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Background: Diet in the first 2 y of life may be a pivotal period regarding effects on future blood pressure (BP). However, data on early-life diet and BP in childhood are sparse., Objective: We prospectively assessed associations between types of diet spanning infancy and toddlerhood (ie, transition diets across the complementary feeding period) and BP at age 7.5 y., Design: In a birth cohort study (Avon Longitudinal Study of Parents and Children; United Kingdom), a total of 1229 children had complete dietary intake data at 6, 15, and 24 mo; BP data at 7.5 y of age; and all 18 covariables., Results: Of the 2 transition diets that were extracted by using principal components analysis, the less-healthy diet was associated with an increase in systolic BP of 0.62 mm Hg (95% CI: 0.00, 1.24 mm Hg) and an increase in diastolic BP of 0.55 mm Hg (95% CI: 0.10, 1.00 mm Hg) for every one-unit (SD) increase in the less-healthy-diet score after adjustment for 15 potential confounders, including maternal characteristics and sociodemographic factors, birth variables, and breastfeeding duration. In contrast with systolic BP, the positive association between the less-healthy transition-diet score and diastolic BP persisted after additional adjustment for child body-size factors [height, body mass index (BMI), and waist circumference] at 7.5 y., Conclusions: A less-healthy transition diet by age 2 y was associated with higher BP at 7.5 y. The BMI-related reduction in effect size reinforces the importance of BMI on the diet-BP relation.

Background and Aims: Vitamin A affects inflammation and immune function and is thus a factor of interest in relation to cardiovascular disease (CVD). As vitamin A circulates in the plasma in the form of retinol, this study aims to describe the relationship between plasma retinol and the 5-year incidence of CVD mortality., Methods and Results: Community-dwelling adults (n = 441, 45% with type 2 diabetes) were recruited in Melbourne, assessed at baseline and followed for 5 years. At baseline, CVD risk factors were assessed by clinical evaluation, by personal lifestyle questionnaire and from biochemistry (plasma fasting glucose, lipids, total homocysteine, C-reactive protein, retinol and carotenoids plus the urinary albumin excretion rate over 24 h.). Dietary intake was assessed by a validated food frequency questionnaire. CVD mortality over 5-years was determined by consulting state or national registries. The majority of participants had adequate plasma retinol concentrations (≥30 μg/dL). The final Cox regression model indicated that those in the highest tertile of plasma retinol (mean ± SD) 76 ± 14 μg/dL) had a significantly lower risk of 5-year CVD mortality (hazard ratio 0.27 [95% confidence interval 0.11, 0.68], P = 0.005), an effect that was not readily explained in terms of traditional CVD risk factors or dietary intake., Conclusion: In well-nourished older Australian adults, plasma retinol was inversely associated with CVD mortality via mechanisms apparently unrelated to established CVD risk factors and dietary intake., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: The portrayal of diet over time is a natural progression from the characterization of diet at single time points. The transition dietary period, a dynamic period of rapid dietary change spanning infancy and toddlerhood when children shift from a milk-based to a food-based diet, has not been characterized., Objective: The objective was to summarize variation in dietary intakes spanning infancy and toddlerhood., Design: A prospective principal components analysis was applied to dietary intakes from 3 successive follow-ups of children enrolled in the ALSPAC (Avon Longitudinal Study of Parents and Children). The frequency of food and beverage consumption was assessed via questionnaire at ages 6, 15, and 24 mo (n = 2169)., Results: Two types of transition diet were identified. The first transition diet was characterized by the consumption of home-prepared and raw foods ("healthy") at all time points and the second by ready-prepared and discretionary foods ("less healthy") consistently over time. Higher educational level and maternal age were associated with higher scores on the "healthy" diet, whereas younger maternal age and a lower educational level were associated with higher scores on the "less healthy" diet. Maternal BMI, number of older siblings, and lower social class were associated with the less-healthy transition diet but not with the healthy transition diet., Conclusions: Unique transition diets, including a less-healthy type, emerge by age 2 y. These diets are consistent with childhood and adult dietary patterns reported at single time points and show convergent validity both with known maternal sociodemographic predictors of childhood diet and with intake gradients across diet scores.

The complementary feeding period is an important stage of child development. The study aim was to develop an index reflecting the degree of adherence to complementary feeding guidelines, evaluate its convergent validity, and explore associations with socio-demographic factors and dietary pattern scores in childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children (n = 6065) using parent-completed dietary questionnaires at 6 mo of age, socio-demographic information, and dietary patterns derived by principal component analysis at age 3 y. The Complementary Feeding Utility Index (CFUI) consists of 14 components: breastfeeding duration, feeding to appetite, timing of introduction to solids, exposure to iron-rich cereals, fruit and vegetable intake, exposure to high-fat/-salt/-sugar foods including sugary drinks, food texture, and meal/snack frequency. Regression analyses were undertaken to investigate associations between index scores, socio-demographic factors, food and nutrient intakes, and dietary pattern scores at age 3 y. Milk and food intake at 6 mo and nutrient intake at 8 mo of age varied across quintiles of index score in largely the expected directions. Associations were found among index score, maternal age, education, social class, maternal smoking history, and prepregnancy BMI. After adjustment for socio-demographic factors, the index score was associated with "processed" [β = -0.234 (95% CI = -0.260, -0.209)] and "healthy" [β = 0.185 (95% CI = 0.155, 0.215)] dietary pattern scores at age 3 y. The CFUI is able to discriminate across food intake, nutrient intake, and socio-demographic factors and is associated with later dietary patterns.

