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Perng W, Francis EC, Schuldt C, Barbosa G, Dabelea D, Sauder KA. Pre- and Perinatal Correlates of Ideal Cardiovascular Health during Early Childhood: A Prospective Analysis in the Healthy Start Study. J Pediatr 2021; 234:187-194. [PMID: 33741366 PMCID: PMC8238850 DOI: 10.1016/j.jpeds.2021.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To characterize prevalence of ideal cardiovascular health (ICVH) during early childhood (4-7 years of age), and to identify pre- and perinatal biological, sociodemographic, metabolic, and behavioral correlates of ICVH. STUDY DESIGN Among 350 mother-child pairs in the Healthy Start Study, we defined ICVH as no exposure to second hand smoke; ≥1 hour/day of moderate-to-vigorous physical activity; body mass index ≤85th percentile; systolic and diastolic blood pressure <90th percentile; cholesterol <170 mg/dL, fasting glucose <100 mg/dL; and healthy diet, per the American Heart Association. Pre- and perinatal characteristics were obtained from questionnaires, medical records, and in-person visits. Because of low prevalence of ICVH, we focused on prevalence of meeting ≥6 metrics in the analysis. We examined bivariate associations of each characteristic with % meeting ≥6 metrics and included those that were significant (P < .05) in a multivariable logistic regression model. RESULTS ICVH prevalence at mean ± SD age 4.7±0.6 years was 6.9%; boys had twice the prevalence as girls (9% vs 4.4%). Most (>85%) children met criteria for second hand smoke, body mass index, blood pressure, cholesterol, and glucose, and only one-third met criteria for physical activity (31.4%) and diet (35.1%). In multivariable analyses, key correlates of ICVH were maternal weight status (ORoverweight/obese vs nonoverweight/obese = 0.41 [0.23, 0.73]) and offspring sex (ORmale vs female = 2.14 [1.22, 3.65]). CONCLUSIONS At age 4-7 years, ICVH prevalence is already low, with diet and adequate physical activity being the limiting factors. Healthy maternal weight prior to pregnancy and male sex are potential determinants of childhood ICVH. Additional work is required to explore associations of early-life ICVH with future health outcomes.
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Affiliation(s)
- Wei Perng
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO.
| | - Ellen C Francis
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Caylor Schuldt
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Gregory Barbosa
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Dana Dabelea
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Katherine A Sauder
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
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Abstract
Postprandial glycaemia and insulinaemia are important risk factors for type 2 diabetes. The prevalence of insulin resistance in adolescents is increasing, but it is unknown how adolescent participant characteristics such as BMI, waist circumference, fitness and maturity offset may explain responses to a standard meal. The aim of the present study was to examine how such participant characteristics affect the postprandial glycaemic and insulinaemic responses to an ecologically valid mixed meal. Data from the control trials of three separate randomised, crossover experiments were pooled, resulting in a total of 108 participants (fifty-two boys, fifty-six girls; aged 12·5 (SD 0·6) years; BMI 19·05 (SD 2·66) kg/m2). A fasting blood sample was taken for the calculation of fasting insulin resistance, using the homoeostatic model assessment of insulin resistance (HOMA-IR). Further capillary blood samples were taken before and 30, 60 and 120 min after a standardised lunch, providing 1·5 g/kg body mass of carbohydrate, for the quantification of blood glucose and plasma insulin total AUC (tAUC). Hierarchical multiple linear regression demonstrated significant predictors for plasma insulin tAUC were waist circumference, physical fitness and HOMA-IR (F(3,98) = 36·78, P < 0·001, adjusted R2 = 0·515). The variance in blood glucose tAUC was not significantly explained by the predictors used (F(7,94) = 1·44, P = 0·198). Significant predictors for HOMA-IR were BMI and maturity offset (F(2,102) = 14·06, P < 0·001, adjusted R2 = 0·021). In summary, the key findings of the study are that waist circumference, followed by physical fitness, best explained the insulinaemic response to an ecologically valid standardised meal in adolescents. This has important behavioural consequences because these variables can be modified.
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Henriksson H, Henriksson P, Tynelius P, Ekstedt M, Berglind D, Labayen I, Ruiz JR, Lavie CJ, Ortega FB. Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men. Eur Heart J 2021; 41:1503-1510. [PMID: 31710669 PMCID: PMC7154806 DOI: 10.1093/eurheartj/ehz774] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/21/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022] Open
Abstract
Aims Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with later chronic disability due to specific causes of CVD disability (i.e. cerebrovascular disease, ischaemic heart disease and heart failure). Methods and results This population-based cohort study included 1 078 685 male adolescents (16–19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05–0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak. Conclusions This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight.
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Affiliation(s)
- Hanna Henriksson
- PROmoting FITness and Health through physical activity research group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada 18071, Spain.,Department of Medical and Health Sciences, Linköping University, Linköping 581 83, Sweden
| | - Pontus Henriksson
- PROmoting FITness and Health through physical activity research group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada 18071, Spain.,Department of Medical and Health Sciences, Linköping University, Linköping 581 83, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge 141 83, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm 171 77, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm 113 65, Sweden
| | - Mattias Ekstedt
- Department of Medical and Health Sciences, Linköping University, Linköping 581 83, Sweden
| | - Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Stockholm 171 77, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm 113 65, Sweden
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain, Public University of Navarra, Campus de Arrosadía, Tajonar 22, Pamplona 31006, Spain
| | - Jonatan R Ruiz
- PROmoting FITness and Health through physical activity research group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada 18071, Spain.,Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge 141 83, Sweden
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA 70121, USA
| | - Francisco B Ortega
- PROmoting FITness and Health through physical activity research group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada 18071, Spain.,Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge 141 83, Sweden
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54
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Pedretti RFE. Antenatal, perinatal, and primordial cardiovascular prevention: What is known, what is happening, and future directions. Eur J Prev Cardiol 2021; 28:359-360. [PMID: 31838878 DOI: 10.1177/2047487319896142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roberto F E Pedretti
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Institute of Pavia, Italy
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Pengpid S, Peltzer K. Ideal Cardiovascular Health Behaviours in Nationally Representative School-Based Samples of Adolescents in the Caribbean. Vasc Health Risk Manag 2021; 17:187-194. [PMID: 33976549 PMCID: PMC8106475 DOI: 10.2147/vhrm.s302168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ideal cardiovascular health behaviour (CVHB) measures four ideal health behaviours (non-smoking, body mass index <85th Percentile, healthy diet, and physical activity). This study aimed to determine the prevalence, distribution, and correlates of ideal CVHB among adolescents in the Caribbean. Methods Nationally representative cross-sectional data of 2016 or 2017 with complete CVHB measurements were analysed from 7556 school adolescents from four Caribbean countries. Results The prevalence of 0-1 ideal metrics CVHB was 20.4%, 2 ideal metrics 48.7%, and 3-4 ideal metrics 30.8%. Only 5.0% had all 4 ideal CVHB metrics, 41.0% intermediate CVH (≥1 metric in the intermediate category and none in the poor category), and 54.0% had poor CVH (≥1 metric in poor category). In adjusted logistic regression analysis, compared to students from Dominican Republic, students from Jamaica (Adjusted Odds Ratio-AOR: 1.36, 95% confidence interval-CI: 1.01-1.85), students from Trinidad and Tobago (AOR: 1.46, 95% CI: 1.17-1.82) and male sex (AOR: 1.35, 95% CI: 1.11-1.64) were positively associated with meeting 3-4 ideal CVHB metrics. In addition, in unadjusted analysis, rarely or sometimes experiencing hunger was negatively and high peer and parent support were positively associated with meeting 3-4 ideal CVHB metrics. Conclusion The proportion of meeting 3-4 ideal CVHB metrics was low among adolescents in four Caribbean countries. Both high-risk and school-wide intervention programmes should be implemented in aiding to improve CVHB in Caribbean countries. Several factors associated with ideal CVHB were identified, which can be targeted in school health interventions.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
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56
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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57
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Ruan S, Raeside R, Singleton A, Redfern J, Partridge SR. Limited Engaging and Interactive Online Health Information for Adolescents: A Systematic Review of Australian Websites. HEALTH COMMUNICATION 2021; 36:764-773. [PMID: 31964190 DOI: 10.1080/10410236.2020.1712522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adolescents need access to interactive and high-quality online health information about strategies to reduce their risk for non-communicable diseases (NCDs). This study aimed to evaluate the quality, readability and interactivity of webpages with adolescent-specific information on NCD risk factors. Included web pages were: (i) Australian-based; (ii) authored by government bodies or public health organizations; (iii) contained information relevant to NCD risk factors; and (iv) contained adolescent-specific information. In total, 69 web pages were included for evaluation (smoking, n = 6; nutrition, n = 22; alcohol, n = 15; physical activity n = 11; mental health, n = 6; health and obesity, n = 9). Content quality score (modified DISCERN tool) ±standard deviation ranged from fair (49.6 ± 13.6 for nutrition) to good quality (58.4 ± 11.0 for alcohol). Mean readability score (Flesch-Kincaid tool) found most webpages were difficult to read (49.6 ± 14.9, University student level). Adolescent-directed websites were written in plain English (62 ± 7.5, understood by 13-15-year-olds). Mean interactivity score indicated web pages were fairly interactive (13 ± 2.0). The study found very few webpages were written specifically for adolescents and no webpages were of excellent quality, highly interactive and written in plain English. Given the plethora of online health information from non-credible sources, we recommend public health organizations invest in co-designing excellent-quality and interactive online health information with adolescents.
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Affiliation(s)
- Stella Ruan
- Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
| | - Rebecca Raeside
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
| | - Anna Singleton
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
| | - Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
- The George Institute for Global Health, University of New South Wales
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney
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Wang M, Ying J, Ugbolue UC, Buchan DS, Gu Y, Baker JS. Cardio-Metabolic Risk Factors in Scottish South Asian and Caucasian Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094667. [PMID: 33925726 PMCID: PMC8125757 DOI: 10.3390/ijerph18094667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Abstract
(1) Background: Scotland has one of the highest rates of obesity in the Western World, it is well established that poor weight profiles, and particularly abdominal obesity, is strongly associated with Type II diabetes and cardiovascular diseases. Whether these associations are apparent in ethnic population groups in Scotland is unclear. The purpose of this study was to examine the associations between different measures of fatness with clustered cardio metabolic risk factors between Scottish South Asian adolescents and Scottish Caucasian adolescents; (2) Methods: A sample of 208 Caucasian adolescents and 52 South Asian adolescents participated in this study. Stature, waist circumference, body mass index, blood pressure, physical activity, and cardiovascular disease (CVD) risk were measured; (3) Results: Significant, partial correlations in the South Asian cohort between body mass index (BMI) and individual risk factors were generally moderate. However, correlations between Waist circumference (WC) and individual risk factors were significant and strong. In the Caucasian cohort, a significant yet weak correlation between WC and total cholesterol (TG) was noted although no other associations were evident for either WC or BMI. Multiple regression analysis revealed that both BMI and WC were positively associated with CCR (p < 0.01) in the South Asian group and with the additional adjustment of either WC or BMI, the independent associations with clustered cardio-metabolic risk (CCR) remained significant (p < 0.005); (4) Conclusions: No positive relationships were found between BMI, WC, and CCR in the Caucasian group. Strong and significant associations between measures of fatness and metabolic risk were evident in Scottish South Asian adolescents.
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Affiliation(s)
- Meizi Wang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China;
| | - Jianhua Ying
- College of Science Technology, Ningbo University, Ningbo 315211, China;
| | - Ukadike Chris Ugbolue
- Institute for Clinical Exercise and Health Sciences, School of Science, University of the West of Scotland, Hamilton, Scotland ML3 0JB, UK; (U.C.U.); (D.S.B.)
| | - Duncan S. Buchan
- Institute for Clinical Exercise and Health Sciences, School of Science, University of the West of Scotland, Hamilton, Scotland ML3 0JB, UK; (U.C.U.); (D.S.B.)
