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Niagara Falls, Canada

McCrindle B.W.,University of Toronto | Manlhiot C.,University of Toronto | Millar K.,University of Toronto | Gibson D.,Heart Niagara Inc. | And 6 more authors.
Journal of Pediatrics | Year: 2010

Objective: To determine prevalence and cross-sectional trends over time for cardiovascular risk factors in Canadian adolescents. Study design: Cross-sectional trends in cardiovascular risk and lifestyle factors were gathered annually in 14- to 15-year-old students in the Niagara region, Ontario, Canada. Results: A total of 20 719 adolescents were screened between 2002 and 2008. The proportion of obese adolescents (>95th percentile for body mass index [BMI]) increased significantly, by +0.34%/year (P = .002). The proportions of adolescents with borderline high cholesterol (4.4-5.1 mmol/L) (+0.57%/year; P <.001) and with high cholesterol (≥5.2 mmol/L) (+0.43%/year; P <.001) both increased significantly over time. The proportion of adolescents with prehypertension decreased by -0.23%/year (P = .02), whereas the proportion of those with stage I hypertension (5%-6%) or stage II hypertension (2%-4%) remained constant. The proportion of adolescents classified as being at high cardiovascular risk increased by +0.67%/year (P <.001). Family history, low levels of physical activity, sedentary behaviors, poor nutrition, and lower socioeconomic status were all independently and negatively associated with all aspects of cardiovascular risk. Conclusions: A significant proportion of 14- to 15-year-old Canadian adolescents have at least one cardiovascular risk factor, and the cross-sectional trends worsened during the period 2002-2008. © 2010 Mosby Inc. All rights reserved. Source

Khoury M.,University of Toronto | Manlhiot C.,University of Toronto | Gibson D.,Heart Niagara Inc. | Chahal N.,University of Toronto | And 3 more authors.
BMC Pediatrics | Year: 2016

Background: Universal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended. Given the clustering of cardiovascular risk factors within families, one benefit of screening adolescents may be to identify "at-risk" families in which adult members might also be at elevated risk and potentially benefit from medical evaluation. Methods: Cross-sectional study of grade 9 students evaluating adiposity, lipids and blood pressure. Data collected by Heart Niagara Inc. through the Healthy Heart Schools' Program. Parents completed questionnaires, evaluating family history of dyslipidemia, hypertension, diabetes and early cardiovascular disease events in parents and siblings (first-degree relatives), and grandparents (second-degree relatives). Associations between positive risk factor findings in adolescents and presence of a positive family history were assessed in logistic regression models. Results: N = 4014 adolescents ages 14-15 years were screened; 3467 (86 %) provided family medical history. Amongst adolescents, 4.7 % had dyslipidemia, 9.5 % had obesity, and 3.5 % had elevated blood pressure. Central adiposity (waist-to-height ratio ≥0.5) in the adolescent was associated with increased odds of diabetes in first- (OR:2.0 (1.6-2.6), p < 0.001) and second-degree relatives (OR:1.3 (1.1-1.6), p = 0.002). Dyslipidemia was associated with increased odds of diabetes (OR:1.6 (1.1-2.3), p < 0.001), hypertension (OR:2.2 (1.5-3.2), p < 0.001) and dyslipidemia (OR:2.2 (1.5-3.2),p < 0.001) in first degree relatives. Elevated blood pressure did not identify increased odds of a positive family history. Conclusions: Presence of obesity and/or dyslipidemia in adolescents identified through a universal school-based screening program is associated with risk factor clustering within families. Universal pediatric cardiometabolic screening may be an effective entry into reverse cascade screening. © 2016 Khoury et al. Source

Narang I.,University of Toronto | Manlhiot C.,University of Toronto | Davies-Shaw J.,University of Toronto | Gibson D.,Heart Niagara Inc. | And 5 more authors.
CMAJ | Year: 2012

