Macronutrient intake of black and white adolescent girls over 10 years: the NHLBI Growth and Health Study

OBJECTIVE: To compare age-related changes in macronutrient and cholesterol intake between black and white girls, compare intakes with National Cholesterol Education Program (NCEP) recommendations, and examine sociodemographic associations with macronutrient intake. DESIGN: Cohort study with 3-day food records collected over 10 years. SUBJECTS: 2,379 girls, 1,166 white and 1,213 black, age 9 to 10 years at baseline, recruited from three geographic locations. Statistical Analysis Longitudinal generalized estimating equation (GEE) regression models examined the relationships of age, ethnicity, and sociodemographic factors with macronutrient and cholesterol intake and with percentage of girls meeting NCEP recommendations. RESULTS: Total and saturated fat intakes decreased with age, more in white girls than black girls, from 35.1% and 13.6% kcal at age 9 to 29.3% and 10.4% at age 19 for white girls and from 36.5% and 13.4% kcal at age 9 to 35.1% and 11.7% kcal at age 19 for black girls. Dietary cholesterol decreased with age, but decreased more in white girls than black girls (range 95 to 119 mg/1,000 kcal for white girls and 119 to 132 mg/1,000 kcal for black girls). Depending on age, 7% to 51% of white girls and 8% to 26% of black girls met NCEP recommendations for total fat (相似文献   

The NHLBI twin study of cardiovascular disease risk factors: methodology and summary of results

Coronary heart disease (CHD) risk factors were studied in 250 monozygotic (MZ) and 264 dizygotic (DZ) male veteran twin pairs, aged 42-56. All coronary heart disease risk factors studied showed significant correlations in both MZ and DZ twins. Substantial genetic variation was detected for height, blood pressure, glucose intolerance, uric acid, plasma triglyceride, and relative weight but little or no significant genetic variability in low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), total plasma cholesterol or hematocrit was demonstrable. These findings suggest that familial aggregation results from genetic influence on blood pressure, glucose intolerance, uric acid, triglyceride and, possibly, obesity, while largely shared environmental factors contribute to familial similarities in HDL, LDL, total cholesterol and hematocrit.     

Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study.

Associations between sleep-disordered breathing and cardiovascular disease (CVD) may be mediated by higher cardiovascular risk factor levels in those with sleep-disordered breathing. The authors examined these relations in the Sleep Heart Health Study, a multiethnic cohort of 6,440 men and women over age 40 years conducted from October 1995 to February 1998 and characterized by home polysomnography. In 4,991 participants who were free of self-reported CVD at the time of the sleep study, moderate levels of sleep-disordered breathing were common, with a median Respiratory Disturbance Index (RDI) of 4.0 (interquartile range, 1.25-10.7). The level of RDI was associated cross-sectionally with age, body mass index, waist-to-hip ratio, hypertension, diabetes, and lipid levels. These relations were more pronounced in those under age 65 years than in those over age 65. Women under age 65 years with RDI in the higher quartiles were more obese than men with similar RDI. Although the pattern of associations was consistent with greater obesity in those with higher RDI, higher body mass index did not explain all of these associations. If sleep-disordered breathing is shown in future follow-up to increase the risk for incident CVD events, part of the risk is likely to be due to the higher cardiovascular risk factors in those with higher RDI.     

Correlates of obesity in young black and white women: the CARDIA Study.

OBJECTIVES. Although differences in obesity between Blacks and Whites are well documented in adult women, less information is available on potential correlates of these differences, especially in young adults. METHODS. The association between behavioral and demographic factors and body size was assessed in 2801 Black and White women aged 18 to 30 years. RESULTS. Black women had significantly higher age-adjusted mean body mass index and subscapular skinfold thickness than did White women. Obesity had different associations with age and education across racial groups. A positive relationship between age and obesity was seen in Black women but not in White women, whereas a negative association between education and body size was noted only in White women. Potential contributing factors to the increased prevalence of obesity in Black women include a more sedentary lifestyle, higher energy intake, earlier menarche, and earlier age at first childbirth. CONCLUSIONS. The difference in obesity across race could not be explained completely by these factors, since within virtually all strata, Black women had higher body mass indexes. Further investigation is needed to develop interventional strategies to prevent or reduce excess levels of obesity in Black women.     

