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High cholesterol in children.

If a noted Louisiana doctor has his way, children will be tested for high blood pressure and cholesterol before they enter first grade, and lessons in a "heart smart" lifestyle will be integrated into the current elementary school curriculum.

These recommendations come from Dr. Gerald Berenson, director of the Bogalusa Heart Study, the head of Louisiana State University's Specialized Center of Research on Atherosclerosis, and overseer of the country's most in-depth look at heart disease and children. More than 10,000 people have participated in the study since 1973. Current guidelines suggest that cholesterol screenings be done only on children with family histories of heart problems. But Dr. Berenson says that's not good enough. He says early testing could prevent 40 percent of adult heart disease cases.

For years, researchers had no firm evidence that linked elevated cholesterol levels in childhood to high cholesterol in adulthood. Now, findings of the Bogalusa Heart Study confirm that high blood pressure at age ten is connected to adult hypertension and that high cholesterol at even six months can lead to high cholesterol in adulthood. Dr. Berenson says these new findings mandate the screening of youngsters for blood pressure, cholesterol, height, weight, body fat, and family history. His team has also developed a program called "Heart Smart," which encourages the total school environment to promote cardiovascular health and teaches children the components of a healthful lifestyle.

Because habits form early and die hard, Heart Smart is designed to instill toned-down eating habits and stepped-up exercise habits during the formative years. Every known contributor to heart disease among adults-diet, stress, lack of exercise-is countered head-on by the prevention program. School lunches are balanced, physical education is monitored, and stress-management skills are taught. Because no program can be successful if followed only during school hours, an all-out effort has been made to involve parents. Role modeling underscores classroom instruction; and teachers, cafeteria workers, and physical-education instructors undergo staff training in Heart Smart's plan. A special unit called "It's Me" boosts children's self-esteem and self-identity; and aerobic activities, labeled "Super Kids-Super Fit," encourage regular exercise. The total experience, although designed to strengthen cardiovascular health, also discourages other negative habits, such as cigarette smoking and drug use.

Dr. Kenneth Cooper, a recognized leader in the fitness movement and the author of Controlling Cholesterol, agrees with Dr. Berenson on early cholesterol testing. He endorses a low-fat diet after the age of two and encourages regular aerobic exercise. Again, the hope is that habits formed in childhood will spill over to adult life. "If the epidemic of heart disease in the country is ever going to be controlled, it must start with an aggressive preventive approach with our children," Dr. Cooper says.

Study after study across the country confirms that cholesterol levels among much of American youth are too high. Fortunately, subtle changes in diet and exercise can significantly lower these levels. In New York, nearly 80 percent of nine-year-old children are eating too much saturated fat, and 60 percent are consuming too much cholesterol. To turn these numbers around, youngsters would need only to trade ice cream and doughnuts for sherbet and fruit and to substitute turkey and fish for red meat and sausages.

The results would make the sacrifice worthwhile. In such countries as Greece, where a non-Western diet is consumed, cholesterol levels among children are significantly lower than in the States. Moreover, the incidence of heart disease is rare among adults. Some of our trade neighbors, however, seem to be in a state of flux. In Japan, for instance, adults still register low levels of cholesterol, but children, enamored of anything Western, including our diet, are showing increased cholesterol levels.

Researchers suspect that cholesterol levels above 180 milligrams per 100 milliliters of blood in children lead to an increased risk of developing high cholesterol levels in adulthood. In the United States, an estimated one-quarter to one-third of children have cholesterol levels above 176 milligrams per 100 milliliters of blood. As a precaution, the American Academy of Pediatrics recommends that children with cholesterol levels higher than 176 receive long-term dietary counseling from nutrition experts.

Probably the most impressive information on childhood-onset heart disease comes from the Bogalusa anatomic studies. Since 1978, autopsies have been done on all residents who died between the ages of 3 and 26. Even in that youthful age group, evidence of early heart disease has been found. Fibrous plaques have been identified in the coronary arteries of several men who had previously been examined for risk factors. These plaques, which were associated with low HDL ("good cholesterol") and high LDL ("bad cholesterol"), often progress to the point of blocking the coronary vessels and causing angina pectoris and heart disease.

High blood pressure in childhood also portends ill for adults, say Bogalusa researchers, who found that elevated blood pressure correlates with increased heart size, structural changes in some small arteries, and increased thickness in heart walls.

Clearly, coronary-artery disease and essential hypertension begin early. "They are percolating in childhood," Bogalusa study's Dr. Berenson says. If we want to help stop heart disease in the next generation, today's elementary schools are the places to start.

But, elementary school teachers can't be responsible for sufficient exercise for children. The Children's Better Health Institute is helping parents organize Fitness Fairs that can be duplicated all over the country. Parents who wish to put on neighborhood Fitness Fairs can write to the Institute for instructions. Games include horseshoe pitching, parent-child relays (foot races), basketball-dribble courses, bean-bag toss, football toss, tricycle races, and more. Ribbons, trophies, and instructions for warm-up exercises can also be ordered from the Institute. Address: Children's Better Health Institute, I 100 Waterway Blvd., Indianapolis, IN 46202.
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Publication:Saturday Evening Post
Date:Apr 1, 1989
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