The associations of childhood psychosocial factors with cognitive function in midlife-The young finns study.

OBJECTIVE: An adverse psychosocial environment in childhood may harm cognitive development, but the associations for adulthood cognitive function remain obscure. We tested the hypothesis that adverse childhood psychosocial factors associate with poor cognitive function in midlife by leveraging the prospective data from the Young Finns Study. METHOD: At the age of 3-18 years, the participants' psychosocial factors (socioeconomic and emotional environment, parental health behaviors, stressful events, child's self-regulatory behavior, and social adjustment) were collected. In addition to the separate psychosocial factors, a score indicating their clustering was created. Cognitive function was measured at the age of 34-49 years with a computerized test addressing learning and memory (N = 1,011), working memory (N = 1,091), sustained attention and information processing (N = 1,071), and reaction and movement time (N = 999). RESULTS: We observed an inverse association between the accumulation of unfavorable childhood psychosocial factors and poorer learning and memory in midlife (age, sex, education, adulthood smoking, alcohol drinking, and physical activity adjusted ß = -0.032, SE = 0.01, p = .009). This association corresponded approximately to the effect of 7 months aging. Specifically, poor self-regulatory behavior (ß = -0.074, SE = 0.03, p = .032) and social adjustment in childhood (ß = -0.111, SE = 0.03, p = .001) associated with poorer learning ability and memory 30 years later. No associations were found for other cognitive domains. CONCLUSIONS: The findings suggest an association of childhood psychosocial factors with midlife learning ability and memory. If these links are causal, the results highlight the importance of a child's self-regulation and social adjustment as plausible determinants for adulthood cognitive health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risk Factor Profile in Youth, Genetic Risk, and Adulthood Cognitive Function: The Cardiovascular Risk in Young Finns Study.

INTRODUCTION: The role of risk factor profile in childhood and adolescence on adulthood cognitive function and whether it differs by genetic risk is still obscure. To bring this evidence, we determined cognitive domain-specific youth risk factor profiles leveraging the childhood/adolescence data from the Cardiovascular Risk in Young Finns Study and examined whether genetic propensity for poor cognitive function modifies the association between the risk profiles and adulthood cognitive function. METHODS: From 1980, a population-based cohort of 3,596 children (age 3-18 years) has been repeatedly followed up for 31 years. Computerized cognitive test measuring (1) memory and learning, (2) short-term working memory, (3) reaction time, and (4) information processing was performed for 2,026 participants (age 34-49 years). Cognitive domain-specific youth risk profile scores, including physical and environmental factors, were assessed from the data collected at baseline and categorized into favourable, intermediate, and unfavourable. A polygenic risk score for a poor cognitive function was categorized into low, intermediate, and high risk. RESULTS: At all genetic risk levels, a favourable youth risk factor profile is associated with better learning and memory, short-term working memory, and information processing compared to unfavourable risk profile (e.g., ß = 0.501 SD, 95% CI: 0.043-0.959 for memory and learning among participants with high genetic risk). However, no significant interactions were observed between the youth risk factor profile score and genetic propensity for any cognitive domain (p > 0.299 for all). CONCLUSION: A favourable youth risk factor profile may be beneficial for cognitive function in adulthood, irrespective of genetic propensity for poor cognitive function.

Dietary Intervention in Infancy and Cognitive Function in Young Adulthood: The Special Turku Coronary Risk Factor Intervention Project.

