Abstract 26: DASH-Style Eating Pattern in Early Adolescence Reduces Cardiometabolic Risk Clustering

Abstract

Cardiometabolic risk (CMR) factor clustering has its roots in childhood and the presence of multiple cardiovascular risk factors in younger populations has been linked with early vascular dysfunction. A DASH-style eating pattern has been shown to reduce blood pressure and other selected cardiometabolic outcomes, primarily in adults, but its role in the development of CMR clustering during adolescence has not been studied. Data from the National Heart, Lung, and Blood Institute’s Growth and Health Study (NGHS) will be used to evaluate the relation between early-to-mid adolescent dietary intake and CMR clustering at the end of adolescence. The NGHS began in 1987-1988 with the enrollment of 2,379 adolescent girls (with approximately equal numbers of blacks and whites), ages 9-10 years. Diet was assessed using 3-day diet records during eight of 10 years of follow up. A total of 1,369 girls had complete data on diet, all potential confounding variables, and follow-up over 10 years for all CMR factors of interest. Risk factor clustering scores were created by summing individual CMR outcomes defined as follows: waist circumference ≥88 cm, systolic and/or diastolic blood pressure ≥90th percentile for age, sex and height, LDL ≥110 mg/dL, HDL <50 mg/dL, serum TG ≥110mg/dl, and HOMA-IR ≥4. Multiple logistic regression analyses were used to estimate the impact of a DASH-style pattern on the relative risk (odds ratio) of CMR clustering at the end of adolescence, defined as having ≥ 2 or ≥ 3 of the above risk factors at 18-20 years of age. The proportion of white and black girls with CMR clustering was very similar. However, the types of risk factors differed by race with blacks being nearly twice as likely to have an increased waist size, elevated BP, or insulin resistance and white girls being much more likely to have abnormal lipid levels, particularly elevated triglyceride levels. By the end of adolescence, only 30.1% of girls had no abnormal CMR factors and 34.9% had a single risk factor; 16.6% of girls had two risk factors and 18.4% had between 3-6 prevalent risk factors. Higher intakes of fruit and non-starchy vegetables, dairy, and grains were independently associated with less CMR clustering. After adjusting for age, race, socio-economic status, height, physical activity, and television watching, girls with a DASH-style eating pattern during early-to-mid adolescence were nearly 50% less likely to have three or more CMR factors (O.R.=0.52; 95% CI: 0.30, 0.89) by late adolescence (at 18-20 years of age). These results suggest a DASH-style eating pattern during adolescence, characterized by higher intakes of fruit, non-starchy vegetables, and dairy, may lower risk for the development of subsequent cardiometabolic disorders.