Added sugar and trans fatty acid intake and sedentary behavior were associated with excess total-body and central adiposity in children and adolescents with congenital heart disease

Impact of Underweight, Overweight, and Obesity on Health-Related Quality of Life in Children with Tetralogy of Fallot Variants

Traditional cardiovascular risk factors put patients with congenital heart disease (CHD) at increased risk for cardiovascular morbidity and mortality. The aim of this study was to evaluate whether body mass index (BMI) is associated with health-related quality of life (HRQoL) in patients with variants of Tetralogy of Fallot (TOF). Patients and parents of children with variants of TOF-CHD were asked to fill out the PedsQL 4.0 questionnaire and provide weight and length. Patients were categorized into low, normal, and high BMI percentiles. Other demographic data were obtained from the Swedish national registry for congenital heart disease (SWEDCON). Statistical analyses included non-parametric Mann-Whitney U test, Fisher exact, and Chi-square tests. Eighty-five patients were included. Twelve were overweight or obese, 57 had a normal BMI, and 16 were underweight. There was a significant difference in age and gender between the groups. Comparing overweight/obese children to those with normal BMI, physical and social functioning were impaired, while emotional and school function were comparable between the groups. This applied to both child and parental assessment. When comparing underweight to normal weight children, school functioning assessed by the parent was the only domain significantly different from patients with a normal BMI. Children with variants of TOF and overweight/obesity have lower HRQoL, particularly in physical and social functioning, while underweight children may have impaired school functioning. We suggest that preventive measures aimed at maintaining a normal weight should be taken early in life to reduce long-term cardiovascular risk in the CHD population.

Consumption and Breakfast Patterns in Children and Adolescents with Congenital Heart Disease

Little is known about skipping breakfast and breakfast patterns (BP) and their evaluation according to sociodemographic, clinical, lifestyle, cardiometabolic and nutritional data in children and adolescents with congenital heart disease (CHD). This cross-sectional study with 232 children and adolescents with CHD identified the prevalence and patterns of the breakfast, described these according to sociodemographic, clinical and lifestyle characteristics, and assessed their association with cardiometabolic and nutritional markers. Breakfast patterns were identified by principal components, and bivariate and linear regression analysis were applied. Breakfast consumption was observed in 73% of participants. Four BP were identified: pattern 1 "milk, ultra-processed bread, and chocolate milk", pattern 2 "margarine and processed bread", pattern 3 "cold meats/sausages, cheeses and butter/cream" and pattern 4 "fruits/fruit juices, breakfast cereals, yogurts, and homemade cakes/pies and sweet snacks". Family history for obesity and acyanotic CHD were associated with breakfast skipping. Younger participants and greater maternal education were associated with greater adherence to pattern 1 and pattern 4. Older participants and longer post-operative time showed greater adherence to pattern 3. No association between skipping breakfast or BP and cardiometabolic and nutritional markers was observed. Nonetheless, the findings reinforce the need for nutritional guidance for healthy breakfast, aiming to reduce the consumption of ultra-processed foods and to prioritize fresh and minimally processed foods.

Ambivalence is associated with decreased physical activity and cardiorespiratory fitness among adolescents with critical congenital heart disease

BACKGROUND

Adolescents with congenital heart disease (CHD) are insufficiently physically active. Given that increasing physical activity may reduce their cardiovascular risk, it is important to identify correlates of this behavior. Perceived benefits of and barriers to physical activity are associated with physical activity engagement. Existing research has only considered these constructs separately. This population may be ambivalent toward physical activity (i.e., perceive both strong benefits and barriers). The association of ambivalence and physical activity related outcomes is unknown among this at-risk population.

OBJECTIVE

Determine the association of ambivalence and sedentary behavior, moderate-to-vigorous physical activity (MVPA), and cardiorespiratory fitness (VO2Peak) among adolescents with CHD.

METHODS

The present study is an analysis of data from an eligibility assessment for a randomized clinical trial of an intervention to promote MVPA among adolescents aged 15 to 18 years with moderate or complex CHD. Participants (N = 84) completed a survey assessing perceived benefits and barriers from which ambivalence toward physical activity was calculated, an exercise stress test to measure VO2Peak, and wore an accelerometer for one week to determine their engagement in sedentary behavior and MVPA. Linear regression analyses determined associations between ambivalence and physical activity related outcomes. RESULTS: Greater ambivalence toward physical activity was associated with increased sedentary behavior, decreased MVPA, and reduced VO2Peak, adjusting for demographic and clinical covariates.

CONCLUSIONS

Ambivalence is associated with objectively measured physical activity (sedentary behavior, MVPA) and a biomarker of cardiovascular health (VO2Peak). Screening for ambivalence may help clinicians identify those most likely to benefit from physical activity-related education.

