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Liang Y, Zhang M, Jin W, Zhao L, Wu Y. Association of heavy metals exposure with lower blood pressure in the population aged 8-17 years: a cross-sectional study based on NHANES. Front Public Health 2024; 12:1411123. [PMID: 39035189 PMCID: PMC11259964 DOI: 10.3389/fpubh.2024.1411123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Background The existing evidence regarding the joint effect of heavy metals on blood pressure (BP) in children and adolescents is insufficient. Furthermore, the impact of factors such as body weight, fish consumption, and age on their association remains unclear. Methods The study utilized original data from the National Health and Nutrition Examination Survey, encompassing 2,224 children and adolescents with complete information on 12 urinary metals (barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, tungsten, uranium, mercury and arsenic), BP, and core covariates. Various statistical methods, including weighted multiple logistic regression, linear regression, and Weighted Quantile Sum regression (WQS), were employed to evaluate the impact of mixed metal exposure on BP. Sensitivity analysis was conducted to confirm the primary analytical findings. Results The findings revealed that children and adolescents with low-level exposure to lead (0.40 μg/L, 95%CI: 0.37, 0.42), mercury (0.38 μg/L, 95%CI: 0.35, 0.42) and molybdenum (73.66 μg/L, 95%CI: 70.65, 76.66) exhibited reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP). Conversely, barium (2.39 μg/L, 95%CI: 2.25, 2.54) showed a positive association with increased SBP. A 25th percentile increase in the WQS index is significantly associated with a decrease in SBP of 0.67 mmHg (95%CI, -1.24, -0.10) and a decrease in DBP of 0.59 mmHg (95% CI, -1.06, -0.12), which remains statistically significant even after adjusting for weight. Furthermore, among individuals who consume fish, heavy metals have a more significant influence on SBP. A 25 percentile increase in the WQS index is significantly associated with a decrease of 3.30 mmHg (95% CI, -4.73, -1.87) in SBP, primarily attributed to mercury (27.61%), cadmium (27.49%), cesium (17.98%), thallium (8.49%). The study also identified a declining trend in SBP among children aged 10-17, whereas children aged 11-18 exhibited lower levels of systolic and diastolic blood pressure, along with a reduced risk of hypertension. Conclusion Some heavy metals demonstrate an inverse association with the BP of children and adolescents, particularly notable in groups with fish consumption and older children and adolescents. Future studies are warranted to validate these findings and delve deeper into the interplay of heavy metals.
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Affiliation(s)
| | | | | | - Liqing Zhao
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Heidari H, Mirzaei S, Asadi A, Akhlaghi M, Saneei P. Association of priori-defined DASH dietary pattern with metabolic health status among Iranian adolescents with overweight and obesity. Sci Rep 2024; 14:4993. [PMID: 38424444 PMCID: PMC10904873 DOI: 10.1038/s41598-024-55749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024] Open
Abstract
There was no evidence on the relationship of Dietary Approaches to Stop Hypertension (DASH) with metabolic health condition in adolescents with overweight and obesity. The purpose of this research was to investigate the association of priori-defined DASH dietary pattern with metabolic health status among adolescents with overweight and obesity in Iran. A cross-sectional survey performed on a representative sample of adolescents with overweight and obesity (n = 203). Dietary intakes were collected via a validated food frequency questionnaire and DASH score was characterized according to eight components. Data of anthropometric measures, blood pressure, circulating insulin, fasting blood sugar, and lipid profile were collected. Metabolic health status was defined based on criteria of International Diabetes Federation (IDF) and insulin resistance (IR). Based on IDF and IDF/IR criteria, 38.9% and 33.0% of adolescents suffered from metabolically unhealthy overweight/obesity (MUO). After controlling all confounders, subjects in the highest vs. lowest tertile of DASH diet had respectively 92% and 91% lower odds of MUO based on IDF definition (OR = 0.08; 95%CI 0.03-0.22) and IDF/IR criteria (OR = 0.09; 95%CI 0.03-0.29). Subgroup analysis by sex and body mass index determined that this relationship was more powerful in girls and overweight individuals. Also, in fully adjusted model, highest vs. lowest adherence to DASH diet was linked to decreased odds of hyperglycemia (OR = 0.07; 95% CI 0.03-0.21), hypertriglyceridemia (OR = 0.26; 95% CI 0.09-0.73), low HDL cholesterolemia (OR = 0.30; 95% CI 0.12-0.73) and insulin resistance (OR = 0.07; 95% CI 0.02-0.28), as metabolic health components. Greater compliance to DASH dietary pattern was linked to a remarkable lower odd of metabolic unhealthy condition among Iranian adolescents, especially in overweight subjects and girls. More prospective surveys are required to assert these results.
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Affiliation(s)
- Hajar Heidari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeideh Mirzaei
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Asadi
- Department of Exercise Physiology, School of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Masoumeh Akhlaghi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, PO Box 81745-151, Isfahan, Iran.
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Bassareo PP, Calcaterra G, Sabatino J, Oreto L, Ciliberti P, Perrone M, Martino F, D'Alto M, Chessa M, DI Salvo G, Guccione P. Primary and secondary paediatric hypertension. J Cardiovasc Med (Hagerstown) 2023; 24:e77-e85. [PMID: 37052224 DOI: 10.2459/jcm.0000000000001432] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
High blood pressure (BP) or hypertension is a well known risk factor for developing heart attack, stroke, atrial fibrillation and renal failure. Although in the past hypertension was supposed to develop at middle age, it is now widely recognized that it begins early during childhood. As such, approximately 5-10% of children and adolescents are hypertensive. Unlike that previously reported, it is now widely accepted that primary hypertension is the most diffuse form of high BP encountered even in paediatric age, while secondary hypertension accounts just for a minority of the cases. There are significant differences between that outlined by the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and the last statement by the American Academy of Pediatrics (AAP) concerning the BP cut-offs to identify young hypertensive individuals. Not only that, but the AAP have also excluded obese children in the new normative data. This is undoubtedly a matter of concern. Conversely, both the AAP and ESH/ESC agree that medical therapy should be reserved just for nonresponders to measures like weight loss/salt intake reduction/increase in aerobic exercise. Secondary hypertension often occurs in aortic coarctation or chronic renal disease patients. The former can develop hypertension despite early effective repair. This is associated with significant morbidity and is arguably the most important adverse outcome in about 30% of these subjects. Also, syndromic patients, for example those with Williams syndrome, may suffer from a generalized aortopathy, which triggers increased arterial stiffness and hypertension. This review summarizes the state-of-the-art situation regarding primary and secondary paediatric hypertension.
