Field Notes

Cholesterol Levels Appear to Be Improving Among US Youths

In a study involving more than 16,000 US children and adolescents, there has been a decrease in average total cholesterol levels over the past two decades, although almost one in 10 had elevated total cholesterol in 2007-2010, according to a study in The Journal of the American Medical Association.

"The process of atherosclerosis begins during childhood and is associated with adverse serum lipid concentrations including high concentrations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides, and low concentrations of high-density lipoprotein cholesterol (HDL-C). Serum lipid concentrations in childhood are associated with serum lipid concentrations in adulthood," according to background information in the article. "For more than 20 years, primary prevention of coronary heart disease has included strategies intended to improve overall serum lipid concentrations among youths."

Brian K. Kit, MD, MPH, of the Centers for Disease Control and Prevention, and colleagues conducted a study to examine the trends in serum lipid concentrations among US children and adolescents. The study included data on 16,116 youths aged 6 to 19 who participated in the National Health and Nutrition Examination Survey (NHANES) during three time periods: 1988-1994,1999-2002, and 2007-2010. Among the measures analyzed for all the participants were average serum total cholesterol (TC), non–HDL-C, and HDL-C, and among adolescents only (aged 12 to 19) LDL-C and geometric average triglyceride levels.

Trends in adverse lipid concentrations were reported for TC levels of 200 mg/dL and greater, non–HDL-C levels of 145 mg/dL and greater, HDL-C levels of less than 40 mg/dL, LDL-C levels of 130 mg/dL and greater, and triglyceride levels of 130 mg/dL and greater.

The researchers found that among youths aged 6 to 19 between 1988-1994 and 2007-2010, there was a decrease in average serum TC from 165 to 160 mg/dL and an increase in average serum HDL-C from 50.5 to 52.2 mg/dL. There also was a decrease in the average serum non–HDL-C levels during this time period.

"Generally, the sex-, age-, and race/ethnicity-specific trends for TC, HDL-C, and non-HDL-C were similar in direction to the overall trends and consistent with a favorable trend, although for each group, the magnitude was not the same and the trend was not always significant," the authors wrote.

Between 1988-1994 and 2007-2010, there was a decrease in prevalence among youths aged 6 to 19 of elevated TC from 11.3% to 8.1% and non–HDL-C from 13.6% to 10%. Prevalence of low HDL-C was 17.3% in 1988-1994 and 14.8% in 2007-2010, a nonsignificant decrease.

Among adolescents, there was a decrease in the prevalence of elevated LDL-C and triglycerides between 1988-1994 and 2007-2010 and a decrease in average serum LDL-C from 95 to 90 mg/dL and geometric average serum triglycerides from 82 to 73 mg/dL.

In 2007-2010, 22% of youths had either a low HDL-C level or high non–HDL-C, which was lower than the 27.2% in 1988-1994.

The authors also found that age- and race/ethnicity-adjusted TC was 4.3 mg/dL lower for males and 6.5 mg/dL lower for females in 2007-2010 than in 1988-1994. Males and females who were non-Hispanic black or Mexican American and also females who were non-Hispanic white had a lower age-adjusted TC in 2007-2010 than in 1988-1994. Age- and race/ethnicity- adjusted HDL-C was higher for males and females in 2007-2010 than in 1988-1994.

"Between 1988-1994 and 2007-2010, a favorable trend in serum lipid concentrations was observed among youths in the United States but adverse lipid profiles continue to be observed among youths," the researchers wrote. "For example, in 2007-2010, slightly more than 20 percent of children aged 9 to 11 years had either a low HDL-C or high non-HDL-C concentration, which, according to the most recent cardiovascular health guidelines for children and adolescents, indicates a need for additional clinical evaluation.

"The recently released Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents provides recommendations for preventing the development of cardiovascular risk factors including optimizing nutrition and physical activity and reducing exposure to tobacco smoke. Specific screening approaches, including universal screening at select ages and management of adverse lipid concentrations, have also been detailed in these recent guidelines for youths. Future research from longitudinal studies or mortality-linked data, including NHANES, may include examining clinical outcomes for cardiovascular disease, including cardiovascular mortality, based on lipid concentrations present during childhood," the authors concluded.

— Source: American Medical Association


Technology to Trim Childhood Obesity

To combat the ongoing epidemic of childhood obesity, two Johns Hopkins University School of Nursing students are using smartphones and websites to engage and invite young audiences.

Janna Stephens, RN, BSN, a doctoral student, is reaching out through a smartphone app that provides tips for healthful food and physical activity. The app also allows users to interact through Facebook and Twitter, helping them view losing weight as a more fun and positive experience.

“To engage this population in studies about weight loss, the intervention needs to be something that will stimulate them and [be] something they want to do,” Stephens says. “Adolescents spend hours on their smartphones and use applications to do just about everything, so why not weight loss? The use of smartphone applications to aid in weight loss gives adolescents the power to monitor their intake instantly and to gain real-time feedback related to eating and exercise behaviors.”

She’ll recruit overweight and obese adolescents from Baltimore City and place them into groups at random. Some of the adolescents will use the app to help with weight loss and some will not.

Michelle Brei, APRN, CPNP, a doctor of nursing practice student, is developing an interactive website for adolescents at Yale Health in order to reduce pediatric obesity. Her motivation for creating this platform stems from what she witnesses regularly.

“As a pediatric nurse practitioner in primary care, I see children struggle with maintaining a healthy weight on a daily basis. Childhood obesity has become an epidemic,” Brei says. “I felt strongly that greater prevention efforts were needed to keep children healthy.”

The site, scheduled to launch in the fall, will be child friendly and include games about nutrition along with entertaining videos. Part of the website’s interaction will offer healthy recipes, educational materials, links to vetted websites with resources, and printable tracking charts for following healthy lifestyle goals. Much of the site design has been guided by feedback from focus groups of parents and children.

“The long-term goal,” Brei says, “is to have an effective Web-based family resource for pediatric obesity prevention that reinforces and expands upon the counseling clinicians provide during office visits.”

— Source: Johns Hopkins University School of Nursing