Search

Few studies have examined long-term associations of walnut, other nut, and no nut consumption with cardiovascular disease (CVD) risk factors. Results from prospective studies with long-term follow-up can provide further evidence for dietary guideline messaging to consume nuts. Therefore, we examined the associations of walnut, other nut, and no nut consumption with diet quality and CVD risk factors over 30 years of follow-up.Data were analyzed from 3092 young adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary intake, including walnuts and other nuts, was assessed 3 times over 20 years. CVD risk factors were measured at multiple exams. General linear regression evaluated the associations of walnut, other nut, and no nut consumption with CVD risk factors over 30 years (Y30) of follow-up. The 20-year cumulative mean intake of walnuts (0.74 oz/d), other nuts (1.6 oz/d), or no nut consumption was differentially associated with HEI-2015 and CVD risk factors by Y30. Generally, walnut consumers had significantly higher HEI-2015, lower body mass index, waist circumference, blood pressure, and triglyceride concentration, and gained less weight since baseline than other nut consumers (p ≤ 0.05 for all). Further, walnut consumers had lower fasting blood glucose than no nut consumers (p ≤ 0.05).Study findings that walnut and other nut consumption was associated with better CVD risk factors and diet quality aligns with the 2020-2025 US. Dietary Guidelines for Americans recommendation to consume nuts, such as walnuts, within the context of a healthy diet.

BACKGROUND AND AIMS: Various food groups have been associated with measures of left ventricular geometry and function. Whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in mid-life is associated with a favorable cardiac structure and function later in life is unknown. METHODS AND RESULTS: The study population consisted of the Atherosclerosis Risk in Communities study participants free of cardiovascular disease at study visit 3 in 1993 to 1995. Dietary intake was assessed by food frequency questionnaire at study visits 1 (1987–1989) and 3 (1993–1995). Participants who underwent transthoracic echocardiograms at the Jackson field center at visit 3 (n=1,974) and at all field centers at study visit 5 (2011–2013; n=4,651) were included in this study. General linear regression was used to evaluate associations between dietary intake and markers of cardiac structure and function adjusting for potential confounders. Higher DASH score was associated with lower left ventricle mean wall thickness and higher absolute value of longitudinal strain at visit 5 (p(trend)=0.004 and

BACKGROUND: Few studies have evaluated whether plant-centered diets prevent progression of early stage chronic kidney disease (CKD). OBJECTIVES: We examined the association between plant-centered diet quality and early CKD markers. METHODS: We prospectively examined 2869 black and white men and women in the Coronary Artery Risk Development in Young Adults Study free of diagnosed kidney failure in 2005–2006 [examination year 20 (Y20); mean age: 45.3 ± 3.6 y]. CKD marker changes from Y20 to 2015–2016 (Y30) were considered, including estimated glomerular filtration rate (eGFR; serum creatinine), urinary albumin-to-creatinine ratio (ACR), and both. Diet was assessed through interviewer-administered diet histories at Y0, Y7, and Y20, and plant-centered diet quality was quantified with the A Priori Diet Quality Score (APDQS). Linear regression models were used to examine the association of APDQS and subsequent 10-y changes in CKD markers. RESULTS: After adjustment for sociodemographic, behavioral, and diet factors, we found that higher APDQS was related to less adverse changes in CKD markers in the subsequent 10-y period. Compared with the lowest APDQS quintile, the highest quintile was associated with an attenuated increase in lnACR (−0.25 mg/g; 95% CI: −0.37, −0.13 mg/g; P-trend

BACKGROUND: High diet quality is associated with a lower risk of chronic diseases. Metabolomics can be used to identify objective biomarkers of diet quality. OBJECTIVES: We used metabolomics to identify serum metabolites associated with 4 diet indices and the components within these indices in 2 samples from African Americans and European Americans. METHODS: We studied cross-sectional associations between known metabolites and Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension Trial (DASH) diet, alternate Mediterranean diet (aMED), and their components using untargeted metabolomics in 2 samples (n(1) = 1,806, n(2) = 2,056) of the Atherosclerosis Risk in Communities study (aged 45–64 y at baseline). Dietary intakes were assessed using an FFQ. We used multivariable linear regression models to examine associations between diet indices and serum metabolites in each sample, adjusting for participant characteristics. Metabolites significantly associated with diet indices were meta-analyzed across 2 samples. C-statistics were calculated to examine if these candidate biomarkers improved prediction of individuals in the highest compared with lowest quintile of diet scores beyond participant characteristics. RESULTS: Seventeen unique metabolites (HEI: n = 6; AHEI: n = 5; DASH: n = 14; aMED: n = 2) were significantly associated with higher diet scores after Bonferroni correction in sample 1 and sample 2. Six of 17 significant metabolites [glycerate, N-methylproline, stachydrine, threonate, pyridoxate, 3-(4-hydroxyphenyl)lactate)] were associated with ≥1 dietary pattern. Candidate biomarkers of HEI, AHEI, and DASH distinguished individuals with highest compared with lowest quintile of diet scores beyond participant characteristics in samples 1 and 2 (P value for difference in C-statistics

Background Very-long-chain SFAs (VLSFAs) have recently gained considerable attention as having beneficial effects on health and aging. Objectives The objective of this study was to assess the associations of plasma phospholipid VLSFAs [arachidic acid (20:0), behenic acid (22:0), tricosanoic acid (23:0), and lignoceric acid (24:0)] with 20-y cognitive decline in the Atherosclerosis Risk in Communities (ARIC) participants. Furthermore, this study compared the associations of plasma phospholipid VLSFAs with 5 common groups of fatty acids [i.e., total SFAs, total MUFAs, total ω-3 (n-3) PUFAs, total marine-derived ω-3 PUFAs, total ω-6 PUFAs]. Methods This study used a cohort study design of 3229 ARIC participants enrolled at the Minnesota field center. Fatty acids were measured at visit 1 (1987-1989); and cognition was assessed at visits 2 (1990-1992), 4 (1996-1998), and 5 (2011-2013) using 3 tests: the Delayed Word Recall Test (DWRT), the Digit-Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). Results Higher proportions of plasma phospholipid total VLSFAs and each individual VLSFA were associated with less decline in WFT, a test of verbal fluency. For example, 1 SD higher in total VLSFAs at baseline was associated with 0.057 SD (95% CI: 0.018, 0.096, P = 0.004) less cognitive decline over 20 y as measured by WFT score. None of the 5 common fatty acid groups were associated with change in WFT, but a higher proportion of plasma phospholipid total MUFAs was associated with greater decline in DWRT; higher total ω-6 PUFAs with less decline in DWRT; and higher total ω-3 and total marine-derived ω-3 PUFAs with less decline in DSST. Conclusions This study suggests that higher proportions of plasma phospholipid VLSFAs in midlife may be associated with less 20-y cognitive decline.

BACKGROUND: Vegetables and fruits (VF) may differentially affect cognitive functions, presumably due to their various nutrient contents, but evidence from epidemiologic studies is limited. OBJECTIVES: The aim of this study was to examine the long-term association between VF intakes, including VF subgroups, in young adulthood and cognitive function in midlife. METHODS: A biracial cohort of 3231 men and women aged 18–30 y at baseline in 1985–1986 were followed up for 25 y in the Coronary Artery Risk Development in Young Adults Study. Diet was measured at baseline, and in examination years 7 and 20. Cognitive function was assessed at examination year 25 through the use of 3 tests: the Rey Auditory Verbal Learning Test (RAVLT), the Digit Symbol Substitution Test (DSST), and the Stroop test. The mean differences (MDs) with 95% CIs in cognitive scores across intake categories were estimated through the use of the multivariable-adjusted general linear regression model. RESULTS: Excluding potatoes, intake of whole vegetables was significantly associated with a better cognitive performance after adjustment for potential confounders in all 3 cognitive tests (quintile 5 compared with quintile 1—RAVLT, MD: 0.33; 95% CI: 0.01, 0.64; P-trend = 0.08; DSST, MD: 2.84; 95% CI: 0.93, 4.75; P-trend

