Cardiometabolic risk factors in siblings from a statewide screening program.

Background: The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project is a state-wide risk factor screening program that operated in West Virginia for 19 years and screened more than 100,000 5th graders for obesity, hypertension, and dyslipidemia.

Objectives: We investigated siblings in the CARDIAC Project to assess whether cardiometabolic risk factors (CMRFs) correlate in siblings.

Methods: We identified 12,053 children from 5752 families with lipid panel, blood pressure, and anthropometric data.

Clinical Genetic Testing for Familial Hypercholesterolemia: JACC Scientific Expert Panel.

Although awareness of familial hypercholesterolemia (FH) is increasing, this common, potentially fatal, treatable condition remains underdiagnosed. Despite FH being a genetic disorder, genetic testing is rarely used. The Familial Hypercholesterolemia Foundation convened an international expert panel to assess the utility of FH genetic testing.

Pediatric metabolic outcome comparisons based on a spectrum of obesity and asthmatic symptoms.

Rationale: Asthma and obesity are 2 of the most prevalent public health issues for children in the U.S. Trajectories of both have roughly paralleled one another over the past several decades causing many to explore their connection to one another and to other associated health issues such as diabetes and dyslipidemia.

The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project: An 18 Year Review.

Background: The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project is a chronic disease risk factor surveillance, intervention, and research initiative aimed at combating the unacceptably high prevalence of heart disease, diabetes, and other chronic illnesses in West Virginia.

Objectives And Methods: The school-based public health project identifies health risk factors in children, educates families, informs primary care physicians, and provides resources to schools to help improve population health, beginning with children.

Results And Conclusion: Details regarding methodology, results, and conclusions derived from this unique public health initiative that has screened over 200,000 children are the subject of this 18- year review.

LDL cholesterol level in fifth-grade schoolchildren associates with stature.

Short stature is associated with increased LDL-cholesterol levels and coronary artery disease in adults. We investigated the relationship of stature to LDL levels in children in the West Virginia Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project to determine whether the genetically determined inverse relationship observed in adults would be evident in fifth graders. A cross-sectional survey of schoolchildren was assessed for cardiovascular risk factors.

The relationship between children's physical activity and family income in rural settings: A cross-sectional study.

Objective: To examine potential differences in children's physical activity and parent support of their children's physical activity based on family income within the rural setting.

Methods: A cross-sectional survey of 566 parents of children (5-15 years-old; mean = 7.7 years; standard deviation = 2.

Chronic disease risk screening: characteristics of parents who participate in screening with their children.

Objective: To characterize adults who participate in a free health screening based on their children's participation in the same program and to identify factors that potentially contribute to their participation.

Methods: Child (n = 81,156) and parent (n = 5,257) results from a statewide, school-based project from 1998-2010 were assessed. Parent and child health outcomes including fasting lipids, and body composition were assessed using standardized procedures.

Reducing the burden of disease and death from familial hypercholesterolemia: a call to action.

Familial hypercholesterolemia (FH) is a genetic disease characterized by substantial elevations of low-density lipoprotein cholesterol, unrelated to diet or lifestyle. Untreated FH patients have 20 times the risk of developing coronary artery disease, compared with the general population. Estimates indicate that as many as 1 in 500 people of all ethnicities and 1 in 250 people of Northern European descent may have FH; nevertheless, the condition remains largely undiagnosed.

Association between birth characteristics and coronary disease risk factors among fifth graders.

Objective: To evaluate the associations between selected birth characteristics-prematurity and poor intrauterine growth-and risk factors for coronary artery disease detected among children enrolled in the fifth grade.

Study Design: Children (n = 3054) with matched birth and fifth grade health screening data on body mass index (BMI), systolic blood pressure, and fasting lipid profiles were analyzed using MANOVA with the following independent variables of weight gain by the fifth grade: BMI percentile, normal or overweight/obese (BMI ≥ 85 th percentile), prematurity, and intrauterine growth (ie, small for gestational age [SGA], appropriate for gestational age [AGA], or large for gestational age [LGA]).

Results: LGA status at birth was associated with overweight/obesity later in life.

Individual-, family-, community-, and policy-level impact of a school-based cardiovascular risk detection screening program for children in underserved, rural areas: the CARDIAC Project.

The Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) Project has screened more than 80,000 children (10-12 years) for cardiovascular and diabetes risk factors over the past 15 years. Simultaneous referral and intervention efforts have also contributed to the overall program impact. In this study, we examined evidence of programmatic impact in the past decade at the individual, family, community, and policy levels from child screening outcomes, referral rates, participation in subsequent services, and policies that embed the activities of the project as a significant element.

Identifying the people and factors that influence children's intentions to make lifestyle changes.

Childhood obesity and health behavior programs are increasingly a focus within literature and individual provider practices. This study was designed to inform "best practices" for establishing effective programs in the medical setting by identifying persons and factors that influence children's willingness to be active, eat healthy, and lose weight when medically appropriate. A total of 342 child and parent dyads living in a rural setting participated in this study.

Metabolic abnormalities in children with asthma.

Rationale: Childhood asthma and obesity have reached epidemic proportions worldwide, and the latter is also contributing to increasing rates of related metabolic disorders, such as diabetes. Yet, the relationship between asthma, obesity, and abnormal lipid and glucose metabolism is not well understood, nor has it been adequately explored in children.

Objectives: To analyze the relationship between asthma diagnosis and body mass in children across the entire range of weight percentile categories, and to test the hypothesis that early derangement in lipid and glucose metabolism is independently associated with increased risk for asthma.

