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Today's teenagers have more risk factors for cardiovascular disease than did teens of earlier decades, largely because excess weight is fueling an increase in prediabetes and diabetes, a national survey showed.

Data from among nearly 4,000 teenagers from the National Health and Nutrition Examination Survey (NHANES) showed that 34% were overweight or obese, a number largely unchanged over a decade, but those considered prediabetic or diabetic more than doubled to 23% ( P<0.05), according to Ashleigh L. May, MS, PhD, and colleagues from the Centers for Disease Control and Prevention in Atlanta.

And nearly half (49%) of the overweight teens and 61% of the obese teens had one or more CVD risk factors, May and colleagues wrote online in the June issue of Pediatrics.

Even 37% of the normal-weight adolescents had at least one risk factor for CVD, risk factors which usually surfaced and did their damage in adulthood, the researchers wrote.

To track the prevalence of four major CVD risk factors -- high levels of low-density lipoprotein cholesterol (LDL), low levels of high-density lipoprotein (HDL) cholesterol, hypertension, and diabetes -- May and colleagues analyzed NHANES data from 1999 to 2008.

They looked at data from 3,383 adolescents ages 12 to 19. Nearly two-thirds were non-Hispanic whites, comprising slightly more boys than girls, with age fairly evenly distributed.

The overall prevalence of each of the four major risk factors was over 10%.

The prevalence of prediabetes/diabetes increased from 9% in 1999 to 23% in 2008, and there was a major decrease in the number of teens with low HDL from 9% to 3% ( P<0.05). But the prevalence of prehypertension/hypertension and borderline-high/high LDL cholesterol did not change appreciably.

While obesity is still considered epidemic in the U.S., the proportion of affected teens did not substantially increase during the period studied, and May and her colleagues suggested this may explain why other CVD risk factors have plateaued, such as borderline-high/high LDL and prehypertension/hypertension.

For example, 22% of teenagers had levels of LDL cholesterol considered borderline-high, coupled with the decrease of 6% in the number with low levels of HDL cholesterol, thought to be protective since it helps the body get rid of LDL and goes down as LDL rises.

Overall, 43% of adolescents had at least one risk factor for CVD, the authors wrote, and there were significant demographic differences found in the distribution of the number of risk factors by gender, age, and body mass index.

For example, the most common combination of CVD risk factors among overweight and obese adolescents was prehypertension/hypertension and borderline-high/high LDL cholesterol (26%).

The analysis also found boys were more likely than girls to have one, two, or three or more CVD risk factors and a higher percentage of older adolescents (those ages 18 to 19) had more than two risk factors than did adolescents ages 12 to 13.

However, the authors noted there were no significant differences in CVD risk factors based on race or ethnicity.

Study authors concluded that "the results of this national study indicate that U.S. adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese. Adolescence represents a window of opportunity for assessment of CVD risk factors and the promotion of lifestyles that will affect the development and progression of CVD."

Limitations of the study included: lack of data on other cardiovascular risk factors, reliance on BMI as the determination of obesity, and sparse numbers of other nationally representative surveys of adolescents for comparison.
From the American Heart Association:
There was no external funding for this article.

The authors indicated they had no financial relationships relevant to this article to disclose.

Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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Teens Today at More Risk for Heart Disease

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Today's teenagers have more risk factors for cardiovascular disease than did teens of earlier decades, largely because excess weight is fueling an increase in prediabetes and diabetes, a national survey showed.

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Heart-healthy diet: 8 steps to prevent heart disease

Ready to start your heart-healthy diet? Here are eight tips to get you started.
By Mayo Clinic Staff
Although you might know that eating certain foods can increase your heart disease risk, changing your eating habits is often tough. Whether you have years of unhealthy eating under your belt or you simply want to fine-tune your diet, here are eight heart-healthy diet tips. Once you know which foods to eat more of and which foods to limit, you'll be on your way toward a heart-healthy diet.

1. Control your portion size

How much you eat is just as important as what you eat. Overloading your plate, taking seconds and eating until you feel stuffed can lead to eating more calories than you should. Portions served in restaurants are often more than anyone needs.

Following a few simple tips to control food portion size can help you shape up your diet as well as your heart and waistline:

Use a small plate or bowl to help control your portions.

Eat more low-calorie, nutrient-rich foods, such as fruits and vegetables

Eat smaller amounts of high-calorie, high-sodium foods, such as refined, processed or fast foods.

It's also important to keep track of the number of servings you eat. Some things to keep in mind:

A serving size is a specific amount of food, defined by common measurements such as cups, ounces or pieces. For example, one serving of pasta is about 1/3 to 1/2 cup, or about the size of a hockey puck. A serving of meat, fish or chicken is about 2 to 3 ounces, or about the size and thickness of a deck of cards.

The recommended number of servings per food group may vary depending on the specific diet or guidelines you're following.

Judging serving size is a learned skill. You may need to use measuring cups and spoons or a scale until you're comfortable with your judgment.

