoking was a potent risk factor for polycythemia in white males. Number of cigarettes smoked per week and number of years as a regular smoker increased hemoglobin concentration. New criteria, based on population distribution of hemoglobin levels, may be needed for defining anemia and polycythemia in black populations and cigarette smokers.

Atherosclerosis and hypertension begin in childhood. Studies of children have identified black-white differences in anthropometric, hormonal, enzymatic, and renal mechanisms related to the development of coronary artery disease and hypertension. Black children have greater body density, higher blood pressure, and higher serum total cholesterol, α-lipoprotein cholesterol, and insulin levels, whereas white children have a higher percentage of body fat, a faster heart rate, and higher hemoglobin, serum triglyceride, pre-β-lipoprotein cholesterol, plasma renin, and dopamine-β-hydroxylase levels. At puberty, white male children have decreased high-density lipoprotein (HDL) levels and increased low-density lipoprotein/HDL ratios. Black children have lower urinary K + excretion and demonstrate natriuresis when K + is administered orally. These black-white contrasts provide clues for studying disease development early in life. Rational approaches to primary prevention of atherosclerosis and hypertension may require a diversity of strategies because of these black-white differences.

A review of the literature indicated that moderate alcohol consumers appear to have a lower rate of heart disease and a lower mortality than nondrinkers or heavy drinkers. A geographic analysis of 20 countries in 1972 suggested that moderate alcohol consumption appeared to be negatively related to rates of heart disease mortality. A temporal analysis within the United States indicated that changes in alcohol consumption, particularly beer, were highly negatively related to changes in heart disease mortality for 1950 to 1975. The review, in addition to the geographic and temporal analyses, suggests a U-shaped relationship between alcohol consumption and heart disease. Possible reasons for the negative relationship between moderate alcohol consumption and heart disease were discussed, including relationships to high-density lipoprotein cholesterol, changes in food patterns, and stress.

Adolescence and young adulthood represents a transition period for biologic and lifestyle characteristics. In a preliminary investigation of young adults (ages 18-20 years), the Bogalusa Heart Study documented patterns of alcohol, tobacco, and oral contraceptive use, as well as changes in education, occupational, marital and parenting status. Such behaviors accelerate the cardiovascular disease process and may differentially influence risk factor patterns of race and sex groups. Adverse levels of systolic blood pressure and alpha-lipoprotein cholesterol were more frequent in married vs single men; elevated triglyceride levels were more frequent in married vs single whites. However adverse levels of beta- and alpha-lipoprotein cholesterol were more frequent in nonparents than in parents. Cigarette smoking and oral contraceptive use were independently related to elevated beta-lipoprotein cholesterol and decreased alpha-lipoprotein cholesterol levels of young white women. Alcohol consumption was highest among white males, with 32% reporting daily consumption of the equivalent of two or more beers or one mixed drink. Alcohol consumption was negatively correlated with blood pressure in white males and positively correlated with alpha-lipoprotein cholesterol in black males. Since such lifestyle factors are related to physiologic risk factors that result in heart disease and adult cardiovascular morbidity and mortality in the older ages, early targeting during adolescence and young adulthood is important.

Risk factors for cardiovascular disease were measured in 990 young adults, aged 17-24 years, in a 1982-1983 survey of the biracial (black-white) community of Bogalusa, Louisiana. Even after controlling for age and obesity, several lifestyle factors (cigarette smoking, alcohol consumption, and oral contraceptive use) were independently related (p less than 0.05) to levels of serum lipids, lipoprotein cholesterol fractions, and blood pressure. Oral contraceptive use was associated with increased levels of both serum triglycerides (20 mg/dl, blacks; 25 mg/dl, whites) and low density lipoprotein (LDL) cholesterol (19 mg/dl, whites), and decreased levels of high density lipoprotein (HDL) cholesterol (-6 mg/dl, whites). Linear regression analyses also showed that cigarette smoking was associated with elevated levels of serum triglycerides (ranging from 15 to 26 mg/dl) and decreased levels of HDL cholesterol (ranging from -9 to -11 mg/dl) in white males and females. Although persons who smoked cigarettes were also likely to consume alcohol, alcohol intake in nonsmokers was positively associated with levels of serum triglycerides, LDL cholesterol, and very low density lipoprotein cholesterol in white males, and with blood pressure levels in black males. A statistically significant association between alcohol intake and HDL cholesterol levels (r = 0.24) was observed only in white females who did not smoke. These adverse influences of lifestyle factors on cardiovascular disease risk may provide a rational basis for intervention during adolescence and early adulthood.

