你可知自己孩子的動脈已經老化了嗎大綱

Do you know how old your kids' arteries are?

你知道自己孩子的動脈有多老嗎？

It's a potentially important question as scientists increasingly uncover links between healthy habits in childhood and risk for heart disease later in life. And there are growing concerns about the cardiovascular health of millions of children in the U.S. who are considered obese or overweight.

這個問題可能很重要，因爲科學家們越來越多地發現，人們兒時的健康習慣與日後罹患心臟病的風險之間存在關聯。在美國，被視爲肥胖或超重的兒童數以百萬計，圍繞他們心血管健康的擔憂正在與日俱增。

A new study suggests there is a simple way to assess a child's arterial health with a calculation based on an often-overlooked component of cholesterol: triglycerides.

一項新的研究表明，有一種評估兒童動脈健康的簡便方法，即以甘油三酯──膽固醇中一個常常被忽略掉的成分──爲基礎來進行計算。

The calculation is the ratio of triglycerides to HDL, or good cholesterol. It can be easily determined from a standard cholesterol blood test. In the study, based on nearly 900 children and young adults, researchers at Cincinnati Children's Hospital Medical Center found that the higher the ratio, the greater the likelihood a child would have stiff and damaged arteries.

這就是要算出甘油三酯與高密度脂蛋白（又名有益膽固醇）的比值，這個數值通過一項常規的膽固醇血檢便能輕易得出。該研究共涉及近900名兒童及青少年。辛辛那提兒童醫學中心(Cincinnati Children's Hospital Medical Center)的研究人員發現，這個比值越高，兒童動脈硬化或動脈受損的可能性就越大。

'We are demonstrating vascular changes in supposedly healthy adolescents,' said Elaine Urbina, head of preventive cardiology at Cincinnati Children's and lead author of the study. 'Stiff vessels make your heart work harder. It isn't good for you.' The study was published in the journal Pediatrics in April.

圖：如何從小預防心血管疾病該研究的首席作者、辛辛那提兒童醫學中心預防心臟病學主管伊萊恩•烏爾比納(Elaine Urbina)說：“我們正在論證那些據稱身體健康的青少年的血管變化。血管硬化會加重你的心臟工作負擔。這對你並無益處。”這項研究於4月份發表在《兒科學》(Pediatrics)雜誌上。

The problem is also called hardening of the arteries. In adults it typically arises from a combination of aging and the cumulative impact of blood pressure, cholesterol and other assaults on the walls of blood vessels over decades of life. It carries heightened risk for heart attacks, strokes and sudden death.

這個問題也被稱作動脈硬化。成年人之所以會出現動脈硬化通常是因爲身體老化和血壓、膽固醇及其他一些血管壁毛病長年累月影響共同作用的結果。而動脈硬化則會使人們罹患心臟病、中風或突然死亡的風險增高。

When it shows up in children, it's a sign of 'accelerated aging,' Dr. Urbina said, and likely raises the risk of dangerous outcomes relatively early in adult life. The good news is that doctors believe health can be restored to young people's arteries with regular physical activity and a healthy diet. This includes cutting back on sugary beverages and foods high in carbohydrates such as potatoes, white rice and pasta.

烏爾比納博士說，當這個問題出現在兒童身上時，它就是“加速老化”的跡象，它還可能增高人們在青壯年時期罹患重病的風險。好消息是，醫生們相信，通過進行常規的身體鍛鍊及保持健康的飲食，年輕人的動脈便能重獲健康。保持健康的飲食包括要少喝含糖飲料、少吃像土豆、白米飯和意大利麪這樣的高碳水化合物食品。

In late 2011, concern that a generation of children is growing up with already established heart risks prompted federal health officials with the support of the American Academy of Pediatrics to recommend universal cholesterol screening for kids, preferably between ages 9 and 11.

2011年末，出於對一代兒童將會伴隨業已形成的心臟病風險成長起來的擔憂，聯邦健康官員在美國兒科學會(American Academy of Pediatrics)的支持下推介了普遍適用於兒童──最適用於那些年齡在9到11歲間孩子──的膽固醇篩查機制。

Generally, the focus of attention in such tests is LDL, or bad cholesterol, which at high levels has long been associated with increased chances of heart attacks and strokes. A large body of evidence shows that heart risk can be reduced by lowering LDL with one of a class of drugs called statins.

