Document Type : Original Article


1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Department of Public Health and Community Health, Technological Educational Institution of Athens, Athens

2 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University

3 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University,

4 Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta,

5 Department of Preschool Education, School of Education, University of Crete, Crete, Greece


BACKGROUND: Cardiovascular disease (CVD) risk factors are adopted during childhood and
adolescence. Health literacy at these ages remains the cornerstone of a healthy adult life. The aim
of the study was to examine the role of gender regarding CVD risk factors’ awareness and to develop
an evaluation tool for the assessment of CVD risk factors’ knowledge and perception among children.
METHODS: During the school years 2014–2015 and 2015–2016, 1728 students aged
10–12 years (5th and 6th grade), from 5 Greek cities (including Athens metropolitan area), were enrolled;
nearly 45% were boys (participation rate varied from 95% to 100% from school to school). Students
and their parents completed an anonymous questionnaire; students’ somatometric characteristics were
also recorded. Schools were randomly selected. Linear regression models were applied to evaluate
the impact of children’s gender on knowledge and perceptions about CVD risk factors.
RESULTS: Significant higher percentage of correct answers, among girls compared to boys, was
revealed regarding the weekly consumption of legumes, the breakfast weekly consumption, and
the effects of soft drinks on health (all P < 0.05). As far as CVD risk factors’ knowledge, significantly
higher percentage of girls than boys also answered that high blood pressure and television viewing
are bad for health and particularly for heart‑related problems (all P < 0.05). Girls had a significantly
higher mean score of 0.304 than boys, after adjusting for several confounders (P = 0.029).
CONCLUSION: Health education programs should take into account gender differences in children’s
perception and attitudes toward CVD risk factors, in order to increase awareness of children and
eventually reduce CVD risk during adulthood.