Children were selected from a total community survey and categorized into three blood pressure (BP) groups (low less than 10 percentile, midrange 10 to 90 percentile, high greater than 90 percentile) based on resting diastolic pressure (DBP). To examine the relationship of cardiovascular reactivity with BP levels 4 years later, three cardiovascular response tasks (orthostatic, handgrip, and cold pressor) were administered. Partial correlations, adjusted for initial resting BP, showed that peak BP responses to the three tasks were related to future resting systolic and diastolic BP. Further analyses showed that DBP reactivity was related to future BP tracking in children with high DBP levels. In the high DBP group, while resting DBP levels did not differ for trackers vs nontrackers, peak DBP responses to each of the three tasks did (orthostatic, p less than 0.001; handgrip, p less than 0.05; cold pressor, p less than 0.01). The combination of resting and peak BP levels may provide more powerful predictions of future BP levels in children.

Fasting serum lipids, lipoprotein cholesterol, and other cardiovascular disease risk factors were examined in 321 natural parents of children with low and/or high levels of beta- and pre-beta-lipoprotein cholesterol. Parents of children from low pre-beta-lipoprotein groups had elevated alpha- and lower pre-beta-lipoprotein cholesterol levels. Parents whose children had high beta-lipoprotein cholesterol levels also had high serum total and beta-lipoprotein cholesterol levels. Parents of children with high levels of both beta- and pre-beta-lipoprotein cholesterol had a high prevalence of both abnormal risk factor levels, as well as clinical evidence of early coronary artery disease (before age 50 years). These observations show that parents of children with high beta- and/or pre-beta-lipoprotein cholesterol levels have greatly enhanced risk for cardiovascular disease, and children mirror their parents' lipoprotein cholesterol levels. These observations emphasize the need for cardiovascular risk evaluation early in life, especially in high-risk families.

Dietary intakes of two cross-sectional cohorts of 10-year-old children were collected in 1973 and 1976 to examine dietary trends over time. A longitudinal sample of the initial 1973 cohort examined at both 10 and 13 years of age identified changes in patterns and aging effect on intake. Significantly higher energy, total protein, and polyunsaturated fatty acids were noted for both 10- and 13-year-olds in 1976 compared with the 1973 sample. Saturated fat intake per 1,000/kcal was significantly lower but polyunsaturated fat was significantly higher per 1,000/kcal for the second 10-year-old group. Boys consumed more energy, protein, saturated fat, cholesterol, and iron than did girls. A sex × age interaction was noted for energy, sucrose, starch, and potassium, with boys ingesting more at 13 than at 10 years. A race × age interaction occurred for sodium, with black children having higher levels than white children at 10 but not at 13 years. Statistically significant correlations were noted between intake at 10 and 13 years of age for protein, cholesterol, and potassium for boys. Eighty-five percent of all children exceeded the protein Recommended Dietary Allowance. Over half the children exceeded the maximum recommended sodium range; potassium intakes were low. Excessive intakes of saturated fat, sucrose, animal protein, and sodium with low potassium and vegetable protein intakes create a potential health risk, influencing cardiovascular risk.

• We determined serum lipid and lipoprotein percentiles from a total community study of 5,250 fasting children (35% black, 65% white), aged 2 to 19 years. A serum turbidity index was used as a rapid, inexpensive screening test for hyper-β-lipoproteinemia and hyper-pre-β-lipoproteinemia. Percentile grids for the turbidity index and serum total cholesterol and β-lipoprotein cholesterol levels may be used for either black or white children. Triglyceride and pre-β-lipoprotein cholesterol level percentile grids were reported by race because of lower levels in black children, while grids for α-lipoprotein cholesterol levels were reported separately by sex for black and white subjects. A five-step method was outlined for screening children for lipid and lipoprotein abnormalities. Those with hyper-β-lipoproteinemia and hyperpre-β-lipoproteinemia would be candidates for therapy and indicate screening of other family members, after secondary causes are excluded. ( AJDC 1984;138:379-387)