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Current dietary guidance recommends limiting intakes of saturated fats, but most fails to consider that saturated fats from different food sources may have different health effects.We aimed to evaluate the associations of saturated fats from dairy and nondairy sources with measures of body fat, inflammatory biomarkers, lipid concentrations, and lipid particle sizes and concentrations.The Framingham Offspring Study is a prospective cohort study. Participants (n = 2391) ≥30 y of age who had dietary records and data on the outcomes of interest were included.Among females, those in the highest quintile (compared with the lowest) of dairy-derived saturated fat had lower multivariable-adjusted levels of body fat [BMI (in kg/m2): 26.2 compared with 27.8, P 0.01; and percentage fat mass: 36.7% compared with 38.0%, P = 0.09) and larger LDL particle sizes. Nondairy saturated fat in females was inversely associated with the triglyceride (TG):HDL ratio (P = 0.03). Among males, intakes of dairy-derived saturated fats were inversely associated with C-reactive protein (P 0.01), fibrinogen (P 0.01), TGs (P 0.01), and the TG:HDL ratio (P 0.01). HDL cholesterol was 2.8 mg/dL (P = 0.04) higher among males in the highest (compared with the lowest) quintile of saturated fat from dairy sources. Males with the highest intakes of dairy-derived saturated fats had larger HDL and LDL particle sizes (P 0.01 for both), a higher HDL particle concentration (P 0.01), and a lower VLDL particle concentration (P 0.01). There were no statistically significant adverse effects of saturated fats from nondairy sources on any of these outcomes in either males or females.Males with higher intakes of dairy-derived saturated fats had a less atherogenic profile than males with lower intakes of these fats. These effects were weaker in females. Nondairy saturated fats were not associated with these cardiometabolic outcomes.

Prevalence of site-specific obesity-related cancers according to exposure group.

Background: It is unknown whether the risk for obesity-related cancers differs between metabolically unhealthy and healthy overweight/obese adults.Methods: Data on body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and random blood glucose in Framingham Heart Study adults (n = 3,763) ages 55 to 69 years were used to estimate risks of obesity-related cancers (n = 385), including postmenopausal breast, female reproductive, colon, liver, gallbladder, pancreas, and kidney cancers, as well as esophageal adenocarcinomas. Multivariable-adjusted Cox proportional hazards models were used to estimate risk for obesity-related cancers associated with body fat and metabolic health (as defined by glucose levels) among subjects in three risk groups (vs. referent group with normal weight/normal glucose): normal weight/elevated glucose, overweight/normal glucose, and overweight/elevated glucose.Results: Overweight adults [BMI ≥ 25 or WHtR ≥ 0.51 (men) and ≥0.57 (women)] with elevated glucose (≥125 mg/dL) had a statistically significant 2-fold increased risk of developing obesity-related cancer, whereas overweight adults with normal glucose had a 50% increased risk. Normal-weight adults with elevated glucose had no excess cancer risk. The effects of BMI and WHtR were independent of one another. Finally, overweight women with elevated blood glucose had a 2.6-fold increased risk [95% confidence interval (CI), 1.4–4.9] of female reproductive (cervical, endometrial, uterine cancers) and postmenopausal breast cancers, whereas overweight women with normal glucose levels had only a 70% increased risk (95% CI, 1.1–2.5).Conclusion: These results suggest that cancer risk may be lower among metabolically healthy overweight/obese older adults than among overweight/obese adults with metabolic dysfunction.Impact: Metabolic dysfunction and obesity act synergistically to increase cancer risk. Cancer Epidemiol Biomarkers Prev; 23(10); 2057–65. ©2014 AACR.

Background: For decades, dietary guidelines have recommended restricting egg consumption out of concern about the high content of dietary cholesterol and potential effects on LDL cholesterol levels and, in turn, cardiovascular risk. However, the evidence supporting these recommendations has been increasingly questioned. Objective: To examine the association of egg consumption with plasma lipid levels and risk of dyslipidemia in adults in the Framingham Offspring Study, and to determine whether these effects are modified by other dietary factors. Methods: We included 1,852 adults aged 30-64 years with available 3-day food records, and without prevalent CVD or use of lipid-lowering or glucose-lowering medications. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of elevated fasting LDL-C and triglycerides after adjusting for confounding. Analysis of covariance models were used to estimate sex-specific mean plasma levels of total cholesterol, LDL, the ratio of LDL:HDL, and triglycerides associated with categories of egg intake. Confounding factors retained in the final models included age, BMI, and other dietary factors. Stratified analyses were used to evaluate effect modification by several dietary factors. Findings: Over approximately 6 years of follow-up, 372 adults developed new-onset elevated LDL and 306 adults developed new-onset elevated triglycerides levels. Overall, those with higher egg consumption (vs. lower) had very similar intakes of other healthy foods at baseline (e.g., whole grains, fruits, vegetables, dairy, and fish). Men and women consuming ≥5 eggs per week (vs. 5 eggs/week (vs. Conclusions: This study suggests that higher egg intakes had no adverse effects on serum lipids in healthy adults and may be beneficial as part of a healthy eating pattern.

The association between egg consumption and cardiometabolic risk factors such as high blood pressure (HBP) and impaired fasting glucose (IFG) or type 2 diabetes (T2D) is still under debate. This study examines the association between egg consumption and these outcomes among 2349 30–64 year-old adults in the prospective Framingham Offspring Study. Diet was assessed using three-day dietary records. Potential confounders retained in the final models included age, sex, body mass index, and other dietary factors. The analysis of covariance and Cox proportional hazard’s models were used to assess the relevant continuous (i.e., FG, SBP, DBP) and categorical (i.e., T2D, HBP) outcomes. Consuming ≥5 eggs per week was associated with lower mean FG (p = 0.0004) and SBP (p = 0.0284) after four years of follow-up. Higher egg intakes led to lower risks of developing IFG or T2D (HR: 0.72; 95% CI: 0.51–1.03) and high blood pressure (HBP) (HR: 0.68; 0.50–0.93). The beneficial effects of egg consumption were stronger in combination with other healthy dietary patterns. This study found that regular egg consumption as part of a healthy diet had long-term beneficial effects on blood pressure and glucose metabolism and lowered the long-term risks of high blood pressure and diabetes.