The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

OBJECTIVES. Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS. Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS. The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS. The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.     

Regional obesity and risk of cardiovascular disease; the Framingham Study

Risk of cardiovascular events was determined over 24 years of surveillance in relation to general adiposity reflected by relative weight and by regional obesity estimated by skinfolds and waist girth per inch of height. Upper quintile values of relative weight, subscapular skinfolds and waist girth were each associated with increased risks of cardiovascular disease in both sexes. Risk of total cardiovascular events increased with the degree of regional, central or abdominal obesity. Mortality from cardiovascular disease was also increased. Increased relative weight and central obesity were both associated with increased risk factors including cholesterol, blood pressure, glucose and uric acid. Changes in weight were mirrored by changes in risk factors with linear trends over a 15 lb range of weight fluctuations. Subscapular skinfold and the ratio of subscapular-to-triceps skinfold, measures of central obesity, were in either sex also associated with an increased probability of coronary attacks in particular. The subscapular skinfold contributed to CHD risk independent of body mass index (BMI). Multivariate analyses taking all the risk factors into account indicate an independent effect of abdominal obesity on stroke, cardiac failure and cardiovascular and all-cause mortality in men. In women, only the subscapular-to-triceps skinfold ratio independently contributes to CHD, cardiovascular and all cause mortality. Regional obesity appears to be an independent contributor to cardiovascular disease at a given level of general adiposity, its effect only partially mediated through promotion of other known risk factors. These data suggest that cardiovascular disease is as closely linked to abdominal as to general adiposity.     

Emotion-induced eating and sucrose intake in children: the NHLBI Growth and Health Study

OBJECTIVE: Emotion-induced eating has been implicated as a risk factor for the development of obesity, yet no research has been done on emotion-induced eating in children. The National Heart, Lung, and Blood Institute Growth and Health Study (NGHS), a multicenter collaborative study of risk factors for obesity, developed an instrument for measuring emotion-induced eating in children and tested hypotheses regarding the association of emotion-induced eating with food intake and adiposity in preadolescent children. METHOD: Subjects were 1,213 black girls and 1,166 white girls who were 9 and 10 at study entry. Baseline data were utilized in this report. Girls were assessed by trained female health examiners who recorded height, weight, and indices of sexual maturation. Girls kept a 3-day food diary. Dietary data were coded and analyzed for total caloric and macro nutrient intake. A measure of emotion-induced eating was derived from seven questions about eating in response to emotions (Cronbach's alpha = .78). RESULTS: Black girls had significantly higher emotion-induced eating scores than white girls (10.8 vs. 9.7, p < .0001). For white girls, but not for black girls, emotion-induced eating was associated with increased intake of sucrose. In both races, a modest inverse association was found between body mass index and emotion-induced eating. DISCUSSION: Prospective studies are needed to explore further the role of emotion-induced eating and food intake and the role of emotion-induced eating in the development of obesity.     

Familial aggregation of cardiovascular disease risk factors: the Cuenca Study

OBJECTIVE: The familial aggregation of lipid levels, blood pressure, and body mass index (BMI) was studied in schoolchildren in Cuenca, Spain. METHODS: A cross-sectional observation study was made of 307 schoolchildren of both sexes, age range 9-12 years, from three schools in Cuenca, Spain, and of 346 parents. Social and demographic variables, weight, height, body mass index, systolic blood pressure, diastolic blood pressure, and fasting plasma concentrations of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were evaluated. RESULTS: The Spearman coefficients of correlation for total cholesterol, LDL-cholesterol, and BMI for parents and daughters were 0.34-0.42 (P < 0.01). These coefficients of correlation for parents and sons were lower (P > 0.05). The coefficient of correlation for blood pressure in parents and sons was low (P < 0.05). None of the variables showed any coefficient of correlation between spouses. The sexual differences in the correlations between the levels of the different variables were confirmed by multiple regression analysis. Total cholesterol and LDL-cholesterol levels and BMI accounted for larger percentages of variability in these parameters in daughters than in sons. The paternofilial aggregation of HDL-cholesterol and triglyceride levels was weak. The only variable that accounted for a significant variability in blood pressure (systolic and diastolic) was weight in children of both sexes. CONCLUSIONS: The familial aggregation of lipid levels and body mass index showed sex differences. The paternofilial aggregation of blood pressure was weak. There was no relation between spouses.     

