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BACKGROUND. Recent studies have shown considerable variation in body fatness among children and adolescents defined as obese by a percentile rank for skinfold thickness. METHODS. We examined the relationship between percent body fat and risk for elevated blood pressure, serum total cholesterol, and serum lipoprotein ratios in a biracial sample of 3320 children and adolescents aged 5 to 18 years. Equations developed specifically for children using the sum of subscapular (S) and triceps (T) skinfolds were used to estimate percent fat. The S/T ratio provided an index of trunkal fat patterning. RESULTS. Significant overrepresentation (greater than 20%) of the uppermost quintile (UQ) for cardiovascular disease (CVD) risk factors was evident at or above 25% fat in males (32.2% to 37.3% in UQ) and at or above 30% fat in females (26.6% to 45.4% in UQ), even after adjusting for age, race, fasting status, and trunkal fat patterning. CONCLUSIONS. These data support the concept of body fatness standards in White and Black children and adolescents as significant predictors of CVD risk factors. Potential applications of these obesity standards include epidemiologic surveys, pediatric health screenings, and youth fitness tests.

An anastomotic leak after colorectal surgery is associated with significant morbidity and decreased survival. Our aim was to identify the early predictors of anastomotic leaks.The records of patients undergoing restorative resection for colorectal disease from January 2000 to November 2005 were reviewed. Demographics, clinical events, and laboratory parameters were recorded.A total of 311 patients were included. An anastomotic leak was identified in 25 patients (8%). A leak was suspected and diagnosis confirmed at a mean of 10+/-1 days postoperatively. More respiratory and neurological events occurred in patients with an anastomotic leak (p0.001). These events occurred early in the postoperative course and were usually the first signs and symptoms of a leak. More patients with a leak had absence of bowel activity by postoperative day 6 compared to patients without a leak (p0.0001). Elevations of the white blood cell count or temperature were a late finding.The earliest clinical predictors of an anastomotic leak are pulmonary and/or neurological. Awareness of these findings might help in early diagnosis and treatment of an anastomotic leak.

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.Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools.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.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.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.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.

The US Surgeon General concluded that nicotine in tobacco is addictive. Few studies actually explore the nature of nicotine addiction in youth. In Bogalusa, Louisiana, surveys to assess tobacco usage were administered to 11-18 year olds according to a standardized protocol developed in 1976. In 1991-92, a special substudy explored the nature of nicotine addiction in youth. Overall, 14.7% were current cigarette smokers; however, as many as 44.3% of white females, ages 15-16, indicated they were current smokers. Twelve percent of the surveyed population purchased single cigarettes. Thirty-two percent of current smokers reported they smoke a cigarette within 30 minutes after waking up. Thirty-one percent said they would find it difficult to refrain from smoking in places where it is forbidden. And 23% said they continue to smoke cigarettes when they are ill. From the findings in this study, it is clear there are young people who are addicted to tobacco. It is important to develop prevention of tobacco usage in childhood. Those who are addicted require a carefully developed intervention program to assist them with their cessation efforts.

To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures.In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.

RESEARCHERS RECORDED BLOOD PRESSURE LEVELS of children and adolescents in the Bogalusa Heart Study (black and white populations) and in the Brooks Country Study (Hispanic population). Hispanic children had smaller stature, while whites and Hispanics tended to be fatter than blacks in childhood. In Bogalusa, black boys showed higher blood pressure levels. Hispanic girls showed lower systolic blood pressure than the other ethnic groups. In cultures with a high prevalence of hypertension, such as blacks in the United States, it is important to understand the effect of environmental factors like dietary intake and electrolytes and obesity on the control of hypertension.

Data on cardiovascular risk factors (body mass index, triceps and subscapular skinfolds, blood pressure, serum total cholesterol, high density lipoprotein (HDL) cholesterol, and apolipoprotein B) were collected as part of the baseline examination (fall 1991) of the Child and Adolescent Trial for Cardiovascular Health, a multicenter school-based intervention study for promoting healthful behaviors. A total of 5,106 third grade children (mean age, 8.76 years) in four states (California, Louisiana, Minnesota, and Texas) were examined. After excluding 194 children of other or unknown origin, the study population consisted of 3,530 Anglo-American children, 674 African-American children, and 708 Latino children. African-American children were the tallest by 1-3 cm (p0.0001), while Latino children had the largest body mass index (p0.05). Blood pressure levels were similar for boys and girls and among the three races, but systolic levels were 2 mmHg higher in Texas than at the other sites. Serum total cholesterol levels were 5 mg/dl higher in girls than in boys (p0.05), while HDL cholesterol levels were 2 mg/dl higher in boys (p0.05). HDL cholesterol levels were highest in African-Americans (55.5 mg/dl) compared with Anglo-Americans (50.7 mg/dl) and Latinos (51.3 mg/dl) (p0.0001).

