Maternal and fetal genetic contribution to gestational weight gain.

BACKGROUND: Clinical recommendations to limit gestational weight gain (GWG) imply high GWG is causally related to adverse outcomes in mother or offspring, but GWG is the sum of several inter-related complex phenotypes (maternal fat deposition and vascular expansion, placenta, amniotic fluid and fetal growth). Understanding the genetic contribution to GWG could help clarify the potential effect of its different components on maternal and offspring health. Here we explore the genetic contribution to total, early and late GWG. PARTICIPANTS AND METHODS: A genome-wide association study was used to identify maternal and fetal variants contributing to GWG in up to 10 543 mothers and 16 317 offspring of European origin, with replication in 10 660 mothers and 7561 offspring. Additional analyses determined the proportion of variability in GWG from maternal and fetal common genetic variants and the overlap of established genome-wide significant variants for phenotypes relevant to GWG (for example, maternal body mass index (BMI) and glucose, birth weight). RESULTS: Approximately 20% of the variability in GWG was tagged by common maternal genetic variants, and the fetal genome made a surprisingly minor contribution to explain variation in GWG. Variants near the pregnancy-specific beta-1 glycoprotein 5 (PSG5) gene reached genome-wide significance (P=1.71 × 10-8) for total GWG in the offspring genome, but did not replicate. Some established variants associated with increased BMI, fasting glucose and type 2 diabetes were associated with lower early, and higher later GWG. Maternal variants related to higher systolic blood pressure were related to lower late GWG. Established maternal and fetal birth weight variants were largely unrelated to GWG. CONCLUSIONS: We found a modest contribution of maternal common variants to GWG and some overlap of maternal BMI, glucose and type 2 diabetes variants with GWG. These findings suggest that associations between GWG and later offspring/maternal outcomes may be due to the relationship of maternal BMI and diabetes with GWG.

Abnormal coagulation and enhanced fibrinolysis due to lysinuric protein intolerance associates with bleeds and renal impairment.

INTRODUCTION: Lysinuric protein intolerance (LPI), a rare autosomal recessive transport disorder of cationic amino acids lysine, arginine and ornithine, affects intestines, lungs, liver and kidneys. LPI patients may display potentially life-threatening bleeding events, which are poorly understood. AIMS: To characterize alterations in haemostatic and fibrinolytic variables associated with LPI. METHODS: We enrolled 15 adult patients (8 female) and assessed the clinical ISTH/SSC-BAT bleeding score (BS). A variety of metabolic and coagulation assays, including fibrin generation test derivatives, clotting time (CT) and clot lysis time (CLT), thromboelastometry (ROTEM), and PFA-100 and Calibrated Automated Thrombogram (CAT), were used. RESULTS: All patients had mild-to-moderate renal insufficiency, and moderate bleeding tendency (BS 4) without spontaneous bleeds. Mild anaemia and thrombocytopenia occurred. Traditional clotting times were normal, but in contrast, CT in fibrin generation test, and especially ROTEM FIBTEM was abnormal. The patients showed impaired primary haemostasis in PFA, irrespective of normal von Willebrand factor activity, but together with lowered fibrinogen and FXIII. Thrombin generation (TG) was reduced in vitro, according to CAT-derived endogenous thrombin potential, but in vivo TG was enhanced in the form of circulating prothrombin fragment 1 and 2 values. Very high D-dimer and plasmin-α2-antiplasmin (PAP) complex levels coincided with shortened CLT in vitro. CONCLUSIONS: Defective primary haemostasis, coagulopathy, fibrin abnormality (FIBTEM, CT and CLT), low TG in vitro and clearly augmented fibrinolysis (PAP and D-dimer) in vivo were all detected in LPI. Altered fibrin generation and hyperfibrinolysis were associated with the metabolic and renal defect, suggesting a pathogenetic link in LPI.

Is carbohydrate intake in the first years of life related to future risk of NCDs?

