Assessing Cardiovascular Risk in Children: The Jackson Mississippi CRRIC Study

Article excerpt

Abstract: According to the NHANES III study, obesity, a cardiovascular risk factor, is now an epidemic in the United States. An estimated 97 million adults and one in five children between 6 and 17 are overweight. The purpose of this pilot study was to determine the prevalence of cardiovascular risk factors among a group of 3rd, 4th, and 5th graders at two randomly chosen elementary schools in Jackson, Mississippi. The sample consisted of 246 ethnic minority children. Results revealed that 16% of the boys had systolic blood pressures at or above the 90th percentile for sex and age and 13% had abnormally high diastolic blood pressures. For girls, 8% exhibited systolic blood pressures and 21% had diastolic blood pressures at or above the 90th percentile. Body mass index (BMI) levels revealed that 39% of the boys and 49% of the girls had BMIs at or above the 85th percentile for age and sex.

Key Words: Cardiovascular Disease, Risk Factors, Blood Pressure, Childhood Obesity, Children, Ethnic Minority, Mississippi

The Cardiovascular Risk Reduction in Chil dren (CRRIC) study is a multidisciplinary ap proach to identify and eventually reduce risk factors for heart disease in Mississippi. A number of factors contribute to the urgency of this study. First, overweight and obesity, a cardiovascular risk factor, is increasing in what has been termed epidemic proportions in the United States. According to the1999 National Health and Nutrition Examination Survey (NHANES), 34 percent of US adults aged 20 to 74 years are overweight and an additional 27 percent are obese (NCHS, CDC, 2001). Estimates for children indicate that 13 percent of those aged 6 -11 years and 14 percent of adolescents aged 12 to 19 are overweight . Further, during the past two decades, the percentage of children who are overweight has nearly doubled from 7 to 13 percent, and the percentage of adolescents who are overweight has almost tripled from 5 to 14 percent (NCHS, CDC, 2001).

A second impetus for the urgency of the CRRIC initiative is that from a state perspective, the cardiovascular mortality rate in Mississippi is the highest in the nation. The mortality rate in 1997 was 30% higher than the rate for the U.S. as a whole. In 1998, CVD death rates in Mississippi were 25% higher for African American men than white men, and 32% higher for African American women than white women (MSDH, 2001). Thirdly, Mississippi pediatric practitioners are reporting increased numbers of children being seen in clinical practice with morbid weights and the accompanying risk factors. Recently, a local physician reported treating a four year-old who weighed 200 pounds. While this may be the exception, health care practitioners are in general agreement that there is a growing problem of childhood obesity that was not nearly as prevalent ten years ago (Smith, J., pediatric cardiologist, personal communication, March 22, 2001; Moll, G., pediatric endocrinologist, personal communication, March 22, 2001). Pediatric health practitioners are observing obesity among children, more frequently locally, regionally, nationally, and internationally (Figureo, Franklin, Lee, Aldridge, & Alexander, 1997; Melnyk & Weinstein, 1994; Pinhas, Dalow, Daniels, Skandiofold, Khovex, & Zeitler, 1996; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997).

Previous research amply demonstrates that if measures are not initiated among the children at risk, they too will follow the natural progressive degenerative course as did their parents and grandparents (Attwood, 1998, Libman & Arslanian, 1999, Glaser & Jones, 1996; Gutin et. al., 1994; Freeman, Dietz, Srinivasant & Berenson, 1999; Parson, Power, Logan & Summerbell, 1999; Hulman, Kushner, Katz & Falkner, 1998). CRRIC aims to be a catalyst for childhood interventions for children at risk.

Data from Mississippi State Department of Health (1998) reveals the disproportionate age-adjusted death rate in 1996 in all categories from under one year of age through 75. …