Coronary Risk Factor Intervention Project Research Articles

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

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. http://www.clinicaltrials.gov. Unique identifier: NCT00223600.

Plenary conference: Keys to successful physical activity during childhood

Plenary conference: Keys to successful physical activity during childhood

The STRIP Study: Long-Term Impact of a Low Saturated Fat/Low Cholesterol Diet

The STRIP study (Special Turku coronary Risk factor Intervention Project) has examined the influences of saturated fat-oriented counseling on dietary intakes, serum lipid, and apolipoprotein concentrations and growth and development in children aged 7 months to 20 years of age. The study subjects were randomly assigned to either intervention group (n = 540) or a control group (n = 522) and dietary counseling was given to intervention families through childhood and adolescence at 3- to 12-month intervals. Compared with controls, the intervention children had a lower saturated fat intake as well as lower LDL-C concentration but growth and physical development were not influenced. The intervention effect on coronary heart disease risk factors was larger in boys than girls. Physically active lifestyle and avoidance of tobacco smoke may prevent the development of subclinical atherosclerotic vascular changes in healthy adolescents. The ‘ideal cardiovascular health’ concept as determined by AHA can be effectively promoted in adolescents.

Infancy-Onset Dietary Counseling of Low-Saturated-Fat Diet Improves Insulin Sensitivity in Healthy Adolescents 15–20 Years of Age

OBJECTIVEWe reported previously that low-saturated-fat dietary counseling started in infancy improves insulin sensitivity in healthy children 9 years of age. The aim of this study was to evaluate the effect of lifelong dietary counseling on insulin sensitivity in healthy adolescents between 15 and 20 years of age. In addition, we examined dietary fiber intake and the polyunsaturated fatty acid (PUFA) + monounsaturated (MUFA)-to-saturated fatty acid (SFA) ratio in the intervention and control adolescents and the association of these dietary factors with homeostasis model of insulin resistance (HOMA-IR).RESEARCH DESIGN AND METHODSThe study comprised adolescents participating in the randomized, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP) study, which aims to guide the study participants toward a diet beneficial for cardiovascular health. HOMA-IR was assessed annually between 15 and 20 years of age (n = 518; intervention, n = 245; control, n = 273), along with diet, BMI, pubertal status, serum cotinine concentrations, and physical activity. Dietary counseling was given biannually during the follow-up.RESULTSHOMA-IR was lower (7.5% on average) in the intervention group than in the control group between 15 and 20 years of age (P = 0.0051). The intervention effect was similar in girls and boys. The PUFA+MUFA-to-SFA ratio was higher (P < 0.0001) and the dietary fiber (g/MJ) intake was higher (P = 0.0058) in the intervention group compared with the control group. There was no association between the PUFA+MUFA-to-/SFA ratio and HOMA-IR, whereas dietary fiber intake (g/MJ) was associated with HOMA-IR in girls (P < 0.0001).CONCLUSIONSDietary counseling initiated in infancy and maintained until 20 years of age was associated with improved insulin sensitivity in adolescents.

Association of Fitness With Vascular Intima-Media Thickness and Elasticity in Adolescence

Vascular intima-media thickness (IMT) and elasticity are surrogate markers of atherosclerosis. Data on the effect of cardiorespiratory fitness on these measures of vascular health in adolescence are scarce. The aim was to examine the association of fitness with aortic and carotid artery IMT and elasticity in adolescents. Aortic (n = 449) and carotid (n = 467) IMT and elasticity were measured ultrasonographically in 17-year-old adolescents participating in a prospective, longitudinal atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project). Distensibility and Young's elastic modulus (YEM) were used as measures of arterial elasticity. Cardiorespiratory fitness (maximum oxygen uptake, mL/kg/min) was measured with a maximal cycle ergometer test. Data on fitness were available for 341 of adolescents with aortic and 355 with carotid ultrasound measures. Fitness was inversely associated with aortic IMT (β[SE] = -0.0029[0.0013]; P = .031) and YEM (β[SE] = -0.012[0.0053]; P = .025) after adjusting for gender, physical activity, high-density lipoprotein/total cholesterol, triglycerides, high-sensitivity C-reactive protein, homeostasis model of assessment-insulin resistance, BMI, systolic blood pressure, and smoking. Risk of having low aortic distensibility (≤10th percentile) decreased with increasing fitness (odds ratio = 0.89, 95% confidence interval 0.82-0.98); P = .014). The increase in aortic IMT and YEM between ages 11 and 17 years was smaller in adolescents who were fit at age 17 compared with adolescents who had the lowest fitness level (P for IMT = .015, P for YEM = .0072). Fitness was not associated with carotid IMT or elasticity. Lifestyle counseling given in the Special Turku Coronary Risk Factor Intervention Project was not associated with fitness. Fitness was favorably associated with aortic IMT and elasticity in adolescents. No association of fitness with the respective carotid indices was found. These data suggest that fitness in part enhances vascular health in healthy adolescents.

