Associations of Whole Blood n-3 and n-6 Polyunsaturated Fatty Acids with Blood Pressure in Children and Adolescents – Results from the IDEFICS/I.Family Cohort

BACKGROUND: Polyunsaturated n-3 and n-6 polyunsaturated fatty acids (PUFA) are precursors of biologically active metabolites that affect blood pressure (BP) regulation. This study investigated the association of n-3 and n-6 PUFA and BP in children and adolescents. METHODS: In a subsample of 1267 children aged 2–9 years at baseline of the European IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) cohort whole blood fatty acids were measured by a validated gas chromatographic method. Systolic and diastolic BP was measured at baseline and after two and six years. Mixed-effects models were used to assess the associations between fatty acids at baseline and BP z-scores over time adjusting for relevant covariables. Models were further estimated stratified by sex and weight status. RESULTS: The baseline level of arachidonic acid was positively associated with subsequent systolic BP (β = 0.08, P = 0.002) and diastolic BP (β = 0.07, P<0.001). In thin/normal weight children, baseline alpha-linolenic (β = -1.13, P = 0.003) and eicosapentaenoic acid (β = -0.85, P = 0.003) levels were inversely related to baseline and also to subsequent systolic BP and alpha-linolenic acid to subsequent diastolic BP. In overweight/obese children, baseline eicosapentaenoic acid level was positively associated with baseline diastolic BP (β = 0.54, P = 0.005). CONCLUSIONS: Low blood arachidonic acid levels in the whole sample and high n-3 PUFA levels in thin/normal weight children are associated with lower and therefore healthier BP. The beneficial effects of high n-3 PUFA on BP were not observed in overweight/obese children, suggesting that they may have been overlaid by the unfavorable effects of excess weight

Early Life Factors and Inter-Country Heterogeneity in BMI Growth Trajectories of European Children : The IDEFICS Study

Background Starting from birth, this explorative study aimed to investigate between-country differences in body mass index (BMI) trajectories and whether early life factors explain these differences. Methods The sample included 7,644 children from seven European countries (Belgium, Cyprus, Germany, Hungary, Italy, Spain, Sweden) participating in the multi-centre IDEFICS study. Information on early life factors and in total 53,409 repeated measurements of height and weight from 0 to <12 years of age were collected during the baseline (2007/2008) and follow-up examination (2009/2010) supplemented by records of routine child health visits. Country-specific BMI growth curves were estimated using fractional polynomial mixed effects models. Several covariates focussing on early life factors were added to the models to investigate their role in the between-countries differences. Results Large between-country differences were observed with Italian children showing significantly higher mean BMI values at all ages ≥ 3 years compared to the other countries. For instance, at age 11 years mean BMI values in Italian boys and girls were 22.3 [21.9;22.8; 99% confidence interval] and 22.0 [21.5;22.4], respectively, compared to a range of 18.4 [18.1;18.8] to 20.3 [19.8;20.7] in boys and 18.2 [17.8;18.6] to 20.3 [19.8;20.7] in girls in the other countries. After adjustment for early life factors, differences between country-specific BMI curves became smaller. Maternal BMI was the factor being most strongly associated with BMI growth (p<0.01 in all countries) with associations increasing during childhood. Gestational weight gain (GWG) was weakly associated with BMI at birth in all countries. In some countries, positive associations between BMI growth and children not being breastfed, mothers’ smoking during pregnancy and low educational level of parents were found. Conclusion Early life factors seem to explain only some of the inter-country variation in growth. Maternal BMI showed the strongest association with children’s BMI growth

Flow chart of the inclusion and exclusion of IDEFICS/I.Family participants.

<p>Flow chart of the inclusion and exclusion of IDEFICS/I.Family participants.</p

Associations of fatty acids with systolic and diastolic blood pressure z-scores at baseline, after two years and after six years of follow-up stratified by BMI category¹.

<p>Associations of fatty acids with systolic and diastolic blood pressure z-scores at baseline, after two years and after six years of follow-up stratified by BMI category<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165981#t003fn001" target="_blank">¹</a>.</p

Associations of fatty acids with systolic and diastolic blood pressure z-scores at baseline, after two years and after six years of follow-up stratified by sex¹.

<p>Associations of fatty acids with systolic and diastolic blood pressure z-scores at baseline, after two years and after six years of follow-up stratified by sex<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165981#t004fn001" target="_blank">¹</a>.</p

Associations of polyunsaturated fatty acids with systolic and diastolic blood pressure z-scores at baseline, after 2 years and after 6 years of follow-up estimated based on fully adjusted mixed-effects models¹.

<p>Associations of polyunsaturated fatty acids with systolic and diastolic blood pressure z-scores at baseline, after 2 years and after 6 years of follow-up estimated based on fully adjusted mixed-effects models<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165981#t002fn001" target="_blank">¹</a>.</p

Baseline characteristics of the study population by blood pressure category¹ and sex.

<p>Baseline characteristics of the study population by blood pressure category<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165981#t001fn001" target="_blank">¹</a> and sex.</p

Cardiometabolic Risk is Positively Associated with Underreporting and Inversely Associated with Overreporting of Energy Intake Among European Adolescents:The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study

[Background]: Dietary misreporting is the main limitation of dietary assessments and has been associated with BMI during youth. However there are no prior studies assessing misreporting and cardiometabolic risks (CMRs) in adolescence.[Objectives]: To examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias in the association between CMR and energy intake (EI) driven by dietary misreporting.[Methods]: Two 24-hour dietary recalls were obtained from 1512 European adolescents (54.8% girls) aged 12.5–17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), the sum of 4 skinfold thicknesses, diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) measurements were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio were analyzed. A sex- and age-specific clustered CMR score (n = 364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status, and physical activity.[Results]: Underreporting (24.8% adolescents) was significantly (P < 0.05) associated with a higher WC, waist-to-height ratio (WHeR), and sum of skinfold thickness, whereas overreporting (23.4% adolescents) was significantly associated with a lower WC, WHeR, sum of skinfold thickness, and SBP. Associations between CMR factors and EI were significantly affected by misreporting, considering various approaches. Significant, positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for the sum of skinfold thickness, SBP, and CMR score. The associations between EI and DBP and CRF did not remain significant after adjusting for misreporting.[Conclusions]: CMR factors differed among misreporting groups, and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than was BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations.The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study was carried out with the financial support of the European Community Sixth Framework Programme Research and Technological Development (RTD) Framework Programme (contract FOODCT-2005-007034).Peer reviewe

Predicted BMI growth trajectories of children having a mother with a BMI of 20 kg/m² (solid) vs. with a BMI of 25 kg/m² (dashed) by sex (girls: black; boys: grey) and country; all other covariates were set to a constant value (continuous covariates were set to 0 (i.e. to the value used for centring), categorical variables were set to the reference category).

<p>Predicted BMI growth trajectories of children having a mother with a BMI of 20 kg/m² (solid) vs. with a BMI of 25 kg/m² (dashed) by sex (girls: black; boys: grey) and country; all other covariates were set to a constant value (continuous covariates were set to 0 (i.e. to the value used for centring), categorical variables were set to the reference category).</p

Theoretical models displaying the direct effects in proposed pathways through which BP (SBP or DBP, respectively) is affected by the SNP (rs174546), by fatty acids (DGLA, ARA, EPA, D5D index) as well as by BMI.

<p>Theoretical models displaying the direct effects in proposed pathways through which BP (SBP or DBP, respectively) is affected by the SNP (rs174546), by fatty acids (DGLA, ARA, EPA, D5D index) as well as by BMI.</p