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Huey SL, Mehta NH, Steinhouse RS, Jin Y, Kibbee M, Kuriyan R, Finkelstein JL, Mehta S. Precision nutrition-based interventions for the management of obesity in children and adolescents up to the age of 19 years. Cochrane Database Syst Rev 2025; 1:CD015877. [PMID: 39882755 PMCID: PMC12045580 DOI: 10.1002/14651858.cd015877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
BACKGROUND Precision nutrition-based methods develop tailored interventions and/or recommendations accounting for determinants of intra- and inter-individual variation in response to the same diet, compared to current 'one-size-fits-all' population-level approaches. Determinants may include genetics, current dietary habits and eating patterns, circadian rhythms, health status, gut microbiome, socioeconomic and psychosocial characteristics, and physical activity. In this systematic review, we examined the evidence base for the effect of interventions based on precision nutrition approaches on overweight and obesity in children and adolescents to help inform future research and global guidelines. OBJECTIVES To examine the impact of precision nutrition-based interventions for the management of obesity in children and adolescents in all their diversity. SEARCH METHODS We searched CENTRAL, MEDLINE, CINAHL, Web of Science Core Collection, BIOSIS Previews, Global Index Medicus (all regions), IBECS, SciELO, PAHO, PAHO IRIS, WHO IRIS, WHOLIS, Bibliomap, and TRoPHI, as well as the WHO ICTRP and ClinicalTrials.gov. We last searched the databases on 23 July 2024. We did not apply any language restrictions. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials that evaluated precision nutrition-based interventions (accounting for 'omics' such as phenotyping, genotyping, gut microbiome; clinical data, baseline dietary intake, postprandial glucose response, etc., and/or including artificial intelligence such as machine learning methods) compared to general or one-size-fits-all interventions or no intervention in children and adolescents aged 0 to 9 years or 10 to 19 years with overweight or obesity. DATA COLLECTION AND ANALYSIS Two review authors independently conducted study screening, data extraction, and risk of bias and GRADE assessments. We used fixed-effect analyses. Our outcomes of interest were physical and mental well-being, physical activity, health-related quality of life, obesity-associated disability, and adverse events associated with the interventions as defined or measured by trialists, and weight change (reduction, stabilisation or maintenance). MAIN RESULTS Two studies (3 references, 105 participants) conducted in Ukraine and Greece met our eligibility criteria. One study reported nonprofit funding sources, whilst the other did not report funding, and the certainty of evidence ranged from very low to low across outcomes (all measured at endpoint). Only one trial (65 participants) contributed data on our primary outcomes of interest. Precision nutrition-based intervention versus one-size-fits-all intervention or standard of care In children 0 to 9 years of age, evidence is very uncertain about the effect of a precision nutrition-based intervention (a computerised Decision Support Tool (DST) that incorporates a variety of participant data and provides personalised diet recommendations based on decision-tree algorithms) on body mass index (BMI) (mean difference (MD) -1.40 kg/m2, 95% confidence interval (CI) -3.48 to 0.68; 1 study, 35 participants; very low-certainty evidence) and on weight (MD -2.60 kg, 95% CI -8.42 to 3.22; 1 study, 35 participants; very low-certainty evidence) compared with a one-size-fits-all control intervention. In children and adolescents 10 to 19 years of age, evidence is very uncertain about the effect of a precision nutrition-based intervention (computerised DST) on BMI (MD 3.00 kg/m2, 95% CI -0.26 to 6.26; 1 study, 30 participants; very low-certainty evidence) and on weight (MD 11.40 kg, 95% CI -0.47 to 23.27; 1 study, 30 participants; very low-certainty evidence) compared with a one-size-fits-all control intervention. AUTHORS' CONCLUSIONS Based on data from two small studies with a total of 105 participants, the evidence is very uncertain about the effect of precision nutrition-based interventions on body weight or BMI. This review was limited by the number of available randomised controlled trials in this relatively nascent field. Given these limitations, the two studies do not provide sufficient evidence to adequately inform practice. Future research should report participant outcome data, including outcomes related to mental, emotional, and functional well-being, in addition to biochemical and physical measures, stratified by World Health Organization-defined age groups (children (0 to 9 years), and children and adolescents (10 to 19 years)). Future studies should also report methods related to randomisation, blinding, and compliance, as well as include prespecified analysis plans.
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Affiliation(s)
- Samantha L Huey
- Cornell Joan Klein Jacobs Center for Precision Nutrition and Health, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Neel H Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Ruth S Steinhouse
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Yue Jin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Matthew Kibbee
- Albert R. Mann Library, Cornell University, Ithaca, NY, USA
| | - Rebecca Kuriyan
- Division of Nutrition, St Johns Research Institute, Bengaluru, India
| | - Julia L Finkelstein
- Cornell Joan Klein Jacobs Center for Precision Nutrition and Health, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Cornell Joan Klein Jacobs Center for Precision Nutrition and Health, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Dâmaso AR, Masquio DCL, Campos RMDS, Corgosinho FC, Cercato C. Effects of multidisciplinary therapy on energy balance, inflammation, and metabolic diseases in adolescents with obesity: A narrative review. Ann N Y Acad Sci 2024; 1542:25-50. [PMID: 39549018 DOI: 10.1111/nyas.15251] [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] [Indexed: 11/18/2024]
Abstract
Obesity is a consequence of multiple factors, including genetics, lifestyle and nutritional choices, physical activity, sleep duration, screen time, and mood disorders. These behavioral elements can impair the regulation of energy balance and obesity management that link obesity to a constellation of chronic conditions that lead to a high prevalence of cardiometabolic risk factors, metabolic syndrome, and nonalcoholic fatty liver disease. Multidisciplinary therapy is defined as an approach delivered by a multidisciplinary-trained health team covering at least two components of behavior, physical activity/exercise, dietary habits, and/or psychological counseling associated with clinical interventions. This narrative review summarizes the effects of multidisciplinary therapy on neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, metabolic syndrome, nonalcoholic fatty liver diseases, behavior, and quality of life. We found that multidisciplinary therapy, including medical, nutritional, exercise, and behavioral counseling, and/or education, was useful for addressing outcomes such as visceral adiposity, neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, nonalcoholic fatty liver disease, and metabolic syndrome. The effects were mediated by improvements in neuroendocrine regulation of energy balance, downregulation of the pro-inflammatory states, and a reduction in comorbidities. Multidisciplinary therapy also improved mood disorders and quality of life.
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Affiliation(s)
- Ana Raimunda Dâmaso
- Post-Graduate Program of Nutrition-Federal University of São Paulo-Paulista Medicine School-UNIFESP-EPM, São Paulo, Brazil
- Brazilian Association for the Study of Obesity and Metabolic Syndrome-ABESO, São Paulo, Brazil
| | - Deborah Cristina Landi Masquio
- Post-Graduate Program of Nutrition-Federal University of São Paulo-Paulista Medicine School-UNIFESP-EPM, São Paulo, Brazil
- Centro Universitário São Camilo-Post-Graduate Program of Professional Nutrition: from Birth to Adolescence - Undergraduate course in Nutrition and Medicine, São Paulo, Brazil
| | - Raquel Munhoz da Silveira Campos
- Post-Graduate Program of Interdisciplinary in Health Sciences-Federal University of São Paulo-Campus Baixada Santista-UNIFESP, Santos, Brazil
| | | | - Cintia Cercato
- Brazilian Association for the Study of Obesity and Metabolic Syndrome-ABESO, São Paulo, Brazil
- University of São Paulo-Medicine School-Post-Graduate Program of Endocrinology, São Paulo, Brazil
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Zarei I, Eloranta AM, Klåvus A, Väistö J, Lehtonen M, Mikkonen S, Koistinen VM, Sallinen T, Haapala EA, Lintu N, Soininen S, Haikonen R, Atalay M, Schwab U, Auriola S, Kolehmainen M, Hanhineva K, Lakka TA. Eight-year diet and physical activity intervention affects serum metabolites during childhood and adolescence: A nonrandomized controlled trial. iScience 2024; 27:110295. [PMID: 39055945 PMCID: PMC11269805 DOI: 10.1016/j.isci.2024.110295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/16/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Long-term lifestyle interventions in childhood and adolescence can significantly improve cardiometabolic health, but the underlying molecular mechanisms remain poorly understood. To address this knowledge gap, we conducted an 8-year diet and physical activity intervention in a general population of children. The research revealed that the intervention influenced 80 serum metabolites over two years, with 17 metabolites continuing to be affected after eight years. The intervention primarily impacted fatty amides, including palmitic amide, linoleamide, oleamide, and others, as well as unsaturated fatty acids, acylcarnitines, phospholipids, sterols, gut microbiota-derived metabolites, amino acids, and purine metabolites. Particularly noteworthy were the pronounced changes in serum fatty amides. These serum metabolite alterations could represent molecular mechanisms responsible for the observed benefits of long-term lifestyle interventions on cardiometabolic and overall health since childhood. Understanding these metabolic changes may provide valuable insights into the prevention of cardiometabolic and other non-communicable diseases since childhood.