Protein intake has been shown to lower risk of aging-related functional decline. The goal of this study was to assess long-term effects of weight-adjusted animal (AP) and plant protein (PP) intakes on aging-related change in functional status and grip strength.Framingham Offspring Study participants (n = 1896, 891 men and 1005 women), ≥age 50, were followed for an average of 14.4 years. Protein intake derived from two sets of 3-day diet records (exams 3 and 5) was expressed as both weight-adjusted intake (from residuals) and per kilogram of body weight (g/kg/d). Seven tasks from two standardized assessments (Nagi and the Rosow-Breslau scales) were selected to determine functional status at exams 5-9. Functional impairment was defined as failure to complete (or having a lot of difficulty completing) a given task. Grip strength was assessed by dynamometer at exams 7-9.Participants with higher (vs. lower) weight-adjusted intakes of AP and PP maintained higher functional scores (p = 0.001 and p 0.001, respectively). After accounting for baseline skeletal muscle mass (SMM) and physical activity, only AP was linked with lower risks of functional impairment. Higher AP intake among sedentary individuals led to 29% (95% CI: 0.51-1.00) reduced risks of impairment; among subjects with lower SMM, higher AP was associated with 30% (95% CI: 0.49-0.98) reduced risks. Physical activity and SMM were independently associated with reduced risks of functional impairment, regardless of protein intake. Finally, higher AP intake led to 34% and 48% greater preservation of grip strength in men (p = 0.012) and women (p = 0.034). Results were similar for protein intake expressed as g/kg/d.Higher AP intake and higher levels of physical activity and SMM were independently associated with lower risks of functional impairment and greater preservation of grip strength in adults over the age of 50 years.

Background/objective Obesity has been associated with the risk of developing certain cancers. A limited number of studies have examined effects of various anthropometric measures of body composition on cancer risk. The aim of this study was to estimate the sex-specific effects of various anthropometric measures on risk of obesity-related cancers (ObCa). Subjects/methods Data on body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and hip circumference (HC) among 3818 45-69-year olds in the Framingham Offspring Study were included. Cox proportional hazards models were used to estimate adjusted risks of 16 obesity-related cancers, with the most common being postmenopausal breast, endometrial, and colon cancers. Results Obesity as measured by BMI in both men and women was a predictor of ObCa; those in the highest quintile (Q5) of BMI (>30.07 in women; >30.80 kg/m2 in men) had more than twice the risk of ObCa (HR = 2.07; 95% CI: 1.06-4.07 (women) and HR = 2.25; 95% CI: 1.08-4.69 (men)). Waist-related measures (WC, WHtR) were stronger predictors of ObCa in men than in women, and HC confounded the relations between waist size and cancer risk. After adjusting for HC, men in Q5 of WC had more than a threefold increased risk of ObCa (HR: = 3.22; 95% CI: 1.39-7.45). Comparable effects in women were weak and non-statistically significant. Results were similar for WHtR. Finally, an inverse J-shaped relation was found between HC and ObCa after adjusting for WC among men but not in women. Conclusions These results suggest that obesity as measured by BMI is a predictor of obesity-related cancer risk in men and women. They also suggest that waist and hip circumference measures are interrelated and confound the independent effects of each measure. Among men, a large waist size and a small hip size are independent predictors of cancer risk.

A Mediterranean-style diet is a healthy eating pattern that may benefit cancer risk, but evidence among Americans is scarce. We examined the prospective association between adherence to such a diet pattern and total cancer risk. A Mediterranean-style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire at exam 5 (1991–1995). Subjects included 2966 participants of the Framingham Offspring Study who were free of prevalent cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, lifestyle, and anthropometric measures. Cox-models were also used to examine effect modification by lifestyle and anthropometric measures. During 18 years of median follow-up, 259 women and 352 men were diagnosed with cancer. Women with moderate or higher adherence to the MSDP had ≥25% lower risks of cancer than women with the lowest MSDP (HR (moderate vs. lowest): 0.71, 95% CI: 0.52–0.97 and HR (highest vs. lowest): 0.74, 95% CI: 0.55–0.99). The association between MSDP score and cancer risk in men was weaker except in non-smokers. Beneficial effects of the MSDP in women were stronger among those who were not overweight. In this study, higher adherence to MSDP was associated with lower cancer risk, especially among women.

We examined the association between potato consumption in two different age periods during adolescence and risk of obesity and cardiometabolic dysfunction in White and Black girls. We used data from the biracial prospective National Growth and Health Study. Average potato consumption was derived from multiple 3-d food records in two age periods, 9–11 and 9–17 years, and included white and sweet potatoes from all sources. Multivariable logistic regression models were used to estimate OR for becoming overweight, developing prehypertension, elevated TAG levels or impaired fasting glucose (IFG) at 18–20 years of age according to the category of daily potato intake. We also stratified by cooking method (fried/non-fried) and race. ANCOVA was also used to estimate adjusted mean levels of BMI, systolic blood pressure, diastolic blood pressure, log-transformed TAG, the TAG:HDL ratio and fasting glucose levels associated with potato intake category. Higher potato consumption was associated with higher fruit and non-starchy vegetable intakes and higher Healthy Eating Index scores in Black girls. There were no statistically significant associations overall between moderate or higher (v. lower) intakes of potatoes and risks of overweight, prehypertension, elevated fasting TAG, high TAG:HDL ratio or IFG. Also, no adverse associations were found between fried or non-fried potato intake and cardiometabolic outcomes. Potato consumption has been the subject of much controversy in recent years. This study adds evidence that potato consumption among healthy girls during the critical period of adolescence was not associated with cardiometabolic risk.

Some studies suggest that dairy foods may be linked with less chronic inflammation. However, few studies have investigated the separate effects of different types of dairy on inflammation. Therefore, the current study aims to examine the separate prospective impacts of milk, yogurt and cheese on biomarkers of chronic inflammation in 1753 community-dwelling participants of the Framingham Offspring Study (FOS). Mean intakes of dairy foods were derived from two sets of three-day diet records. Six inflammatory biomarkers were assessed approximately seven years later at exam 7. Results showed that those who consumed yogurt (vs. those who did not) had statistically significantly lower levels of interleukin-6 (IL-6) (mean log-transformed levels of 1.31 and 1.26 in consumers/non-consumers, respectively, p = 0.02) and fibrin (mean log-transformed levels of 5.91 and 5.89 in consumers/non-consumers, respectively, p = 0.03). The inverse association between IL-6 and yogurt consumption was similar in participants who were of normal weight and those who were overweight. For fibrin, the effects were stronger in overweight individuals. No statistically significant associations were observed between any of these inflammation biomarkers and milk or cheese intakes. Overall, our study compared the separate impacts of three types of dairy foods on chronic inflammation and found that only yogurt intake was linked with lower levels of chronic inflammation.

