Childhood Determinants Of Adult Health Research Articles

Modelling the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity in a cohort of Australian adults

Dietary guidelines are increasingly promoting plant-based diets, limits on red meat consumption, and plant-based sources of protein for health and environmental reasons(1). It is unclear how the resulting food substitutions associate with insulin resistance, a risk factor for type 2 diabetes. Here, we modelled the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity. We included 783 participants (55% female) from the Childhood Determinants of Adult Health (CDAH) study, a population-based cohort of Australians. In adulthood, diet was assessed at three time points using food frequency questionnaires: CDAH-1 (2004–06), CDAH-2 (2009–11), and CDAH-3 (2017–19). The median follow-up duration was 13 years. The cumulative average intake of each food group was calculated to reflect habitual consumption. Insulin sensitivity (%) was estimated from fasting glucose and insulin concentrations at CDAH-3 (aged 39–49 years) using homeostasis model assessment. Applying the partition model(2), we simulated the replacement of one food group with another by including both in the model simultaneously (e.g., red meat and legumes), along with potential confounders and energy intake. The difference between parameter estimates (i.e., regression coefficients and variances) and their covariance were used to estimate the “substitution” effect. We report the simulated percentage point change in log-transformed insulin sensitivity for a 1 serve/day lower intake of one food group with a 1 serve/day higher intake of another food group. Replacing red meat with a combination of plant-based alternatives was associated with higher insulin sensitivity (β = 0·10, 95% CI 0·04–0·16). Adjustment for waist circumference attenuated this association by 61·4%. On an individual basis, replacing red meat with legumes (β = 0·12, 95% CI 0·02–0·21), nuts and seeds (β = 0·15, 95% CI 0·06–0·23), or whole grains (β = 0·11, 95% CI 0·04–0·17) was likewise associated with higher insulin sensitivity. Point estimates were similar when replacing processed meat with plant-based alternatives, but more uncertain due to wide confidence intervals. Our modelling suggests that habitually replacing red meat, and possibly processed meat, with plant-based alternatives may associate with higher insulin sensitivity, and thus, a lower risk of type 2 diabetes. Abdominal adiposity was identified as a potentially important mediator in this relationship. In relation to insulin sensitivity, our findings support the recommendation to choose plant-based sources of protein at the expense of red meat consumption.

Trajectory of metabolic syndrome and its association with knee pain in middle-aged adults

ObjectiveMetabolic syndrome (MetS) is characterised by the clustering of central obesity with metabolic abnormalities. We aimed to describe the association of MetS and trajectories of MetS over 10–13 years with knee symptoms in general population-based middle-aged adults. MethodsFasting blood biochemistry, waist circumference and blood pressure measures were collected during Childhood Determinants of Adult Health (CDAH)-1 study (year:2004–6; n = 2447; mean age:31.48 ± 2.60) and after 10–13 year at CDAH-3 (year:2014–2019; n = 1549; mean age:44 ± 2.90). Participants were defined as having MetS as per International Diabetes Federation (IDF) definition. Knee symptoms were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale at CDAH-3 (mid-adulthood). ResultsThe prevalence of MetS increased from 8 % at young adulthood (female:52.06 %) to 13 % in mid-adulthood (female:53.78 %) over 10–13 years. Presence of MetS at mid-adulthood was associated with knee symptoms at mid-adulthood [ratio of means (RoM): 1.33; 95%CI:1.27,1.39]. Four MetS trajectories were identified—‘No MetS’ (85.01 %); ‘Improved MetS’ (2.14 %), ‘Incident MetS’ (8.81 %), and ‘Persistent MetS, (4.04 %). Compared to ‘No MetS‘, ‘Persistent MetS’ [RoM:1.15; 95%CI:1.06,1.25], ‘Incident MetS’ [RoM:1.56; 95%CI:1.48,1.65], and ‘Improved MetS’ [RoM:1.22; 95%CI:1.05,1.41] was associated with higher knee symptoms. Notably, ‘Incident MetS’ was strongly associated with knee symptoms [RoM: 1.56; 95%CI:1.48,1.65] and pain [RoM:1.52; 95%CI:1.37,1.70] at mid-adulthood. ConclusionIn this sample of middle-aged adults, there was a significant positive association between MetS and knee symptoms. Relative to those without MetS at either life stage, the elevation in mean knee pain scores was more pronounced for those who developed MetS after young adulthood than for those who had MetS in young adulthood.