OBJECTIVE: Consumption of saturated fatty acids (SAFAs), polyunsaturated fatty acids (PUFAs), cholesterol, and fiber have been linked with cognitive function in adults. We evaluated these associations from childhood by leveraging data from the Special Turku Coronary Risk Factor Intervention Project (STRIP). STUDY DESIGN: STRIP recruited children aged 5 months and randomly assigned them into intervention/control groups. The intervention introduced a heart-healthy diet, characterized mainly by low consumption of SAFAs and cholesterol, through counseling at least biannually between age 7 months and 20 years. Diet was assessed repeatedly using food diaries. Six years after the end of the intervention phase, at age 26 years, the participants were invited to the first postintervention follow-up, which included cognitive testing that covered learning and memory, verbal memory, short-term working memory, reaction time, information processing, and cognitive flexibility and inhibitory control. We studied the associations of the STRIP intervention and the consumptions of SAFAs, PUFAs, cholesterol, and fiber within these cognitive domains. RESULTS: Participants in the STRIP intervention group had better cognitive flexibility and inhibitory control and were better able to manage conflicting information and ignore task-irrelevant information (0.18 SD higher in the intervention group, adjusted for sex and socioeconomic status). No associations were observed with the dietary components studied. CONCLUSIONS: The infancy-onset STRIP intervention, which promoted a heart-healthy diet, was favorably associated with cognitive flexibility and inhibitory control at age 26 years. No associations were found for the intervention targets studied, indicating that these specific dietary components did not underlie the observed effect of the intervention.

Weight gain in infancy and markers of cardiometabolic health in young adulthood.

AIM: We studied whether repeatedly measured weight gain from birth up to age 2 years associated with cardiometabolic health in young adulthood. METHODS: Using the data collected in the longitudinal Special Turku Coronary Risk Factor Intervention Project, we investigated in 454 healthy subjects how early weight gain in six age intervals (birth to 7 months, 7-13 months, 13-18 months, 18-24 months, and birth to 13 and 24 months) associated with measures of cardiometabolic health at age 20 years. Linear regression analyses were controlled for (1) child's sex, intervention/control group, gestational age, baseline weight and change in length for each interval, and (2) parents' education, mother's weight before pregnancy, height and weight gain during pregnancy, and father's body mass index at the 7-month visit. RESULTS: Weight gain after the first year of life associated directly, when adjusted for traits of the child and parents, with systolic blood pressure, waist circumference and body mass index at age 20 years. In the fully adjusted analyses, weight gain from birth to 1 year and to 2 years of age associated inversely with insulin and insulin resistance. We found no association between early growth and diastolic blood pressure or serum lipids. CONCLUSION: Early weight gain during first 2 years of life may predict later markers of cardiometabolic health.

Repeatedly Measured Serum Creatinine and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study.

BACKGROUND AND OBJECTIVES: Serum creatinine is typically used to assess kidney function. Impaired kidney function and thus high serum creatinine increase the risk of poor cognitive performance. However, serum creatinine might have a nonlinear association because low serum creatinine has been linked to cardiovascular risk and impaired cognitive performance. We studied the longitudinal association between serum creatinine and cognitive performance in midlife. METHODS: Since 2001, participants from the Cardiovascular Risk in Young Finns Study were followed up for 10 years. Serum creatinine was measured repeatedly in 2001, 2007, and 2011. Sex-specific longitudinal trajectories for serum creatinine among participants without kidney disease were identified with latent class growth mixture modeling. Overall cognitive function and 4 specific domains-working memory, episodic memory and associative learning, reaction time, and information processing-were assessed with a computerized cognitive test. RESULTS: Four serum creatinine trajectory groups with clinically normal serum creatinine were identified for both men (n = 973) and women (n = 1,204). After 10 years of follow-up, cognitive testing was performed for 2,026 participants 34 to 49 years of age (mean age 41.8 years). In men and women, consistently low serum creatinine was associated with poor childhood school performance, low adulthood education, low adulthood annual income, low physical activity, and smoking. Compared to the men in the low serum creatinine trajectory group, those in the high serum creatinine group had better overall cognitive performance (ß = 0.353 SD, 95% CI 0.022-0.684) and working memory (ß = 0.351 SD, 95% CI 0.034-0.668), while those in the moderate (ß = 0.247 SD, 95% CI 0.026-0.468) or normal (ß = 0.244 SD, 95% CI 0.008-0.481) serum creatinine groups had better episodic memory and associative learning. No associations were found for women. DISCUSSION: Our results indicate that in men, compared to low serum creatinine levels, consistently high levels may be associated with better memory and learning function in midlife.

