Original Article

Cardiovascular Risk Factors in Young Adolescents: Results from the National Health and Nutrition Examination Survey 1988–2016

Authors: Eric M. Hecht, MD, PhD, Ana-Ysabel P. Williams, BS, Gary A. Abrams, MD, Rod S. Passman, MD

Abstract

Objectives: Lifestyle behaviors relevant to cardiovascular health are learned during childhood and continued into adulthood. Children and adolescents who participate in unhealthy behaviors have a higher lifetime risk of cardiovascular disease in adulthood. Public health institutions publish behavior and clinical recommendations designed for adolescents to reduce their lifetime cardiovascular risk. We assessed the prevalence and trends of cardiovascular-relevant behaviors and clinical tests among early adolescents using a nationally representative database.

Methods: In 2020, we compared the prevalence of cardiovascular risk factors among 1408 adolescents surveyed from 1988 to 1994 with that of 1812 adolescents surveyed from 2011 to 2016 by obtaining and comparing measures on physical activity, diet, body mass index, smoking status, cholesterol levels, hemoglobin A1c, sodium intake, and blood pressure.

Results: The prevalence of adherence to the current recommendations regarding physical activity, diet, and body weight declined over time. Conversely, the prevalence of adhering to recommendations to avoid smoking increased. Clinical indicators, including blood pressure control and normal measures of hemoglobin A1c and total serum cholesterol, showed mixed results, with more individuals showing signs of hyperglycemia, fewer showing signs of hypercholesterolemia, and the percentage of individuals with abnormal blood pressure remaining the same. The use of cardiometabolic medications also increased during the study period. Finally, the number of adolescents with all seven cardiovascular protective factors declined significantly during the study period, from 27.6% to 9.6%.

Conclusions: Modern American teenagers aged 12 to 16 years have more cardiovascular risk factors relating mostly to diet, exercise, and obesity than those of a prior generation; however, smoking rates have also declined precipitously.
Posted in: Cardiovascular Disease40

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References

1. Shay CM, Ning H, Daniels SR, et al. Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005–2010. Circulation 2013;127: 1369–1376.
 
2. US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd ed. Washington, DC: US Department of Health and Human Services; 2018.
 
3. Kim J-K, Park JT, Oh HJ, et al. Estimating average glucose levels from glycated albumin in patients with end-stage renal disease. Yonsei Med J 2012;53, 578–586.
 
4. Acar Tek N, Yildiran H, Akbulut G, et al. Evaluation of dietary quality of adolescents using Healthy Eating Index. Nutr Res Pract 2011;5:322–328.
 
5. Hurley KM, Oberlander SE, Merry BC, et al. The Healthy Eating Index and Youth Healthy Eating Index are unique, nonredundant measures of diet quality among low-income, African American adolescents. J Nutr 2009;139:359–364.
 
6. Janghorbani M, Amini M. Normal fasting plasma glucose and risk of prediabetes and type 2 diabetes: the Isfahan Diabetes Prevention Study. Rev Diabet Stud 2011;8:490–498.
 
7. Hopkins Tanne J. US guidelines say blood pressure of 120/80 mm Hg is not “normal.” BMJ 2003;326:1104.
 
8. US Department of Health and Human Services. Promoting Positive Adolescent Health Behaviors and Outcomes. https://opa.hhs.gov/sites/default/files/2020-07/promoting_pahbo.pdf. Accessed February 27, 2021.
 
9. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 2010;7:40.
 
10. Grimm KA, Kim SA, Yaroch AL, et al. Fruit and vegetable intake during infancy and early childhood. Pediatrics 2014;134(suppl 1):S63–S69.
 
11. Centers for Disease Control and Prevention. Health effects of cigarette smoking. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm. Accessed February 27, 2021.
 
12. Yang Q, Yuan K, Gregg EW, et al. Trends and clustering of cardiovascular health metrics among U.S. adolescents 1988–2010. J Adolesc Health 2014;55: 513–520.
 
13. May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics 2012;129:1035–1041.
 
14. Department of Health and Human Services, US Department of Agriculture. 2015–2020 dietary guidelines for Americans, 8th edition. https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015. Accessed February 27, 2021.
 
15. Centers for Disease Control and Prevention. Assessing your weight. https://www. cdc.gov/healthyweight/assessing/index.html. Accessed February 27, 2021.
 
16. Gorber SC, Schofield-Hurwitz S, Hardt J, et al. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009;11:12–24.
 
17. Moran VE. Cotinine: beyond that expected, more than a biomarker of tobacco consumption. Front Pharmacol 2012;3:173.
 
18. Benowitz NL, Bernert JT, Carabello RS, et al. Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ ethnic groups in the United States between 1999 and 2004. Am J Epidemiol 2009;169:236–248.
 
19. Steinberger J, Daniels SR, Hagberg N, et al. Cardiovascular health promotion in children: Challenges and opportunities for 2020 and beyond: a scientific statement from the American Heart Association. Circulation 2016;134:236–255.
 
20. Hecht EM, Layton MR, Abrams GA, et al. Healthy behavior adherence: the National Health and Nutrition Examination Survey, 2005−2016. Am J Prev Med 2020;59:270–273.
 
21. Andersen LF, Bere E, Kolbjornsen N, et al. Validity and reproducibility of self-reported intake of fruit and vegetable among 6th graders. Eur J Clin Nutr 2004;58:771–777.
 
22. Hardy LL, Mihrshahi S, Bellew W, et al. Children’s adherence to health behavior recommendations associated with reducing risk of non-communicable disease. Prev Med Rep 2017;8:279–285.
 
23. World Health Organization. Diet, nutrition, and the prevention of chronic diseases. Report of the Joint WHO/FAO Expert Consultation. https://www.who.int/dietphysicalactivity/publications/trs916/en/. Published 2003. Accessed February 27, 2021.
 
24. McNaughton SA, Ball K, Mishra GD, et al. Dietary patterns of adolescents and risk of obesity and hypertension. J Nutr 2008;138:364–370.
 
25. O'Brien W, Issartel J, Belton S. Relationship between Physical Activity, Screen Time and Weight Status among Young Adolescents. Sports (Basel). 2018;6:57.