Biomedical subjects

L S Webber

Publications and source records attributed to L S Webber.

At least 73 records · Page 4Linked to original sources

PubMed1990

School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH).

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s. The study has three phases: Phase I deals with study design, intervention, and measurement development, Phase II involves the main trial in 96 schools in four states, and Phase III focuses on analysis. The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors, including eating habits, physical activity, and cigarette smoking. Classroom curricula, school environmental change, and family involvement programs are developed for each grade level and behavioral focus. This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth. The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts.

Adolescent↗

PubMed1990

Serum total cholesterol screening for the detection of elevated low-density lipoprotein in children and adolescents: the Bogalusa Heart Study.

The use of serum total cholesterol measurement was evaluated as a screening tool to predict elevated levels of low-density lipoprotein cholesterol in 2857 children and adolescents, aged 5 to 17 years, examined in 1981 and 1982. Subjects were from the biracial community of Bogalusa, Louisiana. For selected serum total cholesterol values (150 to 210 mg/dL, 3.88 to 5.43 mmol/L), sensitivities were higher for blacks than whites and higher for females than males, whereas the positive predictive values were higher for whites than blacks and higher for males than females. With the age-, race-, and sex-specific 95th percentiles of serum total cholesterol levels as cutoff points, only 44% to 50% of subjects with elevated low-density lipoprotein cholesterol levels (greater than or equal to 95th percentile) were detected, and approximately 50% of those identified had false-positive results. Lowering the serum total cholesterol cutoff point increased the sensitivity, but decreased the specificity and positive predictive value. At the 75th percentiles of serum total cholesterol levels, sensitivities were 92% to 95% for females and 100% for males and specificities were 78% to 79%, but the false-positive results increased to 81% to 84%. The low cost and ease of obtaining serum total cholesterol measurements contribute to its appeal as a screening tool for hyperlipidemia. However, its poor test characteristics make serum total cholesterol measurement inefficient as a screening tool for detecting elevated levels of low-density lipoprotein cholesterol in children and adolescents.

Adolescent↗

PubMed1990

Serum creatinine and its relation to cardiovascular disease risk variables in children and young adults from a biracial community. The Bogalusa Heart Study.

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.

Adolescent↗

PubMed1989

Insight into a bad omen for white men: coronary artery disease--the Bogalusa Heart Study.

Clinical experience of diagnostic and interventional procedures, including cardiac surgery, indicates a greater prevalence of coronary heart disease in white men than in other race-gender groups. Studies of children and young adults in the Bogalusa Heart Study have provided evidence that might account for this race-gender contrast. A variety of anthropometric and metabolic parameters influencing serum lipid and lipoprotein levels places white boys and young white men selectively at high risk for the development of atherosclerotic coronary artery disease. Obesity and greater central body fat, subtle aberrations in carbohydrate-lipid metabolic relations and variability in sex hormone profiles appear to underlie a trend to adverse lipoprotein changes in white men. A lower high-density lipoprotein cholesterol level and apolipoprotein A-l at puberty and a dramatic increase of low-density lipoprotein cholesterol are seen in young white men; such adverse changes identify them to be at greater risk. It is noteworthy that children whose fathers had myocardial infarction tend to be white. These children also have relatively high ratios of apolipoprotein B/apolipoprotein A-l and apolipoprotein B/low-density lipoprotein cholesterol. Studies of risk factors in children emphasize their importance in the early natural history of coronary artery disease. These findings show the need for beginning prevention of adult heart disease in childhood.

Adolescent↗

PubMed1989

Pathogenesis of hypertension in black and white children.

Studies of cardiovascular risk factors in children conducted in the Bogalusa Heart Study provide a better understanding of the early natural history of essential hypertension. Contrasts in the biracial community of Bogalusa furnish some clues as to why essential hypertension is more prevalent in blacks. Black children tend to have higher blood pressure levels than whites. Autopsy studies and echocardiographic examinations have provided evidence of early cardiac enlargement in children and young adults with blood pressure levels in the 90th percentile. This suggests that the anatomic changes related to high blood pressure levels occur early in life. Blacks have lower plasma renin and serum dopamine beta-hydroxylase levels than whites. In general, obesity is not as closely correlated with higher blood pressure levels in black children as in white children. Prevention of hypertension should begin in early life. A major approach may be to educate children about cardiovascular risk factors and to encourage them to adopt healthy lifestyles while still young.

Adolescent↗

PubMed1989

Serum apolipoprotein E in children and adolescents: the Bogalusa Heart Study.

