Cardiovascular risk factors in children and young adults : current status and strategies for prevention

Background: The growing obesity epidemic among Australian children points to the need to identify strategies that may have a positive impact on cardiovascular disease (CVD) risk in school-aged children. Our review of the literature suggests that a single strategy school-based intervention, taking into account the pervasive control that the environment has over behaviour (such as diet and lifestyle) has the potential to reduce CVD risk among children and young adults. Studies analysing the current status of CVD risk factor measures in these age groups, obtained at local school levels, would also give an indication of the need for preventative strategies and a comparative measure of the local population to the national. And in exploring these possible preventative strategies, reviewing current policies and practices in place in schools would help fill in the gaps for future direction and emphasis. Utilising the school community would also harness parental involvement, which could also lead to more favourable results in obesity prevention, as parent role modelling and children's accessibility to healthy food are important determinants of preference for and intake of such foods. These interventions and programs would need to be trialled for feasibility without it being a burden in terms of resources or impact on school learning time. Methods: To achieve this, we sought to explore and validate these potentials through the following reviews and studies: 1) Literature review of existing literature to identify the effectiveness of nutrition-based interventions in school communities to reduce CVD risk factors in children and adolescents. 2) 'Monitoring Cardiovascular Risk Factors' (MCVRF) - a crosssectional study of CVD risk factors in children and adolescents, including body mass index (BMI), blood pressure (BP), blood cholesterol and glucose levels, cardiovascular endurance, and dietary eating and lifestyle habits. This project was designed to establish a CVD risk factor surveillance program suitable for implementation at the individual school level, and monitor the status and any trends of CVD risk over a four-year period. 3) 'Fruit Intake STudy' (FIST) Pilot - a pilot study in one school to assess determining the feasibility of a school-based intervention of providing fruit daily in the classroom and its effects on risk factors of CVD, and dietary behaviour. Assessment measures were as for the risk factors listed in MCVRF (above). 4) Fruit Intake STudy (FIST)- a randomised controlled trial involving four schools and with survey instruments assessing determining the impact of a school-based intervention of providing fruit daily in the classroom and its effects on risk factors for CVD, and dietary behaviour. 5) Survey of school principals to examine the current state of environmental and policy approaches to providing healthy CVD prevention nutrition choices in Victorian schools and subsequently recommends opportunities for state and local health departments to initiate and participate in environmental and nutrition policy initiatives. Results: This collection of studies have shown evidence that a complex and pressing issue of CVD risk and associated complications among children and adolescents can be addressed positively through a monitoring system (MCVRF), and an accompanying preventative strategy involving the school community as a vehicle of implementation (FIST), with improvements seen in dietary choice behaviour in both participants and their parents in just over 2 months. The approach of nutrition-based strategies was evidently neglected as seen in the school audit, but with clear benefits as shown in the strategy of fruit provision in the FIST studies. Discussion: The FIST studies revealed that a simple intervention strategy can be easily implemented in local schools, without being a burden on the school community in resources or curriculum. There is also the potential to concurrently collect useful baseline data for monitoring CVD risk (MCVRF) in these age groups at a local school level, empowering the local school to be better informed in formulating relevant health-related policy and practice. Conclusion: In a school age population, prevention is undoubtedly an effective strategy against CVD risk through these demonstrated auditing, monitoring and intervention programs.