A Healthful Plant-Based Eating Pattern Is Longitudinally Associated with Higher Insulin Sensitivity in Australian Adults

BackgroundA healthful plant-based eating pattern is associated with lower type 2 diabetes risk; however, the association with its preceding state, impaired insulin sensitivity, is less well established, particularly in younger populations with repeated measures of diet over time. ObjectiveWe aimed to examine the longitudinal relationship between a healthful plant-based eating pattern and insulin sensitivity in young to middle-aged adults. MethodsWe included 667 participants from the Childhood Determinants of Adult Health (CDAH) study, a population-based cohort in Australia. Healthful plant-based diet index (hPDI) scores were derived from food frequency questionnaire data. Plant foods considered “healthful” were scored positively (e.g., whole grains, fruit, vegetables), with all remaining foods scored reversely (e.g., refined grains, soft drinks, meat). Updated homeostatic model assessment (HOMA2) estimated insulin sensitivity from fasting insulin and glucose concentrations. We used linear mixed-effects regression to analyze data from 2 time points: CDAH-1 (2004–2006, 26–36 y of age) and CDAH-3 (2017–2019, 36–49 y of age). hPDI scores were modeled as between- and within-person effects (i.e., a participant’s overall mean and their deviation from said mean at each time point, respectively). ResultsThe median follow-up duration was 13 y. In our primary analysis, each 10-unit difference in hPDI score was associated with higher log-HOMA2 insulin sensitivity [95% confidence interval], with between-person (β = 0.11 [0.05, 0.17], P < 0.001) and within-person effects (β = 0.10 [0.04, 0.16], P = 0.001). The within-person effect persisted despite accounting for compliance with dietary guidelines. Adjustment for waist circumference attenuated the between-person effect by 70% (P = 0.26) and the within-person effect by 40% (P = 0.04). ConclusionsIn young to middle-aged Australian adults, a healthful plant-based eating pattern (determined using hPDI scores) was longitudinally associated with higher insulin sensitivity, and therefore, potentially lower type 2 diabetes risk later in life.

Association between osteoarthritis-related serum biochemical markers over 11 years and knee MRI-based imaging biomarkers in middle-aged adults

To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years. Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06; n=156) and 10-13 year follow-up at CDAH-3 (n=167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10; n=313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML. In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070; 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548; 95%CI:-254.917,-28.179) and total bone area (β:-0.729; 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years); a significant negative association of patellar cartilage volume (β:-0.001; 95%CI:-0.002,-0.00004), and total bone area (β:-0.158; 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001; 95%CI:-0.001,-0.0001) and total bone area (β:-0.373; 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA. COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.

Prevalence and Clinical Significance of Residual or Reconverted Red Bone Marrow on Knee MRI.