Serum apolipoprotein (apo) E levels and its relationship to lipids and lipoprotein cholesterol fractions were examined in a random subsample (n = 561) of children and adolescents (7 to 17 years of age) from a total biracial community. Mean (+/- SD) levels of apo E were higher in blacks (males 4.8 +/- 1.8 mg/dL; females 5.2 +/- 1.8 mg/dL) than in whites (males 3.9 +/- 1.2 mg/dL; females 4.3 +/- 1.0 mg/dL) irrespective of sex (P less than .001). The black-white difference in apo E persisted after controlling for the covariates: sexual maturation, age, adiposity, cigarette smoking, alcohol use, and oral contraceptive use (P less than .001). A sex differential (females greater than males, P less than .01) for apo E was seen in both racial groups. Apo E levels were inversely associated with age (P less than .01) and sexual maturation (P less than .05) only in white males. Apo E related positively and significantly to total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol fractions (HDL2-C and HDL3-C) in certain race-sex groups. Race, HDL2-C, triglycerides (very-low density lipoprotein cholesterol), HDL3-C, and sex were identified as predictor variables for apo E, in that order, and accounted for 21% of its variability in serum. It is conceivable that the observed race-sex differences in apo E may be related to apo E-HDL subfraction, which is thought to participate in the reverse cholesterol transport.

Adolescent↗

PubMed1989

Relationship between change in height and changes in serum lipid and lipoprotein levels in adolescent males: the Bogalusa Heart Study.

The relationship between increase in height and changes in levels of serum lipids and lipoproteins in adolescent males were examined through a biracial sample of 397 individuals, ages 8-12 years, who were reexamined 5 years after the initial screening. Significant negative correlations were observed between height change and changes in levels of serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) after controlling for age, initial cholesterol level, height, weight, Tanner stage, and changes in Tanner stage and weight. There was significant inverse association between height change and change in the level of HDL-C in black males, while there was significant inverse association between height change and change in the level of LDL-C in white males. These associations were independent of age, sexual maturation, and weight. Thus, changes in levels of serum lipids and lipoproteins in males during adolescence are partly associated with the growth spurt in height.

Adolescent↗

PubMed1989

Parental history of cardiovascular disease as an indication for screening for lipoprotein abnormalities in children.

We studied the relationship between parental history of cardiovascular disease and risk for adverse lipid and lipoprotein levels in a total community study of 3313 children (ages 4 to 17 years, 63% white, 37% black). Older white children (11 to 17 years) with a parental history of heart attack or diabetes were 4.3 and 5.6 times, respectively, more likely to have high levels (greater than or equal to 95th percentile) of serum total cholesterol than those without such a history (all p less than 0.05). White children with a parental history of heart attack or diabetes were twice as likely to have an elevated (greater than or equal to 95th percentile) low-density lipoprotein cholesterol (LDL-C) level than those without such a history (both p less than 0.05). In contrast, parental history of cardiovascular disease did not predict elevated levels of total cholesterol or LDL-C in black children. However, older black children with a parental history of heart attack, hypertension, or diabetes were 4 1/2 to 5 times more likely to have low levels (less than or equal to 5th percentile) of high-density lipoprotein cholesterol than those without such a history (all p less than 0.05). Only 40% of white children and 21% of black children with elevated LDL-C levels had a parental history of vascular disease. These findings raise questions about the current practice of screening only children with a family history of cardiovascular disease to identify those with elevated total cholesterol and LDL-C levels.

Adolescent↗

PubMed1989

A multivariate model for assessing eating patterns and their relationship to cardiovascular risk factors: the Bogalusa Heart Study.

Eating patterns were studied in 1275 adolescents and young adults (aged 12-24 y). Factor analysis of 64 foods consumed weekly revealed 17 eating-pattern factors, accounting for 57% of the item variance. Factor I (12 food items from either the seafood or meat group) accounted for 8% of the variance, factor II (snacks), 5%, and factors III (fats and pasta) and IV (beef and chicken), 4% each. Remaining factors accounted for from 1.9% to 3.9%. The factors were effective in discriminating eating patterns across race and gender. Significant age effects were also noted for 10 of the 17 factors. Eating patterns for persons in the upper or lower quartiles differed consistently for specific cardiovascular (CV) risk factors. Use of this statistical model to identify differences in eating patterns by race, gender, and CV risk factors during maturation can assist health professionals in targeting food sources for changing eating behavior.

Adolescent↗

PubMed1989

Relation of body fat patterning to lipid and lipoprotein concentrations in children and adolescents: the Bogalusa Heart Study.

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.

Adipose Tissue↗

PubMed1989

Risk factors in early life as predictors of adult heart disease: the Bogalusa Heart Study.

The adult heart diseases, coronary artery disease and essential hypertension, are now clearly recognized to begin in childhood. The evidence comes from autopsy studies of cardiovascular-renal changes in the first two decades of life. Cardiovascular risk factors can be identified in children just as in adults and these have a high correlation with the anatomic disease. This relationship underscores the importance of risk factor screening of children. Of interest is that clinical risk factors tend to persist within a rank (track) so that studies in childhood can be predictive of future levels. Behavior and lifestyle of eating, cigarette smoking, alcohol intake, and use of oral contraceptive pills influence risk factors in children. Familial aggregation of risk factors are also noted. Studies of apolipoproteins, B and A-I, have identified subsets of children that have a greater frequency of paternal myocardial infarction. The findings from the Bogalusa Heart Study and other epidemiological studies of children show the need to begin prevention of adult heart disease in early life. Approaches to prevention should include high risk families and children and a public health or population approach. Cardiovascular health education for elementary school children should be directed to children in the general population in an effort to encourage them to adopt healthy life styles.