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Affiliation(s)
- Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children's Health Ireland at Crumlin, Dublin, Ireland
| | | | - Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Lilia Oreto
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Pediatric Hospital, Taormina, Messina
| | - Paolo Ciliberti
- Department of Cardiology, Cardiac Surgery, Heart and Lung Transplantation, IRCCS Bambino Gesu'Paediatric Hospital
| | - Marco Perrone
- Department of Cardiology, Cardiac Surgery, Heart and Lung Transplantation, IRCCS Bambino Gesu'Paediatric Hospital
| | - Francesco Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - University 'L. Vanvitelli', Naples
| | - Massimo Chessa
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Vita Salute San Raffaele University, Milan, Italy
| | - Giovanni DI Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Paolo Guccione
- Department of Cardiology, Cardiac Surgery, Heart and Lung Transplantation, IRCCS Bambino Gesu'Paediatric Hospital
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Hypertension and Associated Risk Factors among Children with Intellectual Disability: A Cross-Sectional Study. Nutrients 2022; 14:nu14153127. [PMID: 35956301 PMCID: PMC9370698 DOI: 10.3390/nu14153127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
To investigate the prevalence of hypertension and associated risk factors in Chinese children with intellectual disability, a cross-sectional study was conducted in a sample of 558 children with intellectual disability aged 6–18 years in Hong Kong, and 452 (81.0%) with valid data were included in the data analysis. Blood pressure was measured according to a standard protocol. Hypertension was defined using the age-, gender-, and height-specific classification criteria recommended by the 2018 Chinese Guidelines for Children. Multivariate and hierarchical logistic regression was fitted to examine the associations of hypertension with potential risk factors. Overall, 31.4% of the participants were classified as having hypertension. Obese children were more likely to develop hypertension than non-obese children (adjusted OR = 2.77, 95% CI: 1.28, 5.99, p = 0.010). A paternal education of college or above and a paternal occupation of clerks, sales representatives, and workers were also associated with an increased risk of hypertension. The prevalence of hypertension is high among Chinese children with intellectual disability. Obesity was the strongest risk factor. Further longitudinal studies are warranted to confirm our findings. Nevertheless, preventions against obesity are promising to receive doubled benefits in reducing both obesity and hypertension, given its strong relationship with hypertension in this special population.
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Browne NT, Cuda SE. Nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 2:100012. [PMID: 37990712 PMCID: PMC10661897 DOI: 10.1016/j.obpill.2022.100012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details nutritional and activity recommendations for the child with normal weight, overweight, and obesity (Appendix A) with consideration of food insecurity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices in the normal range and body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement details nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity. In addition, this CPS addresses nutritional recommendations for complications related to the disease of obesity as well as providing guidance on food insecurity as it impacts children with obesity and their families. Conclusions This OMA Clinical Practice Statement on nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
| | - Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Salt sensitivity of blood pressure in childhood and adolescence. Pediatr Nephrol 2022; 37:993-1005. [PMID: 34327584 DOI: 10.1007/s00467-021-05178-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
Although moderation of sodium intake is recommended population-wide, it remains uncertain who benefits from salt restriction. Salt sensitivity refers to changes in blood pressure in response to sodium intake and may occur with or without hypertension. Unfortunately, there is no practical way to assess salt sensitivity in daily practice. Assessment of salt sensitivity even in research studies is challenging with varying protocols utilized which may contribute to differing results. Building on studies in animals and adults, risk factors and conditions associated with salt sensitivity have been identified in the pediatric and young adult populations. This review presents the limited evidence linking obesity, low birth weight, diabetes, chronic kidney disease, and race/ethnicity with salt sensitivity in children, adolescents, and young adults. The impact of stress on sodium handling is also reviewed. The influence of age on the timing of introduction of dietary salt restriction and the long-term influence of salt sensitivity on risk for hypertension are considered. Lastly, interventions other than salt restriction that may improve salt sensitivity and may inform recommendations to families are reviewed.
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Aljahdali AA, Peterson KE, Cantoral A, Ruiz-Narvaez E, Tellez-Rojo MM, Kim HM, Hébert JR, Wirth MD, Torres-Olascoaga LA, Shivappa N, Baylin A. Diet Quality Scores and Cardiometabolic Risk Factors in Mexican Children and Adolescents: A Longitudinal Analysis. Nutrients 2022; 14:nu14040896. [PMID: 35215546 PMCID: PMC8878155 DOI: 10.3390/nu14040896] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023] Open
Abstract
There is limited evidence for the effects of diet on cardiometabolic profiles during the pubertal transition. We collected repeated measures of diet quality and cardiometabolic risk factors among Mexican youth. This analysis included 574 offspring of the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort followed up to three time points. Dietary Approaches to Stop Hypertension (DASH), alternate Mediterranean Diet (aMedDiet), and Children’s Dietary Inflammatory Index (C-DIITM) scores were computed from food frequency questionnaires. Higher DASH and aMedDiet scores reflect a higher diet quality, and lower C-DII scores reflect an anti-inflammatory diet. Cardiometabolic risk factors were lipid profile, glucose homeostasis, blood pressure, and waist circumference. Linear mixed models were used between quartiles of each diet score and outcomes. Compared to the first quartile, the fourth DASH quartile was inversely associated with log serum insulin (μIU/mL) [β = −0.19, p = 0.0034] and log-Homeostatic Model Assessment of Insulin Resistance [β = −0.25, p = 0.0008]. Additionally, log serum triglycerides (mg/dL) was linearly associated with aMedDiet score [β = −0.03, p = 0.0022]. Boys in the highest aMedDiet quartile had higher serum high-density lipoprotein cholesterol (mg/dL) [β = 4.13, p = 0.0034] compared to the reference quartile. Higher diet quality was associated with a better cardiometabolic profile among Mexican youth.
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Affiliation(s)
- Abeer Ali Aljahdali
- Department of Clinical Nutrition, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA; (E.R.-N.); (A.B.)
| | - Karen E. Peterson
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA; (E.R.-N.); (A.B.)
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +1-(734) 647-1923
| | - Alejandra Cantoral
- Department of Health, Iberoamericana University, Mexico City 01219, Mexico;
| | - Edward Ruiz-Narvaez
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA; (E.R.-N.); (A.B.)
| | - Martha M. Tellez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico; (M.M.T.-R.); (L.A.T.-O.)
| | - Hyungjin Myra Kim
- Center for Computing, Analytics and Research, University of Michigan, Ann Arbor, MI 48109, USA;
| | - James R. Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (J.R.H.); (M.D.W.); (N.S.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
| | - Michael D. Wirth
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (J.R.H.); (M.D.W.); (N.S.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Libni A. Torres-Olascoaga
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico; (M.M.T.-R.); (L.A.T.-O.)
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (J.R.H.); (M.D.W.); (N.S.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
| | - Ana Baylin
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA; (E.R.-N.); (A.B.)
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA
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Drogalis-Kim D, Cheifetz I, Robbins N. Early nutritional influences of cardiovascular health. Expert Rev Cardiovasc Ther 2021; 19:1063-1073. [PMID: 34927523 DOI: 10.1080/14779072.2021.2021070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke. AREAS COVERED This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD. EXPERT OPINION Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.