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China;
- Correspondence: (Y.G.); (J.S.B.); Tel.: +86-5748-7600-456 (Y.G.); +852-3411-8032 (J.S.B.)
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong 999077, China
- Correspondence: (Y.G.); (J.S.B.); Tel.: +86-5748-7600-456 (Y.G.); +852-3411-8032 (J.S.B.)
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Juonala M, Lewis S, McLachlan R, Hammarberg K, Kennedy J, Saffery R, McBain J, Welsh L, Cheung M, Doyle LW, Amor DJ, Burgner DP, Halliday J. American Heart Association ideal cardiovascular health score and subclinical atherosclerosis in 22-35-year-old adults conceived with and without assisted reproductive technologies. Hum Reprod 2021; 35:232-239. [PMID: 31834929 DOI: 10.1093/humrep/dez240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Is ART related with the association of American Heart Association (AHA) ideal cardiovascular health score and markers of subclinical atherosclerosis? SUMMARY ANSWER The associations between AHA score and markers of subclinical atherosclerosis in ART and non-ART groups were similar in magnitude. WHAT IS KNOWN ALREADY Long-term consequences of ART on cardiovascular health are unknown. STUDY DESIGN, SIZE, DURATION The study cohort for the cross-sectional analyses consisted of 172 ART-conceived and 78 non-ART conceived individuals of same age (range 22-35 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Cardiovascular risk factor status was evaluated with American Heart Association (AHA) ideal cardiovascular health score consisting of seven factors (body mass index, blood pressure, total cholesterol, glucose, diet and physical activity, non-smoking). Carotid artery intima-media thickness (cIMT), arterial pulse-wave velocity (PWV) and retinal microvascular parameters were evaluated as markers of early atherosclerosis. Group comparisons in continuous variables were performed with t-tests. For categorical variables, comparisons were performed with chi-square tests. The relationships between AHA score and the markers of atherosclerosis were examined with linear regression analyses adjusted for age and sex. MAIN RESULTS AND THE ROLE OF CHANCE There was no difference in AHA ideal health score between the ART and non-ART groups; mean (SD) scores were 4.1(1.4) versus 4.0(1.5), respectively, P = 0.65. No differences were observed between groups for any individual ideal health metric (P always >0.2). AHA score was not associated with cIMT or retinal measures in either group (P always >0.05). An inverse association was observed between AHA score and PWV in the ART group (beta (95% CI) -0.18(-0.26 to -0.10)). A numerically similar relationship was observed in the smaller non-ART group (-0.19(-0.39 to 0.01)). LIMITATIONS, REASONS FOR CAUTION Even though this cohort is among the largest ART studies with extensive cardiovascular data, the sample is still relatively small and the statistical power is limited. As the study population was still in early adulthood, we were not able to evaluate the associations with clinical cardiovascular events, but utilized non-invasive methods to assess early markers of subclinical atherosclerosis. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that ART-conceived individuals do not have increased vulnerability for cardiovascular risk factors. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by a National Health & Medical Research Council Project Grant (APP1099641), The Royal Children's Hospital Research Foundation, Monash IVF Research and Education Foundation, and Reproductive Biology Unit Sperm Fund, Melbourne IVF. The authors have no conflicts of interest relevant to this article to disclose.
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Affiliation(s)
- Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children's Research Institute, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Clayton, Australia
- Monash IVF Group Pty Ltd, Richmond, Australia
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Karin Hammarberg
- Global Public Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Joanne Kennedy
- Murdoch Children's Research Institute, Parkville, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - John McBain
- Reproductive Services, Royal Women's Hospital, Parkville, Australia
| | - Liam Welsh
- Murdoch Children's Research Institute, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Research Office, The Royal Women's Hospital, Parkville, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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60
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Siddiqui KN. Diet as a tool for primordial cardiovascular prevention in developing countries. Panminerva Med 2021; 63:104-109. [PMID: 33878847 DOI: 10.23736/s0031-0808.21.04268-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a rising burden of non-communicable disease (NCD), especially cardiovascular diseases (CVD) in the developing nations to an extent that they are sometimes terms as NCD epidemics. If unchecked, these NCD epidemics, can impact the healthcare systems and adversely affect the development of the whole country. While CVD is a matter of concern worldwide, it is even more so in low- and middle-income countries, where the incidence and prevalence of these diseases are much worse than developed countries, owning to their large population. According to the WHO, CVDs cause 28.5% of all deaths, in the developing nations. Even within the developing countries, the profile of CVD varies greatly, depending on the phase of epidemiological transition the country is currently undergoing. While primary prevention is about treating risk factors to prevent CVD, primordial prevention refers to avoiding the development of risk factors in the first place. As we now know, atherosclerosis starts in youth and is related to dyslipidemia, smoking, and hypertension, Body Mass Index and blood glucose levels. Therefore, the primordial prevention must start early in life. High-quality clinical trials have traditionally been mainly focusing on primary and secondary prevention settings. There are some key studies that evaluated the role of diet in primordial setting that were discussed in this review.
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Affiliation(s)
- Khawer N Siddiqui
- Unit of Cardiology, Department of Cardiology, Ruby General Hospital, Kolkata, India -
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Reciprocal Longitudinal Relationship Between Fitness, Fatness, and Metabolic Syndrome in Brazilian Children and Adolescents: A 3-Year Longitudinal Study. Pediatr Exerc Sci 2021; 33:74-81. [PMID: 33857920 DOI: 10.1123/pes.2020-0197] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/10/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To verify the reciprocal longitudinal relationships between cardiorespiratory fitness (CRF), percentage body fat (%body fat), and metabolic syndrome in Brazilian primary school students. METHOD This longitudinal study involved 420 children and adolescents followed for 3 years (2011-2014). The continuous Metabolic Syndrome (cMetSyn) score was calculated by summing adjusted z scores of glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference. The CRF was assessed using running/walking tests, and %body fat was assessed through sex-specific 2-site skinfold thickness. Cross-lagged panel models were used to analyze longitudinal reciprocal relationships between CRF and %body fat with cMetSyn. RESULTS Results indicated that 2011 %body fat significantly predicted both 2014 CRF scores and 2014 cMetSyn scores (P < .001); however, 2011 CRF only predicted 2014 %body fat (P < .001) but not 2014 cMetSyn (P = .103). Furthermore, 2011 cMetSyn predicted 2014 %body fat (P = .002). The model explained 36%, 48%, and 37% of the variance in 2014 CRF, %body fat, and cMetSyn, respectively. CONCLUSION The results suggest a reciprocal inverse relationship between %body fat and metabolic syndrome risk and that %body fat may play a more important role in the risk of developing metabolic syndrome compared with CRF.
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Gande N, Pechlaner R, Bernar B, Staudt A, Stock K, Hochmayr C, Geiger R, Kiechl-Kohlendorfer U, Knoflach M. Cardiovascular health behaviors and associations of sex, age, and education in adolescents - Results from the EVA Tyrol study. Nutr Metab Cardiovasc Dis 2021; 31:1286-1292. [PMID: 33558093 DOI: 10.1016/j.numecd.2020.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Ideal cardiovascular health (CVH) behaviors in adolescents are defined by body mass index (BMI), diet, physical activity and smoking, and are directly associated with better health in later life. To further improve health prevention programs we investigated the prevalence of these behaviors in a cohort of healthy adolescents and focused on the associations with sex, age, and education. METHODS AND RESULTS The Early Vascular Aging Tyrol study is a cross-sectional study assessing 14- to 19-year-old pupils and apprentices in Western Austria and South Tyrol. Between May 2015 and July 2018 2047 adolescents (43.6% males, mean age 16.4 years) with complete data for all 4 health behaviors were included. The prevalence of ideal body mass index (BMI) was 78.3%, of ideal physical activity 42.5%, of non-smoking 70.4% and of ideal diet 8.1%. Females showed a higher smoking prevalence and a lower physical activity, but better dietary habits than males. Older adolescents of both sexes had lower prevalence of ideal smoking and diet. Apprentices and pupils of vocational schools had a higher BMI and a less favorable diet compared to secondary academic school students. Smoking prevalence was highest in apprentices. Non-ideal BMI was independently associated with smoking. CONCLUSION In our cohort, only a minority showed ideal CVH behaviors which were best in adolescents younger than 16 years. We observed significant differences between males and females and a clear impact of school education with apprentices being at risk for non-ideal CVH behaviors. CLINICAL TRIAL REGISTRATION NUMBER NCT03929692, clinicaltrials.gov.
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Affiliation(s)
- Nina Gande
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benoît Bernar
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Staudt
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Stock
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria; Department of Pediatrics III (Cardiology), Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Hochmayr
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics, Bruneck Hospital, Bruneck, Italy; Department of Pediatrics III (Cardiology), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Jaspers Faijer-Westerink H, Stavnsbo M, Hutten BA, Chinapaw M, Vrijkotte TGM. Ideal cardiovascular health at age 5-6 years and cardiometabolic outcomes in preadolescence. Int J Behav Nutr Phys Act 2021; 18:33. [PMID: 33676545 PMCID: PMC7936465 DOI: 10.1186/s12966-021-01090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The American Heart Association (AHA) developed a definition of ideal cardiovascular health (ICH) based on the presence of both ideal health behaviours (diet, physical activity, weight status and smoking) and ideal health factors (glucose, total cholesterol and blood pressure levels). However, research of ICH in the paediatric population is scarce. We aimed to study ICH at age 5-6 years by extending the original ICH score with the health behaviours: sleep duration, screen time and prenatal smoke exposure, and to evaluate its association with cardiometabolic outcomes at age 11-12. METHODS A total of 1666 children aged 5-6 years were selected from the database of the ABCD-study, a prospective cohort study on the health and development of children born in Amsterdam, the Netherlands. Of these, 846 (50.8%) were boys and 1460 (87.6%) had a healthy weight. Data on self-reported health behaviours and health factors were used to calculate the ICH scores (original and extended) by adding the frequency of scoring 'healthy' on each indicator, based on international cut-offs. The children were followed up for 6 years and cardiometabolic outcomes (carotid intima-media thickness (CIMT), blood pressure, glucose and lipids) were measured. Associations between ICH (both original and extended) and cardiometabolic outcomes were examined using multivariable regression models. RESULTS At age 5-6 years, 11% scored poor (score 1-5), 56% intermediate (score 6-7) and 33% good (score 8-9) on extended ICH. Healthy diet and normal total cholesterol concentrations were the least prevalent. Neither the original nor the extended ICH scores were associated with CIMT at age 11-12. A higher score on the extended ICH was associated with lower total cholesterol (p for trend < 0.001), lower systolic (p for trend = 0.012) and diastolic blood pressure (p for trend = 0.011), and lower body mass index (BMI) (p < 0.001) at age 11-12. The original ICH score was associated with lower total cholesterol (p < 0.001) and BMI (p < 0.001) only. CONCLUSION Our findings suggest that extending the ICH score in young children with additional health behaviours improves prediction of some cardiometabolic outcomes, but not CIMT in preadolescence, compared to the original ICH score. We would recommend other researchers to incorporate objective measures of health behaviours and longer follow-up to find out whether associations persist into adulthood.
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Affiliation(s)
- Hester Jaspers Faijer-Westerink
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, Meibergdreef 9, room J2-209, 1100 DE, Amsterdam, The Netherlands
| | - Mette Stavnsbo
- Department of Sports Science and Physical Education, University of Agder, PO BOX 422, 4604, Kristiansand, Norway
| | - Barbara A Hutten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, Meibergdreef 9, room J1B-209-1, 1100 DE, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, PO Box 7057, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, Meibergdreef 9, room J2-209, 1100 DE, Amsterdam, The Netherlands.
