In this article, Dr Aju Mathew talks about a clinical study that establishes a link between obesity in childhood and its impact on cardiac health in adolescence.

The study

A newly published clinical study has found that children with certain known risk factors for heart disease are more likely to develop severe heart disease as adults. This finding assumes significance because while it was previously known that poor health maintenance in childhood was associated with poor cardiac health as adults, this study has been able to prove a link between risk and serious heart disease requiring medical attention/intervention.

Such data has been lacking to date due to two main concerns:

1. Due to the unavailability of comprehensive childhood data of individuals.
2. Long interval to the age of onset of heart disease makes it challenging to prospectively study children to adulthood.

In the study, the investigators followed a large group of children from the United States, Australia and Finland over a period of more than 35 years.

Risk factors

The risk factors used for this analysis were the ones most often evaluated in children and adolescents. These were the body mass index, systolic blood pressure, total cholesterol levels, triglyceride levels and history of smoking. The education levels of the parents, as well as the individuals themselves, were also noted.

Results

The outcomes that were measured included both fatal and non-fatal heart disease. Non-fatal heart disease included MI, stroke, angina and peripheral vascular disease. They found the relationship between risk factors and these cardiovascular events to be similar for both fatal and non-fatal heart disease. Participants with cardiovascular events were older, more likely to be male, and had a lower parental and personal education level than those without cardiovascular events.

The risk factors were examined to check for their prediction of cardiovascular events in adulthood. They found an increased risk of developing cardiovascular events with every unit increase in triglyceride levels in childhood. Similarly, smoking was also associated with an increased risk of experiencing a cardiovascular event. But the finding that was of note was that the children who possessed all five risk factors together were the most likely to experience cardiovascular events in adulthood.

The investigators also independently measured cardiovascular risk in children and adults and also the change in risk from childhood to adulthood. While 30-50% of children with a risk of the cardiovascular disease continued to have the same risk in adulthood, those who made positive changes to their risk factors experienced a significant reduction in their chance of developing the disease. Such a glimmer of hope showing that people with poor health during childhood can still make positive strides in their overall health must be used to inform policy-making.

Conclusion

This study unravels the necessity of broader childhood strategies for reducing the risk of premature cardiovascular disease. Rather than a sole focus on a medical approach to identifying children with elevated risk-factor levels, the current results would suggest that an equally relevant focus on public health strategies for maintaining ideal cardiovascular health in all children is warranted. This is all the more important because new research shows fat deposition and calcification of arteries is a process that may begin as early as in the second decade of life.

Understanding the difficulty of individual behavioural change, these findings suggest a need for stronger public health programs for children. The research findings are even more important in a post-COVID world where childhood obesity rates may rise even further.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Dr Aju Mathew is a medical oncologist, haematologist, internist and epidemiologist practising in Kochi.