Morbidly obese diagnosis as an indicator of cardiovascular disease risk in children: results from the CARDIAC Project.

Objective: Obesity, an epidemic in children in the United States and abroad, is associated with risk factors for cardiovascular disease (CVD). Less is known about the consequences of morbid obesity in children. In the rural Appalachian population, obesity rates have reached such high proportions that it is difficult to target individual children.

Body mass index as a surrogate measure of cardiovascular risk factor clustering in fifth-grade children: results from the coronary artery risk detection in the Appalachian Communities Project.

Background: Obesity, an increasing problem in children in the United States and abroad, has been associated with risk factors for cardiovascular disease (CVD). Consequently, there is a need to determine body mass index (BMI) cut-off values for recommending comprehensive assessment and intervention for high-risk children. The objective of this study was to use results from a large-scale cross-sectional screening project, the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC), to derive BMI cut-off values that predict clustering of CVD risk factors.

Assessing BMI in West Virginia schools: parent perspectives and the influence of context.

West Virginia is a state at the forefront of the obesity epidemic and one that is experiencing immense health and economic costs as a result. The childhood obesity research discussed in this article was conducted over the past 10 years through 4 projects that range from a school-based cardiovascular risk screening program to an evaluation of state legislation targeting childhood obesity via modifications in the school environment. In the course of these projects, we have collected BMI and other health indices on students, provided feedback to students and their parents, and assessed the obesity and health-related beliefs of West Virginians through individual and focus-group interviews and questionnaires.

Using the theory of reasoned action to determine physicians' intention to measure body mass index in children and adolescents.

Background: Over the past few decades, childhood obesity has become a major public health issue in the United States. Numerous public and professional organizations recommend that physicians periodically screen for obesity in children and adolescents using the body mass index (BMI). However, studies have shown that physicians infrequently measure BMI in children and adolescents.

Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project.

Background: A number of cardiovascular disease (CVD) risk factors have been linked to obesity and associated negative health outcomes in children. However, no consistent definition of metabolic syndrome exists for children. In addition, research is needed to systematically examine the prevalence of metabolic syndrome in high-risk children, including those with insulin resistance.

Promoting youth physical activity and healthy weight through schools.

The prevalence of overweight in youth has increased three- to four-fold in the United States since the 1960s. The school environment can play prominently in the mitigation of this epidemic by increasing physical activity opportunities/ levels, decreasing the availability of food/ beverage with added sugar, and enhancing students' scientific understandings about energy balance. The potential to increase energy expenditure goes beyond the school day to include safe routes for walking and biking to school (active transport) as well as the availability of school facilities as a community resource for physical activity outside of school hours.

Comparisons of parent cardiovascular knowledge, attitudes, and behaviors based on screening and perceived child risks.

Questionnaire reports and universal screening procedures from 244 children (kindergarten, 5th grade, and 9th grade) were used to explore differences in parent health knowledge and attitudes of cardiovascular risks among children and parental involvement in promoting healthy lifestyles relative to whether their children were identified as being overweight or at risk of being overweight. The knowledge, attitudes, and behaviors of the parents of children who were identified as being at risk or overweight were further examined based on their perceptions of their children's level of risk. Parents' reports demonstrated significantly greater parent encouragement and knowledge of issues related to eating healthier foods and ways to cut calories among parents of children who were identified as being at risk or already overweight.

The adult with congenital heart disease.

There are approximately 800,000 adult survivors of congenital heart disease in the U.S., and this number continues to increase on an annual basis.

A kindergarten cardiovascular risk surveillance study: CARDIAC-Kinder.

Objective: To evaluate an intervention aimed at increasing family physical activity and parent education about diet and activity for kindergarten students and issues related to their children's BMI.

Methods: A randomized, controlled trial design was used to assess intervention impact in parental report of child diet and physical activity, and step logs over a 4-week period.

Results: Participants in the intervention group reported that their children obtained more steps by the end of the program period, were more active, and had consumed fewer sweets than the comparison group.

Dietary intake of children at high risk for cardiovascular disease.

Cardiovascular disease and obesity begin in childhood, and dietary interventions to prevent them should be initiated then. We hypothesized that children who were at high risk for cardiovascular disease based on family history would have diets that were different than those of children from low-risk families. Two hundred ninety-seven children were screened for family history of early cardiovascular disease; had height, weight, and finger-stick total cholesterol measured; and filled out food frequency questionnaires.

School-based obesity screening in rural Appalachia.

Background: Although identification of obesity during childhood is strongly recommended for the prevention of adult disease, access to obesity screening for children is almost exclusively through physicians' office visits. We examined the feasibility and utility of conducting a school-based obesity and cardiovascular disease (CVD) risk factor screening program in a rural Appalachian population.

Methods: Height, weight, blood pressure, total cholesterol (TC), and high-density lipoprotein (HDL) cholesterol were measured in 1338 fifth-grade children (631 boys and 707 girls) in 14 rural West Virginia counties in 2000-2001.

The relation of obesity to cardiovascular risk factors among children: the CARDIAC project.

West Virginia's prevalence of obesity is among the highest in the nation, contributing to an excess mortality rate from heart disease. Individuals who are overweight and obese have a greater risk for coronary artery disease. To gain insight into the impact of obesity on other modifiable cardiovascular disease (CVD) risk factors among children, 5,887 students from 27 rural West Virginia counties participated in the school-based Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project during the 1999-2002 school years.