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Islam MR, Rahman SM, Selling K, Näsänen-Gilmore P, Kippler M, Kajantie E, Rahman A, Pervin J, Ekström EC. Dietary patterns and indicators of cardiometabolic risk among rural adolescents: A cross-sectional study at 15-year follow-up of the MINIMat cohort. Front Nutr 2023; 10:1058965. [PMID: 36761218 PMCID: PMC9905110 DOI: 10.3389/fnut.2023.1058965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Background Diet being a modifiable factor, its relationship with cardiometabolic risk is of public health interest. The vast majority of studies on associations of dietary patterns with cardiometabolic risk indicators among adolescents are from high-income countries and urban settings. We sought to describe dietary patterns and examine their associations with selected cardiometabolic risk indicators-waist circumference (WC), systolic blood pressure, fasting lipid profile and insulin resistance-along with its gender stratification among adolescents in a low-income, rural setting. Methods This cross-sectional study utilized data from the 15-year follow-up of the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort in southeast Bangladesh. The children who were born as singletons to the mothers randomized in the MINIMat trial and had valid birth anthropometrics were eligible for the follow-up. We employed a single, qualitative 24-hour recall to assess diet. Dietary patterns were derived from simple K-means cluster analysis, and calculation of dietary diversity score (DDS) using a validated instrument. Anthropometric parameters and systolic blood pressure were recorded. Fasting plasma triglyceride, total cholesterol, low- and high-density lipoproteins, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Three right-skewed outcome variables were natural log (Ln) transformed: WC, triglyceride and HOMA-IR. Omnibus and gender-specific multiple linear regression models were fitted. Results Among 2,253 adolescents (52.1% girls, 7.1% overweight/obese), we identified four diet clusters: Traditional, Fish-dominant, Meat-dominant, and High-variety. No significant associations were found between the clusters and indicators. On gender-stratification, triglyceride levels were lower among boys in the Fish-dominant (Ln-triglyceride βadjusted: -0.09; 95% confidence interval (CI): -0.15, -0.02) and Meat-dominant (Ln-triglyceride βadjusted: -0.08; 95% CI: -0.15, -0.004) clusters than among boys in the Traditional cluster. Compared to boys in the bottom quartile of DDS, boys in the top quartile had 2.1 mm of Hg (95% CI: 0.5, 3.6) higher systolic blood pressure and 1.9% (95% CI: 0.01-3.8%) higher WC. Conclusion While statistically significant, the gender-specific differences in triglyceride, systolic blood pressure, and waist circumference across dietary patterns were small. Associations between dietary patterns and cardiometabolic risk indicators may require a time lag beyond mid-adolescence to manifest in a rural setting. Prospective studies are warranted to delineate the magnitude and direction of those associations.
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Affiliation(s)
| | - Syed Moshfiqur Rahman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Katarina Selling
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Pieta Näsänen-Gilmore
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eero Kajantie
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Anisur Rahman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Mascarenhas P, Furtado JM, Almeida SM, Ferraz ME, Ferraz FP, Oliveira P. Pediatric Overweight, Fatness and Risk for Dyslipidemia Are Related to Diet: A Cross-Sectional Study in 9-year-old Children. Nutrients 2023; 15:329. [PMID: 36678200 PMCID: PMC9865454 DOI: 10.3390/nu15020329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Pediatric overweight, dyslipidemia and insulin resistance can result from unhealthy lifestyle habits and increase morbidity and mortality in adulthood. Herein, we evaluated the relationship between diet and physical activity patterns with the metabolic health of 9-year-old school children. Measurements included anthropometry, adiposity, lipid, and glycemic profiles. Questionnaires evaluated diet and physical activity. Exploratory factor analysis (EFA) screened for diet patterns, and multilevel models evaluated diet and physical activity patterns against overweight, dyslipidemia, and insulin resistance markers across schools and children. EFA highlighted two diet patterns, Western and Traditional. Food rich in fat, salt, and sugar and fewer vegetables and fruits defined the Western pattern. The Traditional pattern, linked to healthier eating habits, had analogies to the Mediterranean diet. Overall, 39% of the children were overweight (including the obese), while 62% presented cardiovascular risk factors on their lipid profiles. Normal-weight children presented 60% high cholesterol incidence. Global insulin resistance incidence was 4.1%, but almost doubled among the overweight/obese. The Westernized diet consistently linked to worse cardiovascular risk markers, even independently of physical practice. Intensive or competitive physical activity was associated with decreased triglycerides (p = 0.003), regardless of diet. Future prospective studies are warranted to validate these results externally.
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Affiliation(s)
- Paulo Mascarenhas
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz, Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
| | - José M. Furtado
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz, Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
| | - Sílvia M. Almeida
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz, Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
| | - Maria E. Ferraz
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz, Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
| | - Fernando P. Ferraz
- Centro de Genética Médica e Nutrição Pediátrica Egas Moniz, Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
| | - Pedro Oliveira
- Department of Population Studies, ICBAS—Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
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Chrissini MK, Panagiotakos DB. Acute Myocardial Infarction in Young Patients and its Correlation with Obesity Status at Pre-adolescent Stage: A Narrative Review. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Cardiovascular diseases (CVD), especially acute myocardial infarction (AMI), remain a worldwide major cause of premature morbidity and mortality, with considerable health care costs. Metabolic, behavioural, environmental, and social risk factors are significant drivers of AMI, with obesity being a key determinant among them. Childhood obesity constitutes a major health threat that is considered a global epidemic of the 21st century.
Objective:
To assess whether excess weight from the first years of life acts as a predisposing factor in increasing the risk of AMI in young adults.
Methods:
This is a narrative review of the evidence concerning the epidemiology of early AMI and obesity, using PubMed and Google Scholar.
Results:
There is substantial evidence showing that excess weight during childhood multiplies the risk of AMI at an early age.
Conclusion:
Premature AMI seems to have significant drivers related to lifestyle factors, such as childhood obesity. In the era of a childhood obesity epidemic, the aforementioned relationship underlines the need for early prevention and management.