Relation of obesity to clustering of cardiovascular disease risk factors in children and young adults. The Bogalusa Heart Study

The relation of obesity to clustering of systolic blood pressure, fasting insulin, and ratio of low and very low density lipoprotein cholesterol to high density lipoprotein cholesterol [LDL-C + VLDL-C)/HDL-C) was investigated in 3,503 subjects aged 5-24 years in Bogalusa, Louisiana, from September 1981 to September 1983. Risk ratios (RR) were calculated as the number of subjects with risk factor variables in the upper tertile divided by the expected number. The variables showed strong clustering (RR = 3.1); however, after adjusting for obesity, clustering of systolic pressure, (LDL-C + VLDL-C)/HDL-C, and insulin was reduced (RR = 1.3). Lean subjects (lower tertile of obesity) showed less clustering than expected (RR = 0.4), while more obese subjects (upper tertile of obesity) had greater clustering than expected (RR = 3.1). Furthermore, trunk fat deposition (subscapular skinfold) had a greater impact on clustering at high levels than limb fat deposition (triceps skinfold). Since obesity is related to clustering of risk factor variables in children and young adults, the prevention of the onset of obesity in early life may be important to reducing the risk of coronary heart disease in later life.     

Nongenetic influences of obesity on other cardiovascular disease risk factors: an analysis of identical twins.

The importance of genetic influences on obesity has been emphasized recently. We conducted matched co-twin analyses of 250 pairs of White, male, monozygotic twins from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Entirely in the absence of genetic influences, obesity was significantly associated with systolic and diastolic blood pressures; one-hour, post-load glucose; total, LDL-, and HDL-cholesterol; and triglycerides among these 42-55 year old men. Similar results were obtained in longitudinal analyses of weight change during adulthood (from mean age of 20 to mean age of 48 years) and risk factor status at middle-age. These results indicate that behaviors and environmental exposures that occur later in life are responsible, at least in part, for the associations between adult obesity and cardiovascular disease risk, supporting the appropriateness of weight reduction efforts during adulthood.     

Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention

BACKGROUND: Data concerning the long-term improvement of cardiovascular disease (CVD) risk factors after an obesity intervention in children are limited. OBJECTIVE: We studied changes in weight status and CVD risk factors in children in an intervention program and evaluated whether these changes were sustained 1 y after the end of the intervention. DESIGN: We analyzed changes in the SD score (SDS) of body mass index [BMI; in kg/m2 (SDS-BMI)], blood pressure (BP), lipids, and homeostasis model assessment index of insulin resistance (HOMA-IR) over the course of 2 y in 240 obese (BMI > 97th percentile) children aged 6-14 y (x age: 10.4 y; x BMI: 26.9). Of these 240 children, 203 participated in a 1-y intervention program of physical exercise, nutrition education, and behavior therapy. We compared these children with 37 obese children who underwent no intervention and with 12 normal-weight children of the same age and sex. RESULTS: Obese children had significantly (P < 0.05) higher BP, HOMA-IR, and insulin, triacylglycerol, and LDL-cholesterol concentrations and lower HDL-cholesterol concentrations than did normal-weight children. Twenty-nine children dropped out of the intervention. Only in the 126 children who reduced their SDS-BMI did BP (8% and 12% decreases in systolic and diastolic BP, respectively), lipids (12% and 5% decreases in triacylglycerol and LDL cholesterol, respectively; 7% increase in HDL cholesterol), insulin (13% decrease), and HOMA-IR (17% decrease) improve significantly (P < 0.05). Reduction in SDS-BMI and all benefits regarding CVD risk factors were sustained 1 y after the end of the intervention in the children whose SDS-BMI decreased. CONCLUSIONS: Long-term multidisciplinary intervention led to a reduction in SDS-BMI in most of the obese children 1 y after the end of the intervention. Reduction in SDS-BMI was accompanied by an improvement in CVD risk factors.     

