Maintaining healthy behaviors in early life essential to preserving future heart health
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Key takeaways:
- Healthy behaviors during adolescence may improve the trajectory of CV health into early adulthood.
- The inflection points at which CV health scores began to decline were as early as 10 years of age.
Maintaining healthful behaviors may be key to improving the trajectory of heart health from early adolescence into adulthood, according to study findings published in JAMA Cardiology.
To identify the age at inflection points across childhood and sociodemographic factors associated with changes in CV health trajectory, Izzuddin M. Aris, PhD, assistant professor in the department of population medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School, and colleagues used data from the Massachusetts-based Project Viva, a prospective prebirth cohort that enrolled pregnant women during their first prenatal visit between April 1999 and November 2002.
“Better CV health in childhood is associated with lower risks of metabolic syndrome, coronary artery calcification, and adverse cardiac structure and function in adulthood. However, the status of CV health in U.S. children is far from ideal,” Aris and colleagues wrote. “Identifying specific age periods when CV health begins to decline and sociodemographic characteristics associated with CV health trajectory parameters would be crucial to facilitate more targeted preventive efforts to high-risk children during these periods and improve our understanding of the early life drivers of CV health loss.”
CV metrics including diet, nicotine exposure, physical activity, sleep duration, BMI and BP were evaluated at early childhood (median age, 3.2 years), middle childhood (median age, 7.7 years), early adolescence (median age, 13 years) and late adolescence (median age, 17.5 years). Mothers self-reported their annual household income, education and race/ethnicity.
An algorithm was developed that scored each CV health metric on a scale of 0 to 100, and the researchers calculated the average of each to produce an overall CV health score.
Health behaviors impacting CV heath trajectory
Overall, 1,523 children were included in the analysis (51% male), of which 3.5% were Asian, 15.2% were Black, 65% were white and 11.5% were non-Hispanic other.
The overall average CV health score was 82.6 at early childhood, 84.1 at middle childhood, 82 at early adolescence and 73.8 at late adolescence, and the mean age of inflection when CV health score declined was at approximately 10.1 years for male children and 10 years for female children.
The decline in CV health score was associated with health behaviors such as diet, nicotine exposure, physical activity and sleep duration rather than health factors such as BMI, BP, fasting glucose and non-HDL, according to the study.
In addition, children of mothers without a college degree or with household income $70,000 or less per year had lower CV health score trajectory throughout childhood compared with children of mothers with a college degree or higher annual household income.
Children of mothers with some college education were slightly older at their time of CV health score trajectory inflection (beta, 0.16 years; 95% CI, 0.07-0.26) compared with children of mothers with a college degree, and demonstrated slower CV health score gain before the inflection point (beta, 0.24 points per year; 95% CI, 0.4 to 0.08), according to the study.
Compared with white children, Black children (beta, 0.32 years; 95% CI, 0.2-0.43) and children of other non-Hispanic races (beta, 0.16 years; 95% CI, 0.05 to 0.28) were older at the time of CV health trajectory inflection.
“A key finding is that the overall and behavioral CV health trajectories demonstrated similar patterns, suggesting that the overall CV health in children is driven in large part by behavioral rather than biological CV health, which aligns with prior findings. Behavioral factors are more modifiable and may change over time,” the researchers wrote. “Our findings highlight the potential early influence of structural factors linked to socioeconomic status and race and ethnicity that might contribute to future CV health disparities, such as residence in favorable neighborhood environments, the ability to access healthy foods and proximity to built environment features that are safe and encourage physical activity.”
Possible outside factors affecting CV heath trajectory
In a related editorial, Natalie A. Cameron, MD, MPH, instructor in medicine (general internal medicine) and preventive medicine (epidemiology), and Norrina B. Allen, PhD, MPH, Quentin D. Young Professor of Health Policy and professor of preventive medicine (epidemiology), medical social sciences (determinants of health) and pediatrics at Northwestern University Feinberg School of Medicine, wrote: “The explanation likely involves a complex interplay of biological and psychosocial factors that dramatically change throughout childhood and adolescence. These include hormonal changes, increasing academic and extracurricular demands and socioemotional experiences, including social media use and peer pressure. ... Although not discussed in this publication, declining mental health may also play a role in shaping adverse CV health trajectories.
“Improving CV health during childhood and adolescence will require a multipronged approach that spans across multiple sectors, including individuals, parents, schools, communities and public health policies,” they wrote. “Focusing these efforts during critical life periods and events when individuals are most vulnerable to declines in CV health could have a substantial impact on CV health trajectories and CVD risk across the life course.”
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