Family Based Prevention of Cardiovascular Disease Risk Factors in Children by Lifestyle Change: The PEP Family Heart Study

  • Peter Schwandt
  • Gerda-Maria Haas
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1121)


Aim: The 14 years’ Prevention Education Program PEP was started 1994 among first graders, their siblings and parents living in the half million city Nuremberg (Germany). The aim of prospective family-based observational study was early detection and lifestyle intervention of traditional cardiovascular risk factors.

Subjects and methods: Out of 3370 families 24,927 adults and 23,740 children participated in the PEP Family Heart study. Anthropometric parameters including blood pressure and fasting lipids were measured. Because these variables change specifically because of natural growth and development in 3–18 years old children we had to calculate age-and gender-specific growth curves using the LMS method. Non-overweight (normal weight) is defined as BMI < 85th percentile (pctl), overweight as BMI 85th to <95th percentile, obesity as BMI ≥ 95th percentile and severe obesity as ≥ 120% of the 95th pctl. Prehypertension is categorized as the ≥90th to <95th pctl or ≥120/80 mm Hg and hypertension as ≥95th pctl on ≥3 occasions.

Main results:
  1. 1.

    Cardiovascular risk (CVD) factor screening in school children predicted CVD risk in parents.

  2. 2.

    The growths curves for auscultatory systolic (SBP) and diastolic (DBP) blood pressure of non-overweight 8713 boys and 8138 girls nearly identical with the percentile curves of all 11,328 boys and 10,723 girls.

  3. 3.

    The shapes of the 10 lipid percentile curves between the 3rd and 97th pctl differ considerably by age and gender.

  4. 4.

    The wais-to-height ratio (WHtR) percentiles as a measure for abdominal adiposity vary substantially by age and gender

  5. 5.

    Among overweight and obese ≥85th pctl the percentile curves of body fat increase steeply until age 10 years and then decrease slowly in boys whereas the BF% percentile curves in girls increase continuously until age 18 years

  6. 6.

    The prevalence of hypertension increased strongly in severe obesity at the 99th pctl, more steeply beyond 120% of the 95th pctl to 59.1% in boys and 56% in girls.

  7. 7.

    The association between hypertension and normal weight, overweight and obesity increased in boys from 0,5, via 2,7 to 4,3 and in girls from 0,4 via 2,1 to 5,9.

  8. 8.

    Between 2000 and 2007 mean blood pressure decreased from 138.3 ± 18.5 mm Hg to 124.0 ± 13.8 mm Hg in fathers and from 119.1 ± 2.8 mm Hg to 110.4 ± 11.2 mm Hg in mothers.

  9. 9.

    After 1 year weighed dietary protocols demonstrate in 166 fathers a decrease of all six nutrional components like daily energy consumption from 2423 to 2307 Kcal, from 98 g to 91 g fat, from 260 g to 252 g carbohydrates, from 88 g to 84 g protein, cholesterol from 362 mg to 339 mg and alcohol from 19 g to 17 g per day and in 237 mothers from 1915 Kcal to 1830 Kcal, from 79 g to 73 g total fat, from 216 g to 212 g carbohydrates, from 66 g to 64 g protein, from 299 g to 244 mg cholesterol.

  10. 10.

    Sustained intensive individual and family-based lifestyle counseling in daily life in terms of healthy diet, less sedentary behavior and more leisure time physical activity slightly improved the CVD risk factor profiles in parents and their children already after 1 year.



PEP Family Heart Study CVD risk factors Lifestyle intervention 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Peter Schwandt
    • 1
    • 2
  • Gerda-Maria Haas
    • 1
  1. 1.Arteriosclerosis-Prevention-InstituteMunich-NurembergGermany
  2. 2.Ludwig-Maximilians UniversityMunichGermany

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