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      Improved nutrition in early life and pulse wave velocity and augmentation index in mid-adulthood: Follow-up of the INCAP Nutrition Supplementation Trial Longitudinal Study

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          Abstract

          Nutrition in pregnancy and early childhood affects later blood pressure and precursors of atherosclerosis, but its influence on arterial stiffness is unexplored. This study determines whether exposure to improved nutrition during early life influences Augmentation index (AI) and pulse wave velocity (PWV) in mid-adulthood. We included 1221 adults (37-54y) who participated in a cluster-randomized nutritional supplementation trial of a protein-energy beverage ( Atole), conducted between 1969–1977 in Guatemala. The comparison group received Fresco, a low-calorie protein-free beverage. In 2015–17, we measured anthropometry (weight, height, and waist-to-height ratio); AI and PWV (using carotid—femoral tonometry); blood pressure; fasting plasma glucose and serum lipids; and sociodemographic characteristics. Based on patterns of exposure, we characterized participants as fully, partially or unexposed to the intervention from conception to their second birthday (the ‘first 1000 days’). We fit pooled and sex-specific models using intention-to-treat, difference-in-difference regression analysis to test whether exposure to the supplement in the first 1000 days was associated with AI and PWV in adulthood adjusting for basal and current sociodemographic variables and current life-style and cardio-metabolic risk factors. Prevalence of obesity in men and women was 39.6% and 19.6%, and prevalence of hypertension was 44.0% and 36.0%, respectively. Women had higher AI (34.4±9.6%) compared to men (23.0± 9.8%), but had similar PWV (7.60±1.13 m/s and 7.60±1.31, respectively). AI did not differ significantly across intervention groups. PWV was lower in individuals with full exposure to the supplement during the first 1000 days (-0.39m/s, 95% CI -0.87, 0.09; p = 0.1) compared to unexposed individuals. This difference was similar after adjusting for cardio-metabolic risk factors (-0.45m/s; 95%C-0.93, 0.01; p = 0.06). Exposure to improved nutrition during the first 1000 days was marginally associated with lower PWV, but not with AI.

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          Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis.

          Our aim was to differentiate the screening potential of waist-to-height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI). We undertook a systematic review and meta-analysis of studies that used receiver operating characteristics (ROC) curves for assessing the discriminatory power of anthropometric indices in distinguishing adults with hypertension, type-2 diabetes, dyslipidaemia, metabolic syndrome and general cardiovascular outcomes (CVD). Thirty one papers met the inclusion criteria. Using data on all outcomes, averaged within study group, WHtR had significantly greater discriminatory power compared with BMI. Compared with BMI, WC improved discrimination of adverse outcomes by 3% (P < 0.05) and WHtR improved discrimination by 4-5% over BMI (P < 0.01). Most importantly, statistical analysis of the within-study difference in AUC showed WHtR to be significantly better than WC for diabetes, hypertension, CVD and all outcomes (P < 0.005) in men and women. For the first time, robust statistical evidence from studies involving more than 300 000 adults in several ethnic groups, shows the superiority of WHtR over WC and BMI for detecting cardiometabolic risk factors in both sexes. Waist-to-height ratio should therefore be considered as a screening tool. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
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            2. Classification and Diagnosis of Diabetes.

            (2017)
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              WEIGHT IN INFANCY AND DEATH FROM ISCHAEMIC HEART DISEASE

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                Author and article information

                Contributors
                Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 October 2020
                2020
                : 15
                : 10
                : e0239921
                Affiliations
                [1 ] INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
                [2 ] Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, Georgia, United States of America
                University of Tasmania, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-8631-3101
                https://orcid.org/0000-0002-6463-5094
                Article
                PONE-D-20-13660
                10.1371/journal.pone.0239921
                7591084
                33108379
                df163329-3c25-4665-8c00-848685a19293
                © 2020 Kroker-Lobos et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 May 2020
                : 15 September 2020
                Page count
                Figures: 1, Tables: 3, Pages: 14
                Funding
                Funded by: National Institutes of Health (US)
                Award ID: HD-075784
                Award Recipient :
                This work was supported by the National Institutes of Health (USA) under grant HD-075784. ADS received the award. https://www.nih.gov/ The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Physical Sciences
                Materials Science
                Material Properties
                Mechanical Properties
                Stiffness
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Physical Sciences
                Chemistry
                Chemical Compounds
                Organic Compounds
                Carbohydrates
                Monosaccharides
                Glucose
                Physical Sciences
                Chemistry
                Organic Chemistry
                Organic Compounds
                Carbohydrates
                Monosaccharides
                Glucose
                Medicine and Health Sciences
                Cardiology
                Heart Rate
                Biology and Life Sciences
                Biochemistry
                Proteins
                Lipoproteins
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Custom metadata
                The data contain potentially identifying and sensitive participant information. Due to privacy considerations imposed by the INCAP Institutional Ethics Committee, the data are not publicly available. Requests for access to the data may be made to the INCAP Institutional Ethics Committee and to the corresponding author by researchers whose activities are reviewed by a Research Ethics Committee and who agree to sign an appropriate confidentiality agreement. President of INCAP Ethics Committee: Valentina Santacruz vsantacruz@ 123456incap.int .

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