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Association between major dietary patterns and metabolic health status in overweight and obese adolescents. Nutrition 2022; 103-104:111793. [DOI: 10.1016/j.nut.2022.111793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
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Hajhashemy Z, Mirzaei S, Asadi A, Akhlaghi M, Saneei P. Association of Dietary Insulin Index and Dietary Insulin Load With Metabolic Health Status in Iranian Overweight and Obese Adolescents. Front Nutr 2022; 9:821089. [PMID: 35369069 PMCID: PMC8969564 DOI: 10.3389/fnut.2022.821089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Limited data are available on the association of dietary insulin load (DIL) and dietary insulin index (DII) with health status in pediatrics. We aimed to investigate the relationship of DIL and DII with metabolic health status in Iranian overweight/obese adolescents. Methods In this cross-sectional study, using a multistage cluster random-sampling method, 203 overweight/obese adolescents (aged 12 to <18 years) were included. A validated 147-item food frequency questionnaire (FFQ) was used for a dietary intake assessment. Glycemic and lipid profile, blood pressure (BP), and anthropometric indices were measured. Participants were categorized as metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO) using the two methods of the International Diabetes Federation (IDF) and a combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR). Results According to IDF and IDF/HOMA-IR strategies, 38.9% (n = 79) and 33.0% (n = 67) of participants belonged to MUO category. After adjustments for potential confounders, subjects in the highest tertile of DIL in comparison with those in the lowest tertile had the odds ratio (OR) values of 8.44 (95% CI: 2.24-31.78) and 5.86 (95% CI: 1.39-24.58) for MUO based on IDF and IDF/HOMA-IR definitions, respectively. Moreover, after considering potential confounders, adolescents in the highest tertile of DII, compared to the lowest tertile, were, respectively, 6.93 (OR: 6.93; 95% CI: 2.59-18.57) and 5.26 (OR: 5.26; 95% CI: 1.85-14.97) times more likely to be MUO, based on IDF and IDF/HOMA-IR definitions. A significant decreasing trend was observed for OR of MUO in tertiles of DIL and DII. The stratified analysis revealed that these associations were stronger in obese participants; in overweight subjects, the association was not independent of confounders. Conclusion This population-based study revealed that higher DIL and DII were strongly related to increased OR of MUO in Iranian adolescents, especially in obese participants. Further investigations, especially with a prospective design, are needed to affirm these findings.
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Affiliation(s)
- Zahra Hajhashemy
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeideh Mirzaei
- Department of Community Nutrition, School of Nutrition and Food Sciences, 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, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Association of dietary patterns with blood pressure and body adiposity in adolescents: a systematic review. Eur J Clin Nutr 2021; 75:1440-1453. [PMID: 33531634 DOI: 10.1038/s41430-020-00850-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023]
Abstract
This paper aimed to systematically review the results of observational studies that investigated the association of dietary patterns with blood pressure and body adiposity markers in adolescents. Articles were searched in July 2020 in PubMed, Scopus, Web of Science, and Scientific Electronic Library Online (SciELO). Of the 3408 studies found, 24 fulfilled the inclusion criteria and were considered in this review. Almost all studies (n = 23) identified at least one unhealthy pattern, predominantly characterized as consumption of confectionery, refined grains, sweets, sweetened drinks, red meats, and processed meats. Fourteen of the twenty-four studies found a significant association between any dietary pattern and blood pressure and/or body adiposity markers. There was a positive association of dietary patterns - characterized by the consumption of foods rich in sodium, animal fat, refined carbohydrates, and low in fiber - with increased blood pressure and body adiposity. Our findings highlight the importance of studies with this scope, whose results can support the surveillance of adolescent's health. However, considering the limited number of studies that found a significant association and their limitations, the present results should be interpreted carefully. More prospective studies are needed to determine how adherence to dietary patterns could influence blood pressure and body adiposity markers in the long term.
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Neta ADCPDA, Steluti J, Ferreira FELDL, Farias Junior JCD, Marchioni DML. Dietary patterns among adolescents and associated factors: longitudinal study on sedentary behavior, physical activity, diet and adolescent health. CIENCIA & SAUDE COLETIVA 2021; 26:3839-3851. [PMID: 34468677 DOI: 10.1590/1413-81232021269.2.24922019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 02/07/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to identify dietary patterns and associations with socioeconomic characteristics, lifestyle, nutritional status, lipid profile and inflammatory profile in adolescents. A cross-sectional study was conducted with a probabilistic sample using baseline data (2014) from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits and Adolescent Health. A total of 1,438 adolescents (10 to 14 years old) from public schools in the city of João Pessoa, Brazil, participated in the study. Data were collected on socioeconomic characteristics, nutritional status, lifestyle and the results of biochemical tests. Dietary data were obtained using the 24-hour recall method and dietary patterns were identified by exploratory factor analysis. Associations of interest were estimated using multiple logistic regression. Three dietary patterns were found: "Traditional", "Snacks" and "Western". These patterns were associated with age, socioeconomic status, parental education and lifestyle. The "Traditional" pattern was associated lower adiposity and a better lipid profile. However, with the increase in age, greater frequencies of the "Snacks" and "Western" patterns were found. The present findings underscore the need for strategies that encourage healthy behaviors.
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Affiliation(s)
| | - Josiane Steluti
- Departamento de Políticas Públicas e Saúde Coletiva, Instituto Saúde e Sociedade, Campus Baixada Santista da Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | | | - Dirce Maria Lobo Marchioni
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
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Prospective association between dietary patterns and BMI Z-score in Brazilian adolescents. Public Health Nutr 2021; 24:4230-4237. [PMID: 33472719 DOI: 10.1017/s1368980021000252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify dietary patterns and prospectively evaluate their influence on the BMI Z-score of adolescents. DESIGN A longitudinal study, using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits and Adolescent Health - LONCAAFS. SETTING To obtain data on food consumption, a 24-h recall survey was conducted; a second 24-h recall was applied to 30 % of the sample in all waves. Dietary patterns were identified by exploratory factor analysis using principal components. BMI Z-score was determined according to the recommendation of the WHO, based on the BMI for age and sex. Socio-economic data, sedentary behaviour and physical activity level were obtained. Associations between BMI Z-score and dietary patterns and between BMI Z-score and variables of interest were determined using generalised estimating equations. PARTICIPANTS Totally, 1431 adolescents were assessed in 2014, 1178 in 2015, 959 in 2016 and 773 in 2017, belonging to the public schools of João Pessoa, Northeast Brazil. RESULTS Three dietary patterns were identified throughout the study: 'traditional', 'snacks' and 'Western'. The 'Western' dietary pattern was positively associated with BMI Z-score (β = 0·025; 95 % CI 0·002, 0·048), regardless of sex and physical activity level, prospectively. CONCLUSION A dietary pattern composed of foods with high energy density, high fat and sugars, and low fibre influences the BMI Z-score of adolescents over time.
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Kafyra M, Kalafati IP, Kumar S, Kontoe MS, Masson C, Siest S, Dedoussis GV. Dietary Patterns, Blood Pressure and the Glycemic and Lipidemic Profile of Two Teenage, European Populations. Nutrients 2021; 13:198. [PMID: 33435217 PMCID: PMC7826952 DOI: 10.3390/nu13010198] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 12/11/2022] Open
Abstract
The present study sought to retrospectively investigate the dietary habits of two adolescent, European populations from the cross-sectional Greek TEENAGE Study and French STANISLAS Family Study. We aimed to explore the relation between the populations' dietary patterns and blood pressure, glycemic and lipidemic profile. Dietary patterns were extracted via Principal Component Analysis (PCA), based on data collected from two 24 h dietary recalls for the TEENAGE study and a 3-day food consumption diary for the STANISLAS study. Multiple linear regressions and mixed models analyses, adjusting for confounding factors, were employed to investigate potential associations. A total of 766 Greek teenagers and 287 French teenagers, were included in analyses. Five dietary patterns were extracted for each population accounting for 49.35% and 46.69% of their respective total variance, with similarities regarding the consumption of specific food groups (i.e., western-type foods). In the TEENAGE Study, the "chicken and sugars" pattern was associated with lower CRP levels, after adjusting for confounding factors (p-value < 0.01). The "high protein and animal fat" dietary pattern of the STANISLAS Family Study was related to higher BMI (p-value < 0.01) and higher triglycerides levels (p-value < 0.01). Our findings summarize the dietary habits of two teenage, European populations and their associations with cardiometabolic risk factors.