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Perak AM, Lancki N, Kuang A, Labarthe DR, Allen NB, Shah SH, Lowe LP, Grobman WA, Lawrence JM, Lloyd-Jones DM, Lowe WL, Scholtens DM. Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence. JAMA 2021; 325:658-668. [PMID: 33591345 PMCID: PMC7887661 DOI: 10.1001/jama.2021.0247] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Pregnancy may be a key window to optimize cardiovascular health (CVH) for the mother and influence lifelong CVH for her child. OBJECTIVE To examine associations between maternal gestational CVH and offspring CVH. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study (examinations: July 2000-April 2006) and HAPO Follow-Up Study (examinations: February 2013-December 2016). The analyses included 2302 mother-child dyads, comprising 48% of HAPO Follow-Up Study participants, in an ancillary CVH study. Participants were from 9 field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada. EXPOSURES Maternal gestational CVH at a target of 28 weeks' gestation, based on 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking. Each metric was categorized as ideal, intermediate, or poor using pregnancy guidelines. Total CVH was categorized as follows: all ideal metrics, 1 or more intermediate (but 0 poor) metrics, 1 poor metric, or 2 or more poor metrics. MAIN OUTCOMES AND MEASURES Offspring CVH at ages 10 to 14 years, based on 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Total CVH was categorized as for mothers. RESULTS Among 2302 dyads, the mean (SD) ages were 29.6 (2.7) years for pregnant mothers and 11.3 (1.1) years for children. During pregnancy, the mean (SD) maternal CVH score was 8.6 (1.4) out of 10. Among pregnant mothers, the prevalence of all ideal metrics was 32.8% (95% CI, 30.6%-35.1%), 31.7% (95% CI, 29.4%-34.0%) for 1 or more intermediate metrics, 29.5% (95% CI, 27.2%-31.7%) for 1 poor metric, and 6.0% (95% CI, 3.8%-8.3%) for 2 or more poor metrics. Among children of mothers with all ideal metrics, the prevalence of all ideal metrics was 42.2% (95% CI, 38.4%-46.2%), 36.7% (95% CI, 32.9%-40.7%) for 1 or more intermediate metrics, 18.4% (95% CI, 14.6%-22.4%) for 1 poor metric, and 2.6% (95% CI, 0%-6.6%) for 2 or more poor metrics. Among children of mothers with 2 or more poor metrics, the prevalence of all ideal metrics was 30.7% (95% CI, 22.0%-40.4%), 28.3% (95% CI, 19.7%-38.1%) for 1 or more intermediate metrics, 30.7% (95% CI, 22.0%-40.4%) for 1 poor metric, and 10.2% (95% CI, 1.6%-20.0%) for 2 or more poor metrics. The adjusted relative risks associated with 1 or more intermediate, 1 poor, and 2 or more poor (vs all ideal) metrics, respectively, in mothers during pregnancy were 1.17 (95% CI, 0.96-1.42), 1.66 (95% CI, 1.39-1.99), and 2.02 (95% CI, 1.55-2.64) for offspring to have 1 poor (vs all ideal) metrics, and the relative risks were 2.15 (95% CI, 1.23-3.75), 3.32 (95% CI,1.96-5.62), and 7.82 (95% CI, 4.12-14.85) for offspring to have 2 or more poor (vs all ideal) metrics. Additional adjustment for categorical birth factors (eg, preeclampsia) did not fully explain these significant associations (eg, relative risk for association between 2 or more poor metrics among mothers during pregnancy and 2 or more poor metrics among offspring after adjustment for an extended set of birth factors, 6.23 [95% CI, 3.03-12.82]). CONCLUSIONS AND RELEVANCE In this multinational cohort, better maternal CVH at 28 weeks' gestation was significantly associated with better offspring CVH at ages 10 to 14 years.
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Affiliation(s)
- Amanda M. Perak
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nicola Lancki
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alan Kuang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Norrina B. Allen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Svati H. Shah
- Duke University Medical Center, Durham, North Carolina
| | - Lynn P. Lowe
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jean M. Lawrence
- Kaiser Permanente of Southern California, Pasadena
- currently with Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - William L. Lowe
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Berger JH, Chen F, Faerber JA, O'Byrne ML, Brothers JA. Adherence with lipid screening guidelines in standard- and high-risk children and adolescents. Am Heart J 2021; 232:39-46. [PMID: 33229294 PMCID: PMC7854880 DOI: 10.1016/j.ahj.2020.10.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Because atherosclerosis begins in childhood, universal lipid screening is recommended with special attention to conditions predisposing to early atherosclerosis. Data about real-world penetration of these guidelines is not available. METHODS Retrospective cohort study using MarketScan® commercial and Medicaid insurance claims databases, a geographically representative sample of U.S. children. Subjects who passed through the 9- to 11-year window and had continuous insurance coverage between 1/1/2013 and 12/31/2016 were studied. Multivariable models were calculated, evaluating the association between other patient factors and the likelihood of screening. The primary hypothesis was that screening rates would be low, but that high-risk conditions would be associated with a higher likelihood of screening. RESULTS In total, 572,522 children (51% male, 33% black, 11% Hispanic, 51% Medicaid) were studied. The prevalence of high-risk conditions was 2.2%. In unadjusted and adjusted analyses, these subjects were more likely to be screened than standard-risk subjects (47% vs. 20%, OR: 3.7, 95% CI 3.5-3.8, P < .001). Within this group, the diagnosis-specific likelihood of screening varied (26-69%). Endocrinopathies (OR 5.4, 95% CI 5.2-5.7), solid organ transplants (OR 5.0, 95% CI 3.8-6.6), and metabolic disease (OR 3.9, 95% CI 3.1-5.0, all P < .001) were associated with the highest likelihood of undergoing screening. CONCLUSIONS Despite national recommendations, lipid screening was performed in a minority of children. Though subjects with high-risk conditions had a higher likelihood of screening, rates remained low. This study highlights the need for research and advocacy regarding obstacles to lipid screening of children in the United States.
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Affiliation(s)
- Justin H Berger
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Feiyan Chen
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jennifer A Faerber
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute for Health Economics and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA
| | - Julie A Brothers
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Allen NB, Krefman AE, Labarthe D, Greenland P, Juonala M, Kähönen M, Lehtimäki T, Day RS, Bazzano LA, Van Horn LV, Liu L, Alonso CF, Webber LS, Pahkala K, Laitinen TT, Raitakari OT, Lloyd-Jones DM. Cardiovascular Health Trajectories From Childhood Through Middle Age and Their Association With Subclinical Atherosclerosis. JAMA Cardiol 2021; 5:557-566. [PMID: 32159727 DOI: 10.1001/jamacardio.2020.0140] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Cross-sectional measures of cardiovascular health (CVH) have been associated with cardiovascular disease in older age, but little is known about longitudinal trajectories in CVH and their association with subclinical atherosclerosis in middle age. Objectives To model long-term patterns in CVH starting in childhood and to assess their association with subclinical atherosclerosis in middle age. Design, Setting, and Participants This cohort study used data from 5 prospective cardiovascular cohort studies from the United States and Finland from 1973 to 2015. A total of 9388 participants aged 8 to 55 years had at least 3 examinations and were eligible for this study. Statistical analysis was performed from December 1, 2015, to June 1, 2019. Exposures Clinical CVH factors (body mass index, total cholesterol level, blood pressure, and glucose level) were classified as ideal, intermediate, or poor, and were summed as a clinical CVH score. Group-based latent class modeling identified trajectories in this score over time. Main Outcomes and Measures Carotid intima-media thickness (cIMT) was measured for participants in 3 cohorts, and high cIMT was defined as a value at or above the 90th percentile. The association between CVH trajectory and cIMT was modeled using both linear and logistic regression adjusted for demographics, baseline health behaviors, and baseline (or proximal) CVH score. Results Among 9388 participants (5146 [55%] female; 6228 [66%] white; baseline mean [SD] age, 17.5 [7.5] years), 5 distinct trajectory groups were identified: high-late decline (1518 participants [16%]), high-moderate decline (2403 [26%]), high-early decline (3066 [32%]), intermediate-late decline (1475 [16%]), and intermediate-early decline (926 [10%]). The high-late decline group had significantly lower adjusted cIMT vs other trajectory groups (high-late decline: 0.64 mm [95% CI, 0.63-0.65 mm] vs intermediate-early decline: 0.72 mm [95% CI, 0.69-0.75 mm] when adjusted for demographics and baseline smoking, diet, and physical activity; P < .01). The intermediate-early declining group had higher odds of high cIMT (odds ratio, 2.4; 95% CI, 1.3-4.5) compared with the high-late decline group, even after adjustment for baseline or proximal CVH score. Conclusions and Relevance In this study, CVH declined from childhood into adulthood. Promoting and preserving ideal CVH from early life onward may be associated with reduced CVD risk later in life.
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Affiliation(s)
- Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy E Krefman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Darwin Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mika Kähönen
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - R Sue Day
- Department of Epidemiology, UtahHealth School of Public Health, Houston, Texas
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Linda V Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lei Liu
- Division of Biostatistics, Washington University of Medicine in St Louis, St Louis, Missouri
| | - Camilo Fernandez Alonso
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Larry S Webber
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland
| | - Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Tissot H, Pfarrwaller E, Haller DM. Primary care prevention of cardiovascular risk behaviors in adolescents: A systematic review. Prev Med 2021; 142:106346. [PMID: 33275966 DOI: 10.1016/j.ypmed.2020.106346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/15/2022]
Abstract
Adolescence is associated with behavioral changes offering opportunities for prevention of cardiovascular risk behaviors. Primary care physicians are ideally placed to deliver preventive interventions to adolescents. The objective was to systematically review the evidence about effectiveness of primary care-led interventions addressing the main cardiovascular risk behaviors in adolescents: physical activity, sedentary behaviors, diet and smoking. PubMed, Embase, PsycINFO, CINAHL, Cochrane, ClinicalTrials.gov, and ISRCTN registry were searched from January 1990 to April 2020. Randomized controlled trials of interventions in primary care contexts on at least one of the cardiovascular behaviors were included, targeting 10-19-year old adolescents, according to the World Health Organization's definition. Two authors independently assessed risk of bias. Twenty-two papers were included in the narrative synthesis, reporting on 18 different studies. Interventions targeting smoking uptake seemed more effective than interventions targeting established smoking or the three other risk behaviors. Intervention components or intensity were not clearly associated with effectiveness. Risk of bias was mostly unclear for most studies. There is little evidence for specific interventions on adolescents' cardiovascular risk behaviors in primary care, mainly due to studies' methodological limitations. Further research should investigate the effectiveness of opportunistic primary care-based interventions as compared to more complex interventions, and address the methodological shortcomings identified in this review.
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Affiliation(s)
- Hervé Tissot
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Eva Pfarrwaller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of General Practice, The University of Melbourne, Melbourne, Australia.
