We assessed the relation of risk factors for cardiovascular disease to early atherosclerotic lesions in the aorta and coronary arteries in 35 persons (mean age at death, 18 years). Aortic involvement with fatty streaks was greater in blacks than in whites (37 vs. 17 percent, P less than 0.01). However, aortic fatty streaks were strongly related to antemortem levels of both total and low-density lipoprotein cholesterol (r = 0.67, P less than 0.0001 for each association), independently of race, sex, and age, and were inversely correlated with the ratio of high-density lipoprotein cholesterol to low-density plus very-low-density lipoprotein cholesterol (r = -0.35, P = 0.06). Coronary-artery fatty streaks were correlated with very-low-density lipoprotein cholesterol (r = 0.41, P = 0.04). Mean systolic blood-pressure levels also tended to be higher in the four subjects with coronary-artery fibrous plaques than in those without them: 112 mm Hg as compared with 104 (P = 0.09). These results document the importance of risk-factor levels to early anatomical changes in the aorta and coronary arteries. The progression of fatty streaks to fibrous plaques is uncertain, but these data suggest that a rational approach to the prevention of cardiovascular disease should begin early in life.

The relation of body fat distribution to plasma levels of glucose and insulin during an oral glucose tolerance test was examined in 355 Black and White school-age children. Both central and peripheral fat were similarly related to fasting, 30-min, and 1-h glucose. Unlike peripheral fat, central body fat was more strongly related to the 1-h insulin response (r = 0.35 vs 0.26); this association remained significant for central fat independent of peripheral fat (r = 0.18). The strong relation of central fat to insulin response was noted in both races and sexes but not in either sexually immature or relatively thin children. These findings indicate that, even in early life, a central body fat pattern relates positively to insulin response to glucose load. Thus, knowledge of body fat localization may help identify persons most susceptible to hyperinsulinemia in early life.

A dietary study of 10-year-old children was incorporated into a larger epidemiological survey investigating the distributions, interrelationships, and course-over-time of arteriosclerosis risk factor variables in children. Food intakes, eating patterns, and diet-risk factor interrelationships are described for 185 children (35% black, 65% white) using an improved 24-hr dietary recall method. Protein intakes were high. The polyunsaturated-to-saturated fatty acid ratio averaged 0.4 and a sucrose-to-starch proportion of 1.1 was noted. Eggs were the main food source of cholesterol and milk was the prime source of saturated fatty acids and protein. Black girls had a significantly greater mean sodium intake than the three other sex-race groups. Intermittent snacks provided the most calories; breakfast and dinner contributed most of the day's cholesterol, and lunch was the prime source of lactose and calcium. Longer eating spans reflected significantly greater intakes of calories, protein, fat, carbohydrate, and sodium, and greater levels of total serum cholesterol. A lack of correlations was noted in large matrices of dietary components and risk factor variables, but results of the comparison of mean intakes of dietary components for children grouped according to serum cholesterol showed significant differences in the intakes of various forms of fat and carbohydrate.

Cardiovascular disease risk factors were studied in Hispanic children in Brooks County, Texas, and in white and black children in Bogalusa, Louisiana, in 1984-1985. The same protocols were used at both sites; examiners in Brooks County were trained by Bogalusa Heart Study staff. All blood samples were analyzed in a single laboratory standardized by the Centers for Disease Control. Hispanic children were about 4 cm shorter and were about the same weight as white and black children. Subscapular skinfolds were thickest in Hispanic children. Little difference was noted for blood pressure levels in the three ethnic groups. Total cholesterol levels were highest in black children, with a drop during puberty being noted in all of the ethnic groups. This drop with puberty appeared somewhat earlier in the Hispanic children. Lipoprotein levels for Hispanic children were, in general, similar to those noted for white children. Some of the Hispanic-black differences in lipid and lipoprotein levels could be explained by differences in body size. Because Hispanics are at increased risk for specific diseases, such as diabetes, increased study of this population is warranted. Intervention and education programs aimed at altering this risk must address the unique cultural heritage of this population.