Objectives The aim of this study was to examine the longitudinal association between seafood and intake of long-chain ω-3 polyunsaturated fatty acids (LCω-3 PUFA) and cognitive function and to explore the possible effect modifications owing to mercury (Hg) and selenium (Se) levels. Methods Participants (N = 3231) from the CARDIA (Coronary Artery Risk Development in Young Adults) study underwent baseline examination and were reexamined in eight follow-up visits. Diet was assessed at baseline and in exam years 7 and 20. Toenail Hg and Se were measured at exam year 2. Cognitive function was measured at exam year 25 using three tests: Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and the Stroop test. The general linear regression model was used to examine cumulative average intakes of LCω-3 PUFA and seafood in relation to the cognitive test scores; and to explore the possible effect modifications caused by Hg and Se. Results LCω-3 PUFA intake was significantly associated with better performance in the DSST test (quintile 5 versus quintile 1; mean difference = 1.74; 95% confidence interval, 0.19–3.29; Ptrend, 0.048]), but not in the RAVLT and Stroop tests. Similar results were observed for intakes of eicosapentaenoic acid, docosahexaenoic acid, and non-fried seafood. The observed associations were more pronounced in participants with body mass index ≥25 kg/m2, but not significantly modified by toenail Hg or Se. Conclusion This longitudinal study supported the hypothesis that LCω-3 PUFA or non-fried seafood intake is associated with better cognitive performance in psychomotor speed among US adults, especially those who are overweight or obese.

AIMS: To determine the association between 20-year trajectories in insulin resistance (IR) since young adulthood and appendicular lean mass (ALM) at middle-age in adults without diabetes. METHODS: A prospective cohort study was designed among young and middle-aged US men (n=925) and women (n=1,193). Fasting serum glucose and insulin were measured five times in 1985–2005. IR was determined using the homeostasis model assessment (HOMA). ALM was measured in 2005 and ALM adjusted for BMI (ALM/BMI) was the outcome. Sex-specific analyses were performed using latent class models and multivariable linear regressions. RESULTS: Three HOMA-IR trajectories were identified. Compared to the low-stable group, the adjusted ALM/BMI difference was −0.041 (95% CI: −0.060 to −0.022) and −0.114 (−0.141 to −0.086) in men, and −0.052 (−0.065 to −0.039) and −0.043 (−0.063 to −0.023) in women, respectively, for the medium-increase and high-increase group. Further adjusting for the treadmill test duration attenuated these estimates to −0.022 (−0.040 to −0.004) and −0.061 (−0.089 to −0.034) in men and −0.026 (−0.038 to −0.014) and −0.007 (−0.026 to 0.012) in women. CONCLUSIONS: Compared to the low-stable insulin resistance trajectory between early and middle adulthood, the high-increase insulin resistance trajectory was associated with lower ALM/BMI middle-aged men, but not women, without diabetes, after taking into account cardiorespiratory fitness.

Healthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention. Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations. The availability of these new indices raises questions regarding the best selection relevant to a given population. In this perspective, we critically evaluate a priori–defined dietary indices commonly applied in epidemiological studies of CVD risk and mortality. A systematic literature search identified 59 observational studies that applied a priori–defined diet quality indices to CVD risk factors and/or CVD incidence and/or CVD mortality. Among 31 different indices, these scores were categorized as follows: 1) those based on country-specific dietary patterns, 2) those adapted from distinct dietary guidelines, and 3) novel scores specific to key diet-related factors associated with CVD risk. The strengths and limitations of these indices are described according to index components, calculation methods, and the application of these indices to different population groups. Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD. The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use. Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level.

The PREDIMED clinical trial provided strong evidence that a Mediterranean dietary pattern (MedDiet) could help prevent cardiovascular disease (CVD) events in high risk middle-aged/older people. This report considers the feasibility of replicating PREDIMED in the U.S., including recommendations for dietary and behavioral principles. A 14-point Mediterranean diet Adherence Score (MEDAS) guided the PREDIMED MedDiet recommendations. At baseline MEDAS points were ~8.5. During intervention this score increased to nearly 11 in MedDiet vs. 9 in control. In the MedDiet groups, only about 0.5 points of the net 2 point MEDAS increase was attributable to the gratis supplements of olive oil or nuts. An issue in a U.S. replication is the large difference in typical U.S. versus Spanish diet and lifestyle. A typical U.S. diet would achieve a MEDAS of 1–2. A replication is scientifically feasible with an assumption such as that the MedDiet reflects a continuum of specific food choices and meal patterns. As such, a 2 point change in MEDAS at any point on the continuum would be hypothesized to reduce incident CVD. A conservative approach would aim for a randomized 4 point MEDAS difference, e.g. 5–6 points vs. an average U.S. diet group that achieved only 1–2 points.

BACKGROUND: Moderate coffee consumption has been suggested to be associated with lower risk of chronic conditions such as diabetes, a major precursor to chronic kidney disease (CKD). However, the association between coffee and CKD has not been fully established. STUDY DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: 14,209 participants aged 45–64 years from the Atherosclerosis Risk in Communities (ARIC) Study. PREDICTORS: Coffee consumption (cups/day) was assessed at visit 1 (1987–89) and visit 3 (1993–95) using food frequency questionnaires. OUTCOMES: Incident CKD defined as eGFR

Introduction Data from epidemiological studies and clinical trials suggest an influence of dietary and circulating polyunsaturated fatty acids (PUFAs) on the hemostasis profile. Genome-wide association studies (GWAS) have identified single nucleotide polymorphisms (SNPs) related to plasma PUFAs levels. We aimed to investigate whether the SNPs related to plasma PUFAs levels were also associated with plasma levels of hemostatic variables. Materials and methods We tested the associations between 9 PUFA-related SNPs and 6 hemostatic variables in 9035 European Americans (EAs) and 2702 African Americans (AAs) in the Atherosclerosis Risk in Communities (ARIC) Study. We then conducted a replication study by looking-up our novel observed associations in three published GWAS for hemostatic factors in different EA populations. Results We observed a novel linoleic acid-related locus at the JMJD1C region associated with factor VII activity (FVIIc): rs10740118 and rs1935, Beta (p) = −1.31 (1 × 10−3) and 1.37 (5 × 10−4) in EAs, respectively, and − 1.24 (5 × 10−4) and 1.28 (3 × 10−4) in meta-analysis of EAs and AAs of ARIC. This novel association was replicated in two of three independent EA populations (p = 0.01 and 0.03 in meta-analyses). We confirmed previously reported associations at the docosapentaenoic acid-related GCKR locus with protein C and FVIIc and at JMJD1C with fibrinogen. Adjustment for plasma PUFAs did not abolish the associations between these loci and hemostatic variables. Conclusions Our study identified a novel association for FVIIc at JMJD1C, a histone demethylase that plays a role in DNA repair and possibly transcription regulation and RNA processing.

OBJECTIVES: A low-saturated fat diet has been suggested to reduce serum cholesterol and thereby presumably lower the risk of atherosclerotic cardiovascular disease (CVD). We compared associations of a low-saturated fat diet vs a plant-centered diet with lower serum low-density lipoprotein cholesterol (LDL-C) concentration and risk of incident CVD, coronary heart disease (CHD), and stroke. METHODS: We followed 4,887 Black and White men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, ages 18–30 years and free of CVD at baseline from 1985–86 (exam year 0) to 2018 (year 32). The A Priori Diet Quality Score (APDQS), a measure of plant-centered diet quality, was assessed in an interviewer-administered diet history at years 0, 7, and 20. Higher APDQS implies higher intake of nutritionally-rich plant foods with less high-fat meats and unhealthy plant foods. Low-saturated fat diet was judged by lower the Keys score, based on saturated fat, polyunsaturated fat, and dietary cholesterol intake. Linear and proportional hazards regression models were used, the latter with time-varying average APDQS and CVD outcomes, both adjusted for age, sex, race, education, energy intake, physical activity, smoking, and parental history of CVD (CVD outcome only). RESULTS: Higher APDQS had higher dietary fiber and lower total and saturated fat. Keys score and APDQS 7-year changes correlated similarly with lower concurrent LDL-C change. During the 32 year follow-up, we documented 280,135, and 92 incident cases of CVD, CHD, and stroke, respectively. LDL-C predicted CVD and CHD, but not stroke. APDQS, but not Keys score, was associated with a lower risk of each CVD outcome. Multivariable-adjusted HRs per 1-SD increment for the APDQS were 0.81 (95% CI: 0.68 − 0.96) for CVD, 0.78 (95% CI: 0.61 − 1.00) for CHD, and 0.71 (95% CI: 0.52 − 0.98) for stroke. The primary results for APDQS and for LDL-C were not substantially altered in mutually adjusted models. CONCLUSIONS: Both a plant-centered and a low-saturated fat diet were associated with lower LDL-C. A plant-centered diet and LDL-C, but not a low-saturated fat diet, were associated with long-term CVD risk. Our findings imply that dietary strategies aimed solely to lower saturated fat may be less effective in reducing CVD burden than recommendations for a plant-centered diet. FUNDING SOURCES: HFHL, MnDRIVE, NHLBI.