Ideal Cardiovascular Health in Adolescence

Background— In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study, repeated dietary counseling introduced in infancy and maintained until 20 years of age has led to lower intakes of saturated fat and serum low-density lipoprotein cholesterol. In this study, we examined prospectively the intervention effects on the ideal cardiovascular health concept recently described by the American Heart Association. Additionally, we investigated the association between the concept and vascular intima-media thickness and elasticity in adolescence. Methods and Results— In adolescents participating in the longitudinal, randomized, atherosclerosis-prevention STRIP study, complete data on ideal cardiovascular health metrics were available at 15 (n=394), 17 (n=376), and 19 (n=298) years of age. Aortic intima-media thickness and elasticity were measured with ultrasonography at the same ages. None of the adolescents had all 7 ideal cardiovascular health metrics. At least 5 ideal metrics was found in 60.2%, 45.5%, and 34.2% of the adolescents at 15, 17, and 19 years of age, respectively. Adolescents in the control group had an increased risk of low ideal cardiovascular health (≤3 metrics) compared with the intervention adolescents (risk ratio=1.35; 95% confidence interval=1.04–1.77). The number of ideal cardiovascular health metrics was inversely associated with aortic intima-media thickness ( P &lt;0.0001) and directly associated with elasticity ( P =0.045). The risk of having high intima-media thickness (&gt;85th percentile) was nearly 2-fold in adolescents with a low number of metrics (≤3) compared with those with a higher score (risk ratio=1.78; 95% confidence interval=1.31–2.43). Conclusions— Ideal cardiovascular health as determined by the AHA can be promoted in adolescents. The ideal cardiovascular health concept is beneficially associated with vascular health already in adolescence, supporting the relevance of targeting these metrics as part of primordial prevention. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00223600

Left Ventricular Mass and Geometry in Adolescence

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&lt; 0.0001), and male sex ( P &lt;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 &lt;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 &lt;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 &lt;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.