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Affiliation(s)
- Maria Kafyra
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (I.P.K.)
- IGE-PCV, Université de Lorraine, F-54000 Nancy, France; (S.K.); (M.S.K.); (C.M.); (S.S.)
| | - Ioanna Panagiota Kalafati
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (I.P.K.)
| | - Satish Kumar
- IGE-PCV, Université de Lorraine, F-54000 Nancy, France; (S.K.); (M.S.K.); (C.M.); (S.S.)
| | | | - Christine Masson
- IGE-PCV, Université de Lorraine, F-54000 Nancy, France; (S.K.); (M.S.K.); (C.M.); (S.S.)
| | - Sophie Siest
- IGE-PCV, Université de Lorraine, F-54000 Nancy, France; (S.K.); (M.S.K.); (C.M.); (S.S.)
| | - George V. Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (I.P.K.)
- IGE-PCV, Université de Lorraine, F-54000 Nancy, France; (S.K.); (M.S.K.); (C.M.); (S.S.)
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Shih DP, Wen CT, Kuo HW, Liang WM, Liu LF, Su CT, Wang JY. Spousal Concordance in Dietary Behaviors and Metabolic Components, and Their Association: A Cross-Sectional Study. Nutrients 2020; 12:nu12113332. [PMID: 33138145 PMCID: PMC7692615 DOI: 10.3390/nu12113332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
This study aims to investigate spousal concordance in dietary behaviors, spousal concordance in metabolic components (MCs), and their association. A cross-sectional survey was conducted in Taiwan from November 2014 to May 2015. Matched-pair analysis, McNemar’s test, logistic regression analysis, and stratified analysis were performed. A total of 901 pairs of spouses (1802 participants) were analyzed. Husbands were less likely to report intakes of high-fiber food (ORMP (matched pairs odds ratio) = 0.30, p < 0.0001), fish (ORMP = 0.74, p = 0.0128), biscuits or cakes (ORMP = 0.60, p < 0.0001), and fast food (ORMP = 0.65, p = 0.01) compared with their wives. Husbands had significantly higher odds of being overweight (ORMP = 2.34, p < 0.0001); and of having hypertension (ORMP = 2.14, p < 0.0001), hypercholesterolemia (ORMP = 1.75, p = 0.0007), hyperlipidemia (ORMP = 2.96, p < 0.0001), and one or more metabolic components (composite MCs) (ORMP = 2.50, p < 0.0001) compared with their wives. After adjusting for age and education, the spousal concordance in high-fiber food intake was inversely associated with the spousal concordance in composite MCs (aOR = 0.62, 95% CI = 0.44–0.88, p = 0.0074), whereas the spousal concordance in processed food intake was positively associated with the concordance in composite MCs (aOR (adjusted odds ratio) = 1.56, 95% CI (Confidence Interval) = 1.03–2.36, p = 0.034). An intervention study for couples with intakes of different fiber foods and/or processed foods is critical for future study, in order to test what kinds of fiber foods/processed foods are associated with the development of the spousal concordance of metabolic components.
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Affiliation(s)
- Dann-Pyng Shih
- Department of Public Health, China Medical University, Taichung City 406040, Taiwan;
- Center for Teaching Excellence, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Chu-Ting Wen
- Strategy Planning Office, Cheng Ching Hospital, Taichung 40764, Taiwan;
| | - Hsien-Wen Kuo
- Institute of Environmental and Occupational Health Sciences, National Yang Ming University, Taipei 11221, Taiwan;
- National Defense Medical Center, School of Public Health, Taipei 11490, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, Taichung City 406040, Taiwan;
| | - Li-Fan Liu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Chien-Tien Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan;
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung City 406040, Taiwan;
- Correspondence: ; Tel.: +886-4-2205-3366 (ext. 6313)
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Kim SA, Shin S, Ha K, Hwang Y, Park YH, Kang MS, Joung H. Effect of a balanced Korean diet on metabolic risk factors among overweight/obese Korean adults: a randomized controlled trial. Eur J Nutr 2020; 59:3023-3035. [PMID: 31927671 DOI: 10.1007/s00394-019-02141-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 11/11/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE This study was to see the effects of a balanced Korean diet (BKD) on metabolic risk factors in overweight or obese Korean adults, comparing with those of a typical American diet (TAD) and a diet recommended by the 2010 Dietary Guidelines for Americans (2010DGA). METHODS The study was designed as a randomized crossover controlled trial, in which 61 overweight or obese volunteers were divided into six groups and each consumed the BKD, 2010DGA, and TAD in a random order for 4 weeks separated by 2-week washout intervals. Anthropometric indices, blood pressure, blood lipid content, fasting blood glucose, and blood insulin level were measured at the beginning and end of each diet period. RESULTS A total of 54 participants completed the trial. The BKD caused more significant reductions of body mass index (BMI) (p < 0.001), body fat percent (p < 0.001), blood total cholesterol (p < 0.001), and low-density lipoprotein (LDL) cholesterol (p = 0.007) compared with the 2010DGA or TAD (all p values for differences between diets < 0.05). All three diets significantly lowered blood triglyceride levels (p < 0.05). The BKD decreased high-density lipoprotein (HDL) cholesterol (p = 0.001) and increased fasting blood glucose (p = 0.018), whereas TAD and 2010DGA increased HDL cholesterol and did not affect blood glucose levels. Furthermore, the BKD significantly decreased the proportion of individuals with elevated total cholesterol (p < 0.001) and LDL cholesterol (p < 0.01), whereas the 2010DGA significantly reduced the number of obese individuals (p < 0.05), and the TAD decreased the number of participants with elevated triglyceride levels (p < 0.05), but increased that of those with elevated LDL cholesterol (p < 0.05). CONCLUSIONS The Korean diet based on dietary guidelines improved metabolic risk factors such as BMI, body fat percent, and blood lipid profiles in overweight or obese Korean adults. These results provide evidence to recommend the Korean diet for preventing various metabolic diseases. CLINICAL TRIAL REGISTRATION The trial was registered at the Clinical Research Information Service (CRIS) in Korea, the primary registry of the World Health Organization (WHO) international clinical trial registry platform, under number KCT0002437.
