STRATEGIES FOR PREVENTION OF ADULT HYPERTENSION AND CARDIOVASCULAR RISK BEHAVIOR IN CHILDHOOD - AN AUSTRALIAN PERSPECTIVE

This paper addresses approaches to evaluating the importance of differ ent childhood behaviours on subsequent risk of high blood pressure and related cardiovascular risk factors and outlines results of a randomi sed controlled trial of nutrition and exercise interventions in school children. Clustering of cardiovascular risk factors was studied in rel ation 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 associa ted with dietary excesses, particularly In fat, cholesterol and sodium intake, and deficiencies of minerals, vitamins and dietary fibre. Soc io-economic status was inversely associated with cardiovascular risk a nd undernutrition in girls. Thus 21% of the school children shared unh ealthy lifestyles putting them at substantial risk of subsequent cardi ovascular disease. A randomised controlled trial designed to reduce ca rdiovascular risk was conducted in 1147 children 10-12 years old, assi gned to one of six groups for a year. The groups were fitness, fitness and school nutrition, school nutrition, school and home nutrition, ho me nutrition or controls. On cluster analysis 30% of the children were at higher risk at baseline in terms of blood pressure, blood choleste rol levels, fitness and body fat. With the fitness programmes fitness increased in both high and low risk girls but only in high risk cluste r boys. Systolic pressure fell more in the high risk boys in the fitne ss group than in low risk boys, while diastolic pressure fell in girls regardless of initial risk. Triceps skinfold thickness fell more in h igher than lower risk girls in the school and home nutrition group, an d more in high risk boys in the home nutrition group. Higher risk girl s showed a greater reduction in fat intake and increase in dietary fib re with home nutrition programmes. We concluded that higher risk child ren 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 lowe r risk children and for boys and girls.