358th original article
In online and offline consultations, there are relatively few families who come to the doctor because their children are overweight and obese, unless obesity causes diabetes, precocious puberty and other problems. Even if doctors and nutritionists have warned parents that "children are too fat and need to control their weight", it is not easy to attract attention.
Because, in the traditional cognition of the Chinese people, chubby is a sign of "good life". Especially chubby children, rich and cute, cute and cute. "Children are fat, indicating good nutrition" - this is the voice of the vast majority of parents.
However, the vast majority of parents do not know, or are unwilling to accept, an important message: fat can be regarded as a source of all diseases, whether for children or adults. Overweight/obesity is an important predisposing factor for chronic NCDs. These chronic noncommunicable diseases include, but are not limited to, cardiovascular disease, diabetes, certain cancers, etc.
Today we are going to talk about cardiovascular disease, which ranks first among chronic diseases. This kind of disease sounds very common, because many people around us have this kind of problem. But many people, even though they have been diagnosed, don't think it's dangerous.
In fact, among non-communicable diseases, cardiovascular disease ranks first and is also a type of disease with a very high fatality rate. Statistics from the "China Cardiovascular Health and Disease Report 2020" tell us that there are currently 330 million patients with cardiovascular and cerebrovascular diseases in the mainland, with an average of 1 in 5 people. And cardiovascular disease mortality is higher than tumors and any other disease, with an average of 2 out of 5 deaths from cardiovascular disease. This number will continue to grow with an aging population and unhealthy lifestyles.
The direct causes or risk factors for cardiovascular disease in adults include heredity, overweight/obesity, hypertension, dyslipidemia, diabetes, and poor lifestyle habits such as smoking, lack of physical activity, high salt intake, high fat intake, excessive alcohol consumption, etc.
Reading this, you might ask and say for half a day:
What does it have to do with children?
For so many years, the medical community has been unable to conclude "whether there is a correlation between cardiovascular risk factors in childhood and cardiovascular disease in adulthood." However, recently, at the just-concluded American Society of Cardiology 2022 (ACC 2022), this evidence was finally filled! The New England Journal of Medicine (NEJM) published this meta-analysis of 38,589 people, seven cohorts (from Australia, Finland and the United States) with an average follow-up of 35 years during the same period.
The conclusion is that there is a clear correlation between the increase in cardiovascular disease risk factors in childhood (3-19 years) and cardiovascular disease in adulthood. That is to say, some "indicators" in childhood exceed the standard, which means that children are more likely to get cardiovascular disease when they grow up! These risk factors include:
Childhood mass index BMI
Systolic blood pressure
Total cholesterol levels
Triglyceride levels
smoking
Knock on the blackboard! Parents and friends pay attention! You need to:
Regularly monitor your child for overweight or obesity
Regularly monitor your child's blood pressure for too high
Regularly monitor your child's blood lipids for excess
Keep your child exposed to first- and second-hand smoke
Among them, blood lipids need to be understood through annual physical examinations, and a second-hand cigarette needs parents and friends to regulate themselves and their children. Blood pressure and weight can be monitored at home. The specific method is detailed in the following section.
High blood pressure
The following table is from the American Academy of Pediatrics (AAP) Clinical Practice Guidelines for the Screening and Management of Hypertension in Children and Adolescents, and is based on the 90th percentile blood pressure of children and adolescents in the 5th percentile of different ages, sexes, and heights. Parents can check the age of the child and find the corresponding blood pressure value as the safe upper limit of "screening". If the blood pressure value is always higher than this value, consider going to the pediatric department and asking the doctor to help determine whether the child is in pre-hypertension or can already be diagnosed with high blood pressure.
The Guidelines for the Prevention and Treatment of Hypertension in China (Revised Edition in 2018) also give reference standards for blood pressure in China for males and females aged 3 to 17 years old and height. The professional version of the standard is more complicated, parents and friends can refer to a simplified formula as a preliminary judgment before visiting the doctor, that is:
Boys, systolic blood pressure = 100 + 2× age (years), diastolic blood pressure = 65 + age (years)
In girls, systolic blood pressure = 100 + 1.5 × age (years), diastolic blood pressure = 65 + age (years)
When a child is screened for suspected hypertension using simplified formula criteria, go to a pediatrician and ask the doctor to further use "tabular criteria" to determine the diagnosis.
Love Tips:
Home sphygmomanometers may not be able to truly reflect your child's blood pressure due to improper use of cuffs, frequency of blood pressure measurement, and the error of the instrument itself. So, avoid blind optimism or blind anxiety. When you are not sure, you still have to go to the pediatrician.
Overweight / Fat
You can refer to the Judgment/Diagnosis Criteria of the World Health Organization (WHO) to determine whether a child is overweight/obese. Children under 5 years old use the "height-by-weight curve", and children and adolescents aged 5-19 use the "age-specific BMI curve". The details are as follows.
Children under 5 years of age:
Overweight: height-for-weight > 2 standard deviations of the WHO median child growth standard (i.e. the second curve from top to bottom, the red curve with the red number 2 next to it);
Obesity: height-for-weight > 3 standard deviations of the WHO child growth standard (i.e. the first curve from top to bottom, the black curve labeled black with the black number 3 next to it).
