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    Food Choices in Youth May Determine CV Health Come Midlife

    The best way to prevent cardiovascular disease (CVD) risk factors in adulthood is to start during youth with a foothold in good dietary habits. This may seem intuitive, but published clinical evidence on this topic is sparse. The mantle was taken up by researchers from the Nurses’ Health Study (NHS) II.1 They investigated whether following a healthy diet, as assessed by the Alternative Healthy Eating Index (AHEI), in adolescence prevents CVD and development of its clinical risk factors (ie, hypercholesterolemia, hypertension, and diabetes) in adulthood.

    Eight years after the NHS II  launch in 1989, its participants were invited to complete a 124-item food frequency questionnaire (FFQ) designed to capture foods commonly consumed between 1960 and 1982, when the study participants were in high school (HS). Of the total NHS II population (n=116,430), 47,355 female nurses actively participated in the HS-FFQ, and, of these, 42,112 were eligible and available for analysis of CVD risk (no history of CVD in or before 1998) and a subpopulation of 27,406 within this cohort were available for analysis of clinical risk factors (no history of CVD clinical risk factors in or before to 1998). Participants were followed to June 2011.

    Using the AHEI, data from the HS-FFQ were correlated with data gleaned from the FFQs that NHS II participants regularly complete every 4 years. Thus, the impact of early dietary habits on mid-life CVD risk was examined by comparing HS-AHEI and adult-AHEI scores. The AHEI, which measures CVD risk based on diet, has correlated high intake of fruits and vegetables, fish, whole grains, and nuts and low intake of red and processed meats, sodium, and trans fats with lower risk of type 2 diabetes and CVD.2 The adult-AHEI was based on the AHEI 2010 but measures regarding alcohol consumption were excluded to parallel the HS-AHEI, which omitted this parameter. The HS-AHEI included 10 types of edibles: fruits, vegetables, whole grains, sugar-sweetened beverages and juices, nuts and legumes, red/processed meat, trans fats, dark meat fish, PUFAs, and high-sodium foods. Consumption for each was rated on a 10-point scale in which 0 equaled the poorest dietary behavior about the edible and 10 the best. The total score ranged from 0 (complete nonadherence to dietary-based CVD risk prevention behaviors) to 100 (complete adherence).

    At the end of the 13-year study, 1 or more CVD risk factors had been diagnosed in 11,542 women, and 423 CVD events had occurred. After adjusting for potential confounders, it was determined that the higher the HS-AHEI score, the lower the number of CVD risk factors, with a hazard ratio (HR) of 0.82 (95% confidence interval [CI], 0.77–0.87; P trend <.001). Women with the highest HS-AHEI scores (median score, 55.6; range, 49.7-97.9) had a 16% lower risk of hypercholesterolemia and a 20% lower risk of hypertension compared with women with the lowest HS-AHEI scores (median score, 29.9; range, 11.3-33.8). Notably, higher HS-AHEI scores were inversely associated with presence 1 or more clinical risk factors in women with low, medium, and high adult-AHEI scores (HR 0.79 [95% CI, 0.74–0.85]).

    The inverse correlation between HS-AHEI score and diabetes, however, did not reach statistical significance, and statistical significance was not achieved in relation to incidence of CVD. The researchers conjectured that prevention of type 2 diabetes and subsequent CVD may hinge on early identification of and intervention for dyslipidemia, hypercholesterolemia, and hypertension, which often precede type 2 diabetes.

    They concluded that a healthy diet during adolescence appears to lower development of CVD risk factors, adding that additional research is needed to determine whether dietary improvements in children and adolescents can impact preclinical cardiovascular disease.

     

    References

    1. Dahm CC, Chomistek AK, Jakobsen MU, et al. Adolescent diet quality and cardiovascular disease risk factors and incident cardiovascular disease in middle-aged women. J Am Heart Assoc. 2016;5: e003583. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210420/

    2. Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012;142:1009-1018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738221/