Cardiovascular Risk Factor Trajectories Since Childhood and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study.

BACKGROUND: Cardiovascular risk factors, such as high blood pressure, adverse serum lipids, and elevated body mass index in midlife, may harm cognitive performance. It is important to note that longitudinal accumulation of cardiovascular risk factors since childhood may be associated with cognitive performance already since childhood, but the previous evidence is scarce. We studied the associations of cardiovascular risk factors from childhood to midlife, their accumulation, and midlife cognitive performance. METHODS: From 1980, a population-based cohort of 3596 children (3-18 years of age) have been repeatedly followed up for 31 years. Blood pressure, serum lipids, and body mass index were assessed in all follow-ups. Cardiovascular risk factor trajectories from childhood to midlife were identified using latent class growth mixture modeling. Cognitive testing was performed in 2026 participants 34 to 49 years of age using a computerized test. The associations of the cardiovascular risk factor trajectories and cognitive performance were studied for individual cardiovascular risk factors and cardiovascular risk factor accumulation. RESULTS: Consistently high systolic blood pressure (ß=-0.262 SD [95% CI, -0.520 to -0.005]) and serum total cholesterol (ß=-0.214 SD [95% CI, -0.365 to -0.064]) were associated with worse midlife episodic memory and associative learning compared with consistently low values. Obesity since childhood was associated with worse visual processing and sustained attention (ß=-0.407 SD [95% CI, -0.708 to -0.105]) compared with normal weight. An inverse association was observed for the cardiovascular risk factor accumulation with episodic memory and associative learning (P for trend=0.008; 3 cardiovascular risk factors: ß=-0.390 SD [95% CI, -0.691 to -0.088]), with visual processing and sustained attention (P for trend<0.0001; 3 cardiovascular risk factors: ß=-0.443 SD [95% CI, -0.730 to -0.157]), and with reaction and movement time (P for trend=0.048; 2 cardiovascular risk factors: ß=-0.164 SD [95% CI, -0.318 to -0.010]). CONCLUSIONS: Longitudinal elevated systolic blood pressure, high serum total cholesterol, and obesity from childhood to midlife were inversely associated with midlife cognitive performance. It is important to note that the higher the number of cardiovascular risk factors, the worse was the observed cognitive performance. Therefore, launching preventive strategies against cardiovascular risk factors beginning from childhood might benefit primordial promotion of cognitive health in adulthood.

Effects of 20-year infancy-onset dietary counselling on cardiometabolic risk factors in the Special Turku Coronary Risk Factor Intervention Project (STRIP): 6-year post-intervention follow-up.