Background: Residual/reconverted red bone marrow (RBM) in adult knees is occasionally observed on routine knee magnetic resonance imaging (MRI). We aimed to identify its prevalence, distribution, and associations with lifestyle factors, knee structural abnormalities, and knee symptoms in young adults. Methods: Participants (n = 327; aged = 31–41 years) were selected from the Childhood Determinants of Adult Health (CDAH) knee study. They underwent T1-weighted and proton-density-weighted fat-suppressed MRI scans of knees. Residual/reconverted RBM in distal femur and proximal tibia were graded semi-quantitatively (grades: 0–3) based on the percentage area occupied. Knee structural abnormalities were graded semi-quantitatively using previously published MRI scoring systems. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale during CDAH knee study (year: 2008–2010) and at 6–9-year follow-up during the CDAH-3 study (year: 2014–2019). Associations between definite RBM (grade ≥ 2) and lifestyle factors, knee symptoms, and structural abnormalities were described using log-binomial regressions. Results: Definite RBM was seen in females only, in 29 out of 154 cases (18.8%), with femoral involvement preceding tibial involvement. Definite RBM was associated with increased BMI (PR = 1.09/kg/m2; 95% CI: 1.03, 1.16), overweight status (PR = 2.19; 95% CI: 1.07, 4.51), and WOMAC knee pain (PR = 1.75; 95% CI: 1.11, 2.74) in cross-section analysis. However, there was no association between RBM and knee-pain after seven years (PR = 1.15; 95% CI: 0.66, 2.00). There were no associations between RBM and knee structural abnormalities. Conclusion: Presence of definite RBM in young adult knees was observed in females only. Definite RBM was associated with overweight measures, and the modest association with knee pain may not be causally related.

Factors associated with change and stability in adherence to muscle-strengthening guidelines among young Australian adults: A longitudinal study

ObjectivesThe 2014 Australian Physical Activity and Sedentary Behaviour Guidelines (Adults) recommend muscle-strengthening activities ≥2 days/week. This study aimed to identify factors associated with 5-year change and stability in adherence to these guidelines. DesignTwo adult follow-ups of the Childhood Determinants of Adult Health (CDAH) Study. Participants (n = 1510) were 26–36 years (CDAH-1, 2004–06) and 31–41 years (CDAH-2, 2009–11). MethodsInformation on muscle-strengthening activities, sociodemographics, health, physical activity and sedentary behaviour was collected. Participants reporting muscle-strengthening activities ≥2 days/week ‘met guidelines’, with change and stability categorised as ‘persistent adherence’, ‘increasing adherence’, ‘decreasing adherence’ and ‘persistent non-adherence’. Differences in sociodemographic, health and behavioural factors were analysed using log multinomial regression. ResultsBetween 15–21% of women (CDAH-1: 14.5%, 95% confidence interval = 12.5–16.9; CDAH-2: 20.7%, 95% confidence interval = 18.3–23.4) and ~21% of men (CDAH-1: 22.2%, 95% confidence interval = 19.0–26.0; CDAH-2: 21.0%, 95% confidence interval = 17.8–24.7) met muscle-strengthening guidelines, but only 8.5% (95% confidence interval = 7.2–10.1) of participants were persistently adherent. Remaining in or moving from a major city, CDAH-1 weight status, cumulative self-rated health and vigorous physical activity were positively associated with persistent adherence (relative risk range = 1.51–3.92), while female gender, becoming partnered and having children at any timepoint were negatively associated with persistent adherence (relative risk range = 0.38–0.58). ConclusionsAdherence – particularly persistent adherence – to muscle-strengthening guidelines in this sample was low. Gender, marital status, weight status, BMI, self-rated health, urban-rural status, parental status, physical activity and sedentary behaviour were associated with adherence, and should be considered in intervention development to maximise effectiveness.

POS0129 ASSOCIATION BETWEEN OSTEOARTHRITIS-RELATED SERUM BIOCHEMICAL MARKERS OVER 11 YEARS AND KNEE MRI-BASED IMAGING BIOMARKERS IN MIDDLE-AGED ADULTS