一般來說，這類測試的關注焦點在低密度脂蛋白（又名有害膽固醇）身上。低密度脂蛋白偏高長期以來都與心臟病和中風機率增高息息相關。大量的證據表明，通過服用一類名爲斯達汀(statins)的藥物降低低密度脂蛋白可以減少心臟病發病風險。

But high triglycerides and low HDL─the other components that are measured in a standard cholesterol blood test─are a hallmark reflection of the poor diets and sedentary lifestyles that researchers say are behind the wide prevalence of obesity among both children and adults. These markers may get less attention because efforts to develop drugs that prevent serious events by manipulating either component have come up short.

但甘油三酯偏高且高密度脂蛋白偏低──後者是另一種在常規膽固醇血檢可以測量出的元素──是飲食不良、久坐不動生活方式的一個特徵體現。研究人員說，它們是衆多兒童和成年人變得肥胖的原因。但這些誘因可能不再那麼受人關注，因爲人們研發藥物的諸多努力成效不大──他們是通過控制其中任一元素來研發那些預防嚴重疾病的藥物的。

Triglycerides amount to an indicator of both fat and sugar in the blood stream. Dr. Urbina describes them to patients as having a backbone of fat with three (tri) sugars (glycerides) attached.

甘油三酯相當於一項能顯示出血液中脂肪和糖份含量的指標。烏爾比納向患者形容說，這就像一根附帶了三種糖（甘油脂）的脂肪脊柱。

Other research has linked a high triglyceride-to-HDL ratio to arterial stiffness in adults. Dr. Urbina and her colleagues wondered whether a similar correlation existed in children and young people.

其他的研究已將成年人甘油三酯/高密度脂蛋白比值偏高的情況與動脈硬化聯繫了起來。烏爾比納和她的同事想知道，在兒童和青少年身上是否也存在着一種與此相似的關聯性。

Participants in the study, who ranged in age from 10 to 26, underwent fasting tests for cholesterol, blood pressure, blood sugar and other heart-risk markers. They also had three different noninvasive tests that measure elasticity in blood vessels.

該研究的參與者年齡在10到26歲之間，他們都做了膽固醇、血壓、血糖和其他心臟病風險指標的空腹檢查。他們還進行了三項不同的、旨在測量血管彈性的無創檢測。

One third of the participants were found to have stiff arteries based on one of the elasticity tests; 13% had abnormalities on two of the tests and 3% had arterial stiffness according to all three tests.

結果發現，有三分之一的參與者在其中一項血管彈性檢測中被查出有動脈硬化；13%的人在其中兩項檢測中被查出指標不正常；有3%的人在經過全部三項檢查後被認定爲動脈硬化。

The researchers found a 'progressive rise' in both heart-related risk factors and stiff arteries as the triglyceride-to-HDL ratio increased.

研究人員發現，隨着甘油三酯/高密度脂蛋白比值增高，心臟病相關的風險因素和動脈硬化狀況也均隨之“逐步上升”。

The study wasn't large enough or intended to establish when a ratio is 'healthy' or when especially aggressive treatment is called for. That will require additional research. But scientists found that the 378 participants whose ratio was in the highest of three groups had an average ratio of 2.7.

但該研究涉及範圍不夠廣，或者說它並未打算去設立一個標準：即何時一個比值纔算得上“健康”或患者什麼時候需要實施特別積極的治療。所以這就需要再進行額外的研究。但科學家們也發現，在三組當中比值最高的378名參與者的平均比值爲2.7。

What this shows 'is that being overweight and the cholesterol problems that often accompany it have an important impact on your blood vessels,' said Sarah de Ferranti, director of preventive cardiology at Boston Children's Hospital, who wasn't involved with the study. A direct correlation to damaged blood vessels in kids hadn't previously been shown.

波士頓兒童醫院(Boston Children's Hospital)預防心臟病學主管薩拉•德•費倫蒂(Sarah de Ferranti)並未參與上述研究，她說，該研究告訴我們“體重超重和常常與之伴生的膽固醇問題會對你的血管產生重要的影響。”但之前的研究並未表明，兒童體內受損的血管與超重有什麼直接的關係。

Dr. de Ferranti, a pediatrician, said that based on the study, 'I would worry more about my patients in the realm' of 2.7 or higher.

兒科醫生費倫蒂說，基於這項研究，“我將會更擔心我的那些患者中比值等於或高於2.7的人。”

The American Heart Association recommends adults maintain an HDL level of at least 40 milligrams per deciliter of blood (mg/dL) for men and 50 mg/dL for women, and preferably higher. Triglycerides for adults should be below 150 mg/dL, with lower being better. The ratio using these numbers is higher than that found in the study. That is partly because children generally have lower triglyceride levels than those of adults.