UNLABELLED: Studies on children's carbohydrate intake, especially fibre intake, and its associations with later health are rare. The current recommendations for fibre intake in children are based on average assumptions and data extrapolated from intakes in adults. Generally, increase in whole-grain consumption and decrease in sucrose intake are considered healthy. Due to fibre's high bulk volume however, excessive dietary fibre has been feared to decrease energy density have effects on growth, at least in developing countries and in children consuming very restricted diets. Furthermore, it has been speculated that if fats are reduced from the diet, it may become high in sucrose. In STRIP study, which is a long-term, randomized controlled trial designed to decrease the exposure of children to known risk factors of atherosclerosis, carbohydrate intakes have been investigated in detail in children aged 13 months to 9 years. The intervention was successful in decreasing saturated fat intake and cholesterol concentrations throughout childhood and adolescence. The study results also show that a higher than average fibre intake does not displace energy or disturb growth in children and that children with high fibre intake have better dietary quality than those with low fibre intake. Dietary fibre intake associated with lower serum total cholesterol concentrations whereas increases in total carbohydrate, sucrose and fructose intakes associated with increases in serum triglyceride concentrations. In conclusion, from the point of view of CHD risk factor prevention, efforts aiming at increasing the fibre intake while restricting that of refined sugar seem justified in the child population in developed countries. CLINICAL TRIAL REGISTRATION INFORMATION: NCT00223600.

Dietary and lifestyle counselling reduces the clustering of overweight-related cardiometabolic risk factors in adolescents.

AIM: The aim of this study was to evaluate the impact of individualised dietary and lifestyle counselling, primarily aimed to decrease serum low-density lipoprotein cholesterol, on the clustering of overweight-related cardiometabolic risk factors in children. DESIGN AND PARTICIPANTS: The 7-month-old study children were randomized either to counselling (n = 540) or control group (n = 522). MAIN OUTCOME MEASURES: The 5- to 15-year-old participants who fulfilled the international criteria were classified as overweight. Being in the highest [lowest for high-density lipoprotein (HDL) cholesterol] age- and gender-specific quintile of body mass index (BMI), blood pressure, serum triglycerides, HDL cholesterol or glucose was considered a risk factor. A cluster was defined as having high BMI and > or = 2 other risk factors. RESULTS: The counselling did not reduce the prevalence of overweight in 5- to 15-year-old participants. From age 7 onwards, the proportion of children with > or = 2 risk factors was lower in the intervention than in the control group (p = 0.005). At the age of 15 years, 13.0% of girls and 10.8% of boys in the intervention group and 17.5% of girls and 18.8% of boys in the control group had the risk factor cluster (p = 0.046 for main effect of the study group). Having even one risk factor at the age of 5 years predicted the clustering of risk factors at the age of 15 years (OR: 3.8, p < 0.001). CONCLUSION: Repeated, individualized dietary and lifestyle counselling may reduce the clustering of overweight-related cardiometabolic risk factors in adolescents even though the counselling is not intense enough to prevent overweight.

Nutrient intake in lysinuric protein intolerance.

Lysinuric protein intolerance (LPI) is a rare autosomal recessive disorder characterized by defective transport of cationic amino acids. Poor intestinal absorption and increased renal loss of arginine, ornithine and lysine lead to low plasma concentrations of these amino acids and, subsequently, to impaired urea cycle function. The patients therefore have decreased nitrogen tolerance, which may lead to hyperammonaemia after ingestion of normal amounts of dietary protein. As a protective mechanism, most patients develop strong aversion to protein-rich foods early in life. Oral supplementation with citrulline, which is absorbed normally and metabolized to arginine and ornithine, improves protein tolerance to some extent, as do sodium benzoate and sodium phenylbutyrate also used by some patients. Despite effective prevention of hyperammonaemia, the patients still consume a very restricted diet, which may be deficient in energy, essential amino acids and some vitamins and minerals. To investigate the potential nutritional problems of patients with lysinuric protein intolerance, 77 three- to four-day food records of 28 Finnish LPI patients aged 1.5-61 years were analysed. The data suggest that the patients are clearly at risk for many nutritional deficiencies, which may contribute to their symptoms. Their diet is highly deficient in calcium, vitamin D, iron and zinc. Individualized nutritional supplementation accompanied by regular monitoring of dietary intake is therefore an essential part of the treatment of LPI.

Genetic risk clustering increases children's body weight at 2 years of age - the STEPS Study.