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Affiliation(s)
- Diana Drogalis-Kim
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Ira Cheifetz
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Nathaniel Robbins
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Firat S, Nogay NH. Association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents. Niger J Clin Pract 2021; 24:1616-1623. [PMID: 34782499 DOI: 10.4103/njcp.njcp_685_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Determining high blood pressure in childhood is an important step to reduce the risk of occurrence of high blood pressure-related diseases in adulthood. Aims This study aimed to assess the association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents. Patients and Methods This cross-sectional study included 370 students (202 females, 168 males) aged 14 to 18 years from one private and one public school in Kayseri, Turkey. Some anthropometric measurements and 24-hour dietary recall of the students were obtained. Their blood pressures were measured, and the International Physical Activity Questionnaire and the Mediterranean Diet Quality Index (KIDMED) were used. Results The body mass index (BMI) mean and waist/height ratio of the hypertensive group were significantly higher than those of the prehypertensive group, whereas their daily potassium, calcium, and magnesium intakes were significantly lower than those of the normotensive group. The percentage of individuals with very low diet quality was higher in the hypertensive group than in the normotensive group (P > 0.05). The percentage of participants with sufficient physical activity was higher in the normotensive group than in the prehypertensive and hypertensive groups. Conclusion Factors such as high BMI and waist/height rates; low calcium, magnesium, and potassium intakes with diet; insufficient physical activity; and low quality of diet might cause an increase in the blood pressure.
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Affiliation(s)
- S Firat
- Department of Nutrition and Dietetics, Kirklareli University College of Health, Kırklareli, Turkey
| | - N H Nogay
- Department of Nutrition and Dietetics, Erciyes University Faculty of Health Sciences, Kayseri, Turkey
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Bekelman TA, Ringham BM, Sauder KA, Johnson SL, Harrall KH, Glueck DH, Dabelea D. Adherence to index-based dietary patterns in childhood and BMI trajectory during the transition to adolescence: the EPOCH study. Int J Obes (Lond) 2021; 45:2439-2446. [PMID: 34304241 PMCID: PMC8542564 DOI: 10.1038/s41366-021-00917-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the United States, one in five adolescents are obese. Index-based dietary patterns are measures of the overall diet that have the potential to serve as valuable obesity risk stratification tools. However, little is known about the association between adherence to index-based dietary patterns in childhood and BMI during the transition from childhood to adolescence. OBJECTIVE To prospectively examine the relationship between adherence to three index-based dietary patterns in childhood and BMI trajectory during the transition to adolescence. METHODS The study included 581 children enrolled in a Colorado prospective cohort study conducted between 2006 and 2015. Dietary intake was assessed with the Block Kids Food Frequency Questionnaire at age 10 years. Scores were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternate Mediterranean (aMED) diet, and the Dietary Approaches to Stop Hypertension (DASH) diet. Weight and height were assessed via anthropometry at two research visits (ages 10 and 16 years), with interim clinical measurements extracted from Kaiser Permanente medical records. Separate mixed models were used to assess the association between each diet index score and BMI over a 6-year period. Models were stratified by sex and adjusted for age, race/ethnicity, income, and exposure to gestational diabetes. RESULTS Median (IQR) number of BMI assessments was 14 (10-18). Among girls, for every ten-unit increase in HEI-2010 score, there was an average 0.64 kg/m2 decrease (p = 0.007) in BMI over time, after adjustment for covariates. Among girls, there was no association between BMI and aMED (β = -0.19, p = 0.24) or DASH (β = 0.28, p = 0.38). Among boys, there was no statistically significant association between BMI and HEI-2010 (0.06, p = 0.83), aMED (0.07, p = 0.70), or DASH (0.42, p = 0.06). CONCLUSIONS Efforts to prevent adolescent obesity could benefit from considering the degree of adherence to federal dietary guidance, as assessed by the HEI, in the period preceding adolescence, especially among girls.
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Affiliation(s)
- Traci A. Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, Colorado,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Brandy M. Ringham
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, Colorado
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, Colorado,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Susan L. Johnson
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kylie H. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, Colorado
| | - Deborah H. Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, Colorado,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, Colorado,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Diet quality, excess body weight and cardiometabolic risk factors in adolescents living in São Paulo, Brazil and in the USA: differences and similarities. Public Health Nutr 2021; 24:4091-4101. [PMID: 32907665 PMCID: PMC8501489 DOI: 10.1017/s1368980020002736] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA. DESIGN Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression. SETTING São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA. PARTICIPANTS Adolescents (12-16 years) living in São Paulo (n 189) and USA (n 787). RESULTS ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99). CONCLUSIONS Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.
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Yeh WJ, Ko J, Cheng WY, Yang HY. Dehulled Adlay Consumption Modulates Blood Pressure in Spontaneously Hypertensive Rats and Overweight and Obese Young Adults. Nutrients 2021; 13:2305. [PMID: 34371815 PMCID: PMC8308423 DOI: 10.3390/nu13072305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022] Open
Abstract
High blood pressure is a crucial risk factor for many cardiovascular diseases, and a diet rich in whole-grain foods may modulate blood pressure. This study investigated the effects of dehulled adlay consumption on blood pressure in vivo. We initially fed spontaneous hypertensive rats diets without (SHR group) or with 12 or 24% dehulled adlay (SHR + LA and SHR + HA groups), and discovered that it could limit blood pressure increases over a 12-week experimental period. Although we found no significant changes in plasma, heart, and kidney angiotensin-converting enzyme activities, both adlay-consuming groups had lower endothelin-1 and creatinine concentrations than the SHR group; the SHR + HA group also had lower aspartate aminotransferase and uric acid levels than the SHR group did. We later recruited 23 participants with overweight and obesity, and they consumed 60 g of dehulled adlay daily for a six-week experimental period. At the end of the study, we observed a significant decrease in the group's systolic blood pressure (SBP), and the change in SBP was even more evident in participants with high baseline SBP. In conclusion, our results suggested that daily intake of dehulled adlay had beneficial effects in blood-pressure management. Future studies may further clarify the possible underlying mechanisms for the consuming of dehulled adlay as a beneficial dietary approach for people at risk of hypertension.