Clinical Implications

HomeHypertensionVol. 60, No. 5Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Nov 2012https://doi.org/10.1161/HYP.0b013e31827679abHypertension. 2012;60:1087Blood Pressure Characteristics and Early Onset Preeclampsia (page 1338)Download figureDownload PowerPointSome women develop preeclampsia very early in their pregnancy. Interestingly, such women are also more likely to have a family history of preeclampsia, develop preeclampsia again in subsequent pregnancies, and have a higher risk of later cardiovascular disease. These observations raise the possibility that women develop early onset preeclampsia because they have distinct, heritable, physiological traits that predispose them to both preeclampsia and later cardiovascular disease. In this issue of Hypertension, Lazdam et al report distinct differences in blood pressure characteristics during pregnancy, and <13 years later, in women who develop early onset preeclampsia. They demonstrate for the first time that compared with those with late-onset preeclampsia or normotensive pregnancies, such women have persistently higher blood pressure 6 weeks after delivery, a substantially greater increase in blood pressure over the next decade relative to levels during pregnancy, and significantly higher nocturnal blood pressures in later life. Lazdam et al then studied blood pressure in the offspring and found that those born to the pregnancies complicated by early onset disease had 6 mm Hg higher systolic blood pressure compared with those born to either late-onset disease or normotensive pregnancy. Characterization of the biology that underlies these distinct variations in blood pressure behavior may identify pathways for novel interventions. Furthermore, a diagnosis of early onset disease seems to identify individuals who may warrant targeted blood pressure surveillance.Determinants of Adolescent Left Ventricular Mass (page 1266)Cardiac left ventricular hypertrophy is a strong independent predictor of cardiovascular disease morbidity and mortality in adulthood. Left ventricular growth and geometric remodeling in adolescence may have long-term consequences on cardiovascular health in later life. However, factors influencing left ventricular mass in early life are poorly characterized. The determinants of left ventricular mass and patterns of geometric remodeling in healthy adolescents with specific emphasis on birth size and growth in early childhood were studied. Left ventricular measurements were obtained with echocardiography in 418 adolescents at 15 years of age in a prospective atherosclerosis prevention study, Special Turku Coronary Risk Factor Intervention Project (STRIP). Birth weight was directly associated with left ventricular mass, regardless of sex and current weight, pulse pressure, and physical activity level. Growth in early childhood was not associated with left ventricular mass in adolescence. Adolescents who were overweight had 17 g greater left ventricular mass than those with normal body mass index. The results indicate that birth weight has a long-lasting impact on left ventricular mass and normal body weight is beneficial for cardiac structure in adolescents, whereas weight gain during the first 2 years of life does not associate with adolescent left ventricular mass. These data extend the knowledge of the determinants of left ventricular mass from early life to adolescence, relevant for the prevention of cardiovascular disease.Is Blood Pressure Variability a Risk Factor? (page 1138)Download figureDownload PowerPointAttempts to anchor blood pressure variability as an established cardiovascular risk factor span ≈30 years. Recent findings challenge the concept of usual blood pressure and led to the proposition to consider blood pressure variability in the diagnosis, treatment, and monitoring of patients with hypertension. Because these findings originated from post hoc analyses within the context of clinical trials in selected high-risk patients or in patients with a history of stroke, confirmation from an unbiased population sample was necessary. In this issue of Hypertension, results from the prospective Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO) indicate that systolic blood pressure variability does not have any independent prognostic significance over and beyond mean systolic pressure. These findings from 2944 randomly recruited participants, representative of a general population, and followed up for a median of 12 years, suggest that what matters most in the management of hypertension is to reduce the blood pressure level, as recommended in current guidelines. FLEMENGHO results do not support blood pressure variability as an independent risk factor. Previous Back to top Next FiguresReferencesRelatedDetails November 2012Vol 60, Issue 5 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/HYP.0b013e31827679ab Originally publishedNovember 1, 2012 PDF download Advertisement

Effect of Repeated Dietary Counseling on Serum Lipoproteins From Infancy to Adulthood

As atherosclerosis is a lifelong process, prevention of exposure to its risk factors should start at an early age. Our aim was to study the influences of repeated low saturated fat dietary counseling on dietary intakes and lipoprotein measures from infancy to adulthood. Dietary intakes (food records) and serum lipid profile were studied annually from 7 months to 19 years of age in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project), comprising 540 children in the intervention group and 522 children in the control group. Serum total and high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured and used to estimate very low-density lipoprotein-TG, intermediate-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and HDL(2)-C, as well as apolipoproteins A-1 and B. Compared with controls, the intervention children had a lower saturated fat intake (mean daily difference [95% confidence interval] between groups: -2.1 [-2.3, -1.9] percentage of total energy intake in boys; -1.9 [-2.1, -1.7] percentage of total energy intake in girls, both P < .001) and LDL-C concentration (difference [95% confidence interval] between groups: -0.18 [-0.26, -0.10] mmol/L, P < .001 in boys; -0.10 [-0.19, -0.01] mmol/L, P = .037 in girls), whereas HDL-C and apolipoprotein A-1 did not differ between the study groups. In boys, total cholesterol and intermediate-density lipoprotein cholesterol, very low-density lipoprotein-TG, apolipoprotein B, and TG concentrations were also lower in the intervention than in the control group, whereas no differences were found in girls. Repeated dietary counseling is effective in decreasing saturated fat intake and serum LDL-C values from infancy until 19 years of age in both genders. In boys, significant intervention effects are evident in various lipoprotein measures, indicating a more favorable lipid profile in the counseling group.