BACKGROUND: Genetic determinants have an impact on adult weight but the association between genetic determinants and weight at young age is still poorly understood. OBJECTIVE: The objective of this study was to examine the association between genetic risk scores and early growth from birth to 2 years of age. METHODS: Genetic risk scores of 83 adiposity-related or obesity-related single nucleotide polymorphisms (SNPs) (genetic risk score [GRS]83) were calculated for 1278 children. Specific phenotype score for 16 weight-related SNPs (weightGRS) was calculated. Anthropometric data were obtained at birth, 13 months and 2 years of age. RESULTS: The GRS83 was associated with weight at 13 months (ß = 0.080, P = 0.015) and 2 years (ß = 0.080, P = 0.017) of age and with weight gain from birth to 13 months (ß = 0.069, P = 0.036) and to 2 years of age (ß = 0.074, P = 0.028). At 2 years of age, the GRS83 was also associated with weight for height (ß = 0.065, P = 0.046), weight-for-height standard deviation score (SDS) (ß = 0.074, P = 0.022) and body mass index SDS (ß = 0.068, P = 0.045). WeightGRS was associated with higher body weight at 13 months (ß = 0.081, P = 0.014) and 2 years of age (ß = 0.086, P = 0.011). The genetic effect on weight varied from 0.69 to 1.89 kg at 2 years of age according to number of risk alleles. Children with high genetic risk for adiposity were heavier than children with low genetic risk at 2 years of age (12.8 vs. 13.4 kg, P = 0.017). CONCLUSION: The GRS 83 revealed increased genetic risk for higher weight in children already at 13 months and 2 years of age, which may result in increased obesity risk later in life.

Prospective, randomized, infancy-onset trial of the effects of a low-saturated-fat, low-cholesterol diet on serum lipids and lipoproteins before school age: The Special Turku Coronary Risk Factor Intervention Project (STRIP).

BACKGROUND: We showed previously that repeated dietary counseling during the first 3 years of life reduces the concentration of serum nonfasting cholesterol. We have now extended the study to children 5 years of age and analyzed fasting blood samples, enabling LDL cholesterol calculations for the first time. METHODS AND RESULTS: Families of 7-month-old infants (n=1062) were randomized to a control group (n=522) or an intervention group (n=540) that received individualized dietary counseling with the aims of a fat intake of 30% to 35% of daily energy, a saturated/monounsaturated/polyunsaturated fatty acid ratio of 1:1:1, and a cholesterol intake of <200 mg/d. Nutrient intakes were studied biannually, nonfasting serum lipid values were studied annually, and fasting values were studied at 5 years of age. The intervention children always had lower intakes of saturated fat and cholesterol than the control children. The intervention boys had 0.39 mmol/L (P:<0.0001) lower mean serum cholesterol values than the control boys between 13 and 60 months of age, but among girls, the difference was of marginal significance (0.15 mmol/L, P:=0.052). Five-year-old intervention boys had 9% lower mean serum LDL cholesterol concentrations than the control boys (P:=0.0002; 95% CI, -0.39 to -0.12 mmol/L), whereas no difference was observed in girls. In both sexes, serum triglyceride concentrations were similar in the 2 groups. CONCLUSIONS: The restriction of saturated fat and cholesterol intake by repeated, individualized dietary counseling since infancy resulted in lower serum total and LDL cholesterol concentrations at 5 years of age. However, the effect was significant only in boys.

Coronary flow reserve is impaired in young men with familial hypercholesterolemia.