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Petrovics P, Sandor B, Palfi A, Szekeres Z, Atlasz T, Toth K, Szabados E. Association between Obesity and Overweight and Cardiorespiratory and Muscle Performance in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E134. [PMID: 33375469 PMCID: PMC7796204 DOI: 10.3390/ijerph18010134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/24/2022]
Abstract
The high prevalence of obesity in childhood and adolescence has major public health consequences, since it is associated with various chronic diseases in the short- and long-term. The goal of our study was to examine the possible association between obesity and overweight and cardiorespiratory and muscle performance during a 4-year follow up period in adolescents. The body mass index (BMI) and physical performance of adolescents (360 girls and 348 boys) between 14-18 years of age was measured twice a year, and the possible correlation between overweight and obesity and cardiorespiratory and muscle performances were investigated. Our results revealed that cardiorespiratory performance increased significantly in boys during the 4 years (p < 0.001), but the aerobic performance of girls only showed seasonal fluctuation. Muscle performance significantly increased both in boys and girls (p < 0.001). Inverse association between obesity and cardiorespiratory and muscle performance was proved. Overweight was also inversely correlated with cardiorespiratory performance, but it demonstrated no correlation with muscle strength. Avoiding increased BMI and decreased physical fitness is essential for adolescents' health to prevent short- and long-term adverse effects.
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Affiliation(s)
- Peter Petrovics
- 1st Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pecs, Medical School, H-7623 Pecs, Hungary; (P.P.); (B.S.); (A.P.); (Z.S.)
| | - Barbara Sandor
- 1st Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pecs, Medical School, H-7623 Pecs, Hungary; (P.P.); (B.S.); (A.P.); (Z.S.)
| | - Anita Palfi
- 1st Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pecs, Medical School, H-7623 Pecs, Hungary; (P.P.); (B.S.); (A.P.); (Z.S.)
| | - Zsolt Szekeres
- 1st Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pecs, Medical School, H-7623 Pecs, Hungary; (P.P.); (B.S.); (A.P.); (Z.S.)
| | - Tamas Atlasz
- Institute of Physical Education and Sport Sciences, Faculty of Sciences, University of Pecs, H-7624 Pecs, Hungary;
| | - Kalman Toth
- 1st Department of Medicine, Division of Cardiology and Angiology, University of Pecs, Medical School, H-7624 Pecs, Hungary;
| | - Eszter Szabados
- 1st Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pecs, Medical School, H-7623 Pecs, Hungary; (P.P.); (B.S.); (A.P.); (Z.S.)
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Perak AM, Ning H, Khan SS, Bundy JD, Allen NB, Lewis CE, Jacobs DR, Van Horn LV, Lloyd-Jones DM. Associations of Late Adolescent or Young Adult Cardiovascular Health With Premature Cardiovascular Disease and Mortality. J Am Coll Cardiol 2020; 76:2695-2707. [PMID: 33181243 PMCID: PMC8100998 DOI: 10.1016/j.jacc.2020.10.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND When measured in adolescence or young adulthood, cardiovascular health (CVH) is associated with future subclinical cardiovascular disease (CVD), but data are lacking regarding CVD events or mortality. OBJECTIVES This study examined associations of CVH at ages 18 to 30 years with premature CVD and mortality. METHODS This study analyzed data from the CARDIA (Coronary Artery Risk Development in Young Adults Study). CVH was scored at baseline (1985 to 1986) using Life's Simple 7 metrics and categorized as high (12 to 14 points), moderate (8 to 11), or low (0 to 7). CVD events and cause-specific mortality were adjudicated over 32 years of follow-up. Adjusted associations were estimated using Cox models and event rates and population attributable fractions were calculated by CVH category. RESULTS Among 4,836 participants (mean age: 24.9 years, 54.8% female, 50.5% Black, mean education: 15.2 years), baseline CVH was high (favorable) in 28.8%, moderate in 65.0%, and low in 6.3%. During follow-up, 306 CVD events and 431 deaths occurred. The adjusted hazard ratios for high (vs. low) CVH were 0.14 (95% confidence interval [CI]: 0.09 to 0.22) for CVD and 0.07 (95% CI: 0.03 to 0.19) for CVD mortality, and the population attributable fractions for combined moderate or low (vs. high) CVH were 0.63 (95% CI: 0.47 to 0.74) for CVD and 0.81 (95% CI: 0.55 to 0.92) for CVD mortality. Among individuals with high CVH, event rates were low across sociodemographic subgroups (e.g., CVD rates per 1,000 person-years: age 18 to 24 years, 0.64; age 25 to 30 years, 0.65; men, 1.04; women, 0.36; Blacks, 0.90; Whites, 0.50; up to/through high-school education, 1.00; beyond high-school education, 0.61). CONCLUSIONS High CVH in late adolescence or young adulthood was associated with very low rates of premature CVD and mortality over 32 years, indicating the critical importance of maintaining high CVH.
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Affiliation(s)
- Amanda M Perak
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Pediatrics, Northwestern University, Chicago, Illinois.
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua D Bundy
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Pediatrics, Northwestern University, Chicago, Illinois
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Rovio SP, Pihlman J, Pahkala K, Juonala M, Magnussen CG, Pitkänen N, Ahola-Olli A, Salo P, Kähönen M, Hutri-Kähönen N, Lehtimäki T, Jokinen E, Laitinen T, Taittonen L, Tossavainen P, Viikari JSA, Raitakari OT. Childhood Exposure to Parental Smoking and Midlife Cognitive Function. Am J Epidemiol 2020; 189:1280-1291. [PMID: 32242223 DOI: 10.1093/aje/kwaa052] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/23/2020] [Indexed: 11/14/2022] Open
Abstract
We studied whether exposure to parental smoking in childhood/adolescence is associated with midlife cognitive function, leveraging data from the Cardiovascular Risk in Young Finns Study. A population-based cohort of 3,596 children/adolescents aged 3-18 years was followed between 1980 and 2011. In 2011, cognitive testing was performed on 2,026 participants aged 34-49 years using computerized testing. Measures of secondhand smoke exposure in childhood/adolescence consisted of parental self-reports of smoking and participants' serum cotinine levels. Participants were classified into 3 exposure groups: 1) no exposure (nonsmoking parents, cotinine <1.0 ng/mL); 2) hygienic parental smoking (1-2 smoking parents, cotinine <1.0 ng/mL); and 3) nonhygienic parental smoking (1-2 smoking parents, cotinine ≥1.0 ng/mL). Analyses adjusted for sex, age, family socioeconomic status, polygenic risk score for cognitive function, adolescent/adult smoking, blood pressure, and serum total cholesterol level. Compared with the nonexposed, participants exposed to nonhygienic parental smoking were at higher risk of poor (lowest quartile) midlife episodic memory and associative learning (relative risk (RR) = 1.38, 95% confidence interval (CI): 1.08, 1.75), and a weak association was found for short-term and spatial working memory (RR = 1.25, 95% CI: 0.98, 1.58). Associations for those exposed to hygienic parental smoking were nonsignificant (episodic memory and associative learning: RR = 1.19, 95% CI: 0.92, 1.54; short-term and spatial working memory: RR = 1.10, 95% CI: 0.85, 1.34). We conclude that avoiding childhood/adolescence secondhand smoke exposure promotes adulthood cognitive function.
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Kavey REW, Manlhiot C, Runeckles K, Collins T, Gidding SS, Demczko M, Clauss S, Harahsheh AS, Mietus-Syder M, Khoury M, Madsen N, McCrindle BW. Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience. CJC Open 2020; 2:473-482. [PMID: 33305206 PMCID: PMC7710927 DOI: 10.1016/j.cjco.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Statin use for hypercholesterolemia in children is predominantly reported from short-term clinical trials. In this study, we assess the efficacy and safety of statin treatment in clinical pediatric practice. METHODS Records of all patients who began statin treatment at age <18 years and remained on statins for >6 months from 5 pediatric lipid clinics were reviewed. Information at baseline and from all clinic evaluations after statin initiation was recorded, including lipid measurements, statin drug/dose, safety measures (anthropometry, hepatic enzymes, creatine kinase levels), and symptoms. Lipid changes on statin therapy were assessed from baseline to 6 ± 3 months and from 6 ± 3 months to last follow-up with a mixed-effects model, using piecewise linear splines to describe temporal changes, controlling for repeated measures, sex, and age. RESULTS There were 289 patients with median low-density lipoprotein cholesterol (LDL-C) of 5.3 mmol/L (interquartile range [IQR]:4.5-6.5) and mean age of 12.4 ± 2.9 years at statin initiation. Median duration of therapy was 2.7 years (IQR: 1.6-4.5) with 95% on statins at last evaluation. There were significant decreases in total cholesterol, LDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6 ± 3 months (P < 0.001) and from 6 ±3 months to last follow-up (P < 0.001). Triglycerides and HDL-C were unchanged but the triglyceride to HDL-C ratio decreased significantly by late follow-up. At final evaluation, median LDL-C had decreased to 3.4 mmol/L (IQR:2.8-4.2). No patient had statins discontinued for safety measures or symptoms. CONCLUSIONS In real-world clinical practice, intermediate-term statin treatment is effective and safe in children and adolescents with severe LDL-C elevation.
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Affiliation(s)
- Rae-Ellen W. Kavey
- Preventive Cardiology—Lipid Clinic, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Cedric Manlhiot
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Runeckles
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Tanveer Collins
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Samuel S. Gidding
- Preventive Cardiology—Lipid Clinic, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Matthew Demczko
- Preventive Cardiology—Lipid Clinic, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Sarah Clauss
- Preventive Cardiology Program—Lipid Clinic, Children’s National Hospital, George Washington University School of Medicine and Health, Washington, DC, USA
| | - Ashraf S. Harahsheh
- Preventive Cardiology Program—Lipid Clinic, Children’s National Hospital, George Washington University School of Medicine and Health, Washington, DC, USA
| | - Michele Mietus-Syder
- Preventive Cardiology Program—Lipid Clinic, Children’s National Hospital, George Washington University School of Medicine and Health, Washington, DC, USA
| | - Michael Khoury
- Pediatric Lipid Clinic, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicolas Madsen
- Pediatric Lipid Clinic, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian W. McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Kim KK, Lee KR, Hwang IC. Association between handgrip strength and cardiovascular risk factors among Korean adolescents. J Pediatr Endocrinol Metab 2020; 33:1213-1217. [PMID: 32809958 DOI: 10.1515/jpem-2020-0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022]
Abstract
Background It remains unclear whether muscle strength, which reduces cardiovascular (CV) risk in adults, is associated with similar protection in Asian adolescents. This study investigated the association between handgrip strength and CV health in a large Korean sample of school-age adolescents. Methods We performed a cross-sectional analysis of adolescents aged 10-18 years (n=4,018) from the Korean National Health and Nutrition Survey between 2014 and 2017. Handgrip strength was measured using a dynamometer. CV risk factors include waist circumference, blood pressure, fasting glucose or hemoglobin A1c, and lipid levels. Logistic regression models were applied with adjustment for potential confounders. Results The mean age of participants was 14.0 years, and 53.6% were boys. Mean handgrip strength was 30.4 kg for boys and 22.0 kg for girls. Boys more frequently had high systolic blood pressure and impaired fasting glucose, whereas girls more frequently had low high-density lipoprotein cholesterol. Multivariate logistic regression analysis revealed that in boys only, handgrip strength was negatively associated with central obesity and hypertriglyceridemia and positively associated with higher systolic blood pressure. Conclusion Handgrip strength is independently associated with some CV risk factors only in boys.
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Affiliation(s)
- Kyoung Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyu Rae Lee
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
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73
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Shang X, Li Y, Xu H, Zhang Q, Liu A, Du S, Guo H, Ma G. Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis. Nutr J 2020; 19:105. [PMID: 32950062 PMCID: PMC7502204 DOI: 10.1186/s12937-020-00611-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children. METHODS We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed. RESULTS The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR. CONCLUSION Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.
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Affiliation(s)
- Xianwen Shang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia
| | - Yanping Li
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Haiquan Xu
- Institute of food and nutrition development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Hongwei Guo
- School of Public Health, Fudan University, Shanghai, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Beijing, 100191, China.
