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Nutrition in acute and chronic diseases

Lipid and saturated fatty acids intake and cardiovascular risk factors of obese children and adolescents

European Journal of Clinical Nutrition volume 75, pages 1109–1117 (2021)Cite this article

Subjects

Abstract

Objective

To test the hypothesis that lipid intake is associated with triglycerides to HDL-cholesterol ratio (TG/HDL-cholesterol), a predictor of the development of cardiovascular disease, in obese children and adolescents, independently from the level of overweight, insulin resistance, blood pressure, and non-alcoholic fatty liver disease (NAFLD).

Study design

One hundred and eighty non-diabetic obese children/adolescents (age range 6–16 years) were enrolled. Diet (3-day weighed dietary record), physical and biochemical parameters and liver ultrasonography were measured. The impact of lipid intake on TG/HDL-cholesterol ratio >2.2 was measured by regression models, adjusting for covariates (age, gender, height, weight, systolic and diastolic blood pressure, NAFLD positivity, HOMA-IR, and total energy intake).

Results

Independently from covariates, children consuming a diet with a fat content higher than 35% of total energy had a significantly higher chance [OR = 3.333 (95% CI: 1.113–9.979), P = 0.031] to have a TG/HDL-cholesterol >2.2 than children consuming less than 35% of fat. Moreover, if saturated fatty acids (SFA) intake was higher than 13% of total energy, children had a significantly higher chance [OR = 4.804 (95% CI: 1.312–17.593), P = 0.018] to have a TG/HDL-cholesterol >2.2 than children consuming less than 13% of SFA in their diet.

Conclusions

High fat intake, especially SFA intake, is associated with TG/HDL-cholesterol levels of obese children and adolescents, independently from other cardiovascular risk co-factors. Further intervention studies will contribute to clarify the potential role of changes in the composition and amount of fat in the diet of obese children and adolescents, on their cardiovascular risk factors.

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References

  1. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;2:71–82.

    Google Scholar 

  2. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891–8.

    CAS  Google Scholar 

  3. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016;23:2430–40.

    Google Scholar 

  4. Reinehr T, Widhalm K, l’Allemand D, Wiegand S, Wabitsch M, Holl RW, et al. Two-year follow-up in 21,784 overweight children and adolescents with lifestyle intervention. Obesity 2009;17:1196–9.

    PubMed  Google Scholar 

  5. National Institutes of Health National Heart, Lung, and Blood Institute. Expert panel on integrated pediatric guideline for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011;128:S1–S446.

    Google Scholar 

  6. Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, et al. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr. 2018;31:88.

    Google Scholar 

  7. Howell S, Kones R. “Calories in, calories out” and macronutrient intake: the hope, hype, and science of calories. Am J Physiol Endocrinol Metab. 2017;313:E608–12.

    PubMed  Google Scholar 

  8. Tremblay A, Bellisle F. Nutrients, satiety, and control of energy intake. Appl Physiol Nutr Metab. 2015;40:971–9.

    PubMed  Google Scholar 

  9. Dubois L, Diasparra M, Bogl LH, Fontaine-Bisson B, Bédard B, Tremblay RE, et al. Dietary intake at 9 years and subsequent body mass index in adolescent boys and girls: a study of monozygotic twin pairs. Twin Res Hum Genet. 2016;19:47–59.

    PubMed  Google Scholar 

  10. Setayeshgar S, Ekwaru JP, Maximova K, Majumdar SR, Storey KE, McGavock J, et al. Dietry intake and prospective changes in cardiometabolic risk factors in children and youth. Appl Physiol Nutr Metab 2017;42:39–45.

    CAS  PubMed  Google Scholar 

  11. Morandi A, Fornari E, Opri F, Corradi M, Tommasi M, Bonadonna R, et al. High-fat meal, systemic inflammation and glucose homeostasis in obese children and adolescents. Int J Obes. 2017;41:986–9.

    CAS  Google Scholar 

  12. Feskens EJ, Virtanen SM, Räsänen L, Tuomilehto J, Stengård J, Pekkanen J, et al. Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care. 1995;18:1104–12.

    CAS  PubMed  Google Scholar 

  13. Niinikoski H, Jula A, Viikari J, Rönnemaa T, Heino P, Lagström H, et al. Blood pressure is lower in children and adolescents with a low-saturated-fat diet since infancy: the special turku coronary risk factor intervention project. Hypertension 2009;53:918–24.

    CAS  PubMed  Google Scholar 

  14. Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2017;136:e1–e23.