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Affiliation(s)
- Wan-Ju Yeh
- Graduate Program of Nutrition Science, National Taiwan Normal University, Taipei 106308, Taiwan;
| | - Jung Ko
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo 113-8657, Japan;
| | - Wei-Yi Cheng
- Department of Nutrition, I-Shou University, Kaohsiung City 824005, Taiwan;
| | - Hsin-Yi Yang
- Department of Nutritional Science, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 242062, Taiwan
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13
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Kerr JA, Liu RS, Gasser CE, Mensah FK, Burgner D, Lycett K, Gillespie AN, Juonala M, Clifford SA, Olds T, Saffery R, Gold L, Liu M, Azzopardi P, Edwards B, Dwyer T, Wake M. Diet quality trajectories and cardiovascular phenotypes/metabolic syndrome risk by 11-12 years. Int J Obes (Lond) 2021; 45:1392-1403. [PMID: 33824404 DOI: 10.1038/s41366-021-00800-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate associations between early-life diet trajectories and preclinical cardiovascular phenotypes and metabolic risk by age 12 years. METHODS Participants were 1861 children (51% male) from the Longitudinal Study of Australian Children. At five biennial waves from 2-3 to 10-11 years: Every 2 years from 2006 to 2014, diet quality scores were collected from brief 24-h parent/self-reported dietary recalls and then classified using group-based trajectory modeling as 'never healthy' (7%), 'becoming less healthy' (17%), 'moderately healthy' (21%), and 'always healthy' (56%). At 11-12 years: During children's physical health Child Health CheckPoint (2015-2016), we measured cardiovascular functional (resting heart rate, blood pressure, pulse wave velocity, carotid elasticity/distensibility) and structural (carotid intima-media thickness, retinal microvasculature) phenotypes, and metabolic risk score (composite of body mass index z-score, systolic blood pressure, high-density lipoproteins cholesterol, triglycerides, and glucose). Associations were estimated using linear regression models (n = 1100-1800) adjusted for age, sex, and socioeconomic position. RESULTS Compared to 'always healthy', the 'never healthy' trajectory had higher resting heart rate (2.6 bpm, 95% CI 0.4, 4.7) and metabolic risk score (0.23, 95% CI 0.01, 0.45), and lower arterial elasticity (-0.3% per 10 mmHg, 95% CI -0.6, -0.1) and distensibility (-1.2%, 95% CI -1.9, -0.5) (all effect sizes 0.3-0.4). Heart rate, distensibility, and diastolic blood pressure were progressively poorer for less healthy diet trajectories (linear trends p ≤ 0.02). Effects for systolic blood pressure, pulse wave velocity, and structural phenotypes were less evident. CONCLUSIONS Children following the least healthy diet trajectory had poorer functional cardiovascular phenotypes and metabolic syndrome risk, including higher resting heart rate, one of the strongest precursors of all-cause mortality. Structural phenotypes were not associated with diet trajectories, suggesting the window to prevent permanent changes remains open to at least late childhood.
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Affiliation(s)
- Jessica A Kerr
- Murdoch Children's Research Institute, Parkville, VIC, Australia. .,The University of Melbourne, Parkville, VIC, Australia.
| | - Richard S Liu
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Constantine E Gasser
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Australian Institute of Family Studies, Southbank, VIC, Australia
| | - Fiona K Mensah
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Monash University, Clayton, VIC, Australia
| | - Kate Lycett
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Deakin University, Burwood, VIC, Australia
| | - Alanna N Gillespie
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Internal Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Susan A Clifford
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Tim Olds
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Lisa Gold
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Mengjiao Liu
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Maternal and Child Health Program, International Development Discipline, Burnet Institute, Melbourne, Australia
| | - Ben Edwards
- Australian National University Centre for Social Research and Methods, Canberra, ACT, Australia
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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14
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Cohen JFW, Scott M, Sutton M, Cueva K, Shonkoff ET, Goldman RE, Margolis DN, Potempa AE, Fink K, Gustus S, Stock M. A Mixed-Methods Evaluation of a School Wellness Initiative: An Examination of Longer Lunch Periods and More Physical Activity Opportunities. J Acad Nutr Diet 2021; 121:1961-1974. [PMID: 33888437 DOI: 10.1016/j.jand.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are currently no national standards for lunch period lengths or physical activity in schools. Research is needed to better understand the impact of school initiatives that improve policies related to lunch and movement opportunities on student outcomes. Additionally, best practices are necessary to support schools that are considering initiatives that address these factors. OBJECTIVE This study examined the impact of implementing longer lunch periods, recess, and other movement opportunities on student outcomes and best practices for implementation. DESIGN A mixed-methods study including surveys and semistructured interviews and focus groups conducted during the 2019-2020 school year. PARTICIPANTS/SETTING Surveys (n = 5107) from students in grades 3 and 4 attending 19 pilot and 11 matched control elementary schools and interviews/focus groups among principals, cafeteria managers, teachers, and parents in a representative subsample (n = 6) of pilot schools in Anchorage Alaska. MAIN OUTCOME MEASURES Students' self-reported hunger levels and mood and perceptions and supportive strategies from school principals, cafeteria staff, teachers, and parents were examined. STATISTICAL ANALYSES PERFORMED Mixed-model analysis of variance accounting for student demographics with students as a random effect (students nested within schools) were used to examine differences in hunger and mood. For interviews/focus groups, responses were analyzed qualitatively using principles of content analysis. RESULTS Longer lunch periods were associated with significantly reduced hunger at the end of lunch period and significantly increased self-reported happiness in the cafeteria. Based on interviews/focus groups with school staff and parents, the initiative was generally perceived positively with reported benefits including reductions in disciplinary issues and improvements in student focus, social and emotional learning, and overall student happiness and well-being. Several supportive strategies were identified. CONCLUSIONS Initiatives that increase lunch period lengths and physical activity opportunities have the potential to reduce students' hunger levels and improve focus and behaviors in the classroom. Schools should consider similar initiatives that incorporate the suggested strategies to potentially improve outcomes among students.
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15
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Blood pressure and resting heart rate in 3-17-year-olds in Germany in 2003-2006 and 2014-2017. J Hum Hypertens 2021; 36:544-553. [PMID: 33854175 PMCID: PMC9225953 DOI: 10.1038/s41371-021-00535-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/12/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
To track blood pressure (BP) and resting heart rate (RHR) in children and adolescents is important due to its associations with cardiovascular outcomes in the adulthood. Therefore, the aim of this study was to examine BP and RHR over a decade among children and adolescents living in Germany using national examination data. Cross-sectional data from 3- to 17-year-old national survey participants (KiGGS 2003–06, n = 14,701; KiGGS 2014–17, n = 3509) including standardized oscillometric BP and RHR were used for age- and sex-standardized analysis. Measurement protocols were identical with the exception of the cuff selection rule, which was accounted for in the analyses. Different BP and RHR trends were observed according to age-groups. In 3- to 6-year-olds adjusted mean SBP and DBP were significantly higher in 2014–2017 compared to 2003–2006 (+2.4 and +1.9 mm Hg, respectively), while RHR was statistically significantly lower by −3.8 bpm. No significant changes in BP or in RHR were observed in 7- to 10-year-olds over time. In 11- to 13-year-olds as well as in 14- to 17-year-olds lower BP has been observed (SBP −2.4 and −3.2 mm Hg, respectively, and DBP −1.8 and −1.7 mm Hg), while RHR was significantly higher (+2.7 and +3.7 bpm). BP trends did not parallel RHR trends. The downward BP trend in adolescents seemed to follow decreasing adult BP trends in middle and high-income countries. The increase in BP in younger children needs confirmation from other studies as well as further investigation. In school-aged children and adolescents, the increased RHR trend may indicate decreased physical fitness.