Highlights • Cardiovascular health decline occurs during adolescence. • Black-white disparities begin before early adolescence. • Disparities are associated with differential cardiovascular health trajectories. • Modifying early adolescent behaviors may prevent cardiovascular health decline., Adolescence is a critical time for the preservation or loss of cardiovascular health. We aimed to describe trajectories of cardiovascular health in adolescent girls and identify early adolescent factors associated with cardiovascular health in young adulthood. We used data from the National Growth and Health Study, a longitudinal cohort of 2,379 girls followed annually from ages 9–19 years. We classified participants as having ideal, intermediate, or poor levels of the seven cardiovascular health metrics at four developmental stages: early (ages 9–11), middle (ages 12–14), and late (ages 15–17) adolescence, and early young adulthood (ages ≥ 18). We calculated total cardiovascular health scores (range 0–14) at each stage and empirically identified patterns of cardiovascular health trajectories. We examined associations between trajectory group membership and various demographic, behavioral, and physiological factors. Mean cardiovascular health scores declined with age from 10.8 to 9.4 in white girls and 10.3 to 8.9 in black girls; 17% of white girls and 23% of black girls had low cardiovascular health (score

OBJECTIVES: We examined the prospective association between potato consumption and risk of cardiometabolic disorders including hypertension, high fasting plasma triglycerides, low-density lipoproteins (LDL), and type 2 diabetes mellitus (T2DM) or impaired fasting glucose (IFG) in the prospective Framingham Offspring (FOS) cohort. We also assessed the relationship between fried or non-fried potato consumption and risk of cardiometabolic disorders. METHODS: We included 2549 subjects, aged 30 years old and older. Dietary data were derived from 3-day records from examination visits 3–5. Average consumption of potatoes was classified as

OBJECTIVES: Potatoes are typically considered to be less healthy than most vegetables although the 2015 Dietary Guidelines provide no specific recommendations for intake other than to reduce consumption of fried potatoes. Evidence linking potato consumption, including consumption of fried potatoes with a risk of obesity, is limited. The objective of the current analysis was to study the impact of potato consumption on the risk of obesity and elevated cardiometabolic risk (CMR) in adolescent girls. METHODS: We used data for 2091 girls, ages 9–10 years at enrollment in the prospective National Growth and Health Study (NGHS). and followed for 10 years. Potato consumption was derived from 3-day records collected during the annual follow-up periods. Total potato intake included white and sweet potatoes from all sources including mixed dishes. Total intake was classified as 85% ile of CDC cutoff values); the effects of higher intakes were the same. The odds ratio for elevated blood pressure (≥90th percentile for age, sex, height) associated with moderate (vs. low) intakes of potatoes was 1.16 (95% CI: 0.84–1.59) and again, the effects of higher intakes were very similar. For the relation between potatoes and elevated triglycerides (≥110 mg/dl), the risk was U-shaped with those who had moderate (vs. low) intakes having a 24% lower risk (95% CI: 0.54–1.08). Finally, moderate and higher (vs. lower) potato intakes were linked with non-statistically significant 26% and 30% reduced risks of elevated fasting glucose levels, respectively. CONCLUSIONS: These analyses suggest that there is no adverse effect of moderate daily potato consumption on cardiometabolic risk in adolescent girls. FUNDING SOURCES: The Framingham Heart Study.

OBJECTIVES: Few studies have estimated the independent effects of butter and margarine on risk of cardiovascular disease (CVD). Our goal was to examine these effects as well as that of other fats and oils on risk of CVD and markers of cardiometabolic risk in subjects in the prospective Framingham Offspring Study. METHODS: Data from 2038 adults, who were free of CVD and diabetes through exam 5 were included. Intakes of butter, margarine, mayonnaise, oils, and shortening were assessed using 3-day diet records at exams 3 and 5. Concentrations of low-density lipoproteins (LDL), high-density lipoproteins (HDL), and their particle sizes were analyzed cross-sectionally at exam 5. Subjects were followed from exam 5 to 9 for incident CVD and type 2 diabetes (T2DM) (median follow-up, 16.9 years). Cox proportional hazards models were used to estimate risk of CVD and T2DM and generalized linear models were used to evaluate effects on other cardiometabolic outcomes, while adjusting for age, sex, pack-years of smoking, BMI, physical activity, intakes of other fats, hypertension and use of lipid-lowering medication. Intake of each type of dietary fat was categorized as low, moderate, or high using sensitivity analyses. RESULTS: Intake of >5 g/day of butter (vs. non-consumers) had no effect on CVD risk but was associated with a non-statistically significant 24% lower risk of T2DM. In men, higher butter intake was linked with larger LDL and HDL particles sizes (P 7 g/day (vs. ≤2) of margarine was associated with a 48% (95% CI: 1.03–2.13) increased risk of CVD and a 68% (95% CI: 1.00–2.82) higher risk of T2DM in women. In men, higher margarine intake was associated with much weaker, non-statistically significant increased risks of CVD and T2DM. Finally, total intake of oils (>7 vs. ≤2 g/day) was associated with a strong reduced risk of T2DM (HR: 0.55; 95% CI: 0.36–0.85) in men but not women. There was no effect of margarine or oils on lipid particle sizes in either men or women. CONCLUSIONS: While butter intake had no adverse effect on risk of CVD in either men or women, it was beneficially associated with lipid profiles in men. In women, higher intakes of margarine but not butter were associated with increased risks of both CVD and T2DM. Finally greater oil consumption led to lower risks of T2DM in men. FUNDING SOURCES: NHLBI National Dairy Council.

OBJECTIVES: The objectives of this study were to determine the dose-response relations and combined effects of sodium, potassium, magnesium and calcium on the risk of cardiovascular disease. METHODS: Data for 2362 30–64 year-old men and women free of CVD at baseline in the Framingham Offspring Study were included in these analyses. Cox proportional hazard models were used to investigate the association between categories of sodium, potassium, calcium, and magnesium intake and risk of incident CVD. Further, Cox models with restricted cubic spline functions were used to examine the dose-response relations of these minerals with CVD risk. RESULTS: Compared with higher sodium intakes (≥3500 mg), those with the lowest intakes (

BackgroundThe role of fruit juice in pediatric dietary guidelines continues to be controversial, particularly with respect to concerns about unhealthy dietary habits and the potential promotion of excessive weight gain. The objective of the current study was to determine the association between preschool fruit juice consumption and the following outcomes during childhood and adolescence: whole and total fruit intake, diet quality, likelihood of meeting current dietary recommendations, and BMI change.MethodsThe data were previously collected from 100 children enrolled in the Framingham Children’s Study at 3–6 years of age and subsequently followed for 10 years. Dietary data were collected annually using multiple sets of 3-day diet records. Compliance with dietary recommendations was estimated based on2015–2020 Dietary Guidelines for Americansand diet quality was measured using the associated Healthy Eating Index (HEI). Mixed linear and logistic regression models were used for statistical analyses.ResultsPreschool children (3–6 years) who drank ≥1.0 (vs. p p p = 0.0044). Preschoolers consuming Dietary Guidelinesfor whole fruit intake during adolescence (p ConclusionThese data suggest that preschool consumption of 100% fruit juice is associated with beneficial effects on whole fruit intake and diet quality without having any adverse effect on BMI during childhood and into middle adolescence.

