Nutrition intervention and health risk reduction in childhood: creating healthy adults.

Reducing health risk factors in childhood is a critical component of well-child pediatric care. Risks to eventual adult health status must be considered with equal importance as risks to the child's immediate health. Heart disease, cancer and stroke risk begins in childhood, when risk factors, especially obesity and positive family history, may easily be identified. Obese children (and those at high risk of obesity based on parental obesity) constitute a special group of children for whom chronic disease risk factor evaluation is of particular importance. This is based on observations that cardiovascular risk factors tend to aggregate among obese children (similar to adults), particularly with respect to elevated blood pressure, elevated serum cholesterol and triglycerides, and decreased cardiovascular response to exercise. In addition, many obese adolescents adopt cigarette smoking with the notion that it may aid weight reduction, thereby compounding their risk status. Risk reduction in childhood can be successfully approached both through school-based programs incorporating risk evaluation with health education curricula, or by relatively simple office- or clinic-based procedures designed to evaluate and track risk status over time. Such practices, though not currently prevalent, are increasingly being incorporated into routine pediatric care, especially following the American Association of Pediatrics Nutrition Committee's recommendations with respect to children with positive family histories for early coronary events.