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Affiliation(s)
- Seong-Ah Kim
- Institute of Health and Environment, Seoul National University, Seoul, 08826, Korea
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Korea
| | - Kyungho Ha
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, 08826, Korea
| | - Young Hwang
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Korea
| | - Young-Hee Park
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Korea
| | - Min-Sook Kang
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Korea
| | - Hyojee Joung
- Institute of Health and Environment, Seoul National University, Seoul, 08826, Korea. .,Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, 08826, Korea.
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Lee H, Kim J, An J, Lee S, Kong H, Song Y, Choi HR, Lee SJ, Chae KS, Kwon JW, Kim K. Amelioration of hyperglycemia by Rubus occidentalis (black raspberry) and increase in short-chain fatty acids producing bacteria. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.01.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Vaz JDS, Buffarini R, Kac G, Bielemann RM, Oliveira I, Menezes AB, Assunção MCF. Dietary patterns are associated with blood lipids at 18-year-olds: a cross-sectional analysis nested in the 1993 Pelotas (Brazil) birth cohort. Nutr J 2018; 17:77. [PMID: 30134901 PMCID: PMC6106900 DOI: 10.1186/s12937-018-0389-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background Evidence regarding the deleterious effects of diet on blood lipids in adolescence has been inconsistent, and few studies have investigated this association using a dietary pattern approach. We examined whether dietary pattern of adolescents are associated with blood lipid concentrations. Methods Cross-sectional analysis of 3524 18-year-old participants in the 1993 Pelotas (Brazil) Birth Cohort Study. A semi-quantitative food frequency questionnaire was administered. Dietary patterns were established using principal component analysis and analysed as tertiles of factor scores. Independent associations between each dietary pattern tertile and blood lipid values (total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) were tested using adjusted linear regression models stratified by sex. Triglycerides were log-transformed due to their skewed distribution, and the beta coefficients should be interpreted as the % change (increase or decrease). Results Four dietary patterns were derived: Meat Products and Fast Foods; Fruits and Vegetables; Candies, Sodas and Dairy Products; and Common Brazilian Foods. In the adjusted models, which compared the highest and lowest tertiles of dietary pattern scores, we observed that among girls: 1) the third tertile of the Meat Products and Fast Foods pattern was associated with 1.5 mg/dL (95% CI -3.05; –0.04) lower HDL-cholesterol; 2) the second and third tertile of the Candies, Sodas and Dairy Products pattern was associated with 5% and 10% higher triglycerides (β 1.05, 95% CI 1.01; 1.09, β 1.10, 95% CI 1.05; 1.16), respectively; 3) the second and third tertiles of the Common Brazilian Foods pattern were associated with 4 mg/dL (β − 4.30, 95% CI -7.75; –0.85, β − 4.95, 95% CI -8.53; –1.36, respectively) lower total cholesterol and 6% lower triglycerides (β 0.94, 95% CI 0.90; 0.99, β 0.93, 95% CI 0.89; 0.98, respectively). For boys, 4) the third tertile of the Common Brazilian Foods was associated with 4.6 mg/dL (95% CI -7.91; –1.37) lower total cholesterol and 3.8 mg/dL (95% CI -6.51; − 1.13) lower LDL-cholesterol. Conclusions Dietary patterns were more closely associated with blood lipids among girls than boys at age 18. Higher scores for the Common Brazilian Foods pattern were associated with lower total cholesterol in both sexes. Electronic supplementary material The online version of this article (10.1186/s12937-018-0389-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juliana Dos Santos Vaz
- Faculty of Nutrition, Federal University of Pelotas, Rua Gomes Carneiro, 1, 2° andar, Pelotas, RS, 96010-610, Brazil.
| | - Romina Buffarini
- Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS, 96020-220, Brazil
| | - Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 367, CCS - Bloco J - 2° andar, sala 29, Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ, 21941-590, Brazil
| | - Renata Moraes Bielemann
- Faculty of Nutrition, Federal University of Pelotas, Rua Gomes Carneiro, 1, 2° andar, Pelotas, RS, 96010-610, Brazil
| | - Isabel Oliveira
- Institute of Biology, Federal University of Pelotas, Campus Capão do Leão, s/n, Capão do Leão, RS, 96010-900, Brazil
| | - Ana Baptista Menezes
- Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS, 96020-220, Brazil
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Dietary patterns and cardiometabolic risk factors among adolescents: systematic review and meta-analysis. Br J Nutr 2018; 119:859-879. [DOI: 10.1017/s0007114518000533] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractThis study systematised and synthesised the results of observational studies that were aimed at supporting the association between dietary patterns and cardiometabolic risk (CMR) factors among adolescents. Relevant scientific articles were searched in PUBMED, EMBASE, SCIENCE DIRECT, LILACS, WEB OF SCIENCE and SCOPUS. Observational studies that included the measurement of any CMR factor in healthy adolescents and dietary patterns were included. The search strategy retained nineteen articles for qualitative analysis. Among retained articles, the effects of dietary pattern on the means of BMI (n 18), waist circumference (WC) (n 9), systolic blood pressure (n 7), diastolic blood pressure (n 6), blood glucose (n 5) and lipid profile (n 5) were examined. Systematised evidence showed that an unhealthy dietary pattern appears to be associated with poor mean values of CMR factors among adolescents. However, evidence of a protective effect of healthier dietary patterns in this group remains unclear. Considering the number of studies with available information, a meta-analysis of anthropometric measures showed that dietary patterns characterised by the highest intake of unhealthy foods resulted in a higher mean BMI (0·57 kg/m²; 95 % CI 0·51, 0·63) and WC (0·57 cm; 95 % CI 0·47, 0·67) compared with low intake of unhealthy foods. Controversially, patterns characterised by a low intake of healthy foods were associated with a lower mean BMI (−0·41 kg/m²; 95 % CI −0·46,−0·36) and WC (−0·43 cm; 95 % CI −0·52,−0·33). An unhealthy dietary pattern may influence markers of CMR among adolescents, but considering the small number and limitations of the studies included, further studies are warranted to strengthen the evidence of this relation.
