A dietary study of 10-year-old children was incorporated into a larger epidemiological survey investigating the distributions, interrelationships, and course-over-time of arteriosclerosis risk factor variables in children. Food intakes, eating patterns, and diet-risk factor interrelationships are described for 185 children (35% black, 65% white) using an improved 24-hr dietary recall method. Protein intakes were high. The polyunsaturated-to-saturated fatty acid ratio averaged 0.4 and a sucrose-to-starch proportion of 1.1 was noted. Eggs were the main food source of cholesterol and milk was the prime source of saturated fatty acids and protein. Black girls had a significantly greater mean sodium intake than the three other sex-race groups. Intermittent snacks provided the most calories; breakfast and dinner contributed most of the day's cholesterol, and lunch was the prime source of lactose and calcium. Longer eating spans reflected significantly greater intakes of calories, protein, fat, carbohydrate, and sodium, and greater levels of total serum cholesterol. A lack of correlations was noted in large matrices of dietary components and risk factor variables, but results of the comparison of mean intakes of dietary components for children grouped according to serum cholesterol showed significant differences in the intakes of various forms of fat and carbohydrate.

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SUMMARY Cardiovascular risk factors In childhood were assessed by re-examining a random sample of 278 children stratified by diastolic blood pressure (BP), obtained from 3524 children aged 7-15 years in an entire geographic biraclal community (Bogalusa). Re-examination included plasma renin and serum electrolytes, 24-hour urine electrolytes, heart rates, and BP at rest and in response to standardized physical stresses (orthostatic, isometric handgrip, and cold pressor tests). The BP responses in these tests were not increased in the high BP strata, which argues against a prevailing labile phase In early essential hypertension. Black children tended toward larger BP responses than whites. In black boys of the high BP stratum (n = 25), systolic supine or stressed BP were higher than for other race-sex groups; these pressures were associated negatively with plasma renin activity, which was low. White children in the high BP strata had increased heart rates, possibly indicating hyperkinetic circulation. These findings indicate that multiple mechanisms operate to control BP at different intensities for black and white children. serum lipids, and other cardiovascular risk factors already "track" in childhood, 1 ' J and their level in adolescence and early adulthood becomes predictive of later disease.'" Therefore, it seems important to examine the control mechanism of these risk factors in childhood. To this end we have completed a community-wide survey of children aged 5-14 years and have reported elsewhere 7 that height, weight, and to a lesser extent external maturation, hemoglobin level, black race, and male sex are correlates of higher BP levels.To explore further determinants of BP levels in children, a random sample was selected stratified according to diastolic pressure and specific for age, race, and sex. The sample was weighted in favor of the extreme BP ranks. In this group we have previously reported that blacks had lower plasma renin activity (PRA), especially in the high BP strata, and lower Received May 8, 1979; revision accepted April 7, 1980. 686 serum dopamine /9-hydroxylase levels, and lower urinary K + excretion than white children. 8'" In the high BP stratum, urinary sodium excretion in the black children was positively associated with their BP levels as measured on the same day, 9 while in white children in the high BP stratum, resting heart rates were faster 8 and the 1-hour glucose of a tolerance curve was greater.

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Essential hypertension begins in early childhood. Current evidence suggests that those children persisting at high levels over time may be considered to have essential hypertension. The evaluation of high levels is best judged from blood pressure percentile grids representing population measurements, as long as the methods used to measure blood pressure and to generate the grids are similar. Resting, basal blood pressure measurements are more reproducible and are better for following the time course of blood pressure levels in children. Measurements should be made in an unhurried, relaxed atmosphere by trained observers using adequately lighted instruments placed at eye level and a cuff size appropriate for the child's arm length and circumference. Repeated observations and serial blood pressure measurements of growing children are necessary for judgments of abnormal levels. There is a progressive rise of approximately 1.5 mm Hg systolic and 1 mm Hg diastolic pressure per year of age, but blood pressure levels in the growing child are more closely related to height. In most instances elevated blood pressure levels in children cannot be attributed to secondary causes. Various hemodynamic and biochemical mechanisms have been identified in the early stages of hypertension, and mechanisms contributing to the development of hypertension may be of different magnitudes in black children and white children. Studies following young adults over many years have shown the predictive value of baseline blood pressure levels for subsequent hypertension. Children tracking at the high percentiles can be identified and are candidates for early intervention. The key to early prevention of essential hypertension is to influence children and adolescents to adopt lifestyles that promote good health and prevent development of cardiovascular risk factors.