To assess whether circulating insulin is a major contributor to adverse lipid profiles during the transition from adolescence to young adulthood.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.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.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 intake of military wives and factors that influence nutrition of military families were examined in 186 military wives--67% white, 18% black, 11% Hispanic, and 4% other. The ages ranged from 19 to 45 years (mean = 28.7 years). The observations show that 1.7 meals per day were shared by all family members. Due to differences in energy intake and RDAs by age, dietary intakes were assessed in two age groups: 19-24 years (N = 51) and 25-45 years (N = 135). For both age groups, total energy intakes were lower than the RDAs, and the dietary composition was 52% carbohydrate (CHO), 14% protein, and 34% fat. Military wives 25-45 years old consumed more CHO in the form of sugar compared to the younger wives, who consumed more CHO in the form of starch. Some families require food stamps and are in the WIC program. There were no age differences in the type of protein or fat consumed, averaging 66% animal protein and 12% saturated fat. Dietary cholesterol intake was 229 mg for wives 19-24 and 243 mg for older wives and, based on approximately 1,900 kcal, dietary cholesterol exceeded 100 mg/1,000 kcal in both age groups. Sodium intake averaged 3.2 g. Forty-five percent of the military wives did not meet two-thirds of the RDA for vitamins D, E, B-6, iron, folic acid, zinc, and magnesium. Less than 20% met two-thirds of the RDA for riboflavin, vitamin A, thiamin, iodine, selenium, and calcium.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper introduces three cardiovascular health evaluation and promotion projects targeting military families at Fort Polk, Louisiana. These studies examine dietary behavior and life-styles including tobacco and alcohol use of military wives, physical activity, cardiovascular disease risk factors of military personnel and their families, and other behavioral profiles with the goal of developing a healthy lifestyle modification program for families. Relevant biomedical background and rationale considerations are developed to support the current research. In addition, conclusions drawn from these studies indicate the opportunity for future health promotion programs at other military installations. The studies will provide the background for a manual of operations to conduct health promotions for families on a military base. Further, the model provides the opportunity for a social support mechanism for families during times of stress and military operations.

In order to identify potential abnormalities, a cardiovascular risk-factor screening was developed as part of the Fort Polk Heart Smart Program. Serum lipids and lipoproteins, blood pressure, and selected anthropometric indices were measured on 703 individuals. Overweight was more a problem for females, with over 40% having a body mass index greater than 27. The percentage of subjects exceeding National Cholesterol Education Program guidelines increased with age. Some 30% of white men 30-39 years old and 60% of white men above 40 years old had elevated total cholesterol. These observations provide the basis for a health promotion program for young military families.

Lifestyles are major determinants in development of heart disease. Tobacco and alcohol use, physical activity, and hostility, a component of type A, were assessed in a sample of active military men and their wives at Fort Polk, Louisiana. Findings included: (1) a greater frequency of cigarette smoking at Fort Polk compared to national surveys; (2) a higher frequency of alcohol consumption in ages 30-39, and more blacks reported alcohol use than other race groups; (3) a greater frequency of alcohol use at Fort Polk compared to a worldwide military survey; (4) no consistent differences in lipid or blood pressure levels for high and low activity groups of wives; and (5) wives' hostility scores were low, and were not correlated with other cardiovascular risk factors. The implication of lifestyle descriptions is the need for intervention and health promotion, not only for military personnel, but also for their families. The significance of health promotion programs is the eventual reduction of health care costs and the well-being of families and fitness of military personnel.

Serum lipid and lipoprotein distributions and their correlates were examined in white, black, and Hispanic Army personnel and their families (N = 589) as part of the Fort Polk Heart Smart Program. In general, blacks tended to have higher HDL-C and lower triglycerides and VLDL-C than whites and Hispanics, whereas Hispanics tended to manifest higher triglycerides, VLDL-C, and LDL-C than whites. Unlike black and Hispanic men, white men tended to have lower HDL-C than white women. In contrast to white men, both black and Hispanic men displayed elevated LDL-C compared with black and Hispanic women. A considerable proportion of individuals tended to manifest adverse lipoprotein patterns according to National Cholesterol Education Program guidelines for children and adults. Cigarette smoking and alcohol use were the major contributors to the variance of lipoproteins in men, whereas overweight and oral contraceptive use remained the major factors in this regard for women. These results indicate that early targeting of military personnel and their family members for primary prevention is highly desirable.

A self-administered food frequency questionnaire (FFQ) was developed to indicate weekly consumption of 64 foods. Reliability, validity, and usefulness of the tool to define a protein eating pattern were determined. Adolescents (N = 1,108) completed the FFQ during the Bogalusa Heart Study. Two-hour and 2-week reliability measures demonstrated consistency of intake of specific foods. Frequency of foods obtained from seven consecutive 24-hour recalls was compared with frequency obtained from the FFQ. A mean 50% agreement for both frequency and quantity of food intake was observed. Geometric means showed differences in mean number of protein foods by age of adolescent but the only significant difference was for beef intake of 15-year-olds. White children reported more servings of beef, cheese, and vegetables with meat than did black children. Black children reported more servings of eggs, luncheon meat, pork, poultry, and total protein than did white children. Boys reported a greater frequency of total protein foods, specifically, eggs, milk, and poultry, than did girls. Significant correlations were noted between low-density-lipoprotein cholesterol and intake of eggs and luncheon meat. We were able to quantitate the reliability and validity of the FFQ and to use it to explore the association of specific eating patterns with cardiovascular disease risk.

