Cardiovascular Health in US Children | Journal Scan

Study Questions:

Using American Heart Association (AHA) defined metrics for cardiovascular health, how healthy are children under the age of 12 years, who reside in the United States?


Using the National Health and Nutrition Examination Surveys (NHANES), a sample of 8,961 children between the ages of 2 and 11 years who contributed data to NHANES cohorts between 2003 and 2010 were included. Cardiovascular metrics included body mass index (BMI), a healthy diet score, total cholesterol, and blood pressure (BP). Dietary score was based on fruit and vegetable intake, whole grains consumed with less sweetened beverages, and sodium <1500 mg/day. Diet score was associated with BMI, BP, and total cholesterol. BMI was defined as ideal if <85th percentile for age and gender, and poor if >95th percentile. BP was categorized in a similar fashion, with ideal being <90th percentile. Ideal total cholesterol was defined as <170 mg/dl.


A total of 8,961 children were included, of which 4,518 were boys and 4,443 were girls. The mean age of the cohort was 6.8 years and 58% were non-Hispanic white, 15% were non-Hispanic black, 15% were Mexican American, and 12% were other. No child had ideal levels for all four cardiovascular metrics, but 2-3 had ideal metrics. Very few children had an ideal healthy diet (0-0.1%). Most children consumed a diet high in sodium, with about 10% of the cohort meeting a goal of <1500 mg/day for sodium. More than half of the cohort consumed greater than recommended amounts of sugar-sweetened drinks and <10% consumed recommended levels of fruits and vegetables. Only 67% of older children (ages 6-11 years) were in a healthy BMI range compared to 77% of younger children (ages 2-5 years). Unhealthy or intermediate total cholesterol levels were observed in approximately 40% of the cohort. A healthy BP level was observed for most children, across both sex and race/ethnicity groups.


The investigators concluded that cardiovascular health, as measured by four metrics (BMI, total cholesterol, BP, and diet) among children under 12 years, demonstrated a mixed picture. While BMI, total cholesterol, and BP were in the healthy range for a majority of the cohort, poor dietary patterns were common. The authors further commented that limited availability of these metrics reduced the ability to detect secular trends, which increased incident cardiovascular disease and thus represented missed opportunities.


Regular surveillance of measureable cardiovascular metrics in children would allow for the detection of healthy and unhealthy trends. Such data represent an opportunity to develop effective primordial and primary prevention programs to reduce the burden of cardiovascular disease.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins

Keywords: Blood Pressure, Body Mass Index, Cholesterol, Carbohydrates, Cardiovascular Diseases, Fruit, Sodium, Vegetables, Sweetening Agents, Nutrition Surveys, Child, Primary Prevention, Dyslipidemias, Metabolic Syndrome X

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