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Longitudinal Effects of Transportation Vulnerability on the Association Between Racial/Ethnic Segregation and Youth Cardiovascular Health. J Racial Ethn Health Disparities 2020; 8:618-629. [DOI: 10.1007/s40615-020-00821-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
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75
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Agostinis-Sobrinho C, Werneck ADO, Kievišienė J, Moreira C, Ramírez-Vélez R, Rosário R, Norkiene S, Lopes L, Mota J, Santos R. IDEAL CARDIOVASCULAR HEALTH STATUS AND HEALTH-RELATED QUALITY OF LIFE IN ADOLESCENTS: THE LABMED PHYSICAL ACTIVITY STUDY. ACTA ACUST UNITED AC 2020; 39:e2019343. [PMID: 32876307 PMCID: PMC7457468 DOI: 10.1590/1984-0462/2021/39/2019343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/19/2020] [Indexed: 02/22/2023]
Abstract
Objective: Adolescent’s ideal cardiovascular health index (ICVH) seems to be an
important indicator of youth’s lifestyles and cardiometabolic health with
potential positive consequences for their Health-Related Quality of Life
(HRQoL). The purpose of this study was to examine the associations between
the ICVH index and HRQoL in adolescents. Methods: This was a cross-sectional study based on secondary analyses from the LabMed
Physical Activity Study (n=407 adolescents, 53% girls). ICVH, as defined by
the American Heart Association, was determined as meeting ideal behaviors
(physical activity, body mass index, smoking status, and diet intake) and
health factors (blood pressure, total glucose, and cholesterol). HRQoL was
measured with the Kidscreen-10 self-report questionnaire. Results: Analysis of covariance (ANCOVA) showed a significant association between the
accumulation of ideal cardiovascular health metrics and HRQoL
(F(4,403)=4.160; p=0.003). In addition, the higher the number
of ideal health behaviors accumulated, the higher the mean values of HRQoL
(p-value for trend=0.001), after adjustments for age, sex, socioeconomic
status and pubertal stage. Conclusions: ICVH index was positively associated with HRQoL in adolescents. Ideal health
behaviors metrics seem to have a stronger association with HRQoL than the
ideal health factors metrics in adolescents.
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Affiliation(s)
| | | | - Justina Kievišienė
- Faculty of Health and Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Carla Moreira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Robinson Ramírez-Vélez
- Department of Health Sciences, Public University of Navarra, Navarrabiomed- Pamplona, Navarra, Spain
| | - Rafaela Rosário
- School of Coimbra (ESEnfC), School of Nursing, University of Minho, Braga, Portugal
| | - Sigute Norkiene
- Faculty of Health and Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Luís Lopes
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
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76
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Gooding HC, Brown CA, Liu J, Revette AC, Stamoulis C, de Ferranti SD. Will Teens Go Red? Low Cardiovascular Disease Awareness Among Young Women. J Am Heart Assoc 2020; 8:e011195. [PMID: 30835591 PMCID: PMC6475073 DOI: 10.1161/jaha.118.011195] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The American Heart Association Go Red for Women campaign has improved awareness of cardiovascular disease (CVD) among adult women aged 25 years and older. Little is known about awareness among younger women. Methods and Results We assessed awareness of CVD and prevention efforts among 331 young women aged 15 to 24 years using the American Heart Association National Women's Health Study survey. We compared responses from this cohort to the 2012 American Heart Association online survey of 1227 women aged 25 years and older. Only 33 (10.0%) young women correctly identified CVD as the leading cause of death in women. This was significantly lower than awareness among all adult women in 2012 (785 [64.0%]) and among women aged 25 to 34 years (90 of 168 [53.6%]) (P<0.01 for both). Many young women in the current study (144 [43.5%]) said they were not at all informed about CVD; most worried little (130 [39.2%]) or not at all (126 [38%]) about CVD. Young women did report engaging in behaviors known to reduce risk of CVD, although not considering oneself at risk was cited as the number one barrier to engaging in prevention behaviors. Conclusions Young women are largely unaware of CVD as the leading cause of death for women. Given that most young women are not worried about CVD and their 10‐year risk for CVD events is low, campaigns to promote heart‐healthy behaviors among younger women should underscore the benefits of these preventive behaviors to current health in addition to reductions in lifetime risk of CVD.
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Affiliation(s)
- Holly C Gooding
- 1 Division of Adolescent/Young Adult Medicine Boston Children's Hospital Boston MA.,2 Department of Pediatrics Harvard Medical School Boston MA
| | - Courtney A Brown
- 1 Division of Adolescent/Young Adult Medicine Boston Children's Hospital Boston MA
| | - Jingyi Liu
- 2 Department of Pediatrics Harvard Medical School Boston MA
| | - Anna C Revette
- 3 Survey and Data Management Core Division of Population Sciences Dana-Farber Cancer Institute Boston MA
| | - Catherine Stamoulis
- 1 Division of Adolescent/Young Adult Medicine Boston Children's Hospital Boston MA.,2 Department of Pediatrics Harvard Medical School Boston MA
| | - Sarah D de Ferranti
- 2 Department of Pediatrics Harvard Medical School Boston MA.,4 Department of Cardiology Boston Children's Hospital Boston MA
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Ideal cardiovascular health in adolescents and young adults is associated with alexithymia over two decades later: Findings from the cardiovascular risk in Young Finns Study: Department: Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. Psychiatry Res 2020; 289:112976. [PMID: 32413709 DOI: 10.1016/j.psychres.2020.112976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/16/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
We evaluated the association of cardiovascular health in adolescence and young adulthood with alexithymia 25 years later. The study sample (n = 1122) participated in evaluations conducted in 1986 (baseline) and in 2011-2012 (T2). Baseline health factors and behaviors were assessed utilizing seven ideal cardiovascular health metrics (ICH index) including blood pressure, cholesterol and glucose levels, smoking, physical activity, body-mass-index, and diet. The stability of the ICH index was evaluated with corresponding assessments in 2007 (T1). At T2, alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). The main analyses were conducted using ANCOVA and adjusted for depression, age, and present social and lifestyle factors. TAS-20 subscales, Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally Oriented Thinking, were analyzed separately. The ICH index was significantly associated with the TAS-20 total score, as well as both with DIF and DDF. A less ideal cardiovascular health was associated with higher alexithymia scores. However, regarding the separate factors, only the association between non-ideal dietary habits and DIF was significant in the multivariate analyses. The baseline ICH index score was stable from baseline to T1. We conclude that non-ideal cardiovascular lifestyle habits in adolescence and young adulthood are significantly associated with later alexithymia.
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Warkentin S, Santos AC, Oliveira A. Associations of appetitive behaviors in 7-year-old children with their cardiometabolic health at 10 years of age. Nutr Metab Cardiovasc Dis 2020; 30:810-821. [PMID: 32143895 DOI: 10.1016/j.numecd.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later. METHODS AND RESULTS A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness - boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating - boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference. CONCLUSIONS Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While 'food avoidant' behaviors protect against cardiometabolic risk and 'food approach' behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.
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Affiliation(s)
- Sarah Warkentin
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], Porto, Portugal.
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Andreia Oliveira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Mayr HL, Cohen F, Isenring E, Soenen S, Marshall S. Multidisciplinary lifestyle intervention in children and adolescents - results of the project GRIT (Growth, Resilience, Insights, Thrive) pilot study. BMC Pediatr 2020; 20:174. [PMID: 32312241 PMCID: PMC7169025 DOI: 10.1186/s12887-020-02069-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/06/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND During childhood and adolescence leading behavioural risk factors for the development of cardiometabolic diseases include poor diet quality and sedentary lifestyle. The aim of this study was to determine the feasibility and effect of a real-world group-based multidisciplinary intervention on cardiorespiratory fitness, diet quality and self-concept in sedentary children and adolescents aged 9 to 15 years. METHODS Project GRIT (Growth, Resilience, Insights, Thrive) was a pilot single-arm intervention study. The 12-week intervention involved up to three outdoor High Intensity Interval Training (HIIT) running sessions per week, five healthy eating education or cooking demonstration sessions, and one mindful eating and Emotional Freedom Technique psychology session. Outcome measures at baseline and 12-week follow-up included maximal graded cardiorespiratory testing, the Australian Child and Adolescent Eating Survey, and Piers-Harris 2 children's self-concept scale. Paired samples t-test or Wilcoxon signed-rank test were used to compare baseline and follow-up outcome measures in study completers only. RESULTS Of the 38 recruited participants (median age 11.4 years, 53% male), 24 (63%) completed the 12-week intervention. Dropouts had significantly higher diet quality at baseline than completers. Completers attended a median 58 (IQR 55-75) % of the 33 exercise sessions, 60 (IQR 40-95) % of the dietary sessions, and 42% attended the psychology session. No serious adverse events were reported. Absolute VO2peak at 12 weeks changed by 96.2 ± 239.4 mL/min (p = 0.06). As a percentage contribution to energy intake, participants increased their intake of healthy core foods by 6.0 ± 11.1% (p = 0.02) and reduced median intake of confectionary (- 2.0 [IQR 0.0-3.0] %, p = 0.003) and baked products (- 1.0 [IQR 0.0-5.0] %, p = 0.02). Participants significantly improved self-concept with an increase in average T-Score for the total scale by 2.8 ± 5.3 (p = 0.02) and the 'physical appearance and attributes' domain scale by median 4.0 [IQR 0.5-4.0] (p = 0.02). CONCLUSIONS The 12-week group-based multidisciplinary lifestyle intervention for children and adolescents improved diet quality and self-concept in study completers. Future practice and research should focus on providing sustainable multidisciplinary lifestyle interventions for children and adolescents aiming to improve long-term health and wellbeing. TRIAL REGISTRATION ANZCTR, ACTRN12618001249246. Registered 24 July 2019 - Retrospectively registered.
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Affiliation(s)
- Hannah L Mayr
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia. .,Weight Loss Solutions Australia, Gold Coast, Queensland, Australia. .,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Felicity Cohen
- Weight Loss Solutions Australia, Gold Coast, Queensland, Australia
| | - Elizabeth Isenring
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Stijn Soenen
- Adelaide Medical School, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | | | - Skye Marshall
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Nutrition Research Australia, Sydney, New South Wales, Australia
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80
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Fernández-Jiménez R, Briceño G, Céspedes J, Vargas S, Guijarro J, Baxter J, Hunn M, Santos-Beneit G, Rodríguez C, Céspedes MP, Bagiella E, Moreno Z, Carvajal I, Fuster V. Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old. J Am Coll Cardiol 2020; 75:1565-1578. [PMID: 32241373 DOI: 10.1016/j.jacc.2020.01.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/03/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. OBJECTIVES This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). METHODS In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. RESULTS In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: -0.28 to 2.13; p = 0.133) and -0.20 points (95% CI: -0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). CONCLUSIONS Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children. Reintervention strategies may be required at multiple stages to induce sustained health promotion effects (Salud Integral Colombia [SI! Colombia II]; NCT03119792).