Background:Serum levels of osteoarthritis (OA)-related cartilage and joint-specific biochemical markers – cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) –are shown to be associated with cartilage degradation, joint tissue degradation, and synovitis in patients with OA. Although these OA-related biochemical markers may initially precede the MRI biomarkers of joint structural changes, such changes detected in MRI can lead to biochemical marker changes later as the condition progresses. However, there is a lack of data on OA-related biochemical markers’ association with MRI-based biomarkers in the middle-aged general population.Objectives:We aimed to describe the associations between OA-related biochemical markers and MRI-based imaging biomarkers in middle-aged adults followed up over 10-13 years.Methods:Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study at baseline (year: 2004-06, age: 26–36 years) and 10-13 year follow-up (CDAH-3; year: 2014–2019, age: 36–49 years). Serum samples from baseline (n=156) and follow-up (n= 167) were analyzed for three OA-related biomarkers – namely COMP, MMP-3, and HA– using non isotopic ELISA assay methodology. Knee MRI scans were obtained during the CDAH-knee study (year: 2008-10, age: 30-40 years, n=313), and MRIs were assessed for cartilage volume, cartilage thickness, subchondral bone area, cartilage defects, and bone marrow lesions (BML). Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) linear regression and logistic regression were used to describe the association of biochemical marker at CDAH-1 and MRI-based imaging biomarkers at CDAH-knee, and Tobit regression was used to describe the association of MRI-based imaging biomarkers at CDAH-knee and biochemical markers at CDAH-3.Results:In the multivariable model for the association of biochemical marker with MRI-based imaging biomarkers (assessed after 4 years), we found a significant negative association of COMP with medial femorotibial compartment cartilage thickness (-0.010 (-0.019, -0.000) p=0.045), and MMP-3 with patellar cartilage thickness (-9.075 (-16.344, -1.807) p=0.015) and total bone area (-0.047 (-0.086, -0.007) p=0.020). No significant association was observed between HA and MRI markers.In the multivariable model for association of MRI-based imaging biomarkers with biochemical markers (assessed after 6-9 years), a significant negative association of total cartilage volume (-0.0005 (-0.0008, -0.0002) p=0.001) and total cartilage thickness (-0.628 (-1.143, -0.114) p=0.017) with MMP-3, and total bone area with COMP (0.270 (-0.474, -0.006) p=0.010) was observed. No significant association was observed between MRI-based imaging biomarkers and HA.Conclusion:COMP and MMP-3 levels were negatively associated with knee cartilage thickness assessed 4-years later. Similarly, knee cartilage thickness and volume were negatively associated with COMP and MMP-3 levels assessed 6-9 years later in population-based middle-aged adults, indicating an interdependent negative association of OA-related biochemical markers and MRI-based imaging biomarkers. These results suggest that OA-related biochemical markers may predict future MRI-based imaging biomarkers in middle-aged adults and thus represent possible at-risk populations to target for structure modification interventions.Acknowledgements:This project was funded by the National Health and Medical Research Council of Australia Project Grant and Royal Hobart Hospital Research Foundation Project Grant.Disclosure of Interests:Benny Antony Grant/research support from: Investigator-Initiated Clinical Trial support from Nat Rem Ltd., Ambrish Singh: None declared, Leigh Blizzard: None declared, Alison Venn: None declared, Graeme Jones Speakers bureau: Speaker for various pharma, Grant/research support from: Investigator-Initiated Clinical Trial support, John Burgess: None declared, Venkat Parameswaran: None declared, Flavia Cicuttini: None declared, Lyn March: None declared, Changhai Ding: None declared

Abstract 15431: Childhood Passive Smoke Exposure is Associated With Subclinical Left Ventricular Dysfunction in Adulthood - Childhood Determinants of Adult Health Study