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Affiliation(s)
- Iman Zarei
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Aino-Maija Eloranta
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Anton Klåvus
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juuso Väistö
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marko Lehtonen
- School of Pharmacy, Faculty of Health Science, University of Eastern Finland, Kuopio, Finland
- LC-MS Metabolomics Center, Biocenter Kuopio, Kuopio, Finland
| | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ville M. Koistinen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Food Chemistry and Food Development Unit, Department of Biochemistry, University of Turku, Turku, Finland
| | - Taisa Sallinen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eero A. Haapala
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Lintu
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sonja Soininen
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Physician and Nursing Services, Health and Social Services Centre, Wellbeing Services County of North Savo, Varkaus, Finland
| | - Retu Haikonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mustafa Atalay
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Seppo Auriola
- School of Pharmacy, Faculty of Health Science, University of Eastern Finland, Kuopio, Finland
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kati Hanhineva
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Food Chemistry and Food Development Unit, Department of Biochemistry, University of Turku, Turku, Finland
| | - Timo A. Lakka
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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Zembura M, Lula P, Matusik P. Ten-Year Differences in Nutritional Status and Obesity-Related Risk Factors in Polish Preschool Children. CHILDREN 2023; 10:children10040636. [PMID: 37189885 DOI: 10.3390/children10040636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
The aim of this study was to assess ten-year differences in nutritional statuses and obesity prevalences between populations of preschool children from Katowice, Poland, examined in 2007 and 2017, and to determine factors associated with overweight and obesity in preschool children. A cross-sectional questionnaire was conducted among parents and legal guardians of 276 preschool children in 2007 and 259 preschool children in 2017. Basic anthropometric measurements were performed. Overall, the prevalence of overweight and obesity among our sample of Polish preschool children (median age 5.25 year) was 16.82%, whereas 4.49% of children were obese. No significant differences in the number of overweight and obese children were observed when comparing the years 2017 to 2007. Overall body mass index (BMI) z-score was significantly lower in this group of children from 2017. However, median values of the BMI z-score were higher in two of the weight categories (overweight and obesity) in 2017. The child’s BMI z-score was positively correlated with birth weight (r = 0.1, p < 0.05). The BMI z-score was positively correlated with maternal BMI, paternal BMI, and maternal pregnancy weight gain, r = 0.24 p < 0.01; r = 0.16 p < 0.01; r = 0.12 p < 0.05, respectively. A decrease in overweight and obesity prevalence over the past decade and higher median values of BMI z-scores in the group of children with excessive weight in 2017 were observed. Birth weight, maternal BMI, paternal BMI, and maternal pregnancy weight gain all correlate positively with a child’s BMI z-score.
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Feigin VL, Owolabi M, Hankey GJ, Pandian J, Martins SC. Digital Health in Primordial and Primary Stroke Prevention: A Systematic Review. Stroke 2022; 53:1008-1019. [PMID: 35109683 DOI: 10.1161/strokeaha.121.036400] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without effective and widely implemented primordial and primary stroke prevention measures, including those on the individual level. The unprecedented growth of smartphone and other digital technologies with digital solutions are now being used in almost every area of health, offering a unique opportunity to improve primordial and primary stroke prevention on the individual level. However, there are several issues that need to be considered to advance development and use this important digital strategy for primordial and primary stroke prevention. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we provide a systematic review of the current knowledge, challenges, and opportunities of digital health in primordial and primary stroke prevention.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand (V.L.F.).,Institute for Health Metrics Evaluation, University of Washington, Seattle (V.L.F.).,Research Centre of Neurology, Moscow, Russia (V.L.F.)
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan and Blossom Specialist Medical Center, Ibadan, Nigeria (M.O.O.)
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia. Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.)
| | | | - Sheila C Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network (S.M.)
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Siddiqui KN. Diet as a tool for primordial cardiovascular prevention in developing countries. Panminerva Med 2021; 63:104-109. [PMID: 33878847 DOI: 10.23736/s0031-0808.21.04268-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a rising burden of non-communicable disease (NCD), especially cardiovascular diseases (CVD) in the developing nations to an extent that they are sometimes terms as NCD epidemics. If unchecked, these NCD epidemics, can impact the healthcare systems and adversely affect the development of the whole country. While CVD is a matter of concern worldwide, it is even more so in low- and middle-income countries, where the incidence and prevalence of these diseases are much worse than developed countries, owning to their large population. According to the WHO, CVDs cause 28.5% of all deaths, in the developing nations. Even within the developing countries, the profile of CVD varies greatly, depending on the phase of epidemiological transition the country is currently undergoing. While primary prevention is about treating risk factors to prevent CVD, primordial prevention refers to avoiding the development of risk factors in the first place. As we now know, atherosclerosis starts in youth and is related to dyslipidemia, smoking, and hypertension, Body Mass Index and blood glucose levels. Therefore, the primordial prevention must start early in life. High-quality clinical trials have traditionally been mainly focusing on primary and secondary prevention settings. There are some key studies that evaluated the role of diet in primordial setting that were discussed in this review.
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Affiliation(s)
- Khawer N Siddiqui
- Unit of Cardiology, Department of Cardiology, Ruby General Hospital, Kolkata, India -
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7
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Wu Y, Marc I, Bouchard L, Ouyang F, Luo ZC, Fan J, Dubois L, Mâsse B, Zhang J, Leung PCK, Liao XP, Herba CM, Booij L, Shen J, Lewin A, Jiang H, Wang L, Xu J, Wu W, Sun W, Wu J, Li H, Lei C, Kozyrskyj A, Semenic S, Chaillet N, Fortier I, Masse L, Zhan J, Allard C, Knoppers B, Zawati M, Baillargeon JP, Velez MP, Zhang H, Yu Y, Yu W, Ding Y, Vaillancourt C, Liu H, Tetu A, Fang W, Zhang R, Zhao X, Jin Y, Liu XM, Zhang H, Chen Z, Yang X, Hao YH, Abdelouahab N, Fraser W, Huang HF. Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obesity. BMJ Open 2021; 11:e045192. [PMID: 33795307 PMCID: PMC8021741 DOI: 10.1136/bmjopen-2020-045192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk. METHODS AND ANALYSIS This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie-CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation. TRIAL REGISTRATION NUMBER ChiCTR1800017773. PROTOCOL VERSION November 11, 2020 (Version #5).
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Affiliation(s)
- Yanting Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
| | - Isabelle Marc
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Luigi Bouchard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fengxiu Ouyang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Zhong-Cheng Luo
- Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jianxia Fan
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Lise Dubois
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benoît Mâsse
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Jun Zhang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Peter C K Leung
- The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Xiang Peng Liao
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - C M Herba
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Linda Booij
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Department of Psychology, Concordia University, Montreal, Québec, Canada
| | - Jian Shen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Antoine Lewin
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hong Jiang
- Department of Maternal and Child Care, School of Public Health, Fudan University, Shanghai, China
| | - Liping Wang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jian Xu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Weibin Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Wenguang Sun
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jiahao Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Chen Lei
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - N Chaillet
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Louise Masse
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Janelle Zhan
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Catherine Allard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Hanqiu Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wen Yu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Ding
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Caroline Vaillancourt
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Han Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Amelie Tetu
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Wenli Fang
- Changing Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Rong Zhang
- Department of Obstetrics and Gynecology, Shanghai Fengxian Central Hospital, Shanghai, China
| | - Xinzhi Zhao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Jin
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xin-Mei Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Huijuan Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Zhirou Chen
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xi Yang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan-Hui Hao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Nadia Abdelouahab
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - William Fraser
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - He-Feng Huang
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
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Lehtovirta M, Matthews LA, Laitinen TT, Nuotio J, Niinikoski H, Rovio SP, Lagström H, Viikari JSA, Rönnemaa T, Jula A, Ala-Korpela M, Raitakari OT, Pahkala K. Achievement of the Targets of the 20-Year Infancy-Onset Dietary Intervention-Association with Metabolic Profile from Childhood to Adulthood. Nutrients 2021; 13:nu13020533. [PMID: 33562015 PMCID: PMC7915301 DOI: 10.3390/nu13020533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023] Open
Abstract
The Special Turku Coronary Risk Factor Intervention Project (STRIP) is a prospective infancy-onset randomized dietary intervention trial targeting dietary fat quality and cholesterol intake, and favoring consumption of vegetables, fruit, and whole-grains. Diet (food records) and circulating metabolites were studied at six time points between the ages of 9-19 years (n = 549-338). Dietary targets for this study were defined as (1) the ratio of saturated fat (SAFA) to monounsaturated and polyunsaturated fatty acids (MUFA + PUFA) < 1:2, (2) intake of SAFA < 10% of total energy intake, (3) fiber intake ≥ 80th age-specific percentile, and (4) sucrose intake ≤ 20th age-specific percentile. Metabolic biomarkers were quantified by high-throughput nuclear magnetic resonance metabolomics. Better adherence to the dietary targets, regardless of study group allocation, was assoiated with higher serum proportion of PUFAs, lower serum proportion of SAFAs, and a higher degree of unsaturation of fatty acids. Achieving ≥ 1 dietary target resulted in higher low-density lipoprotein (LDL) particle size, lower circulating LDL subclass lipid concentrations, and lower circulating lipid concentrations in medium and small high-density lipoprotein subclasses compared to meeting 0 targets. Attaining more dietary targets (≥2) was associated with a tendency to lower lipid concentrations of intermediate-density lipoprotein and very low-density lipoprotein subclasses. Thus, adherence to dietary targets is favorably associated with multiple circulating fatty acids and lipoprotein subclass lipid concentrations, indicative of better cardio-metabolic health.
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Affiliation(s)
- Miia Lehtovirta
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
- Correspondence: ; Tel.: +358-2333-7552
| | - Laurie A. Matthews
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
| | - Tomi T. Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
- Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, 20520 Turku, Finland
| | - Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
- Heart Center, Turku University Hospital, University of Turku, 20520 Turku, Finland
| | - Harri Niinikoski
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, 20520 Turku, Finland;
| | - Suvi P. Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
| | - Hanna Lagström
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
- Department of Public Health, Turku University Hospital, University of Turku, 20520 Turku, Finland
| | - Jorma S. A. Viikari
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, 20520 Turku, Finland; (J.S.A.V.); (T.R.)
| | - Tapani Rönnemaa
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, 20520 Turku, Finland; (J.S.A.V.); (T.R.)
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, 20750 Turku, Finland;
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu & Biocenter Oulu, 90014 Oulu, Finland;
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, 70210 Kuopio, Finland
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, 20520 Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland; (L.A.M.); (T.T.L.); (J.N.); (S.P.R.); (O.T.R.); (K.P.)