T-helper type 1 (Th1) cells are pro-inflammatory and provide signals to immune cells. Animal models and in vitro human cell culture experiments have indicated that long chain n-3 polyunsaturated fatty acids (LCn3PUFAs) reduce Th1 cell levels; however, the association is unknown in healthy humans. We hypothesized that circulating levels and dietary intake of LCn3PUFAs have an inverse association with circulating levels of Th1 cells and studied 895 participants in the Multi-Ethnic Study of Atherosclerosis (age 61 ± 10 years at exam 1, 52% women, 44% white, 21% African-American, 24% Hispanic-American, 11% Chinese-American). Phospholipid LCn3PUFAs (% of total fatty acids), measured by gas chromatography, and intake of LCn3PUFAs, evaluated by food frequency questionnaire, were evaluated at exam 1 (2000-02) and defined as the sum of eicosapentaenoic and docosahexaenoic acids. Th1 cells were measured by flow cytometry at exam 4 (2005-07), expressed as a percentage of CD4+ lymphocytes that were interferon-γ+ (%Th1: CD4+IFN-γ+). Median (interquartile range) plasma LCn3PUFA, dietary LCn3PUFA, and %Th1 levels were 4.31% (3.40–5.82%), 0.09 (0.05–0.16) g/day, and 14.4% (9.8–20.0%), respectively. When the association of LCn3PUFA-quartiles with %Th1 was analyzed using general linear models, neither plasma nor dietary LCn3PUFAs were significantly associated with %Th1 (P-trend = 0.58 and 0.80, respectively), which remained even after adjusting for demographics, lifestyle factors, lipids, season, and cytomegalovirus titers. In this multi-ethnic U.S. population, circulating levels and dietary intake of LCn3PUFAs were not significantly associated with Th1 cell levels. Further research is needed to assess potential benefits of supplementation and much higher dietary consumption of LCn3PUFAs on Th1 cells.

Objective Dietary protein restriction is recommended for patients with moderate to severe renal insufficiency. Long-term data on the relationship between dietary protein sources and risk for incident kidney disease in individuals with normal kidney function are largely missing. This study aimed to assess the association between dietary protein sources and incident chronic kidney disease (CKD). Design Prospective cohort. Setting Atherosclerosis Risk in Communities study participants from 4 US communities. Subjects A total of 11,952 adults aged 44-66 years in 1987-1989 who were free of diabetes mellitus, cardiovascular disease, and had an estimated glomerular filtration rate (eGFR) ≥ 60 mL/minute/1.73 m 2 . Main Outcome Measure A 66-item food frequency questionnaire was used to assess food intake. CKD stage 3 was defined as a decrease in eGFR of ≥25% from baseline resulting in an eGFR of less than 60 mL/minute/1.73 m 2 ; CKD-related hospitalization; CKD-related death; or end-stage renal disease. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression. Results During a median follow-up of 23 years, there were 2,632 incident CKD cases. Red and processed meat consumption was associated with increased CKD risk (HR Q5 vs. Q1 : 1.23, 95% CI: 1.06-1.42, p trend = 0.01). In contrast, higher dietary intake of nuts, legumes, and low-fat dairy products was associated with lower CKD risk (nuts: HR Q5 vs. Q1 : 0.81, 95% CI: 0.72-0.92, p trend Q5 vs. Q1 : 0.75, 95% CI: 0.65-0.85, p trend Q5 vs. Q1 : 0.83, 95% CI: 0.72-0.95, p trend = 0.03). Conclusion There were varied associations of specific dietary protein sources with risk of incident CKD; with red and processed meat being adversely associated with CKD risk; and nuts, low-fat dairy products, and legumes being protective against the development of CKD.

Background: Peripheral arterial disease (PAD) is a costly source of morbidity and mortality among older persons in the United States. Dietary intake plays a role in the development of atherosclerotic cardiovascular disease; however, few studies have examined the relation of food intake or dietary patterns with PAD.Objective: We examined the relation between habitual dietary intake at midlife and incident PAD over ∼20 y of follow-up.Design: Among 14,082 participants enrolled in the ARIC (Atherosclerosis Risk in Communities) Study initially free of PAD, dietary intake was assessed at baseline in 1987-1989 by using a modified Harvard food-frequency questionnaire. Food groups were created, and principal components analysis was used to develop "healthy" and "Western" dietary patterns; both were categorized into quintiles or quartiles. Incident PAD was determined by an ankle-brachial index

OBJECTIVES: Healthy dietary patterns are recommended for health promotion. Metabolomics can be used to identify objective biomarkers of healthy dietary patterns, which has the potential to improve dietary assessment. We used metabolomics to identify serum metabolites associated with healthy dietary patterns and the components within these dietary patterns in middle-aged US adults. METHODS: We evaluated known metabolites associated with 4 dietary patterns [Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean diet (aMED)] and their components using untargeted metabolomics in two subsamples (N(1 )= 1864; N(2 )= 2091) of the Atherosclerosis Risk in Communities Study. Dietary intakes were assessed using a food frequency questionnaire. We used multivariable linear regression models to examine associations between dietary patterns and individual serum metabolites in each sample, adjusting for sociodemographic factors, health behaviors, and clinical factors. RESULTS: 21 out of 373 metabolites (HEI = 10; AHEI = 9; DASH = 15; aMED = 2) in sample 1 and 57 out of 758 metabolites (HEI = 32; AHEI = 22; DASH = 44; aMED = 22) in sample 2 were significantly associated with healthy dietary patterns after Bonferroni correction. More than half of the significant metabolites (n(1 )= 10; n(2 )= 35) were associated with more than one dietary pattern. The DASH diet had the highest number of unique metabolites (n(1 )= 7; n(2 )= 17), a majority of which were amino acids. Other diets had similar number of unique metabolites (range: 0–3), which were mostly lipids. Some of the unique metabolites were positively associated with components of every diet. For example, N-methylproline was associated with fruit and dairy intake in the DASH diet; docosahexaenoate (22:6n3) was associated with omega-3 fatty acid intake in AHEI, and 1-docosahexaenoylglycerophosphoethanolamine was associated with plant protein and saturated fat intake in HEI. CONCLUSIONS: An untargeted metabolomics approach identified many metabolites associated with healthy dietary patterns. A considerable overlap of metabolites associated with HEI, AHEI, DASH, and aMED reflects the similar food components within healthy diets. FUNDING SOURCES: NIDDK, NHLBI.