Introduction: Prolonged childhood passive smoke exposure may affect adult cardiovascular health but there are few studies of cardiac function. Subclinical left ventricular dysfunction detected by global longitudinal strain (GLS) is predictive of the subsequent development of heart failure. We investigated the association of passive smoke exposure during childhood with GLS in adults. Methods: Data were from the Childhood Determinants of Adult Health (CDAH) study 34-year follow-up (2014-19). Three measures of passive smoking (severity of exposure index [SEI], cumulative years of exposure [CYE], total household smokers [THS]) were derived retrospectively from a validated questionnaire. GLS was measured in clinics using a Siemens Acuson SC2000 ultrasound machine and 4V1c transducer with speckle tracking analysis. Linear regression adjusted for confounding factors (age, gender, childhood socioeconomic position, childhood smoking, adult smoking status, parental education level) examined the association between childhood passive smoke exposure and GLS in adulthood. Results: Among 781 participants (mean age 45.2 ± 2.5 SD years, 52.6% females, 54.2% exposed to passive smoking), GLS showed a decrease (β adjusted -0.17% 95% CI -0.32%, -0.02%) per SD of SEI (range: 0-318, mean 24.2 ± 35.8 SD). CYE (range: 0-106, mean 10.4 ± 13.9 SD) was associated with a decrease in GLS (β adjusted -0.18% 95% CI -0.33%, -0.05%) per SD of exposure. For each THS in childhood (range: 0-5, mean 0.9 ± 1.0 SD), there was a decrease in GLS (β adjusted -0.20% 95% CI -0.36%, -0.05%). Conclusion: Childhood passive smoke exposure, independent of own smoking, was associated with a reduction in GLS, a measure of subclinical cardiac dysfunction. Each 1% decrease in GLS has been associated with 12% higher risk of cardiovascular morbidity and mortality in low-risk general population. There are potential long-term consequences to cardiac function from childhood passive smoke exposure.

Childhood health motivation and adult cardiometabolic health in the Childhood Determinants of Adult Health (CDAH) study.

This research examined if childhood health motivation was associated with adult health behaviors and objectively measured health outcomes. Data were from the Childhood Determinants of Adult Health study. Children aged 9 to 15 years in 1985 completed a questionnaire with health motivation items. In 2004-2006, when aged 26 to 36, participants completed assessments of health behaviors (smoking, diet, alcohol consumption, and physical activity) and cardiometabolic outcomes (body mass index, carotid intima-media thickness from ultrasound, and HOMA insulin resistance from fasting blood samples). Structural path regression analyses examined pathways from health motivation in childhood to adult cardiometabolic outcomes, mediated via adult health behaviors measured concurrently, controlling for age, sex and socioeconomic position. There were 6,230 (49% female) children with data on health motivation. There were two latent constructs: health motivation (4 items: visiting a dentist, visiting a doctor, knowing about your body, and eating a good diet) and risk motivation (3 items: not being a smoker, not being fat, and not drinking alcohol). Greater health motivation was directly associated with nonsmoking, lower carotid intima-media thickness, and lower body mass index in adulthood. Greater risk motivation was directly associated with smoking, higher alcohol consumption, and poorer diets in adulthood. It was also indirectly associated with higher carotid intima-media thickness and higher HOMA insulin resistance via poorer health behaviors. Health motivation during childhood appears important to maintain health across the life course. It could be a target for interventions to improve cardiovascular health in children and adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Supplemental Material for Childhood Health Motivation and Adult Cardiometabolic Health in the Childhood Determinants of Adult Health (CDAH) Study

Supplemental Material for Childhood Health Motivation and Adult Cardiometabolic Health in the Childhood Determinants of Adult Health (CDAH) Study

Job Stress in Young Adults is Associated With a Range of Poorer Health Behaviors in the Childhood Determinants of Adult Health (CDAH) Study.

To examine job stress and health behaviors, including their co-occurrence, in Australians aged 31 to 41 year assessed in 2009 to 2011. Cross-sectional analyses using multivariable regression models of the association between the Effort Reward Imbalance (ERI) scale and health behaviors (smoking, alcohol consumption, diet, physical activity, and body mass index [BMI]) both individually and co-occurring (0 to 3 vs 4 to 5 behaviors) were undertaken. Covariates included sociodemographics, personality, and life events. Greater ERI was associated with a significantly lower prevalence of having co-occurring healthy behaviors and poorer diets in both sexes. Higher ERI was also associated greater physical inactivity and sedentary behavior in men and smoking, high alcohol consumption, and more pedometer-measured physical activity in women. Job stress at work was associated with a range of unhealthy behaviors, which may explain the higher chronic disease associated with job stress.