1. World Health Organization (WHO). Fact Sheet No. 317
Cardiovascular Diseases (CVDs). Updated; 2015. Available from: [Last
accessed on 2017 Nov 30].
2. Nichols M, Townsend N, Scarborough P, Luengo‑Fernadez R,
Leal J, Gray A, et al. European Cardiovascular Disease Statistics.
2012 edition. European Heart Network AISBL, Brussels, European
Society of Cardiology, Sophia Antipolis. Available from:‑media/
pdf. [Last accessed on 2017 Nov 30].
3. Mendis S, Puska P, Norrving B. Global Atlas on Cardiovascular
Disease Prevention and Control. World Health Organization
(in Collaboration with the World Heart Federation and World
Stroke Organization), Geneva; 2011. Available from: http://www.
pdf. [Last accessed on 2017 Nov 30].
4. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J,
Manolio T, et al. Heart disease and stroke statistics‑2006 update:
A report from the American Heart Association statistics committee
and stroke statistics subcommittee. Circulation 2006;113:e85‑151.
5. Hong YM. Atherosclerotic cardiovascular disease beginning in
childhood. Korean Circ J 2010;40:1‑9.
6. McGill HC Jr., McMahan CA, Herderick EE, Malcom GT,
Tracy RE, Strong JP, et al. Origin of atherosclerosis in childhood
and adolescence. Am J Clin Nutr 2000;72:1307S‑15S.
7. Natale RA, Messiah SE, Asfour L, Uhlhorn SB, Delamater A,
Arheart KL, et al. Role modeling as an early childhood obesity
prevention strategy: Effect of parents and teachers on preschool
children’s healthy lifestyle habits. J Dev Behav Pediatr
8. Mosca L, Barrett‑Connor E, Wenger NK. Sex/gender differences
in cardiovascular disease prevention: What a difference a decade
makes. Circulation 2011;124:2145‑54.
9. Mikkola TS, Gissler M, Merikukka M, Tuomikoski P, Ylikorkala O.
Sex differences in age‑related cardiovascular mortality. PLoS One
10. Hitchman SC, Fong GT. Gender empowerment and
female‑to‑male smoking prevalence ratios. Bull World Health
Organ 2011;89:195‑202.
11. Patsopoulou A, Tsimtsiou Z, Katsioulis A, Rachiotis G,
Malissiova E, Hadjichristodoulou C, et al. Prevalence and risk
factors of overweight and obesity among adolescents and their
parents in central Greece (FETA project). Int J Environ Res Public
Health 2015;13:83.
12. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M,
et al. European guidelines on cardiovascular disease prevention
in clinical practice (version 2012). The Fifth Joint Task force of the European Society of Cardiology and Other Societies on
Cardiovascular Disease Prevention in Clinical Practice (constituted
by representatives of nine societies and by invited experts). Eur
Heart J 2012;33:1635‑701.
13. Comrey AL, Lee HB. A First Course in Factor Analysis. Hillsdale,
NJ: Erlbaum; 1992.
14. US Department of Health and Human Services. Heart
Disease and Stroke: Objectives; 2017. Available from: https://‑objectives/topic/
heart‑disease‑and‑troke/objectives. [Last accessed on
2017 Dec 15].
15. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis
of hypertension in children and adolescents. JAMA
16. Humphries SE, WhittallRA, Hubbart CS, Maplebeck S, CooperJA,
Soutar AK, et al. Genetic causes of familial hypercholesterolaemia
in patients in the UK: Relation to plasma lipid levels and coronary
heart disease risk. J Med Genet 2006;43:943‑9.
17. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE,
WattigneyWA, et al. Association between multiple cardiovascular
risk factors and atherosclerosis in children and young adults. The
Bogalusa Heart Study. N Engl J Med 1998;338:1650‑6.
18. Shaikh RB, Mathew E, Sreedharan J, Muttappallymyalil J,
Sharbatti SA, Basha SA, et al. Knowledge regarding risk factors of
hypertension among entry year students of a medical university.
J Family Community Med 2011;18:124‑9.
19. Maksimović MŽ, Marinković JM, Vlajinac HD, Maksimović JM,
Tomanić MS, Radak DJ, et al. Awareness and knowledge of
cardiovascular disease risk factors among medical students. Wien
Klin Wochenschr 2017;129:458‑63.
20. Piwońska A, Piotrowski W, Piwoński J, Kozela M, Nadrowski P,
Bielecki W, et al. Cardiovascular health knowledge of the polish
population. Comparison of two national multi‑centre health
surveys: WOBASZ and WOBASZ II. Kardiol Pol 2017;75:711‑9.
21. Ha SA, Lee SY, Kim KA, Seo JS, Sohn CM, Park HR, et al. Eating
habits, physical activity, nutrition knowledge, and self‑efficacy by
obesity status in upper‑grade elementary school students. Nutr
Res Pract 2016;10:597‑605.
22. Shin A, Nam CM. Weight perception and its association with
socio‑demographic and health‑related factors among Korean
adolescents. BMC Public Health 2015;15:1292.
23. Ray M, Guha S, Ray M, Kundu A, Ray B, Kundu K, et al.
Cardiovascular health awareness and the effect of an educational
intervention on school‑aged children in a rural district of India.
Indian Heart J 2016;68:43‑7.
24. Hill A. The development of children’s body shape concerns.
In: Jaffa T, McDermott B, editors. Eating Disorders in Children
and Adolescents. New York: Cambridge University Press; 2007.
p. 32‑44.
25. KoroniM, Garagouni‑AreouF, Roussi‑VergouCJ, ZafiropoulouM,
Piperakis SM. The stigmatization of obesity in children. A survey
in greek elementary schools. Appetite 2009;52:241‑4.
26. McCreary D. Gender and age differences in the relationship
between body mass index and perceived weight: Exploring the
paradox. Int J Mens Health 2002;1:31‑42.
27. Truby H, Paxton SJ. The children’s body image scale: Reliability
and use with international standards for body mass index. Br J
Clin Psychol 2008;47:119‑24.
28. ClarkLA, TiggemannM. Appearance culture in nine‑to 12‑year‑old
girls: Media and peer influences on body dissatisfaction. Soc Dev
29. Schur EA, Sanders M, Steiner H. Body dissatisfaction and dieting
in young children. Int J Eat Disord 2000;27:74‑82.
30. McCabe MP, Ricciardelli LA. Body image dissatisfaction among
males across the lifespan: A review of past literature. J Psychosom
Res 2004;56:675‑85.