BACKGROUND: Primordial and primary prevention is the cornerstone for cardiometabolic health. In the randomised, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP; n=1116), a 20-year dietary counselling intervention was given to children biannually from infancy, and cardiometabolic health benefits had been observed among the participants in the intervention group. Here, we report on the key results of the first follow-up done 6 years after the end of the intervention, at age 26 years. METHODS: The randomised controlled STRIP study recruited children at age 5 months from well-baby clinics in Turku, Finland, and randomly assigned them to either an intervention or control group; group allocation was unmasked. The intervention introduced participants to a heart-healthy diet, characterised by low proportional intake of saturated fat and cholesterol, by dietary counselling and nutrition education sessions to parents and children from the age of 7 months to 20 years. Children in the control group received only the basic health education given at Finnish well-baby clinics and school health care. We assessed diet, lifestyle, and cardiometabolic risk factor data, including blood pressure, anthropometry, serum biochemistry (lipids, apolipoproteins, glucose, and insulin), and homoeostatic model assessment of insulin resistance (HOMA-IR) in the participants at age 26 years. FINDINGS: 1116 children were included in the original STRIP study, of whom 551 provided data at the age 26 years follow-up, and data for 507 participants were analysed (243 in the intervention group and 264 in the control group). At follow-up, those who had been in the intervention group had slightly lower mean intake of saturated fat as a proportion of total energy intake than the control group (13·0% [SD 3·3] vs 13·7% [3·6], p=0·049). A higher proportion of participants in the intervention group achieved the targeted monounsaturated and polyunsaturated fat to saturated fat ratio of more than 2:1 than the control group (78 [39%] of 200 vs 70 [30%] of 235; risk ratio [RR] 1·16 [95% CI 1·01-1·33]; p=0·035). A higher proportion of intervention group participants met the ideal total cholesterol concentration of less than 5·17 mmol/L (194 [81%] of 240 vs 187 [72%] of 261; RR 1·45 [1·05-2·01], p=0·024) and optimal LDL cholesterol concentration of less than 3·0 mmol/L (166 [69%] of 240 vs 158 [61%] of 251; RR 1·30 [1·03-1·66], p=0·031). Those who received the intervention had lower glucose (5·00 mmol/L [SD 0·43] vs 5·07 mmol/L [0·46], p=0·040) and HOMA-IR (median 1·44 [IQR 1·09-1·91] vs 1·62 [1·22-2·09], p=0·037) than the participants in the control group. INTERPRETATION: Previously observed intervention effects during the 20-year counselling were largely maintained into adulthood 6 years after the withdrawal of the intervention. Dietary counselling introduced in infancy thus provided a sustained benefit to diet quality and cardiometabolic risk factor levels. FUNDING: Academy of Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Ministry of Education and Culture, Finnish Cultural Foundation, Sigrid Jusélius Foundation, Special Governmental grants for Health Sciences Research (Turku University Hospital), Yrjö Jahnsson Foundation, Finnish Medical Foundation, and Turku University Foundation.

Childhood Exposure to Parental Smoking and Midlife Cognitive Function.

We studied whether exposure to parental smoking in childhood/adolescence is associated with midlife cognitive function, leveraging data from the Cardiovascular Risk in Young Finns Study. A population-based cohort of 3,596 children/adolescents aged 3-18 years was followed between 1980 and 2011. In 2011, cognitive testing was performed on 2,026 participants aged 34-49 years using computerized testing. Measures of secondhand smoke exposure in childhood/adolescence consisted of parental self-reports of smoking and participants' serum cotinine levels. Participants were classified into 3 exposure groups: 1) no exposure (nonsmoking parents, cotinine <1.0 ng/mL); 2) hygienic parental smoking (1-2 smoking parents, cotinine <1.0 ng/mL); and 3) nonhygienic parental smoking (1-2 smoking parents, cotinine ≥1.0 ng/mL). Analyses adjusted for sex, age, family socioeconomic status, polygenic risk score for cognitive function, adolescent/adult smoking, blood pressure, and serum total cholesterol level. Compared with the nonexposed, participants exposed to nonhygienic parental smoking were at higher risk of poor (lowest quartile) midlife episodic memory and associative learning (relative risk (RR) = 1.38, 95% confidence interval (CI): 1.08, 1.75), and a weak association was found for short-term and spatial working memory (RR = 1.25, 95% CI: 0.98, 1.58). Associations for those exposed to hygienic parental smoking were nonsignificant (episodic memory and associative learning: RR = 1.19, 95% CI: 0.92, 1.54; short-term and spatial working memory: RR = 1.10, 95% CI: 0.85, 1.34). We conclude that avoiding childhood/adolescence secondhand smoke exposure promotes adulthood cognitive function.

The effect of an apple polyphenol extract rich in epicatechin and flavan-3-ol oligomers on brachial artery flow-mediated vasodilatory function in volunteers with elevated blood pressure.