2. Eat more vegetables and fruits

Vegetables and fruits are good sources of vitamins and minerals. Vegetables and fruits are also low in calories and rich in dietary fiber. Vegetables and fruits, like other plants or plant-based foods, contain substances that may help prevent cardiovascular disease. Eating more fruits and vegetables may help you cut back on higher calorie foods, such as meat, cheese and snack foods.

Featuring vegetables and fruits in your diet can be easy. Keep vegetables washed and cut in your refrigerator for quick snacks. Keep fruit in a bowl in your kitchen so that you'll remember to eat it. Choose recipes that have vegetables or fruits as the main ingredients, such as vegetable stir-fry or fresh fruit mixed into salads.

Fruits and vegetables to choose

Fruits and vegetables to limit

Fresh or frozen vegetables and fruits

Low-sodium canned vegetables

Canned fruit packed in juice or water

Coconut

Vegetables with creamy sauces

Fried or breaded vegetables

Canned fruit packed in heavy syrup

Frozen fruit with sugar added

3. Select whole grains

Whole grains are good sources of fiber and other nutrients that play a role in regulating blood pressure and heart health. You can increase the amount of whole grains in a heart-healthy diet by making simple substitutions for refined grain products. Or be adventuresome and try a new whole grain, such as whole-grain farro, quinoa or barley.

Grain products to choose

Grain products to limit or avoid

Whole-wheat flour

Whole-grain bread, preferably 100% whole-wheat bread or 100% whole-grain bread

High-fiber cereal with 5 g or more fiber in a serving

Whole grains such as brown rice, barley and buckwheat (kasha)

Whole-grain pasta

Oatmeal (steel-cut or regular)

4. Limit unhealthy fats

Limiting how much saturated and trans fats you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease. A high blood cholesterol level can lead to a buildup of plaques in the arteries, called atherosclerosis, which can increase the risk of heart attack and stroke.

The American Heart Association offers these guidelines for how much fat to include in a heart-healthy diet:

Type of fat

Recommendation

Saturated fat

Less than 6% of total daily calories.* If you're eating 2,000 calories a day, that's about 11 to 13 grams.

*Note: The 2020-2025 Dietary Guidelines for Americans recommend limiting saturated fat to less than 10% of total daily calories.

There are simple ways to cut back on saturated and trans fats:

Trim fat off meat or choose lean meats with less than 10% fat.

Use less butter, margarine and shortening when cooking and serving.

Use low-fat substitutions when possible for a heart-healthy diet. For example, top a baked potato with low-sodium salsa or low-fat yogurt rather than butter, or use sliced whole fruit or low-sugar fruit spread on toast instead of margarine.

Check the food labels of cookies, cakes, frostings, crackers and chips. Not only are these foods low in nutritional value, some - even those labeled reduced fat - may contain trans fats. Trans fats are no longer allowed to be added to foods, but older products may still contain them. Trans fats may be listed as partially hydrogenated oil on the ingredient label.

Fats to choose

Fats to limit

Olive oil

Canola oil

Vegetable and nut oils

Margarine, trans fat free

Cholesterol-lowering margarine, such as Benecol, Promise Activ or Smart Balance

Nuts, seeds

Avocados

Butter

Lard

Bacon fat

Gravy

Cream sauce

Nondairy creamers

Hydrogenated margarine and shortening

Cocoa butter, found in chocolate

Coconut, palm, cottonseed and palm kernel oils

When you do use fats, choose monounsaturated fats, such as olive oil or canola oil. Polyunsaturated fats, found in certain fish, avocados, nuts and seeds, also are good choices for a heart-healthy diet. When used in place of saturated fat, monounsaturated and polyunsaturated fats may help lower your total blood cholesterol. But moderation is essential. All types of fat are high in calories.

An easy way to add healthy fat (and fiber) to your diet is to use ground flaxseed. Flaxseeds are small brown seeds that are high in fiber and omega-3 fatty acids. Studies have shown that flaxseed lowers unhealthy cholesterol levels in some people. You can grind the flaxseeds in a coffee grinder or food processor and stir a teaspoon of them into yogurt, applesauce or hot cereal.

5. Choose low-fat protein sources

Lean meat, poultry and fish, low-fat dairy products, and eggs are some of the best sources of protein. Choose lower fat options, such as skinless chicken breasts rather than fried chicken patties and skim milk rather than whole milk.

Fish is a good alternative to high-fat meats. Certain types of fish are rich in omega-3 fatty acids, which can lower blood fats called triglycerides. You'll find the highest amounts of omega-3 fatty acids in cold-water fish, such as salmon, mackerel and herring. Other sources are flaxseed, walnuts, soybeans and canola oil.

Legumes - beans, peas and lentils - also are good, low-fat sources of protein and contain no cholesterol, making them good substitutes for meat. Substituting plant protein for animal protein - for example, a soy or bean burger for a hamburger - will reduce fat and cholesterol intake and increase fiber intake.

