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Retinal arteriolar narrowing and venular widening are associated with increased cardiovascular risk, even at young ages. Whether diet contributes to early microvascular changes in children is not widely explored. We explored the associations of frequency of healthy and unhealthy food group intake with retinal vessel calibers in black and white children. This study included school-aged (5–9 years) black (N = 433, 7.46 ± 0.98 years), and white (N = 403, 7.43 ± 0.82 years) children. Anthropometric and blood pressure measurements were taken, along with retinal vessel calibers (central retinal arteriolar (CRAE) and venular (CRVE) equivalents). Frequencies of food group intake were assessed using a food-frequency questionnaire. A factor analysis was performed to describe food group patters. Independent associations between retinal vessel calibers and frequencies of food group intake and food group patters were explored. In black children, cookies, cakes, and biscuits were associated with narrower arterioles (p < 0.05). In white children, cold sweetened beverages were associated with narrower arterioles (p = 0.02), whereas salty snacks were associated with narrower arterioles (p = 0.01) and wider venules (p < 0.05). Fruits were positively associated with CRAE (p = 0.03) in white children only. A higher frequency of unhealthy food group consumption was associated with retinal arteriolar narrowing and venular widening in both black and white children. However, fruit intake was shown beneficial for retinal microvascular health in white children only. Our findings may highlight the importance of promoting healthy eating patterns from early childhood which may reduce the risk of premature cardiovascular disease development. • In primary school-aged children, retinal vessel calibers and food groups frequency intake were measured. • Unhealthy food groups intake related to narrower retinal arterioles and wider retinal venules. • Healthy food groups intake related to wider retinal arterioles in white children only. • Promotion of healthy eating patterns from early childhood is encouraged. [ABSTRACT FROM AUTHOR]

The prevalence of high childhood blood pressure (BP) is rising globally and has been associated with subclinical vascular impairments in children. Longitudinal data on the association of microvascular alterations with the development of high BP in children are lacking. We aimed to analyze the association of central retinal arteriolar (CRAE) and venular (CRVE) diameters with development of higher BP over 4 years in young school children. In 2014, 391 children aged 6 to 8 years were screened for BP and retinal vessel diameters using standardized protocols. Retinal vessel analysis was performed using a retinal vessel analyzer to determine CRAE and central retinal venular equivalent. In the follow-up of 2018, all parameters were assessed in 262 children using the same standardized protocols. During follow-up, systolic and diastolic BP increased significantly (Δ 3.965±8.25 and 1.733±7.63 mm Hg, respectively), while CRAE decreased by Δ -6.325±8.55 µm without significant changes in central retinal venular equivalent (Δ -0.163±7.94 µm). Children with narrower CRAE at baseline developed higher systolic BP after four years (β [95% CI] 0.78 [0.170-1.398] mm Hg per 10 µm decrease, P=0.012). Children with increased systolic or diastolic BP at baseline developed narrower CRAE (β [95% CI] -0.154 [-0.294 to -0.014] µm per 1mmHg, P=0.031 and β [95% CI] -0.02 [-0.344 to -0.057] µm per 1 mmHg, P=0.006, respectively) at follow-up. Narrowing of retinal arterioles predicted evolution of systolic BP. In turn, higher initial systolic and diastolic BP was associated with subsequent development of microvascular impairments. Our results give good evidence for a bivariate temporal relationship between BP and microvascular health in children. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of combined aerobic and coordinative exercise on retinal microcirculation and its association with changes in cognitive performance in healthy adolescents.Design: Using cluster-randomization (on class-level), 36 participants were allocated to an exercise group (EX) performing a 20-min aerobic and coordinative exercise session on each school day over a period of 8 weeks or a control group, which was encouraged to have social interactions (CON).Method: Prior to and following the intervention period, central retinal arteriolar (CRAE) and venular diameters (CRVE) were assessed by use of a static vessel analyzer. Additionally, a computer-based version of the Stroop Color-Word task was administered to assess inhibitory control.Results: The statistical analysis revealed that EX compared to CON showed higher CRAE at post-test, when pre-test values were accounted for, F(1,32)=4.92, p=0.036, η2=0.130. In contrast, no such effect was reported for CRVE. With regard to cognitive performance, a greater reduction of reaction time on the Stroop task was observed in EX relative to CON, F(1,30)=8.58, p=0.006, η2=0.222. The increase in CRAE was significantly correlated with a decrease of reaction time on trials demanding inhibitory control, even after adjusting for covariates, r(31)=-0.438, p=0.011.Conclusions: A structured exercise program leads to a widening of retinal arteriolar diameters, which is associated with improvements in inhibitory control. Consequently, daily exercise sessions performed during the school break-time can be recommended for promoting both cardiovascular and cognitive health in adolescents. [ABSTRACT FROM AUTHOR]