OBJECTIVES: Chronic kidney disease (CKD) is an increasing health problem in young adults and may be associated with dietary patterns. We examined the association of a plant-centered diet with incident moderate-to-very high risk CKD in young adults who were initially free of CKD. METHODS: We followed 3026 community-based participants (Black and White men and women) from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (1985–86 to 2015–16). Diet was assessed by an interviewer-administered diet history at exam years (Y) 0, 7, and 20. Higher plant-centered diet quality was judged by higher cumulative average value of the A Priori Diet Quality Score (APDQS, range 0–132), a hypothesis-driven index based on 46 food groups. A higher APDQS is characterized by high consumption of nutritionally rich plant foods and limited meat, added sugars, and other less nutritious foods. Kidney status, assessed at 5-year intervals from Y10 to Y30, was based on estimated glomerular filtration rate (eGFR) using CKD-EPI creatinine equation and spot urine albumin-to-creatinine ratio (ACR). CKD diagnosis included new onset of micro- or macro-albuminuria (ACR ≥30 mg/g), eGFR

Sugar-sweetened beverage (SSB) intake is associated with metabolic disorders. The reduction of SSB intake has been promoted to prevent death and disability from chronic diseases. We investigated the association between SSB intake and the risk of coronary events and death, and assessed if substitution of coffee, tea, milk, fruit juice and artificially-sweetened beverages (ASB) for SSBs was associated with a reduced risk of coronary events and death. This was a follow-up study in which data from six studies were pooled and standard observational analyses were performed. Diet intake was assessed at baseline by food-frequency questionnaires. Hazard ratios (HRs) with 95% confidence intervals for the incidence of coronary events and deaths were calculated by Cox proportional hazards regression. The effect of substituting another beverage for SSBs was calculated by taking the difference in the individual effect estimates. During the median 8.2-year follow-up, 4248 coronary events and 1630 coronary deaths were documented among 284,345 individuals. 355 ml daily increase of SSB intake was associated with an increased risk of coronary events (HR: 1.08; 95%CI: 1.02, 1.14) and possibly coronary death (HR: 1.05; 95%CI: 0.96, 1.16). Substitution analyses suggested that replacing SSBs with coffee (HR: 0.93; 95%CI: 0.87, 1.00) or ASB (HR: 0.89; 95%CI: 0.83, 0.97), might be associated with a lower risk of developing coronary events. We found that SSB intake was associated with an increased risk of coronary events and possibly coronary death. Our findings also suggest that replacing SSB's with ASBs or coffee may lower the risk of developing CHD.

Circulating trans fatty acids (TFAs), which cannot be synthesized by humans, are linked to adverse health outcomes. Although TFAs are obtained from diet, little is known about subsequent influences (e.g., relating to incorporation, metabolism, or intercompetition with other fatty acids) that could alter circulating concentrations and possibly modulate or mediate impacts on health.The objective was to elucidate novel biologic pathways that may influence circulating TFAs by evaluating associations between common genetic variation and TFA biomarkers.We performed meta-analyses using 7 cohorts of European-ancestry participants (n = 8013) having measured genome-wide variation in single-nucleotide polymorphisms (SNPs) and circulating TFA biomarkers (erythrocyte or plasma phospholipids), including trans-16:1n-7, total trans-18:1, trans/cis-18:2, cis/trans-18:2, and trans/trans-18:2. We further evaluated SNPs with genome-wide significant associations among African Americans (n = 1082), Chinese Americans (n = 669), and Hispanic Americans (n = 657) from 2 of these cohorts.Among European-ancestry participants, 31 SNPs in or near the fatty acid desaturase (FADS) 1 and 2 cluster were associated with cis/trans-18:2; a top hit was rs174548 (β = 0.0035, P = 4.90 × 10(-15)), an SNP previously associated with circulating n-3 and n-6 polyunsaturated fatty acid concentrations. No significant association was identified for other TFAs. rs174548 in FADS1/2 was also associated with cis/trans-18:2 in Hispanic Americans (β = 0.0053, P = 1.05 × 10(-6)) and Chinese Americans (β = 0.0028, P = 0.002) but not African Americans (β = 0.0009, P = 0.34); however, in African Americans, fine mapping identified a top hit in FADS2 associated with cis/trans-18:2 (rs174579: β = 0.0118, P = 4.05 × 10(-5)). The association between rs174548 and cis/trans-18:2 remained significant after further adjustment for individual circulating n-3 and n-6 fatty acids, except arachidonic acid. After adjustment for arachidonic acid concentrations, the association between rs174548 and cis/trans-18:2 was nearly eliminated in European-ancestry participants (β-coefficient reduced by 86%), with similar reductions in Hispanic Americans and Chinese Americans.Our findings provide novel evidence for genetic regulation of cis/trans-18:2 by the FADS1/2 cluster and suggest that this regulation may be influenced/mediated by concentrations of arachidonic acid, an n-6 polyunsaturated fat.

Very long-chain saturated fatty acids (VLSFAs) are saturated fatty acids with 20 or more carbons. In contrast to the more abundant saturated fatty acids, such as palmitic acid, there is growing evidence that circulating VLSFAs may have beneficial biological properties. Whether genetic factors influence circulating levels of VLSFAs is not known. We investigated the association of common genetic variation with plasma phospholipid/erythrocyte levels of three VLSFAs by performing genome-wide association studies in seven population-based cohorts comprising 10,129 subjects of European ancestry. We observed associations of circulating VLSFA concentrations with common variants in two genes, serine palmitoyl-transferase long-chain base subunit 3 (SPTLC3), a gene involved in the rate-limiting step of de novo sphingolipid synthesis, and ceramide synthase 4 (CERS4). The SPTLC3 variant at rs680379 was associated with higher arachidic acid (20:0 , P = 5.81 × 10(-13)). The CERS4 variant at rs2100944 was associated with higher levels of 20:0 (P = 2.65 × 10(-40)) and in analyses that adjusted for 20:0, with lower levels of behenic acid (P = 4.22 × 10(-26)) and lignoceric acid (P = 3.20 × 10(-21)). These novel associations suggest an inter-relationship of circulating VLSFAs and sphingolipid synthesis.

Background and aim: Dietary patterns are associated cross-sectionally with cellular adhesion molecules (CAMs). We studied prospective associations of three dietary patterns with CAMs. Methods and results: In the Coronary Artery Risk Development in Young Adults (CARDIA) study, diet was assessed at years 0 (1985-86) and 7 (1992-93) examinations. Four circulating CAMs (E-selectin, P-selectin, soluble intercellular adhesion molecule 1 (sICAM-1), and vascular cellular adhesion molecule (VCAM)) were assayed at years 7 and 15 (2000-01). We created one index score "A Priori Diet Quality Score" and derived dietary patterns using principal components analysis (PCA). Multivariable linear regression models predicted year 15 CAMs from averaged (year 0/7) dietary patterns. The A Priori Diet Quality Score rated 46 food groups beneficial, neutral or adverse based on hypothesized health effects. We derived two PCA dietary patterns: "fruit and vegetables (FV)" (high intakes of fruit, vegetables, and whole grains) and "meat" (high intakes of red meat, refined grain, and butter). All dietary patterns were related to E-selectin and sICAM-1. P-selectin was not related to the FV dietary pattern. VCAM was only related to the A Priori Diet Quality Score. Strongest associations were for the meat dietary pattern with E-selectin (effect size 28% of an SD (+3.9/13.7 ng/mL)) and P-selectin (effect size 37% of an SD (+4.1/11.2 ng/mL)) and the A Priori Diet Quality Score with sICAM-1 (effect size 34% of an SD (-15.1/44.7 ng/mL)) and VCAM (effect size of 26% of an SD (-45.1/170.3 ng/mL)). Conclusion: This prospective analysis suggests that dietary patterns are associated with CAMs. (C) 2014 Elsevier B. V. All rights reserved.

Background: Effects of alcohol consumption on health and disease are complex and involve a number of cellular and metabolic processes. Objective: We examined the association between alcohol consumption habits and metabolomic profiles. Design: We conducted a cross-sectional study to explore the association of alcohol consumption habits measured by using a questionnaire with serum metabolites measured by using untargeted mass spectrometry in 1977 African Americans from the Jackson field center in the Atherosclerosis Risk in Communities Study. The whole sample was split into a discovery set (n = 1500) and a replication set (n = 477). Alcohol consumption habits were treated as an ordinal variable, with nondrinkers as the reference group and quartiles of current drinkers as ordinal groups with higher values. For each metabolite, a linear regression was conducted to estimate its relation with alcohol consumption habits separately in both sets. A modified Bonferroni procedure was used in the discovery set to adjust the significance threshold (P < 1.9 × 10−4). Results: In 356 named metabolites, 39 metabolites were significantly associated with alcohol consumption habits in both discovery and replication sets. In general, alcohol consumption was associated with higher levels of most metabolites such as those in amino acid and lipid pathways and with lower levels of γ-glutamyl dipeptides. Three pathways, 2-hydroxybutyrate-related metabolites, γ-glutamyl dipeptides, and lysophosphatidylcholines, which are considered to be involved in inflammation and oxidation, were associated with incident cardiovascular diseases. Conclusions: To our knowledge, this is the largest metabolomic study thus far conducted in nonwhites. Metabolomic biomarkers of alcohol consumption were identified and replicated. The results lend new insight into potential mediating effects between alcohol consumption and future health and disease.