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15
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At-home and away-from-home dietary patterns and BMI z-scores in Brazilian adolescents. Appetite 2018; 120:374-380. [DOI: 10.1016/j.appet.2017.09.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/24/2017] [Accepted: 09/27/2017] [Indexed: 11/21/2022]
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16
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So E, Kim J, Joo S, Lee J, Joung H. Association of dietary patterns with overweight risk and all-cause mortality in children with cancer. Nutr Res Pract 2017; 11:492-499. [PMID: 29209460 PMCID: PMC5712500 DOI: 10.4162/nrp.2017.11.6.492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/11/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the association of dietary patterns with overweight risk and all-cause mortality in pediatric cancer patients. SUBJECTS/METHODS Prospective cohort study was undertaken; 83 cancer patients admitted to the pediatric cancer ward at a university hospital in Seoul were included and followed for obesity and death over 24 months. Food consumption data were collected from patients using validated meal order sheets for breakfast, lunch, and dinner at the pediatric cancer ward over 3 days. Using principal component analysis, three dietary patterns were derived from 29 food groups. RESULTS Eighteen deaths occurred among the patient cohort during the follow-up period. The “spicy & fried meat and fish” dietary pattern was positively associated with overweight risk at both baseline [odds ratio (OR) = 4.396, 95% confidence interval (CI) = 1.111-17.385, P for trend = 0.023] and after 6 months (OR = 4.088, 95% CI = 1.122-14.896, P for trend = 0.025) as well as all-cause mortality (hazard ratios = 5.124, 95% CI = 1.080-24.320, P for trend = 0.042), when comparing the highest and lowest tertiles after adjusting for covariates. The “fish, egg, meat, and fruits & vegetables” dietary pattern was associated with lower overweight risk after 24 months (OR = 0.157, 95% CI = 0.046-0.982, P for trend = 0.084). CONCLUSION The results imply that dietary patterns might be associated with weight gain and premature death among pediatric cancer patients.
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Affiliation(s)
- Eunjin So
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea.,Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
| | - Jeeyeon Kim
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea
| | - Sehwa Joo
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea
| | - Jisun Lee
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea
| | - Hyojee Joung
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.,Institute of Health and Environment, Seoul National University, Seoul 08826, Korea
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17
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Dietary Patterns and Metabolic Syndrome in Children and Adolescents: A Systematic Review. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.11656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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18
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Perng W, Fernandez C, Peterson KE, Zhang Z, Cantoral A, Sanchez BN, Solano-González M, Téllez-Rojo MM, Baylin A. Dietary Patterns Exhibit Sex-Specific Associations with Adiposity and Metabolic Risk in a Cross-Sectional Study in Urban Mexican Adolescents. J Nutr 2017; 147:1977-1985. [PMID: 28855420 PMCID: PMC5610554 DOI: 10.3945/jn.117.256669] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/17/2017] [Accepted: 08/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Studies in Western nations have shown associations of certain dietary patterns with obesity and metabolic risk in youth. Little is known about these relations in newly industrialized countries where obesity prevalence is surpassing those of developed countries.Objective: We sought to characterize dietary patterns in a cross-sectional study in 224 adolescents aged 8-14 y in Mexico and to investigate associations of the dietary patterns with adiposity and metabolic risk.Methods: We used principal components analysis to derive dietary patterns from food-frequency questionnaire data. By using linear regression models that accounted for mother's marital status, education, and smoking habits and child's age and physical activity, we examined associations of the dietary patterns with adiposity [body mass index z score, waist circumference, the sum and ratio of the subscapular and triceps skinfold thicknesses, blood pressure, serum fasting glucose and a C-peptide-based measure of insulin resistance (CP-IR), lipid profile, and a metabolic syndrome risk z score (MetS z score)].Results: We identified a "prudent" dietary pattern characterized by high intakes of vegetables, fruit, fish, chicken, and legumes and a "transitioning" dietary pattern, which comprises processed meats, Mexican foods, and sweetened beverages. Each unit increase in the prudent pattern factor score corresponded with 0.33 ng/mL (95% CI: 0.09, 0.57 ng/mL) lower C-peptide, 0.08 units (95% CI: 0.02, 0.13 units) lower CP-IR, and a 0.14 unit (0.00, 0.27 unit) lower MetS z score in boys. In girls, the transitioning pattern corresponded with higher subscapular + triceps skinfold thickness (per 1-unit increase in the factor score: 2.46 mm; 95% CI: 0.10, 4.81 mm). These results did not change after accounting for pubertal status.Conclusions: A prudent dietary pattern was protective against metabolic risk in adolescent boys, whereas a transitioning dietary pattern corresponded with higher adiposity among adolescent girls. Given that adolescence is a key developmental period for long-term health, efforts to elucidate dietary determinants of metabolic risk during this life stage may have long-term benefits.
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Affiliation(s)
- Wei Perng
- Departments of Nutritional Sciences, .,Epidemiology, and
| | | | - Karen E Peterson
- Departments of Nutritional Sciences,,Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; and
| | - ZhenZhen Zhang
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Alejandra Cantoral
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Brisa N Sanchez
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Maritsa Solano-González
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Martha Maria Téllez-Rojo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Baylin
- Departments of Nutritional Sciences,,Epidemiology, and
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19
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Silva DFDO, Lyra CDO, Lima SCVC. [Dietary habits of adolescents and associated cardiovascular risk factors: a systematic review]. CIENCIA & SAUDE COLETIVA 2017; 21:1181-96. [PMID: 27076017 DOI: 10.1590/1413-81232015214.08742015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/24/2015] [Indexed: 02/08/2023] Open
Abstract
The scope of this study was to conduct a systematic review to establish the major dietary habits of adolescents and the corresponding association with cardiovascular risk factors. Research was performed in the LILACS, SciELO, PubMed, Scopus and Web of Science databases in addition to a manual search for original articles published between 2005 and 2014. Of the 371 entries identified; 26 fulfilled the inclusion criteria and were covered in the review. The main dietary habits observed were Western (61%) Healthy (42%) and Traditional (38%). Western dietary habits were positively associated with total cholesterol and SM, while Healthy dietary habits were inversely associated with fasting glycaemia, DBP and SM and positively with HDL-C, all of the aforementioned associations with very low (D) quality of evidence in accordance with the GRADE rating. The Traditional dietary habits were considered a risk factor for hyperglycemia, hyperinsulinemia and hypertriglyceridemia and protection for physical activity and eutrophic BMI. Although these results need to be analyzed with caution, due to the low quality of evidence, there is a clear need for actions aimed at promoting healthy dietary habits in adolescents in order to contribute to the prevention of cardiovascular risk factors.