Introduction: While saturated fat (SFA) intake has long been considered as an important risk factor for cardiovascular disease (CVD), some evidence in recent years has called these findings into question. There is limited evidence examining the separate effects of SFAs from different food sources on cardiovascular risk. Objective: The goal of this study was to determine whether higher (vs. lower) intakes of SFA from dairy and non-dairy sources were associated with risk of incident cardiovascular disease. Methods: Data from 1991 adults, ages 30 and older, who were free of CVD at the time of baseline dietary assessment in the prospective Framingham Offspring Study were included in these analyses. Dairy and non-dairy SFA was assessed using 3-day diet records at exams 3 and 5; intakes were adjusted for body weight using the residual method. Subjects were followed from exam 5 to exam 9 for CVD events (median follow-up 16.9 years). Cox proportional hazards models were used to adjust for confounding by sex, age, BMI, physical activity, smoking (pack-years), non-dairy SFA (in dairy SFA models, and vice versa for non-dairy models), and time dependent occurrence of hypertension or use of lipid-lowering medications. Results: Subjects were classified into 3 categories of sex-specific intake of dairy SFA ( Conclusions: Saturated fats derived from dairy sources were associated with a reduced risk of incident CVD in women. For both men and women, those who had higher intakes of dairy-derived SFA combined with lower intakes of non-dairy SFA tended to have lower risks of CVD than those with lower intakes of SFA from both sources.

Introduction: Diet and exercise are key prevention strategies for type 2 diabetes (T2DM). Few longitudinal studies have examined separate effects of animal and plant proteins on T2DM risk and results are conflicting. The goal of this study was to evaluate the association between usual intake of dietary protein (total, animal, and plant) and T2DM risk. Methods: Data from middle-aged men and women in the longitudinal Framingham Offspring Study (FOS) with approximately 20 years of follow-up were used. Diet was assessed using three-day diet records (exams 3 and 5); protein intake was adjusted for body weight using the residuals from a linear regression model. Glucose was measured after an overnight fast; impaired fasting glucose (IFG) was defined as a FG >100; diabetes was diagnosed using a standardized and validated FOS protocol. To estimate the hazards ratios) (HR) for IFG or T2DM, Cox proportional hazards models were used to adjust for confounding by age, sex, education level, physical activity, cigarette smoking, height, energy intake, and weight-adjusted carbohydrate intake. Results: Subjects with the highest total protein intakes (≥100 g, men, ≥90 g women) had 34% reduced risks of IFG/T2DM (HR: 0.66; 95% CI: 0.51, 0.85). In this cohort, intakes of animal protein were more than double those of plant protein. The highest intakes of animal protein (≥65 g, men; ≥55 g, women) vs. lower intakes ( Conclusions: This prospective study of middle-aged men and women provides important evidence to suggest that dietary protein when combined with an active lifestyle, may be a strategy for lowering long-term risk of diabetes. In this study, animal protein had stronger beneficial effects, but future studies are needed in population groups with higher intakes of plant protein to determine whether these effects would be comparable.

Background Overweight and diabetes are known cancer risk factors. This study examines independent and combined effects of weight gain and metabolic dysfunction during middle-adult years on obesity-related cancer risk. Methods Subjects (n = 3850) aged 45–69 years at exams 3–5 in the Framingham Offspring Study were classified according to current and prior (~14 years earlier) weight status, interim weight change and prevalent metabolic dysfunction. Cancer risk among subjects who were overweight at baseline and remained overweight, as well as those who became overweight during follow-up, was compared with risk among normal-weight individuals. Results Gaining ≥0.45 kg (≥1.0 pound)/year (vs. maintaining stable weight) over ~14 years increased cancer risk by 38% (95% confidence interval (CI), 1.09, 1.76); combined with metabolic dysfunction, weight gain increased cancer risk by 77% (95% CI, 1.21, 2.59). Compared with non-overweight adults, men and women who became overweight during midlife had 2.18-fold and 1.60-fold increased cancer risks; those who were overweight from baseline had non-statistically significant 28 and 33% increased cancer risks, respectively, despite having a midlife body mass index that was 3.4 kg/m2 higher than those who gained weight later. Conclusion Midlife weight gain was a strong cancer risk factor. This excess risk was somewhat stronger among those with concurrent metabolic dysfunction.

The dietary protein allowance for older men to maintain lean body mass and muscle strength and to accrue optimal anabolic responses to promyogenic stimuli is poorly characterized. The OPTIMEN trial was designed to assess in older men with moderate physical dysfunction and insufficient habitual protein intake (

Background Some clinical trials suggest that protein supplementation enhances the effects of resistance exercise on skeletal muscle mass (SMM); fewer studies examine the effects of diets rich in protein-source foods on SMM and functional status among community-dwelling adults. Methods Data from the Framingham Offspring study including diet (three-day records, exams 3 and 5), physical activity (exams 2 and 4), percent SMM (%SMM) (exams 6 and 7), and functional performance (exams 5 through 8) were used to evaluate independent and combined effects of physical activity and high-protein foods on adjusted mean %SMM (using analysis of covariance) and risk of functional decline (using Cox proportional hazard's models). Analyses were adjusted for such factors as age, education, height, smoking, and fruit and grain consumption). Results Higher intakes of protein-source foods (red meat, poultry, fish, dairy, and soy, nuts, seeds and legumes) were associated with higher %SMM over 9 years, particularly among women. Men and women with higher intakes of foods from animal sources had a higher % SMM regardless of activity; beneficial effects of plant-based protein foods were only evident in physically active adults. Active subjects with higher intakes of animal or plant protein-source foods had 35% lowest risks of functional decline. Among less active individuals, only those consuming more animal protein-source foods had reduced risks of functional decline (HR: 0.7l; 95% CI: 0.50-1.01). Conclusion Higher intake of animal-protein foods, alone and especially in combination with a physically active lifestyle, was associated with preservation of muscle mass and functional performance in older adults.