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16
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Diet quality at age 5-6 and cardiovascular outcomes in preadolescents. Clin Nutr ESPEN 2021; 43:506-513. [PMID: 34024563 DOI: 10.1016/j.clnesp.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/09/2020] [Accepted: 02/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Specific dietary components during childhood may affect risk factors for cardiovascular disease. Whether overall higher diet quality prevents children from adverse cardiovascular outcomes remains contradictive. We aimed to examine the associations between diet quality at age 5-6 years and cardiovascular outcomes after a 6-year follow-up. METHODS We used data from the Amsterdam Born Children and their Development study, a multi-ethnic birth cohort. Dietary intake was assessed at age 5-6 using a semi-quantitative food frequency questionnaire and diet quality was ascertained with the Dietary Approaches to Stop Hypertension (DASH) score and the child diet quality score (CDQS), an index specifically developed for Dutch school-age children. Cardiovascular outcomes were examined after 6-years follow-up (age 11-12, N = 869). Outcomes were body mass index (BMI), waist circumference (WC), blood pressure (BP), lipid profile, fasting glucose and carotid intima-media thickness (CIMT). Multivariable linear and logistic regression models adjusted for baseline value were used to examine associations between diet quality and cardiovascular outcomes. RESULTS Higher diet quality at age 5-6 was associated with lower BMI (DASH score: Δ quintile (Q) 5 and Q1: -0.35 kg/m2, p for trend = 0.016), lower WC (DASH score: Δ Q5 and Q1: -1.0 cm, p for trend = 0.028), lower systolic (DASH score: Δ Q5 and Q1: -2.7 mmHg, p for trend = 0.046) and diastolic BP (DASH score: Δ Q5 and Q1: -2.4, p for trend < 0.001) and with lower plasma triglycerides (DASH score: Δ Q5 and Q1: -0.20 mmol/L, p for trend = 0.032) after 6-years follow-up. Associations of the CDQS with these outcomes showed similar trends, but less pronounced. We found no statistically significant associations between diet quality and LDL-C, HDL-C, total cholesterol, fasting glucose or CIMT. CONCLUSIONS Higher diet quality in childhood at age 5-6 years predicted better health on some cardiovascular outcomes in preadolescence.
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17
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Bricarello LP, de Almeida Alves M, Retondario A, de Moura Souza A, de Vasconcelos FDAG. DASH diet (Dietary Approaches to Stop Hypertension) and overweight/obesity in adolescents: The ERICA study. Clin Nutr ESPEN 2021; 42:173-179. [PMID: 33745574 DOI: 10.1016/j.clnesp.2021.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Childhood and adolescent obesity is one of the most important issues in the global health of the population and has been increasing dramatically in recent decades. The aim of this study was to evaluate the association between overweight/obesity and the Dietary Approaches to Stop Hypertension (DASH) diet score in a representative sample of Brazilian adolescents. METHODS Data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based survey, were used. A total of 71,553 adolescents (12-17 years old), of both sexes, participated in the study; they had their anthropometric measurements taken and responded to a 24-h dietary recall. Eight food components of the DASH score were evaluated. 1) fruits (except fruit juices), 2) vegetables (except potatoes and beans), 3) pulses/nuts, 4) whole grains, 5) low-fat and diet/light dairy products, 6) sodium, 7) red and processed meats, and 8) sugary drinks and fruit juices. A higher score was indicative of greater accordance with the DASH diet, with a final score ranging from eight to 40 points. The association between overweight/obesity and the DASH score was assessed using Poisson regression models. RESULTS The highest prevalence of overweight/obesity was observed among boys aged 12-14 years (28.2%), white (27.7%), enrolled in private schools (32.4%) and among those who practiced ≥300 min physical activity/week (26.1%). The food groups most frequently consumed were sugary drinks, pulses and nuts, and red and processed meats. No association was found between overweight/obesity and the DASH diet score in Brazilian adolescents, in the adjusted analysis models. CONCLUSIONS Low consumption of foods considered protective and high consumption of health-risk foods, even among adolescents with greater accordance with the DASH diet, may have contributed to these findings. Public health measures are needed to prevent/reduce the prevalence of overweight/obesity in adolescence, as it is a risk for overweight/obesity in adulthood as well as other complications, leading to loss of quality of life for the individual and increased health spending.
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Affiliation(s)
| | | | | | - Amanda de Moura Souza
- Institute of Study in Public Health, Federal University of Rio de Janeiro, Ilha Do Fundão, Cidade Universitária, Rio de Janeiro, 21941-598, Brazil
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18
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Couch SC, Saelens BE, Khoury PR, Dart KB, Hinn K, Mitsnefes MM, Daniels SR, Urbina EM. Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure. Hypertension 2020; 77:241-251. [PMID: 33190559 DOI: 10.1161/hypertensionaha.120.16156] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832.
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Affiliation(s)
- Sarah C Couch
- From the Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati (S.C.C.)
| | - Brian E Saelens
- Department of Pediatrics, University of Washington Seattle Children's Research Institute (B.E.S.)
| | - Philip R Khoury
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (P.R.K., M. M. M., E.M.U.)
| | - Katherine B Dart
- Department of Nutrition, Northside Hospital, Atlanta, GA (K.B.D.)
| | - Kelli Hinn
- Department of Nutrition, VA Medical Center, Richmond (K.H.)
| | - Mark M Mitsnefes
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (P.R.K., M. M. M., E.M.U.)
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Denver (S.R.D.)
| | - Elaine M Urbina
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (P.R.K., M. M. M., E.M.U.)
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19
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The Impact of Micronutrient Fortified Foods on Cognitive Functioning among Low-Income Children: A Pilot and Feasibility Study. Nutrients 2020; 12:nu12113351. [PMID: 33143203 PMCID: PMC7693551 DOI: 10.3390/nu12113351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
Brain development continues throughout childhood and requires micronutrients for optimal maturation, but studies have typically examined only a limited number of micronutrients and there has been inconsistent use of validated cognitive measures. This study evaluated the impact of providing low-income children with a daily fortified meal (570 kcal) in the form of a bar and shake containing >75% of the FDA Daily Values for all essential vitamins and minerals, as well as macronutrients (e.g., omega-3 and omega-6 fatty acids and protein), in an afterschool care setting (instead of the usual meal provided) on cognitive functioning. Students aged 8–12 were randomly assigned to intervention (n = 19) or control (n = 16) meals. Students completed the Stroop Color Word Task, Trail Making Test, and Conner’s Continuous Performance Task (CPT) at baseline and 3 months post-intervention. Differences in cognitive scores were examined using 2 × 2 mixed model ANOVAs (Stroop and CPT) and ANCOVAs (Trail Making Test). Significant main effects of time indicated improvements in both intervention and control groups, but there were no significant main effects of group or group*time interactions. When the amount of meal consumed was examined, most results became non-significant, suggesting that overall meal consumption significantly impacted the observed results. Overall, this pilot study suggests that there may be limited additional benefits to short-term consumption of micronutrient fortified meals among low-income children in an afterschool care setting, and potential benefits observed may be directly related to the amount of food consumed.