Objective To assess the awareness and implementation of lipid guidelines among primary pediatric providers. Study design An online survey was administered to primary pediatric providers (n = 1488): pediatricians, family medicine/general practitioners, and advanced practitioners (nurse practitioners/physician assistants) in Minnesota. The survey was conducted over 12 weeks in 2012-2013. A multiple-choice questionnaire was used to evaluate the participants' knowledge, screening, and management attitudes regarding pediatric lipid guidelines. Results The overall response rate was 39% (n = 548 of 1402 successful e-mails). Respondents were primarily pediatricians and family medicine practitioners (37% each), followed by general practitioners (11%) and advanced practitioners (nurse practitioners, 5.5%; physician assistants, 1.6%). Although 74% of providers reportedly believed that lipid screening and treatment would reduce future cardiovascular risk, 34% performed no screening, 50% screened selectively, and only 16% performed universal screening. Pediatricians were more likely to screen, with 30% performing universal screening and 41% performing selective screening. Among perceived barriers to screening, providers reported uneasiness addressing lipid disorders (43%), and unfamiliarity with screening guidelines (31%). The majority (83%) were uncomfortable managing lipid disorders, and 57% were opposed to the use of lipid-lowering medications in children. Conclusion These findings underscore the need to further educate providers and supply easily accessible information on the screening and treatment of childhood lipid disorders.

The benefits of fish oil fatty acids eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) on plasma lipid profiles have been inconsistent but may partially depend on individual Apolipoprotein E (APOE) genotypes. We aimed to determine whether APOE genotype modifies the association of lipid profile characteristics with plasma EPA and DHA levels.APOE genotype was determined in this cross-sectional analysis of 2340 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Relative plasma phospholipid EPA and DHA levels, plasma lipids, and lipoprotein subclass particle sizes and concentrations were measured.Significant gene-EPA interactions were found with HDL-C, and particle concentrations of large and total HDL (p(interaction) = 0.0002, 0.006, and 0.007, respectively). The above lipid targets were positively associated with EPA in the E2 groups, whereas negative trends were observed among the E4 participants. Gene-DHA interactions were noted for small LDL particle concentrations alone (p(interaction) = 0.01), where a positive trend was found among E4 but not E2 or E3 participants.These results indicate a significant contribution of the APOE genotype to the EPA-lipid profile relationship; however, the results do not explain the differences in previous findings regarding LDL-C, triglycerides or total cholesterol. Future investigators examining the effects of EPA on HDL-C or lipoprotein characteristics may consider including APOE genotype in their analyses.

Background: Epidemiologic evidence suggests that fruit consumption may lower the risk of cardiovascular diseases through blood pressure (BP)–lowering effects; little is known on the independent effect of raw fruit and fruit juice on BP. Objective: The objective was to quantify associations of raw fruit and fruit juice consumption with BP by using cross-sectional data from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) of 4680 men and women aged 40–59 y from Japan, China, the United Kingdom, and the United States. Design: During 4 visits, 8 BP, four 24-h dietary recalls, and two 24-h urine samples were collected. Country-specific multivariate-controlled linear regression coefficients, including adjustment for urinary sodium excretion, were estimated and pooled weighted by inverse of their variance. Results: The average total raw fruit consumption varied from a mean 6 SD 52 6 65 g/1000 kcal in the United States to 68 6 70 g/1000 kcal in China. Individual raw fruit intake was not associated with BP in pooled analyses for all countries or in participants from Western countries, although a positive association with diastolic BP was observed in East Asian participants (per 50 g/1000 kcal; 0.37 mm Hg; 95% CI: 0.02, 0.71). Positive relationships with diastolic BP were found for citrus fruit intake in Western consumers (per 25 g/1000 kcal; 0.47 mm Hg; 95% CI: 0.12, 0.81) and for apple intake in East Asian consumers (0.40 mm Hg; 95% CI: 0.03, 0.78). Among East Asian banana consumers, banana intake was inversely associated with diastolic BP (21.01 mm Hg; 95% CI: 21.88, 20.02). Fruit juice intake, which was negligible in Asia, was not related to BP in Western countries. Conclusion: Consistent associations were not found between raw fruit and fruit juice consumption of individuals and BP. This observational study was registered at www.clinicaltrials.gov as NCT00005271. Am J Clin Nutr doi: 10.3945/ajcn.112.046300.

Background Cross-sectional studies suggest that parents eat more saturated fat than nonparents. Few studies exist on other dietary factors or using longitudinal data. Objective To compare change in daily dietary intake of selected foods and nutrients across 7 years between adults who have children enter the home and those who do not. Design Analysis of data from the Coronary Artery Risk Development in Young Adults cohort study. Dietary intake was assessed by the diet history questionnaire used in that study. The main dependent variables were change from baseline (1985-1986) to Year 7 (1992-1993) for intake of percent saturated fat, energy, daily servings of fruits and vegetables and sugar-sweetened beverages, and frequency of fast-food intake. The primary independent variable was whether or not participants had children in their home by Year 7. Participants Two thousand five hundred sixty-three black and white adults who did not have children at baseline from four urban centers. Statistical analyses performed Linear regression adjusting for baseline demographics, energy intake, physical activity, and smoking status. Results Parents were more likely to be women, full-time workers, married, and older. Diet did not differ at baseline. Seven-year change in diet for parents and nonparents did not differ for fruit and vegetable, sugar-sweetened beverages, or fast food. Percent saturated fat decreased among both groups but parents showed a smaller decrease in percent saturated fat (1.59 vs 2.10; P P =0.058), but this difference did not reach statistical significance. Conclusions Parenthood does not have unfavorable effects on parents' diets, but neither does it lead to significant improvements. In fact, parents lag behind their childless counterparts in decreasing intake of saturated fat and overall diets remain poor. Nutrition education programs and food and nutrition practitioners should develop strategies to support and motivate healthy eating habits in parents.

Background: Although diet beverages are typically consumed to promote weight control, positive associations with increased cardiometabolic risk have been reported. Objective: The objective was to examine the joint and independent association between dietary pattern and diet beverage consumption with 20-y cardiometabolic risk. Design: We analyzed a prospective 20-y cohort of young adults from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. With the use of cluster analysis, we identified 2 baseline (year 0) dietary patterns [Prudent (higher intakes of fruit, whole grains, milk, and nuts and seeds; n = 1778) and Western (higher intakes of fast food, meat and poultry, pizza, and snacks; n = 2383)] and examined the interaction with diet beverage consumption (Consumers compared with Nonconsumers) by using proportional hazards regression models. Results: Among Consumers, 66% were classified as having a Prudent diet. In fully adjusted models, being a Nonconsumer with a Prudent diet was independently associated with a lower risk of the metabolic syndrome through year 20. Lower risk in the Prudent than in the Western dietary pattern was maintained after stratification by diet beverage consumption: Prudent Nonconsumers had the lowest risk of high waist circumference (HR: 0.78; 95% CI: 0.62, 0.97), high triglycerides (HR: 0.72; 95% CI: 0.56, 0.93), and the metabolic syndrome (HR: 0.64; 95% CI: 0.50, 0.82) compared with Western Consumers. Conclusions: Our results suggest that both overall dietary pattern and diet beverage consumption are important, to various degrees, for different metabolic outcomes. This covariation and interaction may partially explain differences in the relation between diet beverage consumption and cardiometabolic health observed in previous studies.

