Halfon Neal, Verhoef Philip A, Kuo Alice A
University of California Los Angeles Center for Healthier Children, Families, and Communities, Los Angeles, CA, USA.
Pediatr Rev. 2012 Feb;33(2):51-60; quiz 61. doi: 10.1542/pir.33-2-51.
Through research in the prevention and treatment of adult diseases, it has become clear that many adult diseases have their origins in childhood. As illustrated in this review, these antecedents are largely a function of the nutrition, physical activity, and habits of developing children. There is also increasing evidence that chronic and toxic levels of stress can play a significant role not only in the development of mental and behavioral conditions but in the developmental pathways that lead to a number of chronic physical health conditions. Internists, family medicine physicians, and medicine-pediatrics physicians generally are comfortable managing patients with a number of cardiovascular risk factors or conditions. Although pediatric clinical guidelines have recommended universal screening for hypertension since 1977 and targeted screening for dyslipidemia since 1992 and type 2 DM since 2000, this screening is not yet common practice in general pediatrics. As the population of children and youth with risk factors for metabolic syndrome--hypertension, dyslipidemia, and type 2 DM--increases as a result of the obesity epidemic, pediatricians will have to screen routinely, and diagnose and treat these conditions in the primary care setting. Pediatric residency programs and continuing medical education programs will have to provide knowledge and clinical training in the management of these conditions before primary care pediatricians are comfortable treating children and youth with multiple cardiovascular conditions.
通过对成人疾病防治的研究，已明确许多成人疾病起源于儿童时期。如本综述所示，这些前期因素很大程度上取决于发育中儿童的营养、身体活动和习惯。越来越多的证据表明，长期的高压力水平不仅会在精神和行为状况的发展中起重要作用，还会在导致多种慢性身体健康状况的发育途径中发挥重要作用。内科医生、家庭医学医生和儿内科医生通常能够处理患有多种心血管危险因素或疾病的患者。尽管自1977年以来儿科临床指南就建议对高血压进行普遍筛查，自1992年以来对血脂异常进行针对性筛查，自2000年以来对2型糖尿病进行筛查，但这种筛查在普通儿科中尚未成为普遍做法。由于肥胖流行导致具有代谢综合征危险因素（高血压、血脂异常和2型糖尿病）的儿童和青少年人数增加，儿科医生将不得不进行常规筛查，并在初级保健环境中诊断和治疗这些疾病。在初级保健儿科医生能够自如地治疗患有多种心血管疾病的儿童和青少年之前，儿科住院医师培训项目和继续医学教育项目将必须提供有关这些疾病管理的知识和临床培训。
