Metabolic Syndrome Yields to Diet, Lifestyle Counseling From Infancy

Pam Harrison

January 29, 2015

TURKU, FINLAND — A diet- and lifestyle-counseling program aimed at kids, initiated when they were infants and provided through parents and school, seemed to drop the rate of metabolic syndrome (MetS) by about 40% by the time they had reached aged 15 to 20, in a randomized trial conducted here[1].

"The primary target of the study was to modify the quality of fat, with anticipated effects on serum lipoprotein levels, especially low-density-lipoprotein cholesterol," principal investigator Dr Olli Raitakari (University of Turku, Finland) told heartwire by email.

"Based on our [observation] that individuals in the intervention [counseling] group had better insulin sensitivity, as judged by lower insulin levels, we did expect to see lower rates of the metabolic syndrome," he said. But he and his colleagues didn't expect such a steep reduction.

"We considered that the 41% risk reduction in MetS was surprisingly large, because the differences in individual components of the MetS were rather modest."

The findings came from the Special Turku Coronary Risk Factor Intervention Project (STRIP), which randomized 1062 infants and their families, recruited through well-baby clinics, to a diet- and lifestyle-counseling arm (n=540) or a nonintervention control group (n=522).

The children were aged 15 to 20 at the follow-up in the current report, published online January 20, 2015 in Circulation, with lead author Mari Nupponen (Research Centere of Applied and Preventive Cardiovascular Medicine, Turku, Finland).

"The main target of the counseling was to replace saturated fat with unsaturated fat in the child's diet," with information on salt-reduction strategies and recommendations to favor whole grains, fruits, and vegetables. Counseling was directed at the parents until the subjects reached age seven. Thereafter, information was provide to the children gradually, with primary prevention of smoking introduced at age eight along with encouragement of a physically active lifestyle.

The prevalence of MetS at follow-up was 6% to 7.5% in the intervention group and 10% to 14% in the control group, depending on use of either modified International Diabetes Federation or National Cholesterol Education Program criteria for measurements of waist circumference, blood pressure, triglycerides, glucose, and HDL cholesterol. The long-term relative risk (RR) of MetS was significantly lower in the intervention group (RR=0.59, 95% CI=0.40–0.88; P=0.009).

"Although the intervention was only modestly associated with the components of MetS when continuous variables were used, we found significant differences when dichotomized components were compared," the group writes. Males and females in the intervention group showed significant reductions in RR of elevated blood pressure (0.83, 95% CI=0.70–0.99) and, for boys only, of high triglycerides (0.71, 95% CI=0.52–0.98). A trend toward reduced risk of high waist circumference was seen in the intervention group (0.78, 95% CI=0.59–1.03).

Nupponen et al write that they observed that "associations between the components of MetS seemed to be stronger in the control group than in the intervention group, although statistical significance was not reached."

Therefore, they propose, "small, favorable shifts in the individual components among the intervention group in combination with tendency to stronger associations between the components in the control group largely explain the observed result of strong protective intervention effect on MetS, while weaker associations are found for the components."

In an accompanying editorial[2], Dr Matthew Gillman (Harvard School of Public Health, Boston, MA) argues that because atherosclerosis starts in youth and is related to well-described risk factors, primordial prevention must start early in life.

"Over the past two decades, a literature has emerged suggesting that starting interventions very early—as early as infancy and perhaps before—may be an especially effective approach to prevent chronic disease over the life course."

As he notes, the first 1000 days from conception to preschool age are a period of maximal developmental plasticity. "Prevention interventions during this period may thus set individuals on the best possible trajectories of lifelong cardiovascular health, whereas later inventions, even those in later childhood or adolescence, may be stymied by inadequate physiological responses."

The study was supported by a number of government and organizations in Finland, including the Finnish Ministry of Education and Culture and the Finnish Cardiac Research Foundation. The authors have no relevant financial relationships. Gillman discloses receiving royalties from Cambridge University Press as coeditor of book titled Maternal Obesity and from UpToDate as author of the chapter on dietary fat.


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