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Winkleby MA, Robinson TN, Sundquist J, Kraemer HC. Ethnic Variation in Cardiovascular Disease Risk Factors Among Children and Young Adults: Findings From the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA. 1999;281(11):1006–1013. doi:10.1001/jama.281.11.1006
Author Affiliations: Stanford Center for Research in Disease Prevention, Department of Medicine (Drs Winkleby, Robinson, and Sundquist), and the Departments of Pediatrics (Dr Robinson) and Psychiatry (Dr Kraemer), Stanford University School of Medicine, Palo Alto, Calif.
Context Knowledge about ethnic differences in cardiovascular
disease (CVD) risk factors among children and young adults from
national samples is limited.
Objective To evaluate ethnic differences in CVD risk factors, the
age at which differences were first apparent, and whether differences
remained after accounting for socioeconomic status (SES).
Design Third National Health and Nutrition Examination Survey,
Setting Eighty-nine mobile examination centers.
Participants A total of 2769 black, 2854 Mexican American, and
2063 white (non-Hispanic) children and young adults aged 6 to 24 years.
Main Outcome Measures Ethnicity and household level of
education (SES) in relation to body mass index (BMI), percentage of
energy from dietary fat, cigarette smoking, systolic blood pressure,
glycosylated hemoglobin (HbA1c), and non–high-density
lipoprotein cholesterol (non–HDL-C [the difference between total
cholesterol and HDL-C]).
Results The BMI levels were significantly higher for black and
Mexican American girls than for white girls, with ethnic differences
evident by the age of 6 to 9 years (a difference of approximately 0.5
BMI units) and widening thereafter (a difference of >2 BMI units
among 18- to 24-year-olds). Percentages of energy from dietary fat
paralleled these findings and were also significantly higher for
black than for white boys. Blood pressure levels were higher for black
girls than for white girls in every age group, and glycosylated
hemoglobin levels were highest for black and Mexican American girls and
boys in every age group. In contrast, smoking prevalence was highest
for white girls and boys, especially for those from low-SES homes (77%
of young men and 61% of young women, aged 18-24 years, from low-SES
homes were current smokers). All ethnic differences remained
significant after accounting for SES and age.
Conclusion These findings show strong ethnic differences in CVD
risk factors among youths of comparable age and SES from a large
national sample. The differences highlight the need for heart disease
prevention programs to begin early in childhood and continue throughout
young adulthood to reduce the risk of atherosclerosis.
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