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20
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Cohen JFW, Richardson S, Roberto CA, Rimm EB. Availability of Lower-Sodium School Lunches and the Association with Selection and Consumption among Elementary and Middle School Students. J Acad Nutr Diet 2020; 121:105-111.e2. [PMID: 33350941 DOI: 10.1016/j.jand.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND During 2010, the US Department of Agriculture updated the school meals standards, including three progressively decreasing sodium targets. The Target 1 standards went into effect in 2014, but during 2018, the US Department of Agriculture delayed the Target 2 standards until 2024 and eliminated the Target 3 standards citing concerns regarding the availability and acceptability of lower-sodium foods. In addition, there are currently no sugar standards, and it is unknown whether sugar is substituted for salt in lower-sodium school foods. OBJECTIVE To examine the availability, selection, and consumption of school lunches already in alignment with the Target 2 and 3 sodium levels and the association between sodium and sugar. DESIGN An observational cafeteria-based study conducted during fall 2018. PARTICIPANTS AND SETTING Students (n = 1985) in grades three through eight attending 13 elementary/kindergarten through eighth-grade schools in a large, urban school district in New England. MAIN OUTCOME MEASURES Availability, selection, and consumption were examined using plate waste methodology. STATISTICAL ANALYSES PERFORMED Mixed-model analysis of variance accounting for student demographic characteristics with schools/students as a random effect (students nested within schools) were used to examine differences in availability, selection, and consumption. Linear regression was used to examine the association between sodium and sugar in the school foods. RESULTS The majority of meals selected (87%) and consumed (98%) were already in alignment with the Target 2 standards. There were significant inverse associations between sodium levels and consumption; each 100-mg increase in sodium was associated with a decrease in consumption by 2% for entrées (P = 0.002) and 5% for vegetables (P = 0.01). When examining the association between sodium and sugar, each 10-mg reduction in sodium was associated with 1-g increase in sugar among entrées (P < 0.0001), whereas there was a significant positive association between sodium and sugar with vegetables and condiments. CONCLUSIONS This study provides some evidence that schools may already have the ability to provide lower-sodium meals that are acceptable to students, and therefore the recent rollbacks to the sodium standards may be unwarranted. Study findings suggest that the US Department of Agriculture should take under consideration policies that would limit added sugar for school meals as sugar may be substituted for salt.
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Affiliation(s)
- Juliana F W Cohen
- (1)Department of Health Sciences, Merrimack College, North Andover, MA; (2)Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
| | - Scott Richardson
- (2)Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Christina A Roberto
- (3)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric B Rimm
- (4)Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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21
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Meal Quality of Entrées That Can Be Sold as Competitive Foods in Schools and Potential Impact of the Proposed USDA Rollbacks. Nutrients 2020; 12:nu12103003. [PMID: 33007897 PMCID: PMC7601296 DOI: 10.3390/nu12103003] [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] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
The Healthy, Hunger-Free Kids Act strengthened competitive food standards (i.e., Smart Snacks), but an exemption allows reimbursable meal entrées that do not meet Smart Snack standards to be sold as “competitive entrées” on the same day they are served in the reimbursable meal, and the following day. Proposed rollbacks would enable these competitive entrées to continue to be sold on a third day, increasing the availability of competitive foods exempt from Smart Snacks standards. This study compared the Healthy Eating Index (HEI) scores of potential competitive entrées alone versus full reimbursable school lunches, and examined the nutritional characteristics of potential competitive entrées. Data were from a national sample of 1108 schools from the School Nutrition and Meal Cost Study. Linear regression models, accounting for school-level and state and district policy characteristics, found that HEI scores of competitive entrées were an average of 30 points lower than HEI scores of reimbursable lunches, with greater differences in small and rural schools. Less than 1% of common potential competitive entrees met Smart Snack standards, primarily due to higher sodium and saturated fat levels. The proposed rollbacks are estimated to potentially add approximately 662 mg of sodium and 3 g of saturated fat over three days (1103 mg sodium and 5 g saturated fat over a week) on average relative to Smart Snacks limits. Instead of increasing opportunities to sell competitive entrées, their sales should be further limited.
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22
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Jia L, Lu H, Wu J, Wang X, Wang W, Du M, Wang P, Du S, Su Y, Zhang N. Association between diet quality and obesity indicators among the working-age adults in Inner Mongolia, Northern China: a cross-sectional study. BMC Public Health 2020; 20:1165. [PMID: 32711506 PMCID: PMC7382798 DOI: 10.1186/s12889-020-09281-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Obesity is a major risk factor for the global burden of disease in countries that are economically developed or not. This study aimed to investigate the association between diet quality and obesity indicators applying DASH and aMed. Methods This cross-sectional study on adult nutrition and chronic disease in Inner Mongolia (n = 1320). Dietary data were collected using 24-h diet recall for 3 consecutive days and weighing method. DASH and aMed were used to assess the dietary quality. WC, BMI and WC-BMI were used as obesity indicators. Logistic regression models were used to examine the associations between diet quality and obesity indicators. Results Higher diet quality, assessed by DASH, was only associated with WC. The odds ratio (OR) for abdominal obesity in the highest tertile of DASH scores compared with the lowest was 0.71 (95% confidence interval (CI) 0.53, 0.96; Ptrend = 0.03). Furthermore, aMed was inversely associated with obesity indicators. OR for abdominal obesity in the highest tertile of aMed score compared with the lowest were 0.63 (95% CI 0.47, 0.87; Ptrend = 0.005) and 0.57 (95% CI 0.41, 0.77; Ptrend = 0.02) for overweight and obesity, respectively, and 0.60 (95% CI 0.44, 0.81; Ptrend = 0.02) for high obesity risk. Conclusions Our findings suggest that dietary quality assessed using aMed is more closely associated with obesity than assessment using DASH in working-age adults in Inner Mongolia. The Mediterranean diet can be recommended as a healthy diet to control weight.
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Affiliation(s)
- Lu Jia
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Haiwen Lu
- Department of Medical Imaging, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Medical University, Hohhot, 010050, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Xuemei Wang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China.
| | - Wenrui Wang
- Department of Chronic Disease Control and Prevention, Inner Mongolia Center for Disease Control and Prevention, Hohhot, 010031, China
| | - Maolin Du
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Sha Du
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Yuenan Su
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Nan Zhang
- Department of Hygienic Toxicology, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China
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The Effect of a Family-Based Lifestyle Education Program on Dietary Habits, Hepatic Fat and Adiposity Markers in 8-12-Year-Old Children with Overweight/Obesity. Nutrients 2020; 12:nu12051443. [PMID: 32429379 PMCID: PMC7284532 DOI: 10.3390/nu12051443] [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: 03/26/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 12/18/2022] Open
Abstract
Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.
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Pérez-Gimeno G, Rupérez AI, Vázquez-Cobela R, Herráiz-Gastesi G, Gil-Campos M, Aguilera CM, Moreno LA, Leis Trabazo MR, Bueno-Lozano G. Energy Dense Salty Food Consumption Frequency Is Associated with Diastolic Hypertension in Spanish Children. Nutrients 2020; 12:nu12041027. [PMID: 32283662 PMCID: PMC7230361 DOI: 10.3390/nu12041027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/09/2023] Open
Abstract
High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well.