Clusters of lifestyle behaviors associated with atherosclerosis risk factors in children and adolescents with congenital heart disease: Floripa CHild Study

Secondary cardiovascular disease is the main cause of mortality in congenital heart disease (CHD) patients. The cardiovascular risk could be widely prevented with adherence to a healthy lifestyle; however, clusters of lifestyle behaviors related to atherosclerosis risk factors in children and adolescents with CHD remain unclear. We aimed to describe the clusters of lifestyle behaviors of children and adolescents with CHD and to evaluate their association with atherosclerosis risk factors. We conducted a cross-sectional study on 227 children and adolescents with CHD (median age:10.02 [IQR:7.08-13.02] years). Dietary intake, physical activity (PA), and sedentary behavior (SB) were evaluated. Clusters of lifestyle behaviors were determined using a two-step cluster analysis. Atherosclerosis risk factors evaluated include body fat mass, central obesity, blood pressure, lipid parameters, glucose, C-reactive protein, and carotid intima-media thickness (cIMT). Multiple logistic regressions were used. The "unhealthy: high SB + low PA" cluster was associated with elevated body fat mass, central obesity, and elevated cIMT. Furthermore, the "unhealthy: low PA + unhealthy eating habits" cluster was associated with elevated body fat mass, central obesity, and elevated glucose. The unhealthier lifestyle behavior clusters were associated with atherosclerosis risk factors in children and adolescents with CHD. Multidisciplinary strategies to promote healthy behaviors are needed to prevent cardiovascular disease in later life.

Amelioration of central neurodegeneration by docosahexaenoic acid in trigeminal neuralgia rats through the regulation of central neuroinflammation

Trigeminal neuralgia (TN) is a stubborn head and face neuropathic pain with complex pathogenesis. Patients with TN have a significantly increased risk of central neurodegeneration, which manifests as cognitive impairment and memory loss, but the specific mechanism underlying central nervous degeneration is still unclear. This study aimed to explore central neurodegeneration and its possible mechanism of action in TN rats based on changes in the brain fatty acid content and microglia-related neuroinflammation. Using a TN neuropathic pain model established by us, we found that TN rats have obvious cognitive impairment. Furthermore, changes in the brain fatty acid content were analyzed using gas chromatography-mass spectrometry (GC-MS). It was found that the docosahexaenoic acid (DHA) content in the central nervous system (CNS) of TN rats was significantly decreased compared to that in the CNS of Sham rats. An important component in maintaining brain cognition, DHA also plays a key role in regulating central neuroinflammation. Here, by continuous supplementation of DHA, the CNS DHA content was increased to a certain extent in TN rats. The cognitive impairment of TN rats was improved after restoring the central DHA level; this may be related to the improvement of neuroinflammation through the DHA-mediated regulation of microglial polarization. Overall, this study provides a theoretical basis for explaining the pathogenesis of central neurodegeneration in TN. It also suggests DHA as a target for protecting the CNS of patients with TN from damage.

Prevalence of dyslipidemia, atherogenic and cardiovascular risk in overweight and obese adolescents

OBJECTIVE

To analyze the lipid profile and cardiovascular risk of overweight and obese adolescents and correlate the findings with anthropometric measurements.

METHODS

This is a cross-sectional study on overweight and obese adolescents of both sexes (aged 14 to 18 years old). The collected variables were sex, weight, height, age, total cholesterol, triglycerides, High-density lipoprotein (HDL) and low-density lipoprotein (LDL). The Atherogenic Index of Plasma and Castelli Risk Indices I and II were calculated. These indices were classified into cutoff points to stratify cardiovascular risk. The anthropometric profile was evaluated by Z score according to Body Mass Index for age. Significance level was considered as p≤0.05.

RESULTS

A total of 146 adolescents participated in the study; the mean age was 16.4±1.1 years and most of them were girls (74.7%) and obese (52.7%). The prevalent dyslipidemias were high triglycerides (47.9%), LDL (26.7%), total cholesterol (37.7%), and low HDL (46.6%). Most adolescents presented increased atherogenic risk according to the Atherogenic Index of Plasma (55.5%); 15.1% presented high cardiovascular risk according to Castelli Risk Index I; and 13.7%, according to Castelli Risk Index II. Boys presented higher values of anthropometric measurements and Castelli Risk Indices I and II in relation to girls - who, conversely, presented higher values of HDL. There was a positive correlation of the Z score with Atherogenic Index of Plasma and a negative correlation with HDL.

CONCLUSIONS

The adolescents of the study presented high prevalence of cardiovascular and atherogenic risk according to the evaluated indices. In addition, the increased cardiovascular risk was correlated with higher Body Mass Index.