Impact of adiposity on cardiac structure in adult life: the Childhood Determinants of Adult Health (CDAH) study.

BackgroundWe have examined the association between adiposity and cardiac structure in adulthood, using a life course approach that takes account of the contribution of adiposity in both childhood and adulthood.MethodsThe Childhood Determinants of Adult Health study (CDAH) is a follow-up study of 8,498 children who participated in the 1985 Australian Schools Health and Fitness Survey (ASHFS). The CDAH follow-up study included 2,410 participants who attended a clinic examination. Of these, 181 underwent cardiac imaging and provided complete data. The measures were taken once when the children were aged 9 to 15 years, and once in adult life, aged 26 to 36 years.ResultsThere was a positive association between adult left ventricular mass (LVM) and childhood body mass index (BMI) in males (regression coefficient (β) 0.41; 95% confidence interval (CI): 0.14 to 0.67; p = 0.003), and females (β = 0.53; 95% CI: 0.34 to 0.72; p < 0.001), and with change in BMI from childhood to adulthood (males: β = 0.27; 95% CI: 0.04 to 0.51; p < 0.001, females: β = 0.39; 95% CI: 0.20 to 0.58; p < 0.001), after adjustment for confounding factors (age, fitness, triglyceride levels and total cholesterol in adulthood). After further adjustment for known potential mediating factors (systolic BP and fasting plasma glucose in adulthood) the relationship of LVM with childhood BMI (males: β = 0.45; 95% CI: 0.19 to 0.71; p = 0.001, females: β = 0.49; 95% CI: 0.29 to 0.68; p < 0.001) and change in BMI (males: β = 0.26; 95% CI: 0.04 to 0.49; p = 0.02, females: β = 0.40; 95% CI: 0.20 to 0.59; p < 0.001) did not change markedly.ConclusionsAdiposity and increased adiposity from childhood to adulthood appear to have a detrimental effect on cardiac structure.

Exposure to parental smoking in childhood or adolescence is associated with increased carotid intima-media thickness in young adults: evidence from the Cardiovascular Risk in Young Finns study and the Childhood Determinants of Adult Health Study

Recent evidence suggests that the exposure of children to their parents' smoking adversely effects endothelial function in adulthood. We investigated whether the association was also present with carotid intima-media thickness (IMT) up to 25 years later. The study comprised participants from the Cardiovascular Risk in Young Finns Study (YFS, n = 2401) and the Childhood Determinants of Adult Health (CDAH, n = 1375) study. Exposure to parental smoking (none, one, or both) was assessed at baseline by questionnaire. B-mode ultrasound of the carotid artery determined IMT in adulthood. Linear regression on a pooled dataset accounting for the hierarchical data and potential confounders including age, sex, parental education, participant smoking, education, and adult cardiovascular risk factors was conducted. Carotid IMT in adulthood was greater in those exposed to both parents smoking than in those whose parents did not smoke [adjusted marginal means: 0.647 mm ± 0.022 (mean ± SE) vs. 0.632 mm ± 0.021, P = 0.004]. Having both parents smoke was associated with vascular age 3.3 years greater at follow-up than having neither parent smoke. The effect was independent of participant smoking at baseline and follow-up and other confounders and was uniform across categories of age, sex, adult smoking status, and cohort. These results show the pervasive effect of exposure to parental smoking on children's vascular health up to 25 years later. There must be continued efforts to reduce smoking among adults to protect young people and to reduce the burden of cardiovascular disease across the population.