Association of Physical Activity With Vascular Endothelial Function and Intima-Media Thickness

Impairment of vascular endothelial function and increased intima-media thickness (IMT) are important early steps in atherogenesis. Longitudinal data on the effect of physical activity on endothelial function and IMT in healthy adolescents are lacking. We investigated prospectively the association of leisure-time physical activity with endothelial function (brachial artery flow-mediated dilatation; FMD) and aortic IMT in adolescents. FMD and IMT were measured with ultrasonography at 13 (n=553), 15 (n=531), and 17 (n=494) years of age in adolescents participating in a longitudinal atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children). Mean aortic IMT, maximum FMD, and total FMD response (area under the dilatation curve 40 to 180 seconds after hyperemia) were calculated. Leisure-time physical activity was assessed with a questionnaire, and metabolic equivalent (MET) hours per week of leisure-time physical activity were calculated by multiplying weekly mean exercise intensity, duration, and frequency. Leisure-time physical activity was directly associated with endothelial function (P for maximum FMD=0.0021, P for total FMD response=0.0036) and inversely with IMT (P=0.011) after adjustment for age, sex, body mass index, high-density lipoprotein/total cholesterol, systolic blood pressure, and C-reactive protein and regarding FMD brachial artery diameter. Sedentary adolescents who increased their leisure-time physical activity from <5 to >5 (IMT) or >30 (maximum FMD) MET h/wk between 13 and 17 years of age had an increased maximum FMD (P=0.031) and decreased progression of IMT (P=0.047) compared with adolescents who remained sedentary. IMT progression was attenuated in persistently active adolescents compared with those who became sedentary (P=0.0072). Physical activity is favorably associated with endothelial function and IMT in adolescents. Importantly, a moderate increase in physical activity is related to decreased progression of IMT. A physically active lifestyle seems to prevent the development of subclinical atherosclerotic vascular changes in healthy adolescents. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00223600 (STRIP19902010).

When and how to start prevention of atherosclerosis? Lessons from the Cardiovascular Risk in the Young Finns Study and the Special Turku Coronary Risk Factor Intervention Project

This review provides an up-to-date summary of findings from two ongoing population-based, prospective studies conducted in Finland: The Cardiovascular Risk in Young Finns Study, and the Special Turku Coronary Risk Factor Intervention Project (STRIP), which have contributed significantly to the scientific literature concerning the childhood origin of cardiovascular disease, and whether prevention efforts in adults can be expanded to young people. From the Young Finns Study, we summarize evidence demonstrating childhood risk factors to be associated with both risk factors and preclinical markers of atherosclerosis in adulthood, and from STRIP, we summarize evidence showing that supervised dietary counseling of a low saturated fat diet effectively decreases exposure to cardiovascular risk factors without affecting growth and development of healthy children and adolescents. The evidence available from these studies supports that the ability to prevent or delay the risk of premature atherosclerosis and its clinical sequelae later in life lies in maintaining a low lifetime risk by preventing the development of risk factors in early life.

Parental eating attitudes and indicators of healthy eating in a longitudinal randomized dietary intervention trial (the STRIP study)

To examine the effects of child-oriented dietary intervention on parental eating attitudes and dietary behaviour. In the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (the STRIP study), a cohort of Finnish families took part in a nutritional intervention trial focused on the quality of their children's fat intake since the age of 8 months. Health-related and hedonic eating attitudes of the parents were measured after 10 years of dietary intervention using a validated Health and Taste Attitude Scales (HTAS) questionnaire (n 660). Parents' eating behaviour was studied using a 1 d food record (n 491). Finland. Mothers and fathers (n 660) of the STRIP children. The parents of the intervention families had a higher level of interest in healthy eating compared with control parents. The interest in natural products or hedonic eating attitudes did not differ between the groups. The parents' general health interest was associated with low saturated fat intake, fruit and vegetable consumption, fibre intake and seeking pleasure in eating, but it was not associated with BMI. The intervention also improved the quality of dietary fat among parents with the lowest level of interest in healthy eating. Parents' general health interest was associated with regular dietary counselling as well as with healthier food choice behaviour. However, the dietary intervention that focused especially on the quality of the child's fat intake also enhanced specific changes in the family's fat consumption without a high level of interest in healthy eating.