Background: Fibrosis is a process that, in healthy individuals, is characterized by deposition of extracellular matrix (ECM) components. However, in pathological states, such as the low-grade inflammation associated with obesity, excessive tissue ECM production is associated with dysfunction of various organs such as liver, kidney, and adipose tissue. Procollagen Type III N-terminal peptide (P3NP) is produced during collagen synthesis and is linked to adverse outcomes including cardiovascular events. Few studies have examined the relationship between systemic inflammation or body fat distribution and P3NP. Methods: Data from the prospective Framingham Offspring study were used to examine the link between systemic inflammation, body fat distribution and P3NP. Of the 944 individuals with P3NP measured at exam 6, 737 had CRP measured at exam 2 and 859 had waist circumference measured at exam 4, along with potential confounders including sex, age, smoking, and body mass index (BMI). Levels of serum CRP at exam 2 were classified into 3 groups (≤1.0, 1.0 to ≤3.0, >3.0 mg/L) and waist circumference was divided in sex specific quintiles. Due to non-normality, levels of P3NP were log transformed. Multivariable general linear models were used to assess the associations between both CRP and waist circumference and P3NP. Age, sex, smoking status, physical activity and BMI were assessed as potential confounders. Results: Compared with individuals with the lowest levels of CRP at exam 2 (≤1mg/L) those with intermediate or high levels (CRP: 1.0 to ≤3.0, and >3.0) had statistically significantly higher levels of plasma P3NP at exam 6 (3.8 ± 0.2, 4.2 ± 0.3, and 4.3 ± 0.3 mg/L, from lowest to highest category, respectively, p-trend Conclusions: These results suggest a link between both systemic inflammation and waist size (a simple indicator of central adiposity) and circulating markers of fibrosis. These findings may suggest that adverse health outcomes associated with visceral adiposity and systemic inflammation may be linked with development of fibrosis.

Introduction: Dietary protein has been shown to prevent age-related functional decline and strength loss, but few studies have examined the separate effects of animal and plant proteins on these outcomes. Hypothesis: We hypothesized that animal protein might provide greater protection against strength loss and functional decline than plant protein in older adults (aged ≥ 50 years) in the Framingham Offspring Study (FOS). Methods: Dietary protein was assessed using 3-day diet records at exams 3 and 5 in the prospective FOS; intakes were adjusted for body weight using the residual method. Functional status scores (median follow-up 17.3 years) was derived from standardized questionnaires at exams 5-9, while grip strength (median follow-up 10.3 years) was measured by hand-held dynamometer at exams 7-9. Multivariable analyses included Cox proportional hazards modeling, repeated-measures mixed models, and analysis of covariance to adjust for sex, age, education, percent of calories from saturated fats, and physical activity. Models for animal protein were adjusted for plant protein intake and vice versa. Results: Subjects were categorized into 3 categories of sex-specific intakes of animal protein ( Conclusions: Higher intakes of both animal and plant protein were protective of self-reported functional status in these analyses while only animal protein was associated with the preservation of grip strength among older adults.

We explored the dose-response relations of sodium, potassium, magnesium and calcium with cardiovascular disease (CVD) risk in the Framingham Offspring Study, as well as the combined effects of these minerals. Analyses included 2362 30&ndash, 64 year-old men and women free of CVD at baseline. Cox proportional-hazards models were used estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for mineral intakes and incident CVD. Cox models with restricted cubic spline functions were used to examine dose-response relations, adjusting for confounding by age, sex, body mass index, dietary fiber intake, and time-varying occurrence of hypertension. Lower sodium intake (&lt, 2500 vs. &ge, 3500 mg/d) was not associated with a lower risk of CVD. In contrast, potassium intake &ge, 3000 (vs. &lt, 2500) mg/d was associated with a 25% lower risk (95% CI: 0.59, 0.95), while magnesium intake &ge, 320 (vs. &lt, 240) mg/d led to a 34% lower risk (95% CI: 0.51, 0.87) of CVD. Calcium intake &ge, 700 (vs. &lt, 500) mg/d was associated with a non-statistically significant 19% lower risk. Restricted cubic spline curves showed inverse dose-response relations of potassium and magnesium with CVD risk, but no such associations were observed for sodium or calcium. These results highlight the importance of potassium and magnesium to cardiovascular health.

OBJECTIVES: We examined the prospective association between a Mediterranean diet pattern using four separate a priori indices of adherence and breast cancer risk in the Framingham Offspring (FOS) cohort. METHODS: The four indices included in this study reflect two different approaches to measuring adherence to a Mediterranean diet: a. scores based on population food intake distributions (i.e., the alternate Mediterranean Diet (aMED) and Mediterranean Diet (MDS) score); and b. scores based on recommended intakes of relevant foods (i.e., Mediterranean Style Dietary Pattern (MSDP) and Mediterranean Diet (MeDiet) scores). The scores were derived from a semi-quantitative food frequency questionnaire. Subjects included 1703 women, aged 30 years old and older, who were free of prevalent cancer. Each score was classified into three categories (low, moderate, and high) to evaluate the association between the Mediterranean diet and breast cancer risk (overall, post-menopausal, and hormone receptor positive) from 1991 through 2014. Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for confounding by age, physical activity, waist-to-height ratio, pack-years of cigarette smoking, supplement use, diabetes status, age at menopause and total calorie intake. RESULTS: During a median follow-up of approximately 18 years, 93 breast cancer cases were documented. Women in the highest category of MSDP score or MeDiet score had approximately 45% lower breast cancer risks than women in the lowest categories (MSDP high category HR:0.56, 95% CI: 0.33–0.94; MeDiet high category HR: 0.55, 95% CI: 0.31–0.98). This effect was similar for post-menopausal breast cancer cases. In addition, the high (vs. low) MeDiet score was associated with 55% decreased risk of hormone receptor positive breast cancer (HR:0.45, 95% CI:0.23–0.87). Neither of the scores calculated on the basis of dietary intakes in the study population (i.e., aMED, MDS) was associated with breast cancer risk. CONCLUSIONS: In this large prospective cohort, scores based on recommended intakes of relevant Mediterranean diet foods may lead to strong evidence of the inverse relation between a Mediterranean dietary pattern and incidence of breast cancer among women aged 30 years old or older in the US. FUNDING SOURCES: The Framingham Heart Study.

