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Pediatric Obesity and Cardiovascular Health: What We Learned From the Cardiovascular Health Intervention Program (CH

Pediatric Obesity and Cardiovascular Health: What We Learned From the Cardiovascular Health Intervention Program (CHIP) Paul S. Visich PhD, MPH, University of New England Bill Saltarelli , PhD, Central Michigan University . Objectives.

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Pediatric Obesity and Cardiovascular Health: What We Learned From the Cardiovascular Health Intervention Program (CH

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  1. Pediatric Obesity and Cardiovascular Health: What We Learned From the Cardiovascular Health Intervention Program (CHIP) Paul S. Visich PhD, MPH, University of New England Bill Saltarelli, PhD, Central Michigan University

  2. Objectives 1. Understand the prevalence and implications of pediatric obesity 2. Understanding of the CVD risk factors observed in overweight and obese children along withstructural and functional changes in one’s blood vessels. 3. How CVD risk factors are quantified (MetS) 4. Lessons learned from the CHIP 5. How do we alter the course of obesity in children? Is anything working?

  3. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1999 1990 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% BRFSS; Behavioral Risk Factor Surveillance Survey, www.cdc.gov/brfss

  4. What About children and adolescents?

  5. Trends in Obesity 1976 - 2008 2-5y, 5.0 to 10.4% 6-11y, 6.5 to 19.6% 12-19y, 5.0 to 18.1% http://www.cdc.gov/obesity/childhood/index.html

  6. Prevalence of Obesity among U.S. Adolescents aged 12-19y of age * * Note: Native Americans/American Indians and Alaskan natives were found to have the highest rate of obesity Ogden, C. and M. Carroll, Division of Health and Nutrition Examination Surveys, June, 2010

  7. Percentage of High School students who were Obese* 2003 2011 * Obesity; BMI> to th 95th% for age and sex. Youth Risk Behavior Survey, 2003 and 2011

  8. Geographic Similarities Between Adults and High School Students Adults High School Students

  9. State of Maine/2010 Adults 62.9% overweight (BMI> 25) 26.8% obese (BMI > 30) Vs 35.7% for US 2009-2010 Adolescents 15.1% overweight (85th to < 95th%) 12.5% obese (> 95th%) Children (2-<5y of age) 17.1% overweight (85th to < 95th%) 14.3% obese (> 95th%) Vs 12.1% for US in 2010 http://www.cdc.gov/brfss http://www.cdc.gov/HealthyYouth/yrbs/index.htm http://www.cdc.gov/pednss/pednss_tables/tables_health_indicators.htm

  10. Bottom Line or Waist Line for Children and Adolescents 17% of the US population 2-19y of age are obese Since 1980 prevalence of obesity has almost tripled There are significant racial and ethnic disparities in obesity prevalence among US children and adolescents There was no change in the prevalence of obesity among adults or children from 2007-2008 to 2009-2010 http://www.cdc.gov/obesity/childhood/index.html

  11. How Much of an Impact is Obesity having on our children’s Health? Life Expectancy Year Born S.J. Olshansky, etal. A Potential Decline in Life Expectancy in the United States in the 21st Century. N Engl J Med 352(11):1138-1144, 2005

  12. Contributing Factors to Obesity Strong4Life, Atlanta Georgia (40% of the children are obese)

  13. Meals Away From Home Typically higher saturated and trans fat, higher glycaemic index, high energy density and larger portion sizes From 1970 to the late 1990’s meals eaten away from home have nearly doubled Ebbeling, CB, etal Lancet, 2002; 360(9331): 473-482

  14. Portion Sizes 7-Eleven (1976) Gulps (20 ounces) Big Gulps (30 ounces) Super Big Gulps (40 ounces) Double Gulps (64 ounces), 1988 but reduced to 50 ounces this spring, why? Caloric content of Double Gulp with Coca-Cola: 600 calories (25% the recommended caloric Intake for a 30y old, 160 lb. man) Interesting note: Mayor Bloomberg proposed a ban on the sale of large size of sugary drinks in NYC

  15. Price of Foods Fruits and vegetables have increased in price 118% from 1985 to 2000 whereas prices for foods high in fats and oils has only increased by 35% Major problem with those with a limited budget!

  16. Influence of Technology on Obesity - 26% of US children watched 4h+/day of TV per day - 67% watched at least 2h/day - Non-Hispanic black children had the highest rate of watching TV 4h+/day (42%) - The children that watched 4+h/day had significantly > %fat and BMI Vs those that watched < 2h/day Andersen, R.E., JAMA, March 25, 1998, Vol 279, No. 12

  17. Physical Activity and Obesity General consensus (though not consistent) is that moderate/ vigorous activity has a positive benefit in reducing adiposity in overweight/obese youths. Physical activity recommendation: 60 minutes of combined moderate and vigorous activity daily. Problem: only 18.4% of our youth are achieving this recommendation (YRBS, 2009) Daily PE in schools has dropped 33% from 1991 to 2009 (YRBS, 2009) Davis, MM, etal, Pediatrics, 2007

  18. Obesity and Socioeconomic Status in Children Percentage Obese PIR: Poverty Income Ratio (130%= salary of $29,000 for a family of four and 350%= salary of $77,000 for a family of four). Ogden, C.L., NCHS Brief, No. 51, December, 2010