Background: Evidence suggests that inadequate or disturbed sleep is associated with increased cardiovascular risk in adults. There are limited data on sleep quality and associated cardiovascular risk in children. Methods: We obtained data on adolescents from the 2009/10 cycle of the Healthy Heart Schools' Program, a population-based cross-sectional study in the Niagara region of Ontario. Participants underwent measurements of cardiometabolic risk factors, including body mass index (BMI), lipid profile and blood pressure, and they completed questionnaires measuring sleeping habits and nutritional status. We assessed sleep disturbance using the sleep disturbance score derived from the Pittsburgh Sleep Quality Index. We explored associations between sleeping habits and cardiovascular risk factors. Results: Among 4104 adolescents (51% male), the mean hours of sleep per night (± standard deviation) were 7.9 ± 1.1 on weeknights and 9.4 ± 1.6 on weekends. In total, 19% of participants reported their sleep quality as fairly bad or very bad on weeknights and 10% reported it as fairly bad or very bad on weekends. In the multivariable regression models, a higher sleep disturbance score was associated with increased odds of being at high cardiovascular risk (highest v. lowest tertile odds ratio [OR] 1.43 [95% confidence interval (CI) 1.16-1.77], p < 0.001), increased odds of hypertension (highest v. lowest tertile OR 1.44 [95% CI 1.02-2.05], p = 0.05) and increased odds of elevated non-high density lipoprotein cholesterol (highest v. lowest tertile OR 1.28 [95% CI 1.00-1.64], p = 0.05). The mean duration of sleep was not associated with these outcomes. Interpretation: In healthy adolescents, sleep disturbance is associated with cardiovascular risk factor abnormalities. Intervention strategies to optimize sleep hygiene early in life may be important for the prevention of cardiovascular disease. © 2012 Canadian Medical Association or its licensors. Source

Khoury M.,University of Toronto | Manlhiot C.,University of Toronto | Dobbin S.,Heart Niagara Inc. | Gibson D.,Heart Niagara Inc. | And 6 more authors.
Archives of Pediatrics and Adolescent Medicine | Year: 2012

Objective: To determine if the interaction of waist circumference percentile and waist to height ratio (WHtR) with body mass index (BMI) may serve to provide further risk specification in the lipid and blood pressure assessment of adolescents beyond BMI classification. Design: Population-based, cross-sectional study. Data collected during the 2009-2010 academic school year. Setting: Geographically and administratively defined Niagara Region, Ontario, Canada. Data collected in school, during subjects' mandatory physical education class. Part of the Heart Niagara Inc Healthy Heart Schools' Program. Participants: Entire population of grade 9 (14- and 15-year-old) students in the Niagara Region, Ontario. Four thousand eight hundred eighty-four students enrolled in grade 9 during the study period, of which 4104 participated (51% male) and 3248 (79%) had complete data. Main Outcome Measures: Nonfasting lipid values and blood pressure categories in subjects categorized based on BMI/waist circumference percentile and BMI/WHtR. Results: The associations between blood pressure, lipid profile, and measures of adiposity (BMI alone, BMI/waist circumference percentile, and BMI/WHtR) were statistically significant but had a limited strength and were not statistically significant from each other. For overweight and obese subjects, increased WHtR categories were associated with worsened lipid profile and increased odds of hypertension both relative to subjects with both normal BMI and normal WHtR and subjects with normal WHtR within each BMI category. Conclusion: Waist measures should be included in the screening and assessment of overweight and obese adolescents. ©2012 American Medical Association. All rights reserved. Source

Lord S.,University of Toronto | Manlhiot C.,University of Toronto | Tyrrell P.N.,University of Toronto | Dobbin S.,Heart Niagara Inc. | And 5 more authors.
BMJ Open | Year: 2015

Objective: Understanding obesity and its modifiable risk factors in youth is key to addressing the burden of cardiovascular disease later in life. Our aim was to examine the associations among adiposity, negative health behaviours and socioeconomic status in youth from the Niagara Region. Design, setting and participants: Cross-sectional observational study of 3467 grade 9 students during their mandatory health and physical education class to investigate the association between socioeconomic status ( postal code), self-reported health behaviour and adiposity in the Niagara Region, Ontario, Canada. Results: Median household income was $63 696 and overall percentage below the after-tax low-income cutoff was 4.2%. Negative health behaviours (especially skipped meals, lower fruit and vegetable consumption, higher screen time) were associated with lower income neighbourhoods, however, the absolute effect was small. Those participants in the lowest income quintile had a significantly greater body mass index z-score than those in the highest (0.72±1.19 vs 0.53±1.12), but the overall trend across quintiles was not statistically significant. A similar trend was noted for waist-to-height ratio. The lowest income neighbourhoods according to after-tax low-income cut-off had small but statistically significant associations with higher adiposity compared with the middle or highest income neighbourhoods. Conclusions: Obesity prevention efforts should target modifiable behaviours, with particular attention to adolescents from lower income families and neighbourhoods. © 2015, BMJ Publishing Group. All rights reserved. Source

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