EDITORIAL: No-Pharmacological Intervention: Pomegranate Juice for the Management of Hypertension and the Improvement of Cardiovascular Health

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Childhood lifestyle and clinical determinants of adult ideal cardiovascular health: The Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Princeton Follow-up Study

BackgroundThe American Heart Association recently defined ideal cardiovascular health by simultaneous presence of seven health behaviors and factors. The concept is associated with cardiovascular disease incidence, and cardiovascular disease and all-cause mortality. To effectively promote ideal cardiovascular health already early in life, childhood factors predicting future ideal cardiovascular health should be investigated. Our aim was thus to comprehensively explore childhood determinants of adult ideal cardiovascular health in population based cohorts from three continents. MethodsThe sample comprised a total of 4409 participants aged 3–19years at baseline from the Cardiovascular Risk in Young Finns Study (YFS; N=1883) from Finland, Childhood Determinants of Adult Health Study (CDAH; N=1803) from Australia and Princeton Follow-up Study (PFS; N=723) from the United States. Participants were re-examined 19–31years later when aged 30–48years. ResultsIn multivariable analyses, independent childhood predictors of adult ideal cardiovascular health were family socioeconomic status (P<0.01; direct association) and BMI (P<0.001; inverse association) in all cohorts. In addition, blood pressure (P=0.007), LDL-cholesterol (P<0.001) and parental smoking (P=0.006) in the YFS, and own smoking (P=0.001) in CDAH were inversely associated with future ideal cardiovascular health. ConclusionsAmong several lifestyle and clinical indicators studied, higher family socioeconomic status and non-smoking (parental/own) in childhood independently predict ideal cardiovascular health in adulthood. As atherosclerotic cardiovascular diseases are rooted in childhood, our findings suggest that special attention could be paid to children who are from low socioeconomic status families, and who smoke or whose parents smoke, to prevent cardiovascular disease morbidity and mortality.

Parental Smoking in Childhood and Brachial Artery Flow-Mediated Dilatation in Young Adults

Passive smoking has been associated with increased cardiovascular morbidity. The present study aimed to examine the long-term effects of childhood exposure to tobacco smoke on endothelium-dependent vasodilation in adults. The analyses were based on 2171 participants in the population-based Cardiovascular Risk in Young Finns (N=2067) and Childhood Determinants of Adult Health (N=104) studies who had measures of conventional risk factors (lipids, blood pressure, adiposity, socioeconomic status) and self-reported parental smoking status when aged 3 to 18 years at baseline. They were re-examined 19 to 27 years later when aged 28 to 45 years. Brachial artery flow-mediated dilatation was measured at follow-up with ultrasound. In analyses adjusting for age, sex, and childhood risk factors, flow-mediated dilatation was reduced among participants who had parents that smoked in youth compared to those whose parents did not smoke (Young Finns: 9.2 ± 0.1% (mean ± SEM) versus 8.6 ± 0.1%, P=0.001; Childhood Determinants of Adult Health: 7.4 ± 0.6% versus 4.9 ± 0.9%, P=0.04). These effects remained after adjustment for adult risk factors including own smoking status (Young Finns, P=0.003; Childhood Determinants of Adult Health, P=0.03). Parental smoking in youth is associated with reduced flow-mediated dilatation in young adulthood measured over 20 years later. These findings suggest that passive exposure to cigarette smoke among children might cause irreversible impairment in endothelium-dependent vasodilation.

Longitudinal Associations of Adiposity With Adult Lung Function in the Childhood Determinants of Adult Health (CDAH) Study

Childhood BMI has been reported to be positively associated with adult lung function. The aim of this study was to investigate the effect of childhood BMI on young adult lung function independently of the effects of lean body mass (LBM). Clinical and questionnaire data were collected from 654 young Australian adults (aged 27-36 years), first studied when age 9, 12, or 15 years. Adult lung function was measured by forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC ratio, and the forced expiratory flow in the middle 50% of FVC (FEF(25-75)). BMI and LBM were derived from anthropometric measures at baseline (1985) and at follow-up (2004-2006). Multivariable models were used to investigate the effect of age and sex standardized BMI in childhood on adult lung function, before and after adjustment for LBM. Adult adiposity had a strong deleterious effect on lung function, irrespective of childhood BMI, and adjustment for childhood LBM eliminated any apparent beneficial effect of childhood BMI on adult FEV(1) or FVC. This suggests that the beneficial effect of increased BMI in childhood on adult FEV(1) and FVC observed in previous longitudinal studies is likely to be attributable to greater childhood LBM not adiposity. Obese children who become obese adults can expect to have poorer lung function than those who maintain healthy weight but large deficits in lung function are also likely for healthy weight children who become obese adults. This highlights the importance of lifetime healthy weight maintenance.

