Maiju Saarinen

Arterial Intima-Media Thickness, Endothelial Function, and Apolipoproteins in Adolescents Frequently Exposed to Tobacco Smoke

Background—Exposure to tobacco smoke is associated with markers of preclinical atherosclerosis in adults, but its effect on arterial structure in adolescents is unknown. Methods and Results—Healthy 13-year-old adolescents from the atherosclerosis prevention trial STRIP were studied. Maximum carotid and aortic intima-media thickness and brachial artery flow-mediated dilation were measured in 494 adolescents using high-resolution ultrasound. Serum lipid, lipoprotein, and apolipoprotein (Apo) A-I and B concentrations were determined using standard methods. Exposure to tobacco smoke was measured annually between ages 8 and 13 years using serum cotinine concentrations, analyzed with gas chromatography. To define longitudinal exposure, cotinine values of children having serum cotinine measured 2 to 6 times during follow-up were averaged and divided into tertiles (exposure groups): low (n=160), intermediate (n=171), and high (n=163). Adolescents with higher longitudinal exposure to tobacco smoke had increased carotid intima-media thickness (exposure groups [mean±SD]: low, 0.502±0.079 mm; intermediate, 0.525±0.070 mm; high, 0.535±0.066 mm; P<0.001) and increased aortic intima-media thickness (exposure groups: low, 0.527±0.113 mm; intermediate, 0.563±0.139 mm; high, 0.567±0.126 mm; P=0.008). The flow-mediated dilation decreased when cotinine level increased (exposure groups: low, 10.43±4.34%; intermediate, 9.78±4.38%; high, 8.82±4.14%; P=0.004). Moreover, ApoB (P=0.014) and ApoB/ApoA-I ratio (P=0.045) increased with increase in cotinine level. The associations between tobacco smoke exposure and ultrasound variables were unchanged after adjusting for traditional atherosclerosis risk factors and for ApoB. Conclusions—Frequent exposure to tobacco smoke is independently associated with arterial changes of preclinical atherosclerosis and increased ApoB levels among healthy adolescents. Clinical Trial Registration—clinicaltrials.gov. Identifier: NCT00223600.

Growth patterns and obesity development in overweight or normal-weight 13-year-old adolescents: the STRIP study.

OBJECTIVE. 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. PARTICIPANTS AND METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

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

OBJECTIVE. The goal was to assess the relationship between passive smoking and arterial elasticity in children. METHODS. 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, Youngs 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 ≥1.7 ng/mL). RESULTS. Higher cotinine concentrations were associated with increased aortic stiffness index values. An increase in aortic Youngs 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. CONCLUSIONS. Childhood exposure to tobacco smoke (verified with serum cotinine levels) decreases aortic elastic properties in healthy children.

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

BACKGROUND Dietary fiber has health benefits, but fiber recommendations for children are controversial because fiber may displace energy. OBJECTIVE 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. DESIGN 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. RESULTS 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. CONCLUSION 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.

Childhood-onset epilepsy five decades later. A prospective population-based cohort study

To study the impact of childhood‐onset epilepsy on a variety of outcomes across the life span.

Metabolic Syndrome from Adolescence to Early Adulthood: Effect of Infancy-Onset Dietary Counseling of Low-Saturated-Fat: The Special Turku Coronary Risk Factor Intervention Project (STRIP)

Background— Adolescent metabolic syndrome (MetS) predicts type 2 diabetes mellitus and subclinical atherosclerosis in adulthood. Our aim was to establish the relationship between an infancy-onset dietary intervention and risk of having MetS between 15 and 20 years of age. Methods and Results— The Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study is a longitudinal, randomized atherosclerosis prevention trial in which repeated dietary counseling aiming at reducing intake of saturated fat took place from infancy to early adulthood. Participants who had complete data on the MetS components (waist circumference, blood pressure, triglycerides, glucose, high-density lipoprotein cholesterol) at 15 (n=512), 16 (n=485), 17 (n=475), 18 (n=459), 19 (n=439), and 20 (n=407) years of age were included in the study. Modified International Diabetes Foundation criteria with 80th/20th percentile cutoff points for the components were primarily applied in statistical analyses, and the results were replicated with the use of other pediatric MetS definitions. Between the ages of 15 and 20 years, the prevalence of MetS varied between 6.0% and 7.5% in participants in the intervention group and between 10% and 14% in the control group. The long-term relative risk of MetS was significantly lower in the intervention group (relative risk, 0.59; 95% confidence interval, 0.40–0.88; P=0.009). Of the individual MetS components, the intervention decreased risk of high blood pressure in both sexes (relative risk, 0.83; 95% confidence interval, 0.70–0.99) and high triglycerides in male subjects (relative risk, 0.71; 95% confidence interval, 0.52–0.98). A statistically nonsignificant reduction was seen in the risk of high waist circumference in the intervention individuals (relative risk, 0.78; 95% confidence interval, 0.59–1.03). Conclusion— Repeated infancy-onset dietary intervention is effective in the prevention of MetS in adolescence. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00223600.