- Centre for Population Health Research, Turku University Hospital, University of Turku, 20520 Turku, Finland;
- Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, 20520 Turku, Finland
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9
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He S, Stein AD. Early-Life Nutrition Interventions and Associated Long-Term Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2020; 12:461-489. [PMID: 33786595 PMCID: PMC8009753 DOI: 10.1093/advances/nmaa107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/08/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Early-life nutrition interventions can have lifelong cardiometabolic benefits. Most evidence on this topic is derived from observational studies. We evaluated the association of randomized controlled nutritional trials in early life and long-term cardiometabolic outcomes. Through literature search of PubMed, CABI Global Health, Embase, and Cochrane, with manual reference check and weekly alert from PubMed, we identified 8312 records, and included 53 records from 40 cohorts in 21 countries. The total number of participants was 33,551. Interventions were initiated as early as conception, and the longest until 7 y (except 1 study from infancy to 20 y). The cohorts were followed up for between 3 and 73 y. We identified 7 types of interventions (protein-energy supplements, long-chain PUFAs, single micronutrient, multiple micronutrients, infant and young child feeding, dietary counseling, and other) and 4 categories of cardiometabolic outcomes (biomarkers, cardiovascular, body size and composition, and subclinical/clinical outcomes). Most findings were null. Fasting glucose concentration was 0.04 mmol/L lower (95% CI: -0.05, -0.02 mmol/L; I2 = 0%) in the intervention groups than in the control groups (15 studies). BMI (kg/m2) was 0.20 higher (95% CI: 0.12, 0.28; I2 = 54%) in the intervention groups than control groups (14 studies). No significant effect was observed for total cholesterol (12 studies) or blood pressure (17 studies). Ongoing and personalized dietary counseling was associated with lower glucose and cholesterol, better endothelial function, and reduced risk of metabolic syndrome. The timing of intervention mattered, with earlier initiation conferring greater benefit (improved lipid profile and marginally lower glucose concentration) based on 2 studies. In sum, glucose concentration was lower following early-life nutrition interventions, but there is a risk of unintended consequences, including higher BMI. Maternal and child nutrition interventions must be evidence-based and tailored to each population to promote long-term cardiometabolic health.
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Affiliation(s)
- Siran He
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
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10
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Laitinen TT, Nuotio J, Niinikoski H, Juonala M, Rovio SP, Viikari JSA, Rönnemaa T, Magnussen CG, Sabin M, Burgner D, Jokinen E, Lagström H, Jula A, Simell O, Raitakari OT, Pahkala K. Attainment of Targets of the 20-Year Infancy-Onset Dietary Intervention and Blood Pressure Across Childhood and Young Adulthood: The Special Turku Coronary Risk Factor Intervention Project (STRIP). Hypertension 2020; 76:1572-1579. [PMID: 32921196 DOI: 10.1161/hypertensionaha.120.15075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined whether success in achieving the key targets of an infancy-onset 20-year dietary intervention was associated with blood pressure (BP) from infancy to young adulthood. In the prospective randomized STRIP (Special Turku Coronary Risk Factor Intervention Project; n=877 children), dietary counseling was provided biannually based on the Nordic Nutrition Recommendations primarily to improve the quality of dietary fat in children's diets and secondarily to promote intake of vegetables, fruits, and whole grains. Dietary data and BP were accrued annually from the age of 13 months to 20 years. The dietary targets for fat quality were defined as the ratio of saturated fatty acids to monounsaturated and polyunsaturated fatty acids <1:2 and intake of saturated fatty acids <10 E%, dietary fiber intake in the top age-specific quintile, and dietary sucrose intake as being in the lowest age-specific quintile. Attaining a higher number of the dietary targets was associated with lower systolic BP (mean [SE] systolic BP, 107.3 [0.3], 107.6 [0.3], 106.8 [0.3], and 106.7 [0.5] mm Hg in participants meeting 0, 1, 2, and 3 to 4 targets, respectively; P=0.03) and diastolic BP (mean [SE] diastolic BP, 60.4 [0.2], 60.5 [0.2], 59.9 [0.2], and 59.9 [0.3] mm Hg; P=0.02). When the lowest age-specific quintile of dietary cholesterol was added as an additional target, the association with systolic BP remained significant (P=0.047), but the association with diastolic BP attenuated (P=0.13). Achieving the key targets of an infancy-onset 20-year dietary intervention, reflecting dietary guidelines, was favorably albeit modestly associated with systolic and diastolic BP from infancy to young adulthood. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT00223600.
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Affiliation(s)
- Tomi T Laitinen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (T.T.L., J.N., S.P.R., C.G.M., O.T.R., K.P.), University of Turku, Finland.,Sports and Exercise Medicine Unit, Department of Physical Activity and Health, Paavo Nurmi Centre (T.T.L., K.P.), University of Turku, Finland.,Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland.,Murdoch Children's Research Institute (T.T.L., J.N., M.S., D.B.), The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Joel Nuotio
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (T.T.L., J.N., S.P.R., C.G.M., O.T.R., K.P.), University of Turku, Finland.,Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland.,Heart Center (J.N.), Turku University Hospital, University of Turku, Finland.,Murdoch Children's Research Institute (T.T.L., J.N., M.S., D.B.), The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Harri Niinikoski
- Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland.,Department of Paediatrics and Adolescent Medicine (H.N., O.S.), Turku University Hospital, University of Turku, Finland
| | - Markus Juonala
- Department of Medicine (M.J., J.S.A.V., T.R.), University of Turku, Finland.,Division of Medicine, Turku University Hospital, Finland (M.J., J.S.A.V., T.R.)
| | - Suvi P Rovio
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (T.T.L., J.N., S.P.R., C.G.M., O.T.R., K.P.), University of Turku, Finland.,Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine (M.J., J.S.A.V., T.R.), University of Turku, Finland.,Division of Medicine, Turku University Hospital, Finland (M.J., J.S.A.V., T.R.)
| | - Tapani Rönnemaa
- Department of Medicine (M.J., J.S.A.V., T.R.), University of Turku, Finland.,Division of Medicine, Turku University Hospital, Finland (M.J., J.S.A.V., T.R.)
| | - Costan G Magnussen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (T.T.L., J.N., S.P.R., C.G.M., O.T.R., K.P.), University of Turku, Finland.,Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.)
| | - Matthew Sabin
- Murdoch Children's Research Institute (T.T.L., J.N., M.S., D.B.), The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Endocrinology (M.S.), The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia (M.S., D.B.)
| | - David Burgner
- Murdoch Children's Research Institute (T.T.L., J.N., M.S., D.B.), The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia (M.S., D.B.).,Department of Paediatrics, Monash University, Clayton, Victoria, Australia (D.B.)
| | - Eero Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Finland (E.J.)
| | - Hanna Lagström
- Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland.,Department of Public Health (H.L.), Turku University Hospital, University of Turku, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland (A.J.)
| | - Olli Simell
- Department of Paediatrics and Adolescent Medicine (H.N., O.S.), Turku University Hospital, University of Turku, Finland
| | - Olli T Raitakari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (T.T.L., J.N., S.P.R., C.G.M., O.T.R., K.P.), University of Turku, Finland.,Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland.,Department of Public Health (H.L.), Turku University Hospital, University of Turku, Finland
| | - Katja Pahkala
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (T.T.L., J.N., S.P.R., C.G.M., O.T.R., K.P.), University of Turku, Finland.,Sports and Exercise Medicine Unit, Department of Physical Activity and Health, Paavo Nurmi Centre (T.T.L., K.P.), University of Turku, Finland.,Centre for Population Health Research (T.T.L., J.N., H.N., S.P.R., C.G.M., H.L., O.T.R., K.P.), Turku University Hospital, University of Turku, Finland
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11
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Laitinen TT, Nuotio J, Rovio SP, Niinikoski H, Juonala M, Magnussen CG, Jokinen E, Lagström H, Jula A, Viikari JSA, Rönnemaa T, Simell O, Raitakari OT, Pahkala K. Dietary Fats and Atherosclerosis From Childhood to Adulthood. Pediatrics 2020; 145:peds.2019-2786. [PMID: 32209700 DOI: 10.1542/peds.2019-2786] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The association of dietary fat distribution with markers of subclinical atherosclerosis during early life is unknown. We examined whether success in achieving the main target of an infancy-onset dietary intervention based on the distribution of dietary fat was associated with aortic and carotid intima-media thickness (IMT) and distensibility from childhood to young adulthood. METHODS In the prospective randomized controlled Special Turku Coronary Risk Factor Intervention Project trial, personalized dietary counseling was given biannually to healthy children from infancy to young adulthood. The counseling was based on Nordic Nutrition Recommendations, with the main aim of improving the distribution of dietary fat in children's diets. IMT and distensibility of the abdominal aorta and common carotid artery were measured repeatedly at ages 11 (n = 439), 13 (n = 499), 15 (n = 506), 17 (n = 477), and 19 years (n = 429). The targeted distribution of dietary fat was defined as a ratio of saturated fatty acids to monounsaturated and polyunsaturated fatty acids of <1:2 and as an intake of saturated fatty acids of <10% of energy intake. Participants who met ≥1 of these 2 criteria were defined to achieve the main intervention target. RESULTS Individuals who achieved the main intervention target had lower aortic IMT (age- and sex-adjusted mean difference 10.4 µm; 95% confidence interval: 0.3 to 20.5 µm) and better aortic distensibility (0.13% per 10 mm Hg; 95% confidence interval: 0.00% to 0.26% per10 mm Hg) compared with their peers who did not meet the target. CONCLUSIONS Achieving the main target of an infancy-onset dietary intervention, reflecting dietary guidelines, was favorably associated with aortic IMT and distensibility during the early life course. These data support the recommendation of favoring unsaturated fat to enhance arterial health.
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Affiliation(s)
- Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and .,Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Departments of Physical Activity and Health and
| | - Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and
| | - Suvi P Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and
| | | | | | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Eero Jokinen
- Department of Pediatric Cardiology, University of Helsinki and Hospital for Children and Adolescents, Helsinki, Finland; and
| | | | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | | | | | - Olli Simell
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and.,Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine and Centre for Population Health Research and.,Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Departments of Physical Activity and Health and
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12
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Kartiosuo N, Ramakrishnan R, Lemeshow S, Juonala M, Burns TL, Woo JG, Jacobs DR, Daniels SR, Venn A, Steinberger J, Urbina EM, Bazzano L, Sabin MA, Hu T, Prineas RJ, Sinaiko AR, Pahkala K, Raitakari O, Dwyer T. Predicting overweight and obesity in young adulthood from childhood body-mass index: comparison of cutoffs derived from longitudinal and cross-sectional data. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:795-802. [DOI: 10.1016/s2352-4642(19)30204-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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13
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Larqué E, Labayen I, Flodmark CE, Lissau I, Czernin S, Moreno LA, Pietrobelli A, Widhalm K. From conception to infancy - early risk factors for childhood obesity. Nat Rev Endocrinol 2019; 15:456-478. [PMID: 31270440 DOI: 10.1038/s41574-019-0219-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/25/2022]
Abstract
Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.