Background: The food supply and dietary preferences have changed in recent decades. Objective: We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985–2006. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women [aged 18–30 y at year 0 (1985–1986)] assessed diet at examinations at study years 0, 7 (1992–1993), and 20 (2005–2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time-specific mean diet scores and servings per day of food groups. Results: In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age-matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups. Conclusions: The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist.

Intake of caloric beverages is hypothesized to contribute to adverse health outcomes, but the beverages and populations studied vary considerably.Our objective was to examine the relation between consumption of low- and whole-fat milk, fruit juice, and sugar-sweetened beverages (SSBs) and cardiometabolic risk factors.We used data from a prospective 20-y cohort of 2774 adults. Data are taken from CARDIA (Coronary Artery Risk Development in Young Adults) Study examination years 0 (1985-1986), 7 (1992-1993), and 20 (2005-2006). Beverage intake was averaged across years 0 and 7, and continuous and categorical (quartile) distributions were used. Incident (year 20) high waist circumference (WC), high triglycerides, high LDL cholesterol, low HDL cholesterol, hypertension, and metabolic syndrome were examined by using multivariable-adjusted Poisson regression models.Higher SSB consumption (across quartiles) was associated with higher risk of high WC [adjusted relative risk (aRR): 1.09; 95% CI: 1.04, 1.14; P for trend0.001]; high LDL cholesterol (aRR: 1.18; 95% CI: 1.02, 1.35; P for trend = 0.018), high triglycerides (aRR: 1.06; 95% CI: 1.01, 1.13; P for trend = 0.033), and hypertension (aRR: 1.06; 95% CI: 1.01, 1.12; P for trend = 0.023). Whole-fat milk consumption was associated with lower risk of high triglycerides (aRR: 0.91; 95% CI: 0.81, 1.00; P for trend = 0.046). With the use of continuous beverage intake, results were similar. Consumers of whole-fat milk and SSBs were more likely to be younger, black, and male and to have lower levels of physical activity and higher total energy intake in comparison with nonconsumers (P0.05).Our findings suggest that higher SSB consumption is associated with cardiometabolic risk. Recommendations to limit consumption of these caloric beverages may help reduce the burden of these risk factors in US adult populations.

Background Sugar-sweetened beverage (SSB) intake is associated with metabolic disorders. The reduction of SSB intake has been promoted to prevent death and disability from chronic diseases. However, a lower SSB intake requires substitution by other fluids to maintain hydration. We investigated the association between SSB intake and the risk of coronary events and death, and assessed if substitution of coffee, tea, milk, fruit juice and artificially-sweetened beverages (ASB) for SSBs is associated with a reduced risk of coronary events and death. Methods This was a follow-up study in which data from six cohort studies were pooled. Results During the mean 5–10 years follow-up, 4248 coronary events and 1630 coronary death occurred among 284.345 individuals; 355 mL daily increase of SSB intake was associated with an increased risk of coronary events (HR: 1.08; 95% CI: 1.02, 1.14) and possibly coronary death (HR: 1.05; 95% CI: 0.96, 1.16). Substitution analyses suggested that replacing SSBs with coffee (HR: 0.93; 95% CI: 0.87, 1.00) or ASB (HR: 0.89; 95% CI: 0.83, 0.97), but not with tea (HR: 0.94; 95% CI: 0.87, 1.01), low-fat milk (HR: 0.96; 95% CI: 0.90, 1.03), whole fat milk (HR: 0.95; 95% CI: 0.87, 1.04) or fruit juice (HR: 0.97; 95% CI: 0.85, 1.07) was associated with a lower risk of developing coronary events. No associations were found for coronary death. Conclusion We found that SSB intake is associated with an increased risk of coronary events and possibly coronary death. Our findings also suggest that substituting ASBs or coffee for SSBs lowers the risk of developing CHD events.

The metabolism of high-fructose corn syrup used to sweeten soda drinks may lead to elevations in uric acid levels. Here we determined whether soda drinking is associated with hyperuricemia and, as a potential consequence, reduced kidney function. At baseline, 15,745 patients in the Atherosclerosis Risk in Communities Study completed a dietary questionnaire and had measurements of their serum creatinine and uric acid. After 3 and 9 years of follow-up, multivariate odds ratios from logistic regressions for binary outcome of hyperuricemia and chronic kidney disease (eGFR less than 60 ml/min per 1.73 m 2 ) were evaluated. Compared to participants who drank less, consumption of over one soda per day was associated with increased odds of prevalent hyperuricemia and chronic kidney disease. The odds ratio for chronic kidney disease significantly increased to 2.59 among participants who drank more than one soda per day and had a serum uric acid level over 9.0 mg/dl. In longitudinal analyses, however, drinking more than one soda per day was not associated with hyperuricemia or chronic kidney disease. Neither preexistent hyperuricemia nor development of hyperuricemia modified the lack of association between soda drinking and incident chronic kidney disease. Thus our study shows that high consumption of sugar-sweetened soda was associated with prevalent but not incident hyperuricemia and chronic kidney disease.

For 30 years, the Atherosclerosis Risk in Communities (ARIC) cohort study has examined the etiology and progression of atherosclerosis and atherosclerotic diseases.1 This research has evaluated variation in cardiovascular disease (CVD) risk in relation to age, race, gender, location and lifestyle factors, including diet. In this commentary, we describe ARIC research that illustrates an expanded view of the relationship between diet and health and suggest ways that future cohort studies may influence the direction of nutrition and dietetics practice.

Although away-from-home eating is adversely associated with weight, other comorbidities have not been examined; therefore, we sought to determine the associations of fast food (e.g. Wendy's, McDonalds) and restaurant (sit-down style) consumption (times per week) with weight and multiple metabolic outcomes, including homeostatic model assessment insulin resistance (HOMA-IR), waist circumference, and plasma triglycerides (TG), LDL cholesterol, and HDL cholesterol (HDL-C). We used 3 waves of data (exam y 7, 10, and 20) from the Coronary Artery Risk Development in Young Adults Study, a prospective cohort study of black and white young adults [aged 25-42 y in 1992-93, n = 3643 (men, 1659; women, 1984)]. Individuals in the highest (vs. lowest) quartile of baseline (defined as the mean of y 7 and 10) fast food consumption had higher y 20 weight [adjusted mean (95% CI): 5.6 kg (CI, 2.1, 9.2); P = 0.002], HOMA-IR [0.9 (CI, 0.4, 1.3); P < 0.001], waist circumference [5.3 cm (CI, 2.8, 7.9); P < 0.000], TG concentrations [0.25 mmol/L (CI, 0.10, 0.40), 22.7 mg/dL (CI, 9.1, 36.3); P = 0.001], and lower HDL-C concentrations [-0.014 mmol/L (CI, -0.215, -0.067), 5.4 mg/dL (CI, -8.3, -2.6); P < 0.000]. Baseline restaurant consumption was unrelated to y 20 outcomes. Adjusted change in weekly restaurant (P < 0.05) and fast food intake (P < 0.001) was associated with 13-y changes in body weight [0.09 kg (CI, 0.02, 0.17) and 0.15 kg (CI, 0.06, 0.24), respectively] and waist circumference [0.08 cm (CI, 0.02, 0.14) and 0.12 cm (CI, 0.04, 0.20), respectively]. Fast food consumption may be an important target for the prevention of adverse metabolic health outcomes.