BACKGROUND: The primary aim of this study was to test the hypothesis that an orally ingested apple polyphenol extract rich in epicatechin and flavan-3-ol oligomers improves endothelium-dependent brachial artery flow-mediated vasodilatation (FMD) in volunteers with borderline hypertension. The secondary aim of the study was to test whether the investigational product would improve endothelium-independent nitrate-mediated vasodilatation (NMD). METHODS: This was a single centre, repeated-dose, double-blind, placebo-controlled, crossover study in 60 otherwise healthy subjects (26 men, 34 women; aged 40-65 years) with borderline hypertension (blood pressure 130-139/85-89 mmHg) or unmedicated mild hypertension (blood pressure 140-165/90-95 mmHg). The subjects were randomised to receive placebo or the apple polyphenol extract to provide a daily dose of 100 mg epicatechin for 4 weeks, followed by a four to five-week wash-out period, and then 4 weeks intake of the product that they did not receive during the first treatment period. FMD and NMD of the left brachial artery were investigated with ultrasonography at the start and end of both treatment periods, and the per cent increase of the arterial diameter (FMD% and NMD%) was calculated. RESULTS: With the apple extract treatment, a significant acute improvement was detected in the mean change of maximum FMD% at the first visit 1.16 (p = 0.04, 95% CI: 0.04; 2.28), last visit 1.37 (p = 0.02, 95% CI: 0.22; 2.52) and for both visits combined 1.29 (p < 0.01, 95% CI: 0.40; 2.18). However, such improvement was not statistically significant when apple extract was compared with placebo. The overall long-term effect of apple extract on FMD% was not different from placebo. No statistically significant differences between the apple extract and placebo treatments were observed for endothelium-independent NMD. CONCLUSIONS: A significant acute improvement in maximum FMD% with apple extract administration was found. However, superiority of apple extract over placebo was not statistically significant in our study subjects with borderline hypertension or mild hypertension. The study raised no safety concerns regarding the daily administration of an apple polyphenol extract rich in epicatechin. TRIAL REGISTRATION: The trial is registered at http://clinicaltrials.gov (identifier: NCT01690676 ). Registered 25th May 2012.

Cardiovascular Risk Factors From Childhood and Midlife Cognitive Performance: The Young Finns Study.

BACKGROUND: In adults, high blood pressure (BP), adverse serum lipids, and smoking associate with cognitive deficits. The effects of these risk factors from childhood on midlife cognitive performance are unknown. OBJECTIVES: This study sought to investigate the associations between childhood/adolescence cardiovascular risk factors and midlife cognitive performance. METHODS: From 1980, a population-based cohort of 3,596 children (baseline age: 3 to 18 years) have been followed for 31 years in 3- to 9-year intervals. BP, serum lipids, body mass index, and smoking were assessed in all follow-ups. Cumulative exposure as the area under the curve for each risk factor was determined in childhood (6 to 12 years), adolescence (12 to 18 years), and young adulthood (18 to 24 years). In 2011, cognitive testing was performed in 2,026 participants aged 34 to 49 years. RESULTS: High systolic BP, elevated serum total-cholesterol, and smoking from childhood were independently associated with worse midlife cognitive performance, especially memory and learning. The number of early life risk factors, including high levels (extreme 75th percentile for cumulative risk exposure between ages 6 and 24 years) of systolic BP, total-cholesterol, and smoking associated inversely with midlife visual and episodic memory and visuospatial associative learning (-0.140 standard deviations per risk factor, p < 0.0001) and remained significant after adjustment for contemporaneous risk factors. Individuals with all risk factors within recommended levels between ages 6 and 24 years performed 0.29 standard deviations better (p = 0.006) on this cognitive domain than those exceeding all risk factor guidelines at least twice. This difference corresponds to the effect of 6 years aging on this cognitive domain. CONCLUSIONS: Cumulative burden of cardiovascular risk factors from childhood/adolescence associate with worse midlife cognitive performance independent of adulthood exposure.

Cholesterol Lowering Effect of Plant Stanol Ester Yoghurt Drinks with Added Camelina Oil.