Proteins to choose

Proteins to limit or avoid

Low-fat dairy products, such as skim or low-fat (1%) milk, yogurt and cheese

Eggs

Fish, especially fatty, cold-water fish, such as salmon

Skinless poultry

Legumes

Soybeans and soy products, such as soy burgers and tofu

Lean ground meats

Full-fat milk and other dairy products

Organ meats, such as liver

Fatty and marbled meats

Spareribs

Hot dogs and sausages

Bacon

Fried or breaded meats

6. Limit or reduce salt (sodium)

Eating too much salt can lead to high blood pressure, a risk factor for heart disease. Limiting salt (sodium) is an important part of a heart-healthy diet. The American Heart Association recommends that:

Healthy adults have no more than 2,300 milligrams (mg) of sodium a day (about a teaspoon of salt)

Most adults ideally have no more than 1,500 mg of sodium a day

Although reducing the amount of salt you add to food at the table or while cooking is a good first step, much of the salt you eat comes from canned or processed foods, such as soups, baked goods and frozen dinners. Eating fresh foods and making your own soups and stews can reduce the amount of salt you eat.

If you like the convenience of canned soups and prepared meals, look for ones with no added salt or reduced sodium. Be wary of foods that claim to be lower in sodium because they are seasoned with sea salt instead of regular table salt - sea salt has the same nutritional value as regular salt.

Another way to reduce the amount of salt you eat is to choose your condiments carefully. Many condiments are available in reduced-sodium versions. Salt substitutes can add flavor to your food with less sodium.

Low-salt items to choose

High-salt items to limit or avoid

Herbs and spices

Salt-free seasoning blends

Canned soups or prepared meals with no added salt or reduced salt

Reduced-salt versions of condiments, such as reduced-salt soy sauce and reduced-salt ketchup

Table salt

Canned soups and prepared foods, such as frozen dinners

Tomato juice

Condiments such as ketchup, mayonnaise and soy sauce

Restaurant meals

7. Plan ahead: Create daily menus

Create daily menus using the six strategies listed above. When selecting foods for each meal and snack, emphasize vegetables, fruits and whole grains. Choose lean protein sources and healthy fats, and limit salty foods. Watch your portion sizes and add variety to your menu choices.

For example, if you have grilled salmon one evening, try a black bean burger the next night. This helps ensure that you'll get all of the nutrients the body needs. Variety also makes meals and snacks more interesting.

8. Allow yourself an occasional treat

Allow yourself an indulgence every now and then. A candy bar or handful of potato chips won't derail your heart-healthy diet. But don't let it turn into an excuse for giving up on your healthy-eating plan. If overindulgence is the exception, rather than the rule, you'll balance things out over the long term. What's important is that you eat healthy foods most of the time.

Include these eight tips into your life, and you'll find that heart-healthy eating is both doable and enjoyable. With planning and a few simple substitutions, you can eat with your heart in mind.

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Show references

1. Sacks FM, et al. Dietary fats and cardiovascular disease: A presidential advisory from the American Heart Association. Circulation. 2017; doi:10.1161/CIR.0000000000000510.

2. How to avoid portion size pitfalls to help manage your weight. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/healthy_eating/portion_size.html. Accessed Feb. 6, 2021.

3. 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov. Accessed Jan. 19, 2021.

4. Grains. U.S. Department of Agriculture. https://www.myplate.gov/eat-healthy/grains. Accessed Feb. 6, 2021.

5. How to use fruits and vegetables to help manage your weight. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/healthy_eating/fruits_vegetables.html. Accessed Feb. 6, 2021.

6. Flaxseed and flax oil. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/flaxseed/ataglance.htm. Accessed Feb. 6, 2021.

7. Hadi A, et al. Effect of flaxseed supplementation on lipid profile: An updated systematic review and dose-response meta-analysis of sixty-two randomized controlled trials. Pharmacological Research. 2020; doi:10.1016/j.phrs.2019.104622.

8. Flaxseed. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 6, 2021.

9. Sea salt vs. table salt. American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sea-salt-vs-table-salt. Accessed Feb. 6, 2021.

10. Zeratsky KA (expert opinion). Mayo Clinic. Feb. 8, 2021.

11. The skinny on fats. American Heart Association. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/the-skinny-on-fats#.WjKhlNjrvIU. Accessed Feb. 6, 2021.

12. How much sodium should I eat per day? American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day. Accessed Feb. 6, 2021.

13. AskMayoExpert. Healthy diet (adult). Mayo Clinic. 2020.

14. FDA extends compliance date for certain uses of partially hydrogenated oils in food; denies petition for certain uses of PHOs. U.S. Food and Drug Administration. https://www.fda.gov/food/cfsan-constituent-updates/fda-extends-compliance-date-certain-uses-partially-hydrogenated-oils-food-denies-petition-certain. Accessed Feb. 8, 2021.

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Ready to start your heart-healthy diet? Here are eight tips to get you started. By Mayo Clinic Staff Although you might know that eating certain foods can increase your heart disease risk, changing your eating habits is often tough.

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If all schools serve students with healthy food snack and lunch, it will lower their calories  after they eat something with higher calories, reduce the risk of kidney problem, and it'll give them energy need to keep active throughout the day.

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What can schools do to change teenagers eating habits