OBJECTIVES: We sought to investigate whether functional abnormalities in coronary vasomotion exist in young adults by studying 15 men (age 31 +/- 8 years [mean +/- SD]) with familial hypercholesterolemia (FH) and a matched group of 20 healthy control subjects. BACKGROUND: Precursors of morphologic coronary artery disease are known to be present in adolescents and young adults with a high risk factor profile. METHODS: Myocardial blood flow was measured at the basal state and during dipyridamole-induced hyperemia using positron emission tomography and oxygen-15-labeled water. RESULTS: Serum total and low density lipoprotein cholesterol concentrations were higher in the patients than in the control subjects (mean +/- SD): 7.7 +/- 1.9 versus 5.3 +/- 1.5 mmol/liter (298 +/- 73 vs. 205 +/- 58 mg/dl) and 6.1 +/- 1.8 versus 3.5 +/- 1.4 mmol/liter (236 +/- 70 vs. 135 +/- 54 mg/dl), respectively (both p < 0.001). The baseline myocardial blood flow was similar in the patients and control subjects: 0.92 +/- 0.24 versus 0.83 +/- 0.13 ml/g per min, respectively (p = 0.21). A significant increase in flow was observed in both groups after dipyridamole infusion, but the flow at maximal vasodilation was 29% lower in the patients: 3.19 +/- 1.59 versus 4.49 +/- 1.27 ml/g per min (p = 0.011). Consequently, coronary flow reserve (the ratio of hyperemia flow to basal flow) was 35% lower in the patients than in the control subjects: 3.5 +/- 1.6 versus 5.4 +/- 1.5 (p = 0.0008). Total coronary resistance during hyperemia was higher in the patients than in the control subjects: 36 +/- 25 versus 21 +/- 10 mm Hg/min per g per ml (p = 0.045). Coronary flow reserve was inversely associated with serum total cholesterol concentration: r = -0.43 (p = 0.009). CONCLUSIONS: Coronary flow reserve is reduced in young men with FH, and, consequently, coronary resistance during hyperemia is increased. The results demonstrate very early impairment of coronary vasomotion in hypercholesterolemic patients.

Early impairment of coronary flow reserve in young men with borderline hypertension.

OBJECTIVES: The purpose of this study was to investigate whether functional abnormalities in coronary vasomotion are present in young healthy asymptomatic men fulfilling the World Health Organization (WHO) criteria for borderline hypertension. BACKGROUND: Previous studies have reported reduced coronary flow reserve in middle-aged subjects with sustained hypertension and hypertension-induced microvascular heart disease or left ventricular hypertrophy. METHODS: Myocardial blood flow was measured at baseline and during dipyridamole-induced hyperemia by means of positron emission tomography and oxygen-15-labeled water in asymptomatic young men with borderline hypertension (group 1: n = 16, mean +/- SD age 37 +/- 4 years, 24-h ambulatory blood pressure 135 +/- 10/81 +/- 9 mm Hg) and matched healthy control subjects (group 2: n = 19, age 35 +/- 3 years, 24-h ambulatory blood pressure 119 +/- 8/69 +/- 8 mm Hg, p < 0.001). Left ventricular (LV) mass, dimensions and function were measured by echocardiography. RESULTS: LV mass, dimensions and diastolic function were similar in the study groups. Baseline myocardial blood flow was similar (0.83 +/- 0.21 vs. 0.80 +/- 0.22 ml/g per min, group 1 vs. group 2, respectively, p = NS), and a significant increase in flow was detected after dipyridamole infusion (0.56 mg/kg body weight in 4 min intravenously) in both groups. However, the flow response to dipyridamole was significantly lower in group 1, leading to lower hyperemic flow in group 1 than in group 2 (2.85 +/- 1.20 vs. 3.80 +/- 1.44 ml/g per min, respectively). Consequently, the coronary flow response was lower in hypertensive than in normotensive men (3.46 +/- 1.23 vs. 4.99 +/- 2.5 ml/g per min, group 1 vs. group 2, respectively, p < 0.05). CONCLUSIONS: These results demonstrate reduced coronary reactivity present in young asymptomatic men with borderline hypertension and no signs of hypertension-induced angina or left ventricular hypertrophy. Because baseline basal myocardial blood flow was unchanged, the reduction in coronary flow reserve depends on an impaired maximal vasodilator capacity.

Intake and indicators of iron and zinc status in children consuming diets low in saturated fat and cholesterol: the STRIP baby study. Special Turku Coronary Risk Factor Intervention Project for Babies.