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Affiliation(s)
- Gloria Pérez-Gimeno
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
| | - Azahara I. Rupérez
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
| | - Rocío Vázquez-Cobela
- Investigation Unit in Nutrition, Growth and Human Development of Galicia GI Pediatric Nutrition-Santiago Health Research Institute (IDIS), Pediatrics Department, Universitary Clinical Hospital of Santiago, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
| | - Gonzalo Herráiz-Gastesi
- Unidad de Endocrinología Pediátrica, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Mercedes Gil-Campos
- Metabolic Pediatric and Investigation Unit, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Concepción M. Aguilera
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Bioquímica y Biología Molecular II, Instituto de Nutrición y Tecnología de los Alimentos, Centro de Investigación Biomédica, Universidad de Granada, 18071 Granada, Spain
| | - Luis A. Moreno
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Rosaura Leis Trabazo
- Investigation Unit in Nutrition, Growth and Human Development of Galicia GI Pediatric Nutrition-Santiago Health Research Institute (IDIS), Pediatrics Department, Universitary Clinical Hospital of Santiago, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-619-019-196
| | - Gloria Bueno-Lozano
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
- Investigation Unit in Nutrition, Growth and Human Development of Galicia GI Pediatric Nutrition-Santiago Health Research Institute (IDIS), Pediatrics Department, Universitary Clinical Hospital of Santiago, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Unidad de Endocrinología Pediátrica, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
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25
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Bricarello LP, de Moura Souza A, de Almeida Alves M, Retondario A, Fernandes R, Santos de Moraes Trindade EB, Zanette Ramos Zeni LA, de Assis Guedes de Vasconcelos F. Association between DASH diet (Dietary Approaches to Stop Hypertension) and hypertension in adolescents: A cross-sectional school-based study. Clin Nutr ESPEN 2020; 36:69-75. [PMID: 32220371 DOI: 10.1016/j.clnesp.2020.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/21/2020] [Accepted: 02/09/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS The DASH diet (Dietary Approaches to Stop Hypertension) is considered a healthy dietary pattern, and is recommended for the control of arterial hypertension (AH). However, its role in the adolescent population needs to be better investigated and clarified. The aim of this study is to identify the association between AH and the DASH diet score in a representative sample of Brazilian adolescents. METHODS A cross-sectional study using data from a national, multicenter and schoolbased probabilistic sample of 71,553 Brazilian adolescents who had their blood pressure (BP) measured and completed a 24-hour dietary recall (2013-2014). The components of the DASH score were assessed. Logistic regression models were used to evaluate the association between AH, anthropometric and sociodemographic variables, and the tertile of the DASH score. RESULTS Approximately 11% of the adolescents who were in the 3rd tertile of the DASH score presented AH, 18% were overweight and 9% were obese. Among the components of the score, the highest intake was sugar-sweetened beverages (92.1%), legumes and oilseeds (68.2%), red and processed meat (64.5%) and the lowest were low-fat dairy (2.2%), whole grains (11.6%) and fruits (18.1%). Sodium intake was above the maximum recommended in all tertiles. CONCLUSIONS A small proportion of Brazilian adolescents consume foods from the DASH diet. No associations were found between this dietary pattern and AH. Strategies to increase the intake of protective foods in adolescents must be investigated as well as the potential health benefits of the standard DASH diet for this age group over time.
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Affiliation(s)
- Liliana Paula Bricarello
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Amanda de Moura Souza
- Institute of Study in Public Health, Federal University of Rio de Janeiro, Ilha Do Fundão, Cidade Universitária, Rio de Janeiro, 21941-598, Brazil
| | - Mariane de Almeida Alves
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Anabelle Retondario
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ricardo Fernandes
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Lúcia Andreia Zanette Ramos Zeni
- Professors of the Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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26
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Arghavani H, Daneshzad E, Namazi N, Larijani B, Askari M, Bellissimo N, Suitor K, Azadbakht L. Association of adherence to the dietary approach to stop hypertension diet and diet quality indices among women in Tehran: A cross- sectional study. Health Promot Perspect 2019; 9:291-298. [PMID: 31777709 PMCID: PMC6875550 DOI: 10.15171/hpp.2019.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Examining dietary approach to stop hypertension (DASH) diet based on other dietary quality indices can be helpful to clarify positive aspects of this healthy dietary pattern. We aimed to examine the association between the DASH diet score and some diet quality indices among Iranian women. Methods: In this cross-sectional study, 304 women aged 20 to 50 years old were recruited. Dietary diversity score (DDS), dietary energy density (DED), adherence to DASH diet, AlternativeHealthy Eating Index (AHEI) and mean adequacy ratio (MAR) were examined as suggested by previous articles. Dietary quality indices, anthropometric indices, and dietary intake were categorized based on DASH tertiles. A semi-quantitative food frequency questionnaire with 168items was used for dietary assessment. Results: There were no significant differences in the demographic characteristics of participants across DASH tertiles (P>0.05). Participants who adhered more to the DASH diet had lower DEDthan those with lower adherence (0.99±0.35 vs 1.26±0.30; P=0.01). Significant differences were observed in the index of DDS across tertiles (P=0.01), however no differences in nutrient adequacy ratio (NAR) and MAR (0.93) index across the DASH categories were found.Additionally, DDS to DED in the top tertile of the DASH diet was greater than the bottom one(6.7±2.9 vs 4.4±1.9; P=0.001). Conclusion: The present study indicated that greater adherence to the DASH diet is inversely associated with DED and AHEI. As well as, there was a positive association between the DASHdiet and DDS/DED ratio. However, more studies are needed to confirm the results of this study
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Affiliation(s)
- Hana Arghavani
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Daneshzad
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Askari
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Leila Azadbakht
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
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27
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Li M, Yan S, Li X, Jiang S, Ma X, Zhao H, Li J, Sun C, Jin L, Yao Y, Li B. Association between blood pressure and dietary intakes of sodium and potassium among US adults using quantile regression analysis NHANES 2007-2014. J Hum Hypertens 2019; 34:346-354. [PMID: 31420581 DOI: 10.1038/s41371-019-0224-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 11/09/2022]
Abstract
Hypertension has become a major public health challenge, and previous studies have observed associations between hypertension and sodium, potassium, and sodium to potassium ratio. However, little is known about how the whole continuum of blood pressure (BP) is related to dietary intake of sodium and potassium. This study aims to examine quantile-specific associations of blood pressure with dietary intake of sodium and potassium. It is based on national-level, cross sectional data for US adults aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2014. A total of 11,095 eligible subjects were included in this study. Quantile regression (QR) models were used to investigate distributional effects in the dietary intake of sodium and potassium on blood pressure by adjusting the confounding factors. We observed some evidence indicating distributional effects of dietary intake of sodium and potassium on systolic blood pressure (SBP) and diastolic blood pressure (DBP). QR showed that the consumption of sodium was positively associated with SBP (P10) and DBP (P10) in males, and positively associated with DBP (P80-P90) alone in females. Intake of potassium was, however, negatively associated with SBP (P20-P30, P70-P80) in males, and also negatively associated with SBP (P10-P80) and DBP(P20-P50) in females. Sodium to potassium ratio was positively associated with SBP (P10-P50, P80) and DBP (P70-P90) in males, and was positively associated with SBP(P10-P70, P90) in females. QR models provided a more detailed view on associations of SBP and DBP with the dietary intake of sodium and potassium and uncovered the quantile-related patterns.