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Affiliation(s)
- Elvira Larqué
- Department of Physiology, University of Murcia, Murcia, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD) and Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carl-Erik Flodmark
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
| | - Inge Lissau
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
- Clinical Research Centre, University Hospital Copenhagen, Hvidovre, Denmark
| | - Sarah Czernin
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kurt Widhalm
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
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14
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Koplin JJ, Kerr JA, Lodge C, Garner C, Dharmage SC, Wake M, Allen KJ. Infant and young child feeding interventions targeting overweight and obesity: A narrative review. Obes Rev 2019; 20 Suppl 1:31-44. [PMID: 31419047 DOI: 10.1111/obr.12798] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
findings from systematic reviews into infant feeding and later adiposity are largely negative. World Health Organization (WHO) is auspicing Healthy Life Trajectories Initiative (HeLTI), a suite of trials aiming to prevent overweight/obesity in childhood. To inform planning, this narrative review sought to detail potentially effective components of nutrition-related interventions involving children aged 0 to 2 years. Systematic searches of PubMed and the Cochrane Library (2006-2016) identified 108 systematic reviews. These included 31 randomized trials in the age group of interest. Of these, 11 reported greater than or equal to 1 statistically significant (P < 0.05) benefit on body weight and/or composition. Six multicomponent trials whose interventions incorporated education to promote breastfeeding (four trials), responsive feeding (two trials), and healthy diet (eg, increasing fruit and vegetables and limiting unhealthy snack foods; five trials), delivered through home visits or at baby health clinics, reported relative reductions in body mass index (BMI) at the end of intervention. Early benefits were not maintained in the two trials reporting follow-up 1 to 3 years later. Other potentially effective approaches included lower protein formulas in formula-fed infants and education around reducing sugar-sweetened beverages. There is some evidence that infant feeding interventions can have a transient positive impact on a child's BMI. It is not known whether ongoing intervention can avoid the subsequent expected wash-out.
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Affiliation(s)
- Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Caroline Lodge
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Carley Garner
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics & the Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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15
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Reilly JJ, Hughes AR, Gillespie J, Malden S, Martin A. Physical activity interventions in early life aimed at reducing later risk of obesity and related non-communicable diseases: A rapid review of systematic reviews. Obes Rev 2019; 20 Suppl 1:61-73. [PMID: 31419046 DOI: 10.1111/obr.12773] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 08/30/2018] [Accepted: 09/01/2018] [Indexed: 12/15/2022]
Abstract
To identify useful components of interventions aimed at prevention of childhood obesity and related non-communicable diseases (NCDs), which included physical activity and which targeted any or all of four life-course stages: peri-conception; pregnancy; infancy and toddlerhood (0 to 23 months); and early childhood (24 to 59 months). In May 2016, WHO Geneva searched the Cochrane Library and PubMed for systematic reviews of interventions including physical activity to prevent childhood obesity or risk factors for obesity-related NCDs. Using a narrative synthesis, the efficacy of randomized controlled trials (RCTs) to alter energy balance outcomes (measures of weight status or body fatness) was characterized by life-course stage, study characteristics, intervention functions (as defined in the behaviour change wheel), and level of the socio-ecological model (SEM) targeted. The quality of included systematic reviews was assessed. We retrieved 82 reviews from the World Health Organization (WHO) search, of which 23 were eligible for the present synthesis. The number of eligible studies by life-course stage was: 0 (peri-conception); 0 (pregnancy); 8 (infancy and toddlerhood, age 0 to 23 months; seven RCTs; age); and 37 (early childhood, age 24 to 59 months; 30 RCTs;). Thus, there was a lack of evidence for physical activity interventions during peri-conception and pregnancy. Almost all relevant studies in the 0- to 23- and 24- to 59-month life-course stages were multicomponent interventions (ie, targeted physical activity, dietary, and/or sedentary behaviours). Interventions with evidence of efficacy tended to target multiple levels of the SEM, with emphasis on parents, and extend over long periods. Effective intervention elements for early life obesity prevention included classes on parenting skills, alteration of the kindergarten playground, and financial incentives. Evidence from low- and middle-income countries was scarce, and evidence for intervention effect on obesity-related NCDs was missing. Future physical activity interventions in toddlerhood and early childhood aimed at prevention of obesity should adopt the characteristics typical of effective interventions identified by the present synthesis. There is an urgent need for more evidence on physical activity interventions set in low- and middle-income countries and which target the peri-conception and pregnancy periods.
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Affiliation(s)
- John J Reilly
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Adrienne R Hughes
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Jennifer Gillespie
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Stephen Malden
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Anne Martin
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Enö Persson J, Bohman B, Tynelius P, Rasmussen F, Ghaderi A. Prevention of Childhood Obesity in Child Health Services: Follow-Up of the PRIMROSE Trial. Child Obes 2019; 14:99-105. [PMID: 29232526 DOI: 10.1089/chi.2017.0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI). METHODS A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect. RESULTS There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons. CONCLUSIONS A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.
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Affiliation(s)
- Johanna Enö Persson
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - Benjamin Bohman
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,2 Centre for Psychiatry Research , Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Tynelius
- 3 Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden .,4 Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services , Stockholm, Sweden
| | - Finn Rasmussen
- 5 Department of Health Sciences, Lund University , Lund, Sweden
| | - Ata Ghaderi
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
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Laitinen TT, Nuotio J, Juonala M, Niinikoski H, Rovio S, Viikari JSA, Rönnemaa T, Magnussen CG, Jokinen E, Lagström H, Jula A, Simell O, Raitakari OT, Pahkala K. Success in Achieving the Targets of the 20-Year Infancy-Onset Dietary Intervention: Association With Insulin Sensitivity and Serum Lipids. Diabetes Care 2018; 41:2236-2244. [PMID: 30072407 DOI: 10.2337/dc18-0869] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/14/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined whether success in achieving the key targets of an infancy-onset 20-year dietary intervention associated with insulin sensitivity and serum lipids from early childhood to young adulthood. RESEARCH DESIGN AND METHODS The sample comprised 941 children participating in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project (STRIP). Dietary counseling was given biannually based on the Nordic Nutrition Recommendations with the main aim to improve the quality of dietary fat in children's diets and the secondary aim to promote intake of vegetables, fruits, and whole-grain products. Food records and serum lipid profile were studied annually from 1 to 20 years of age, and HOMA of insulin resistance (HOMA-IR) was assessed between 7 and 20 years of age. Meeting the intervention targets for quality of dietary fat was defined as the ratio of saturated fatty acids (SAFA) to monounsaturated and polyunsaturated fatty acids (MUFA + PUFA) <1:2 and intake of SAFA <10% of total energy intake (E%). Meeting the target for intake of whole-grain products, fruits, and vegetables was indicated by a fiber intake ≥3 g/MJ. RESULTS Participants in the intervention group had a higher probability of meeting the targets of SAFA/(PUFA + MUFA) <1:2 (risk ratio [RR] 3.91 [95% CI 3.33-4.61]), intake of SAFA <10 E% (RR 3.33 [95% CI 2.99-3.96]), and intake of fiber >3 g/MJ (RR 1.37 [95% CI 1.04-1.80]). Participants who achieved more targets had lower HOMA-IR, lower concentrations of fasting serum glucose, insulin, LDL cholesterol, and non-HDL cholesterol, and a lower ratio of apolipoprotein (Apo) B/ApoA1 (P values all ≤0.003). CONCLUSIONS Achieving the key targets of an infancy-onset 20-year dietary intervention was associated with better insulin sensitivity and serum lipid profile throughout the early life course.
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Affiliation(s)
- Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland .,Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
| | - Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Markus Juonala
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Harri Niinikoski
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Suvi Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jorma S A Viikari
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Tapani Rönnemaa
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Eero Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Olli Simell
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
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18
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Mustila T, Raitanen J, Keskinen P, Luoto R. A pragmatic controlled trial to prevent childhood obesity within a risk group at maternity and child health-care clinics: results up to six years of age (the VACOPP study). BMC Pediatr 2018; 18:89. [PMID: 29486763 PMCID: PMC5828437 DOI: 10.1186/s12887-018-1065-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 02/15/2018] [Indexed: 02/02/2023] Open
Abstract
Background Obesity in childhood appears often during the toddler years. The prenatal environment influences obesity risk. Maternal gestational diabetes, the child’s diet, and physical activity in the first few years have an important role in subsequent weight gain. A study was conducted to evaluate effectiveness of a primary health-care lifestyle counselling intervention in prevention of childhood obesity up to 6 years of age. Methods The study was a controlled pragmatic trial to prevent childhood obesity and was implemented at maternity and child health-care clinics. The participants (n = 185) were mothers at risk of gestational diabetes mellitus with their offspring born between 2008 and 2010. The prenatal intervention, started at the end of the first trimester of pregnancy, consisted of counselling on diet and physical activity by municipal health-care staff. The intervention continued at yearly appointments with a public health-nurse at child health-care clinics. The paper reports the offspring weight gain results for 2–6 years of age. Weight gain up to 6 years of age was assessed as BMI standard deviation scores (SDS) via a mixed-effect linear regression model. The proportion of children at 6 years with overweight/obesity was assessed as weight-for-height percentage and ISO-BMI. Priority was not given to power calculations, because of the study’s pragmatic nature. Results One hundred forty seven children’s (control n = 76/85% and intervention n = 71/56%) weight and height scores were available for analysis at 6 years of age. There was no significant difference in weight gain or overweight/obesity proportions between the groups at 6 years of age, but the proportion of children with obesity in both groups was high (assessed as ISO-BMI 9.9% and 11.8%) relative to prevalence in this age group in Finland. Conclusion As the authors previously reported, the intervention-group mothers had lower prevalence of gestational diabetes mellitus, but a decrease in obesity incidence before school age among their offspring was not found. The authors believe that an effective intervention should start before conception, continuing during pregnancy and the postpartum period through the developmentally unique child’s first years. Trial registration ClinicalTrials.gov NCT00970710. Registered 1 September 2009. Retrospectively registered.