Nutritional adequacy is important when diets and dietary alterations are recommended for children. Concern is expressed that low fat intakes may have deleterious effects on growth and development and may be deficient in total calories and essential nutrients. In a study of the effect of variation in percent fat in the diet, a sample of 871 ten-year-olds was stratified according to four different fat intakes: less than 30% of total kilocalories (kcal), 30% to 35% kcal, 35% to 40% kcal, and greater than 40% kcal. The race/sex distribution was similar within each fat intake group. Fourteen percent of the sample had fat intakes less than 30% of total calories. The amount of calories from breakfast, dinner, and snacks was higher in the children with fat intakes greater than 40% of total calories than those with lower fat intakes. The energy intake of all race/sex groups fell within the recommended range. The low fat intake group was eating 25% less calories than the high fat intake group (1800 kcal vs 2400 kcal). The percentage of calories from carbohydrate, specifically sugar, was greater in the low fat intake group compared with the high fat intake group. Percentage of calories from protein was approximately 13% for all groups. Fiber and starch were the same across all fat intakes.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular diseases, atherosclerosis and essential hypertension, are the major causes of morbidity and death in the United States today. Research over the past 20 years now clearly establishes that both diseases begin in childhood (1,2). Understanding the early natural history of coronary artery disease is tremendously important as it progresses to a clinical horizon later in life. It is equally important to begin considerations on intervention in early life to prevent adult coronary artery disease and hypertensive disease (3). Observations made in the Bogalusa Heart Study and other epidemiologic programs on children now provide a wealth of data on cardiovascular risk factor variables as they occur in various developmental periods of life — infancy, childhood, adolescence and young adulthood.

Obesity is an important determinant of serum lipids and lipoproteins in adults. Since obesity begins early in life, the impact of obesity of serum lipid and lipoprotein levels was examined in 3311 children and young adults (ages 5 to 26 years) from a totally biracial community. Study subjects were grouped according to race, sex, and age categories (5 to 10 years, 11 to 16 years, 17 to 22 years, and 23 to 26 years), excluding females using oral contraceptives or who were pregnant. Overall, associations increase with age, being most prominently noted in white males. The strong positive relation of ponderosity to low-density lipoprotein cholesterol was indicated in the older age groups with correlation coefficients ranging from r = -.09 in the youngest black males to r = .47 in white males aged 17 to 22 years. A negative association was noted between ponderosity and high-density lipoprotein cholesterol with correlation coefficients ranging from r = .08 in black females aged 17 to 22 years to r = -.39 in the oldest white males. Similar results were seen using subscapular skin-fold thickness as a measure of central obesity. Overweight was defined as exceeding 20% above the National Health Anthropometric and Nutritional Examination Survey II survey 50th percentiles. The prevalence of overweight individuals increased with age, being most prominent in black females. The percent(s) of hypercholesterolemic cases, based on the National Cholesterol Education Program criteria, likewise increased with age. A marked proportion of older white males were classified as borderline high and high for low-density lipoprotein cholesterol. A regression model using subscapular skinfold to predict serum lipids and lipoproteins within each age group indicated a consistent increase in the adverse nature of the lipid profile. Intervention and education programs aimed at reducing obesity at younger ages are recommended to reduce serum lipid and lipoprotein levels developing in young adulthood.

