Kids Cardio Health Falls Short

The American Heart Association (AHA) lists seven criteria for ideal cardiovascular health in U.S. children, and the vast majority don’t meet them.

The number one impediment was poor diet. Not surprisingly, the second main factor on the way to cardio compromise was physical activity behavior, or lack thereof.

The position statement resulted from an analysis of youth and adult data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES). NHANES data are collected biannually and have proven to be reliable assessments of the health and nutritional status of the broader U.S. population.

Still, since only 4,000 to 5,000 children and adolescents are recruited for each examination, additional population-based sources were used to gain additional estimates of cardiovascular health prevalence.

The NHANES and other data allowed the researchers to examine “baseline prevalence” of various cardiovascular health components (not just high blood glucose levels, obesity, hypertension and the like but also behavioral components such as eating and exercise habits).

Ideal childhood cardiovascular health encorporates the following habits and metrics:

Healthy diet. An astonishing 91% of children had poor diets. The authors recommend the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1).

The CHILD-1 diet was designed for kids who have high cholesterol, are overweight, have high blood pressure or other health problems, but the diet is a good idea for all children since it promotes healthy eating and a healthy weight, and with 91% of the children in the study falling short nutritionally anyway, it’s safe to say that recommending the diet is sound practice.

The CHILD-1 diet, which children should transition to at age 2, works to:

  1. limit or avoid sugar-sweetened drinks
  2. encourage kids to drink water
  3. avoid trans fat
  4. encourage high-fiber foods
  5. limit sodium
  6. encourage kids to drink fat-free, unflavored milk
  7. teach kids about appropriate portion sizes based on caloric need for age, gender and activity level encourage a diet rich in fruits, vegetables, whole grains, fish and beans

At least an hour of physical activity per day. Among adolescents aged 16 to 19 years, only 10% of boys and 5% of girls got the recommended amount. The activity should be moderate or vigorous.

Healthy BMI. Roughly 10% of 2-to-5-year-olds are obese. In adolescents, that number becomes somewhere between one-fifth and over a quarter of that age group nationally, 19% to 27%.

Additional guideposts:

Total cholesterol under 170 mg/dL.

Blood pressure under the 90th percentile. Ideal blood pressure changes with gender, age and height. For guidance, you can view the NIH’s blood pressure tables for children and adolescents here.

Fasting blood glucose under 100 mg/dL.

Tobacco avoidance.

The American Academy of Pediatrics has also recently issued guidelines on decreasing obesity risk, this time specifically in adolescents. Three recommendations for parents (and clinicians) that stand out are:
Focus on a healthy lifestyle. Rather than making it all about weight, simply demonstrating and discussing the positive aspects of a good diet and regular recreational play and physical activity will go further to embed agreeable habits into your child’s routine.

Reinforce a positive body image. If a child is taking steps to manage or reduce overweight, or better still ignoring weight but attempting to combat their previously sedentary habits, the best practice is to make them feel good about their bodies. As in yoga, accepting where you currently are while acknowledging that every day is a new opportunity to improve will go a long way to establishing a sustainable routine. As the old adage goes, if you’re facing in the right direction, all you have to do (quite literally in this case) is keep on walking.

Establish frequent family meals. Not only does this practice bring eating out of the shadows while promoting regularity in diet, it provides a great opportunity to lead by example by discussing individual gratifications achieved by recent individual physical activity—e.g., “I went on a great walk today.” The dinner table is also a perfect time and place for plotting family outings.   

Circulation, 2016, Vol. 134, e236-e255,

American Academy Pediatrics, Aug. 22, 2016, AAP Clinical Report: Steps to Prevent Teen Obesity and Eating Disorders,

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