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro de Investigación Biomedica En Red en enfermedades CardioVasculares, Madrid, Spain
| | - German Briceño
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Jaime Céspedes
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia.
| | - Sarha Vargas
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | | | | | - Marilyn Hunn
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | | | - Emilia Bagiella
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zorayda Moreno
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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81
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Healthy breakfast habits and changes in obesity-related cardiometabolic markers in children: a longitudinal analysis. Eur J Clin Nutr 2020; 74:1685-1697. [PMID: 32231225 DOI: 10.1038/s41430-020-0614-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data on the association of breakfast habits and changes in cardiometabolic markers in children are limited. METHODS In total, 6964 children aged 6-13 years from Beijing, Shanghai, Chongqing, Jinan, Harbin, and Guangzhou were included in the final analysis. Daily consumption, consumption of ≥3 food groups, and at-home consumption were defined as healthy breakfast habits. Blood pressure, % fat mass, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, glucose, and 50-m × 8 shuttle run were measured at baseline (May 2009) and follow-up (May 2010). Clustered cardiometabolic risk score (CCRS) was computed by summing Z scores of five components: % fat mass, systolic blood pressure, glucose, TC to HDL-C ratio, and triglyceride. RESULTS Children who ate breakfast daily had a higher decrease in TC to HDL-C ratio and a higher increase in HDL-C compared with breakfast skippers (both P values < 0.05). There was an inverse association of the number of food groups consumed at breakfast with the change in CCRS (P trend = 0.005). At-home breakfast consumption was associated with a lower increase in BMI, LDL-C, TC to HDL-C ratio, fasting glucose, and 50-m × 8 shuttle run and a higher increase in HDL-C (all P values < 0.05). Children with two or three healthy breakfast habits had a lower increase in CCRS, LDL-C, TC to HDL-C ratio, glucose, and a higher increase in HDL-C compared with those with none or one (all P values < 0.05). CONCLUSIONS Healthy breakfast habits might help minimize the cardiometabolic risk factors in children.
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Meal Patterns and Changes in Cardiometabolic Risk Factors in Children: A Longitudinal Analysis. Nutrients 2020; 12:nu12030799. [PMID: 32197407 PMCID: PMC7146132 DOI: 10.3390/nu12030799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/22/2022] Open
Abstract
We examined whether energy and macronutrient intake from different meals was associated with changes in cardiometabolic risk (CMR) factors in children. CMR score (CMRS) was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by −1), and triglycerides. We included 5517 children aged 6–13 years from six major cities in China. Five meal patterns were identified according to energy intake: balanced, breakfast dominant, lunch dominant, dinner dominant, and snack dominant patterns. These patterns were not significantly associated with changes in CMR factors. Carbohydrate intake (% energy) at lunch was positively associated with the change in CMRS (beta coefficient (95% CI): (0.777 (0.509, 1.046) in quintile 5 versus quintile 1). A positive association between carbohydrate intake at dinner and change in CMRS was observed. High protein intake at both lunch and dinner was associated with a favorable change in CMRS. Moderate fat intake at lunch was associated with a lower increase in CMRS. Meal patterns driven by energy were not significantly associated with CMR factors; however, a low carbohydrate-high protein-moderate fat lunch and low carbohydrate-high protein dinner were associated with favorable changes in CMRS in children.
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Bernar B, Gande N, Stock KA, Staudt A, Pechlaner R, Geiger R, Griesmacher A, Kiechl S, Knoflach M, Kiechl-Kohlendorfer U. The Tyrolean early vascular ageing-study (EVA-Tyrol): study protocol for a non-randomized controlled trial : Effect of a cardiovascular health promotion program in youth, a prospective cohort study. BMC Cardiovasc Disord 2020; 20:59. [PMID: 32024473 PMCID: PMC7001281 DOI: 10.1186/s12872-020-01357-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND According to the World Health Organization, cardiovascular diseases (CVDs) are the leading non-communicable cause of death. Awareness of the individual risk profile is crucial to implement a healthy lifestyle and prevent CVDs. Multiple studies demonstrated that atherosclerosis, the main cause of CVDs, begins early in life. Therefore, it may be necessary to start prevention programs already in childhood. METHODS The EVA-Tyrol study is a population-based non-randomized controlled trial that will prospectively enroll 2000 participants from high schools and training companies in North- and East-Tyrol (Austria) and South-Tyrol (Italy). Participants will be assigned to either an intervention (n = 1500) or a control (n = 500) group. Intervention group participants will be enrolled at the 10th school grade (mean age 15-16 years), undergo two examinations within a two-year interval, with follow-up at the 12th grade (mean ages 17-18 years). Control group participants will be enrolled at the 12th grade (mean age 17-18 years). Medical examination will include anthropometric measurements, comprehensive lifestyle and dietary questionnaires, a fasting blood sample, high-resolution ultrasound of the carotid arteries, and measurement of carotid-femoral pulse wave velocity. Active intervention will consist of (1) enhancing knowledge about CVDs, (2) individual medical counseling based on the results of the baseline examination, (3) an online health promotion tool and (4) involvement of participants in planning and implementation of health promotion projects. Effectiveness of the intervention will be assessed by comparing the proportion subjects with ideal health metrics as defined by the American Heart Association between study groups. DISCUSSION This study aims to improve cardiovascular health in Tyrolean adolescents by demonstrating the efficacy of a multi-layer health promotion program and may yield novel insights into the prevalence of vascular risk conditions and mechanisms of early vascular pathologies in adolescents. TRIAL REGISTRATION EVA-Tyrol has been retrospectively registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.
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Affiliation(s)
- Benoît Bernar
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Nina Gande
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Katharina A Stock
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Anna Staudt
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.,Department of Pediatrics, Bruneck Hospital, Bruneck, Italy
| | - Andrea Griesmacher
- Central Institute of Clinical Chemistry and Laboratory Medicine (ZIMCL), Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
| | - Ursula Kiechl-Kohlendorfer
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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84
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Shang X, Li Y, Xu H, Zhang Q, Hu X, Liu A, Du S, Li T, Guo H, Li Y, Xu G, Liu W, Ma J, Ma G. Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial. Prev Med 2020; 133:106010. [PMID: 32027918 DOI: 10.1016/j.ypmed.2020.106010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 11/24/2022]
Abstract
Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.
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Affiliation(s)
- Xianwen Shang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Yanping Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Haiquan Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Institute of food and nutrition development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoqi Hu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Songming Du
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingyu Li
- Chongqing Children's Hospital, Chongqing, China
| | - Hongwei Guo
- School of Public Health, Fudan University, Shanghai, China
| | - Ying Li
- Harbin Medical University, Harbin, China
| | - Guifa Xu
- Department of Public Health, Shandong University, Jinan, China
| | - Weijia Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China.
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Shang X, Li Y, Xu H, Zhang Q, Hu X, Liu A, Du S, Li T, Guo H, Li Y, Xu G, Liu W, Ma J, Ma G. Independent and Interactive Associations of Fitness and Fatness With Changes in Cardiometabolic Risk in Children: A Longitudinal Analysis. Front Endocrinol (Lausanne) 2020; 11:342. [PMID: 32595599 PMCID: PMC7304437 DOI: 10.3389/fendo.2020.00342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Findings for associations between cardiorespiratory fitness (CRF) and cardiometabolic risk (CMR) factors are inconsistent, and the interactive association between CRF and fatness with CMR factors is unclear in children. Our study aimed to examine whether CRF and fatness are independently and interactively associated with CMR factors. Methods: We included 5,869 children aged 6-13 years in the analysis. Physical examinations, blood tests, and CRF were measured at baseline and 1 year later. Cardiometabolic risk score (CMRS) was computed by summing Z scores of waist circumference (WC), averaged systolic and diastolic blood pressure, glucose, high-density lipoprotein cholesterol (HDL-C, multiplied by -1), and triglycerides. Results: There was a high correlation between fatness and CRF in both boys and girls. High baseline CRF was independently associated with favorable changes in CMRS, BMI, WC, percent body fat (PBF), total cholesterol, LDL-C, and HDL-C (all P < 0.025). Improved CRF was independently associated with favorable changes in CMRS, BMI, WC, PBF, total cholesterol, LDL-C, HDL-C, triglycerides, and fasting glucose (all P < 0.0321). Baseline BMI was positively associated with changes in CMRS, WC, blood pressure, triglycerides, insulin, and HOMA-IR (all P < 0.0462). Low PBF at baseline was associated with favorable changes in CMRS, BMI, WC, blood pressure, HDL-C, triglycerides, insulin, and HOMA-IR (all P < 0.0423). The percentage of the total effect of baseline CRF on changes in CMRS, triglycerides, HDL-C, PBF, and WC mediated by baseline BMI was 66.0, 61.6, 40.3, 20.7, and 9.2%, respectively. Baseline CRF was a significant mediator for the association between baseline BMI and changes in CMRS (mediated by 4.3%), triglycerides (5.1%), and HDL-C (12.0%). An inverse association was found between baseline CRF and CMRS in children with high baseline BMI/PBF only. Improved CRF was associated with decreased BMI and WC in children with low baseline CRF. Conclusions: Fatness and CRF are each independently associated with changes in CMR factors. Fatness is a major mediator for the association between CRF and CMR factors, whereas the association between fatness and CMR factors is also mediated by CRF. The beneficial effect of high CRF on CMR factors was more evident in obese or unfit children.
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Affiliation(s)
- Xianwen Shang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yanping Li
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Haiquan Xu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Qian Zhang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Xiaoqi Hu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Ailing Liu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Songming Du
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Tingyu Li
- Department of Pediatrics, Chongqing Children's Hospital, Chongqing, China
| | - Hongwei Guo
- School of Public Health, Fudan University, Shanghai, China
| | - Ying Li
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Guifa Xu
- Department of Public Health, Shandong University, Jinan, China
| | - Weijia Liu
- School Health Department, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- *Correspondence: Guansheng Ma
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D’Ascenzi F, Sciaccaluga C, Cameli M, Cecere A, Ciccone MM, Di Francesco S, Ganau A, Imbalzano E, Liga R, Palermo P, Palmiero P, Parati G, Pedrinelli R, Scicchitano P, Zito A, Mattioli AV. When should cardiovascular prevention begin? The importance of antenatal, perinatal and primordial prevention. Eur J Prev Cardiol 2019; 28:361-369. [PMID: 33611390 DOI: 10.1177/2047487319893832] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022]
Abstract
Abstract
Cardiovascular diseases represent a major health problem, being one of the leading causes of morbidity and mortality worldwide. Therefore, in this scenario, cardiovascular prevention plays an essential role although it is difficult to establish when promoting and implementing preventive strategies. However, there is growing evidence that prevention should start even before birth, during pregnancy, aiming to avoid the onset of cardiovascular risk factors, since events that occur early in life have a great impact on the cardiovascular risk profile of an adult. The two pillars of this early preventive strategy are nutrition and physical exercise, together with prevention of cardio-metabolic diseases during pregnancy. This review attempts to gather the growing evidence of the benefits of antenatal, perinatal and primordial prevention, discussing also the possibility to reverse or to mitigate the cardiovascular profile developed in the initial stages of life. This could pave the way for future research, investigating the optimal time and duration of these preventing measures, their duration and maintenance in adulthood, and the most effective interventions according to the different age and guiding in the next years, the best clinical practice and the political strategies to cope with cardiovascular disease.
