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Chapter 15

Pediatric preventive cardiology has increased in importance over the past several years due to the increasing number of children with obesity, hypertension, and dyslipidemia. In adults, elevated blood pressure, abdominal obesity, atherogenic dyslipidemia, and elevated plasma glucose levels are collectively known as the metabolic syndrome. The metabolic syndrome is associated with significantly increased risk of developing premature cardiovascular disease. Although there is currently no agreed upon definition of metabolic syndrome in children and adolescents, we do know that the extent of atherosclerotic progression is significantly correlated with several cardiovascular risk factors found in childhood, including elevated total cholesterol and low-density lipoprotein cholesterol, low levels of high-density lipoprotein cholesterol, obesity, high blood pressure, and smoking. Identifying children at a young age is beneficial because it allows for early implementation of dietary and lifestyle changes that may help delay the onset or progression of atherosclerosis. Indeed, in 2011, integrated cardiovascular risk reduction guidelines were published, specifically focusing on the promotion of cardiovascular health in children and adolescents as well as the identification and management of certain cardiovascular risk factors.1 This chapter will focus on 3 main areas of preventive cardiology: obesity, hypertension, and dyslipidemia.

### Definition

Over the past 2 decades, the labels and definitions for overweight and obesity have changed2 and are demonstrated in Table 15-1. Not included in Table 15-1 are definitions for healthy weight (5th-84th percentile) and underweight (<5th percentile) children. The body mass index (BMI = body weight in kilograms/height in meters squared) category classifications are defined using the 2000 Centers for Disease Control and Prevention growth charts.2 The BMI value used to plot on the growth curves can be obtained in a variety of ways, including calculators and formulas, nomograms, and tables and wheels. Over the past few years, many practitioners calculate the BMI using personal electronic data assistant programs, smart phone applications, electronic healthcare record software, or Internet calculators. Although most of these applications will provide output in BMI percentiles, in most instances, these values still need to be manually plotted on a curve in order to track trends over time. For children less than 2 years of age, the practitioner should plot weight for height values over time.3

Table 15-1. Body Mass Index Category Recommended Terminology

Although BMI is a widely used and inexpensive method for assessment of body fat, it does have limitations. These limitations are in some part due to the fact that body fat is typically higher among older individuals as well as females. In the older adolescent population, it can be particularly troublesome because the classification of obese versus overweight may be different using the adult versus pediatric definitions given the same BMI in the same patient. In addition, the scale cannot differentiate between lean muscle mass and fat; therefore, ...

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