The theme of this year’s World Heart Day, ‘Cardiovascular disease prevention among women and children,’ indicates a paradigm shift in the focus from adults to children. This is a result of the global realisation that the war against the leading killer, atherosclerosis and coronary artery disease, can be won only if remedial measures are initiated from childhood.
Obesity is a result of energy intake exceeding energy expenditure, leading to excessive fat deposition in the body. The excess fat and cholesterol commonly get deposited inside the arteries, resulting in a hardening of the arterial vessel wall. This is called atherosclerosis. The fat deposits inside the vessel are called plaques and the increase in size over a period of time, causing a progressive blockage to blood flow. When the blockage is significant, it will lead to a heart attack.
Recent data from the Centers for Disease Control and Prevention in the United States of America have established that 35.7% of adults and 16.9% of children are obese. Other studies show that at least 70% of these obese adolescents grow up to be obese adults. Once obesity is established in adulthood, it will be extremely difficult to reverse it. This is the rationale for shifting the focus on controlling obesity in children as well as inculcating lifestyle modifications, which in turn will produce a generation of adults free of the early onset of cardiovascular disease and contribute to a healthy society.
Childhood obesity is caused by multiple factors. The predominant cause is an unhealthy dietary habit compounded by a sedentary lifestyle. Other causes include intake of medications such as steroids, some medical conditions such as hypothyroidism and genetic factors. It has been found that if one parent is obese, the chances of obesity in the child are 50%, whereas if both parents are obese, it is nearly 80%. Children whose family members are overweight or have hypercholesterolaemia or a history of cardiovascular disease under 55 years are considered high risk for the early onset of coronary artery disease and should be screened periodically beyond two years of age with a fasting lipid profile. The lipid profile values for children are:
- Total Cholesterol >170mg/dl (Borderline), >200mg/dl (Elevated)
- LDL >110 mg/dl (Borderline), >130 mg/dl (Elevated)
- HDL <35 mg/d
- TGL >150 mg/dl (Elevated)
If the average results of three lipid profile results are above the cut-off values, then intervention will be required in the form of dietary and lifestyle modifications. Medications to reduce cholesterol is indicated when the LDL exceeds 160mg/dl with associated high risks or when it is > 190mg/dl.
In the absence of a medical cause, childhood obesity can be managed only by a strict diet and exercise regimen. This includes avoiding fatty foods and snacks, binge eating, watching television while eating; eating slowly, increasing outdoor physical activities and, if necessary, taking the help of a dietician or psychiatric counsellor.
(The writer is Interventional Paediatric Cardiologist, Frontier Lifeline Hospital, Chennai. Email is >premsekar@yahoo.com )