Ultra-processed food intake is associated with children and adolescents with congenital heart disease clustered by high cardiovascular risk factors

The excessive intake of ultra-processed foods (UPF) is associated with an increase in cardiovascular risk. However, the effect of UPF intake on cardiovascular health in children and adolescents with congenital heart disease (CHD) is unknown. The aim of the present study was to describe UPF intake and evaluate associations with isolated cardiovascular risk factors and children and adolescents with CHD clustered by cardiovascular risk factors. A cross-sectional study was conducted involving 232 children and adolescents with CHD. Dietary intake was assessed using three 24-hour recalls. UPFs were categorized using the NOVA classification. The cardiovascular risk factors evaluated were central adiposity, elevated high-sensitivity C-reactive protein (hs-CRP) and subclinical atherosclerosis. The clustering of cardiovascular risk factors (waist circumference, hs-CRP and carotid intima-media thickness) was performed, allocating the participants to two groups (high versus low cardiovascular risk). UPFs contributed 40.69% (SD 6.21) to total energy intake. The main UPF groups were ready-to-eat and take-away/fast foods (22.2% energy from UPFs). The multivariable logistic regression revealed that an absolute increase of 10% in UPF intake (OR=1.90; 95% CI: 1.01;3.58) was associated with central adiposity. An absolute increase of 10% in UPF intake (OR=3.77; 95% CI: 1.80;7.87) was also associated with children and adolescents with CHD clustered by high cardiovascular risk after adjusting for confounding factors. Our findings demonstrate that UPF intake should be considered a modifiable risk factor for obesity and its cardiovascular consequences in children and adolescents with CHD.

Association between Different Types of Edible Oils and Anthropometric Indices Mood, and Appetite among Women

INTRODUCTION

The objective of this study was to evaluate the relationship between consumption of dietary oils and anthropometric indices, mood, and appetite among women staff of Tehran University of Medical Sciences.

METHODS

A cross-sectional study design was used, and 245 women staff of Tehran University of Medical Sciences participated. A 168-item food frequency questionnaire was used to evaluate dietary and nutrient intake. The association between liquid vegetable oils, hydrogenated vegetable oil, and animal fat intake and anthropometric indices, appetite, and mood was evaluated. The Profile of Mood States (POMS) questionnaire was used to assess mood. A Visual Analogue Scale (VAS) was used to evaluate appetite status. The tape measure was used to measure the waist circumference and height. SPSS was used to compute body mass index (BMI) and waist-to-height ratio (WHtR).

RESULTS

In the present study, sunflower and frying oil were the most consumed liquid oils (n = 135/245 participants). Participants with a moderate intake of MUFA had greater odds ratio (OR: 3.47; 95% CI: 1.20-10.7; P trend = 0.025) of a high appetite compared to those with a low intake of MUFA. However, the study found no evidence of an association between consumption of edible oils (vegetable oils, animal fat oils, and other fatty acid sources) and mood, anthropometric indices, or appetite.

CONCLUSIONS

In the current research, we noticed a significant connection between moderate intake of MUFA and a large appetite and no association between consumption of edible oils and other outcomes. In conclusion, a balanced diet low in fast meals, processed foods, cakes, cookies, and sweets is suggested to limit the consumption of artificial trans-fatty acids.

The Effect of Trans Fatty Acids on Human Health: Regulation and Consumption Patterns

Health effects of trans fatty acids (TFAs) on human organisms can vary according to their type, structure, composition, and origin. Even though the adverse health effects of industrial TFAs (iTFAs) have been widely discussed, the health effects of natural TFAs (nTFAs) are still questionable. Hence, it is important to review the literature and provide an overall picture on the health effects of different TFAs coming from industrial and ruminant sources, underlining those types that have adverse health effects as well as suggesting methods for reducing their harmful effects. Multiple databases (PubMed, Medline, Cochrane Library, etc.) were searched with the key words "trans fatty acid sources", "ruminant", "industrial", "conjugated trans linoleic acid", "human", "coronary heart disease", "cancer", etc. Reference lists of the studies were scanned discussing the health effects of iTFAs and nTFAs. The review of the literature showed that iTFAs are found to be more harmful than ruminant-produced nTFAs. Although several beneficial effects (such as reduced risk of diabetes) for nTFAs have been observed, they should be used with caution. Since during labeling it is usually not mentioned whether the TFAs contained in food are of industrial or natural origin, the general suggestion is to reduce their consumption.

The association between Sugars Sweetened Beverages (SSBs) and lipid profile among children and youth: A systematic review and dose-response meta-analysis of cross-sectional studies

BACKGROUND

The relationship between sugar-sweetened beverages (SSBs) intake and serum lipids among children and youth has been reported in several studies, but the results are still controversial.

OBJECTIVE

In the current study, we summarized the results of studies that assessed the relationship between SSBs consumption and serum lipids among children and youth in a systematic review and dose-response meta-analysis.