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Affiliation(s)
- Taina Mustila
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
| | - Jani Raitanen
- UKK Institute for Health Promotion, Tampere, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Päivi Keskinen
- Pediatric Research Centre, 33014 University of Tampere, Tampere, Finland.,Tampere University Hospital, 33521, Tampere, Finland
| | - Riitta Luoto
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Balata GF, Zidan AS, Abourehab MA, Essa EA. Rapid disintegrating tablets of simvastatin dispersions in polyoxyethylene-polypropylene block copolymer for maximized disintegration and dissolution. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3211-3223. [PMID: 27757012 PMCID: PMC5055116 DOI: 10.2147/dddt.s114724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of this research was to improve the dissolution of simvastatin and to incorporate it in rapid disintegrating tablets (RDTs) with an optimized disintegration and dissolution characteristics. Polyoxyethylene–polypropylene block copolymer (poloxamer 188) was employed as a hydrophilic carrier to prepare simvastatin solid dispersions (SDs). Fourier transform infrared spectroscopy, differential scanning calorimetry (DSC) and X-ray diffractometry were employed to understand the interaction between the drug and the carrier in the solid state. The results obtained from Fourier transform infrared spectroscopy showed absence of any chemical interaction between the drug and poloxamer. The results of differential scanning calorimetry and X-ray diffractometry confirmed the conversion of simvastatin to distorted crystalline state. The SD of 1:2 w/w drug to carrier ratio showed the highest dissolution; hence, it was incorporated in RDT formulations using a 32 full factorial design and response surface methodology. The initial assessments of RDTs demonstrated an acceptable flow, hardness, and friability to indicate good mechanical strength. The interaction and Pareto charts indicated that percentage of croscarmellose sodium incorporated was the most important factor affecting the disintegration time and dissolution parameter followed by the hardness value and their interaction effect. Compression force showed a superior influence to increase RDT’s porosity and to fasten disintegration rather than swelling action by croscarmellose sodium. On the other hand, croscarmellose sodium was most important for the initial simvastatin release. The results suggest the potential use of poloxamer 188-based SD in RDT for the oral delivery of poor water-soluble antihyperlipidemic drug, simvastatin.
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Affiliation(s)
- Gehan F Balata
- Department of Pharmaceutics, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig
| | - Ahmad S Zidan
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig
| | - Mohamad As Abourehab
- Department of Pharmaceutics, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; Department of Pharmaceutics, Faculty of Pharmacy, El-Minia University, El-Minia
| | - Ebtessam A Essa
- Department of Pharmaceutics, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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Viitasalo A, Eloranta AM, Lintu N, Väistö J, Venäläinen T, Kiiskinen S, Karjalainen P, Peltola J, Lampinen EK, Haapala EA, Paananen J, Schwab U, Lindi V, Lakka TA. The effects of a 2-year individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet in children. Prev Med 2016; 87:81-88. [PMID: 26915641 DOI: 10.1016/j.ypmed.2016.02.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the effects of a long-term, individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet quality in children. METHODS We carried out a 2-year intervention study in a population sample of 506 children aged 6-8years in Finland in 2007-2012. We allocated the participants at baseline in the intervention and control group. We assessed physical activity and sedentary behavior by questionnaires and diet by food records. RESULTS Total physical activity (+9min/d in intervention group vs. -5min/d in control group, p=0.001 for time*group interaction), unsupervised physical activity (+7min/d vs. -9min/d, p<0.001) and organized sports (+8min/d vs. +3min/d, p=0.001) increased in the intervention group but not in the control group. Using computer and playing video games increased less in the intervention group than in the control group (+9min/d vs. +19min/d, p=0.003). Consumption of vegetables (+12g/d vs. -12g/d, p=0.001), high-fat vegetable-oil based margarine (+10g/d vs. +3g/d, p<0.001) and low-fat milk (+69g/d vs. +11g/d, p=0.042) and intake of dietary fiber (+1.3g/d vs. +0.2g/d, p=0.023), vitamin C (+4.5mg/d vs. -7.2mg/d, p=0.042) and vitamin E (+1.4mg/d vs. +0.5mg/d, p=0.002) increased in the intervention group but not in the control group. Consumption of butter-based spreads increased in the control group but not in the intervention group (+2g/d vs. -1g/d, p=0.002). CONCLUSIONS Individualized and family-based lifestyle intervention increased physical activity, attenuated increase in sedentary behavior and enhanced diet quality in children. TRIAL REGISTRATION ClinicalTrials.gov: NCT01803776.
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Affiliation(s)
- Anna Viitasalo
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Aino-Maija Eloranta
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Niina Lintu
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Juuso Väistö
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Taisa Venäläinen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Sanna Kiiskinen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Panu Karjalainen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Jaana Peltola
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Eeva-Kaarina Lampinen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Eero A Haapala
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland; Department of Biology of Physical Activity, University of Jyväskylä, Jyväskylä, Finland.
| | - Jussi Paananen
- Institute of Biomedicine, Bioinformatics Center, University of Eastern Finland, Kuopio, Finland.
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland.
| | - Virpi Lindi
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - Timo A Lakka
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland; Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
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Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med 2016; 50:761-779. [PMID: 26916261 DOI: 10.1016/j.amepre.2015.11.012] [Citation(s) in RCA: 626] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/27/2022]
Abstract
CONTEXT Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years. EVIDENCE ACQUISITION PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015. EVIDENCE SYNTHESIS Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity. CONCLUSIONS Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.
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Affiliation(s)
- Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
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Blake-Lamb TL, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review. Am J Prev Med 2016; 50:780-789. [PMID: 26916260 PMCID: PMC5207495 DOI: 10.1016/j.amepre.2015.11.010] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/03/2015] [Accepted: 11/17/2015] [Indexed: 12/19/2022]
Abstract
CONTEXT The "first 1,000 days"-conception through age 24 months-are critical for the development and prevention of childhood obesity. This study systematically reviews existing and ongoing interventions during this period, identifies gaps in current research, and discusses conceptual frameworks and opportunities for future interventions. EVIDENCE ACQUISITION PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched to identify completed and ongoing interventions implemented during pregnancy through age 24 months that aimed to prevent overweight/obesity between ages 6 months and 18 years. English-language, controlled interventions published between January 1, 1980 and December 12, 2014, were analyzed between December 13, 2014 and March 15, 2015. EVIDENCE SYNTHESIS Of 34 completed studies from 26 unique identified interventions, nine were effective. Effective interventions focused on individual- or family-level behavior changes through home visits, individual counseling or group sessions in clinical settings, a combination of home and group visits in a community setting, and using hydrolyzed protein formula. Protein-enriched formula increased childhood obesity risk. Forty-seven ongoing interventions were identified. Across completed and ongoing interventions, the majority target individual- or family-level changes, many are conducted in clinical settings, and few target early-life systems and policies that may impact childhood obesity. CONCLUSIONS Obesity interventions may have the greatest preventive effect if begun early in life. Yet, few effective interventions in the first 1,000 days exist, and many target individual-level behaviors of parents and infants. Interventions that operate at systems levels and are grounded in salient conceptual frameworks hold promise for improving future models of early-life obesity prevention.
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Affiliation(s)
- Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;.
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Palomo Atance E, Bahíllo Curieses P, Bueno Lozano G, Feliu Rovira A, Gil-Campos M, Lechuga-Sancho A, Ruiz Cano R, Vela Desojo A. Recomendaciones del Grupo de Trabajo de Obesidad de la Sociedad Española de Endocrinología Pediátrica sobre hábitos de alimentación para la prevención de la obesidad y los factores de riesgo cardiovascular en la infancia. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpedi.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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24
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Recommendations of the Spanish Paediatric Endocrinology Society Working Group on Obesity on eating habits for the prevention of obesity and cardiovascular risk factors in childhood. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kader M, Sundblom E, Elinder LS. Effectiveness of universal parental support interventions addressing children's dietary habits, physical activity and bodyweight: A systematic review. Prev Med 2015; 77:52-67. [PMID: 25981555 DOI: 10.1016/j.ypmed.2015.05.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/22/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The evidence regarding effectiveness of parental support interventions targeting children's health behaviours is weak. We aimed to review: 1) effectiveness of universal parental support interventions to promote dietary habits, physical activity (PA) or prevent overweight and obesity among children 2-18years and 2) effectiveness in relation to family socio-economic position. METHODS Thirty five studies from 1990 to 2013 were identified from major databases. Quality was assessed by four criteria accounting for selection and attrition bias, fidelity to intervention, and outcome measurement methodology, categorizing studies as strong, moderate or weak. RESULTS Four intervention types were identified: face-to-face counselling, group education, information sent home, and telephone counselling. Face-to-face or telephone counselling was effective in changing children's diet, while there was only weak evidence for improvement in PA. Sending home information was not effective. Concerning body weight, group education seemed more promising than counselling. Intervention effectiveness was generally higher in younger compared to older children. In groups with low socio-economic position, group-based approaches appeared promising. CONCLUSION In the future efforts should be made to improve reporting of intervention content, include a power calculation for the main outcome, the use of high quality outcome assessment methodology, and a follow-up period of at least 6months.
