The Bogalusa Heart Study of 14,000 children

Healthfacts, August, 1998

###Maryann Napoli

The most powerful argument for rethinking the American childs diet comes from the Bogalusa Heart Study. It has been described as the longest and most detailed study of children in the world. In terms of heart disease prevention, this study is as crucial to children as the famous Framingham Heart Study is to adults. Yet, curiously, the Bogalusa Heart Study has received little attention from pediatricians or the media, though results have been published in major medical journals over the last two decades.

Since 1973, 14,000 black and white children and young adults in Bogalusa, Louisiana, have been followed annuallymany of them since birthwith physical examinations that include a blood test and blood pressure measurement. Details on their, height, weight, dietary habits, tobacco use, and physical activity were recorded. The investigators found that children as young as two were consuming a high-fat, high sodium, low-fiber, i.e., typical American, diet. The 25-year project was supported by government grants from the National Heart, Lung, and Blood Institute and the National Institute of Child Health and Human Development.

The Bogalusa Study has one important element that the Framingham Study lacked. When a child died due to accident or other unexpected causes, autopsies were performed. Autopsy studies of American soldiers who died in the Korean war had already demonstrated for that heart disease can begin as early as age 18. But the Bogalusa Heart Study produced the even more startling finding that the pathological signs are evident much earlier. Grossly visible fatty streaks can be seen in the aortas of children after age three and are found in the coronary arteries beginning in the second decade of life, wrote the investigators in 1991.

The most recent autopsy results of 204 participants, aged 2 to 39 years, were published in The New England Journal of Medicine (6/4/98). Dr. Gerald S. Berenson and colleagues at Tulane University School of Public Health found that all participants had fatty streaks in the aorta, and the prevalence of fatty streaks in the coronary arteries increased with age. Both conditions were associated with several known risk factors for heart disease, including high blood pressure, smoking, obesity, and elevated levels of very low-density lipoprotein, or bad cholesterol. The higher the number of risk factors, the greater the extent of fatty streak lesions. In short, the predictors of heart disease in children are similar to those in middle-aged people. Heart disease prevention, therefore, should start early in life.

In a telephone interview, Dr. Berenson, director of the Tulane Center for Cardiovascular Health and Principal Investigator of the Bogalusa Heart Study, said, There should be a reduction in the amount of saturated fat and cholesterol in a childs diet. He does not, however, advise excluding poultry, fish, or even red meat, but he did emphasize that the red meat should be lean. Furthermore, he recommends substitutions such as skim milk for whole milk. Dr. Berenson said that his studys results are representative of whats happening to kids across the nation, Theyre getting heavier, not taller. Parents should visit our Web site [available at http://www1.omi.tulane.edu/cardiohealth/], and theyll see that exercise is as important as our dietary recommendations.