The distribution of serum uric acid and its relationship with cardiovascular risk variables have been studied in 3983 children and young adults, aged 5 to 26 years, drawn from a biracial (black and white) population. For two age groups, 5 to 11 years and 19 to 26 years, white subjects had significantly higher uric acid levels than black subjects, (4.02 mg/dl vs 3.57 mg/dl, p less than 0.0001, and 5.50 mg/dl vs 5.18 mg/dl, p less than 0.0001, respectively). Men in the 19 to 26 years age group had a significantly higher uric acid level than women (6.49 mg/dl vs 4.20 mg/dl, p less than 0.0001). White children and young adults were twice as likely to have levels above clinical limits than blacks, and males more likely to have hyperuricemia than females. Parents with a history of myocardial infarction were more likely to have children with hyperuricemia. Children and young adults with hyperuricemia had significantly higher plasma glucose (p less than 0.01) and insulin (p less than 0.001) levels, total cholesterol level (p less than 0.05), and serum triglyceride (p less than 0.0001), very-low-density lipoprotein cholesterol (p less than 0.01), low-density lipoprotein cholesterol (p less than 0.001), and total protein (p less than 0.0001) levels than subjects without hyperuricemia; high-density lipoprotein cholesterol level was significantly lower (p less than 0.0001) in subjects with hyperuricemia than in those without it.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum lipids (total cholesterol and triglycerides) and lipoprotein cholesterol fractions (low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and high density lipoprotein (HDL) cholesterol) have been measured approximately every 3 years on children and young adults since 1973-1974 in Bogalusa, Louisiana, a community of approximately 22,000 individuals, one-third of whom are black and two-thirds of whom are white. A total of 1,586 children were examined both at baseline (1973-1974) and at the most recent survey (1984-1986), providing 12 years of follow-up. The decreases in levels noted during puberty for total cholesterol and LDL cholesterol, primarily for boys, were followed by a rise until age 26 years. HDL cholesterol levels, particularly for white boys, continued to drop after age 14 years, yielding increasingly high LDL cholesterol/HDL cholesterol ratios. Tracking, as measured by both correlation coefficients and persistence at extreme quartiles, was evident for all of the lipids and lipoproteins. The 12-year correlation coefficients were greatest for LDL cholesterol and no trend in the magnitude of the correlation coefficients with age was noted. Tracking for HDL cholesterol was better after age 9 years, particularly for white males. Approximately 50% of those children who had total cholesterol levels or LDL cholesterol levels above the 75th percentile at baseline remained elevated 12 years later. For HDL cholesterol, a trend with age was noted for white boys: 42% of those aged 9-14 years in the lower most quartile persisted in this rank 12 years later. The best predictor of follow-up lipid or lipoprotein level was baseline level. The next best predictor was increase in weight as defined by weight/height, an index of obesity. That serum lipid and lipoprotein levels continue to track from childhood into young adulthood points to the necessity of measurement early in life and, where indicated, the introduction of preventive and interventional programs aimed at developing healthy lifestyles.

The distributions of serum creatinine levels and their relationship with selected anthropometric and cardiovascular risk variables have been described in 3983 children and young adults, aged 5 to 26 years, obtained from a biracial population, Bogalusa, Louisiana. For both blacks and whites serum creatinine levels increased slowly with age, until 11 years of age when a steeper increase occurred to around 19 years of age. Before this age there was a significant age by sex interaction (p less than 0.0001) in the distributions of serum creatinine. After the age of 19 years mean serum creatinine levels were significantly higher in black men than in white men (1.16 mg/dl vs 1.09 mg/dl, p less than 0.0005) and in black women than in white women (0.87 mg/dl vs 0.84 mg/dl, p less than 0.08). Creatinine levels were also significantly higher in men than in women (1.11 mg/dl vs 0.85 mg/dl, p less than 0.0001). Creatinine clearance, estimated from an equation using serum creatine, age, and weight, showed a steady increase until 13 years of age when a maximum range of 120 to 140 ml/min was reached. By the age of 19 years the clearance had declined to a relatively constant range of 100 to 120 ml/min. Black men had the highest correlation of serum creatinine concentration with height, weight, and lean body mass after adjusting for age. White men had the highest correlation of serum creatinine concentration with uric acid. Diastolic blood pressure becomes an important determinant of creatinine levels by the age of 11 years. The race-sex differences in serum creatinine levels in children and young adults are likely related to body mass.

Parent-child associations of height, weight, subscapular skinfold thickness, blood pressure, and serum lipids and lipoproteins were observed in a cohort of 440 infants and their parents in Bogalusa, LA. The infants were examined according to a standardized protocol six times from birth to 7 years of age, and the parents were examined when the child was 2 years old. Regression analyses were performed with the value of the cardiovascular risk factor variable for the child as the dependent variable and race, sex of child, and either mother's value, father's value, or both mother's and father's values as the independent variables. The most significant relationship between parents and their children was for height (P < .005 at all ages of the child) and weight (P < .05 from age 1 year for father's regression coefficient and at all ages for mother's regression coefficient). Regression coefficients for parental serum lipids and lipoproteins tended to increase with the child's age. Child-father regression coefficients and child-mother regression coefficients were generally significant (P < .05) after age 2 years for total cholesterol. Less association was noted for triglycerides and lipoproteins. Parental diastolic BP was a poor predictor of children's values; the regression coefficients for systolic BP were higher and more significant. The longitudinal nature of this cohort study allows for examination of the changing patterns of familial association with aging and may provide insight as to the best age for examining children for cardiovascular risk factors to determine their relative risk for heart disease.

Although white adults have more extensive aortic surface involvement with fibrous plaques than do blacks, adolescent blacks have more aortic fatty streaks (FS) than do whites of similar ages. Possible determinants of these racial differences in aortic surface involvement with FS were therefore examined in 44 decedents who had previously been examined as part of the Bogalusa Heart Study. Ages at death ranged from 6 to 27 years (mean, 18 years); the median interval between the last risk factor examination and death was 3.5 years. More extensive aortic surface involvement with FS was observed in blacks (n = 11) as compared with whites (n = 33; 37% vs 16%, p = .0003). This racial difference was independent of age at death, and was seen in both male and female subjects. Black-white differences in several of the previously measured risk factors (serum lipids and lipoproteins, blood pressure, and obesity) were also observed, and in both races, aortic FS were related to several of these characteristics. (For example, the correlation between levels of low-density lipoprotein cholesterol and aortic FS was 0.49 in whites and 0.73 in blacks.) However, even after controlling for antemortem levels of risk factors, blacks had an additional 16% surface involvement with aortic FS as compared with whites (p less than .001). These findings suggest that the more extensive surface involvement of the aorta with FS in young blacks is not due to differences in clinical risk factors. Because more extensive raised lesions are found in white adults, the transition of FS to advanced atherosclerotic lesions may differ in whites and blacks.