Arterial Intima-Media Thickness in 13-Year-Old Adolescents and Previous Antichlamydial Antimicrobial Use: A Retrospective Follow-up Study

BACKGROUND. Children with persistent Chlamydia pneumoniae infection may be at increased risk for atherosclerosis. The impact of antimicrobial therapy for primary prevention of atherosclerotic cardiovascular disease is unsolved. OBJECTIVE. The purpose of this study was to determine whether treatment with antimicrobial agents effective against C pneumoniae during childhood, regardless of indication, has a favorable influence on the arterial wall-thickness in children by the time they reach adolescence. SUBJECTS AND METHODS. The association of macrolide, tetracycline, quinolone, and rifamycin use (number of exposure events) between ages 5 and 13 years with carotid and aortic intima-media thickness at age 13 years was investigated among 508 healthy children. Information about the use of medications was obtained from the Finnish prescription register. Arterial intima-media thickness was measured with a high-resolution ultrasound. RESULTS. Mean aortic intima-media thickness showed a significant direct association with the number of antichlamydial antimicrobial exposure events also after controlling for established atherosclerotic risk factors. Elevated C-reactive protein level had an additional effect on aortic intima-media thickness in a multivariable model. Carotid intima-media thickness was not associated with the number of preceding antichlamydial treatments. CONCLUSIONS. Recurrent antichlamydial treatments in childhood have no favorable influence on early vascular changes but are associated with increased intima-media thickness in the abdominal aorta. These findings suggest that the use of antimicrobial agents does not offer protection against the potential atherogenicity of repeated infectious insults.

Long-term risks following first remission in childhood-onset epilepsy. A population-based study

Although most patients with newly-treated epilepsy enter remission, the risks associated with first remission are not well-known. It is thus of great clinical interest to assess the long-term risks of poor seizure outcome and premature retirement for those in their very first remission and to determine predictive clinical features. We determined the likelihood of seizure relapse, remission following relapse, and premature retirement after entering first seizure remission of 5 years or more in a population-based cohort of 115 medically treated patients, who were followed up since their first seizure during childhood. At the end of the 42-year median follow-up from the onset of adequate medication before the age of 16 years, 115 (82%)/141 patients entered a first remission of at least 5 years. Although 69 (60%) of the 115 patients had no relapse, at least one seizure relapse was seen in 46 (40%) and 14 (12%) never re-entered five-year remission. Among the 115 patients, 33 (30%) were prematurely retired. On multivariate analysis of clinical features, cognitive impairment predicted seizure relapse for those entering their first remission of 5 years or more. Relapse, symptomatic etiology, and early onset of epilepsy were significant predictors of premature retirement. Despite entering their first remission of 5 years or more, individuals with epilepsy face clinically important risks including relapse, failure to re-enter remission following relapse, and premature retirement. Cognitive impairment predicted seizure relapse, while relapse, symptomatic etiology, and early onset of epilepsy were significant predictors of premature retirement.

Dietary and lifestyle counselling reduces the clustering of overweight-related cardiometabolic risk factors in adolescents.

Aim:  The aim of this study was to evaluate the impact of individualised dietary and lifestyle counselling, primarily aimed to decrease serum low‐density lipoprotein cholesterol, on the clustering of overweight‐related cardiometabolic risk factors in children.

Infantile colic associated with childhood migraine: A prospective cohort study:

Purpose To explore the association between infantile colic and adolescent migraine. Method In a randomized general population sample, families expecting their first child were prospectively followed for infantile colic and adolescent migraine. Results Colic was diagnosed in 160 (13%) of 1267 infants until the age of 3 months. Migraine was ascertained in 129 (16%) of 787 adolescents at age 18 years. History of infantile colic was identified in 96 (12%) of 787 adolescents and no such history in 658 (88%) of 787 adolescents. Migraine was present in 22 (23%)/96 adolescents who had a history of infantile colic, but in only 74 (11%)/658 ones who had no such history. Of the 22 adolescents, 14 (64%) had migraine without aura and eight (36%) had migraine with aura. Infants with colic had an almost three-fold risk (risk ratio 2.8, 95% confidence interval 1.2–6.5) for adolescent migraine without aura, but no increased risk for migraine with aura (0.8, 0.3–2.2). Discussion and conclusions Infantile colic seems to be associated with an increased risk for migraine without aura, but not for migraine with aura. Whether infantile colic per se is a type of infantile migraine or an antecedent of future migraine remains to be answered by further research.