The aim of this study was to investigate the effects of yoghurt minidrinks containing two doses of plant stanol ester either with or without added camelina oil on the serum cholesterol levels in moderately hypercholesterolemic subjects. In this randomised, double-blind, parallel group study, 143 subjects consumed a 65 mL minidrink together with a meal daily for four weeks. The minidrink contained 1.6 or 2.0 grams of plant stanols with or without 2 grams of alpha-linolenic acid-rich camelina oil. The placebo minidrink did not contain plant stanols or camelina oil. All plant stanol treated groups showed statistically significant total, LDL, and non-HDL cholesterol lowering relative to baseline and relative to placebo. Compared to placebo, LDL cholesterol was lowered by 9.4% (p < 0.01) and 8.1% (p < 0.01) with 1.6 g and 2 g plant stanols, respectively. With addition of Camelina oil, 1.6 g plant stanols resulted in 11.0% (p < 0.01) and 2 g plant stanols in 8.4% (p < 0.01) reduction in LDL cholesterol compared to placebo. In conclusion, yoghurt minidrinks with plant stanol ester reduced serum LDL cholesterol significantly and addition of a small amount of camelina oil did not significantly enhance the cholesterol lowering effect. This trial was registered with ClinicalTrials.gov NCT02628990.

Cognitive performance in young adulthood and midlife: Relations with age, sex, and education-The Cardiovascular Risk in Young Finns Study.

OBJECTIVE: Age, education, and sex associate with cognitive performance. We investigated associations between age, sex, education, and cognitive performance in young or middle-aged adults and evaluated data reduction methods to optimally capture cognitive performance in our population-based data. METHOD: This study is part of the Cardiovascular Risk in Young Finns Study. The 3,596 randomly selected subjects (aged 3-18 years in 1980) have been followed up for 30 years. In 2011, a computer-based cognitive testing battery (the Cambridge Neuropsychological Test Automated Battery [CANTAB]) was used to assess several cognitive domains. Principal component analysis, categorical and standardized classifications were applied to the cognitive data. RESULTS: Among 34- to 49-year-old participants, cognitive performance declined with age, while education associated with better cognitive functions in several cognitive domains. Men had higher performance on all cognitive domains except visual or episodic memory, in which women outperformed men. The results were similar regardless of the data reduction method used. CONCLUSIONS: The associations between sex, age, education, and cognitive performance are already apparent in young adulthood or middle age. Principal component analyses, categorical and standardized classifications are useful tools to analyze CANTAB cognitive data. (PsycINFO Database Record

Distensibility of the aorta and carotid artery and left ventricular mass from childhood to early adulthood.

UNLABELLED: In adults, arterial distensibility decreases with age and relates to changes in cardiac left ventricular mass. Longitudinal data on changes in arterial distensibility from childhood to adulthood are lacking. Our aim was to study the effect of age and sex, and low-saturated fat dietary counseling on arterial distensibility from childhood to early adulthood. In addition, we assessed the association of arterial distensibility with left ventricular mass. Distensibility of the abdominal aorta and common carotid artery was measured repeatedly at ages 11, 13, 15, 17, and 19 years (n=395-472) in an atherosclerosis prevention trial (Special Turku Coronary Risk Factor Intervention Project [STRIP]). Aortic and carotid distensibility decreased with age (both P<0.0001). In boys, distensibility values were generally lower (P<0.0001) and showed steeper decrease by age (age and sex interaction: both P<0.01). The low-saturated fat dietary counseling given in STRIP was not significantly associated with arterial distensibility. Left ventricular mass increased with age (P<0.0001), and it was greater in boys (P<0.0001). In conclusion, a marked age-related decrease in vascular distensibility was found already at this young age, and this decrease was more pronounced in boys than girls. The longitudinal progression of aortic and carotid distensibility was related with changes in left ventricular mass. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00223600.

Left ventricular mass and geometry in adolescence: early childhood determinants.