A low-fat diet may predispose children to low meat consumption, low iron intake, and iron deficiency. In the randomized prospective Special Turku Coronary Risk Factor Intervention Project for Babies (STRIP baby study), families of 540 children were counseled to reduce exposure of children > 7 mo of age to known environmental risk factors for coronary heart disease. The control group consisted of 522 children whose families received no specific counseling concerning dietary fat. Iron and zinc intakes of 79 children aged 3-4 y (40 in the intervention group and 39 in the control group) were assessed with 4-d food records. The children in the intervention group consumed less saturated fat than those in the control group and had continuously higher ratios of dietary polyunsaturated to saturated fatty acids. Mean (+/- SD) daily iron intakes in the intervention and control groups were 8.8 +/- 4.2 mg and 8.6 +/- 2.8 mg, respectively. Laboratory findings in the intervention and control groups, respectively, were as follows: hemoglobin, 123 +/- 8 and 122 +/- 7 g/L; mean cell volume, 81.8 +/- 2.9 and 81.7 +/- 3.2 fL; mean corpuscular hemoglobin, 28.1 +/- 1.3 and 27.8 +/- 1.4 pg; ferritin, 21.8 +/- 11.6 and 19.2 +/- 12.4 microg/L; transferrin, 2.90 +/- 0.30 and 2.85 +/- 0.29 g/L; and transferrin receptor, 2.34 +/- 0.46 and 2.29 +/- 0.39 mg/L. There were no significant differences between the groups. Daily zinc intakes were 7.5 +/- 1.2 mg in the intervention group and 7.4 +/- 1.3 mg in the control group; respective serum zinc concentrations were 11.2 +/- 1.9 and 10.5 +/- 1.6 micromol/L (NS). In conclusion, long-term supervised use of a diet low in saturated fat and cholesterol did not influence intake or serum indicators of iron and zinc in children.

Influence of dietary fat on the nutrient intake and growth of children from 1 to 5 y of age: the Special Turku Coronary Risk Factor Intervention Project.

BACKGROUND: Excessive decreases in fat intake in young children have been linked with low intakes of energy and nutrients and possible growth failure. OBJECTIVE: We evaluated nutrient intakes and growth of healthy children with different fat intakes during the first 5 y of life. DESIGN: In the Special Turku Coronary Risk Factor Intervention Project (STRIP), 7-mo-old children were randomly assigned to an intervention aimed at reduced consumption of saturated fat and cholesterol (n = 540) or to a control group (n = 522). This analysis comprises data for children for whom > or = 6 of 8 possible 3-4-d food records were available (n = 730; 353 females). Children were divided according to fat intake pattern (percentage of energy) between the ages of 13 mo and 5 y into groups with continuously high fat intake (5% of children), increasing fat intake (5%), continuously low fat intake (5%), decreasing fat intake (5%), and average fat intake (80%). Children's energy and nutrient intakes and growth were then compared by analysis of variance. RESULTS: Fat intake at 13 mo of age was particularly low (21% of energy) in the increasing fat intake group and in the continuously low fat intake group (22% of energy at 13 mo; 26% of energy at 5 y). Growth of children in all 5 fat intake groups, however, was not significantly different throughout the study period. Intakes of vitamins and minerals, except of vitamin D, met recommended dietary allowances in all fat intake groups. CONCLUSION: Nutrient intakes and growth were not significantly different in children whose fat intake patterns differed between 13 mo and 5 y of age.

Special Turku Coronary Risk Factor Intervention Project for Babies (STRIP).

BACKGROUND: Introducing nutritional and lifestyle principles to children in late infancy may permanently improve their adherence to a low-saturated fat, low-cholesterol diet, thus reducing of coronary risk factors, but worries about possible effects on growth and development have hampered such an approach. OBJECTIVE: The Special Turku Coronary Risk Factor Intervention Project for Babies (STRIP) aimed to decrease exposure to known environmental atherosclerosis risk factors in children 7-36 mo of age. DESIGN: Repeated, individualized counseling aimed at promoting a fat intake of 30% of energy and a 1:1:1 ratio of saturated to monounsaturated to polyunsaturated fat intake was provided (n = 540 intervention children; 284 boys). Nutrition was discussed superficially with the families of the control children (n = 522; 266 boys) and food intake was recorded at 3-6-mo intervals by use of 3-4-d food diaries. Serum lipids were measured at 6-12-mo intervals and growth was monitored regularly. RESULTS: Fat intake of the intervention (control) children provided 29.5% (29.4%) of energy at the age of 8 mo, 26.6% (28.5%) of energy at 13 mo, 30.5% (33.5%) of energy at 24 mo, and 31. 5% (33.5%) of energy at 36 mo. The intervention children consistently consumed less saturated fat than did the control children (P: <0.0001). Recommended intakes of other nutrients (except vitamin D and occasionally iron) were reached irrespective of the amount and type of dietary fat. Serum cholesterol, non-HDL cholesterol, and HDL-cholesterol concentrations were 3-6% lower in the intervention children than in the control children. The intervention had no effect on height, weight, or head circumference gain. Fat intake did not predict children's growth patterns. CONCLUSION: Repeated, individualized counseling in early childhood aimed at reducing consumption of saturated fat and cholesterol was effective and feasible and did not restrict growth in circumstances in which children were regularly monitored.

