American Heart Study

New evidence confirms the adage, ``As the twig is bent, so grows the tree.``

We reported recently on an important study that highlighted the close relationship between parents` weight and that of their offspring.

Now we look at a new study on heart disease. It identifies the beginnings of atherosclerosis in very young children and links these origins with high blood pressure and high levels of serum cholesterol.

Cardiovascular disease develops slowly, often without symptoms until a stroke or heart attack. First, fatty streaks appear on the walls of major arteries. Cholesterol-containing plaque builds up, narrowing vessels and impeding blood flow. The walls of the arteries harden, too, losing their ability to adjust to blood flow.

Most studies on coronary heart disease have examined middle-aged men. But in the Korean War, then in the Vietnam conflict, physicians performing autopsies on soldiers killed in battle or in accidents were disturbed to find the process far more advanced in many young Americans than in Asian soldiers. Other studies have found fatty streaks even in the aortas of 3-year-olds, and in the coronary arteries of teenagers.

The recently reported Bogalusa, La., heart study, which uncovered the latest evidence on the early origins of coronary heart disease, began in 1973. Like other studies both national and international, it is designed to take a long-term look at cardiovascular risk factors in a large population. In this case, the population is young people from birth to 26 years of age.

During the 10-year study, Dr. William P. Newman and colleagues at Louisiana State University Medical Center studied more than 8,000 young people. They measured serum cholesterol, as well as various cholesterol fractions--high-density (HDL), low-density (LDL), and very low-density (VLDL) lipoprotein cholesterol.

The researchers also tracked serum triglycerides (blood fats), blood pressure and cigarette smoking, all strong risk factors for coronary heart disease.

In 1978 they added another dimension. Permission was granted to conduct autopsies on any residents of several Louisiana parishes who died between the ages of 3 and 26. Most were accident, suicide or homicide victims. The rest had succumbed to kidney disease, cancer or infectious diseases. Of the 88 autopsies performed, 35 had been in the heart-study population.

In the aortas of all these young people, fatty streaks were found, from 1 percent involvement in the youngest, who had died at age 7, to 60 percent involvement. All but 6 also had some fatty streaks in their coronary arteries. Six males who had been in their late teens and early 20s already had developed some fibrous plaques as well.

Weighing the evidence on risk factors, the investigators found the extent of atherosclerosis to be directly related to increasing levels of serum cholesterol and low-density lipoprotein cholesterol (the cholesterol fraction that transports cholesterol to the cells) and inversely related to the level of high-density lipoprotein cholesterol (which helps remove excess

cholesterol).

This study hammers home the message that the first, silent signs of atherosclerosis can emerge in early childhood. It also extends the findings of numerous autopsy studies on adults with advanced atherosclerosis in which the lesions almost always have been related to elevated serum cholesterol and blood pressure.

Some children are genetically predisposed to high levels of serum cholesterol or other blood fats. They require dietary management, and sometimes drugs.

But several studies have shown that for other children, who have moderately high serum cholesterol (between 170 and 185 milligrams per deciliter) and perhaps a family history of heart disease, diet alone can reduce total and LDL cholesterol to acceptable levels.

This was demonstrated in a study conducted several years ago in a boarding school by a research team from the department of nutrition at Harvard. Limited dietary changes cut by nearly 50 percent the rise in blood cholesterol that usually occurs between ages 14 and 18.

We are talking not about a ``special diet`` but about the ``prudent diet`` recommended for adults: Cut total fat to about 30 percent of calories, and saturated fat to about one-third of that, while increasing polyunsaturated fat to about one-third of fat intake. Reduce dietary cholesterol to about 250 milligrams a day, and go easy on salt.

A National Institutes of Health Consensus Conference in 1985 recommended this diet as suitable for all family members, including children over 2.

In view of the Louisiana study, Dr. Charles Glueck, of the University of Cincinnati College of Medicine, advises in an accompanying editorial that all children have their blood cholesterol measured at yearly checkups.

As Dr. Glueck emphasizes, cholesterol and blood pressure levels in childhood show considerable degrees of ``tracking`` into adult life.

So do behavior patterns such as physical activity and eating habits. Encouraging children to develop sound habits of diet and exercise will help ensure that the twig is bent in the right direction.

Q--My infant daughter gets colicky every evening around dinnertime. Our pediatrician assures me that the fussiness is well within normal bounds. He has made several suggestions, but nothing seems to help. I hate to see her in pain. Is there anything you can suggest? And can you tell me what causes colic?

A--We really do not know why normal, healthy babies develop colic. It has been suggested that symptoms may be related to problems of an immature gastrointestinal tract, or that it may occur in response to overstimulation. Happily for both the uncomfortable infant and for frustrated parents, it generally lasts for a relatively short period, usually disappearing before the baby is 3 months old.

Pediatricians recommend several methods to help relieve symptoms. It is important to try to minimize the amount of air swallowed and to burp the baby well. If nursing, allowing more time for sucking may be helpful. A pacifier sometimes is useful.

Various home remedies suggested in popular volumes can be dangerous and should not be tried. In one case reported several years ago, an infant nearly died of potassium toxicity when a well-intentioned mother turned to such a book and fed the infant a mixture of lactobaccillus acidolphilus culture and salt substitute in water.

Q--Does okra have any nutritional value?

A--Okra is low in calories--only 50 in a cup of cooked vegetable. Yet that same portion will give appreciable amounts of a medley of nutrients, including over 40 percent of the day`s ascorbic acid requirement and almost 20 percent of the day`s vitamin A. It is rather unusual among vegetables in that it contains more calcium than most; a cup provides more than 10 percent of the daily requirement. It also contains some protein and small amounts of a variety of B vitamins.

Gastronomically, okra is prized by those who like gumbo for the gelatinous quality it imparts to the dish. On the other hand, many people find the gummy texture objectionable. Recently we came across an Indian method of cooking the vegetable that resulted in a far firmer and, to our taste, more agreeable texture. The okra was sliced vertically and slowly sauteed in an uncovered pan along with thinly sliced raw potato in a very small amount of oil. Some cumin seed had been lightly browned in the oil, and tumeric was added during cooking.

Okra is a member of the Hibiscus, or mallow, family of plants. This is the same family of plants that provided the gummy juice from which the French made the first marshmallowlike candy, pate de Guimauve.

Q--What is the difference between ``cold-pressed`` and regular vegetable oil?

A--Cold-pressed oils are those extracted mechanically from nuts or seeds. They undergo no further processing. In conventional production of vegetable oils, both mechanical methods and chemical solvents are used to extract the oil, which then moves through several other steps in the refining process.

These treatments remove impurities, with the result that oils processed by conventional methods generally are milder in flavor and lighter in color than cold-pressed oils. They also tend to foam less and hold up better during frying. And they have a longer shelf-life.

Refining has no effect on the fatty-acid content of the oil and only a limited effect on the vitamin E it provides. In short, there are no nutritionally important differences between oils processed by the two methods. Q--I became concerned when I read that doses of vitamin D as little as 2 or 3 times the Recommended Daily Allowance (RDA) could be toxic. I am nursing an infant and am consuming 5 cups of milk a day, or 125 percent of the RDA for vitamin D. I also take a supplement that provides 100 percent more. Am I getting dangerous amounts?

A--No. Toxicity at levels of 1,000 IU a day appears to be limited to a group of infants who are extremely sensitive to the vitamin. And it has been documented in children taking 10,000 IU a day for as little as 4 months. Adults are less sensitive; so even though your need for vitamin D is clearly being met both from your diet and, we presume, from some exposure to sunlight, the additional amount you are getting in a multivitamin supplement should pose no hazard.

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