Bogalusa Heart Study

1. Bogalusa Heart Study Kathryn Atwater PVAMU Dietetic Internship Spring 2013 Semester

2. Background • Time Frame: 1972-2005 • Founder: Gerald Berenson, MD • Where: Louisiana State University Medical Center in Bogalusa, Louisiana • Population: Bi-racial, semi-rural children & young adults • Main Focus: Early cardiovascular risk factors • CAD • Essential hypertension • Type 2 Diabetes

3. Background cont’d… • >16,000 participants • Ages: 2.5-17 yr old • Methods: • Medical Exams • Questionnaires • Overall Results: • Childhood CV risk factors  Adulthood

4. Initial Study • Cross-Sectional Survey • School year 1973-1974 • 3,542 children • Ages: 5-14 yrs • 63% white, remainder African American • Follow-up: 1978 • Standard protocols in place to reduce possible outside influences • Medical Exams performed • CT scans • Ultrasonography

5. Initial Study Results • Early hypertension and BMI risk factors adults • African Americans at higher risk • Associations in obesity, serum cholesterol, and blood pressure in all groups • Black females higher prevalence of obesity • After follow-up examinations: • High levels during younger yearshigher levels at older age

6. Goals

7. Children are our future • Why children? • Bogalusa Heart Study believed that most CV risk factors began in our youth • If we can start early, we can change the future • Development and screening at an early age, could make our developing children have a healthier, longer life

8. Timing is everything • Major etiologies of adult heart disease, atherosclerosis, coronary heart disease, and essential hypertension begin during childhood • The levels of risk factors change with growth phase:

9. Atherosclerosis & Hypertension Results • Autopsy Study results: • Atherosclerosis and hypertension are early onset

10. Gender & Race Results

11. Environmental Results

12. Nutritional Impact • Many risk factors controllable e.g. DIET • Physicians: Major Role • Obtain risk factor profiles on children • Obtain family history of heart disease • Proper nutrition from early age can decrease risk • Control of improper diet practices=control of factor • School lunches programs=great starting point

13. Summary • Healthy lifestyles should be adopted in childhood • CV risk factors are present in childhood, more likely to develop in adulthood • Early screening  Decrease later development • NUTRITION INTERVENTION CRUCIAL!

14. Research Studies

15. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study1,2,3 David S Freedman, Mary K Serdula, Santhanur R Srinivasan, and Gerald S Berenson Am J ClinNutr February 1999 vol. 69 no. 2 308-317

16. Objective Relationship: Waist/hip circumference & skinfold-thickness vs. lipid & insulin concentration in children & adolescents

17. Design • Conducted: 1992–1994 • 2996 children and adolescent participants • Age 5-17 yrs • Assessments in relation to: • Waist & Hip Circumference • Subscapular & tricepskinfold-thickness • Lipid concentration • Insulin concentration

18. Results • Child in 90th percentile of waist circumference, compared to child in 10th percentile: • Higher levels of • LDL cholesterol • Triacylglycerol • Insulin • Lower levels of: • HDL cholesterol • Significance of 0.001 level across all race-sex groups

19. Summary

20. Persistent hypercholesterolemia is associated with the development of obesity among girls: the Bogalusa Heart Study1,2,3 Andrw M Tershakovec, Abbas F Jaward, Nicole O Stouffer, AbdallaElkasabany, Santhanur R Srrinivasan, and Gerald S Berenson Am J ClinNutr October 2002 vol. 76 no. 4 730-735

21. Objective • Examine age-related changes both in relative weight • Examine association between CVD risk factors in children who have: • High cholesterol • Regular cholesterol • Not obese at baseline measurement

22. Design • 273 participants • Used previous data from BHS on non-obese 5-6 yr old children • Participants had either: • High cholesterol • Regular cholesterol • Reassessement 6 years later • BMI changes & CVD risk factors assessed in relation to: • Age • Sex • Race • Cholesterol concentration

23. Results • High cholesterol girls: larger BMI increase • High cholesterol boys: no significant difference • Overall, strong association of BMI & risk factors for blood pressure, insulin, and blood lipids higher with: • Age • High cholesterol girls

24. Summary • Association of high cholesterol with relative weight: Girls > Boys • Early AgeOverweight girl  Earlier effect on CVD risk factors e.g. high blood lipids

25. Questions?? Founder: Dr. Gerald Berenson

26. References • "39 Years and Counting: Bogalusa Heart Study Charts Risk Factors in Child Health” Tulane University: School of Public Health and Tropical Medicine: Global Health FallWinter 2012. 10 Jan. 2012Web. 4 Apr. 2013. <http://tulanesphtm.wordpress.com/2012/01/10/39-years-and-counting-bogalusa-heart-study-charts-risk-factors-in-child-health/>. • “Bogalusa Heart Study.” Preventing Heart Attack and Stroke: A History of Cardiovascular Disease Epidemiology. Bogalusa Heart Study, Feb. 2006. Web. 1 April 2013. <http://www.epi.umn.edu/cvdepi/study.asp?id=24>. • Freedman, David S., Serdula, Mary K., Srinvasan, Santhanur R., Berenson, Gerald S “Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study1,2,3.” The American Journal of Clinical Nutrition. 69.2 (1999) 308-317. Print. • “The Bogalusa Heart Study.” Tulane University School of Medicine: Center for Cardiovascular Health. Web. 30 Mar 2013. <http://tulane.edu/som/cardiohealth/>. • Tershakovec, Andrew M., Jawad, Abbas F., Elkasabany, Abdalla, Srinivasan, Sathanur R., Berenson, Gerald S. “Persistent hypercholesterolemia is associated with the development of obesity among girls: the Bogalusa Heart Study1,2,3” The American Journal of Clinical Nutrition. 76.4 (2002) 730-735. Print.