    PubMed  Google Scholar 

  15. Bendsen NT, Christensen R, Bartels EM, Astrup A. Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr. 2011;65:773–83.

    CAS  PubMed  Google Scholar 

  16. Wu JHY, Micha R, Mozaffarian D. Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nat Rev Cardiol. 2019;16:581–601.

    PubMed  Google Scholar 

  17. Juonala M, Wu F, Sinaiko A, Woo JG, Urbina EM, Jacobs D, et al. Non-HDL cholesterol levels in childhood and carotid intima-media thickness in adulthood. Pediatrics 2020;145:e2019–2114.

    Google Scholar 

  18. Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FERHDL). Clin Biochem. 2001;34:583–8.

    PubMed  Google Scholar 

  19. Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM. Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA 1988;260:1917–21.

    CAS  PubMed  Google Scholar 

  20. Gardner CD, Fortmann SP, Krauss RM. Association of small low-density lipoprotein particles with the incidence of coronary artery disease in men 31. and women. JAMA 1996;276:875–81.

    CAS  PubMed  Google Scholar 

  21. Quijada Z, Paoli M, Zerpa Y, Camacho N, Cichetti R, Villaroel V, et al. The triglyceride/HDL-cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors. Pediatr Diabetes. 2008;9:464–71.

    CAS  PubMed  Google Scholar 

  22. Urbina EM, Khoury PR, McCoy CE, Dolan LM, Daniels SR, Kimball TR. Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults. Pediatrics 2013;131:e1082–90.

    PubMed  PubMed Central  Google Scholar 

  23. Nomikos T, Panagiotakos D, Georgousopoulou E, Metaxa V, Chrysohoou C, Skoumas I, et al. Hierarchical modelling of blood lipids’ profile and 10-year (2002–12) all cause mortality and incidence of cardiovascular disease: the ATTICA study. Lipids Health Dis. 2015;14:108.

    PubMed  PubMed Central  Google Scholar 

  24. Watabe Y, Arisaka O, Miyake N, Ichikawa G, Koyama S, Shimura N. Estimation of LDL particle size using lipid indices: a population-based study of 1578 schoolchildren. Metab Syndr Relat Disord. 2015;13:465–9.

    CAS  PubMed  Google Scholar 

  25. Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, et al. CARdiometabolic risk factors in overweight and obese children in ITALY (CARITALY) Study Group. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis. 2015;25:489–94.

    PubMed  Google Scholar 

  26. Vaga GL, Barlow CE, Grundy SM, Leonard D, DeFina LF. Triglyceride-to-high-density-lipoprotein-cholesterol ratio is an index of heart disease mortality and incidence of type 2 diabetes mellitus in men. J Invest Med. 2014;62:345–9.

    Google Scholar 

  27. Oni E, Budoff MJ, Zeb I, Li D, Veledar E, Polak JF, et al. Nonalcoholic fatty liver disease is associated with arterial distensibility and carotid intima-media thickness: (from the Multiethnic study of atherosclerosis). Am J Cardiol. 2019;124:534–8.

    PubMed  Google Scholar 

  28. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020;395:795–808.

    PubMed  Google Scholar 

  29. Jelenik T, Flögel U, Álvarez-Hernández E, Scheiber D, Zweck E, Ding Z, et al. Insulin resistance and vulnerability to Cardiac ischemia. Diabetes. 2018;67:2695-–702.

  30. De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7.

    PubMed  PubMed Central  Google Scholar 

  31. Maffeis C, Banzato C, Talamini G. Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology. Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr. 2008;152:207–13.

    PubMed  Google Scholar 

  32. Di Bonito P, Licenziati MR, Di Sessa A, Manco M, Morandi A, Maffeis C, et al. A new simple formula built on the American Academy of Pediatrics criteria for the screening of hypertension in overweight/obese children. Eur J Pediatr. 2019;178:1291–5.

    PubMed  Google Scholar 

  33. Di Bonito P, Miraglia Del Giudice E, Chiesa C, Linceziati MR, Manco M, Franco F, et al. Preclinical signs of liver and cardiac damage in youth with metabolically healthy obese phenotype. Nutr Metab Cardiovasc Dis. 2018;28:1230–6.

    PubMed  Google Scholar 

  34. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    CAS  PubMed  Google Scholar 

  35. Burrows TL, Martin RJ, Collins CE. A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. J Am Diet Assoc. 2010;110:1501–10.

    PubMed  Google Scholar 

  36. National Institute for the Research in Food and Nutrition. Food Composition Tables (Edra Publishing, Florida, 2007).

  37. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011;53:1082–90.

