Big Risks For Little Hearts
Kids whose parents or grandparents had heart attacks or diabetes before their 60s, and kids who are overweight, face highest risk.
At the age of 10, Kori DeBolt had a cholesterol level that would scare a grown man. She also had a mom who was diagnosed with high cholesterol in her 30s, and a grandfather who had a heart attack at the age of 38.
In other words, heart disease was in her family tree. And if she didn't do something now, she was probably heading toward an early heart attack herself.
So, she and her parents and sister changed how they ate, boosted their exercise levels even higher than they were - and within five years, succeeded in bringing Kori's cholesterol down by 82 points. And while she's not out of the woods, and will always have to watch her levels, her chances of a healthy future are much better.
Kori's situation is not unique. Millions of American kids face early heart disease if their families don't do something now, says Kori's heart doctor, Caren Goldberg, M.D., of the University of Michigan Cardiovascular Center.
"The cardiovascular diseases that we think of in adults, like heart attack and stroke, stem from processes that actually start in childhood," says Goldberg, who sees hundreds of children like Kori in her clinic at the Michigan Congenital Heart Center in C.S. Mott Children's Hospital. "Several factors put children, and adults, at risk of heart disease: family history, a diet that's high in fat, obesity, and poor exercise habits."
All of those factors combine to affect the way children's blood vessels work, Goldberg explains. After about the age of 2, too much fat, too little exercise, and too many extra pounds can cause kids' blood vessels to respond abnormally, leading to higher blood pressure and deposits of plaque, and setting the stage for later problems.
Family history is based on the genes that everyone inherits from their parents and grandparents, just like Kori inherited a gene that produces high cholesterol levels. But just because there's heart disease in a child's family, especially heart disease that strikes at a young age, it doesn't mean that the child is doomed to have a heart attack too. The same is true for overweight kids.
In fact, knowing that a child has a higher-than-normal risk should spur families to do everything that is in their control to reduce that risk, Goldberg says. That means choosing healthier foods, and making sure to get regular physical activity. Parents need to set the example that kids will follow, to get them in the habit of making healthy decisions about what to put in their mouths and how to spend their free time.
And even for families that don't have a lot of heart attacks in the family tree, it's important for parents to be the role models for eating and exercising - so that kids don't develop unhealthy habits that can set them up for heart disease later.
"If a child sees his or her parents eating a healthy diet, and having excellent exercise habits, then it will come absolutely naturally to that child, and be easier for them," Goldberg says.
"But if a child sees his or her parents eating high-fat foods every day, then it's going to be harder for that child to make changes," she adds. "And if a high-fat diet starts in childhood and continues into adulthood, a lot of damage has been done, though if you change your diet and exercise habits you can still reverse some of the blood vessel problems later on."
In her clinic, Goldberg advises families to take it slowly, and not try to go "cold turkey" on the foods they love. "Change slowly, and make it a normal part of your life. Don't try to do it all at once, but, as a family, take on one piece at a time and it will soon just become a normal way of life."
For instance, Angela DeBolt, Kori's mom, says the family switched to skim milk, whole-wheat bread, olive oil for cooking, and heart-healthy buttery spreads. They also talked more about their food choices before deciding what to have for dinner or snacks - for instance, if a trip to the ice cream stand was in the works for an evening dessert, then they might plan on a lower-fat dinner.
The family had already been active, with lots of hiking and biking trips, and Kori was active in sports since elementary school. But the family decided to install a pool at the house, too, to make it easier for the girls to get physical activity at home.
Angela says Kori's achievements make her proud. "It's hard to get across to a child what high cholesterol can mean to them," she says. Unlike children with food allergies, who can be taught that eating peanuts will cause an immediate reaction, "to tell a child that you can't eat this now because it's going to affect you 20 years down the road is a really hard concept to get across," she says.
As a teenager, having to choose different foods, or to eat less of high-fat foods, when she's out with her friends can be hard, Kori says. But with the help of the entire family, and with the knowledge that her genes make her just a little different, she can make good choices most of the time. And being a member of the high school rowing team, she gets plenty of exercise.
Goldberg notes that parents shouldn't start too early with low-fat foods - toddlers up to the age of two need fat to help their brains develop normally. But after that age, kids and parents alike should lay a foundation for a healthy heart later in life by choosing the right foods and finding activities and sports that they enjoy.
Some families with a high risk of heart disease, or with children who are moderately overweight, may benefit from a formal program to help them learn healthy eating and exercise habits. One such program is the Family Based Prevention Program, which Goldberg recently launched with U-M cardiologist Melvyn Rubenfire, M.D., and a team of nutrition and exercise experts.
She also advises parents to make sure their child's doctor or other health care provider checks each child's blood pressure regularly. And if there's a family history of heart disease, or if a child is overweight, a cholesterol check once every few years is probably a good idea.
Angela agrees. Her father, who had his first heart attack at the age of 38 when Angela was 10, never had any idea that his cholesterol was high. Angela herself only found out she had high cholesterol at a checkup in her late 30s. That led her daughters' pediatrician to recommend a cholesterol check for both girls - and that's what revealed that Kori's levels were sky-high while her sister's levels were normal.
But the family's efforts are paying off, and Kori is hopeful. "It's important for me to attend to my health choices now, because it'll be easier for me in the future to use the same choices - and I'll be a healthier person," she says.
The American Heart Association's recommendations for kids:
* Eat a diet that is mainly made up of foods that are low in saturated fat, trans fat, cholesterol, salt and added sugars.
* Eat only enough calories to maintain a healthy weight for your height and build. Estimated calories needed by children range from 900 a day for a 1-year-old to 1,800 for a 14-18-year-old girl and 2,200 for a 14-18-year-old boy.
* Total fat intake should be between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts and vegetable oils.
* Choose whole-grain/high-fiber breads and cereals rather than refined grain products. Look for "whole grain" as the first ingredient on the food label and make at least half your grain servings whole grain.
* Eat a variety of fruits and vegetables daily, while limiting juice intake. Each meal should contain at least one fruit or vegetable.
* Choose fat-free and low-fat dairy foods. From ages 1-8, children need two cups of milk or its equivalent each day. Children ages 9-18 need three cups.
* Drink water, diet soda or low-fat milk. Soda pop is loaded with calories you don't need.
* Be physically active for at least 60 minutes a day.
* If you don't like competing against other people in sports, do something else to stay active, like swimming, horseback riding, dancing, bicycling, skateboarding, yoga, walking, etc. Make it part of your routine - like 30 minutes of riding your bike before you start your homework.
* Limit your television, computer and video game time to no more than two hours a day, and plan it in advance by picking the shows you want to watch. Turn the TV on for those shows and turn it off afterwards. Don't just watch whatever comes on next.