  19. Gender Differences with Obesity < 12y of age, very little gender difference 12 to 17y, males more likely to become overweight Possible reason: increased concern in respect to body self-image in females

  20. Obesity and Type 2 Diabetes“Adult Onset” Unheard of in children in the mid-1990s With the obesity epidemic we have seen a rise in Type 2 Diabetes in children (10 fold increase in the last two decades) Hannon, TS, etal. Pediatrics. 2005;116(2):473-480 80% of Type 2 diabetics are overweight or obese 1 in 3 young people born in 2000 will develop Type 2 Diabetes (CDC) http://www.kaiserhealthnews.org/Storeis/2011/March/22/Obesity-Type2-Diabetes-Children.aspx

  21. What’s the Big Deal? Large percentage of children and adolescents (10-15y old) that are obese turn into obese adults (80%). Prevalence of CHD is estimated to Increase 5-16% by 2035, with more than 100,000 cases of CHD attributed to the predicted increase in obesity. Bibbins-Domingo, K. etal, N Engl J Med. 2007;57(23):2371-2379 The risk of increasing one’s CVD risk factors is significantly higher with obesity (not only in adults but also children)- - hypertension - high cholesterol - low HDL-cholesterol - Type 2 diabetes - insulin resistance - Oxidative stress Additional Health Risks- asthma, sleep apnea, fatty liver disease, formation of gall stones, orthopedic problems Psychosocial Risks- social discrimination; low self-esteem, hinder academic performance, social functioning, etc.

  22. Pathophysiology and evidence of blood vessel changes • The CVD process has been shown to begin in children as young as 2 years of age (Berenson et al, 1998). • Multiple risk factors in children have been shown to persist into adulthood (i.e. tracking) (Boa et al, 1994).

  23. Direct evidence of blood vessel changes in children Fatty streaks Plaque Autopsy (Bogulosa Heart Study) Bogolossa

  24. Vascular ultrasound evidence

  25. Vascular Ultra-sound evidence • 1. Carotid artery-Intima-media thickness (IMT) Systolic BP BMI

  26. Influence of Diet and Exercise on Individual Cardiovascular Risk Factors in Obese Children (1 Year Program) Subjects: 56 obese children, median age- 9y old Treatment Nutrition and Eating Behavior Course ExerciseTherapy Psychological Family Counseling P<.05*, p<.01**, p<.001*** Wunsch, R. etal, Pediatrics118(6): 2334-2340, 2006

  27. 2. Arterial Compliance Brachial artery reactivity-Flow Mediated Dilation

  28. Physiological Process

  29. Definition of Metabolic Syndrome “Clustering of CVD risk factors” Children with multiple CVD risk factors (three or more) are more likely to have corresponding blood vessel changes (Strong et al, 1999).

  30. PediatrClin N Am 58(2011) 1241-1255 METs link between: Insulin resistance (Impaired glucose metabolism) Hypertension Dyslipidemia Obesity And the atherosclerotic process

  31. Definitions of metabolic syndrome in children

  32. IDF definition of metabolic syndrome in children Obesity (waist) plus 2 other factors About 63 cm

  33. Age 12-17 Total: 4.0% (0.6) Boys: 6.6% (1.3) Girls: 2.1% (0.6) NHANES data 04 Linear rise with age

  34. Cardiovascular Health Intervention Program Central Michigan University COLLEGE OF HEALTH PROFESSIONS SCHOOL OF HEALTHSCIENCES Bill Saltarelli, PhD and Paul Visich, PhD, MPH

  35. Overall Purpose for Developing the CHIP Awareness: To begin to make children and parents aware and personally responsibleof their health by physically participating in a screening program to learn about their individual cardiovascular disease risk factors. Personal Information: If a child and parent(s) knows what their health risks are, they are more likely to consider making changes to improve their health”

  36. School Bus To CMU Finch Fieldhouse

  37. Total Cholesterol • HDL Cholesterol • LDL Cholesterol • Triglycerides • Non-HDL Cholesterol • TC/HDL ratio • Blood Glucose Station # 1 Blood Lipids and Glucose

  38. Station # 2 Assessment of Body Composition: Height, Weight, Skinfold thickness, waist and hip circumference

  39. Station # 3Heart Rate Monitor (Resting Heart Rate) Station # 4 Resting Blood Pressure

  40. Station # 5Aerobic Capacity Seven Minutes of Stepping to music Recovery HR

  41. A Healthy Lunch and Interactive Presentation on Physical Activity and Health Food choices

  42. CMU Campus Tour Tour Guide C C

  43. CMU Class HSC 586 (2011) Screening CVD risk Factors in children

  44. 1. Individual Child Reports Are Sent Home 120/80

  45. Cardiovascular Disease Risk Factors 2005-2008 Mid-Michigan Children: Age= 11.7y (6th graders) Total N= 3022 Girls N=1550 Boys N=1472

  46. Percent of Children with Multiple CVD Risk Factors * 50% of the children express 3 or more CVDRF Mid-Michigan Children: Age= 11.7y (6th graders) Girls N=1426 Boys N=1441

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