METHODS

The PubMed, Web of Sciences, Cochrane and Scopus electronic databases were searched for observational studies reporting an association between SSBs intake and serum lipids among children and youth that were published before May 2020. For data extracted from cohort studies, only cross-sectional baseline data were included in the current meta-analysis. The Random effects model was used to estimate the pooled weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was assessed with the Cochran Q test and I² statistics.

RESULTS

In our search, 1845 studies were retrieved of which 13 studies (two cohorts and eleven cross-sectional) were included. High SSB consumption was associated with 1.21 mg/dL increase in low-density lipoprotein cholesterol (LDL-C; pooled WMD: 1.21 mg/dL; 95% CI: 0.23, 2.20; P = .01), 1.45 mg/dL decrease in high-density lipoprotein cholesterol (HDL-C, pooled WMD: -1.46 mg/dL; 95% CI, -2.25, -0.67; P < .0001) and 2.49 mg/dL decrease in total cholesterol (TC, pooled WMD: -2.49 mg/dL; 95% CI, -2.89, -2.10; P < .0001). In dose-response meta-analysis, there was an evidence of departure from linearity in the relationship between SSB consumption and change in LDL-C (P-_nonlinearity  = .03) and TC (P-_nonlinearity  = .01). However, no departure from linearity was observed between SSB intake and change in HDL-C (P-_nonlinearity  = .56) or triglyceride (TG) values (P-_nonlinearity  = .85).

CONCLUSION

According to our results, high SSB consumption was significantly associated with higher LDL-C and lower HDL-C and TC among children and youth. However, owing to the limited number of the included studies, further well-designed interventional studies are needed to better elucidate causality.

Dietary patterns are associated with central adiposity and carotid intima-media thickness in children and adolescents with congenital heart disease

PURPOSE

Unhealthy dietary patterns (DP) in childhood are associated with cardiovascular disease in adulthood. DP in children and adolescents with congenital heart disease (CHD) are unknown. The aims of this study were to describe DPs of children and adolescents with CHD and to evaluate their associations with central adiposity, high-sensitivity C-reactive protein (hs-CRP) and carotid intima-media thickness (cIMT).

METHODS

A cross-sectional study including 232 children and adolescents with CHD. Dietary data were based on three 24-h dietary recalls. Central adiposity was evaluated by waist circumference. hs-CRPs were determined by nephelometry. The cIMT was measured using ultrasound. DPs were identified using principal component analysis. Data were examined using logistic and linear regressions.

RESULTS

Six DPs were identified. In multivariable-adjusted analysis, unhealthy DP (high intake of poultry, red meat, cold cuts and processed meats, soft drinks and sweetened beverages) and healthy DP (high intake of fish, eggs, bread, beans, tubers and roots, fruit and fruit juice) were associated with increased and decreased odds of central adiposity, respectively (Odds ratio (OR): 2.10; 95% confidence interval (95% CI) 1.09; 4.02; OR: 0.48 95% CI 0.24; 0.93). Besides, low-fat dairy DP (high intake of low-fat milk and dairy, mixed dishes, ultra-processed breads, candy and chocolate) was inversely associated with cIMT (β: - 0.024; 95% CI - 0.04; - 0.01).

CONCLUSION

Unhealthy DP seems to increase the risk of central adiposity, while the healthy DP seems to decrease the risk of central adiposity. Still, low-fat dairy DP was inversely associated with cIMT. These findings may be helpful to develop nutrition recommendations for early cardiovascular disease prevention in children and adolescents with CHD.

The Homeostatic Theory of Obesity: An Empirical Verification of the Circle of Discontent with an Assessment of Its Relationship to Restrained and Uncontrolled Eating among Children and Adolescents

The purpose of the present study was to provide an empirical verification of the Circle of Discontent with an assessment of its relationship to restrained and uncontrolled eating among children and adolescents. This study examined whether our results confirm a new hypothesized model. The total sample comprised 282 children and adolescents (148 girls and 134 boys; 141 participants with normal body weight and 141 with obesity). The mean age was 12.23 years (SD = 2.80), and the average BMI (body mass index) was 23.29 kg/m² (SD = 6.27). The following were used: Positive and Negative Affect Scale for Children, Children’s Body Image Scale, Figure Rating Scale, Three-Factor Eating Questionnaire and Eating Disorders in Youth. The obtained values of the model fit indices proved the goodness of fit. Our findings show that obesity accompanies body dissatisfaction and uncontrolled and restrictive eating. Moreover, the higher the level of restrictive eating, the lower the level of uncontrolled eating. The relationships between body dissatisfaction, negative affect and restrictive eating, as well as that between uncontrolled eating and high-energy consumption, are significant and positive. Other relationships are non-significant. The above-mentioned relationships established in the Circle of Discontent, as well as relationships of restrained and uncontrolled eating with variables described in the circle, were confirmed. Based on our results, preventive strategies and psychological interventions can be created and may include changes in body image, eating behaviors and emotional functioning.