Table 23 .

Classification of recommendation and level of evidence for the presence of cardiovascular diseases (CVD) in children and adolescents

Recommendation		Class	Level of evidence
Obesity screening
•	Obesity screening by use of BMI in children > 6 years, providing or indicating intensive behavioral interventions directed to achieving a healthy weight	I	B
•	Ask about early CAD family history to identify children at risk
•	In the presence of positive family history, assess all family members, especially the parents
•	In children aged > 2 years with BMI > 85th percentile:	I	C
	Reinforce preventive instructions (see below)
	Identify complications and RF: SBP, gallbladder disease symptoms, diabetes, sleep apnea, hypothyroidism, orthopedic disorders, lipid profile
•	In children aged > 2 years with BMI > 85th- 94th percentile,all measures above plus:t	I	C
	control of weight gain and fat ingestion, focusing on nutrition and developmen
	treatment of RF and complications
	multidisciplinary approach of moderate to high intensity
	measure aspartate aminotransferase (AST), alanine aminotransferase (ALT) and blood sugar in children > 10 years of age
•	In children aged > 2 years with BMI > 95th percentile, all measures above plus: Long-term objective: maintain BMI < 85	I	B
•	Consider more aggressive approaches if conservative strategies fail	I	A
•	Check urea and creatinine every 2 years
Nutrition - Milk/other beverages
Exclusive maternal breastfeeding for the first 6 months		I	B
From the 12th to the 24th month, transition to non-aromatic low-fat milk (2% or skim)		I	B
From 2 to 21 years of age, non-aromatic skim milk should be the major beverage		I	A
Avoid sugar beverages, encourage water ingestion		I	B
Dietary fat
Fat ingestion by infants should not be restricted without medical indication		I	C
From the 12th to the 24th month, transition to family meals with fat corresponding to 30% of the total caloric ingestion, 8%-10% of which of saturated fat		I	B
From 2 to 21 years of age, fat should correspond to 25%-30% of the total caloric ingestion, 8%-10% of which of saturated fat		I	A
Avoid trans fat		I	B
Cholesterol < 300 mg/dL		I	A
Others
From 2 to 21 years of age, encourage fiber ingestion, limit sodium ingestion and encourage healthy life habits: family meals, breakfast, limit fast snacks		I	B
Physical activity
Parents should create an environment that promotes physical activity and limit sedentary activities, and be role models		I	C
Limit sedentary activities, especially TV/video		I	B
Moderate to vigorous physical activity every day		I	A

BMI: body mass index; CAD: coronary artery disease; RF: risk factors; SBP: systolic blood pressure