The following two pictures are the "height-to-weight curve" for children under 5 years old, with pink figures for girls and blue for boys.
illustrate:
Girl, 100 cm tall and weighs 20 kg. Find the value of 100 cm on the abscissa of the pink chart above and draw a vertical line along 100; find the value of 20 kg on the ordinate and draw a horizontal line along 20. The intersection of the two lines, between the first curve (black) and the second curve (red), indicates that the girl is overweight.
If the girl is 100 cm tall and weighs 21 kg, and the intersection of height and weight is above the black curve, the girl can be diagnosed as obese.
Children and adolescents aged 5-19 years:
Overweight: Age-specific body mass index (BMI) > 1 standard deviation of the WHO median growth standard (i.e. the third curve from top to bottom, the yellow curve labeled yellow with the yellow number 1 next to it);
Obesity: The age-specific body mass index (BMI) > 2 standard deviations of the WHO median growth standard (i.e. the second curve from top to bottom, the red curve labeled red number 2 next to it).
The following two pictures are the "BMI curve for ages 5-19", with pink for girls and blue for boys.
illustrate:
Boys, 10 years old, height 140 cm, weight 40 kg, BMI = 20.4 (calculated as 40÷ (1.4)). First find the value of 10 years old on the abscissa coordinate of the blue chart above, draw a vertical line along the age of 10 years old, and then find the value of BMI 20.4 on the ordinate coordinate and draw a horizontal line along BMI 20.4. The intersection of the two lines, between the second curve (red) and the third curve (yellow), indicates that the boy is overweight.
If the boy weighs 44 kg, the BMI = 22.4, and the intersection of age and BMI is above the red curve, the boy can be diagnosed as obese.
For children and adolescents aged 6-19, the People's Republic of China industry health standard WS/T 586-2018 "Overweight and Obesity Screening for School-Age Children and Adolescents" can also be used to determine whether the child is overweight or obese (see table below).
At present, many maternal and child health care institutions use the data of the 2005 Survey of Children's Physical Development in Nine Provinces/Cities in China, which is also feasible. The data will vary a little from the WHO, but the impact on the diagnosis of obesity will not be too great.
What should I do if my child is overweight/obese?
Once the child is found to be overweight or obese, it is recommended to take the child to the nutrition clinic of the pediatric specialist hospital, and ask a professional dietitian or nutritionist to help formulate a personalized diet and behavior pattern adjustment plan.
For families who can't go to the doctor temporarily. You can briefly refer to the "52110 Behavioral Goals" jointly proposed by the Chinese Student Nutrition and Health Promotion Association and the China Working Committee for Caring for the Next Generation.
"52110" Behavioral Goals:
5 - Primary and secondary school students should eat 5 adult fist-sized vegetables and fruits every day, vegetables refer to cooked or chopped lettuce leaves, about 300-500 grams, and about 200-400 grams of fruit
2- Playing computer tv and using video games does not exceed 2 hours per day
1- Moderate or high intensity exercise should be performed for more than 1 hour a day
1- Eat 1 serving of meat per day. One serving of meat, about 80-110 grams, is equivalent to the size and thickness of the palm of the hand (excluding the fingers) of an adult
- Do not drink sugary drinks
Parents and friends need to be reminded that family atmosphere is crucial to help children adjust their eating behavior. Parents themselves must first correct bad eating habits in order to play the role of "upward and downward effect"
A little knowledge: how much do Chinese fat children know?
According to the China Childhood Obesity Report, the overweight/obesity rate of children in China continues to rise. From 1985 to 2005, the detection rate of obesity among children aged 0-7 years in large cities in mainland China increased from 0.9% to 3.2%, and from 1985 to 2014, the obesity rate of school-age children over 7 years old increased from 0.5% to 7.3%. It is estimated that by 2030, the detection rate of obesity among children aged 0 to 7 years old in mainland China will reach 6.0%, and the number of obese children will increase to 6.64 million; the detection rate of overweight/obesity among school-age children aged 7 and above will reach 28.0%, and the number of overweight/obese children will increase to 49.48 million.
Today's content, the amount of information is a bit large. I hope that parents and friends can read and remember and be vigilant. After all, a child's health is always the foundation and source of happiness and hope for a family, more than anything else.
I wish all children to stay away from the risk of cardiovascular disease and thrive healthily!
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(The picture used in the text comes from the network)
So humble and broken thoughts
Don't forget, overweight and obesity can affect height
Cottage owner profile
Liu Suiqian: Australian DAA certified registered practicing dietitian (APD), Certified Registered Dietitian of the Chinese Nutrition Society, member of the Australian DAA and Chinese Nutrition Society, Master of Clinical Nutrition (MND) of the University of Sydney, and holds the Postgraduate Certificate of Pediatric Nutrition at Boston University School of Medicine, clinical nutritionist, science popularizer, member of the Expert Group of China Health Promotion Foundation Caring for Maternal Health Public Welfare Activities, member of the Nutrition Management Expert Committee of Beijing Health Management Association, He is an expert member of the Infant SupplementAry Food Professional Committee of the China Nutrition and Health Food Association. He is a member of the translation committee of Krause Nutrition Diagnosis and Treatment, a nutrition columnist of many magazines and media, and has edited five sets of maternal and infant books, and is the author of the book "Baby Feeding 7 Lessons, Farewell Anxiety Begins with Food Education". Ten years in the face of clinical old and young pregnant patients, it is determined that the prevention and treatment of non-disease and psychological support are the direction of medical help and healing - the road of science popularization, and we work together.
Personal WeChat public account platform: Liu_suiqian
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