Association of glycemic load with cardiovascular disease risk factors: The Women's Health Initiative Observational Study

ObjectiveAssociations between dietary glycemic load (GL) and cardiovascular disease risk factors, including plasma lipoprotein/lipid levels, blood pressure, and glucose metabolism factors, in the Women's Health Initiative Observational Study were examined.MethodsA random sample of 878 Observational Study participants (postmenopausal women 50–79 y of age) with baseline blood measurements (647 white, 104 black, 127 Hispanic) was included. Dietary GL was estimated from baseline food-frequency questionnaires, which assessed dietary intake over the previous 3 mo. At the baseline visit, participants completed demographic and health habit questionnaires, fasting blood samples were collected, anthropometric measurements were completed, and blood pressure was assessed.ResultsIn all participants combined, GL was inversely associated with high-density lipoprotein cholesterol (P for trend = 0.004) and positively associated with log₁₀-transformed triacylglycerols (P = 0.008). Although there were no statistically significant interactions of race/ethnicity with associations between GL and cardiovascular disease risk factors, stratified results were suggestive, showing that GL was positively associated with total cholesterol (P = 0.018) and low-density lipoprotein cholesterol (P = 0.038) in Hispanics. In white subjects, there was a trend of reduced high-density lipoprotein cholesterol with higher GL (P = 0.003), whereas GL was positively associated with log₁₀-transformed triacylglycerols (P = 0.015). Associations between GL and high-density lipoprotein cholesterol and between GL and triacylglycerols also differed by body mass index, although the interactions were not statistically significant.ConclusionAmong these generally healthy postmenopausal women, GL was associated with high-density lipoprotein cholesterol and triacylglycerols. Suggestive effects of race/ethnicity and body mass index on these associations need to be confirmed in larger studies.     

Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study

BACKGROUND: Prospective data relating fruit and vegetable intake to cardiovascular disease (CVD) risk are sparse, particularly for women. OBJECTIVE: In a large, prospective cohort of women, we examined the hypothesis that higher fruit and vegetable intake reduces CVD risk. DESIGN: In 1993 we assessed fruit and vegetable intake among 39876 female health professionals with no previous history of CVD or cancer by use of a detailed food-frequency questionnaire. We subsequently followed these women for an average of 5 y for incidence of nonfatal myocardial infarction (MI), stroke, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, or death due to CVD. RESULTS: During 195647 person-years of follow-up, we documented 418 incident cases of CVD including 126 MIs. After adjustment for age, randomized treatment status, and smoking, we observed a significant inverse association between fruit and vegetable intake and CVD risk. For increasing quintiles of total fruit and vegetable intake (median servings/d: 2. 6, 4.1, 5.5, 7.1, and 10.2), the corresponding relative risks (RRs) were 1.0 (reference), 0.78, 0.72, 0.68, and 0.68 (95% CI comparing the 2 extreme quintiles: 0.51, 0.92; P: for trend = 0.01). An inverse, though not statistically significant, trend remained after additional adjustment for other known CVD risk factors, with RRs of 1.0, 0.75, 0.83, 0.80, and 0.85 (95% CI for extreme quintiles: 0.61, 1.17). After excluding participants with a self-reported history of diabetes, hypertension, or high cholesterol at baseline, the multivariate-adjusted RR was 0.45 when extreme quintiles were compared (95% CI: 0.22, 0.91; P: for trend = 0.09). Higher fruit and vegetable intake was also associated with a lower risk of MI, with an adjusted RR of 0.62 for extreme quintiles (95% CI: 0.37, 1.04; P: for trend = 0.07). CONCLUSION: These data suggest that higher intake of fruit and vegetables may be protective against CVD and support current dietary guidelines to increase fruit and vegetable intake.     