Constantly low HDL-cholesterol concentration relates to endothelial dysfunction and increased in vivo LDL-oxidation in healthy young men.

To test the hypothesis that low HDL-C concentration interferes with vascular endothelial function and lipoprotein oxidation, we measured endothelium-dependent flow mediated dilatation (FMD, %) of the brachial artery in young men (n=20) classified prospectively into two groups on basis of having either low or high HDL-C concentration over the past 2 years. As an estimate of in vivo low-density lipoprotein oxidation (ox-LDL), we measured LDL diene conjugation. FMD was present in the group with high HDL-C concentration, but impaired in the group with low HDL-C (5.5+/-3.2 vs 0.2+/-1.2%, P<0. 001). The group with high HDL-C level had significantly lower levels of ox-LDL compared to low HDL-C group (18.0+/-1.8 vs 22.9+/-4.4, P

Influence of cardiovascular risk status on coronary flow reserve in healthy young men.

To detect changes in vascular physiology associated with early atherosclerosis, we studied whether alterations in coronary flow reserve, as assessed by positron emission tomography imaging with intravenous dipyridamole, would be related to risk factor variables in healthy young men. The number of conventional risk variables correlated significantly with coronary flow reserve (r = -0.58, p = 0.0007), suggesting that alterations in functional vascular reactivity are related to the cardiovascular risk status already in healthy young men.

Nutrient intakes by young children in a prospective randomized trial of a low-saturated fat, low-cholesterol diet. The STRIP Baby Project. Special Turku Coronary Risk Factor Intervention Project for Babies.

OBJECTIVE: To evaluate the impact of individualized and repeatedly given dietary counseling on fat intake and nutrient intake of children aged 8 months to 4 years. DESIGN: Prospective randomized clinical trial. PARTICIPANTS: Children (N = 1062) from 1054 families were randomized to an intervention (n = 540) or a control (n = 522) group when each child participant was 6 months old. INTERVENTIONS: The children in the intervention group were counseled to reduce their intake of saturated fat and cholesterol but to ensure their adequate energy intake. Dietary issues were discussed with the families of the children in the control group only briefly according to the current practice of well-baby clinics. MAIN OUTCOME MEASURES: Food consumption was evaluated by using 3- and 4-day food records that were kept at 5- to 12-month intervals, and nutrient intakes were analyzed with a Micro Nutrica computer program (Social Insurance Institution, Turku, Finland). RESULTS: The intake of fat (29% of the energy intake) and cholesterol (70 mg) showed no differences between the groups of children at 8 months of age. The fat intake in the children in the intervention group was then continuously 2% of the energy intake below that of the children in the control group (P < .001). After the age of 13 months, the cholesterol intake of the children in the control group exceeded that of the children in the intervention group by 20 mg (P < .001). The children in the intervention group consumed 3% (of the energy intake) less saturated (P < .001) and 1% (of the energy intake) more polyunsaturated fats (P < .001) than did the children in the control group at age 13 months and older. The carbohydrate intake was slightly higher in the children in the intervention group than in the children in the control group. Intakes of vitamins, minerals, and trace elements showed no differences between the 2 groups. CONCLUSIONS: The intakes of fat by the children in the intervention and control groups were markedly below values that were recommended for the first 2 years of life. Despite the low intake of fat, the intake of other nutrients fulfilled current recommendations, except for vitamin D and iron. Individualized dietary counseling that led to clear changes in the type of fat intake had a minimal effect on vitamin or mineral intakes.

Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents.

