Atherosclerosis—A Pediatric Nutrition Problem?

Holman, Russell L.

doi:10.1093/ajcn/9.5.565

Cited by 91 publications

(29 citation statements)

References 3 publications

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“…49 Seven similar editorials appeared during the following 20 years but received little attention because the beneficial effects of controlling CHD risk factors had not been firmly established in adults. However, as the natural history of atherosclerosis was appreciated and the effects of the risk factors in adult cardiovascular disease were demonstrated, investigators began in the 1970s to examine the prevalence of risk factors for adult CHD in children and adolescents in widely separated communities: Bogalusa, La 50 ; Muscatine, Iowa 51 ; and multiple sites in Finland.…”

Section: Atherosclerosis As a Pediatric Problemmentioning

confidence: 99%

Preventing Heart Disease in the 21st Century

McMahan²,

2008

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W e could prevent 90% of heart attacks. Such a claim would have seemed outrageous in the 1960s, as the coronary heart disease (CHD) epidemic reached new heights and accounted for one third of all deaths in the United States and most other developed countries. 1 The identification of conditions that predicted the probability of CHD (known as "risk factors") stimulated hope that modification of these risk factors would reduce the frequency of CHD. Long before this idea was validated in clinical trials, individual physicians 2,3 and voluntary health agencies 4 began in the 1960s to promote the concept to the public. Many individuals accepted the idea, and many physicians adopted the recommendations in their practices.The US CHD mortality rate declined to approximately half its former level by 1990. 5 The associated favorable changes in risk factors accounted for about half of this decline, whereas improved treatment of CHD accounted for the other half. 6 The extent and severity of atherosclerosis also declined during this period. 7,8 CHD mortality continued to decline after 1990 but at a slower rate, and CHD remained the leading cause of death in the United States. 9 A convergence of evidence from diverse sources in the last 2 decades now indicates that the claim that we can prevent 90% of CHD should no longer be thought of as outrageous but as achievable. For example, the absence of the major established CHD risk factors at 50 years of age has been shown to indicate a 90% lower lifetime risk (to age 95 years) for men and a 79% lower risk for women. 10 * Subjects in several large cohorts without any of the major risk factors who were followed up for 16 to 22 years had 77% to 92% lower (men) or 79% lower (women) CHD mortality. 11 † A mutation in PCSK9, a gene that regulates low-density lipoprotein (LDL) cholesterol, has been shown to result in a 28% reduction in LDL cholesterol and an 88% lower risk of CHD. 12 The present report reviews the benefits and limitations of CHD prevention efforts in adults and attempts to expand prevention efforts to young people. We summarize evidence showing that CHD risk factors are associated with both the early and advanced stages of atherosclerosis. This evidence supports the need to maintain a low lifetime risk by preventing development of risk factors in youth or controlling risk factors if they do develop, measures that will prevent atherosclerosis and thereby prevent CHD. Risk Factor Control in Adults Reduces but Does Not Eliminate CHDA number of controlled clinical trials of fat-modified diets 13 and drugs 14 yielded mixed results, but ultimately, modification of individual risk factors in adults was shown to reduce CHD risk. Cholestyramine was proven to lower LDL cholesterol levels and reduce CHD incidence 15 ; a decade later, a statin was shown to lower LDL cholesterol and CHD incidence more effectively. 16 Smoking cessation has also been shown to reduce the incidence of CHD. 17 Pharmacological treatment of hypertension lowers both the incidence of CHD and the incidence of is...

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Section: Atherosclerosis As a Pediatric Problemmentioning

confidence: 99%

Preventing Heart Disease in the 21st Century

McMahan²,

2008

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“…5 Although the factors initiating atherosclerosis are not fully understood, prospective studies in adult humans have identified associations between Russell Holman was among the first to address the question of whether the type of diet consumed during childhood and adolescence was important in the development of atherosclerosis. 10 Dietary recommendations to the general public have included changes in eating patterns in which family members over the age of 2 years would consume less saturated fat and more unsaturated fat." In short-term dietary studies with infants and children, plasma lipid and lipoprotein concentrations have been found to be succeptible to manipulation by altering dietary fat type.…”

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confidence: 99%

Childhood consumption of dietary polyunsaturated fat lowers risk for coronary artery atherosclerosis in African green monkeys.

Wolfe

Parks

Morgan

et al. 1993

Arterioscler Thromb

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This study was designed to test the hypothesis that consumption of diets enriched in polyunsaturated fatty acids beginning at birth and continuing into young adulthood would lower the risk for atherosclerotic coronary heart disease early in life through their effects on plasma lipid and apolipoprotein concentrations while supporting good health and normal development Accordingly, African green monkeys (n=140) were raised on atherogenic diets (0.8 mg cholesterol per kcal) enriched with either saturated or n-6 polyunsaturated fatty acids. Breast milk from mothers fed the polyunsaturated fat diet became enriched in polyunsaturated fatty acids relative to the saturated group; thus, the period of nursing also reflected the dietary fatty acid shift. Age, gender, and dietary fat type independently affected plasma lipid and apolipoprotein concentrations. Age effects were similar for all lipid and lipoprotein variables; the concentrations were low immediately after birth, increased dramatically during the first 4-6 months of life, and then attained levels similar to those of adult animals by 2 years of age. Significant differences by gender were found such that females maintained lower total plasma cholesterol concentrations and higher high density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-I concentrations. Dietary fat effects were age dependent Before weaning at 5 months of age, total plasma cholesterol and apoB concentrations were lower in animals consuming polyunsaturated fat and this pattern was maintained into young adulthood. Lower concentrations of plasma triglycerides, HDL cholesterol, and apoA-I for polyunsaturated fat-fed animals were found only in the postweaning period (6-60 months of age). Since this pattern of response to dietary polyunsaturated fat in the juvenile animals was similar to that for adult animals fed these same diets in which there was less atherosclerosis and because subsequent studies have documented less coronary artery atherosclerosis in the polyunsaturated fat-fed juveniles, we conclude that early dietary intervention was beneficial in this group for lowering the risk of coronary artery atherosclerosis. The results in this primate model support the concept that intervention to modify coronary heart disease risk that is initiated early in childhood will have beneficial effects. (Arteriosclerosis and Thrombosis 1993;13:863-875) KEY WORDS • age • gender • polyunsaturated fat • nonhuman primates • risk factors • coronary artery atherosclerosis R esults from autopsy studies have provided evidence that atherosclerosis, both aortic and coronary, begins in childhood,'-4 although clinically significant childhood atherosclerosis has been reported primarily in children with familial hypercholesterolemia. 5 Although the factors initiating atherosclerosis are not fully understood, prospective studies in adult humans have identified associations between From the

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“…Recent progresses in the pathophysiology , however, have suggested that the blood pressure level in childhood is an important factor for the development of essential hypertension. Thus, the incipience of this disease has been traced back to childhood (Holman 1961) .…”

Section: Commentsmentioning

confidence: 99%