TEENAGERS HEART OF THE MATTER

Dr. Vikas Kohli MD FAAP FACCAMERICAN BOARD CERTIFIEDSENIOR CONSULTANT PEDS CARDIOLOGYINDRAPRASTHA APOLLO HOSPITAL

HOW MANY ADULTS IN THIS ROOM ….. WILL NOT HAVE A HEART ATTACK IN THE

NEXT 10 YEARS ?

SIMILARLY, WILL YOUR TEENAGE CHILD OR GRANDCHILD NOT HAVE A HEART ATTACK BEFORE HE/SHE IS 45 YRS OF AGE ?

ARE WE DOING ENOUGH OR HEADING STRAIGHT THERE ?

OBESITY IN CHILDREN

Adolescent Overweight and Future Adult

Coronary Heart Disease

New England Journal of Medicine 2007

OBESE TEENAGERS BECOME OBESE ADULTS Study from California:

Based on statistics and current obesity rates, by 2020:

37% males and 44% females would be obese when they are 35 yrs

This is based on overweight adolescents in 2000 in USA

This would add 19% extra load of heart patients

"Today's adolescents are the young adults of tomorrow -- young adults who would ordinarily be working, raising their families, and not worried about heart disease until they are much older.”

But actually majority of them would be spending a lot of time in hospitalizations and treatment and with medications before they turn 50.

Eighty percent of overweight adolescents become obese adults

Indian Children 13–18 years (n=4700, M:F 2382:2318)

were studied. Body mass index (BMI) was measured. Data on physical activity, food habits, occupation of parents and their economic status, birth weight of the children and age at menarche

prevalence of overweight was 17.8% for boys and 15.8% for girls

Diabetes Research and Clinical Practice

2002

Asia Pac J Clin Nutr 2008

Factors influencing Obesity Birth Weight Life Style Index Diet Parental Obesity Activity Level Time on Computer/TV Snacking

PREVELANCE OF OBESITY childhood obesity varies from over 30%

inUSA Less than 2% in sub- Saharan Africa. 20% in U K and Australia 15.8% in Saudi Arabia 15.6% in Thailand, 10% in Japan 6.2% in Chennai, 7.4% in New Delhi

Hypertension and Obesity Incidence of HTN in Obese kids is 17%

vs in 10% of normal kids

The 10% in a particular study appears very high

HEART PROBLEMS AT YOUNG AGE

How common is fat deposition This study demonstrates that coronary

atherosclerosis begins at a young age and that

lesions are present in 1 of 6 teenagers. These findings suggest the need for intensive efforts at coronary disease prevention in young adults.

What is Fat deposition

General Comments Arteriosclerosis

Thickening and loss of elasticity of arterial walls Hardening of the arteries Greatest morbidity and mortality of all human

diseases viaNarrowingWeakening

18

ATHEROSCLEROTIC PLAQUE

NORMAL ARTERY ATHEROSCLEROTIC PLAQUE

Non-Modifiable Risk Factors

Age A dominant influence Atherosclerosis begins in the young, but

does not precipitate organ injury until later in life

Gender Men more prone than women, but by age 60-

70 about equal frequencyFamily History

Familial cluster of risk factors Genetic differences

Modifiable Risk Factors(potentially controllable)

HyperlipidemiaHypertensionCigarette smokingDiabetes MellitusElevated HomocysteineFactors that affect hemostasis and

thrombosis Infections: Herpes virus; Chlamydia

pneumoniaeObesity, sedentary lifestyle, stress

Normal Artery

                                                                                                     

                                               

Response to Injury

Endothelial Dysfunction

Initiation of Fatty Streak

Fatty Streak

Fibro-fatty Atheroma

Fatty Streak-Aorta

Fatty Streak-Coronary Artery

Normal Artery

Unstable angina with plaque disruption

used with permission from M.J. DaviesAtlas of Coronary Artery Disease 1998Lippincott-Raven Publishers

The plaque cap is torn,projects into the lumen, exposing a mass of thrombus filling the lipid core

WHY THIS IS HAPPENING

Life Style Diet Exercise TV Snacking Computer Lack of urban planning Peer group

ROLE OF FAMILY

Primary Role Estab right dietary habits

Exercise as a part of life

Be a role Model

Decrease In House time: spend time at Sports complexes

ROLE OF SCHOOL

Peer Group & Social Impact This is where they see and decide

complex things in their life They also listen to teachers differently

as compared to parents Exercise and good health a routine

REMOVING ACADEMIC PRESSURE

ROLE OF DOCTOR

GUIDING Main role is to guide

Dietary Implications of Protein VS Carbs Vs. Fat

Early Assessment and Sounding the Alarm

ROLE OF MEDIA

RESPONSIBLE They carry responsibility of not drilling

into heads of kids the great value of Junk Food

They should understand the implications of advertisements

WHAT ARE OTHER COUNTRIES DOING ABOUT IT

LETS MOVE

Active Families: Engage in physical activity each day : a total of 60 minutes for children, 30 minutes for adults.

Active Schools: A variety of opportunities are available for schools to add more physical activity into the school day, including additional physical education classes, before–and afterschool programs, recess, and opening school facilities for student and family recreation in the late afternoon and evening.

Active Communities: Mayors and community leaders can promote physical fitness by working to increase safe routes for kids to walk and ride to school; by revitalizing parks, playgrounds, and community centers; and by providing fun and affordable sports and fitness programs.

Lets Move Healthy Moms

Healthy Communities

Healthy Families

Healthy Schools

WHAT CAN WE

DO IT FOR OUR

KIDS

OURSELVES EDUCATE OURSLEVES MORE ABOUT

DIET AND EXERCISE RELATED ISSUES

AT HOME IMPROVE DIETARY HABITS

INCREASE SPORTS AND ACTIVITY

DECREASE TV AND COMPUTER TIME

DON’T BUY OR ALLOW KIDS TO BUY SNACKS

AT SCHOOL MAKE HEALTHY FOOD AVAILABLE AT

SCHOOL

INCREASE ACTIVITY/SPORTS INVOLVEMENT

DECREASE ACADEMIC PRESSURE

AT COMMUNITY LEVEL INCREASE AVAILABILITY OF SPORTS

COMPLEXES

MAKE MALLS PLACES WHERE MORE PHYSICAL ACTIVITY IS INVOLVED

DIETARY HAZARD FOODS WITH WARNING AND LABEL

WE CAN DO IT

THANK YOU