It is not known whether birth weight and early childhood growth are associated with the development of cardiac left ventricular mass (LVM) in healthy adolescents. Left ventricular growth and geometric remodeling may have long-term consequences on cardiovascular health later in life. We studied the determinants of LVM and patterns of geometric remodeling in adolescents with specific emphasis on birth size and growth in early childhood. Left ventricular measurements were obtained with echocardiography in 418 adolescents at the age of 15 years in a prospective atherosclerosis prevention study, Special Turku Coronary Risk Factor Intervention Project (STRIP). Birth weight (P=0.0004), current pulse pressure (P=0.013), physical activity level (P=0.0024), weight (P<0.0001), and male sex (P<0.001) had an independent direct association with LVM in adolescents explaining 47% of the variation. Growth in early childhood was not associated with LVM in adolescents. Birth weight (P=0.0066), current weight (P<0.0001), and physical activity level (P=0.0017) were directly associated with left ventricular posterior wall thickness. Current weight was also directly associated with septal thickness (P<0.0001). Boys had a thicker septum than girls (P=0.0092). Normal relative wall thickness and increased left ventricular mass index (eccentric remodeling) (P<0.0001), as well as increase in both variables (concentric, increased LVM) (P=0.0003), were associated with higher body mass index. Our results indicate that birth weight has a long-lasting impact on LVM and normal body weight is beneficial for cardiac structure in adolescents.

Long-term consumption of plant stanol and sterol esters, vascular function and genetic regulation.

Polymorphisms of the ABCG5 and ABCG8 genes interfere with cholesterol absorption and synthesis. We determined whether common polymorphisms of these genes regulate the responses of serum cholesterol and vascular function during long-term inhibition of cholesterol absorption. Mildly to moderately hypercholesterolaemic subjects (n 282) completed a 1-year study consuming plant stanol or sterol ester (2 g stanol or sterol) or control spread. Serum cholesterol and non-cholesterol sterols, markers of cholesterol absorption and synthesis, and variables of vascular function and structure were analysed in relation to common polymorphisms of ABCG5 and ABCG8. At baseline, subjects with the 54K allele of ABCG8 had higher brachial endothelial-dependent flow-mediated dilatation than those without it (5.79 (se 0.31) v. 4.46 (se 0.44) %; P = 0.049), and subjects with the 632V allele of ABCG8 had larger brachial artery diameter than those without it. Polymorphisms of ABCG5 and ABCG8 were neither associated with serum cholesterol reduction nor changes in cholesterol metabolism or in vascular function. However, in subjects with the 400K allele of ABCG8, intima media thickness (IMT) was increased in all groups more than in those without it (P < 0.05). In conclusion, serum cholesterol lowering with absorption inhibition was not associated with polymorphic sites of ABCG5 and ABCG8. However, regulation of baseline cholesterol metabolism and vascular function and structure, and IMT progression during 1 year seemed to share some of the common polymorphic sites of these genes, suggesting a gene-regulated interaction between cholesterol metabolism and vascular function and structure.

Plant stanol ester consumption and arterial elasticity and endothelial function.

We evaluated whether plant stanol esters mixed with different vegetable oil spreads improved arterial health. A total of 200 adults with serum cholesterol >5 mmol/l were randomised to consume camelina, rapeseed or sunflower oil spread with stanol (2 g/d) ester or sunflower oil spread without stanol ester (controls) for 3 months. Non-invasive ultrasound was used to measure carotid artery compliance (CAC) and brachial artery flow-mediated endothelial dependent vasodilatation (FMD) at baseline and after the intervention as markers of arterial health. Plant stanol esters reduced LDL-cholesterol by 9 % compared with controls (P < 0.001) similarly in the different treatment groups. In the combined treatment groups (n 147), CAC or FMD were not changed from controls (n 47). In a subgroup analysis, division of subjects at baseline into below and over sex-specific 50th percentiles of CAC and FMD revealed that low CAC was improved from 1.23 to 1.59 % per 10 mmHg in the treatment group (n 69), and from 1.42 to 1.47 % per 10 mmHg in controls (n 25), (P = 0.0035 between groups). Low FMD was improved from 6.9 % to 8.6 % in the treatment group (n 73) and from 6.6 % to 6.8 % in controls (n 24) (P = 0.05 between groups). In the respective high-median groups, CAC and FMD were not changed in spite of significantly lowered LDL-cholesterol. In conclusion, consumption of plant stanol ester for 3 months had no overall significant effect on arterial elasticity and endothelial function. A controlled study is needed to test whether beneficial changes are obtained in subjects with initially reduced arterial elasticity and endothelial function.

Low-fat formulations of plant stanols and sterols.