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20
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Zarkesh M, Asghari G, Amiri P, Hosseinzadeh N, Hedayati M, Ghanbarian A, Azizi F. Familial Aggregation of Metabolic Syndrome With Different Socio-Behavioral Characteristics: The Fourth Phase of Tehran Lipid and Glucose Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e30104. [PMID: 27781113 PMCID: PMC5065923 DOI: 10.5812/ircmj.30104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/09/2015] [Accepted: 08/15/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since genetic and most environmental factors shape the context of families, some studies have been initiated to investigate the role of familial relationships in metabolic syndrome (MetS). OBJECTIVES To estimate the familial aggregation of MetS and its components by identifying both case and control probands among Tehranian adults with different socio-behavioral and reproductive characteristics. PATIENTS AND METHODS This case-controlled/family-based study was conducted on 1,777 families (635 case probands) who participated in the Tehran Lipid and Glucose Study (TLGS). Socio-demographic and reproductive information including levels of education, marital status, occupation status, age at menarche, number of abortions, number of children, and lifestyle habits such as smoking, physical activity and regular diet were obtained from the TLGS data bank. Metabolic syndrome was defined according to the joint interim statement (JIS) criteria. To estimate the regression co-efficient for familial aggregation and environmental factors, the generalized estimation equation method was used. RESULTS The risk of having MetS among family members for case versus control probands was 2.19 (95% CI: 1.68 - 2.84), which, after adjusting for potential confounders including age, sex, educational level, marital status, occupation, age at menarche and energy, soft drink and starchy vegetable intake, increased to 2.31 (95% CI: 1.81 - 2.94; P < 0.05). Compared to control probands, the risk of having MetS components increased significantly from OR = 1.28 for both high waist circumference (WC) and blood pressure (BP) to OR = 1.72 for high triglycerides in cases. Familial aggregation inherited from the father was significantly observed in all MetS components, from adjusted OR = 1.63 for hyperglycemia to adjusted OR = 2.69 for high WC, except for low HDL, after controlling for potential confounders. CONCLUSIONS Considering spouses and siblings, there was a higher risk for MetS components among families whose fathers and offspring had MetS components, implying the pivotal role of genetic inheritance in the incidence of the syndrome and its components.
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Affiliation(s)
- Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Parisa Amiri, Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-212409309, Fax: +98-212402463, E-mail:
| | - Nima Hosseinzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Arash Ghanbarian
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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21
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Oliveira LS, Souza LL, Souza AFP, Cordeiro A, Kluck GEG, Atella GC, Trevenzoli IH, Pazos-Moura CC. Perinatal maternal high-fat diet promotes alterations in hepatic lipid metabolism and resistance to the hypolipidemic effect of fish oil in adolescent rat offspring. Mol Nutr Food Res 2016; 60:2493-2504. [PMID: 27342757 DOI: 10.1002/mnfr.201600171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/08/2016] [Accepted: 06/15/2016] [Indexed: 12/18/2022]
Abstract
SCOPE Maternal high-fat diet (HFD) promotes obesity and metabolic disturbances in offspring at weaning and adult life. We investigated metabolic consequences of maternal HFD in adolescent rat offspring and the potential benefic effects of fish oil (FO) (n-3 polyunsaturated fatty acid source). METHODS AND RESULTS Female rats received isocaloric, standard diet (STD: 9% fat) or HFD (28.6%) before mating, and throughout pregnancy and lactation. After weaning, male offspring received standard diet and, from 25th to 45th day, received oral administration of soybean oil (SO) or FO. HFD offspring showed higher body weight and adiposity, which was not attenuated by FO. In STD offspring, FO reduced serum triglyceride and cholesterol, as expected, but not in HFD offspring. Liver of HFD offspring groups showed increased free cholesterol and FO-treated HFD group showed lower expression of Abcg8, suggesting decreased cholesterol biliary excretion. HFD offspring presented higher hepatic expression of lipogenic markers, Srebf1 mRNA and acetyl CoA carboxylase (ACC). Serum n-3 PUFA were decreased in FO-treated HFD compared to FO-treated STD offspring, which may explain the reduced hypolipidemic FO effect. CONCLUSION Maternal HFD impaired the ability of FO to reduce adiposity and serum lipids in adolescent offspring, suggesting a potential predisposition to future development of metabolic disorders.
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Affiliation(s)
- Lorraine S Oliveira
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Luana L Souza
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Aline F P Souza
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Aline Cordeiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - George E G Kluck
- Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Georgia C Atella
- Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Isis H Trevenzoli
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Carmen C Pazos-Moura
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
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22
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Massarani FA, Cunha DB, Muraro AP, Souza BDSND, Sichieri R, Yokoo EM. Familial aggregation and dietary patterns in the Brazilian population. CAD SAUDE PUBLICA 2016; 31:2535-45. [PMID: 26872230 DOI: 10.1590/0102-311x00090314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/10/2015] [Indexed: 12/19/2022] Open
Abstract
The aim of the study was to identify dietary patterns in Brazil and verify aggregation among members of the same family based on the Brazilian National Dietary Survey, a nationwide dietary survey conducted in 2008-2009 in individuals over 10 years of age. Dietary intake was estimated with a food record. Dietary patterns were identified by factor analysis, and familial aggregation was verified by linear regression. Three major dietary patterns were identified: (1) a traditional snack featuring coffee, rolls, oils and fats, and cheese; (2) traditional main meal, based on rice, beans and other legumes, and meat; and (3) fast food type snacks, namely sandwiches, processed meats, soft drinks, snacks, and pizza. Pattern 2 showed the strongest association (β = 0.37-0.64). Patterns 1 and 3 showed positive associations for all pairs of family members, with β ranging from 0.27 to 0.44 and 0.32 to 0.42, respectively. The study showed familial aggregation of dietary patterns in the Brazilian population.
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Affiliation(s)
| | - Diana Barbosa Cunha
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Ana Paula Muraro
- Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso, Cuiabá, Brasil
| | | | - Rosely Sichieri
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Edna Massae Yokoo
- Instituto de Saúde da Comunidade, Universidade Federal Fluminense, Niterói, Brasil
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23
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Funtikova AN, Navarro E, Bawaked RA, Fíto M, Schröder H. Impact of diet on cardiometabolic health in children and adolescents. Nutr J 2015; 14:118. [PMID: 26574072 PMCID: PMC4647337 DOI: 10.1186/s12937-015-0107-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/05/2015] [Indexed: 01/10/2023] Open
Abstract
The manifestation of cardiovascular risk factors, such as hypertension, diabetes, and particularly obesity begins in children and adolescents, with deleterious effects for cardiometabolic health at adulthood. Although the impact of diet on cardiovascular risk factors has been studied extensively in adults, showing that their cardiometabolic health is strongly lifestyle-dependent, less is known about this impact in children and adolescents. In particular, little is known about the relationship between their dietary patterns, especially when derived a posteriori, and cardiovascular risk. An adverse association of cardiovascular health and increased intake of sodium, saturated fat, meat, fast food and soft drinks has been reported in this population. In contrast, vitamin D, fiber, mono-and poly-unsaturated fatty acids, dairy, fruits and vegetables were positively linked to cardiovascular health. The aim of this review was to summarize current epidemiological and experimental evidence on the impact of nutrients, foods, and dietary pattern on cardiometabolic health in children and adolescents. A comprehensive review of the literature available in English and related to diet and cardiometabolic health in this population was undertaken via the electronic databases PubMed, Cochrane Library, and Medline.
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Affiliation(s)
- Anna N Funtikova
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.,Food and Nutrition PhD program, University of Barcelona, Barcelona, Spain
| | - Estanislau Navarro
- Molecular Oncology Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Rowaedh Ahmed Bawaked
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Biomedicine PhD program, University of Pompeu Fabra, Barcelona, Spain
| | - Montserrat Fíto
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.