Cardiovascular disease often develops during childhood, but the determinants of vascular health and disease in young children remain unclear. The study aimed to investigate the association of obesity and hypertension, as well as physical fitness with retinal microvascular health and large artery stiffness, in children. In this cross-sectional study, 1171 primary school children (aged 7.2±0.4 years) were screened for central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) diameters, pulse wave velocity (PWV), body mass index, blood pressure (BP), and cardiorespiratory fitness by standardized procedures for children. BP was categorized according to the reference values of the population-based German KiGGS study (Kinder- und Jugendgesundheitssurvey [Children- and Adolescents Health Survey]) and the American Academy of Pediatrics guidelines. Overweight (mean [95% CI]: CRAE, 200.5 [197.9-203.2] µm; CRVE, 231.4 [228.6-234.2] µm; PWV, 4.46 [4.41-4.52] m/s) and obese children (CRAE, 200.5 [196.4-204.7] µm; CRVE, 233.3 [229.0-237.7] µm; PWV, 4.51 [4.43-4.60] m/s) had narrower CRAE, wider CRVE, and higher PWV compared with normal-weight children (CRAE: 203.3 [202.5-204.1] µm, P<0.001; CRVE: 230.1 [229.1-230.9] µm, P=0.07; PWV: 4.33 [4.31-4.35] m/s, P<0.001). Children with high-normal BP (CRAE, 202.5 [200.0-205.0] µm; PWV, 4.44 [4.39-4.49] m/s) and BP in the hypertensive range (CRAE, 198.8 [196.7-201.0] µm; PWV, 4.56 [4.51-4.60] m/s) showed narrower CRAE, as well as higher PWV, compared with normotensive peers (CRAE: 203.7 [202.9-204.6] µm, P<0.001; PWV: 4.30 [4.28-4.32] m/s, P<0.001). With each unit increase of body mass index and systolic BP, CRAE decreased and PWV increased significantly. Children with the highest cardiorespiratory fitness had wider CRAE, narrower CRVE, and lower PWV compared with least fit children. Childhood obesity and hypertension, even at preclinical stages, are associated with microvascular and macrovascular impairments in young children. Primary prevention programs targeting physical activity behavior may have the potential to counteract development of small and large vessel disease early in life. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02853747. [ABSTRACT FROM AUTHOR]

The retinal microcirculation serves a proxy of cerebrovascular function and has been linked with both physical fitness and cognitive function. We investigated the role of physical fitness for the development of executive function in children as well as its mediation by microvascular health. Using a cross-lagged panel design, 365 children aged six to eight years completed a baseline assessment, which was followed up after four years. Retinal vessel analysis was performed on digital retinal images obtained with a fundus camera. Additionally, a computerized Flanker task was administered to assess the inhibitory aspect of executive function. With regard to physical fitness tests, participants completed a shuttle run and 20-m sprints. Path-analyses showed that higher performance on the shuttle run and 20-m sprint at baseline were both associated with lower reaction times on the Flanker task at follow-up, when autoregressive effects were accounted for. Stages achieved on the shuttle run at baseline were further related to narrowing of retinal venular diameters, which in turn predicted performance on the Flanker task. However, the direct relation of physical fitness components to reaction time was higher compared to the indirect relation via retinal venular diameters. High physical fitness contributes to the development of cognitive abilities from childhood to preadolescence. This association is not mediated by retinal vessel diameters, while the microvascular phenotype of narrower retinal venules is independently related to a better development of information processing and inhibitory control. • Higher fitness predicted a better development of cognitive abilities over 4 years. • The association was observed for inhibitory control and information processing. • Retinal microcirculation did not mediate the fitness-cognition relation. • Narrower retinal venules independently predicted a better cognitive development. [ABSTRACT FROM AUTHOR]

Background: Health scores such as the Life's Simple 7 (LS7) from the American Heart Association and the assessment of carotid intimamedia thickness (cIMT) are independently used to predict future cardiovascular health burden. However, evidence of their association remains scarce, especially in healthy populations. Methods: A community sample of the healthy Swiss population aged 50-91 years was included as part of the COmPLETE cohort study. CIMT was measured with a semiautomatic state-of-the-art ultrasound system. The LS7 cardiovascular health score was calculated from body-mass index, cholesterol, systolic blood pressure, hemoglobin A1c, smoking status, physical activity, and diet. For every biomarker two points were given for an ideal health metric level, intermediate scores 1 point, and poor scores 0 points. Intermediate health corresponded to a total of 5-9 points and ideal health to 10-14 points. Results: 280 participants (50.7% male) were included in statistical analyses. Age- and sex-adjusted analyses showed an association of "ideal health" with lower cIMT (- 0.038 mm, 95% CI - 0.069 mm to - 0.007 mm, p = 0.017) compared to "intermediate health". Conclusions: Even in a healthy community-dwelling sample of middle-aged to older adults, individuals with an ideal cardiovascular health score showed more favorable carotid properties than those with an intermediate score. This stresses the relevance of promoting an optimal lifestyle, even among the healthy population, for optimal vascular aging. [ABSTRACT FROM AUTHOR]