The genetic determination of high-density-lipoprotein cholesterol (HDL-C) levels was evaluated using segregation analysis techniques in a large multigenerational kindred with a high prevalence of coronary heart disease and myocardial infarction. Univariate segregation analysis of HDL-C levels with the effects of age and sex removed by regression provided evidence of a Mendelian mode of inheritance for a portion of the variability in HDL-C levels. Subsequent analyses included low-density-lipoprotein cholesterol (LDL-C) levels and several behavioral and anthropometric variables that affect HDL-C levels. Pedigree discriminant analysis was used to find the linear functions of the variables that maximized the likelihood given the pedigree structure and assuming monogenic segregation. The best linear function was found to be approximately equivalent to the log of the HDL-C to LDL-C ratio, with concomitant and environmental effects removed by regression. Genetic hypotheses were tested by cross-validation; linear functions derived from data on each side of the kindred were used to test hypotheses on the other side of the kindred. On one side of the kindred, all hypotheses were accepted. On the other side of the kindred, only Mendelian inheritance of the linear function was indicated. Segregation of the age- and sex-adjusted HDL-C values, and of the linear function, was evaluated using a regressive model that allows for intrafamilial correlations in addition to a monogenic effect. All analyses provide evidence for levels of HDL-C being controlled by a major locus with neither dominant nor recessive expression.

Dietary intakes of carbohydrate (CHO) and fiber were examined in children randomly selected from a biracial community-Bogalusa, LA. Intakes of CHO per 1,000 kcal were similar for both sexes and both races at ages 10 and 13 years. No group or race differences were found for nine components assessed in two cohorts of 10-year-old children examined three years apart. There were sex differences in sucrose (boys less than girls) and lactose (boys greater than girls) intakes. Comparison of 10- and 13-year-olds examined in 1976 showed a racial difference in fiber and starch intakes (black greater than white). Longitudinal comparisons of a cohort of 148 children examined at both 10 and 13 years showed lower lactose intakes over time. At both ages starch, fiber, and glucose intakes per 1,000 kcal were higher in black children, with higher sucrose/starch ratios in white children. The percent of calories from CHO and sugars was higher in Bogalusa children than values for US adults, but starch intakes were lower. None of the children's intakes was compatible with prudent dietary recommendations. Dietary CHO patterns of Bogalusa children reflect food market trends of increased use of simple CHO and decreased use of complex CHO.

The "Report of the National Heart, Lung, and Blood Institute's Task Force on Blood Pressure Control in Children" (Pediatrics suppl, May 1977) is a serious and long-needed attempt at establishing guidelines for practitioners in monitoring blood pressure levels in children and diagnosing early primary hypertension. Further, and importantly, it includes a consideration of prevention of future hypertensive disease, encouraging greater research and clinical interest in blood pressure in the pediatric age group. Specifically it encourages the physician examining children to include observations of blood pressure as a routine part of a physical examination.

Onset of QRS was compared between simultaneously recorded conventional ECG leads in 84 subjects with clinically normal hearts from a defined population sample. Mean onset of QRS was 6.4 msec earlier in lead V1 and 7.4 msec earlier in V2 than in lead II. These differences were statistically significant. The measuring system was adapted from drafting techniques and took into account variations in paper speed which occurred during recording. Interobserver differences equivalent to greater than 1 msec occurred in 3.9% of timeline measurements, but in in 38% of QRS onset measurements. The lower precision in measuring QRS onset may be attributed to baseline oscillations and to the relatively slow rate of voltage change at the onset of ventricular depolarization.

Although a truncal distribution of adipose tissue in adults is associated with several metabolic complications, its importance in early life has received little attention. The relation of several anthropometric measures to serum concentrations of lipids, lipoproteins, and apolipoproteins was therefore examined in 361 children who were between ages 6 and 18 y. (Children had been selected previously because of extreme levels of very-low-density- and low-density-lipoprotein cholesterol.) Analyses revealed two groups of anthropometric variables: truncal measures (waist circumference and subscapular, subcostal, and suprailiac skinfold thicknesses) and thickness of peripheral skinfolds (femoral, triceps, calf, and biceps). After generalized obesity was adjusted for children with high concentrations of both cholesterol fractions had more truncal fat but less peripheral fat than did children with low lipoprotein cholesterol concentrations. A truncal fat pattern was also associated with decreased concentrations of high-density-lipoprotein cholesterol and apolipoprotein A-1. Knowledge of fat patterning may help identify persons prone to hyperlipidemia.