Use of B-Mode Ultrasound to Examine Preclinical Markers of Atherosclerosis

The purpose of this study was to examine the association between adiposity measures, ultrasound image quality, and preclinical markers of atherosclerosis in young adults. B-mode ultrasound was used to obtain common carotid intima-media thickness and common carotid artery distensibility of 2265 and 1313 adults aged 24 to 39 years in two population-based studies: the Cardiovascular Risk in Young Finns and Childhood Determinants of Adult Health studies. Qualitative assessments of ultrasound image quality were obtained from each study (scored as 1, excellent; 2, average; and 3, poor) based on the ability to detect arterial interfaces and the amount of noise present in the image. Increased adiposity was associated with significantly increased odds (all P < .05) of average or poor carotid ultrasound image quality. Reduced image quality was associated with lower intima-media thickness in Young Finns (regression coefficient = -0.029; P = .01) and higher intima-media thickness in Childhood Determinants of Adult Health (regression coefficient = 0.013; P = .03) and lower distensibility levels in both studies (Young Finns, β = -.494; P < .01; Childhood Determinants of Adult Health: β = -.195; P < .01). We observed no differences (bias) in the association between adiposity measures and carotid intima-media thickness by image quality, but there was some evidence suggesting that the association between adiposity measures and carotid distensibility differed by image quality. Adiposity affects ultrasound image quality and has the potential to bias associations between adiposity and preclinical markers of atherosclerosis. Studies examining adiposity and ultrasound-derived measures of atherosclerosis should consider taking steps during the design and analysis phase to adequately account for variations in image quality to avoid any potential bias.

Are We There Yet? Pediatric Screening for Inflammatory Biomarkers and Low Cardiorespiratory Fitness to Identify Youth at Increased Risk of Cardiovascular Disease

Are We There Yet? Pediatric Screening for Inflammatory Biomarkers and Low Cardiorespiratory Fitness to Identify Youth at Increased Risk of Cardiovascular Disease

Intergenerational educational mobility is associated with cardiovascular disease risk behaviours in a cohort of young Australian adults: The Childhood Determinants of Adult Health (CDAH) Study

BackgroundAlthough educational disparity has been linked to single risk behaviours, it has not previously been studied as a predictor of overall lifestyle. We examined if current education, parental education or educational mobility between generations was associated with healthy lifestyles in young Australian adults.MethodsIn 2004-06, participant and parental education (high [bachelor degree or higher], intermediate [vocational training], low [secondary school only]) were assessed. Educational mobility was defined as: stable high (participant and parent in high group), stable intermediate (participant and parent in intermediate group), stable low (participant and parent in low group), downwardly (lower group than parent) and upwardly (higher group than parent) mobile. We derived a lifestyle score from 10 healthy behaviours (BMI, non-smoking, alcohol consumption, leisure time physical activity and six components of diet). Scores >4 indicated a high healthy lifestyle score. We estimated the likelihood of having a high healthy lifestyle score by education (participant and parent) and educational mobility.ResultsComplete data were available for 1973 participants (53% female, age range 26 to 36 years). Those with lower education were less likely to have healthy lifestyles. Parental education was not associated with having a high healthy lifestyle score after adjustment for participant's education. Those who moved upward or downward were as likely to have a high healthy lifestyle score as those in the group they attained.ConclusionsWe found clear disparities in health behaviour by participant education and intergenerational educational mobility. People attaining a higher level of education than their parents appeared protected from developing an unhealthy lifestyle suggesting that population-wide improvements in education may be important for health.