High cholesterol, high blood pressure. These are adult worries. But research suggests that in North Carolina we need to beware of them in kids as well.

A study of North Carolina third- and fourth-graders shows that high cholesterol and blood pressure are more prevalent among these children than expected. The study, led by Joanne Harrell, professor of nursing, is the first to evaluate these risk factors for heart disease exclusively among North Carolina children.

As part of the School of Nursing’s CHIC (Cardiovascular Health in Children) study, the researchers plan to follow the kids until they graduate from high school.

Of the children studied, 12.6 percent had high cholesterol levels (above 200 milligrams per deciliter). According to national norms, only 5 percent of children this age are expected to have cholesterol that high.

Eleven percent of these children had high blood pressure (greater than 122/78 for children six to nine and 126/82 for children 10 to 12). Again, researchers would expect only 5 percent of children to have blood pressure at these levels.

Aggravating these problems, 26 percent of the kids were overweight, even under a strict definition of obesity, says Chyrise Bradley, research assistant professor of nursing. Researchers used two criteria: skin-fold measurements, which measure the amount of fat under the skin, and the body mass index, which measures weight adjusted for height.

The findings show the need to routinely screen school-age children for risk factors and educate families about heart-healthy choices, Bradley says.

In a separate phase of the same study, children in an intervention group were taught the importance of eating more whole grains, fruits, and vegetables, and less fat, and they participated regularly in moderate to vigorous physical activity. They showed reduced cholesterol levels and body fat and increased aerobic power.

Physical-education teachers could increase students’ cardiovascular health by putting less emphasis on traditional physical education, “which is almost always skill-oriented, a lot of `stand in line and wait your turn,’” Bradley says. More heart-healthy classes keep everyone moving—jumping rope, performing relays, or dancing.

For the intervention group, “We took the lessons out of curriculum guides available to physical-education teachers,” Bradley says. “So it’s not like we invented new things.”

The researchers studied 2,207 children—about 60 percent of third- and fourth-graders in 21 randomly selected schools throughout North Carolina. The sample matches the racial distribution of the state.

There’s no doubt that many of these kids are overweight, but the study also suggests that national growth curves need to be revised, Bradley says. According to standards now in use, average weight of the study subjects was at the 90th percentile. If the standards were correct, this would mean that nationally, only 10 percent of children would weigh more. Most of the national standards are based on information collected at least 20 years ago, Bradley says.

The most important point of the study, though, is that when it comes to preventing heart disease, “You have to start with the kids,” Bradley says.

Harrell agrees. “We’ve shown that a simple and inexpensive program in elementary schools can decrease obesity and cholesterol and improve the health of our children. I’d like to see similar programs in elementary schools across the state.”

This research appears in the September/October 1997 issue of the North Carolina Medical Journal. Additional authors are Robert G. McMurray (physical education, exercise, and sport science), Shrikant I. Bangdiwala, (biostatistics), Annette C. Frauman (nursing), and Julie P. Webb (nursing). Funding comes from the National Institute for Nursing Research.