Impact of vitamin supplements upon dietary intakes of eight vitamins was examined in 10- and 13-year-old children randomly selected from a biracial community, Bogalusa, LA. More younger children reported taking supplements daily (17%) than did adolescents (12%). Over 90% of the children surveyed had dietary intakes of vitamin E and niacin that met or exceeded the RDA. One-half to two-thirds of children using supplements had adequate intakes of ascorbic acid from diet alone. Children who most needed ascorbic acid supplements were the least likely to take them. One-quarter to one-half of the children did not consume the RDA levels of vitamin A, thiamine, and riboflavin. Adolescents had less adequate vitamin A intakes than younger children. In all surveys, a higher proportion of girls than boys had intakes that did not meet the RDA for vitamins B6 and B12. Vitamin intakes of Bogalusa children and adolescents were comparable to other U.S. surveys. Inclusion of vitamin E and niacin in supplements may be unnecessary.

Diets of four groups of 10-year-old children (no. = 871) from a biracial community were examined to document eating patterns and to note temporal trends in energy, protein, fat, and carbohydrate intakes. A 24-hour dietary recall method, incorporating numerous quality controls, was adapted for interviewing children. Protein provided 13%, fat 38%, and carbohydrate 49% of calories. Few racial differences in eating patterns were detected. Boys had higher energy intakes than girls, but after diets were adjusted per 1,000 kcal, no other sex differences in intake were found. Snacks yielded roughly one-third of daily energy intake, one-fifth of the day's protein, one-third of the fat, and two-fifths of the total carbohydrate intake. Density of macronutrients within the children's diets was consistent over time. Diets of children in the Bogalusa study typify the American eating pattern and are comparable with those found in major national surveys.

Height, weight, and skinfold measurements were obtained on a cohort of 447 children from birth (weight) or 6 months of age (height and skinfold) and monitored yearly thereafter until 7 years of age. At age 7 years, 250 remained for follow-up screening. A significant degree of tracking was found for all variables from age 1 to age 7 years. Height and weight tracked most strongly (age 1- to 7-year correlations = .42 and .44, respectively), whereas skinfold tracked somewhat lower (.28). Earlier levels of each anthropometric variable were the best predictor of later levels of that parameter. Implications for early detection and treatment of growth abnormalities are discussed.

Cardiovascular risk factor variables were examined in a cohort of 440 infants from birth through 7 years of age. Anthropometric measures, BP, serum lipid and lipoprotein values, and dietary intake data were obtained according to detailed protocols. Various quality controls to ensure the collection of valid and reliable data were instituted. Participation remained high throughout the study with 80% of the children examined at 6 months and 60% at 7 years of age. Rates were slightly higher for black than for white children. Children born in the private hospital were more likely to continue in the study than children born in the charity hospital. Children of parents examined when the child was 2 years of age were more likely to be examined during the preschool phases, but parental examination was not related to child examination when the child was 7 years of age. As in studies of school-aged children, measurement errors were lowest for height, weight, and serum total cholesterol. Measurement errors for BP were highest at the younger ages, particularly for diastolic BP. Examination of a newborn cohort throughout time affords the opportunity to study early development of relationships and tracking of cardiovascular risk factors.

To assess relationships between increases in triceps skin-fold thickness (TRSF) and changes in levels of serum lipids and lipoproteins in early life, a biracial sample of 1,598 five to 12 year olds were reexamined five years after an initial examination. Significant positive correlations, controlled for age, were observed between changes in TRSF and changes in levels of serum total cholesterol, serum triglycerides, and low- and very low-density lipoprotein cholesterol. Inverse associations between changes in TRSF and high-density lipoprotein cholesterol were weaker, but also statistically significant. Although females showed the largest increases in TRSF, most associations were stronger in males. Increases in estimated percentage body fat and ponderal index (kilograms per cubic meter) were highly associated with changes in TRSF, but showed slightly different associations with the serum lipids and lipoproteins. Results show that increases in obesity in youth are accompanied by an increasingly atherogenic lipoprotein profile.

Eighty per cent of all identified children 2 1/2-5 1/2 years old in a total geographic community in Bogalusa, Louisiana, were examined for cardiovascular disease risk factor variables, including blood pressure (BP), anthropometric measurements, and blood lipids. Blood pressure was measured by three instrument types, each with three readings, according to a rigid, randomized design. Results from the three instruments were compared, and potential biases for each instrument are listed. All observations on the children were analyzed by multiple regression with BP as the dependent variable. After controlling for the mood of the child, the authors found that some index of body size was positively related to BP, whereas age, race, and serum lipids were not consistently related. The regressions of blood pressure on height as well as on log weight fit straight lines. These results conform with the findings for the 5- to 14-year-olds in this community. The basal or fundamental reference blood pressure is likely to rise gradually from birth to the age of incipient adult stature, and to be linearly related to height and to log weight. Changes observed over time are needed to relate BP levels in childhood to the early natural history of essential hypertension.