OBJECTIVE: To compare nutrition knowledge and food intake in 7-y-old intervention and control children in an atherosclerosis risk factor intervention trial after 6.5 y of nutrition counselling given to the parents. DESIGN, SUBJECTS AND METHODS: Intervention families in the Special Turku Coronary Risk Factor Intervention Project received child-oriented nutritional counselling one to three times a year since child's age of 7 months, aimed at reduced saturated fat and cholesterol intake. Children's nutrition knowledge was analysed in a time-restricted cohort of 70 seven-y-old (34 boys) intervention children and 70 control children (40 boys) with a picture identification test. For comparison, children's food intake was evaluated using scores developed for the project that reflected quality and quantity of fat and quantity of salt in children's two or three 4-day food diaries recorded between 5.5 and 7 y of age. RESULTS: Child-targeted nutrition counselling of the intervention families only slightly increased intervention children's knowledge of heart-healthy foods (42.6% vs 34.9% correct answers by the intervention and control children, P = 0.057). Only < or = 20% of the children were able to adequately justify their answers in the test. The food diaries of the intervention children comprised more foods low in saturated fat and high in unsaturated fat than those of the control children (57.1% vs 41.7% of the maximum score for low fat foods, P = 0.0001; 48.9% vs 37.7% for high unsaturated fat foods, P = 0.0009, respectively), but the intervention and control children consumed similar amounts of low-salt foods (P = 0.23). Nutrition knowledge and food use scores correlated poorly (r = -0.20-0.35). CONCLUSIONS: Child-targeted nutrition counselling repeatedly given to the parents during and after child's infancy strongly influenced food choice scores of the 5.5-7-y-old children but failed to influence children's salt intake or scores in a nutrition knowledge picture test.

Impact of nutrition counselling on nutrition knowledge and nutrient intake of 7- to 9-y-old children in an atherosclerosis prevention project.

OBJECTIVE: To assess the impact of nutrition counselling given to 7.5- to 9-y-old children and their parents on children's nutrition knowledge and nutrient intakes. DESIGN AND SUBJECTS: The study children are participants in a prospective, randomised STRIP study (Special Turku Coronary Risk Factor Intervention Project for Children), whose aim was to decrease the intakes of saturated fat and cholesterol while increasing the intake of unsaturated fat in the intervention children from the age of 7 months onwards. Nutrition counselling was given only to the parents until the child's age of 7 y. Nutrition knowledge and nutrient intakes (total energy, total fat, saturated fat, unsaturated fat and sodium) were studied in a time-restricted cohort of 47, 7-y-old intervention and 51 control children. Thereafter, nutrition counselling was given both to the children and parents. Children's nutrition knowledge and nutrient intakes were measured again at the age of 9 y. RESULTS: Biannual nutrition counselling given to the intervention children and the parents maintained the differences in saturated fatty acid intake attained during the intervention given to the parents alone (11.5 vs 13.3 E% (percent of energy intake), at the age of 7 y, P<0.01; 11.1 vs 13.4 E% at the age of 9 y, respectively; P<0.01). The intervention children used more polyunsaturated fatty acids at the age of 9 y than the control children (5.7 vs 5.1 E%, P=0.05). At 7 y, the intervention and control children had similar nutrition knowledge scores (total knowledge score 12.9 vs 12.0, respectively, P=0.13). After 1.5 y of nutrition intervention, at 9 y, the intervention children's nutrition knowledge was higher than that of the controls (total nutrition score 16.5 vs 13.2, respectively, P<0.001) and the ability to explain the reasons for their picture choices in the nutrition knowledge test had increased. CONCLUSION: This study showed that only a relatively short period of counselling with low input is needed to increase in children's nutrition knowledge and ability to explain nutrition-related subjects if advice has first been given to the parents and if the parents have received reinforcement and concrete help with parent-child communication after their children have been involved in the counselling. The differences attained in nutrient intake could also be maintained.

Risk factors for coronary heart disease in children and young adults.

This review covers two ongoing studies in Finland: the Cardiovascular Risk in Young Finns study, which started in 1978, and the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), which started in 1989. In the cross-sectional Cardiovascular Risk in Young Finns study, cardiovascular risk factors were first assessed in 1980 in 3596 children and adolescents covering ages between 3 and 18 y at 3-y intervals. The latest follow-up examination was performed in 2001, when risk factors and early markers of atherosclerosis in carotid and brachial arteries were examined in 2264 subjects from the original cohorts, now covering ages from 24 to 39 y. The results clearly show that an individual's coronary heart disease (CHD) risk factor profile is regulated by early lifestyle-related factors and that exposure to risk factors in childhood induces changes in arteries that contribute to the development of atherosclerosis in adulthood. In the STRIP study, 1062 infants were randomized into an intervention group (n = 540; low-saturated-fat, low-cholesterol diet) or a control group (n = 522) at 7 mo of age. Fat, saturated fat and cholesterol intakes have been lower, while the polyunsaturated to saturated fat ratio has been higher in the intervention children than in the control children throughout the ongoing trial. During the first 7 y of life, serum cholesterol concentration was 0.2-0.3 mmol/l lower in the intervention boys than in the control boys, but the difference was negligible in girls. Neurological development of the intervention children at age 5 y was at least as good as that of the control children. Counselling had no effect on children's growth.