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A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13-19 years): a cross-sectional study. Br J Nutr 2015; 114:1909-19. [PMID: 26431469 PMCID: PMC4635384 DOI: 10.1017/s0007114515003657] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adolescent obesity is associated with both immediate and longer-term health implications. This study aims to identify dietary patterns among a nationally representative sample of Lebanese adolescents aged between 13 and 19 years (n 446) and to assess the association of these patterns with overweight and obesity. Through face-to-face interviews, socio-demographic, lifestyle and anthropometric variables were collected. Dietary intake was assessed using a sixty-one-item FFQ. Dietary patterns were derived by factor analysis. The following two dietary patterns were identified: Western and traditional Lebanese. The Western pattern was characterised by high consumption of red meat, eggs and fast-food sandwiches. The traditional Lebanese pattern reflected high intakes of fruits and vegetables, legumes and fish. Female sex and a higher maternal education level were associated with a greater adherence to the traditional Lebanese pattern. As for the Western pattern, the scores were negatively associated with crowding index, physical activity and frequency of breakfast consumption. After adjustment, subjects belonging to the 3rd tertile of the Western pattern scores had significantly higher odds of overweight compared with those belonging to the 1st tertile (OR 2·3; 95 % CI 1·12, 4·73). In conclusion, two distinct dietary patterns were identified among adolescents in Lebanon: the traditional Lebanese and the Western, with the latter pattern being associated with an increased risk of overweight. The findings of this study may be used to guide the development of evidence-based preventive nutrition interventions to curb the obesity epidemic in this age group.
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25
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Sayón-Orea C, Bes-Rastrollo M, Martí A, Pimenta AM, Martín-Calvo N, Martínez-González MA. Association between yogurt consumption and the risk of metabolic syndrome over 6 years in the SUN study. BMC Public Health 2015; 15:170. [PMID: 25880313 PMCID: PMC4341573 DOI: 10.1186/s12889-015-1518-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 02/10/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of yogurt consumption in the development of metabolic syndrome (MetS) is not fully understood and the available epidemiologic evidence is scarce. The aim of our study was to assess the association between total, whole-fat, or low-fat yogurt consumption and the risk of developing MetS. METHODS Yogurt consumption was assessed at baseline through a 136-item validated FFQ. MetS was defined following the harmonized definition for MetS according to the AHA and the IDF criteria. Logistic regression models were used. RESULTS During the first 6-y of follow-up of the SUN cohort, 306 incident cases of MetS were identified. Frequent consumption [≥875 g/week (≥7 servings/week) versus ≤ 250 g/week (2 servings/week)] of total, whole-fat and low-fat yogurt consumption showed non-significant inverse associations with MetS [OR = 0.84 (95% CI: 0.60-1.18); 0.98 (95% CI: 0.68-1.41); and 0.63 (95% CI: 0.39-1.02) respectively]. Only one component of the MetS, central adiposity, was inversely associated with total and whole-fat yogurt consumption [OR = 0.85 (95% CI: 0.74-0.98) and 0.85 (95% CI: 0.73-0.99) respectively]. In the joint assessment of exposure to total yogurt consumption and fruit consumption, those in the highest category of total yogurt consumption, and having a high fruit consumption (above the median ≥264.5 g/day) exhibited a significantly lower risk of developing MetS [OR = 0.61 (95% CI: 0.38-0.99)] compared with those in the lowest category of total yogurt consumption and had fruit consumption below the study median. CONCLUSION No significant association between yogurt consumption and MetS was apparent. Only one component out of the 5 MetS criteria, central adiposity, was inversely associated with high yogurt consumption. The combination of high consumption of both yogurt and fruit was inversely associated with the development of MetS.
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Affiliation(s)
- Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Amelia Martí
- CIBERobn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
- Department of Food Sciences and Physiology, School of Pharmacy, University of Navarra, Pamplona, Spain.
| | - Adriano M Pimenta
- Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Metabolic syndrome risk factors are associated with white rice intake in Korean adolescent girls and boys. Br J Nutr 2015; 113:479-87. [DOI: 10.1017/s0007114514003845] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the present study, we examined the associations of total carbohydrate intake, dietary glycaemic load (DGL) and white rice intake with metabolic syndrome risk factors by sex in Korean adolescents. For the present cross-sectional study, data from the Fourth Korea National Health and Nutrition Examination Survey (2007–9) were used. A total of 2209 adolescents (n 1164 boys and n 1045 girls) aged 10–18 years with complete anthropometric, biochemical and dietary intake data were included in the study. Dietary intake data were obtained using the 24 h recall method, and total carbohydrate intake, DGL and white rice intake were divided into quartiles by sex. The metabolic syndrome and its risk factors were defined using the International Diabetes Federation criteria for children and adolescents. Fasting insulin levels and insulin resistance were included as the metabolic syndrome risk factors. All statistical analyses considered the complex sampling design effect and appropriate sampling weights. Multivariate linear regression analysis was used to estimate means with their standard errors of the mean for the metabolic syndrome risk factors across the quartiles of total carbohydrate intake, DGL and white rice intake. While high DGL was significantly associated with increased fasting glucose levels in boys, high total carbohydrate intake, DGL and white rice intake were consistently associated with reduced HDL-cholesterol levels in girls. High white rice intake was significantly associated with an increased risk of insulin resistance and the metabolic syndrome in girls but not in boys. Optimising dietary carbohydrate intake with respect to the source or amount is fundamental to preventing and managing metabolic diseases in Asian adolescents.
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Tavares LF, Castro IRRD, Levy RB, Cardoso LDO, Claro RM. Dietary patterns of Brazilian adolescents: results of the Brazilian National School-Based Health Survey (PeNSE). CAD SAUDE PUBLICA 2014; 30:2679-90. [DOI: 10.1590/0102-311x00016814] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/24/2014] [Indexed: 03/09/2023] Open
Abstract
The objectives of this study were to identify dietary patterns in Brazilian adolescents, describe their distributions in Brazil's State capitals and Federal District, and analyze the correlations with the Municipal Human Development Index (HDI-M). The study analyzed a sample of 60,954 ninth-graders from public and private schools who participated in the National School-Based Health Survey (PeNSE) in 2009. Cluster analysis was used to characterize dietary patterns. Three patterns were identified: healthy (27.7%), unhealthy (34.6%), and mixed (37.7%). Adolescents in the country's Southeast, South, and Central West regions showed a higher proportion of the healthy eating pattern. HDI-M showed a positive correlation with the healthy pattern and a negative correlation with the mixed pattern. The identification of different dietary patterns within and between regions and according to HDI-M highlights the need for better knowledge of each local context in terms of both the magnitude of events and the examination of determinants within these different realities.
