Ebook Diet and the development of atherosclerosis: a whole-diet approach from childhood to adulthood
The Cardiovascular Risk in Young Finns study is one of the largest follow-up studies in the world on cardiovascular risk and its determinants from childhood to adulthood (Juonala et al. 2004). It is a multidisciplinary, prospective multi-centre project with extensive measurements and a follow-up period of more than two decades. For nutrition science, it provides an exceptional opportunity to study dietary factors, their determinants and shaping over the course of a lifetime. Nutrition can be considered a wide spectrum of behavioural and physiological elements of different levels.
Therefore, if studied comprehensively, the nutrition of an individual from childhood into adulthood must be measured with various tools and analysed with various approaches. In the Cardiovascular Risk in Young Finns cohort, nutritional factors have been and are assessed from the level of detailed information on nutritional biomarkers up to the subjective conception of health-related issues. In addition to the Cardiovascular Risk in Young Finns study, the results of nutritional studies from such a long-term setting ranging from childhood into adulthood have been published on only a few cardiovascular study cohorts, the most well known being the Bogalusa Heart Study (Nicklas 1995, Demory-Luce et al. 2004). Given the culture-dependency of diet, the Cardiovascular Risk in Young Finns study provides unique information on the long-term dietary issues in Finland which may be applicable in similar societies in Europe.
Cardiovascular diseases (CVD), including atherosclerosis, are a group of widely prevalent non-communicable diseases of the heart and blood vessels with a multifactorial etiology and long progression time. Although partly genetically determined, the risk for CVD is highly influenced by lifestyle factors during the life-course (Yusuf et al. 2001). The possible effects of diet and nutrients have been widely studied in past decades, and compelling evidence on the mechanisms of nutrients and bioactive dietary compounds has accumulated, such as the harmful effects of saturated fatty acids or sodium and the beneficial role of fibre, unsaturated fatty acids or folate (World Health Organization 2003).
However, outside statistical tables and experimental laboratories, these assumptions on the effects do not seem to work all that well in real life. Clinical trials on the benefits of nutrients, shown in ecological settings, have yielded inconclusive results for the supplementation of ?-carotene, vitamin E and other antioxidants (Omenn et al. 1996, Stephens et al. 1996, Rapola et al. 1997, Yusuf et al. 2000), while population studies on the nutritional effects, shown experimentally, have not always shown consistent effects of e.g. ?-n fatty acids (Ascherio et al. 1995, Knekt et al. 2004) or flavonols and flavones (Hirvonen et al. 2001). The development of CVD is a long process taking decades, and subclinical atherosclerosis occurs even in children and adolescents. Hence, numerous dietary factors influence the pathogenesis in the context of the entire risk factor profile all throughout one's life, and a single measurement of one exposure is unlikely to be a good predictor of outcome (Yusuf et al. 2001).
People do not eat nutrients; they eat foods in different combinations which, along with countless other factors, may affect the risk for CVD (Hegsted 1994, Messina et al. 2001, Voutilainen et al. 2006, Jacobs and Tapsell 2007). Nutrients act in their natural matrices, either plant or animal, in interactions with each other and with other bioactive components, and are likely to do so in the human biological system as well. A single nutrient if isolated from its natural matrix may lose its bioactivity or affect human physiology unexpectedly. Additionally, food items in the diet may also interact with each other and should be considered as parts of the entire diet rather than as single foods. While obtaining information on the role and mechanisms of single components of the diet in the disease process is essential, it may be insufficient to understand such phenomenon in the whole context. Much has been resolved of the CVD-diet relationship, but much remains to be learned. In a complicated picture such as this, with numerous predictors with different pathways and decades of pathological processes, a large, prospective, observational follow-up study with a comprehensive approach provides a well-reasoned setting to achieve a broader view of the complex relations between diet and cardiovascular health.
In this series of studies, the diets of young Finnish adults are investigated longitudinally and holistically, with the primary focus on the relationship between long-term diet and cardiovascular health.
Contents
Abstract
Abbreviations
List of original publications
1 Introduction
2 Review of the literature
- 2.1 Cardiovascular diseases
2.2 Atherosclerosis
2.3 Diet in the development of atherosclerosis
2.3.1 Dietary fatty acids
2.3.2 Other dietary components
2.4 The whole-diet approach
2.4.1 Rationale and methodology
2.4.2 Stability of dietary patterns
2.4.3 Dietary patterns and the development of atherosclerosis
2.4.4 Summary of the whole-diet approach
3 Aims of the study
4 Subjects and methods
- 4.1 The Cardiovascular Risk in Young Finns study
4.2 Subjects
4.3 Dietary assessment
4.4 Identification of dietary patterns
4.5 Biochemical measurements
4.6 Ultrasound measurement of intima media thickness
4.7 Assessment of other variables
4.8 Study designs
4.8.1 Study I
4.8.2 Study II
4.8.3 Study III
4.3.4 Study IV
5 Results
- 5.1 Loss to follow-up
5.2 Changes in nutrient intakes from childhood to adulthood
5.3 Dietary patterns, their characteristics and associations with cardiovascular risk factors
5.4 The role of childhood diet in adulthood food choices
5.5 Associations between diet and intima media thickness
6 Discussion
- 6.1 Setting
6.2 Methodological considerations
6.3 Nutrient intakes among young Finnish adults
6.4 Identified dietary patterns
6.5 Associations between childhood and adulthood diets
6.6 Dietary patterns and the development of atherosclerosis
6.7 Energy distribution and the development of atherosclerosis
7 Conclusions and future considerations
Acknowledgements
References
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