Clustered metabolic risk and leisure-time physical activity in adolescents: effect of dose?

ObjectivesThe authors studied the association of leisure-time physical activity (LTPA) with clustered and individual metabolic risk factors in adolescents taking into account diet and pubertal status. The authors also studied...

Dietary fiber does not displace energy but is associated with decreased serum cholesterol concentrations in healthy children

Dietary fiber has health benefits, but fiber recommendations for children are controversial because fiber may displace energy. The objective was to longitudinally evaluate dietary fiber intake in children and to study associations between growth variables, serum cholesterol concentrations, and intakes of fiber, energy, and nutrients. Altogether, 543 children from a prospective randomized atherosclerosis prevention trial (the Special Turku Coronary Risk factor Intervention Project; STRIP) participated in this study between the ages of 8 mo and 9 y. The intervention children (n = 264) were counseled to replace part of saturated fat with unsaturated fat. Nutrient intakes, weight, height, and serum total, HDL-, and LDL-cholesterol and triglyceride concentrations were analyzed. Children were divided into 3 groups according to mean dietary fiber intake in foods: low (lowest 10%), high (highest 10%), and average (middle 80%) fiber intakes. Fiber intake associated positively with energy intake and inversely with fat intake. Children with a high fiber intake received more vitamins and minerals than did children in other groups. In longitudinal growth analyses, weights and heights were similar in all 3 fiber intake groups, and fiber intake (g/d) associated positively with weight gain between 8 mo and 2 y. Serum cholesterol concentrations decreased with increasing fiber intakes. Children in the intervention group had a higher fiber intake than did the control children during the entire follow-up period. Fiber intake did not displace energy or disturb growth between 13 mo and 9 y of age. Serum cholesterol values correlated inversely with fiber intake, which indicated that part of the cholesterol-lowering intervention effect in the STRIP project may have been explained by dietary fiber.

Blood Pressure Is Lower in Children and Adolescents With a Low-Saturated-Fat Diet Since Infancy

Blood pressure was measured in the prospective randomized Special Turku Coronary Risk Factor Intervention Project Study with an oscillometric method every year from 7 months to 15 years of age in 540 children receiving a low-saturated-fat, low-cholesterol diet and in 522 control children. Dietary intakes, family history of parental hypertension, and grandparental vascular disease were recorded. Systolic and diastolic blood pressures were 1.0 mm Hg lower (95% CI for systolic: -1.7 to -0.2 mm Hg; 95% CI for diastolic: -1.5 to -0.4 mm Hg) in children receiving low-saturated-fat counseling through childhood than in control children. Intakes of saturated fat were lower (P<0.001), those of polyunsaturated fat higher (P<0.001), and intakes of potassium slightly higher (P=0.002) in the intervention group, but sodium intakes were not influenced by the intervention (P=0.76). Children whose parents were hypertensive had 4- to 6-mm Hg higher systolic and 3- to 4-mm Hg higher diastolic blood pressures than children of normotensive parents (P<0.001). Diastolic blood pressure of children with grandparental vascular disease, ie, early cardiovascular or cerebrovascular disease, tended to be higher than that of children with no grandparental disease (P=0.051). We conclude that restriction of saturated fat from infancy until 15 years of age decreases childhood and adolescent blood pressure with a meaningful population-attributable amount. The importance of childhood lifestyle counseling and primary prevention of hypertension should be emphasized, especially in those children with a family history of hypertension or atherosclerotic vascular disease.