Maternal overweight impacts infant feeding patterns--the STEPS Study.

OBJECTIVES: We examined how maternal overweight impacts full breastfeeding (BF), total duration of BF and the age of introduction of complementary foods (CFs) and whether these have effect on children's growth from 0 to 2 years. SUBJECTS/METHODS: From 1797 families participating in the STEPS Study, 848 children had data on BF and anthropometric data at 13 months and 2 years of age and were included in this study. Data on BF and CFs were collected using a self-administered follow-up diary. Information regarding maternal weight, height, pregnancy and delivery were received from maternity clinics and the National Longitudinal Census Files. The children's weight and length/height were recorded during the study visits at 13 months and 2 years. RESULTS: Overweight women breastfed fully (2.2 vs 2.8 months, P<0.0001) and totally (7.4 vs 9.0 months, P<0.0001) for a shorter time and introduced CFs earlier (4.1 vs 4.3 months, P=0.02) than normal weight women. Children of overweight women were heavier and had a higher body mass index at 2 years than children of normal weight women. At 2 years of age 30% of boys and 17% of girls were overweight or obese. However, children's obesity risk was not increased by maternal overweight (odds ratio (OR) 1.04, P=0.12). Longer duration of full BF (OR 0.86, P=0.04) and partial BF (OR 0.91, P=0.02) and delayed introduction of CFs (OR 0.69, P=0.03) were protective against obesity. CONCLUSIONS: Our study suggests that women who were overweight or obese before pregnancy breastfed for a shorter time and introduced CFs earlier than normal weight women, which may further impact children's growth.

The effect of dietary intervention on paraffin-stimulated saliva and dental health of children participating in a randomized controlled trial.

OBJECTIVES: The aim was to study the impact of dietary intervention on the properties of paraffin-stimulated saliva, and on dental caries. STUDY DESIGN: At 7 months of age 1062 infants (540 intervention; 522 controls) started in the prospective, randomized Special Turku Intervention Project (STRIP) aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis of adult age (www.clinicaltrials.gov NCT 00223600). At 3 years of age, every fifth child was invited to an oral sub-study, and 148 (78 boys) children attended. At 6, 9, 12 and 16 years of age 135, 127, 114 and 88 children were restudied, respectively. Dietary intakes of carbohydrates, protein, saturated fat, calcium, phosphate, and fibre were regularly recorded using 4-day food records. Height and weight were regularly monitored. Paraffin-stimulated saliva samples were collected at 6, 9, 12 and 16 years of age, and analyzed for flow rate, buffer capacity, calcium, phosphate and proteins. Dental health was recorded and expressed as d3mft/D3MFT, and as time of caries onset. RESULTS: Dietary intakes of calcium, phosphate and fibre, and salivary flow rate increased with time in both groups (p<0.001, GLM for repeated measures). Fibre intake and salivary flow rate were higher in the intervention than in the control group (p=0.042 and p=0.0394, respectively, GLM for repeated measures). There were no correlations between dietary intakes and salivary concentrations of calcium or phosphate. Children who did not have caries experience (d3mft/D3MFT=0) during the entire follow-up had higher salivary calcium than those who had caries already at 3 years of age. The association between salivary calcium and caries onset was significant up to 12 years of age. Toothbrushing frequency was statistically significantly associated with caries-onset at ages 6 (gamma statistic 0.457, p=0.046) and 12 years (gamma statistic 0.473, p=0.019). CONCLUSIONS: The current long-term dietary intervention increased children's paraffin-stimulated salivary flow rate. The concentration of salivary calcium was directly correlated to dental health. Higher salivary flow rate in the intervention group is believed to be due to higher fibre intake in the intervention group.