Neuropeptide Y polymorphism significantly magnifies diabetes and cardiovascular disease risk in obesity: the Hoorn Study

The leucine7 to proline7 (Leu7Pro) polymorphism in preproneuropeptide Y (preproNPY) has been associated with accelerated atherosclerosis and type II diabetes, both of which are obesity-related diseases. The current study evaluated the impact of obesity on the disease risk linked to the Leu7Pro polymorphism of preproNPY in 393 elderly subjects. In 6 years follow-up, the polymorphism alone did not change the risk for abnormal glucose regulation, while obesity was associated with a significant 3-fold risk (odds ratio (OR) 2.95; 95% confidence interval (CI) 1.81-4.81, P<0.001) and the Leu7Pro polymorphism-obesity interaction, with a remarkable 12-fold risk (OR 12.33; 95% CI 1.18-128.35, P<0.05). The Leu7Pro polymorphism modified significantly the 10-year incidence of cardiovascular events, causing a 7.6-fold increase in the hazard ratio (HR 7.58; 95% CI 2.87-20.03, P<0.001) in the obese but not in the nonobese subjects. The results indicate that obesity may be a pivotal factor in multiplying the disease risk associated with the Leu7Pro polymorphism in preproNPY.     

Centralized obesity and cardiovascular disease risk in Mexican Americans

The association between body fat distribution patterns and cardiovascular disease risk variables (high density lipoprotein (HDL) cholesterol, total cholesterol, diastolic and systolic blood pressures, and fasting blood glucose levels) was sought in a sample of Mexican American adults who were studied during 1981-1983 in Starr County, Texas. In the sample, all diabetics were excluded to see whether centralized obesity carried any risk for cardiovascular disease independent of diabetes. A component of centralized body fat distribution was identified through the use of principal components analysis of five skinfold measurements, which included the upper and lower extremities and trunk areas. The centralized obese were compared with generalized (peripheral) obese and nonobese controls in four subgroups of the population: younger and older adult males and females. The means of all cardiovascular risk variables were in a direction indicating that the centralized obese were significantly at greater risk than nonobese controls (in particular, HDL cholesterol, total cholesterol, and blood glucose levels). The generalized obese differed from the centralized obese in having significantly lower blood glucose levels, and tended to be intermediate between centralized obese and nonobese controls in the other variables. The data confirm that centralized obesity as defined by a linear combination of skinfold measures works in the same way as the waist-to-hip circumference ratio in describing a body build factor which heightens the risk of cardiovascular disease in the obese independent of the clinical diabetic state.     

Correlates of high-density lipoprotein cholesterol in Black girls and White girls: the NHLBI Growth and Health Study.

To determine the correlates of serum high-density lipoprotein cholesterol (HDL-C) in 9- and 10-year-old girls, data were examined from 624 Black girls and 773 White girls. Black girls had, on average, 3.6 mg/dL higher levels than White girls. Each 10-mm increase in sum of skinfolds was associated with a decrease of 1.4 mg/dL; each unit increase in the tricep/suprailiac skinfold ratio was associated with an increase of 2 mg/dL; and each 10% increase in polyunsaturated fat intake was associated with an increase of 3.4 mg/dL. The associations of sedentary activity and sexual maturation with HDL were mediated by differences in adiposity. Interventions to decrease adiposity may be important for the primary prevention of heart disease in women.     

Insulin-like growth factor-1, insulin-like growth factor binding protein-3, and cardiovascular disease risk factors in young black men and white men: the CARDIA Male Hormone Study

Cross-sectional studies have found associations between components of the insulin-like growth factor (IGF) system and hypertension, total cholesterol, and low density lipoprotein cholesterol. Using partial correlation analysis and longitudinal analysis of data collected at the year 2, year 7, and year 10 examinations, the authors assessed the associations of IGF-1 and IGF binding protein-3 (IGFBP-3) with cardiovascular disease risk factors in 544 Black and 747 White male participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Male Hormone Study who were aged 20-34 years at year 2 (1987-1988). There were no consistent independent associations with blood pressure. Cross-sectionally, there were some inverse associations between IGF-1 and lipid levels in White men (strongest r = -0.095 (p = 0.02) for total cholesterol at year 7) and positive associations between IGFBP-3 and lipid levels in Black and White men (for log(triglycerides), r = 0.072-0.136). Longitudinally, a 1,000-ng/ml increase in IGFBP-3 was associated with 3.7-mg/dl and 2.6-mg/dl higher total cholesterol levels and 2.6-mg/dl and 1.7-mg/dl higher low density lipoprotein cholesterol levels in Black men and White men (p < 0.05), respectively. These findings do not support a strong link between IGF-1 and IGFBP-3 and blood pressure, but they do support the possibility of important relations between IGFBP-3 and lipid levels in young adult men.