Longitudinal data on cardiometabolic effects of egg intake during adolescence are lacking. The current analyses aim to evaluate the impact of usual adolescent egg consumption on lipid levels, fasting glucose, and insulin resistance during late adolescence (age 17-20 years).Data from 1392 girls, aged 9 to 10 at baseline and followed for 10 years, in the National Heart, Lung, and Blood Institute's National Growth and Health Study were used to examine the association between usual egg intake alone and in combination with other healthy lifestyle factors and late adolescent lipid levels, fasting glucose, and insulin resistance, measured as homeostasis model assessment of insulin resistance (HOMA-IR). Diet was assessed using 3-day food records during eight examination cycles. Girls were classified according to usual weekly egg intake, ages 9-17 years: 1 egg/wk (n = 361), 1 to3 eggs/wk (n = 703), and ≥3 eggs/wk (n = 328). Analysis of covariance modeling was used to control for confounding by other behavioral and biological risk factors.Girls with low, moderate, and high egg intakes had adjusted low-density lipoprotein cholesterol levels of 99.7, 98.8, and 95.5 mg/dL, respectively (p = 0.0778). In combination with higher intakes of fiber, dairy, or fruits and vegetables, these beneficial effects were stronger and statistically significant. There was no evidence that ≥3 eggs/wk had an adverse effect on lipids, glucose, or HOMA-IR. More active girls who consumed ≥3 eggs/wk had the lowest levels of insulin resistance.These results suggest that eggs may be included as part of a healthy adolescent diet without adverse effects on glucose, lipid levels, or insulin resistance.

OBJECTIVE To evaluate the relation between yogurt consumption as well as cheese, milk, and total dairy, and high blood pressure (HBP) in two Nurses' Health Study cohorts (NHS, n = 69 298), NHS II (n = 84 368) and the Health Professionals Follow-Up Study (HPFS, n = 30 512). METHODS NHS, NHS II, and HPFS participants were followed for incident HBP for up to 30, 20, and 24 years, respectively. Hazard ratios were calculated using time-dependent multivariate-adjusted Cox proportional hazards models. Pooled risk estimates were derived from fixed effects meta-analyses. RESULTS Participants consuming at least five servings per week (vs.

Previous recommendations to limit dietary cholesterol intake have been eliminated for most adults. Questions remain about whether dietary cholesterol has adverse cardiovascular effects among individuals with impaired fasting glucose or diabetes (IFG/T2DM). We used data for 993 adults (40.9% female), ages 35&ndash, &lt, 65 years, with prevalent IFG/T2DM in the prospective Framingham Offspring Study to address this question. Dietary cholesterol was assessed using 3-day diet records at exams 3 and 5 and used to classify subjects into sex-specific tertiles of mean cholesterol intake. Outcomes included fasting lipid levels over 20 years and incident cardiovascular disease (CVD). Statistical analyses included repeated measures mixed regression models and Cox proportional hazards models to adjust for confounding. Among adults with T2DM/IFG, there was no consistent association between dietary cholesterol intake and fasting low-density lipoprotein (LDL), high-density lipoprotein (HDL), LDL/HDL ratio, or triglycerides over 20 years of follow-up. In longitudinal analyses, the adjusted hazard ratio for CVD in the highest (vs. lowest) sex-specific tertile of cholesterol intake was 0.61 (95% CI: 0.41, 0.90). These analyses provide no evidence of an adverse association between dietary cholesterol and serum lipid levels or atherosclerotic CVD risk among adults with prevalent IFG/T2DM.

Importance The Institute of Medicine set the recommended dietary allowance (RDA) for protein at 0.8 g/kg/d for the entire adult population. It remains controversial whether protein intake greater than the RDA is needed to maintain protein anabolism in older adults. Objective To investigate whether increasing protein intake to 1.3 g/kg/d in older adults with physical function limitations and usual protein intake within the RDA improves lean body mass (LBM), muscle performance, physical function, fatigue, and well-being and augments LBM response to a muscle anabolic drug. Design, Setting, and Participants This randomized clinical trial with a 2 × 2 factorial design was conducted in a research center. A modified intent-to-treat analytic strategy was used. Participants were 92 functionally limited men 65 years or older with usual protein intake less thanor equal to 0.83 g/kg/d within the RDA. The first participant was randomized on September 21, 2011, and the last participant completed the study on January 19, 2017. Interventions Participants were randomized for 6 months to controlled diets with 0.8 g/kg/d of protein plus placebo, 1.3 g/kg/d of protein plus placebo, 0.8 g/kg/d of protein plus testosterone enanthate (100 mg weekly), or 1.3 g/kg/d of protein plus testosterone. Prespecified energy and protein contents were provided through custom-prepared meals and supplements. Main Outcomes and Measures The primary outcome was change in LBM. Secondary outcomes were muscle strength, power, physical function, health-related quality of life, fatigue, affect balance, and well-being. Results Among 92 men (mean [SD] age, 73.0 [5.8] years), the 4 study groups did not differ in baseline characteristics. Changes from baseline in LBM (0.31 kg; 95% CI, −0.46 to 1.08 kg; P = .43) and appendicular (0.04 kg; 95% CI, −0.48 to 0.55 kg; P = .89) and trunk (0.24 kg; 95% CI, −0.17 to 0.66 kg; P = .24) lean mass, as well as muscle strength and power, walking speed and stair-climbing power, health-related quality of life, fatigue, and well-being, did not differ between men assigned to 0.8 vs 1.3 g/kg/d of protein regardless of whether they received testosterone or placebo. Fat mass decreased in participants given higher protein but did not change in those given the RDA: between-group differences were significant (difference, −1.12 kg; 95% CI, −2.04 to −0.21; P = .02). Conclusions and Relevance Protein intake exceeding the RDA did not increase LBM, muscle performance, physical function, or well-being measures or augment anabolic response to testosterone in older men with physical function limitations whose usual protein intakes were within the RDA. The RDA for protein is sufficient to maintain LBM, and protein intake exceeding the RDA does not promote LBM accretion or augment anabolic response to testosterone. Trial Registration clinicaltrials.gov Identifier:NCT01275365

To prospectively examine the relation between adolescent dietary intake and cardiometabolic risk (CMR) clustering at the end of adolescence. Data from the NHLBI Growth and Health Study on 1369 girls enrolled at ages 9–10 in 1987–1988 and followed for 10 years were used to estimate the relative risk of having multiple (≥2 or ≥3) risk factors in late adolescence associated with usual food intake patterns from 9 to 17 years of age. Mean food intakes were derived from multiple 3-day diet records and CMR factors included larger waist circumference, insulin resistance, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, high triglycerides, and elevated systolic or diastolic blood pressures. Of 1369 subjects, 18.4 % girls had 3–6 prevalent risk factors by the end of adolescence and 35.0 % had at least two. Higher intakes of fruit and non-starchy vegetables, dairy, and grains were independently associated with having fewer risk factors as were eating patterns characterized by higher combined intakes of these food groups. After adjusting for age, race, socio-economic status, height, physical activity, and television watching, girls with high intakes of dairy and fruits and non-starchy vegetables (vs. those with lower intakes of both) were nearly 50 % less likely to have three or more CMR factors in late adolescence; girls with higher intakes of grains plus fruits and non-starchy vegetables were nearly 60 % less likely. These results suggest that healthy food consumption patterns during adolescence may prevent accumulation of cardiometabolic risk.