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Affiliation(s)
- Meng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Shoumeng Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Xing Li
- Department of Quality Control, the Affiliated Hospital to Changchun University of Chinese Medicine, 130021, Changchun, China
| | - Shan Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Xiaoyu Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Hantong Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Jiagen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Chong Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China
| | - Yan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China.
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China.
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28
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Paula Bricarello L, Poltronieri F, Fernandes R, Retondario A, de Moraes Trindade EBS, de Vasconcelos FDAG. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on blood pressure, overweight and obesity in adolescents: A systematic review. Clin Nutr ESPEN 2018; 28:1-11. [DOI: 10.1016/j.clnesp.2018.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 01/15/2023]
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29
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Dietary patterns and body adiposity in children in Brazil: a cross-sectional study. Public Health 2018; 166:140-147. [PMID: 30500570 DOI: 10.1016/j.puhe.2018.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/18/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Many factors are associated with the increase in total and central body adiposity in children, especially eating habits. This has led to an increasing number of studies analysing food patterns, which consider the synergistic effect of food and nutrient intake on the nutritional status. The objective of this study was to identify the dietary patterns of children aged 4-7 years and associate these with different indicators of total and central body adiposity. STUDY DESIGN Cross-sectional study METHODS: The study consisted of 403 children from a retrospective cohort in Minas Geraes, Brazil. Four indicators of body adiposity were evaluated: body mass index (BMI), waist-to-height ratio (WHtR) and percentages of total and central body fat (assessed by dual-energy X-ray absorptiometry). The dietary habits of the children were evaluated by identifying the dietary patterns using principal component analysis. The adjustment predictor variables were related to the socio-economic characteristics, lifestyle and duration of exclusive breastfeeding. Food patterns were identified by factor analysis. Linear regression was used to estimate the regression coefficient and the confidence interval, considering statistical significance of α = 5%. RESULTS Five dietary patterns were identified, which explained 42.3% of the data variance: 'Traditional', 'Unhealthy', 'Milk and chocolate', 'Snack' and 'Healthy'. The multiple linear regression model showed that a greater adherence to the 'Traditional' and 'Unhealthy' patterns was related to higher BMI, WHtR, and total and central body adiposity. CONCLUSION Children with a higher intake of food from the 'Traditional' and 'Unhealthy' patterns showed an increase in total and central body adiposity.
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30
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Matthews LA, Rovio SP, Jaakkola JM, Niinikoski H, Lagström H, Jula A, Viikari JSA, Rönnemaa T, Simell O, Raitakari OT, Pahkala K. Longitudinal effect of 20-year infancy-onset dietary intervention on food consumption and nutrient intake: the randomized controlled STRIP study. Eur J Clin Nutr 2018; 73:937-949. [DOI: 10.1038/s41430-018-0350-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/13/2018] [Accepted: 10/01/2018] [Indexed: 11/09/2022]
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31
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Rosário R, Santos R, Lopes L, Agostinis-Sobrinho C, Moreira C, Mota J, Póvoas S, Oliveira A, Padrão P, Moreira P, Abreu S. Fruit, vegetable consumption and blood pressure in healthy adolescents: A longitudinal analysis from the LabMed study. Nutr Metab Cardiovasc Dis 2018; 28:1075-1080. [PMID: 30207270 DOI: 10.1016/j.numecd.2018.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The associations between fruit and vegetable consumption and high blood pressure among adults are well studied. Nonetheless, data on the influence of a low consumption of fruit and vegetables on cardiovascular disease risk, particularly blood pressure, among healthy adolescents are scarce. Therefore, we aim to analyse the associations between fruit and/or vegetable intake and blood pressure over a two-year period in healthy adolescents. METHODS AND RESULTS As part of a cohort, 606 adolescents from the LabMed Physical Activity study were evaluated in 2011 (baseline) and 2013 (follow-up). Blood pressure was measured according to standardized procedures and fruit and vegetable consumption was assessed with a food frequency questionnaire. Anthropometric variables, socioeconomic status, pubertal stage and lifestyle determinants were gathered and used as confounders. Prospective associations between fruit and/or vegetable intake and blood pressure were examined using generalized linear models. Girls who consumed more fruit at baseline had a significant decrease in diastolic blood pressure at follow-up [unstandardized beta: -0.005 mmHg (95%CI: -0.01; -0.0002) (p = 0.038)]. CONCLUSION In apparently healthy adolescents, fruit intake may already start to have an effect in blood pressure. Girls who consumed more fruit exhibited lower levels of diastolic blood pressure.
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Affiliation(s)
- R Rosário
- School of Nursing, University of Minho, Portugal; Health Sciences Research Unit-Nursing, Escola Superior de Enfermagem de Coimbra, Portugal.
| | - R Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal; Early Start, Faculty of Social Sciences, School of Education, University of Wollongong, Australia
| | - L Lopes
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - C Agostinis-Sobrinho
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal; Faculty of health Sciences, Klaipeda University, Lithuania; Physical Education, Physiotherapy and Dance, Federal University of the South of Brazil, Porto Alegre, Rio Grande do Sul, Brazil
| | - C Moreira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - J Mota
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - S Póvoas
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Maia, Portugal
| | - A Oliveira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - P Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Portugal; Institute of Public Health, University of Porto, Portugal
| | - P Moreira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Portugal; Institute of Public Health, University of Porto, Portugal
| | - S Abreu
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal; Universidade Lusófona do Porto, Portugal
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32
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Nordkvist S, Sonestedt E, Acosta S. Adherence to diet recommendations and risk of abdominal aortic aneurysm in the Malmö Diet and Cancer Study. Sci Rep 2018; 8:2017. [PMID: 29386636 PMCID: PMC5792541 DOI: 10.1038/s41598-018-20415-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
The research examining the association between quality of diet and abdominal aortic aneurysm (AAA) is scarce. The aim of the present study was to explore the association between diet quality and development of AAA for middle-aged individuals in the Malmö Diet and Cancer Study (MDCS), a prospective cohort study with baseline data collection carried out between 1991 and 1996. At baseline, the study participants who were eligible for this study (n = 26133) documented their dietary habits in a food diary and questionnaire. Incident AAA cases during an average of 20.7 years of follow-up were identified by using registers. A diet quality index consisting of six components, saturated fat, polyunsaturated fat, fibre, sucrose, fruits and vegetables and fish and shellfish, was used to assess the diet quality. After adjusting for potential confounders, the diet quality index was not associated with incident AAA. However, a tendency of decreased risk was observed among individuals adhering to recommendations for fruit and vegetables compared with non-adherence. When comparing the risk of more extreme intake groups, high intakes of both fruits and vegetables were associated with decreased risk.
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Affiliation(s)
- Sara Nordkvist
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Emily Sonestedt
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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