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

2. B ACKGROUND 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. B ACKGROUND CONT ’ D … >16,000 participants Ages: 2.5-17 yr old Methods: Medical Exams Questionnaires Overall Results: Childhood CV risk factors  Adulthood

4. I NITIAL S TUDY 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. I NITIAL S TUDY R ESULTS 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. G OALS Decrease Risk Factor Prevalence Increased Screening & Methods Develop Interventions Nutrition Intervention Healthier Tomorrow

7. C HILDREN 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. T IMING 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: First Year of Life Puberty Adolescence Transition to young adulthood Adulthood

9. A THEROSCLEROSIS & H YPERTENSION R ESULTS Autopsy Study results: Atherosclerosis and hypertension are early onset Athero- sclerotic Lesions Changes in Kidney Vasculature CV Risk Factors

10. G ENDER & R ACE R ESULTS G ender African Americans Both Sexes More severe hypertension DiabetesWhiteMenCADWomen Lag of onset of CAD

11. E NVIRONMENTAL R ESULTS Controllabl e Risk Factors Diet Smoking Exercise Obesity High Cholesterol High Blood Pressure Significant Influence

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. S UMMARY 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. R ESEARCH S TUDIES

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 Clin Nutr February 1999 vol. 69 no. 2 308-317

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

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

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

19. S UMMARY Central Abdominal Body Fat Distribution Triacyl- glycerol LDL chole- sterol HDL Chole- sterol Insulin

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, Abdalla Elkasabany, Santhanur R Srrinivasan, and Gerald S Berenson Am J Clin Nutr October 2002 vol. 76 no. 4 730-735

21. O BJECTIVE 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. D ESIGN 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. R ESULTS 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. S UMMARY 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. R EFERENCES "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.. “Bogalusa Heart Study.” Preventing Heart Attack and Stroke: A History of Cardiovascular Disease Epidemiology. Bogalusa Heart Study, Feb. 2006. Web. 1 April 2013.. 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.. 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.