Although differences in hemoglobin levels between blacks and whites may be due in part to genetic influences, low hemoglobin levels in black girls of childbearing age may nevertheless constitute a health hazard. To study this problem, hemoglobin levels were examined in children of a biracial community not only before but also during and after puberty and menarche. At the same time, 24-hour dietary recalls of a representative group of 13-year-olds in the same population were examined with respect to the intake of iron and nutrients influencing iron absorption. In black girls, hemoglobin levels dropped after menarche, accompanied by a diet marginal in iron and in iron-absorption-promoting nutrients. Questions as to hemoglobin levels compatible with optimum health remain, and racial differences and genetic influences on levels should not be an excuse for failure to address this problem. More investigational studies are also needed to observe responses to an optimum dietary iron intake.

Diets of four groups of 10-year-old children (no. = 871, 30% black, 70% white) were examined over 10 years with 24-hour dietary recalls to study temporal trends in cholesterol, fat, and fatty acid intakes in a community. Boys had higher intakes per day and per kilogram body weight than girls for all nutrients (p less than .0001), but there were no sex differences in nutrients per 1,000 kcal. The only racial difference detected was a higher myristic acid intake in whites (p less than .02). There was a 16% decline in dietary cholesterol intake between 1978 and 1982. Three shifts in fatty acid intake increased the P:S ratio from 0.29 in 1973 to 0.45 in 1978: (a) a 5% decline in oleic acid, coupled with a 5% rise in linoleic acid; (b) a quadrupling of linolenic acid; and (c) less stearic and more myristic acid, with palmitic acid unchanged. Total fat intake provided 38% of the calories in each survey, but the changes in proportions of fatty acids paralleled trends in food consumption patterns and nutrient sources. Despite the changes, few children met prudent diet recommendations, and serum total cholesterol and very-low-density-lipoprotein cholesterol levels did not change over time.

To investigate caffeine intake patterns in children, dietary intakes were examined for a biracial sample of 1,284 infants and children. Twenty-four-hour dietary recalls were completed by parents of children aged 6 months and repeated at ages 1, 2, 3, and 4 years; children 10 years old served as their own respondents and were surveyed at ages 13, 15, and 17 years. The sample was 60% white and 40% black. Additional cohorts of 10-year-olds (no. = 686) were studied for temporal trend. Whites consumed significantly more caffeine than blacks as early as 1 year and persisted at a higher intake level from 2 to 17 years. This trend continued whether intake was measured in total milligrams, milligrams per 1,000 kcal, or milligrams per kilogram body weight. Significant sex differences in caffeine intakes per 1,000 kcal occurred among 15- and 17-year-olds (girls greater than boys). Peak periods of consumption occurred at ages 2, 3, 13, and 17. Snacks contributed large quantities of caffeine, particularly for 10-year-olds. Most frequent sources of caffeine were regular carbonated beverages, chocolate-containing foods, and tea. Mean intakes of caffeine for 10-year-olds were consistent from 1973 to 1982. Those observations document caffeine intakes beginning early in life.

The genetic determination of high-density-lipoprotein cholesterol (HDL-C) levels was evaluated using segregation analysis techniques in a large multigenerational kindred with a high prevalence of coronary heart disease and myocardial infarction. Univariate segregation analysis of HDL-C levels with the effects of age and sex removed by regression provided evidence of a Mendelian mode of inheritance for a portion of the variability in HDL-C levels. Subsequent analyses included low-density-lipoprotein cholesterol (LDL-C) levels and several behavioral and anthropometric variables that affect HDL-C levels. Pedigree discriminant analysis was used to find the linear functions of the variables that maximized the likelihood given the pedigree structure and assuming monogenic segregation. The best linear function was found to be approximately equivalent to the log of the HDL-C to LDL-C ratio, with concomitant and environmental effects removed by regression. Genetic hypotheses were tested by cross-validation; linear functions derived from data on each side of the kindred were used to test hypotheses on the other side of the kindred. On one side of the kindred, all hypotheses were accepted. On the other side of the kindred, only Mendelian inheritance of the linear function was indicated. Segregation of the age- and sex-adjusted HDL-C values, and of the linear function, was evaluated using a regressive model that allows for intrafamilial correlations in addition to a monogenic effect. All analyses provide evidence for levels of HDL-C being controlled by a major locus with neither dominant nor recessive expression.

Since a positive association between blood pressure and plasma glucose level in child populations has been observed previously, we studied this relationship in a stratified random sample of children ages 7-15 years drawn from a total geographic population. We stratified this population (N = 3524) by diastolic blood pressure and weighted the extreme strata. The sample of children (N = 272) was free of secondary hypertensives and was tested by a restricted glucose tolerance test. As a parameter of cellular glucose kinetics, a "peripheral insulin resistance" was defined as one-hour glucose (mg/dl) X one-hour insulin (microU/ml). For white boys, this product showed an increase from 2745 in the low blood pressure strata to 6615 in the high blood pressure strata. To assess the relationship between blood pressure measured during the reexamination and fasting plasma glucose level, we classified the children according to their peripheral insulin resistance in a low, medium, and high group. After controlling for body weight, only white children in the high blood pressure strata with high insulin resistance had a positive association between fasting plasma glucose and systolic blood pressure. The relationship may be initiated by inappropriate intravascular water retention influencing the blood pressure in children with high peripheral insulin resistance and susceptible to hypertension.

