Beilin L, Burke V, Milligan R
Department of Medicine, University of Western Australia, Perth.
J Hum Hypertens. 1996 Feb;10 Suppl 1:S51-4.
This paper addresses approaches to evaluating the importance of different childhood behaviours on subsequent risk of high blood pressure and related cardiovascular risk factors and outlines results of a randomised controlled trial of nutrition and exercise interventions in schoolchildren. Clustering of cardiovascular risk factors was studied in relation to diet, blood pressure, fitness, fatness and blood cholesterol in a representative sample of 555 Perth schoolchildren aged 15 years. Twenty-one percent of males and females had high risk profiles associated with dietary excesses, particularly in fat, cholesterol and sodium intake, and deficiencies of minerals, vitamins and dietary fibre. Socio-economic status was inversely associated with cardiovascular risk and undernutrition in girls. Thus 21% of the school children shared unhealthy lifestyles putting them at substantial risk of subsequent cardiovascular disease. A randomised controlled trial designed to reduce cardiovascular risk was conducted in 1147 children 10-12 years old, assigned to one of six groups for a year. The groups were fitness, fitness and school nutrition, school nutrition, school and home nutrition, home nutrition or controls. On cluster analysis 30% of the children were at higher risk at baseline in terms of blood pressure, blood cholesterol levels, fitness and body fat. With the fitness programmes fitness increased in both high and low risk girls but only in high risk cluster boys. Systolic pressure fell more in the high risk boys in the fitness group than in low risk boys, while diastolic pressure fell in girls regardless of initial risk. Triceps skinfold thickness fell more in higher than lower risk girls in the school and home nutrition group, and more in high risk boys in the home nutrition group. Higher risk girls showed a greater reduction in fat intake and increase in dietary fibre with home nutrition programmes. We concluded that higher risk children do show greater responses to lifestyle intervention programmes in general, with the greatest effects seen with home nutrition or fitness programmes. The results indicate the need for different approaches to prevention of hypertension and cardiovascular risk in higher and lower risk children and for boys and girls.
本文探讨了评估不同儿童期行为对后续高血压风险及相关心血管危险因素重要性的方法，并概述了一项针对学童营养与运动干预的随机对照试验结果。在珀斯555名15岁学童的代表性样本中，研究了心血管危险因素的聚集情况与饮食、血压、体能、肥胖及血液胆固醇之间的关系。21%的男性和女性具有与饮食过量相关的高风险特征，尤其是脂肪、胆固醇和钠摄入过量，以及矿物质、维生素和膳食纤维缺乏。社会经济地位与女孩的心血管风险和营养不良呈负相关。因此，21%的学童有着不健康的生活方式，使他们面临后续心血管疾病的重大风险。一项旨在降低心血管风险的随机对照试验在1147名10至12岁儿童中进行，这些儿童被分为六个组，为期一年。分组情况为体能组、体能与学校营养组、学校营养组、学校与家庭营养组、家庭营养组或对照组。聚类分析显示，30%的儿童在基线时血压、血液胆固醇水平、体能和体脂方面处于较高风险。通过体能训练计划，高风险和低风险女孩的体能均有所提高，但仅高风险聚类男孩的体能有所提高。体能组中高风险男孩的收缩压下降幅度大于低风险男孩，而女孩的舒张压无论初始风险如何均有所下降。在学校与家庭营养组中，高风险女孩的三头肌皮褶厚度下降幅度大于低风险女孩，在家庭营养组中高风险男孩的下降幅度更大。高风险女孩通过家庭营养计划，脂肪摄入量减少更多，膳食纤维摄入量增加更多。我们得出结论，一般而言，高风险儿童对生活方式干预计划的反应确实更大，家庭营养或体能计划的效果最为显著。结果表明，对于高风险和低风险儿童以及男孩和女孩，预防高血压和心血管风险需要采用不同的方法。