Clinical trials have shown that an intake of 2 to 3 g/day of esterified plant stanol--when incorporated in margarines or spreads--significantly reduces serum total and low-density lipoprotein (LDL) cholesterol concentrations without affecting serum high-density lipoprotein cholesterol or triglyceride levels. There is also a growing interest in incorporating cholesterol-lowering ingredients into low-fat foods. Esterification of stanols with long-chain fatty acids increases fat solubility by 10-fold and enables the incorporation of plant stanols into different food products, even low-fat foods. It provides a means of introducing an adequate daily amount of stanol for optimal reduction of cholesterol absorption, while maintaining a high-quality food product. Recent clinical trials show that esterified plant stanols effectively reduce serum total and LDL cholesterol levels, even when used in food vehicles with a low-fat content.

A randomized intervention since infancy to reduce intake of saturated fat: calorie (energy) and nutrient intakes up to the age of 10 years in the Special Turku Coronary Risk Factor Intervention Project.

OBJECTIVE: To evaluate the longitudinal impact of dietary counseling on children's nutrient intake. DESIGN: A prospective, randomized, clinical trial. PARTICIPANTS: Children were recruited to the study between December 1, 1989, and May 30, 1992. At the age of 7 months, children were randomized to the intervention group (n = 540) or the control group (n = 522) and were followed up until the age of 10 years. Intervention Families in the intervention group have, since randomization, received regularly individualized counseling about how to modify the quality and quantity of fat in the child's diet, the goal being an unsaturated-saturated fat ratio of 2:1. MAIN OUTCOME MEASURES: Nutrient intakes between the ages of 4 and 10 years based on annual 4-day food records. RESULTS: The fat intake of the intervention children was constantly around 30% of the calorie (energy) intake, while that of the control children was 2 to 3 calorie percentage units higher (P<.001). The intervention children received 2 to 3 calorie percentage units less saturated fats and 0.5 to 1.0 calorie percentage unit more polyunsaturated fats than the control children (P<.001 for both). However, neither group reached the 2:1 goal set for the unsaturated-saturated fatty acid ratio. The vitamin and mineral intakes of the intervention and control children closely resembled each other despite the marked differences in fat intake. CONCLUSION: Individualized, biannually given, fat intake-focused dietary counseling that began at the child's age of 8 months continued to influence favorably the diet of 4- to 10-year-old intervention children without disadvantageous dietary effects, but the 2:1 goal for unsaturated-saturated fat ratio was not reached.

Impact of dietary intervention, sex, and apolipoprotein E phenotype on tracking of serum lipids and apolipoproteins in 1- to 5-year-old children: the Special Turku Coronary Risk Factor Intervention Project (STRIP).

The effects of dietary intervention, sex, and apolipoprotein E phenotype on tracking of serum lipid values in young children have remained poorly characterized. We investigated these associations in 1062 infants who were randomized into control and intervention groups (n=522 and n=540, respectively) at age 7 months; the intervention group received counseling aimed at maintaining a low-saturated fat, low-cholesterol diet. In 519 children in the control (n=254) and intervention (n=265) groups, serum lipid values were studied annually between 13 months and 5 years of age. In all children, tracking was strongest for the ratio of high density lipoprotein (HDL) cholesterol to total cholesterol; when a 13-month-old child belonged to the lowest quartile of the distribution, the odds ratio for belonging to the same quartile at older ages was 39.0 (95% CI 23.1 to 66.0). Dietary intervention did not influence the tracking of serum lipids. Tracking of HDL cholesterol was stronger in the boys than in the girls (P=0.018). Tracking of non-HDL cholesterol and apolipoprotein B in the children with phenotypes E2/3 or E3/3 was stronger than that in the other children (P=0.031 and P=0.014, respectively). In conclusion, the apolipoprotein E phenotype strongly influences tracking of non-HDL cholesterol and apolipoprotein B values in early childhood, whereas dietary intervention had no effect on tracking of any of the lipids. A child's sex influenced tracking only of HDL cholesterol, with boys showing stronger tracking.