Decreased Aortic Elasticity in Healthy 11-Year-Old Children Exposed to Tobacco Smoke

The goal was to assess the relationship between passive smoking and arterial elasticity in children. Healthy 11-year-old children (N = 386) from an atherosclerosis prevention trial (Special Turku Coronary Risk Factor Intervention Project for Children) were studied. Aortic and carotid elasticities were determined by using M-mode ultrasound imaging based on measurements of blood pressure and arterial diameter changes during the cardiac cycle. The aortic stiffness index, Young's elastic modulus, and distensibility and the respective indices for the carotid artery were calculated. Exposure to tobacco smoke was measured by using serum cotinine concentrations, and children were classified into 3 groups, that is, the noncotinine group (n = 220; undetectable cotinine levels), the low-cotinine group (n = 127; cotinine levels of 0.2-1.6 ng/mL), and the top-decile cotinine group (n = 39; cotinine levels of > or =1.7 ng/mL). Higher cotinine concentrations were associated with increased aortic stiffness index values. An increase in aortic Young's elastic modulus and a decrease in aortic distensibility were observed across the cotinine groups. In multivariate regression models, the cotinine level remained a significant explanatory variable regarding all aortic elasticity indices. Carotid elasticity indices showed no differences across the cotinine groups. Childhood exposure to tobacco smoke (verified with serum cotinine levels) decreases aortic elastic properties in healthy children.

Vascular Endothelial Function and Leisure-Time Physical Activity in Adolescents

Exercise training improves endothelial function in high-risk adolescents, but the influence of habitual leisure-time physical activity on endothelial function in healthy adolescents is unknown. Brachial artery flow-mediated endothelial function and physical activity habits were assessed in 483 adolescents (13 years of age) participating in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children [STRIP]). Endothelial function was examined with ultrasound; physical activity was assessed with self-administered questionnaires. A leisure-time physical activity index was calculated by multiplying mean weekly leisure-time exercise intensity, duration, and frequency [boys, 31.2 +/- 23.0 MET h/wk (mean +/- SD); girls, 24.0 +/- 20.9 MET h/wk; P for gender difference=0.0003]. Maximum flow-mediated dilatation (FMD) and total FMD response (the area under the dilatation curve 40 to 180 seconds after hyperemia) were calculated. In boys, maximum FMD and area under the dilatation curve 40 to 180 seconds after hyperemia were directly associated with leisure-time physical activity index in regression analyses adjusted for brachial artery diameter (maximum FMD, P=0.020; area under the dilatation curve 40 to 180 seconds after hyperemia, P=0.0055). These associations remained significant after further adjustments for body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and systolic blood pressure. A difference of approximately 50 MET h/wk corresponding to approximately 10 hours of moderate intensity activity weekly between sedentary and active boys was associated with an approximately 1% unit difference in maximum FMD. Leisure-time physical activity is directly associated with brachial artery FMD responses in 13-year-old boys, providing evidence that physical activity beneficially influences endothelial function in healthy male adolescents. Lack of association in girls may reflect their overall lower physical activity level.

Growth Patterns and Obesity Development in Overweight or Normal-Weight 13-Year-Old Adolescents: The STRIP Study

Our goal was to study childhood growth patterns and development of overweight in children who were overweight or normal weight at 13 years of age. This study is part of a prospective atherosclerosis-prevention trial Special Turku Coronary Risk Factor Intervention Project for Children). At 7 months of age, 1062 children were randomly assigned to an intervention group (n = 540) receiving biannual fat-oriented dietary counseling or to a control group (n = 522). Height and weight of the children and their parents were monitored annually. Our study group comprised those children who participated in the 13-year study visit (n = 541). At 13 years of age, the child was classified as overweight (n = 84) if his or her BMI exceeded the international age- and gender-specific overweight criteria. In overweight girls, the annual weight gain increased from 2.8 kg during the third and fourth year of life to 7.5 kg during the 12th year of life, whereas the annual weight gain of the girls who were normal weight ranged from 2.1 to 4.8 kg during the same period. The annual weight gain was similar of overweight boys and in their normal-weight peers until the age of 5 years, but after that it increased from 3.5 to 7.9 kg in overweight and from 2.6 to 5.5 kg in normal-weight boys. The BMI of the girls and boys who were overweight at the age of 13 exceeded the international cutoff point for overweight from the age of 5 and 8 years onward, respectively. The mean BMIs of the mothers and fathers of the overweight children were higher than those of the parents of the normal-weight children. The STRIP intervention had no effect on the examined growth parameters or on parental BMI. The children who were overweight at 13 years of age gained more weight than their normal-weight peers by the age of 2 or 3 years onward. The girls became overweight by the age of 5 years, whereas the boys only after 8 years of age. Parental BMI and steep weight gain in early childhood indicate markedly increased risk for becoming overweight.