美國心臟協會(American Heart Association)建議成年男子將高密度脂蛋白保持在至少40毫克/分升的水平，成年女子則爲50毫克/分升，最好比這個數值再高一些。而成年人的甘油三酯水平則應低於150毫克/分升，數值再低些會更好。與該項研究中發現的數字相比，用這些數字算出來的比值會更高，部分原因在於兒童體內的甘油三酯水平一般比成年人更低。

Dr. Urbina sometimes prescribes a prescription form of fish oil for patients with persistently high triglycerides; neither its benefit in children nor long-term impact among adults and children has been determined. Generally doctors are reluctant to give medications to children with the problem. Lifestyle change, including diet and exercise, is the mainstay remedy, although it poses big challenges.

烏爾比納有時會向甘油三酯居高不下的患者以處方藥形式開出魚油藥方。但該藥方對兒童是否有所裨益、對成年人和兒童是否會產生長期影響，迄今都尚無定論。一般來說，醫生都不太願意向患有此類疾病的兒童開藥。儘管困難重重、充滿挑戰，但包括飲食和鍛鍊在內的生活方式的轉變纔是主要補救辦法。

A major strategy for doctors is getting kids to avoid or sharply reduce consumption of sugary beverages, including sodas and sports drinks, big contributors to triglyceride levels.

醫生的一個主要策略就是讓孩子們不喝或者少喝包括蘇打水和運動飲料在內的含糖飲料，這對改善其甘油三酯水平頗有裨益。

'It's incredibly difficult to scale a kid down to the recommended 50 grams of sugar when a juice box has 24,' said Heather Vanderhaar, of suburban Cincinnati. Ms. Vanderhaar's two boys, Benjamin, 12, and Maxwell, 10, have a genetic condition that results in elevated triglyceride levels. They are working with Dr. Urbina to keep those levels under control.

家住辛辛那提郊區的希瑟•範德哈爾(Heather Vanderhaar)說：“一盒果汁就含有24克糖，這種情況下讓孩子將飲用量減到推薦的50克，太難了。”範德哈爾太太的兩個兒子──12歲的本傑明(Benjamin)和10歲的麥克斯韋(Maxwell)──他們天生的身體條件就會導致甘油三酯水平偏高。爲了將體內的甘油三酯水平維持在可控範圍內，他們一直在烏爾比納那兒就醫。

'At this point they're maintaining,' Ms. Vanderhaar said. School sports and bike riding are among their physical activities. The boys aren't allowed soda, cookies or junk food. 'We allow them to have treats but in moderation,' she said. 'The thinking is if you start early, you can reverse any damage done to your arteries.'

範德哈爾太太說：“他們目前病情穩定。”學校的運動和自行車騎行都在兩兄弟的活動範疇之內。但他們不許喝蘇打水、不能吃曲奇或垃圾食品。範德哈爾太太還說：“我們允許他們犒勞自己，但要適量。這麼做是基於這樣的想法：如果你早點行動，你還能修復動脈已受到的損害。”

Molly and Kate Cassabon, 18-year-old identical twins from Waterville, Ohio, went for two years putting on substantial weight before their problem was diagnosed at age 10 as genetically high triglycerides that exceeded 800 mg/dL. Their grade school installed an automated external defibrillator out of fear that either of the girls could collapse at any moment from a heart attack.

來自俄亥俄州沃特維爾(Waterville, Ohio)的同卵雙胞胎姐妹莫莉(Molly)和凱特•卡薩博(Kate Cassabon)在10歲那年被診斷爲先天性甘油三酯水平偏高──比正常值整整超出800毫克/分升，而在這之前的兩年，她們長胖了不少。由於擔心兩姐妹中的任何一個人可能會因爲突發心臟病而倒下，她們就讀的小學安裝了一個自動體外心臟除顫器。

Dr. Urbina prescribes a prescription form of fish oil pills to help reduce triglycerides. Lately, work at portion control and a weekly session with a personal trainer contributed in March to 'the most improvement they've ever shown' during a checkup with Dr. Urbina, their mother, Sally Cassabon, said. Their triglycerides dipped below 200 mg/dL, still short of a goal of below 150 mg/dL, but enough to help them each lose at least 25 pounds.

烏爾比納以處方藥形式開出魚油藥丸用以幫助減少甘油三酯。雙胞胎的媽媽薩利•卡薩博(Sally Cassabon)說，最近，孩子們在飲食上的份量控制和每週一次與私人教練的會面使她們在3月份接受烏爾比納博士檢查時“表現出有史以來最明顯的改善”。她們的甘油三酯已驟降至200毫克/分升以下，雖然還沒有達到低於150毫克/分升的目標值，但足以幫她們減掉25磅（約合11.3公斤）。