Baseline diet modifies the effects of dietary change.

The Dietary Approaches to Stop Hypertension (DASH) eating pattern has been shown to reduce blood pressure (BP) in previous clinical trials. In the PREMIER study, an established behavioural intervention, with or without DASH, promoted greater weight loss than an advice-only control group, but effects of the DASH intervention on BP were weaker. In these analyses, PREMIER data were used to evaluate whether change in dairy product or fruit and vegetable (FV) intake during the first six intervention months impacted changes in weight and/or BP. Study participants were classified as having low or high intakes of dairy products (<1·5 v. ≥1·5 servings/d) and FV (<5 v. ≥5 servings/d) at baseline and 6 months. For dairy products, in particular, participants with higher baseline intakes tended to decrease their intakes during the intervention. In these analyses, subjects consuming <1·5 dairy servings/d at baseline whose intake increased during the intervention lost more weight than those whose intake decreased or remained low throughout (10·6 v. 7·0 pounds (4·8 v. 3·2 kg) lost, respectively, P = 0·002). The same was true for FV intake (11·0 v. 5·9 pounds (5·0 v. 2·7 kg) lost, P < 0·001). We also found synergistic effects of dairy products and FV on weight loss and BP reduction. Specifically, subjects who increased their intakes of dairy products and also consumed ≥5 servings of FV/d lost more weight and had greater reductions in BP than other groups; in addition, higher FV intakes had the greatest benefit to BP among those consuming more dairy products. These results provide evidence that the DASH pattern was most beneficial to individuals whose baseline diet was less consistent with DASH.

Lean red meat consumption and lipid profiles in adolescent girls.

BACKGROUND: Epidemiological studies of red meat consumption often fail to distinguish between leaner and fattier or processed cuts of meat. Red meat has also been frequently linked with less healthy diet patterns. Data exploring the health effects of lean red meat in younger individuals are scarce, particularly in the context of a healthy diet. The present study examined the effects of lean red meat in combination with higher intakes of fruit/nonstarchy vegetables on lipid profiles in older adolescent girls. METHODS: Data from 1461 girls who were followed for 10 years, starting at 9-10 years of age, in the National Heart Lung and Blood Institute Growth and Health Study were used. Diet was assessed using multiple sets of 3-day records collected over eight examination cycles. Outcome measures included fasting levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and triglycerides at age 18-20 years. RESULTS: After adjusting for age, race, socioeconomic status, height, activity level, hours of television per day, and intakes of whole grains and dairy foods using multivariable modelling, girls consuming ≥6 oz lean red meat per week combined with two or more servings of fruit/nonstarchy vegetables per day had LDL-C levels approximately 6-7 mg dL(-1) lower (P < 0.05) than girls with lower intakes of lean red meat and fruit/nonstarchy vegetables. In addition, girls with higher intakes of both were 33% less likely (odds ratio = 0.67, 95% confidence interval = 0.48-0.94) to have an LDL-C ≥110 mg dL(-1) and 41% less likely (odds ratio = 0.59, 95% confidence interval = 0.42-0.83) to have an elevated LDL : HDL ratio (≥2.2) at the end of adolescence. CONCLUSIONS: These analyses suggest that lean red meat may be included in a healthy adolescent diet without unfavourable effects on lipid values.

Eating patterns and lipid levels in older adolescent girls.

BACKGROUND AND AIMS: Few studies have evaluated the effects of food-based eating patterns on adolescent lipid levels. This study examines whether usual adolescent eating patterns (ages 9-17 years) predict lipid levels at 18-20 years of age. METHODS AND RESULTS: This study uses previously collected data from the longitudinal NHLBI Growth and Health Study in which 2379 girls were enrolled at ages 9-10 years and followed for ten years. Food-based eating patterns were derived from multiple 3-day diet records. After adjusting for age, race, socioeconomic status, height, physical activity, and television viewing, girls with higher intakes of dairy, fruit and non-starchy vegetables had about a 40-50% reduced risk an LDL-C ≥ 170 mg/dL and non-HDL-C ≥ 145 mg/dL. Diets characterized by higher intakes of dairy and whole grains had similar benefits on TC and LDL-C. Girls consuming more fruits and non-starchy vegetables as well as more whole grains were much less likely to have high-risk lipid levels. Lean meat, poultry and fish when consumed in the context of other healthy eating patterns had no adverse effects on lipid levels in late adolescence. In fact when consumed with higher amounts of fruit and non-starchy vegetables, lean meat, poultry and fish had beneficial effects on HDL. Finally, dietary patterns that included more whole grains tended to be associated with lower TG levels. CONCLUSION: Healthy childhood eating patterns characterized by higher intakes of a variety of fruits, vegetables, whole grains, dairy, lean meat, poultry and fish are important modifiable predictors of lipid levels in late adolescence.

BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults.

BACKGROUND: It is unclear whether the increased risk of colon cancer associated with obesity differs for men and women, by distribution of body fat, or by location of the tumor. The primary goal of this study was to address these questions. METHODS: Eligible subjects from the Framingham Study cohort were classified according to body mass index (BMI) and waist size during two age periods: 30-54 y (n=3764) and 55-79 y (n=3802). All eligible men and women were cancer-free at baseline and had complete information on the following potential confounders: age, sex, education, height, activity, smoking, and alcohol. There were 157 incident lifetime cases of colon cancer among those followed beginning at 30-54 y of age and 149 lifetime cases among those whose follow up began at 55-79 y. Subjects were stratified further by gender, activity, and tumor location. The Cox Proportional Hazards Models were used to adjust for possible confounding by the above-described factors. RESULTS: A BMI >/=30 led to a 50% increased risk (95% CI: 0.92-2.5) of colon cancer among middle-aged (30-54 y) and a 2.4-fold increased risk (95% CI: 1.5-3.9) among older (55-79 y) adults. The BMI effect was stronger for men than for women and for cases occurring in the proximal colon. These adverse effects generally diminished when waist was added to the multivariable models. A larger waist size (>/=99.1 cm (39 in) and 101.6 cm (40 in) for women and men, respectively) was associated with a two-fold increased risk of colon cancer; this risk increased linearly with increasing waist size and was evident for both proximal and distal colon cancer. There was no attenuation of these effects when BMI was added to the multivariable models. A larger waist had a particularly adverse effect among sedentary subjects (relative risk (RR)=4.4 for middle-aged adults; RR=3.0 for older adults). CONCLUSION: These findings suggest that waist circumference is a stronger predictor of colon cancer risk than is BMI, and that central obesity is responsible for an increased risk of cancer of both the proximal and distal colon.

Television viewing and change in body fat from preschool to early adolescence: The Framingham Children's Study.

OBJECTIVE: To prospectively examine the relation between television watching and body fat change in children from preschool to early adolescence. METHODS: In a longitudinal study, 106 children were enrolled during preschool years (mean age 4.0 y) and followed into early adolescence (mean age 11.1 y). Parents completed an annual questionnaire on the child's television and video habits. Body mass index (BMI), triceps skinfolds, and sum of five skinfolds were recorded yearly at annual clinic visits. Longitudinal statistical analyses were carried out using mixed modeling procedures to control for potential confounding by a number of factors. RESULTS: Television watching was an independent predictor of the change in the child's BMI, triceps, and sum of five skinfolds throughout childhood. Its effect was only slightly attenuated by controlling for the baseline body fat, level of physical activity (as measured repeatedly by Caltrac accelerometer), percent of calories from fat, total calorie intake, or the parents' BMI or education. By age 11, children who watched 3.0 h or more of television per day had a mean sum of skinfolds of 106.2 mm, compared with a mean sum of skinfolds of 76.5 mm for those who watched less than 1.75 h per day (P=0.007). Furthermore, the adverse effect of television viewing was worse for those children who were also sedentary or had a higher-fat diet. CONCLUSIONS: Children who watched the most television during childhood had the greatest increase in body fat over time. Healthy lifestyle education designed to prevent obesity and its consequences should target television-watching habits of children.

A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus.

This study was designed to evaluate the effects of maternal obesity and diabetes mellitus on the risk of nonchromosomal congenital defects. We used data from 22,951 pregnant women enrolled in a prospective cohort study of early prenatal exposures and pregnancy outcome. The relative risks [prevalence ratios (PRs)] of major nonchromosomal congenital defects associated with obesity and diabetes, alone or in combination, were calculated using multiple logistic regression analysis. In this study, in the absence of diabetes, obese women (body mass index > or =28) had no higher risk, overall, of having an offspring with a major defect [PR = 0.95; 95% confidence interval (CI) = 0.62-1.5]. Their offspring, however, did have a higher prevalence of certain types of defects, including orofacial clefts; club foot; cardiac septal defects; and, to a lesser extent, hydrocephaly and abdominal wall defects. Women with pre-existing or gestational diabetes who were not obese also had no excess risk overall of having offspring affected by a major defect (PR = 0.98; 95% CI = 0.43-2.2), although they did have a higher prevalence of musculoskeletal defects. The pregnancies of women who were both obese and diabetic were 3.1 times as likely (95% CI = 1.2-7.6) to result in an offspring with a defect than were those of nonobese, nondiabetic women, which suggests that obesity and diabetes mellitus may act synergistically in the pathogenesis of congenital anomalies. The defects were largely craniofacial or musculoskeletal.