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Affiliation(s)
- Manzur Kader
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden.
| | - Elinor Sundblom
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
| | - Liselotte Schäfer Elinder
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
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Reduced linoleic acid intake in early postnatal life improves metabolic outcomes in adult rodents following a Western-style diet challenge. Nutr Res 2015; 35:800-11. [PMID: 26239950 DOI: 10.1016/j.nutres.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/04/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
The global increase in dietary n-6 polyunsaturated fatty acid (PUFA) intake has been suggested to contribute to the rise in obesity incidence. We hypothesized that reduced n-6 PUFA intake during early postnatal life improves adult body composition and metabolic phenotype upon a Western diet challenge. Male offspring of C57Bl/6j mice and Wistar rats were subjected to a control diet (CTRL; 3.16 En% linoleic acid [LA]) or a low n-6 PUFA diet (low LA; 1.36 En% LA) from postnatal days (PNs) 2 to 42. Subsequently, all animals were switched to a Western-style diet (2.54 En% LA) until PN98. We monitored body composition by dual-energy x-ray absorptiometry and glucose homeostasis by an intravenous glucose and insulin tolerance test in rats and by the homeostasis model assessment of insulin resistance (HOMA-IR) in mice. At PN98, plasma lipids, glucose, insulin, and adipokines were measured and adipocyte number and size were analyzed. In mice, the postnatal low-LA diet decreased fat accumulation during the adult Western-style diet challenge (-27% compared with CTRL, P < .001). Simultaneously, it reduced fasting triglyceride levels and lowered fasting resistin and leptin levels. In rats, the low-LA diet did not affect adult body composition, but decreased the number of retroperitoneal adipocytes and increased the number of large adipocytes. In conclusion, lowering dietary n-6 PUFA intake in early life protected against detrimental effects of an obesogenic diet in adulthood on metabolic homeostasis and fat mass accumulation.
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Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions. Curr Obes Rep 2015; 4:157-73. [PMID: 26213643 PMCID: PMC4512668 DOI: 10.1007/s13679-015-0160-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.
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Affiliation(s)
- Elisabeth M. Seburg
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Barbara A. Olson-Bullis
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Dani M. Bredeson
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Marcia G. Hayes
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
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Yavuz HM, van Ijzendoorn MH, Mesman J, van der Veek S. Interventions aimed at reducing obesity in early childhood: a meta-analysis of programs that involve parents. J Child Psychol Psychiatry 2015; 56:677-92. [PMID: 25292319 DOI: 10.1111/jcpp.12330] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Obesity is a growing problem even in very young childhood, resulting in high costs for individuals and society. As a response, numerous obesity prevention and intervention programs have been developed. Previous research has shown that early intervention programs are more effective when parents are involved, but the effectiveness of specific aspects of programs with parental involvement has not been investigated. This meta-analysis aims to investigate the features related to the effectiveness of different types of obesity intervention programs involving parents and targeting young children (0-6-year-olds). METHODS The Web of Science, PubMed, PsycInfo, CINAHL, and ERIC databases were searched for childhood obesity prevention and intervention programs involving parents. Data were analyzed using the Comprehensive Meta-analysis (CMA) software. RESULTS Fifty studies with effect sizes measured at short-term follow-up (within 3 months from the end of the intervention) and 26 studies with effect sizes measured at long-term follow-up (all reported in a total of 49 publications) were identified. The combined effect size of interventions was small but significant at short-term follow-up (d = .08, p < .01). The results suggested the presence of a potential publication bias in studies providing results at long-term follow-up, with a nonsignificant adjusted effect size (d = .02), which indicated that obesity interventions were not effective at long-term follow-up. Multivariate meta-regression analyses showed that interventions were more effective when including either interactive sessions or educational materials as opposed to those including both interactive sessions and noninteractive educational materials. No other moderators regarding sample characteristics, study design, or methodological quality were significant. CONCLUSION Interventions targeting young children that require parental involvement are effective at short-term follow-up, specifically when interventions include one mode of intervention rather than two. However, results were not retained in the long run.
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Affiliation(s)
- H Melis Yavuz
- Department of Psycholog, Koc University, Istanbul, Turkey
| | | | - Judi Mesman
- Department of Psycholog, Koc University, Istanbul, Turkey
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Affiliation(s)
- Matthew W Gillman
- From Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Nutrition, Harvard School of Public Health, Boston, MA.
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Kwiterovich PO. Detection and Treatment of Children and Adolescents with Dyslipidemia. DYSLIPIDEMIAS 2015. [DOI: 10.1007/978-1-60761-424-1_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Zidan AS, Hosny KM, Ahmed OAA, Fahmy UA. Assessment of simvastatin niosomes for pediatric transdermal drug delivery. Drug Deliv 2014; 23:1536-49. [PMID: 25386740 DOI: 10.3109/10717544.2014.980896] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prevalence of childhood dyslipidemia increases and is considered as an important risk factor for the incidence of cardiovascular disease in the adulthood. To improve dosing accuracy and facilitate the determination of dosing regimens in function of the body weight, the proposed study aims at preparing transdermal niosomal gels of simvastatin as possible transdermal drug delivery system for pediatric applications. Twelve formulations were prepared to screen the influence of formulation and processing variables on critical niosomal characteristics. Nano-sized niosomes with 0.31 μm number-weighted size displayed highest simvastatin release rate with 8.5% entrapment capacity. The niosomal surface coverage by negative charges was calculated according to Langmuir isotherm with n = 0.42 to suggest that the surface association was site-independent, probably producing surface rearrangements. Hypolipidemic activities after transdermal administration of niosomal gels to rats showed significant reduction in cholesterol and triglyceride levels while increasing plasma high-density lipoproteins concentration. Bioavailability estimation in rats revealed an augmentation in simvastatin bioavailability by 3.35 and 2.9 folds from formulation F3 and F10, respectively, compared with oral drug suspension. Hence, this transdermal simvastatin niosomes not only exhibited remarkable potential to enhance its bioavailability and hypolipidemic activity but also considered a promising pediatric antihyperlipidemic formulation.
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Affiliation(s)
- Ahmed S Zidan
- a Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , King Abdulaziz University , Jeddah , KSA .,b Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , Zagazig University , Zagazig , Egypt
| | - Khaled M Hosny
- a Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , King Abdulaziz University , Jeddah , KSA .,c Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , Beni Suef University , Beni Suef , Egypt , and
| | - Osama A A Ahmed
- a Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , King Abdulaziz University , Jeddah , KSA .,d Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , Minia University , Minia , Egypt
| | - Usama A Fahmy
- a Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , King Abdulaziz University , Jeddah , KSA
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Tognon G, Hebestreit A, Lanfer A, Moreno LA, Pala V, Siani A, Tornaritis M, De Henauw S, Veidebaum T, Molnár D, Ahrens W, Lissner L. Mediterranean diet, overweight and body composition in children from eight European countries: cross-sectional and prospective results from the IDEFICS study. Nutr Metab Cardiovasc Dis 2014; 24:205-213. [PMID: 23870847 DOI: 10.1016/j.numecd.2013.04.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 04/17/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS A Mediterranean-like dietary pattern has been shown to be inversely associated with many diseases, but its role in early obesity prevention is not clear. We aimed to determine if this pattern is common among European children and whether it is associated with overweight and obesity. METHODS AND RESULTS The IDEFICS study recruited 16,220 children aged 2-9 years from study centers in eight European countries. Weight, height, waist circumference, and skinfolds were measured at baseline and in 9114 children of the original cohort after two years. Diet was evaluated by a parental questionnaire reporting children's usual consumption of 43 food items. Adherence to a Mediterranean-like diet was calculated by a food frequency-based Mediterranean Diet Score (fMDS). The highest fMDS levels were observed in Sweden, the lowest in Cyprus. High scores were inversely associated with overweight including obesity (OR = 0.85, 95% CI: 0.77; 0.94) and percent fat mass (β = -0.22, 95% CI: -0.43; -0.01) independently of age, sex, socioeconomic status, study center and physical activity. High fMDS at baseline protected against increases in BMI (OR = 0.87, 95% CI: 0.78; 0.98), waist circumference (OR = 0.87, 95% CI: 0.77; 0.98) and waist-to-height ratio (OR = 0.88, 95% CI: 0.78; 0.99) with a similar trend observed for percent fat mass (p = 0.06). CONCLUSIONS Although a Mediterranean dietary pattern is inversely associated with childhood obesity, it is not common in children living in the Mediterranean region and should therefore be advocated as part of EU obesity prevention strategies.
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Affiliation(s)
- G Tognon
- Public Health Epidemiology Unit, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - A Lanfer
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - V Pala
- Nutritional Epidemiology Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Siani
- Institute of Food Sciences, Unit of Epidemiology and Population Genetics, National Research Council, Avellino, Italy
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - S De Henauw
- Department of Public Health, Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - T Veidebaum
- National Institute for Health Development, Tallin, Estonia
| | - D Molnár
- Department of Pediatrics, Medical Faculty, University of Pécs, Hungary
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany; University of Bremen, Bremen, Germany
| | - L Lissner
- Public Health Epidemiology Unit, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Young BE, Krebs NF. Complementary Feeding: Critical Considerations to Optimize Growth, Nutrition, and Feeding Behavior. CURRENT PEDIATRICS REPORTS 2013; 1:247-256. [PMID: 25105082 PMCID: PMC4120968 DOI: 10.1007/s40124-013-0030-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review focuses on complementary feeding (CF) in westernized settings where primary health concerns are risk of obesity and micronutrient inadequacy. The current evidence is reviewed for: (1) when CF should be introduced, (2) what foods (nutrients and food types) should be prioritized and avoided, and (3) how the infant should be fed. Special attention is paid to the underlying physiological differences between breast- and formula-fed infants that often result in distinctly different nutritional and health risks. This difference is particularly acute in the case of micronutrient inadequacy, specifically iron and zinc, but is also relevant to optimal energy and macronutrient intakes. Emphasis is placed on the complex interplay among infants' early dietary exposures; relatively high energy and nutrient requirements; rapid physical, social and emotional development; and the feeding environment-all of which interact to impact health outcomes. This complexity needs to be considered at both individual and population levels and in both clinical and research settings.
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Affiliation(s)
- Bridget E Young
- Section of Nutrition, Department of Pediatrics, University of, Colorado Denver School of Medicine, 12700 E 19th Ave,, Box C-225, Aurora, CO 80045, USA,
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of, Colorado Denver School of Medicine, 12700 E 19th Ave,, Box C-225, Aurora, CO 80045, USA
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Harris SB, Bhattacharyya O, Dyck R, Hayward MN, Toth EL. Le diabète de type 2 chez les Autochtones. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (the VACOPP Study). BMC Pediatr 2013; 13:80. [PMID: 23688259 PMCID: PMC3664621 DOI: 10.1186/1471-2431-13-80] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/15/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes. METHODS The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10-17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26-28 weeks' gestation, the mother's gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models. RESULTS Intervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother's GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups. CONCLUSION Since the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring's weight gain may manifest only later in childhood. TRIAL REGISTRATION Clinical Trials gov: NCT00970710.