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Dibaba DT, Xun P, Fly AD, Yokota K, He K. Dietary magnesium intake and risk of metabolic syndrome: a meta-analysis. Diabet Med 2014; 31:1301-9. [PMID: 24975384 PMCID: PMC4198467 DOI: 10.1111/dme.12537] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/11/2014] [Accepted: 06/24/2014] [Indexed: 12/21/2022]
Abstract
AIMS To estimate quantitatively the association between dietary magnesium intake and risk of metabolic syndrome by combining the relevant published articles using meta-analysis. METHODS We reviewed the relevant literature in PubMed and EMBASE published up until August 2013 and obtained additional information through Google or a hand search of the references in relevant articles. A random-effects or fixed-effects model, as appropriate, was used to pool the effect sizes on metabolic syndrome comparing individuals with the highest dietary magnesium intake with those having the lowest intake. The dose-response relationship was assessed for every 100-mg/day increment in magnesium intake and risk of metabolic syndrome. RESULT Six cross-sectional studies, including a total of 24 473 individuals and 6311 cases of metabolic syndrome, were identified as eligible for the meta-analysis. A weighted inverse association was found between dietary magnesium intake and the risk of metabolic syndrome (odds ratio 0.69, 95% CI 0.59, 0.81) comparing the highest with the lowest group. For every 100-mg/day increment in magnesium intake, the overall risk of having metabolic syndrome was lowered by 17% (odds ratio 0.83, 95% CI 0. 77, 0.89). CONCLUSION Findings from the present meta-analysis suggest that dietary magnesium intake is inversely associated with the prevalence of metabolic syndrome. Further studies, in particular well-designed longitudinal cohort studies and randomized placebo-controlled clinical trials, are warranted to provide solid evidence and to establish causal inference.
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Affiliation(s)
- D T Dibaba
- Department of Epidemiology and Biostatistics, School of Public Health--Bloomington, Indiana University, Bloomington, IN, USA
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Childhood obesity and insulin resistance: how should it be managed? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:351. [PMID: 25293340 DOI: 10.1007/s11936-014-0351-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OPINION STATEMENT Concomitant with the rise in global pediatric obesity in the past decades, there has been a significant increase in the number of children and adolescents with clinical signs of insulin resistance. Given insulin resistance is the important link between obesity and the associated metabolic abnormalities and cardiovascular risk, clinicians should be aware of high risk groups and treatment options. As there is no universally accepted biochemical definition of insulin resistance in children and adolescents, identification and diagnosis of insulin resistance usually relies on clinical features such as acanthosis nigricans, polycystic ovary syndrome, hypertension, dyslipidemia, and nonalcoholic fatty liver disease. Treatment for reducing insulin resistance and other obesity-associated comorbidities should focus on changes in health behaviors to achieve effective weight management. Lifestyle interventions incorporating dietary change, increased physical activity, and decreased sedentary behaviors, with the involvement of family and adoption of a developmentally appropriate approach, should be used as the first line treatment. Current evidence suggests that the primary objective of dietary interventions should be to reduce total energy intake and a combination of aerobic and resistance training should be encouraged. Metformin can be used in conjunction with a lifestyle intervention program in obese adolescents with clinical insulin resistance to achieve weight loss and to improve insulin sensitivity. Ongoing evaluation and research are required to explore optimal protocol and long-term effectiveness of lifestyle interventions, as well as to determine whether the improvements in insulin sensitivity induced by lifestyle interventions and weight loss will lead to a clinical benefit including reduced cardiovascular morbidity and mortality.
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Abstract
Metabolic syndrome (MetS) is a cluster of risk factors that significantly increases the risk of cardiovascular disease. The lack of universally accepted diagnosis criteria makes it difficult to know the real prevalence of MetS in both adult and pediatric population. Lifestyle, especially nutritional habits and physical activity, have been suggested to be independent risk factors for the development of MetS. Recent studies highlight the need to prioritize overall dietary patterns, rather than isolated nutrients, to better appraise the associations between nutritional habits and MetS. In this review we summarize recently published intervention trials and systematic reviews that evaluated the association between overall dietary patterns and the risk of MetS. Westernized dietary patterns, characterized by a high consumption of meat or meat products, snacks, baked desserts and sugar-sweetened beverages, which provide high amounts of saturated fatty acids and simple carbohydrates as added sugars, have been associated with higher risk of MetS. In contrast, more traditional dietary patterns, including the Mediterranean dietary pattern (MDP), characterized by a high consumption of vegetables, fruits, whole cereals and fish are associated with a reduced risk of MetS. The main characteristics of the MDP include a high consumption of nuts and olive oil, resulting in a relatively fat-rich pattern that provides high amounts of mono- and polyunsaturated fatty acids, bioactive polyphenols and dietary fiber. Strong evidence is accumulating to support that a closer conformity with the MDP is inversely associated with the incidence of MetS, cardiovascular risk factors, diabetes and cardiovascular disease.
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Lee JY, Jun N, Baik I. Associations between dietary patterns and screen time among Korean adolescents. Nutr Res Pract 2013; 7:330-5. [PMID: 23964322 PMCID: PMC3746169 DOI: 10.4162/nrp.2013.7.4.330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/17/2013] [Accepted: 06/21/2013] [Indexed: 01/12/2023] Open
Abstract
Data are limited on the association between dietary patterns and screen time among Korean adolescents. The present study identified dietary patterns of 691 adolescents, aged 13-18 years, who had participated in the Third Korean National Health and Nutrition Examination Survey (KNHANES III) and analyzed their associations with screen time. Screen time was defined as the time spent watching TV, using a computer, or playing video games was calculated as a sum of all these times. Dietary patterns and their factor scores were derived from a food frequency questionnaire using the factor analysis method. To analyze the association between dietary patterns and screen time, we conducted multiple linear regression analysis. We also performed multiple logistic regression analysis to estimate odds ratios (OR) of excessive screen time (2 hours or longer per day) and 95% confidence intervals (CI). We identified 2 dietary patterns labeled "the Korean healthy dietary pattern" and "the Western diet and fast foods pattern". The former included mixed grains, legumes, potatoes, red meat, eggs, fish, dairy products, fruits, vegetables, seaweeds, and mushrooms, whereas the latter included noodles, bread, red meat, poultry, fast foods, snack, and soft drinks. After controlling for potential confounding factors, factor scores for the Korean healthy dietary pattern were inversely associated (P-value for trend < 0.01) and those for the Western diet and fast foods pattern were positively associated with the screen time (P-value for trend < 0.01). Adolescents in the top tertile of the scores for the Korean healthy dietary pattern had a multivariable-adjusted OR [95% CI] of 0.44 (0.25-0.75) for excessive screen time compared with those in the lowest tertile. On the basis of these findings, adolescents who have excessive screen time may need to be encouraged to consume a more healthy diet.
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Affiliation(s)
- Jae Yeon Lee
- Department of Foods and Nutrition, College of Natural Sciences, Kookmin University, 861-1 Jeongnung-dong, Songbuk-gu, Seoul 136-702, Korea
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