Abstract: Background: Distance walked in the 6-minute walk test (6MWT) is an important prognostic parameter used clinically to assess functional status in patients with chronic heart failure (CHF). In this study, we investigated if alternative performance parameters with similar prognostic value can be gained from accelerometers. Methods and Results: Fifty CHF patients (age, 60.9 ± 14.0 years) were asked to perform a 6MWT while wearing 2 accelerometers and 1 pedometer. Total 6MWT step frequency (SF) and activity counts (VMU) were correlated to 6MWT distance. The accelerometer was highly accurate at quantifying SF (detected vs. observed: r = 0.99; P < .001), whereas the pedometer was unreliable below 50 m/min. VMU increased linearly with walking speed (r = 0.99), and both SF and VMU correlated strongly with 6MWT distance (VMU: r = 0.91; SF: r = 0.87, respectively; P < .001) and each other (r = 0.80, P < .001). Conclusions: Accelerometers are reliable in measuring physical performance during the 6MWT in CHF patients. Besides the simple acquisition of 6MWT distance currently used for patient assessment, accelerometers provide new data that might be useful to evaluate exercise performance during the 6MWT. This allows for routine assessment of exercise capacity in a home-based setting in the context of telemedicine. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to use an accelerometer to measure daily walking performance in patients with chronic heart failure (CHF) to investigate if this parameter is a determinant of New York Heart Association class and indicative of maximal and functional exercise capacity. Methods: Fifty patients with CHF were instructed to wear an accelerometer for 7 consecutive days while going about their daily business. Maximal and functional exercise capacity was assessed by cardiopulmonary (VO2peak) and 6-minute walk testing, respectively. Results: Patients in New York Heart Association I, II, and III reached an average total walking time (TWT) of 160.6 ± 35.8 minutes, 133.9 ± 59.0 minutes, and 76.1 ± 22.5 minutes per day of which 19%, 19%, and 9% where spent in the fast walking mode (>83 m/minute), respectively. The TWT correlated strongly with VO2peak (r = 0.72; P <.001) and 6-minute walk testing distance (r = 0.68; P <.001). The TWT and time spent in fast walking mode were the strongest determinants in discriminating moderate CHF. Conclusion: Daily walking performance is a clear determinant of maximal and functional exercise capacities in patients with CHF. Walking intensity in particular is an independent predictor in discriminating patients with advanced heart failure. Monitoring of daily walking performance might aid in detecting disease progression and improve clinical outcome. [Copyright &y& Elsevier]

Markers of cardiovascular risk and cognitive performance were assessed in 347 children. In contrast with body mass index and blood pressure, only retinal microcirculation explained a unique proportion of variance in inhibitory control and information processing, when dependencies between markers of cardiovascular risk were accounted for. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to investigate the association between impairment in heart rate recovery (HRrec) after cycle ergometry and prognostic markers in patients with heart failure (HF) compared with healthy controls. Methods: Fifty patients with chronic HF (systolic HF, N = 30; diastolic HF, N = 20; mean age = 62 ± 12 years) and 50 healthy controls (N = 50; mean age = 66 ± 13 years) underwent 2-dimensional and M-mode echocardiography followed by cardiopulmonary exercise testing. Independent predictors of HRrec at 1 and 2 minutes after exercise were analyzed by univariable and multivariable regression analyses, and receiver operating characteristics were performed to obtain area under the curve. Results: In HF, left ventricular end-diastolic diameter (millimeters), left ventricular ejection fraction (%), N-terminal pro-brain natriuretic peptide (picograms/milliliter), peak oxygen uptake (VO2peak [milliliters/kilogram/min]), and peak heart rate (HRpeak) showed a significant association with HRrec (beats/min) in univariate regression analyses (P < .001), but only VO2peak remained independently predictive of both HRrec1 (P = .034) and HRrec2 (P = .008) in the multivariable regression analyses. In controls, VO2peak (P = .035) and HRpeak (P = .032) were significantly associated with HRrec2 in univariate analyses only. Optimal cutoff values for discriminating HF versus non-HF based on HRrec were 17.5 beats/min (sensitivity 92%; specificity 74%) for HRrec1 and 31.5 beats/min (sensitivity 94%; specificity 86%) for HRrec2. Optimal cutoff values for discriminating systolic HF versus diastolic HF were 12.5 beats/min (sensitivity 78%; specificity 80%) for HRrec1 and 24.5 beats/min (sensitivity 82%; specificity 90%) for HRrec2. Conclusion: Impairment in after exercise HRrec is significantly and independently associated with VO2peak in HF and thus might constitute a useful tool for assessing the degree of functional status during exercise rehabilitation. [Copyright &y& Elsevier]