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Affiliation(s)
- Taina Mustila
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland
| | - Jani Raitanen
- UKK Institute for Health Promotion,33501 Tampere, Finland
- Tampere School of Health Sciences, University of Tampere, Tampere, Finland
| | - Päivi Keskinen
- Pediatric Research Centre, University of Tampere, 33014 Tampere, Finland
- Tampere University Hospital, 33521 Tampere, Finland
| | - Antti Saari
- Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Riitta Luoto
- UKK Institute for Health Promotion,33501 Tampere, Finland
- National Institute for Health and Welfare, 00271 Helsinki, Finland
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Impact of nutrition since early life on cardiovascular prevention. Ital J Pediatr 2012; 38:73. [PMID: 23259704 PMCID: PMC3543392 DOI: 10.1186/1824-7288-38-73] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/11/2012] [Indexed: 02/07/2023] Open
Abstract
The cardiovascular disease represents the leading cause of morbidity and mortality in Western countries and it is related to the atherosclerotic process. Cardiovascular disease risk factors, such as dyslipidemia, hypertension, insulin resistance, obesity, accelerate the atherosclerotic process which begins in childhood and progresses throughout the life span. The cardiovascular disease risk factor detection and management through prevention delays the atherosclerotic progression towards clinical cardiovascular disease. Dietary habits, from prenatal nutrition, breastfeeding, complementary feeding to childhood and adolescence nutrition play a basic role for this topic. The metabolic and neuroendocrine environment of the fetus is fundamental in the body’s “metabolic programming”. Further several studies have demonstrated the beneficial effects of breastfeeding on cardiovascular risk factors reduction. Moreover the introduction of complementary foods represents another important step, with particular regard to protein intake. An adequate distribution between macronutrients (lipids, proteins and carbohydrates) is required for correct growth development from infancy throughout adolescence and for prevention of several cardiovascular disease risk determinants in adulthood. The purpose of this review is to examine the impact of nutrition since early life on disease. La malattia cardiovascolare rappresenta la principale causa di morbilità e mortalità dei paesi occidentali ed è correlata a degenerazione vascolare aterosclerotica. I fattori di rischio cardiovascolari quali dislipidemia, ipertensione, insulino resistenza e obesità accelerano tale processo il cui esordio è noto sin dell’età pediatrica ed evolve nel corso della vita. L’individuazione e la cura dei fattori di rischio cardiovascolari mediante la prevenzione dei fattori causali ritardano la progressione dell’aterosclerosi e l’insorgenza dei sintomi cardiovascolari. La nutrizione svolge un ruolo preventivo fondamentale sin dall’epoca prenatale e nelle diverse età della crescita. La condizione metabolica e neuro-endocrino cui è sottoposto il feto è rilevante per la “programmazione metabolica”. E’ dimostrata inoltre l’importanza delle modalità di allattamento e divezzamento con particolare interesse per l’assunzione di proteine nel controllo dei fattori di rischio cardiovascolari. La corretta distribuzione di macronutrienti (lipidi, proteine e carboidrati) dall’infanzia all’adolescenza favorisce una crescita corretta e risulta utile a prevenire l’insorgenza dei determinanti di rischio di malattia cardiovascolare in età adulta. Nella presente review verrà esaminato l’impatto della nutrizione dalle più precoci fasi delle vita sul rischio cardiovascolare.
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Junnila R, Aromaa M, Heinonen OJ, Lagström H, Liuksila PR, Vahlberg T, Salanterä S. The Weighty Matter intervention: a family-centered way to tackle an overweight childhood. J Community Health Nurs 2012; 29:39-52. [PMID: 22313184 DOI: 10.1080/07370016.2012.645742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed "The Weighty Matter" intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n=86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.
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Affiliation(s)
- Riina Junnila
- Department of Nursing Science, University of Turku, Turku, Finland.
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Early determinants of obesity: genetic, epigenetic, and in utero influences. Int J Pediatr 2012; 2012:463850. [PMID: 22701495 PMCID: PMC3371343 DOI: 10.1155/2012/463850] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/26/2012] [Indexed: 01/06/2023] Open
Abstract
There is an emerging body of work indicating that genes, epigenetics, and the in utero environment can impact whether or not a child is obese. While certain genes have been identified that increase one's risk for becoming obese, other factors such as excess gestational weight gain, gestational diabetes mellitus, and smoking can also influence this risk. Understanding these influences can help to inform which behaviors and exposures should be targeted if we are to decrease the prevalence of obesity. By helping parents and young children change certain behaviors and exposures during critical time periods, we may be able to alter or modify one's genetic predisposition. However, further research is needed to determine which efforts are effective at decreasing the incidence of obesity and to develop new methods of prevention. In this paper, we will discuss how genes, epigenetics, and in utero influences affect the development of obesity. We will then discuss current efforts to alter these influences and suggest future directions for this work.
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Abstract
Decades ago, discussion of an impending global pandemic of obesity was thought of as heresy. But in the 1970s, diets began to shift towards increased reliance upon processed foods, increased away-from-home food intake, and increased use of edible oils and sugar-sweetened beverages. Reductions in physical activity and increases in sedentary behavior began to be seen as well. The negative effects of these changes began to be recognized in the early 1990s, primarily in low- and middle-income populations, but they did not become clearly acknowledged until diabetes, hypertension, and obesity began to dominate the globe. Now, rapid increases in the rates of obesity and overweight are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels. Concurrent rapid shifts in diet and activity are well documented as well. An array of large-scale programmatic and policy measures are being explored in a few countries; however, few countries are engaged in serious efforts to prevent the serious dietary challenges being faced.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina 27516, USA.
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Kesten JM, Griffiths PL, Cameron N. A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. Obes Rev 2011; 12:997-1021. [PMID: 21848919 DOI: 10.1111/j.1467-789x.2011.00919.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Childhood overweight/obesity is recognized as an increasing health problem. The objective of this review was to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. The papers included were those studying children (must include results for girls) from within the 7-11 years age range from any country and ethnic background. The included interventions lasted at least 12 weeks and modified a combination of nutrition, physical activity, knowledge, attitudes or health-related behaviours associated with the development of childhood overweight and obesity. Effect sizes were calculated where possible using Cohen's classifications of small (0.2-0.5), medium (0.5-0.8) and large (>0.8) effect sizes. Thirty studies met the inclusion criteria of which four were cluster randomized controlled trials, 14 were randomized controlled trials, 11 were controlled trials and one was a cohort pre-post trial. There were four weak, 11 moderate and 15 strong quality studies. Eleven studies were considered short term and 19 long term (≥12 months). There were 66 effect sizes less than 0.2, 56 categorized as low, 16 as medium and two as high. There is the potential for interventions aimed at pre-adolescent girls to reduce the risk factors associated with childhood overweight and obesity, although the sustainability of the effects of such interventions is less clear.
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Affiliation(s)
- J M Kesten
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK.
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Affiliation(s)
- Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, The Children's Hospital, Aurora, CO 80045, USA.
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Matusik P, Malecka-Tendera E. Overweight prevention strategies in preschool children. ACTA ACUST UNITED AC 2011; 6 Suppl 2:2-5. [DOI: 10.3109/17477166.2011.613651] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lehto R, Ray C, Roos E. Longitudinal associations between family characteristics and measures of childhood obesity. Int J Public Health 2011; 57:495-503. [PMID: 21814847 DOI: 10.1007/s00038-011-0281-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 06/22/2011] [Accepted: 07/18/2011] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate cross-sectional and longitudinal associations between different family characteristics and body mass index (BMI) and waist-to-height ratio (WHtR) in children. METHODS This was a prospective follow-up study conducted in Helsinki region with data collected in 2006 and 2008. The sample consisted of 550 children aged 9-11 at baseline. Children were measured and weighed by research staff, and they completed a questionnaire about their family characteristics. RESULTS More meals together with the family, more parenting practices at meals, less time home without adult company after school, and child's perception of receiving care from mother in 2006 predicted a lower BMI in 2008 and partly a smaller increase in BMI from 2006 to 2008. Fewer associations were found to WHtR. Physical activity with either parent was not associated with BMI or WHtR. CONCLUSIONS Several family characteristics predicted child BMI and WHtR 2 years later. These results contribute new knowledge about parental influence on child weight and weight gain and should be taken into account when planning interventions on the matter.
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Affiliation(s)
- Reetta Lehto
- Folkhälsan Research Center, Paasikivenkatu 4, 00250, Helsinki, Finland.
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Descamps OS, Tenoutasse S, Stephenne X, Gies I, Beauloye V, Lebrethon MC, De Beaufort C, De Waele K, Scheen A, Rietzschel E, Mangano A, Panier JP, Ducobu J, Langlois M, Balligand JL, Legat P, Blaton V, Muls E, Van Gaal L, Sokal E, Rooman R, Carpentier Y, De Backer G, Heller FR. Management of familial hypercholesterolemia in children and young adults: consensus paper developed by a panel of lipidologists, cardiologists, paediatricians, nutritionists, gastroenterologists, general practitioners and a patient organization. Atherosclerosis 2011; 218:272-80. [PMID: 21762914 DOI: 10.1016/j.atherosclerosis.2011.06.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 06/08/2011] [Accepted: 06/09/2011] [Indexed: 01/06/2023]
Abstract
UNLABELLED Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a clear consensus on the management of this disease in young patients is necessary. In Belgium, a panel of paediatricians, specialists in (adult) lipid management, general practitioners and representatives of the FH patient organization agreed on the following common recommendations. 1. Screening for HeFH should be performed only in children older than 2 years when HeFH has been identified or is suspected (based on a genetic test or clinical criteria) in one parent.2. The diagnostic procedure includes, as a first step, the establishment of a clear diagnosis of HeFH in one of the parents. If this precondition is satisfied, a low-density-lipoprotein cholesterol (LDL-C) levelabove 3.5 mmol/L (135 mg/dL) in the suspected child is predictive for differentiating affected from non-affected children. 3. A low saturated fat and low cholesterol diet should be started after 2 years, under the supervision of a dietician or nutritionist.4. The pharmacological treatment, using statins as first line drugs, should usually be started after 10 years if LDL-C levels remain above 5 mmol/L (190 mg/dL), or above 4 mmol/L (160 mg/dL) in the presence of a causative mutation, a family history of early cardiovascular disease or severe risk factors. The objective is to reduce LDL-C by at least 30% between 10 and 14 years and, thereafter, to reach LDL-C levels of less than 3.4 mmol/L (130 mg/dL). CONCLUSION The aim of this consensus statement is to achieve more consistent management in the identification and treatment of children with HeFH in Belgium.