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Affiliation(s)
- Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
- Department of Medicine, University of Pittsburgh, USA
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Annagrazia Cecere
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy
| | - Marco M Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy
| | - Simona Di Francesco
- Department of Medical and Oral Sciences and Biotechnologies, G. D’Annunzio University of Chieti-Pescara, Italy
- Department of Urological, Biomedical and Translational Sciences, Federiciana University, Italy
| | - Antonello Ganau
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | | | | | - Gianfranco Parati
- Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Italy
- School of Medicine and Surgery, University Milano-Bicocca, Italy
| | - Roberto Pedrinelli
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Piero Scicchitano
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy
| | - Annapaola Zito
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Anna V Mattioli
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
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Campbell MD, Laitinen TT, Hughes A, Pahkala K, Juonala M, Kähönen M, Wong TY, Lehtimäki T, Hutri-Kähönen N, Raitakari OT, Tapp RJ. Impact of Ideal Cardiovascular Health in Childhood on the Retinal Microvasculature in Midadulthood: Cardiovascular Risk in Young Finns Study. J Am Heart Assoc 2019; 7:e009487. [PMID: 30371260 PMCID: PMC6474976 DOI: 10.1161/jaha.118.009487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study examined the association between ideal cardiovascular health (CVH) and the retinal microvasculature in midadulthood. Methods and Results The Cardiovascular Risk in Young Finns Study included children from 5 Finnish University cities, who were chosen randomly from the national population register. Participants ranged from 12 to 18 years in childhood (1986) and from 37 to 43 years in midadulthood (2011). Ideal CVH was defined according to the American Heart Association criteria. Retinal microvascular measures included diameters, lengths, length:diameter ratio, and tortuosity. From childhood to adulthood, fasting plasma glucose and blood pressure were significantly higher in those with impaired fasting glucose or diabetes mellitus. Childhood ideal CVH was negatively associated with adult arteriolar tortuosity (β=−0.008; 95% confidence interval [CI], −0.01 to −0.003; P=0.001). Improved ideal CVH from childhood to adulthood was positively associated with adult arteriolar diameter (β=0.122; 95% CI, 0.01–0.24; P=0.033) and negatively associated with adult length:diameter ratio (β=−0.666; 95% CI, −1.25 to −0.08; P=0.026). When stratified by glucose metabolism, among those with diabetes mellitus and impaired fasting glucose, there was a negative association between childhood ideal CVH and adult venular diameter (diabetes mellitus: β=−2.75; 95% CI, −5.46 to −0.04; P=0.047; impaired fasting glucose: β=−2.13; 95% CI, −4.18 to −0.08; P=0.042). Conclusions This study is the first to comprehensively examine the impact of CVH from childhood to midadulthood on quantitative measures of the retinal microvasculature. Ideal CVH in childhood and improvement in CVH from childhood to adulthood appears to have a protective effect on the retinal microvasculature in those with, without, and at risk of diabetes mellitus.
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Affiliation(s)
- Matthew D Campbell
- 1 School of Food Science and Nutrition University of Leeds United Kingdom.,2 Multidisciplinary Cardiovascular Research Centre University of Leeds United Kingdom
| | - Tomi T Laitinen
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland.,4 Paavo Nurmi Centre Sports & Exercise Medicine Unit Department of Health and Physical Activity University of Turku Finland
| | - Alun Hughes
- 5 Institute of Cardiovascular Science University College London United Kingdom
| | - Katja Pahkala
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland.,4 Paavo Nurmi Centre Sports & Exercise Medicine Unit Department of Health and Physical Activity University of Turku Finland
| | - Markus Juonala
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland
| | - Mika Kähönen
- 6 Department of Clinical Physiology Tampere University Hospital and the Faculty of Medicine and Life Sciences University of Tampere Finland
| | - Tien Y Wong
- 7 Singapore National Eye Centre Singapore & Ophthalmology and Visual Sciences Academic Clinical Program Duke-NUS Medical School National University of Singapore
| | - Terho Lehtimäki
- 8 Department of Clinical Chemistry Fimlab Laboratories Faculty of Medicine and Life Sciences University of Tampere Finland
| | - Nina Hutri-Kähönen
- 9 Department of Paediatrics Tampere University Hospital University of Tampere Finland
| | - Olli T Raitakari
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland.,10 Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Robyn J Tapp
- 11 School of Clinical and Applied Sciences Leeds Beckett University Leeds United Kingdom.,12 Population Health Research Institute St George's University of London United Kingdom
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88
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Thomson R, Adams L, Anderson J, Maftei O, Couper J, Giles L, Peña AS. Australian children with type 1 diabetes consume high sodium and high saturated fat diets: Comparison with national and international guidelines. J Paediatr Child Health 2019; 55:1188-1193. [PMID: 30614108 DOI: 10.1111/jpc.14373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/26/2022]
Abstract
AIM We aimed to evaluate the diets of children with type 1 diabetes (T1D) against recommended Australian dietary intakes and international T1D guidelines and compare them to children without T1D. METHODS A cross-sectional analysis in 143 children (103 children aged 8-18 years with T1D and 40 age- and gender-matched controls) and longitudinal analysis at 0, 3, 6 and 12 months in 90 T1D children were conducted. Diet was assessed using an Australian validated food frequency questionnaire. Diet quality was assessed against recommended servings and nutrient intakes from Australian Dietary Guidelines and International Society for Pediatric and Adolescent Diabetes (ISPAD) Nutritional Guidelines. RESULTS Diet was evaluated in 478 questionnaires. Diet composition did not differ between T1D and controls, and both groups did not meet the majority of the Australian Dietary Guidelines, except for fruit intake. The majority of T1D children and controls (80-83%) were overconsuming sodium (2837 ± 848 mg/day), discretionary foods (5.9 ± 2.5 serves/day) and saturated fat and trans fatty acids (13.1 ± 2.7% of total daily energy intake) in comparison with Australian and ISPAD guidelines. A total of 84% of T1D children and controls achieved the recommended intake of fibre (34.4 ± 11.0 g/day). Longitudinal analysis in children with T1D showed that total daily energy, macronutrient, micronutrient and food group servings intake did not change over the 12 months. Overconsumption of sodium, discretionary foods and saturated fat persisted over the 12-month study period. CONCLUSIONS The majority of Australian children, with and without T1D, is not meeting recommended dietary guidelines. Significant overconsumption of sodium, saturated fat and discretionary foods attracts the most concern.
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Affiliation(s)
- Rebecca Thomson
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lucinda Adams
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia
| | - Jemma Anderson
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Oana Maftei
- Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lynne Giles
- School of Public Health, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
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89
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Au JS, Proudfoot NA, Timmons BW, MacDonald MJ. Retrograde shift in carotid artery longitudinal wall motion after one-year follow-up in children. Atherosclerosis 2019; 288:26-32. [DOI: 10.1016/j.atherosclerosis.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
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Hernandez R, Lash JP, Burrows B, Wilund KR, Mattix-Kramer HJ, Peralta C, Durazo-Arvizu RA, Talavera GA, Penedo FJ, Khambaty T, Moncrieft AE, Chen J, Daviglus ML. The association of positive affect and cardiovascular health in Hispanics/Latinos with chronic kidney disease: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med Rep 2019; 15:100916. [PMID: 31293880 PMCID: PMC6595078 DOI: 10.1016/j.pmedr.2019.100916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/01/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
The beneficial influence of positive affect (e.g., joy) remains unexplored in relation to heart health in adults with chronic kidney disease (CKD)-a population at increased risk for poor cardiovascular health (CVH). Therefore, we evaluated the association of positive affect and CVH in a diverse U.S. population of Hispanics/Latinos with CKD. We analyzed cross-sectional data of adults ages 18-74 enrolled between 2008 and 2011 in the Hispanic Community Health Study/Study of Latinos with prevalent CKD (N = 1712). Positively worded items from the Center for Epidemiologic Studies Depression Scale were used to create a composite positive affect score (0-6; higher scores indicate greater positive affect). Prevalent CKD was defined as estimated glomerular filtration <60 ml/min/1.73 m2 or urine albumin-to-creatinine ratio ≥30 mg/g. A composite CVH score was calculated using diet, body mass index, physical activity, cholesterol, blood pressure, fasting glucose, and smoking status. Each metric was defined as ideal, intermediate, or poor to compute an additive score. Linear regression was used for continuous scores of CVH and logistic regression for binary treatment (e.g., ≥4 Ideal). In participants with CKD, each unit increase in the positive affect score was associated with higher CVH scores when modeling CVH as a continuous outcome (β = 0.06, 95% CI = 0.01, 0.11). Similarly, a 1-unit increase in positive affect was associated with 1.15 times the odds of having >4 (vs. <4) ideal CVH indicators. Positive affect is associated with favorable CVH profiles in Hispanics/Latinos with CKD. Replication and prospective studies are needed to elucidate whether emotional well-being is a potential therapeutic target for intervention.
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Affiliation(s)
- Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Corresponding author at: School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada Street, Urbana, IL, United States of America.
| | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Brett Burrows
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Kenneth R. Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | | | - Carmen Peralta
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ramon A. Durazo-Arvizu
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
- Public Health Sciences, Loyola University, Chicago, IL, United States of America
| | - Gregory A. Talavera
- Graduate School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - Frank J. Penedo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Tasneem Khambaty
- Department of Psychology, University of Miami, Miami, FL, United States of America
| | - Ashley E. Moncrieft
- Department of Psychology, University of Miami, Miami, FL, United States of America
| | - Jinsong Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Martha L. Daviglus
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
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91
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Perak AM, Ning H, Kit BK, de Ferranti SD, Van Horn LV, Wilkins JT, Lloyd-Jones DM. Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016. JAMA 2019; 321:1895-1905. [PMID: 31112258 PMCID: PMC6537842 DOI: 10.1001/jama.2019.4984] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
Abstract
Importance Favorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors. Objective To analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016. Design, Setting, and Participants Serial cross-sectional analysis of US population-weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Surveys for 1999 through 2016. Linear temporal trends were analyzed using multivariable regression models with regression coefficients (β) reported as change per 1 year. Exposures Survey year; examined periods spanned 10 to 18 years based on data availability. Main Outcomes and Measures Age- and race/ethnicity-adjusted mean levels of high-density lipoprotein (HDL), non-HDL, and total cholesterol. Among fasting adolescents (aged 12-19 years), mean levels of low-density lipoprotein cholesterol, geometric mean levels of triglycerides, and mean levels of apolipoprotein B. Prevalence of ideal and adverse (vs borderline) levels of lipids and apolipoprotein B per pediatric lipid guidelines. Results In total, 26 047 youths were included (weighted mean age, 12.4 years; female, 51%). Among all youths, the adjusted mean total cholesterol level declined from 164 mg/dL (95% CI, 161 to 167 mg/dL) in 1999-2000 to 155 mg/dL (95% CI, 154 to 157 mg/dL) in 2015-2016 (β for linear trend, -0.6 mg/dL [95% CI, -0.7 to -0.4 mg/dL] per year). Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7 to 53.3 mg/dL) in 2007-2008 to 55.0 mg/dL (95% CI, 53.8 to 56.3 mg/dL) in 2015-2016 (β, 0.2 mg/dL [95% CI, 0.1 to 0.4 mg/dL] per year) and non-HDL cholesterol decreased from 108 mg/dL (95% CI, 106 to 110 mg/dL) to 100 mg/dL (95% CI, 99 to 102 mg/dL) during the same years (β, -0.9 mg/dL [95% CI, -1.2 to -0.6 mg/dL] per year). Among fasting adolescents, geometric mean levels of triglycerides declined from 78 mg/dL (95% CI, 74 to 82 mg/dL) in 1999-2000 to 63 mg/dL (95% CI, 58 to 68 mg/dL) in 2013-2014 (log-transformed β, -0.015 [95% CI, -0.020 to -0.010] per year), mean levels of low-density lipoprotein cholesterol declined from 92 mg/dL (95% CI, 89 to 95 mg/dL) to 86 mg/dL (95% CI, 83 to 90 mg/dL) during the same years (β, -0.4 mg/dL [95% CI, -0.7 to -0.2 mg/dL] per year), and mean levels of apolipoprotein B declined from 70 mg/dL (95% CI, 68 to 72 mg/dL) in 2005-2006 to 67 mg/dL (95% CI, 65 to 70 mg/dL) in 2013-2014 (β, -0.4 mg/dL [95% CI, -0.7 to -0.04 mg/dL] per year). Favorable trends were generally also observed in the prevalence of ideal and adverse levels. By the end of the study period, 51.4% (95% CI, 48.5% to 54.2%) of all youths had ideal levels for HDL, non-HDL, and total cholesterol; among adolescents, 46.8% (95% CI, 40.9% to 52.6%) had ideal levels for all lipids and apolipoprotein B, whereas 15.2% (95% CI, 13.1% to 17.3%) of children aged 6 to 11 years and 25.2% (95% CI, 22.2% to 28.2%) of adolescents aged 12 to 19 years had at least 1 adverse level. Conclusions and Relevance Between 1999 and 2016, favorable trends were observed in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.