High Sucrose Intake Is Associated With Poor Quality of Diet and Growth Between 13 Months and 9 Years of Age: The Special Turku Coronary Risk Factor Intervention Project

Previous studies have suggested that interventions to lower dietary fat content and improved fat quality lead to a compensatory increase in sucrose content. The purpose of this work was to determine what associations exist between sucrose intake and intake of nutrients, intake of specific foods, and growth in children aged 13 months to 9 years of age in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project. Nutrient intake and food consumption were evaluated annually at ages 13 months through 9 years by using food records. Altogether, 543 children were divided into 3 groups according to mean sucrose intake: constantly high sucrose intake (highest 10%), constantly low sucrose intake (lowest 10%), and average sucrose intake (80%). Absolute and relative weights and heights were recorded at 7, 13, and 24 months of age and annually thereafter until 9 years old. The high sucrose-intake group exceeded the recommended sucrose intake (<10% of energy intake, World Health Organization) already at the age of 2 years. Energy and total fat intake did not differ between the sucrose-intake groups. Children with low and average sucrose intake consumed more protein and had a better dietary fat quality than children with high sucrose intake. They also tended to receive more vitamin E, niacin, calcium, iron, zinc, and dietary fiber than children who consumed a high sucrose diet. Children in the low sucrose-intake group consumed more grains, vegetables, and dairy products than the other children. Sugar intake had no direct association with obesity, but weight, height, and BMI of children differed between the sucrose-intake groups between 7 months and 9 years of age. In children aged 13 months to 9 years, long-term low sucrose intake is associated with better nutrient intake and growth than high sucrose intake.

Cohort Profile: The STRIP Study (Special Turku Coronary Risk Factor Intervention Project), an Infancy-onset Dietary and Life-style Intervention Trial

It is now clear that atherosclerosis develops as a result of a life-long process often leading to coronary heart disease. Nutritional recommendations have been delivered to the general community to manage this epidemic. Since fat is an important source of energy and cholesterol is required for sex hormone synthesis, fears have emerged that low intake of saturated fat and cholesterol might influence children’s growth and development. Infants and young children have therefore been excluded from these nutritional recommendations. However, a number of arguments support the concept that prevention of children’s exposure to atherosclerosis risk factors should be started at an early age. Dietary fat intake and quality of fat regulate serum lipoprotein values in childhood in the same way as they do in adults. It has also been shown that children with high serum cholesterol and LDL cholesterol values are predisposed to early atherosclerotic changes in aorta and large arteries and high LDL cholesterol values in childhood associate with increased atherosclerotic changes in carotid arteries measured decades later. All these changes can be influenced by living habits. A lifestyle with emphasis on avoiding atherosclerosis risk factors might be most easily adopted if introduced in early childhood. A large cross-sectional coronary risk factor follow-up study, the Cardiovascular Risk in Young Finns (CRYF) has continued in Finland since 1980. In that study, an extensive number of atherosclerosis risk factors have been studied repeatedly in an initial cohort of 3596 individuals from age 3 years onwards. CRYF is a follow-up study without intervention, and a need for an interventional approach to control the coronary risk factors in childhood was evident. Finland is an ideal location to perform an atherosclerosis risk factor intervention study, since serum cholesterol values of Finnish boys have been high in international comparisons and, at the same time, coronary artery disease incidence in Finnish adults has also been very high. Moreover, the participation rate has by tradition been high in Finnish epidemiological trials. Due to these reasons, grant-funded Special Turku Coronary Risk Factor Intervention Project (STRIP) study was launched in 1989 to study whether it is possible to reduce exposure to coronary risk factors effectively and safely from early age on.