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Affiliation(s)
- O S Descamps
- Département de Médecine Interne et Centre de Recherche Médicale de Jolimont, Hôpital de Jolimont, Haine Saint-Paul, Belgium
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Role of dietary factors and food habits in the development of childhood obesity: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2011; 52:662-9. [PMID: 21593641 DOI: 10.1097/mpg.0b013e3182169253] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This Comment by the Committee on Nutrition of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition aims to provide a summary of the role of nutrition-related factors on obesity prevention in children ages 2 to 18 years. This Comment emphasizes that dietary interventions should be incorporated into a multidisciplinary strategy for obesity prevention. No single nutrient has been unequivocally associated with the development of obesity. Methodological limitations in study design and the complex nature of obesity must be taken into account when interpreting the association with reported dietary factors. Energy intake should be individually determined, taking into account energy expenditure and growth. Preferential intake of slowly absorbed carbohydrates and limiting the ingestion of rapidly absorbed carbohydrates and simple sugars should be promoted. No specific recommendations for macronutrient intakes to prevent obesity can be made. Plant foods can be used as the main food contributors to a well-balanced diet with adequate monitoring of nutrient intake. Plain water should be promoted as the main source of fluids for children instead of sugar-sweetened beverages. Children should eat at least 4 meals, including breakfast, every day. Regular family meals should be encouraged. Regular consumption of fast food with large portion sizes and high energy density should be avoided. Healthy food options should be promoted for snacking. Food portion sizes should be appropriate for age and body size. Nutrition and lifestyle education aimed at the prevention of obesity should be included in the routine care of children by health care professionals.
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Parental eating attitudes and indicators of healthy eating in a longitudinal randomized dietary intervention trial (the STRIP study). Public Health Nutr 2011; 14:2065-73. [PMID: 21729485 DOI: 10.1017/s1368980011000905] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the effects of child-oriented dietary intervention on parental eating attitudes and dietary behaviour. DESIGN In the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (the STRIP study), a cohort of Finnish families took part in a nutritional intervention trial focused on the quality of their children's fat intake since the age of 8 months. Health-related and hedonic eating attitudes of the parents were measured after 10 years of dietary intervention using a validated Health and Taste Attitude Scales (HTAS) questionnaire (n 660). Parents' eating behaviour was studied using a 1 d food record (n 491). SETTING Finland. SUBJECTS Mothers and fathers (n 660) of the STRIP children. RESULTS The parents of the intervention families had a higher level of interest in healthy eating compared with control parents. The interest in natural products or hedonic eating attitudes did not differ between the groups. The parents' general health interest was associated with low saturated fat intake, fruit and vegetable consumption, fibre intake and seeking pleasure in eating, but it was not associated with BMI. The intervention also improved the quality of dietary fat among parents with the lowest level of interest in healthy eating. CONCLUSIONS Parents' general health interest was associated with regular dietary counselling as well as with healthier food choice behaviour. However, the dietary intervention that focused especially on the quality of the child's fat intake also enhanced specific changes in the family's fat consumption without a high level of interest in healthy eating.
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Ponnampalam EN, Lewandowski P, Nesaratnam K, Dunshea FR, Gill H. Differential effects of natural palm oil, chemically- and enzymatically-modified palm oil on weight gain, blood lipid metabolites and fat deposition in a pediatric pig model. Nutr J 2011; 10:53. [PMID: 21586170 PMCID: PMC3115846 DOI: 10.1186/1475-2891-10-53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/18/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Increasing prevalence of obesity and overweight in the Western world, continue to be a major health threat and is responsible for increased health care costs. Dietary intervention studies show a strong positive association between saturated fat intake and the development of obesity and cardiovascular disease. This study investigated the effect of positional distribution of palmitic acid (Sn-1, 2 & 3) of palm oil on cardiovascular health and development of obesity, using weaner pigs as a model for young children. METHODS Male and female weaner piglets were randomly allocated to 4 dietary treatment groups: 1) pork lard (LRD); 2) natural palm olein (NPO); 3) chemically inter-esterified PO (CPO) and 4) enzymatically inter-esterified PO (EnPO) as the fat source. Diets were formulated with 11% lard or with palm olein in order to provide 31% of digestible energy from fat in the diet and were balanced for cholesterol, protein and energy across treatments. RESULTS From 8 weeks onwards, pigs on EnPO diet gained (P<0.05) more weight than all other groups. Feed conversion efficiency (feed to gain) over the 12 week experimental period did not vary between treatment groups. Plasma LDL-C content and LDL-C/HDL-C ratio in pigs fed natural PO tended to be lower compared to all other diets. The natural PO lowered (P<0.02) the plasma triglyceride (TG) content relative to the lard or EnPO diets, but was not different from the CPO diet. The natural PO diet was associated with lower (P<0.05) saturated fat levels in subcutaneous adipose tissue than the CPO and EnPO diets that had lower saturated fat levels than the lard diet. Female pigs had lower lean and higher fat and fat:lean ratio in the body compared with male pigs. No difference in weight gain or blood lipid parameters was observed between sexes. CONCLUSIONS The observations on plasma TG, muscle and adipose tissue saturated fatty acid contents and back fat (subcutaneous) thickness suggest that natural palm oil may reduce deposition of body fat. In addition, dietary supplementation with natural palm oil containing palmitic acid at different positions in meat producing animals may lead to the production of meat and meat products with lower saturated fats. An increase in fat content and a decrease in lean content in female pigs resulted in an increased body fat:lean ratio but gender had no effect on blood lipid parameters or insulin concentrations.
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Affiliation(s)
- Eric N Ponnampalam
- AgriFood Production Systems, FFSR, Department of Primary Industries, 600 Sneydes Road, Werribee VIC 3030, Australia
| | - Paul Lewandowski
- Molecular Nutrition Unit, School of Medicine, Deakin University, Geelong VIC 3217, Australia
| | | | - Frank R Dunshea
- Melbourne School of Land and Environment, The University of Melbourne, Parkville, Vic. 3010, Australia
| | - Harsharn Gill
- AgriFood Production Systems, FFSR, Department of Primary Industries, 600 Sneydes Road, Werribee VIC 3030, Australia
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Monasta L, Batty GD, Macaluso A, Ronfani L, Lutje V, Bavcar A, van Lenthe FJ, Brug J, Cattaneo A. Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials. Obes Rev 2011; 12:e107-18. [PMID: 20576004 DOI: 10.1111/j.1467-789x.2010.00774.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to analyse interventions for the prevention of overweight and obesity in children under 5 years of age. We carried out a systematic review focusing exclusively on randomized controlled trials (RCTs). Data sources include Medline, Cochrane Library, EMBASE, CINHAL, PsychInfo and Web of Science. Data were extracted from seventeen articles describing seven RCTs identified through electronic search, screening of references in systematic reviews, own files and contact with authors. RCTs were assessed with the Jadad scale. Four trials were carried out in preschool settings, one with an exclusive educational component, two with an exclusive physical activity component and one with both. Two trials were family-based, with education and counselling for parents and children. The remaining trial was carried out in maternity hospitals, with a training intervention on breastfeeding. None of the interventions had an effect in preventing overweight and obesity. The failure to show an effect may be due to the choice of outcomes, the quality of the RCTs, the suboptimal implementation of the interventions, the lack of focus on social and environmental determinants. More rigorous research is needed on interventions and on social and environmental factors that could impact on lifestyle.
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Affiliation(s)
- L Monasta
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Italy.
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Viljakainen HT, Pekkinen M, Saarnio E, Karp H, Lamberg-Allardt C, Mäkitie O. Dual effect of adipose tissue on bone health during growth. Bone 2011; 48:212-7. [PMID: 20858556 DOI: 10.1016/j.bone.2010.09.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/05/2010] [Accepted: 09/15/2010] [Indexed: 11/26/2022]
Abstract
Recent studies suggest association between body fat and childhood bone health, although conflicting findings have also been reported. The aim of the present study was to examine the association between body fat content and areal BMD, volumetric BMD, bone turnover markers, and calcitropic factors in apparently healthy children and adolescents. The study was carried out as a school based cross-sectional cohort study with 186 subjects (61% girls) aged from 7 to 19 years. Background characteristics, including medical history and lifestyle factors, were collected. Anthropometry, BMD and body composition measurements with DXA and pQCT, a fasting blood sample and a second morning void urine sample were obtained. The subjects were divided into three groups, representing low, intermediate and high adiposity, based on age and gender specific fat percentage Z-scores. Multivariate analysis was performed to all bone variables using lean body mass, pubertal development, dietary intake of calcium and intensity of physical activity as covariates. In pQCT, a significant difference between the groups was observed in cortical BMD (MANOVA; p=0.02) in proximal radius, the intermediate group having the highest values. Similarly, DXA-derived LS and WB BMD Z-scores differed significantly between the groups (MANOVA; p=0.026 and p=0.036, respectively), with highest values in the intermediate group. High body fat content associated also with low bone turnover markers, low PTH, high S-Ca and high urinary calcium excretion. The differences in biochemical markers explain our and others' findings of bone health in children and adolescents with different body fat content. These findings suggest that normal body fat content is beneficial for bone health in growing children and adolescents while both low and high body fat content have adverse skeletal effects.
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Affiliation(s)
- Heli T Viljakainen
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Biomedicum Helsinki 2, Tukholmankatu 8 C, PO Box 705, 00029 HUS, Helsinki, Finland.
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