Background It is unclear to what extent factors affecting energy balance contribute to the development of body fatness in youth. The objective of the current study was to describe the relationship of physical activity, energy intake, and sedentary behavior to BMI, fat free–mass index (FFMI), and fat mass index (FMI) in children aged 10–18 years. Methods In the subsample studied, participants were 245 girls and 227 boys (aged ≥10 years at entry or during follow-up assessments, or aged 11–14 years at entry) followed for 4 years from entry at ages 8, 11, or 14 years. At baseline and anniversary examinations, trained interviewers used a questionnaire to assess time spent daily in moderate-to-vigorous physical activity (MVPA), sedentary behavior, and energy intake (kcal/day). Sexual maturation was assessed by direct observation of pubic-hair development (Tanner Stages 1–5). Triplicate recordings of height and weight were used to estimate BMI by the standard formula (kg/m 2 ); bioelectric impedance was used to estimate percent body fat for calculating FFMI and FMI (kg/m 2 ). Multilevel models were used to examine the association of MVPA, energy intake, and sedentary behavior with BMI, FFMI, and FMI. Data were analyzed in 2007–2008. Results Energy intake was unrelated to FMI or FFMI in models adjusted for age or sexual maturation or in any model to BMI. Sedentary behavior was unrelated to FMI in any model or to FFMI or BMI in models adjusted for age or sexual maturation. MVPA was inversely related to FMI. Conclusions In children aged 10–18 years, MVPA was inversely associated with fat mass and with BMI. Investigations in youth of dietary intake and physical activity, including interventions to prevent or reverse overweight as represented by BMI, should address its fat and lean components and not BMI alone.

Background Longitudinal data on the normal development of blood lipids and its relationships with body fatness in children and adolescents are limited. Objectives of the current analysis were to estimate trajectories related to age for four blood lipid components and to examine the impact of change in body fatness on blood lipid levels, comparing estimated effects among adiposity indices, in children and adolescents. Methods Three cohorts, with a total of 678 children (49.1% female, 79.9% nonblack) initially aged 8, 11, and 14 years, were followed at 4-month intervals (1991–1995). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were determined in blood samples taken following fasting. Body fatness was measured by five adiposity indices—BMI; percent body fat (PBF); abdominal circumference; and the sums of six and of two skinfold thicknesses. Trajectories of change in blood lipid levels from ages 8 to 18 years were estimated by gender and race. The impact of change in body fatness on lipid levels was evaluated for each index, adjusting for gender, race, and age. Results All lipid components varied significantly with age. Total cholesterol decreased by ∼19 mg/dL from ages 9 to 16 years in girls and more steeply from ages 10 to 17 years in boys. LDL-C decreased monotonically, more steeply in boys than in girls. It was higher among nonblacks than among blacks. HDL-C increased monotonically in girls, mainly from ages 14 to 18 years, but fluctuated sharply among boys. Levels of HDL-C were higher among blacks than among nonblacks. The levels of triglycerides increased from ages 8 to 12 years among girls and, almost linearly, from ages 8 to 18 years among boys. The levels of triglycerides were higher among nonblacks than among blacks. Increase in body fatness was significantly associated with increases in total cholesterol, LDL-C, and triglyceride levels. Significant interactions between the adiposity indices (except for BMI) and gender indicated smaller impacts of change in body fatness on total cholesterol and LDL-C in girls than in boys. The estimated impact on triglycerides was weaker among blacks than among nonblacks, except for PBF. Change in body fatness was negatively associated with HDL-C. The results remained essentially unchanged after adjustments for energy intake, physical activity, and sexual maturation. Conclusions Patterns of change with age in blood lipid components vary significantly among gender and racial groups. Increase in body fatness among children is consistently associated with adverse change in blood lipids. Evaluation of blood lipid level should take into account variation by age, gender, and race. Intervention through body-fat control should help prevent adverse lipid levels in children and adolescents.

Background Parental obesity and TV viewing are risk factors for childhood obesity. This study assessed the association of children's TV viewing and computer use with body mass and examined whether parental weight status modified the association. Methods Cross-sectional associations of parental weight status, hours of TV viewing and computer use, and children's body composition were studied in a subsample of 526 black and nonblack children, aged 8, 11, and 14 years at baseline, enrolled in Project HeartBeat!, a longitudinal study of cardiovascular disease risk factors, 1991–1995. BMI, fat-free mass (FFM), and percent body fat (PBF) were calculated from children's body composition measured at baseline. Children's TV viewing and computer use habits and parental height and weight were self-reported. Multivariate regression analysis was used in assessing inter-relations of parental weight status and child's TV viewing and computer use habits with BMI, FFM, PBF, and risk for overweight status (BMI ≥85th percentile), adjusting for age, gender, race, and Tanner stage. Results Children of one or two overweight/obese parents watched an average of 22±6 minutes or 30±11 minutes more TV per day than children of normal-weight parents, respectively (both p 2 and 1.14% (both p p interaction Conclusions These study findings are consistent with a genetic contribution of parental weight; however, overweight/obese parents may also exhibit behavior patterns that negatively influence children's TV viewing and have an impact on child overweight status. The effect of parental BMI on children's BMI may have both a genetic and an environmental linkage.

The cardioprotective effects of long-chain n-3 polyunsaturated fatty acids (PUFAs) and fish consumption have been observed. However, data on the specific associations of these dietary factors with inflammation and endothelial activation are sparse. A cross-sectional study was conducted of 5,677 men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, including African Americans, Caucasians, Chinese, and Hispanics aged 45 to 84 years and free of clinical cardiovascular disease. Dietary information was collected using a self-administered food frequency questionnaire. Multivariate linear regression analyses were used to examine relations between the intake of long-chain n-3 PUFAs, nonfried fish, and fried fish and biomarkers of inflammation and endothelial activation. Long-chain n-3 PUFA intake was inversely associated with plasma concentrations of interleukin-6 (p = 0.01) and matrix metalloproteinase-3 (p = 0.03) independent of age, body mass index, physical activity, smoking, alcohol consumption, and dietary variables. Nonfried fish consumption was inversely related to C-reactive protein (p = 0.045) and interleukin-6 (p

Background Fruits and vegetables, foods rich in flavonoids and antioxidants, have been associated with lower risk of stroke, coronary heart disease, and markers of inflammation and oxidative stress in adults. Markers of inflammation and oxidative stress are predictors of coronary heart disease risk; however, it is unknown whether these markers are related to dietary flavonoid and antioxidant intake in youth. Objective To determine whether greater intakes of fruit and vegetables, antioxidants, folate, and total flavonoids were inversely associated with markers of inflammation and oxidative stress in 285 adolescent boys and girls aged 13 to 17 years. Design In this cross-sectional study conducted between February 1996 and January 2000, diet was assessed by a 127-item food frequency questionnaire. Height and weight measurements were obtained and a fasting blood sample drawn. Spearman partial correlation analyses evaluated the relation of intakes of fruit and vegetables, antioxidants, folate, and flavonoids with markers of inflammation (C-reactive protein, interleukin-6, tumor necrosis factor-α, and 15-keto-dihydro-PGF 2α metabolite and oxidative stress (urinary 8-iso prostaglandin F 2α , an F 2 -isoprostane), adjusting for age, sex, race, Tanner stage, energy intake, and body mass index. Results Urinary F 2 -isoprostane was inversely correlated with intakes of total fruit and vegetables, vitamin C, beta carotene, and flavonoids. Serum C-reactive protein was significantly inversely associated with intakes of fruit ( r =−0.19; P =0.004), vitamin C ( r =−0.13, P =0.03), and folate ( r =−0.18; P =0.004). Serum interleukin-6 was inversely associated with intakes of legumes, vegetables, beta carotene, and vitamin C. Serum tumor necrosis factor-α was inversely associated with beta carotene ( r =−0.14, P =0.02) and luteolin ( r =−0.15, P =0.02). Conclusion Study results show that the beneficial effects of fruit and vegetable intake on markers of inflammation and oxidative stress are already present by early adolescence and provide support for the Dietary Guidelines for Americans "to consume five or more servings per day" of fruits and vegetables to promote beneficial cardiovascular health.