BACKGROUND High blood pressure (HBP) is a major cardiovascular disease (CVD) risk factor. Clinical trials including Dietary Approaches to Stop Hypertension (DASH) have demonstrated beneficial effects of dairy consumption on risks of HBP and CVD. Yogurt, a fermented dairy product, may independently be related to CVD risk. OBJECTIVE To evaluate the association between yogurt consumption and CVD risk among hypertensive individuals in 2 large cohorts and to determine whether the association differs among those whose eating pattern more closely resembles the DASH diet. METHODS Overall, 55,898 female Nurses’ Health Study (NHS) and 18,232 male Health Professionals Follow-Up Study (HPFS) participants with prevalent HBP were included. Cumulative average estimates of yogurt intake from validated food frequency questionnaires were related to verified self-reported CVD outcomes using Cox proportional hazards models. Hazard ratios and 95% confidence intervals (CI) were adjusted for CVD risk factors, medications, and diet covariates. RESULTS Yogurt intake was inversely associated with CVD risk (myocardial infarction and stroke) among hypertensive participants (P CONCLUSION Hypertensive men and women who consumed ≥2 servings/week of yogurt, especially in the context of a healthy diet, were at lower risk for developing CVD.

Nutrition impacts the development of sarcopenia and protein intake is an important modulator of skeletal muscle mass loss in older people. The Optimizing Protein Intake in Older Men with Mobility Limitation (OPTIMEN) Trial was designed to assess the independent and combined effects of higher protein intake and a promyogenic agent, testosterone, on lean body mass, muscle strength and physical function in older men with mobility disability. The purpose of this paper is to describe the experimental design and nutrition intervention, including techniques used by research dietitians to develop and deliver energy and protein-specific meals to the homes of community-dwelling participants. Strategies to enhance long-term dietary compliance are detailed. Randomized, double-blind, placebo-controlled six-month intervention trial. Participants were recruited from Boston MA USA and surrounding communities. Older men who were mobility-limited (Short Physical Performance Battery (SPPB) 3-10) and consuming less protein (

Dietary protein may help prevent age-related declines in strength and functional capacity. This study examines the independent relationship between dietary protein and longitudinal changes in physical functioning among adults participating in the Framingham Offspring Study from examination 5 (1991–1995) to examination 8 (2005–2008). Protein intakes were derived from 3-day diet records during examinations 3 and 5; functional status was determined over 12 years using 7 items selected from standardized questionnaires. Multivariable models adjusted for age, sex, education, physical activity, smoking, height, and energy intake. Functional tasks that benefitted most from a higher-protein diet (≥1.2 g/kg/day vs.

High blood pressure (HBP) is a major cause of cardiovascular disease and renal failure.1 Evidence from recent reviews2,3 and meta-analyses4,5 suggests that dietary protein consumption may benefit BP. Both of these meta-analyses of short-term clinical trials concluded that compared with carbohydrates, higher dietary protein led to modest BP reductions. In the Rebholtz meta-analysis, both animal and plant proteins were found to have similar short-term effects on BP.5 Observational studies, which have been largely cross-sectional, have shown weak beneficial effects of plant proteins, in particular on BP.2 Few observational studies (and no clinical trials) have addressed the long-term effects of animal and plant proteins on BP, and results are conflicting.6–8 The Dietary Approaches to Stop Hypertension (DASH) studies have documented the importance of diet patterns to BP.9 The greatest reductions in BP in the DASH trials have been seen with higher intakes of fruits and vegetables (FV) plus higher intakes of low-fat dairy products (an important source of dietary protein). In general, the effects of FV alone are modest.10 Higher dietary fiber intakes have also been associated with a BP-lowering effect, particularly among hypertensive individuals.11 Combined effects of dietary protein and fiber intakes on BP are less clear, although at least 1 review suggests that they may be additive.12 Our goal in this study was to evaluate the longitudinal effects of the amount and type of dietary protein on mean BP and the risk of incident HBP among middle-aged adults in the Framingham Offspring Study (FOS). The interactive effects of dietary protein with FV and dietary fiber were also examined.

Childhood obesity is closely associated with adult obesity, hypertension, and cardiovascular disease. This study's aim was to determine the effects of beverage intake patterns on body composition from early childhood into adolescence in the Framingham Children's Study.Multiple sets of 3-day records were used to assess diet over 12 years, beginning in 1987, in 103 non-Hispanic white boys and girls. BMI, waist circumference, and four skinfolds (triceps, subscapular, suprailiac, and abdominal) were measured yearly. Percent body fat was assessed by dual-energy X-ray absorptiometry at end of follow-up. Analysis of covariance and longitudinal mixed modeling were used to control for potential confounding by age, baseline body fat, percent of energy from fat, television/video viewing time, other beverage intakes not included in exposure group, mother's education, and BMI.Children with the lowest milk intakes in early childhood had 7.4% more body fat in later adolescence than those with higher intakes (30.0% body fat in tertile 1 vs. 22.6% in tertile 3; p=0.0095). Fruit and vegetable juice was similarly protective-those in the highest tertile of fruit and vegetable juice intake during childhood had an 8.0-cm smaller waist circumference at 15-17 years of age, compared with those in the lowest tertile (p=0.0328). There was no relation between sugar-sweetened beverages (SSBs) and percent body fat (p=0.9296) or other outcomes.These results suggest that adequate intakes of milk and fruit and vegetable juice may reduce the risk of excess body fat in later childhood and adolescence. Further, modest intakes of SSBs in early childhood may not adversely affect body fat change.