    Google Scholar 

  38. Pastorino S, Richards M, Pierce M, Ambrosini GL. A high-fat, high-glycaemic index, low-fibre dietary pattern is prospectively associated with type 2 diabetes in a British birth cohort. Br J Nutr. 2016;115:1632–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Cheng Y, Zhang K, Chen Y, Li Y, Li Y, Fu K, et al. Associations between dietary nutrient intakes and hepatic lipid contents in NAFLD patients quantified by H-MRS and dual-echo MRI. Nutrients. 2016;8:52.

    Google Scholar 

  40. Di Pino A, DeFronzo RA. Insulin resistance and atherosclerosis: implications for insulin-sensitizing agents. Endocr Rev. 2019;40:1447–67.

    PubMed  PubMed Central  Google Scholar 

  41. Maffeis C, Silvagni D, Bonadonna R, Grezzani A, Banzato C, Tatò L. Fat cell size, insulin sensitivity, and inflammation in obese children. J Pediatr. 2007;151:647–52.

    CAS  PubMed  Google Scholar 

  42. Moreira AP, Texeira TF, Ferreira AB, Peluzio Mdo C, Alfenas, Rde C. Influence of a high-fat diet on gut microbiota, intestinal permeability and metabolic endotoxaemia. Br J Nutr. 2012;108:801–9.

    CAS  PubMed  Google Scholar 

  43. Società Italiana di Nutrizione Umana (SINU) (Italian Society of Human Nutrition). Nutrients and Energy Reference Intake Levels, IV Revision; (Società Italiana di Nutrizione Umana Milan, 2014).

  44. Sacks FM, Lichtenstein AH, Wu JHY, Creager MA, Kris-Etherton PM, Miller M, et al. Dietry fats and cardiovascular disease. Circulation 2017;136:e1–e23.

    PubMed  Google Scholar 

  45. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A Report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;74:e177–e232.

    PubMed  PubMed Central  Google Scholar 

  46. Te Morenga L, Montez JM. Health effects of saturated and trans-fatty acid intake in children and adolescents: systematic review and meta-analysis. PLoS ONE. 2017;12:e0186672.

    Google Scholar 

  47. Ricci C, Baumgartner J, Zec M, Kruger HS, Smuts CM. Type of dietary fat intakes in relation to all-cause and cause specific mortality in US adults: an iso-energetic substitution analysis from the American National Health and Nutrition examination survey linked to the US mortality registry. Br J Nutr. 2018;119:456–63.

    CAS  PubMed  Google Scholar 

  48. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7:e1000252.

    PubMed  PubMed Central  Google Scholar 

  49. Lapinleimu H, Viikari J, Jokinen E, Salo P, Routi T, Leino A, et al. Prospective randomised trial in 1062 infants of diet low in saturated fat and cholesterol. Lancet 1995;345:471–6.

    CAS  PubMed  Google Scholar 

  50. Weech M, Altowaijri H, Mayneris-Perxachs J, Vafeiadou K, Madden J, Todd S, et al. Replacement of dietary saturated fat with unsaturated fats increases numbers of circulating endothelial progenitor cells and decreases numbers of microparticles: findings from randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. Am J Clin Nutr. 2018;107:876–82.

    PubMed  Google Scholar 

  51. National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128:S213–56.

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Acknowledgements

We are sincerely indebted to the children and adolescents who participated in the study and to their families. We thank the dedicated staff of the Pediatric Diabetes and Metabolic Disorders Unit of the University Hospital in Verona for their support during the clinical study.

Funding

This research was funded by grants (FURMAF2019) from the University of Verona to CM.

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Authors and Affiliations

  1. Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy

    Claudio Maffeis, Margherita Cendon, Francesca Tomasselli, Mara Tommasi, Irene Bresadola, Elena Fornari, Anita Morandi & Francesca Olivieri

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  1. Claudio Maffeis
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  2. Margherita Cendon
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  3. Francesca Tomasselli
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Contributions

CM designed the study, analyzed data, and wrote the manuscript. MC and FO researched data and co-wrote the manuscript. FT, MT, IB, EF, and AM researched data. CM is the guarantor of this work and, as such, had full access to all the data in the study and take responsibility for the integrity and the accuracy of the data analysis.

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Correspondence to Claudio Maffeis.

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Maffeis, C., Cendon, M., Tomasselli, F. et al. Lipid and saturated fatty acids intake and cardiovascular risk factors of obese children and adolescents. Eur J Clin Nutr 75, 1109–1117 (2021). https://doi.org/10.1038/s41430-020-00822-0

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