A survey of children for cardiovascular risk factor variables has determined serum lipids and lipoproteins on some 5,000 children from birth through adolescence. Dietary studies have been conducted on a selected sample. Considerable variability of the serum lipids and lipoproteins occurs with significant relationships to age, race, and sex. Serum lipoproteins are altered with obesity especially in white children and a correlation of dietary intake of fat by infants and children had been noted with serum lipids and lipoproteins. A consistent ranking over time or tracking of the serum lipids and lipoproteins, especially beta-lipoprotein, occurs, and a clustering of multirisk factors including high levels of serum total cholesterol and beta-lipoproteins can be observed, especially in the older children. The trend toward increasing interrelationship of multirisk factors suggests an increasing environmental impact with age. The relationships of dietary components with risk factor variables are of a low order, even though children are consuming a relatively high fat, high cholesterol, high salt diet. Dietary factors are potentially the major environmental influence on the high incidence of coronary artery disease. The evidence of the relationship of diet to the serum lipid levels in children warrants further investigation in an effort to understand the precise role of diet in the prevention of adult cardiovascular disease.

Dietary patterns and racial differences in nutrient intake were observed in children 6 months to 4 years of age in the Bogalusa Heart Study. Even in this sample of young children, the composition of the intakes of the majority of children was not compatible with prudent recommendations of less than 35% and 10% of energy from total and saturated fat, respectively. Mean cholesterol intake of the 4-year-old children (390 mg) was approximately one half of the average daily adult levels. The polyunsaturated to saturated fatty acid ratio ranged from 0.41 to 0.53 and sucrose to starch ratio from 1.32 to 1.57, reflecting a high saturated fat and sucrose intake. White children had greater intakes of sucrose than black children; however, total fat and cholesterol intakes were greater in black children. Gender differences were noted among the 2, 3, and 4-year-old children: energy, sugar, and starch intakes were greater in boys, and cholesterol intake per 1,000 kcal was greater in girls. Mean intakes per 1,000 kcal in Bogalusa were higher for fat and carbohydrate and lower for protein than reported in the Second Health and Nutrition Examination Survey. However, when the National Research Council recommended dietary allowances for protein and energy are used for comparison, a more than adequate intake was noted in these children. The data found in this newborn-infant cohort contribute information regarding the early development of dietary habits that likely influence eating behavior in later childhood and adolescence.

Serum lipids and lipoprotein cholesterol fractions were examined in a newborn cohort that was followed from birth to 7 years of age. Although white and female infants had higher cord blood levels of high-density lipoprotein cholesterol (HDL-C) than did black and male infants, respectively, these differences did not persist throughout early childhood. Mean levels of all serum lipids and lipoproteins increased greatly in the first 6 months of life, and by 2 years of age, levels approached those seen in adolescents. Infants consuming cow's milk had higher 6-month levels of serum total cholesterol and low-density lipoprotein cholesterol than did formula-fed infants. However, milk source in infancy did not significantly influence total cholesterol or low-density lipoprotein cholesterol levels at age 7 years. Serum lipid and lipoprotein levels at age 7 years were associated with previously measured levels as early as 6 months of age, and infants with unfavorable levels were likely to have similar adverse levels at 7 years of age. In addition, increases in obesity between 6 months and 7 years of age were positively associated with increases in levels of serum triglycerides. These results suggest that certain persons at increased risk for cardiovascular disease can be identified in infancy.

A self-administered workbook for dietary assessment in small groups was compared with 24-hour dietary recall interviews. Forty-seven 10- to 18-year-olds, in groups of 5 to 8, recorded consumptions during the previous 24 hours and responded to individual recall interviews. Photographs and names of foods served as probes. Standardized food models were used to estimate portions. Nutritionists calculated gram amounts of foods and beverages consumed and analyzed diets for nutrient intakes. Significantly higher niacin (17.4 mg vs. 15.8 mg, p less than .05) and slightly higher protein, animal protein, carbohydrate, and cholesterol (N.S.) were estimated by the group workbook method. Correlations for individual dietary components ranged from 0.69 to 0.93. Dinner accounted for most differences, with statistically greater mean intakes of nine dietary components shown by the workbook method. Thirty-four dinner foods (8%) were not listed in common by the two methods. Sixty-six foods (15%) listed by the two methods had differing gram amounts. Improvements should include increased parental verification of the evening meal, additional training with food models, and periodic rest sessions. The workbook method may expand the time frame studied per individual and increase the number of eating periods examined. Replicate examinations per individual provide measurement of intra-individual variation. This method has applications in studies for which large samples or repeated measures are required.