Background and Aims: To investigate the impact of a diet modeled on the traditional Cretan Mediterranean diet on metabolic control and vascular risk in type 2 diabetes., Methods and Results: Twenty-seven subjects (47-77 yrs) with type 2 diabetes were randomly assigned to consume either the intervention diet ad libitum or their usual diet for 12 weeks and then cross over to the alternate diet. Most of the meals and staple foods for the intervention diet were provided. Lipids, glycemic variables, blood pressure, homocysteine, C-reactive protein, plasma carotenoids and body composition (anthropometry and dual energy X-ray absorptiometry) were assessed at baseline, and at the end of both diet periods. Dietary adherence was monitored using plasma carotenoid and fatty acid (FA) analysis, complemented by diet diaries. Compared with usual diet, on the ad libitum Mediterranean intervention diet glycosylated haemoglobin fell from 7.1% (95% CI: 6.5-7.7) to 6.8% (95% CI: 6.3-7.3) (p=0.012) and diet quality improved significantly [plant:animal (g/day) food ratio increased from 1.3 (95% CI: 1.1-1.5) to 5.4 (95% CI: 4.3-6.6) (p<0.001)], plasma lycopene and lutein/zeaxanthin increased (36% and 25%, respectively), plasma saturated and trans FAs decreased, and monounsaturated FAs increased., Conclusion: A traditional moderate-fat Mediterranean diet improves glycemic control and diet quality in men and women with well-controlled type 2 diabetes, without adverse effects on weight., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objective: To determine which metabolic and cardiovascular risk factors are associated with the change in ankle brachial pressure index and incident peripheral arterial disease over 9 years, and whether these associations differ between healthy weight and overweight & obese individuals., Methods: Metabolic factors, change in ankle brachial pressure index and incidence of peripheral arterial disease (ankle brachial pressure index <0.90) over 9-years were determined in 2139 healthy weight and 1453 overweight & obese participants from the D.E.S.I.R. study., Results: Fasting glucose, insulin, HDL-cholesterol, systolic blood pressure and pulse pressure were all directly associated with the incidence of peripheral arterial disease, however BMI and the metabolic syndrome were not. There was some evidence that the associations of fasting insulin (P(heterogeneity)=0.06), insulin resistance (P(heterogeneity)=0.08) and β-cell function (P(heterogeneity)=0.004) with change in ankle brachial pressure index, differed between healthy weight and overweight & obese subjects. Principal components analysis identified a classical metabolic syndrome cluster, and an alternative clustering of metabolic factors that was characterised by high pulse pressure, high HDL-cholesterol and low triglycerides. This alternative cluster of cardiovascular and metabolic risk factors was associated with reductions in ankle brachial pressure index and an increased incidence of peripheral arterial disease (both P<0.0001)., Conclusions: Overweight & obesity do not increase the risk of developing peripheral arterial disease. We identified an alternative cluster of metabolic factors that is strongly associated with reductions in ankle brachial pressure index and an increased incidence of peripheral arterial disease., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Despite increased cardiovascular disease risk factors, migrants to Australia from Mediterranean countries have lower mortality than do native-born Australians. Dietary patterns may contribute to this., Objective: The objective was to investigate the relation between dietary patterns and mortality from cardiovascular (CVD) and ischemic heart disease (IHD) in an ethnically diverse population., Design: This was a prospective cohort study (mean follow-up: 10.4 y) of 40 653 volunteers (23 980 women) aged 40-69 y in the Melbourne Collaborative Cohort Study (1990-1994); 24% of the subjects were Mediterranean born., Results: Four dietary factors were identified from a food-frequency questionnaire with the use of principal components analysis. They explained 69% of intake variance and reflected frequent intakes of Mediterranean foods, vegetables, meat, and fresh fruit. The Mediterranean factor was inversely associated with CVD and IHD mortality in models adjusting for diabetes, waist-to-hip ratio, body mass index, and hypertension. For IHD, the hazard ratio (HR) for the highest compared with the lowest quartile of consumption was 0.59 (95% CI: 0.39, 0.89; P for trend = 0.03). Associations persisted in analyses excluding people with prior CVD (HR: 0.51; 95% CI: 0.30, 0.88; P for trend = 0.03). Vegetable and fresh fruit factors were inversely associated with CVD mortality but only among those without prior CVD. HRs (highest compared with lowest quartile) were 0.66 (95% CI: 0.48, 0.92; P for trend = 0.02) for vegetables and 0.69 (95% CI: 0.52, 0.93; P for trend = 0.04) for fresh fruit. The meat factor was not associated with CVD or IHD mortality., Conclusion: Our findings suggest that frequent consumption of traditional Mediterranean foods is associated with reduced cardiovascular mortality after controlling for important risk factors and country of birth.