Aging↗

PubMed1988

Cardiovascular risk in parents of children with extreme lipoprotein cholesterol levels: the Bogalusa Heart Study.

Fasting serum lipids, lipoprotein cholesterol, and other cardiovascular disease risk factors were examined in 321 natural parents of children with low and/or high levels of beta- and pre-beta-lipoprotein cholesterol. Parents of children from low pre-beta-lipoprotein groups had elevated alpha- and lower pre-beta-lipoprotein cholesterol levels. Parents whose children had high beta-lipoprotein cholesterol levels also had high serum total and beta-lipoprotein cholesterol levels. Parents of children with high levels of both beta- and pre-beta-lipoprotein cholesterol had a high prevalence of both abnormal risk factor levels, as well as clinical evidence of early coronary artery disease (before age 50 years). These observations show that parents of children with high beta- and/or pre-beta-lipoprotein cholesterol levels have greatly enhanced risk for cardiovascular disease, and children mirror their parents' lipoprotein cholesterol levels. These observations emphasize the need for cardiovascular risk evaluation early in life, especially in high-risk families.

Adolescent↗

PubMed1988

Black-white differences in aortic fatty streaks in adolescence and early adulthood: the Bogalusa Heart Study.

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.

Adolescent↗

PubMed1988

Secular trends of obesity in early life: the Bogalusa Heart Study.

Secular changes in height and weight measurements were examined in five- to 14-year-olds from 1973 to 1984. The age-sex specific 85th percentile was used to classify persons as overweight (based on ponderal index; kg/m3). Secular increases in weight (2.5 kg), and ponderosity (0.5-0.7 kg/m3) were found. Gains in ponderosity over the 11-year period were greater at the 75th percentile than at the 25th percentile, and the prevalence of overweight increased from 15 per cent to 24 per cent.

Age Factors↗

PubMed1988

Cardiovascular risk factors in children and early prevention of heart disease.

Clinical and anatomical observations from the Bogalusa Heart Study over a 15-year span provide data on cardiovascular risk factors and the early natural history of arteriosclerosis. These studies established that: cardiovascular risk can be predicted in early life; interrelationships of risk factors in children are similar to those observed in adults; and concentrations of serum lipoproteins change during sexual maturation. Strategies involving the general population and high-risk groups should be considered to help reduce atherosclerosis and coronary artery disease. Active modification of risk factors in the general populace would include using such methods as screening, education, and mass-media campaigns. Educational promotion ("Heart Smart") has already been implemented in the New Orleans area, focusing on using the total school environment to teach cardiovascular health and to encourage children to adopt desirable lifestyles. Inclusion of cardiovascular health education into general educational studies of children should be a major objective of the future.

Arteriosclerosis↗

PubMed1988

Trends in fatty acid intakes of 10-year-old children, 1973 to 1982.

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.

Body Constitution↗

PubMed1988

Caffeine intakes of children from a biracial population: the Bogalusa Heart Study.

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.

Adolescent↗

PubMed1988

Sodium, potassium, calcium, magnesium, and phosphorus intakes of infants and children: Bogalusa Heart Study.

Electrolyte and mineral intakes assessed by 24-hour dietary recall were examined for race and sex differences in cohorts of infants and school-age children at 6 months and at 1, 2, 3, 4, 10, 13, 15, and 17 years. A fourfold increase in sodium intake occurred from 6 months to 4 years, and potassium intake doubled. Sodium increased from 0.88 gm at 6 months to 3.21 gm at 4 years and 3.67 gm by 17 years; a slight increase for potassium was noted from 4 to 17 years for boys. Calcium intake was relatively constant from 6 months to 17 years. Boys had higher intakes of sodium and sodium per kilogram body weight than did girls. Black children at 2, 3, and 4 years had significantly higher sodium, potassium, calcium, phosphorus, and magnesium expressed as total intake and per kilogram body weight than white children did. At 6 months, 66% of the infants exceeded the National Research Council's recommended range for sodium. At 1 to 10 years, 90% to 100% and at 13 to 17 years, 60% to 65% exceeded the recommended range. In contrast, 58% to 77% of preschool children and only 5% to 20% of school-age children surpassed the recommended potassium range. Fifty percent to 70% of children more than 10 years old achieved the recommended range for potassium. Approximately half of the children 6 months through 4 years of age met the Recommended Dietary Allowance (RDA) for calcium. Sixty percent to 80% of adolescents ingested less than two-thirds the RDA. Girls had lower intakes than did boys.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