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Affiliation(s)
- Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian K. Kit
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda V. Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T. Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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92
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Komulainen K, Mittleman MA, Jokela M, Laitinen TT, Pahkala K, Elovainio M, Juonala M, Tammelin T, Kähönen M, Raitakari O, Keltikangas-Järvinen L, Pulkki-Råback L. Socioeconomic position and intergenerational associations of ideal health behaviors. Eur J Prev Cardiol 2019; 26:1605-1612. [DOI: 10.1177/2047487319850959] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Promoting ideal cardiovascular health behaviors is an objective of the American Heart Association 2020 goals. We hypothesized that ideal health behaviors of parents are associated with health behaviors of their adult offspring, and that higher socioeconomic position in either generation enhances intergenerational associations of ideal health behaviors. Design Prospective cohort study. Methods We included 1856 Young Finns Study participants who had repeated measurements of socioeconomic position (education, income, occupation), smoking status, body mass index, physical activity and diet from 2001, 2007 and 2011, and data on parental socioeconomic position and health behaviors from 1980. We calculated the total number of ideal behaviors in both generations using American Heart Association definitions. Intergenerational associations were examined using ordinal and linear multilevel regression with random intercepts, in which each participant contributed one, two or three measurements of adult health behaviors (2001, 2007, 2011). All analyses were adjusted for offspring sex, birth year, age, parental education and single parenthood. Results Overall, parental ideal health behaviors were associated with ideal behaviors among offspring (odds ratio (OR) 1.28, 95% confidence interval 1.17, 1.39). Furthermore, ORs for these intergenerational associations were greater among offspring whose parents or who themselves had higher educational attainment (OR 1.56 for high vs. OR 1.19 for low parental education; P = 0.01 for interaction, OR 1.32 for high vs. OR 1.04 for low offspring education; P = 0.02 for interaction). Similar trends were seen with parental income and offspring occupation. Results from linear regression analyses were similar. Conclusions These prospective data suggest higher socioeconomic position in parents or in their adult offspring strengthens the intergenerational continuum of ideal cardiovascular health behaviors.
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Affiliation(s)
- Kaisla Komulainen
- Department of Psychology and Logopedics, University of Helsinki, Finland
- Department of Epidemiology, Harvard TH Chan School of Public Health, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard TH Chan School of Public Health, USA
- Cardiovascular Epidemiology Research Unit, Division of Cardiology, Beth Israel Deaconess Medical Center, USA
| | - Markus Jokela
- Department of Psychology and Logopedics, University of Helsinki, Finland
| | - Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Department of Physical Activity and Health, Sports & Exercise Medicine Unit, Paavo Nurmi Centre, University of Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Department of Physical Activity and Health, Sports & Exercise Medicine Unit, Paavo Nurmi Centre, University of Turku, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Finland
- Department of Health Services Research, National Institute for Health and Welfare, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Finland
- Division of Medicine, Turku University Hospital, Finland
- Murdoch Children's Research Institute, Australia
| | - Tuija Tammelin
- LIKES Research Center for Physical Activity and Health, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Finland
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
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Healthy Body Weights With Corticosteroid-free Immunosuppression Is the Best Predictor of Cardiovascular Health in Children After Liver Transplantation. J Pediatr Gastroenterol Nutr 2019; 68:713-719. [PMID: 30676521 DOI: 10.1097/mpg.0000000000002271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Cardiometabolic dysregulation (CMD) influences morbidity and mortality risk in adults post-liver transplantation (LTx). CMD is reported in 10% to 25% of pediatric LTx recipients, but no information regarding the longitudinal expression of CMD is available. The study objective was to examine the longitudinal expression of CMD and associations with body composition and growth in children post-LTx. METHODS A retrospective review was conducted in youth (34 F/30 M) who underwent LTx between 1994 and 2015 at the Stollery Children's Hospital. Primary outcomes included serum markers of CMD (insulin, glucose, hemoglobin A1C [A1C], homeostasis model assessment for insulin resistance [abnormal >3], lipid panel triglycerides, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol) and systolic/diastolic blood pressure (BP: absolute/z scores). RESULTS Mean (±SD) age, weight z, height z, body mass index z was 9.7 ± 3.4 years (3.5-17.9), 0.26 ± 1.03, 0.017 ± 1.2, and 0.41 ± 1.05, respectively. The majority of children had percentage fat mass, percentage fat-free mass within normal reference ranges. Systolic/diastolic BP was within healthy references ranges in 83.1% and 93.5% of children, respectively. Serum insulin (83.4%) and high-density lipoprotein-cholesterol (43.9%) concentrations were low, with abnormal findings of other laboratory markers found in <5% of participants. Abnormal findings for metabolic parameters were independent of weight z, body mass index z, fat mass, and corticosteroids but were positively related to child's age (>9.7 years) and fat-free mass (total, arms). Insulin levels decreased significantly in the first 4 years post-LTx, but no changes in lipid panel, A1C and glucose were noted over 10 years. CONCLUSIONS Pediatric LTx recipients with healthy body weights and corticosteroid-free immunosuppression have a low expression of CMD over 10 years.
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Hird TR, Zomer E, Owen AJ, Magliano DJ, Liew D, Ademi Z. Productivity Burden of Hypertension in Australia. Hypertension 2019; 73:777-784. [DOI: 10.1161/hypertensionaha.118.12606] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Thomas R. Hird
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (T.R.H., D.J.M.)
| | - Ella Zomer
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
| | - Alice J. Owen
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
| | - Dianna J. Magliano
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (T.R.H., D.J.M.)
| | - Danny Liew
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
| | - Zanfina Ademi
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
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Cardiovascular Disease Prevention in Adolescents: eHealth, Co-Creation, and Advocacy. Med Sci (Basel) 2019; 7:medsci7020034. [PMID: 30813490 PMCID: PMC6410225 DOI: 10.3390/medsci7020034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. Early atherosclerotic changes can begin to occur early in life and though adolescence. The prevalence of modifiable CVD risk factors, namely, smoking, poor diet quality, excessive alcohol intake, physical inactivity, and overweight and obesity can exacerbate the early onset of atherosclerosis. There is a need to improve modifiable risk factors during adolescence to prevent progression to CVD in later life. Electronic health (eHealth) behaviour change interventions are a potential solution for adolescents to improve CVD risk factors, given adolescents are digital frontrunners and digital technology is wide-reaching. The process of co-creating eHealth behaviour change interventions with adolescents is a promising strategy to improve intervention effectiveness and engagement. Additionally, effective youth advocacy is an emerging strategy for CVD prevention in adolescents. This narrative review evaluates published eHealth behaviour change interventions targeting cardiovascular disease risk factors in adolescents, which utilize a co-creation process, describe the emerging role of advocacy in CVD prevention for adolescents and provide recommendations for future interventions.
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96
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Yan Y, Liu J, Zhao X, Cheng H, Huang G, Hou D, Mi J. Cardiovascular health in urban Chinese children and adolescents. Ann Med 2019; 51:88-96. [PMID: 30736719 PMCID: PMC7857444 DOI: 10.1080/07853890.2019.1580383] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases remain the leading cause of death and disease burden in China and worldwide. We aimed to evaluate the status of cardiovascular health among urban Chinese children and adolescents. METHODS We conducted a cross-sectional study comprising 12,618 children and adolescents aged 6-18 years, who were recruited from Chinese urban areas during 2013-2015. The poor, intermediate, and ideal levels of 7 cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, blood glucose, and total cholesterol were defined according to revised American Heart Association criteria. RESULTS Ideal smoking status was the most prevalent health component (overall, 90.7%; males, 86.3% and females, 95.4%), whereas ideal health diet score (overall, 8.7%; males, 9.1% and females, 8.3%) was the least prevalent among urban Chinese children and adolescents. The majority (overall, 84.9%; males, 82.6% and females, 87.4%) of participants had 3-5 ideal metrics. The overall prevalence of ideal cardiovascular health (i.e. meeting all 7 ideal components) was extremely low (overall, 0.5%; males, 0.5% and females, 0.4%). CONCLUSIONS The prevalence of ideal cardiovascular health in urban Chinese children and adolescents is extremely low, particularly for physical activity and healthy dietary intake. Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk. Key messages Ideal health diet score was the least prevalent health component among urban Chinese children and adolescents The prevalence of ideal cardiovascular health in urban Chinese children and adolescents was extremely low Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk.
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Affiliation(s)
- Yinkun Yan
- a Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Junting Liu
- a Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Xiaoyuan Zhao
- b Department of Epidemiology , Capital Institute of Pediatrics , Beijing , China
| | - Hong Cheng
- b Department of Epidemiology , Capital Institute of Pediatrics , Beijing , China
| | - Guimin Huang
- b Department of Epidemiology , Capital Institute of Pediatrics , Beijing , China
| | - Dongqing Hou
- b Department of Epidemiology , Capital Institute of Pediatrics , Beijing , China
| | - Jie Mi
- a Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China.,b Department of Epidemiology , Capital Institute of Pediatrics , Beijing , China
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Warnick JL, Pfammatter A, Champion K, Galluzzi T, Spring B. Perceptions of Health Behaviors and Mobile Health Applications in an Academically Elite College Population to Inform a Targeted Health Promotion Program. Int J Behav Med 2019; 26:165-174. [DOI: 10.1007/s12529-018-09767-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arterial Stiffness in Early Phases of Prehypertension. UPDATES IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2019. [DOI: 10.1007/978-3-319-75310-2_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ideal Cardiovascular Health Is Inversely Associated with Nonalcoholic Fatty Liver Disease: A Prospective Analysis. Am J Med 2018; 131:1515.e1-1515.e10. [PMID: 30075104 DOI: 10.1016/j.amjmed.2018.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular health has been proven to be associated with major cardiometabolic diseases. However, little is known of associations between cardiovascular health and nonalcoholic fatty liver disease. METHODS This study included 3424 adults aged ≥40 years who were free of nonalcoholic fatty liver disease at baseline from a community cohort followed for up to 5 years. Liver ultrasonography was conducted at baseline and at follow-up to diagnose incident nonalcoholic fatty liver disease. Six metrics including smoking, physical activity, body mass index, total cholesterol, blood pressure, and fasting glucose were used to define cardiovascular health status. Associations of individual cardiovascular health metrics, number of cardiovascular health metrics, and overall cardiovascular health status at baseline, as well as changes in cardiovascular health during follow-up with risks of developing nonalcoholic fatty liver disease, were examined. RESULTS A total of 649 participants developed nonalcoholic fatty liver disease during follow-up. Risks of nonalcoholic fatty liver disease reduced in a dose-response manner in participants with 3-4 ideal cardiovascular health metrics (odds ratio 0.50; 95% confidence interval, 0.41-0.61) and in participants with 5-6 ideal metrics (odds ratio 0.34; 95% confidence interval 0.22-0.51) compared with participants with 0-2 ideal metrics. An overall ideal or intermediate cardiovascular health was associated with 37% reduction in developing nonalcoholic fatty liver disease compared with poor cardiovascular health. In addition, improving cardiovascular health during follow-up reduced the risk by 71% compared with deteriorating cardiovascular health. Furthermore, an overall ideal or intermediate cardiovascular health was significantly associated with a lower fibrosis score in nonalcoholic fatty liver disease patients compared with an overall poor cardiovascular health. CONCLUSIONS Ideal cardiovascular health was inversely associated with risks of nonalcoholic fatty liver disease. Although treatment of nonalcoholic fatty liver disease and subsequent inflammation and fibrosis remains a challenge, cardiovascular health goals should be advocated for nonalcoholic fatty liver disease prevention.
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