By Peggy O'Farrell
The Cincinnati Enquirer

Cincinnati Children's Hospital Medical Center tests children for "silent" problems, such as atherosclerosis, the buildup of cholesterol and plaque in the arteries. (Craig Ruttle photo) | ZOOM |

Like their parents and grandparents, America's children are getting fatter.

The reasons are all too familiar - too many calories, too little exercise, too many trips through the drive-through - says preventive cardiologist Stephen Daniels of Cincinnati Children's Hospital Medical Center.

And the consequences are just as familiar: Children and teenagers are being diagnosed and treated for high blood pressure, high cholesterol and Type 2 diabetes, diseases once reserved for adults.

Federal statistics indicate that 15 percent of American children and teens are overweight. From 1977 to 1995, walking and bicycling decreased 40 percent among children ages 5 to 15. In 2000, only 29 percent of U.S. high school students attended a daily physical education class, compared to 42 percent in 1992.

It's not a promising trend, Daniels says.

"Using the logic that overweight and obesity are risk factors for cardiovascular disease and looking at what we've seen in the last 10 to 15 years, which is a tripling of the percentage of kids who are overweight and this dramatic increase in Type 2 diabetes, the concern is that we're creating a situation in which we will have a generation of kids who will soon become young adults who have major risks for cardiovascular disease at a younger and younger age," he says.

"If that's the case, we're in for an epidemic of heart disease. That's frightening, considering it's the No. 1 killer now."

It's also discouraging, considering the progress made the last 50 years in preventing heart disease.

"What we're looking at is a reversal of all the hard work we've put in, in terms of accomplishing risk-factor prevention and good clinical care for people who end up having heart disease," he says.

Daniels talked last week about risk factors among Greater Cincinnati's youngsters.

Question: Are you seeing an increase in Type 2 diabetes among children and teens?

Answer: (Yes.) In fact, Cincinnati was one of the first places to recognize that it was going on. Because we at Cincinnati Children's have a diabetes registry, it became clear in the 1990s that we were seeing more and more cases of Type 2 diabetes. We were one of the first to report that trend, and once people recognized it, they started looking for it. And now we're seeing it reported internationally. If you go back 10 or 12 or 15 years, it was considered rare in children. In Cincinnati last year, we had 20 or 22 new cases.

Q: What's the link between Type 2 diabetes and heart disease?

A: It's something that I think needs to be studied in adolescents. The most recent recommendations for treating high cholesterol includes the concept that a person with diabetes should be considered the equivalent of a person who's already had a cardiac event or a stroke. That's recognizing the fact that people with diabetes are at much higher risk for heart disease. That's something that we've known for a long time, and if anything, the concern about it has increased among adults.

What we don't know and what we need to know more about is the process in adolescents. The question is, are these adolescents with Type 2 diabetes developing cardiac and vascular changes in regard to that progression. That's something we're hoping to study in the future.

We're not seeing teenagers having heart attacks at Cincinnati Children's. But we know that the process is a very silent one, and this is what makes it so difficult. As atherosclerosis (the build up of cholesterol and plaque in the arteries) develops and you develop problems in your arteries, the first sign might be a heart attack or sudden death. That's in adults. It might be different in adolescents.

Q: Do you attribute the increase in childhood obesity and Type 2 diabetes to changes in children's diets or in their physical activity levels?

A: I think it has to be a combination of the two. We actually did two studies (in the Princeton School District) that we combined into one analysis back in the '90s. The first was done in the 1970s and it looked at school-age children, their height, weight, level of obesity and cholesterol. We went back into the (district) and did a study in 1989 and '90. We looked at kids in the same grades. What we found, I think, was interesting. We found more evidence of overweight (in the second study). We found more evidence of higher blood pressure and more evidence of abnormal cholesterol, too.

Here's the problem: We had data on diet for both studies, though the methods were different. But the two studies seemed to suggest that while diets in some ways had improved - diets were lower in fat in the late '80s and '90s - they were about the same in terms of calories.

What stuck out like a sore thumb - but we didn't have a measure for it - was physical activity. There was a similar study in Bogalusa, La., and they had the same problem. They had data on diet, but not on physical activity. It seems like the physical activity is quite important, but we don't have the data to show that.

In the end, it's a question of balance of energy, calories going in versus calories being burned by physical activity. You can gain weight at either end of the equation.

Q: What recommendations do you have for parents on monitoring their children's weight and health?

A: Pediatricians have done a very good job for a number of years on height and weight. For many years, the focus was on kids who were underweight. Now I think the focus needs to be: Are kids growing appropriately for their height. The way to do that is with Body Mass Index. That's something that should be checked on a routine basis.

It's also recommended that children after age 3 or so get their blood pressure measured at least annually.

Q: Do you recommend that children get their cholesterol levels checked?

A: The recommendation is that you should test children based on family history. So if you have parents or grandparents who have a history of high cholesterol or stroke or heart attack, you should test the children. It can probably happen any time after age 2. As kids get to 9 or 10, that's where you start to see the abnormalities.

Q: Is that because of diet or physical activity?

A: It's a combination of both. I think there's clearly an underlying genetic predisposition that plays out as an intersection between genetics and the environment, and by environment, I mean diet and activity.

Q: If you have a 10-year-old patient with high cholesterol, do you put him on Lipitor or another cholesterol-lowering drug?

A: Obviously, we try as hard as we can on diet to resolve the problem. But there are some patients where diet doesn't accomplish what you need to accomplish, and for those patients, medication is the right way to go. Luckily, there are more and more data regarding the use of these drugs in children. They seem to be generally safe and effective.

Q: Going back to the Princeton School District Study, on which you're one of the researchers, what's the current focus of the study.

Answer: We're looking at what we see as a progression of events from being overweight to developing what we call insulin resistance, which means your body is not as responsive to the action of insulin, to a state where you have difficulty handling sugar in the diet, what we call impaired glucose tolerance, and you're a step closer to diabetes. Our goal is looking at adolescents in the Princeton School District to get a population-based view of how this progression occurs.

To learn more

HealthWorks! at Cincinnati Children's Hospital Medical Center is a comprehensive program aimed at helping children and teens ages 5 to 19 lose weight and exercise more. Patients must be referred by their physicians, and the program is physician-monitored. For more information, call 636-4305.