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Cardiology

Our children

Action by children reduces cardiovascular risks in parents

design by Nara Lacerda Ferreira, 7 years oldMotherhood accentuated the will of cardiologist Luciana Savoy Fornari to become a professional in the world of children. When her first child was born, the doctor noticed that a child generates a transformation in the home and family environment. And she thought, “to what extent can a child influence the health of the parents?” Contrary to the common questions about how adults have power over the actions of children, the researcher, who is part of the team of cardiologist Bruno Caramelli, at the Heart Institute (InCor) of the University of São Paulo (USP), decided to study how children can contribute to a better quality of life for the father and mother. Through an educational program for children, the group had a surprisingly affirmative answer. Teaching children about cardiovascular risks may decrease the presence of heart disease in their parents by close to 90%.

This result is part of a study that will be exhibited at the European Congress of Cardiology in August of this year. The team evaluated the effectiveness of a multidisciplinary educational program for children in the prevention of cardiovascular risks to their parents. The scientists subjected two groups of students aged 6 to 10 years and enrolled at the Jundiaí private school, 60 kilometers from São Paulo, to two distinct approaches. Parents of students (control group) occupying the school during the morning period received educational brochures with guidelines on healthy eating, the importance of avoiding tobacco and engaging in physical activities. No such information was provided to students.

Training the second group, called the intervention, included a further step. In addition to receiving the same information leaflets that were given to parents, children in the afternoon session attended lectures and engaged in activities about cardiovascular disease prevention, during 2010. Nutritionists taught them about following healthy eating habits in the cafeteria. In physical education classes, physiotherapists explained why it is important to practice physical activities. The staging of plays and a bike ride, in conjunction with parents, were also realized as a means of reinforcing the lessons they learned about in school. “But at no time were the children encouraged to take charge of the healthy attitudes of their parents,” says Luciana.

The researchers had already hoped that this effort would have positive repercussions at home. In the United States in the 90’s, many college curricula began to include lessons on subjects related to quality of life that taught students how to eat better. Researchers who followed the program observed a change in behavior. In Brazil, many schools include lessons in environmental preservation and appropriate attitudes in traffic, that are regularly repeated by the students to their parents. “In fact, on some highways there are signs with pictures of children and messages for parents to drive more carefully in order to avoid accidents. This inspired us,” says Caramelli.

The group told those responsible for children that the study would evaluate cardiovascular risk factors in the family, and for this purpose they would require data from them as well. Parents (323 total, with an average age of 40 years) allowed the participation of their children (197), but were unaware of the fact that adults were the real subject of study. The Framingham Point Scale calculates the probability of a person suffering from a cardiovascular disease. Laboratory tests, questionnaires about nutritional and physical activity habits, measures of weight, height, waist circumference and blood pressure were all taken for comparison at the beginning and end of year school.

Healthier
After the educational program, 91% of the parents in the intervention group left the high risk stage with respect to cardiovascular disease according to the Framingham scale, while the change was only 13% in the control group. Moreover, the average risk of suffering from cardiovascular disease declined from 3.53% to 2.8% in the first (intervention) group, while in the other (control) group the average risk remained virtually the same, around 4.5%. “Children commented to their parents about the best kinds of food that they should buy in the supermarket,” says Caramelli. For example, Karina Martins Caires, 31, notes that the attitudes adopted by her 7 year old daughter changed the habits of her entire family. “We ate pizza or a snack three times a week. Now we only eat pasta on Saturdays or Sundays. My husband and I even went back to working out at the gym,” she says.

“Every time she was presented with a lecture on the topic at school, my daughter came home talking about the importance of what she had learned, such as not smoking. If she saw someone smoking on the street, she would comment that it is bad for your health,” says Karina. In the supermarket, her daughter started asking to buy more fruits and vegetables. “Even today, almost six months after the research was conducted, she says that we should have fruit for dessert,” she says.

At Easter, the girl said that her parents should donate some of their chocolate eggs because there was too much for just the three of them. Each family member eats a piece of chocolate a day. When Karina wants one more, her daughter reinforces that “I don’t forget I am the overseer of my heart”, just as she learned in school. “If the attitude of eating healthier foods is with her, we parents must also set an example to follow. She is a more aware child,” she believes.

“The family relationship is very important. Because of this, children can exert means of disease prevention that doctors seem to have such a hard time communicating to patients, despite their profession assertion that cardiovascular diseases are major killers,” adds the cardiologist. “Of course there are also genetic factors related to cardiovascular risk, but to change the behavior of families can help reduce them,” says Luciana. Now the team plans to enlist the program to prevent cardiovascular risk in public schools. They will also continue studying the effects of their educational initiative over the long run.

The Project
Educating children as a therapeutic instrument in the reduction of cardiovascular risk to parents (nº 2009/17450-3); Modality RegularAid Research Project; Coordinator Bruno Caramelli – Incor/USP; Investment R$ 62,256.88 (FAPESP)

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