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Sons ate unripe, the teeth of fathers will be priests

Don't ask what you can do for your children, ask what they can do for you. Hereditary diseases among the parents often lead to early detection and preventive treatment among the children. Now it turns out that this path also goes the other way around - diseases detected in the children lead to the prevention of heart attacks among the parents. A study recently presented in Rambam revealed interesting data about this phenomenon and also broke some myths about obesity among Israeli children

Prof. Naim Shahada (left) and Dr. Gal Neuman at the Rambam clinic. Photo: Piotr Plitar.
Prof. Naim Shahada (left) and Dr. Gal Neuman at the Rambam clinic. Photo: Piotr Plitar.

Heredity is often a one-way street, but sometimes the hereditary connection takes an opposite turn. One of the medical fields, in which heredity becomes a tool in the service of preventive medicine, is cardiovascular diseases. Surprisingly, this is an advantage for preventing diseases not only among the children, but also among the parents.

In recent years, the concept that risk factors that lead to cardiovascular diseases must be treated at a young age is gaining ground in the world. Statistics show that children of parents who developed heart disease at an early age (before the age of 55), are at 2-4 times more likely to develop cardiovascular disease (cardiovascular disease) in their adulthood. Various diseases that develop at a young age, such as atherosclerosis and metabolic syndrome (obesity, diabetes, fatty liver, blood lipids, hypertension), put children at a significant risk of developing future cardiovascular problems.

Various studies conducted around the world have proven that early intervention is critical and can significantly correct or reduce the risk, and about a year and a half ago a dedicated clinic was opened in Rambam, the first of its kind in the north, which locates and treats children (ages 5-18) who are at risk, in order to prevent their development of cardiovascular diseases at a later stage. The clinic operates under the auspices of the Children's Department A at Rambam, headed by Prof. Naim Shahada.

From data collected during the months of clinic activity, A fascinating phenomenon called "Reverse Cholesterol Screening" stood out in particular. Among the children treated at the clinic, there are those who came for treatment due to symptoms related to their physical health (obesity, chest pains, etc.), regardless of a family history of cardiovascular diseases. Some of them were found to have high cholesterol levels, a result that leads the doctors to the hereditary source, namely the parents. Since the parents of these children did not come with a background of heart attacks and high cholesterol, the parents were also tested and found to have a high level of cholesterol in their blood, without them knowing about it! This phenomenon was discovered in approximately 10-15% of the children being monitored at the clinic, a percentage that is considered relatively high in the world.

"This phenomenon is very interesting," says Dr. Gal Neuman, a doctor in the children's department at Rambam and the clinic's activity center. of themselves. Through the tests we perform on the children, we sometimes get hints about the diseases the parents have, and in fact inform them for the first time that they are at risk."

Location, location, location - do Israeli children overtake the rest of the world in cholesterol levels?

Ischemic heart disease is one of the most common diseases among the adult population in the Western world: about 8% of the entire population suffers from it and it is the cause of almost a quarter of deaths in the Western world.

Children with a significant family history, in the case of overweight in the child and obesity in the family, children of parents with high cholesterol, or children whose family history is unknown (adoption, the identity of one of the parents is unknown, etc.), are those who are mainly among the risk groups.

65% of the children treated at the Rambam clinic were found to have significantly high cholesterol values, a finding that requires treatment. This figure, it turns out, is higher than Europe, India and the USA, the country known for its obesity epidemic. "This is a very high figure," notes Dr. Neuman, "the meaning is that we are in a critical area. It is possible that the reason for these findings lies in the fact that in the population of northern Israel there is a high prevalence of carriers of mutations that cause hypercholesterolemia, that is, the defect in the gene that causes high levels of cholesterol." Another figure found among the clinic's patients is the fact that 30% of its patients suffer from obesity, this is in contrast to 16% in the general population (a similar figure between adults and teenagers). "This is where the issue of lifestyle comes into play," explains Dr. Neuman, "these children did not see a doctor about obesity until they arrived at the Rambam clinic, and this is a worrying phenomenon." In segmenting this group, it was found that more than half of the members of this group come from the Jewish sector (55%), which is more prone to obesity and less to high cholesterol levels, compared to 45% of the Arab sector, where the tendency is the opposite.

These data were revealed about two weeks ago, when Dr. Neuman presented his research on the subject, as part of the "Annual Research Seminar", which took place at the Rambam Medical College. This research earned Dr. Neuman the Outstanding Researcher Award, on behalf of "Meyer" Children's Hospital.

However, alongside these data, the Rambam clinic presents good treatment results, which are inherent in the early detection of the problem and its treatment from a young age. "All the patients who are under follow-up with us have shown improvement since the beginning of the treatment," Dr. Neuman concludes, "Overall, there has been an improvement in the scale of blood cholesterol values ​​and a return to normal among the patients. Even among 5% of the children receiving drug treatment, a return to normal cholesterol values ​​was found. It should be noted that children respond better to medication than adults, and this is another advantage of early detection. Caring for children is challenging and complex for various reasons. For example, among the children who suffer from obesity, we accompany them while they are in the growth process, which means weight gain which is essential for their development. At the same time, they need to lose weight, in order to maintain their health, and our role in the clinic is to navigate this delicate balance."

Background on the Rambam clinic

About one hundred and twenty families and over 150 children are treated within the clinic, who receive comprehensive tests that include: blood tests and cholesterol levels, measurements of weight, height, blood pressure, waist and hip circumferences and ultrasound of the carotid arteries (to demonstrate early thickening of the blood vessel walls), one of the few centers in Israel , who performs these tests on children, the youngest of whom is 5 years old. Another unique test performed at the clinic is an endothelial function test, a test whose purpose is to diagnose vascular dysfunction early, long before the development of actual atherosclerosis. Rambam is the only center in Israel that performs this test in children for the purpose of early detection of the risk of heart disease in "healthy" children.

The treatment plan includes nutritional counseling, counseling regarding physical activity, providing medication to lower cholesterol as needed, family counseling and frequent check-ups. The clinic collaborates with a multidisciplinary team that specializes in various fields of pediatrics such as: a dietitian specializing in pediatric nutrition, pediatric endocrinology, pediatric gastroenterology, pediatric nephrology (kidney and urinary diseases), pediatric cardiology, a psychologist, and more.

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