Background: The balance between the intake of animal and the intake of plant foods may influence renal vascular integrity as reflected by urinary albumin excretion. Objective: We assessed cross-sectional associations between urinary albumin excretion and dietary patterns and intake of plant and animal foods. Design: At baseline, diet (food-frequency questionnaire) and the urinary albumin-to-creatinine ratio (ACR; spot urine collection) were measured in 5042 participants in the Multi-Ethnic Study of Atherosclerosis who were aged 45–84 y and were without clinical cardiovasculardisease,diabetes,ormacroalbuminuria(sex-adjusted ACR 250). We derived dietary patterns by principal components analysis. We also summed food groups to characterize plant food intake(fruit,fruitjuice,vegetables,nuts,legumes,wholegrains,and refined grains), animal food intake (red meat, processed meat, poultry,fish,high-fatdairy,andlow-fatdairy),andnondairyanimalfood intake. Results: After adjustment for multiple demographic and lifestyle confounders,adietarypatterncharacterizedbyhighconsumptionof whole grains, fruit, vegetables, and low-fat dairy foods was associated with 20% lower ACR across quintiles (P for trend 0.004). Neither total animal nor total plant food intake was associated with ACR. However, greater low-fat dairy consumption was associated with 13% lower ACR across quartiles (P for trend 0.03). Total nondairy animal food consumption was associated with 11% higher ACR across quintiles (P for trend 0.03). Conclusions: A high intake of low-fat dairy foods and a dietary pattern rich in whole grains, fruit, and low-fat dairy foods were both associated with lower ACR. In contrast, collectively, nondairy animalfoodintakewaspositivelyassociatedwithACR. AmJClin Nutr 2008;87:1825–36.

Polymorphisms in genes involved in HDL-cholesterol (HDL-C) metabolism influence plasma HDL-C concentrations. We examined whether dietary fat intake modified relations between HDL-C and polymorphisms in hepatic lipase (LIPC-514C--T), cholesteryl ester transfer protein (CETP TaqIB), and lipoprotein lipase (LPL S447X) genes. Diet (food frequency questionnaire), plasma lipids, and LIPC, CETP, and LPL genotypes were assessed in approximately 12,000 White and African American adults. In both races and all genotypes studied, minor allele homozygotes had highest HDL-C concentrations compared to the other genotypes (P0.001). However, main effects were modified by usual dietary fat intake. In African Americans - women somewhat more strongly than men -LIPC TT homozygotes with fat intakeor=33.2% of energy had approximately 3-4 mg/dL higher HDL-C concentrations than CC and CT genotypes. In contrast, when fat intake was33.2% of energy, TT homozygotes had HDL-C concentrations approximately 3.5mg/dL greater than those with the CC genotype but not different from those with the CT genotype (P(interaction)=0.013). In Whites, LPLGG homozygotes had greatest HDL-C at lower total, saturated, and monounsaturated fat intakes but lowest HDL-C at higher intakes of these fats (P(interaction)or=0.002). Dietary fat did not modify associations between CETP and HDL-C. In conclusion, these data show that plasma HDL-C differs according to LIPC, LPL, and CETP genotypes. In the case of LIPC and LPL, data suggest dietary fat modifies these relations.

The association between diet and cardiovascular disease (CVD) may be mediated partly through inflammatory processes and reflected by markers of subclinical atherosclerosis.We investigated whether empirically derived dietary patterns are associated with coronary artery calcium (CAC) and common and internal carotid artery intima media thickness (IMT) and whether prior information about inflammatory processes would increase the strength of the associations.At baseline, dietary patterns were derived with the use of a food-frequency questionnaire, and inflammatory biomarkers, CAC, and IMT were measured in 5089 participants aged 45-84 y, who had no clinical CVD or diabetes, in the Multi-Ethnic Study of Atherosclerosis. Dietary patterns based on variations in C-reactive protein, interleukin-6, homocysteine, and fibrinogen concentrations were created with reduced rank regression (RRR). Dietary patterns based on variations in food group intake were created with principal components analysis (PCA).The primary RRR (RRR 1) and PCA (PCA factor 1) dietary patterns were high in total and saturated fat and low in fiber and micronutrients. However, the food sources of these nutrients differed between the dietary patterns. RRR 1 was positively associated with CAC [Agatston score0: OR (95% CI) for quartile 5 compared with quartile 1 = 1.34 (1.05, 1.71); ln(Agatston score = 1): P for trend = 0.023] and with common carotid IMT [or=1.0 mm: OR (95% CI) for quartile 5 compared with quartile 1 = 1.33 (0.99, 1.79); ln(common carotid IMT): P for trend = 0.006]. PCA 1 was not associated with CAC or IMT.The results suggest that subtle differences in dietary pattern composition, realized by incorporating measures of inflammatory processes, affect associations with markers of subclinical atherosclerosis.

Summary. Background: Hemostatic factors and endothelial markers may play some role in racial/ethnic differences in cardiovascular disease (CVD) rates. However, little information exists on hemostatic factors and endothelial markers across racial/ethnic groups. Objectives: To describe, in four American racial/ethnic groups (Caucasian, Black, Hispanic, and Chinese), mean levels of selected hemostatic factors and endothelial markers. Patients and methods: Multi-ethnic Study of Atherosclerosis baseline data were used (participant age: 45–84 years). Sex-specific analysis of covariance models, and t-tests for pairwise comparisons, were used to compare means of factors and markers. Adjustments were made for demographics and traditional CVD risk factors. Differences were significant at P

An understanding of the relation in adolescents between serum homocysteine and foods rich in vitamin B-6, vitamin B-12, and folate is important because high homocysteine concentrations in childhood and adolescence may be a risk factor for later cardiovascular disease. However, little is known about the relation between food intake and homocysteine in adolescents.Five years after national folic acid fortification of enriched grain products, cross-sectional relations between food intake and serum homocysteine concentrations were examined in 2695 adolescents [x age: 18.3 (range: 15-20) y] enrolled in the Child and Adolescent Trial for Cardiovascular Health.A nonfasting blood specimen was analyzed for serum homocysteine, folate, and vitamins B-6 and B-12. Dietary intake was assessed by using a food-frequency questionnaire. Multiple regression analyses were used to evaluate the relation of intakes of whole grains, refined grains, fruit, vegetables, dairy products, red and processed meats, and poultry with serum homocysteine concentrations after adjustment for demographic characteristics, lifestyle factors, and food intake.Serum homocysteine concentrations were lower with greater intakes of whole grains (P for trend = 0.002), refined grains (P for trend = 0.02), and dairy foods (P for trend0.001); were higher with greater intake of poultry (P for trend = 0.004); and were not related to intakes of fruit, vegetables, or red or processed meat. After additional adjustment for serum B vitamins, the relations of serum homocysteine with most food groups were attenuated.These observational findings suggest a beneficial effect of whole-grain, refined-grain, and dairy products on serum homocysteine concentrations in an adolescent population.

To examine accuracy of reporting of large food portions, 50 adults were invited to eat a restaurant meal that included a hamburger patty, french fries, and ice cream. After eating, participants were asked to estimate the amount of food consumed using commonly used and larger-sized food models as a guide. With the use of commonly used models, underreporting was evident for all three foods. For example, the amount of hamburger patty consumed was on average 4.01 oz, although the average amount reported was 3.04 oz (P.05). When larger-sized models were used, the amount reported more closely matched the amount consumed, although underreporting persisted for the hamburger patty and french fries. In summary, significant underreporting of large food portions may result when commonly used food models are used to assist individuals in reporting food portions.

Objectives To explore the relations of parent-child cardiometabolic risk factors and assess the influence of adiposity on these associations. Study design Associations of adiposity, blood pressure (BP), lipids, fasting insulin and glucose, and a risk factor cluster score (CS) were evaluated in a cross-sectional study of 179 parents and their children (6-18 years, N = 255). Insulin resistance was assessed by euglycemic clamp in parents and children aged 10 years or older. Metabolic syndrome in parents was defined by National Cholesterol Education Program's Adult Treatment Panel III criteria. CSs of the risk factors were created based on age-specific z-scores. Analyses included Pearson correlation and linear regression, adjusted for parent and child age, sex, race, and body mass index (BMI), accounting for within-family correlation. Results We found positive parent-child correlations for measures of adiposity (BMI, BMI percentile, waist, subcutaneous fat, and visceral fat; r = 0.22-0.34, all P ≤ .003), systolic BP (r = 0.20, P = .002), total cholesterol (r = 0.39, P Conclusions Although adiposity is strongly correlated between parents and children, many cardiometabolic risk factors correlate independent of parent and child BMI. Adverse parental cardiometabolic profiles may identify at-risk children independent of the child's adiposity status.