Introduction
Kools, Kennedy, Engler and Engler (2008) draw our attention to the fact that, even as cardiovascular disease (CVD) is the leading cause of morbidity and mortality among American adults, it seems inevitable that the next generation will present with much the same risk factors.
Three Key Points
The three critical themes in the article consist of:
- risk factors for adult CVD already manifesting in childhood;
- interventions centered on restrictive diets and exercise being well-known; and,
- a great many environmental factors militate against parents and children adopting the “cornerstone” of a more sensible diet.
The facts of genetic predisposition and readily-observed childhood markers for premature CVD facilitate the task of identifying children who are more at risk. Pediatric hyperlipidemia (PHL) is easily judged from hypertension, body mass index in the obese range, elevated lipid and lipoprotein count. At the same time, either familial hypercholesterolemia (FH) or familial combined hyperlipidemia (FCH) are the common precursors for PHL. So, it does seem a vicious cycle that parents with lipid disorders are more likely to have offspring who present with PHL. To the authors, it is also worrisome that the etiology for conspicuously elevated plasma low-density lipoprotein cholesterol (LDL-C) among children correlates poorly with “diet, lifestyle, or other underlying disease processes” (Kools et al., 2008, p. 168). And the even gloomier prospect is that both obesity and dyslipidemia in childhood track with premature CVD in adulthood.
The authors contend that the proper program of interventions to combat PHL is well-known. At the core, this consists of a stringent diet low in fat and calories, high in carbohydrates, antioxidants, and phytochemicals. As with any diet for patients of any age, the need for family education and long-term support is clear. Complementary lifestyle changes involve regular exercise and avoiding smoking. Lipid-lowering drugs may also be indicated. And yet, there is a wide gulf between knowledge and behavioral change because children and minors are almost always asymptomatic.
The third key finding involves the barriers to compliance. The authors extracted a subsample from the Endothelial Assessment of Risk from Lipids in Youth (EARLY) randomized clinical trial. As a whole, EARLY investigated the effectiveness of dietary intervention, counting supplements and dietary counseling, on the dependent variable of endothelial function. Qualitative research relying on focus groups and individual, in-depth interviews queried 50 participants 9 to 20 years of age about their cognitions, perceptions and challenges personally encountered while attempting to comply with the dietary intervention. Three factors militate against compliance: individual characteristics, peer pressure, and the family/home environment. On individual characteristics, the more critical may be the level of cognitive development and inadequate future orientation. At home, compliance is well and truly moderated by parental attitudes and role modeling. Most significant, perhaps, is the desire to fit in with peers heedless of the canteen and fast food offerings high in fat and sugar.
Benefit and Practical Application to Nursing
Clearly, acceptance of long-term health goals does not come easy to the youth and even their parents. Practicing pediatric nurses nonetheless confront multiple opportunities to counsel and reinforce the motivation of youth with PHL. Nurses can be neutral sounding board, even play credible authority, in the conflicts between parental concern and peer pressures. The profession is knowledgeable enough to address adolescent questions about mortality and genetic transmission, for example. Nurses also need to remind parents that some of the tug-and-pull with adolescent children is par for the course as young people flex their newly-founded independence. And, as one adult to another, pediatric nurses are in a position to steer parents with FH or FCH and fatalistic about their disease away from modeling hopelessness and towards becoming proactive facilitators of dietary adherence.
References
Kools, S., Kennedy, C., Engler, M. & Engler, M. (2008). Pediatric hyperlipidemia: Child and adolescent disease understandings and perceptions about dietary adherence. Journal for Specialists in Pediatric Nursing, 13 (3): 168-179.