OBJECTIVES: Small dense LDL particles have been shown to promote atherogenic cardiovascular disease (CVD). Dietary fat type may impact LDL particle size, but few studies have examined the association between fatty acid intake and LDL particle size and CVD risk. Our goal was to examine the association of saturated fatty acid (SFA) intake with LDL particle size and CVD risk in subjects in the Framingham Offspring Study (FOS). METHODS: LDL particle profiles were measured by NMR spectroscopic assay during exam visit 4 in the prospective FOS. Dietary fat, carbohydrate and food groups were assessed using 3-day diet records at exams 3 and 5; intakes were adjusted for body weight using the residuals from linear regression models. Multivariable Cox proportional hazards models and generalized linear modeling (GLM) were used to adjust for sex, age, height, pack-years of smoking, fruit and non-starchy vegetable intakes, dairy, LDL particle size, and prevalent hypertension. RESULTS: Subjects were classified into 6 categories using the combined intakes of carbohydrates (

OBJECTIVES: This study examines the prospective association between adherence to a Mediterranean style dietary pattern and cancer risk among men and women in the Framingham Offspring (FOS) cohort. METHODS: The Mediterranean style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire taken at examination visit 5 in the prospective FOS cohort. Subjects included 3199 participants (1703 women and 1496 men), aged 30 years old and older, who were free of prevalent cancer. The MSDP score was classified into tertiles and also dichotomized (MSDP score

Background Epidemiological studies of red meat consumption often fail to distinguish between leaner and fattier or processed cuts of meat. Red meat has also been frequently linked with less healthy diet patterns. Data exploring the health effects of lean red meat in younger individuals are scarce, particularly in the context of a healthy diet. The present study examined the effects of lean red meat in combination with higher intakes of fruit/nonstarchy vegetables on lipid profiles in older adolescent girls. Methods Data from 1461 girls who were followed for 10 years, starting at 9–10 years of age, in the National Heart Lung and Blood Institute Growth and Health Study were used. Diet was assessed using multiple sets of 3-day records collected over eight examination cycles. Outcome measures included fasting levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and triglycerides at age 18–20 years. Results After adjusting for age, race, socioeconomic status, height, activity level, hours of television per day, and intakes of whole grains and dairy foods using multivariable modelling, girls consuming ≥6 oz lean red meat per week combined with two or more servings of fruit/nonstarchy vegetables per day had LDL-C levels approximately 6–7 mg dL−1 lower (P

While dairy products have been shown to reduce the risk for high blood pressure (HBP) in at-risk adults, few long-term studies have examined independent effects of yogurt consumption, a dietary component that may have particularly beneficial effects on blood pressure. We used repeated measures of diet and lifestyle collected over 2-3 decades among participants without prevalent HBP in the two Nurses’ Health Study cohorts (NHS and NHS II) and the Health Professionals Follow-up Study (HPFS) to examine this question. After 18 to 30 years of follow-up, we documented 74,609 new cases of HBP in the three cohorts. After adjusting for age, race, family history of HBP, physical activity, energy, and intakes of total protein, fruits and vegetables, milk, and cheese, women who consumed 5 or more servings of yogurt per week (compared with those consuming 0

Objective To explore mean food group intakes associated with central obesity anthropometry among children and adolescents enrolled in the Third National Health and Nutrition Examination Survey (NHANES III). Design Cross-sectional study. Setting Representative sampling of the US population (1998-2002). Subjects Subjects were 3761 children (5-11 years) and 1803 adolescents (12-16 years) with single 24 h dietary recalls and anthropometric measures of central body fat (waist circumference and sum of subscapular and suprailiac skinfold thicknesses). Results Results were controlled for confounding by age, height, race/ethnicity, Tanner stage, television viewing and parental education. In younger children, there was no relationship between central adiposity and mean intakes of dairy, fruit, vegetables or grains, while a positive association with meat intake was found among boys. In adolescent boys and girls, central body fat measures were inversely associated with mean dairy and grain intakes. Adolescent boys in the highest quartile of central adiposity consumed less fruit and fewer vegetables; those in the lowest central adiposity quartile consumed less meat. Finally, adolescents who met the criteria for central obesity (waist circumference >or=85th percentile for age and sex) reported consuming significantly less total dairy (as well as milk and cheese separately), total grains (whole and refined) and total fruit and vegetables. There was no association with meat consumption. To test the stability of these findings, the final analysis was replicated in 2541 same-aged adolescents from NHANES 1999-2002; the results were very similar. Conclusions These cross-sectional analyses suggest that intakes of dairy, grains and total fruits and vegetables are inversely associated with central obesity among adolescents.

Identification of risk factors early in life for the development of high blood pressure is critical to the prevention of cardiovascular disease.To study prospectively the effect of dietary sodium, potassium, and the potassium to sodium ratio on adolescent blood pressure.The National Heart, Lung, and Blood Institute's Growth and Health Study is a prospective cohort study with sites in Richmond, California; Cincinnati, Ohio; and Washington, DC. Participants included 2185 black and white girls initially aged 9 to 10 years with complete data for early-adolescent to midadolescent diet and blood pressure who were followed up for 10 years. The first examination visits were from March 1987 through February 1988 and follow-up continued until February 1999. Longitudinal mixed models and analysis of covariance models were used to assess the effect of dietary sodium, potassium, and the potassium to sodium ratio on systolic and diastolic blood pressures throughout adolescence and after 10 years of follow-up, adjusting for race, height, activity, television/video time, energy intake, and other dietary factors.Mean dietary sodium and potassium intakes and the mean potassium to sodium ratio in individuals aged 9 to 17 years. To eliminate potential confounding by energy intake, energy-adjusted sodium and potassium residuals were estimated.Mean systolic and diastolic blood pressures throughout adolescence and at the end of follow-up (individuals aged 17-21 years).Sodium intakes were classified as less than 2500 mg/d (19.4% of participants), 2500 mg/d to less than 3000 mg/d (29.5%), 3000 mg/d to less than 4000 mg/d (41.4%), and 4000 mg/d or more (9.7%). Potassium intakes ranged from less than 1800 mg/d (36.0% of participants) to 1800 mg/d to less than 2100 mg/d (26.2%), 2100 mg/d to less than 2400 mg/d (18.8%), and 2400 mg/d or more (19.0%). There was no evidence that higher sodium intakes (3000 to4000 mg/d and ≥4000 mg/d vs2500 mg/d) had an adverse effect on adolescent blood pressure and longitudinal mixed models showed that those consuming 3500 mg/d or more had generally lower diastolic blood pressures compared with individuals consuming less than 2500 mg/d (P = .18). However, higher potassium intakes were inversely associated with blood pressure change throughout adolescence (P.001 for systolic and diastolic) and at the end of follow-up (P = .02 and P = .05 for systolic and diastolic, respectively). While the potassium to sodium ratio was also inversely associated with systolic blood pressure (P = .04), these effects were generally weaker compared with effects for potassium alone.In this study of adolescent girls, consumption of 3500 mg/d of sodium or more had no adverse effect on blood pressure. The beneficial effects of dietary potassium on both systolic and diastolic blood pressures suggest that consuming more potassium-rich foods during childhood may help suppress the adolescent increase in blood pressure.

Adult chronic diseases have their roots in childhood. The long-term effect of waist circumference (WC), a simple anthropometric measure of central adiposity, in early adolescence on subsequent card...