Quantitative rankings of multiple dietary patterns for their effects on non-communicable disease (NCD) biomarkers is lacking and would inform primary prevention strategies. Accordingly, a network meta-analysis (NMA) was conducted to compare and rank the effects of different dietary patterns on NCD biomarkers, and associations of dietary patterns’ underlying macronutrient composition with NCD biomarkers were determined by a nutritional geometry approach. Randomised controlled trials (RCTs) were eligible for inclusion if they enrolled healthy participants, employed food-based dietary pattern interventions without energy restriction, and reported NCD biomarker outcomes. NCD biomarkers were included as an outcome if ≥10 trials were available. A systematic search of five electronic databases identified 4008 records. Sixty-eight articles from 59 RCTs reporting lipids, glycemic, and inflammatory biomarkers were included for quantitative syntheses. Risk-of-bias was predominantly categorized as low or having some concerns, and confidence-of-evidence low. Relative to western habitual diet, the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), dietary guidelines-based, plant-based, and low-fat diets reduced low-density lipoprotein cholesterol (mean difference range: −0.29 to −0.17 mmol/L), total cholesterol (−0.36 to −0.24 mmol/L), and apolipoprotein B (−0.11 to −0.07 g/L) (all p < 0.05); the Paleo, plant-based and dietary guidelines-based diets reduced homeostasis model assessment of insulin resistance (−0.95 to −0.35, all p < 0.05). No dietary pattern ranked consistently highest. The Paleo diet received the highest all-outcomes-combined average Surface Under the Cumulative Ranking Curve value (67%), followed by DASH (62%) and Mediterranean diets (57%), whereas western habitual diet was lowest (36%). Our findings were independent of macronutrient composition, highlighting the significance of dietary pattern-level analysis.

Background: Non-invasive methods assessing subclinical atherosclerosis, such as carotid intima-media thickness (IMT) and carotid-femoral pulse wave velocity (cfPWV), are well-described in adults but less so in the paediatric population. Other techniques, such as aortic IMT, may be more appropriate in children. This study aimed to characterise age-related changes to arterial vasculature using best practice methodology for these measures. Methods: This cross-sectional study involved 97 healthy volunteers aged 2 to 20 (mean age 11.2 years [SD 5.1]). Carotid and aortic IMT were measured using high-resolution ultrasound. A validated semi-automated cuff-based device was used to measure cfPWV. Results: Aortic IMT showed a significant age-related increase of 9 μm per year [95% CI: 6, 12], p < 0.0001) during childhood and adolescence, whilst carotid IMT was significantly associated with male sex (29 μm per year [95% CI: 11, 48], p = 0.002) during this period. cfPWV exhibited an age-related increase from nine years of age onwards (0.11 ms ^-1 per year [95% CI: 0.06, 0.15], p < 0.001). Conclusions: Age-related changes in the arterial vasculature vary between sites and methodologies. During childhood, aortic IMT appears to be a more sensitive marker for early structural changes and should be prioritised over carotid IMT and cfPWV. Impact: Understanding age-related changes in arterial vasculature via non-invasive measures is poorly described in childhood and adolescence. This study finds that the timing and magnitude of age-related changes vary across arterial beds and between non-invasive measures in the first two decades of life. Aortic intima-media thickness is a more age-appropriate measure of early structural changes in the young than the more widely used carotid intima-media thickness. Furthermore, carotid-femoral pulse wave velocity, a measure of aortic stiffness, is best evaluated in late childhood and adolescence and likely has little relevance in early childhood.

Objectives: Non-invasive methodologies for assessing arteriosclerosis, including carotid intimal-medial thickness (cIMT) for assessing subclinical atherosclerosis and carotid-femoral pulse wave velocity (cfPWV) for measuring arterial stiffness, are well established and validated in adults [1, 2]. However, they are less well-described in children. Alternative methodologies, such as aortic IMT (aIMT), may be more appropriate in children provided the natural history of atherosclerotic disease [3]. Previous studies have predominantly applied these methodologies in a narrow age-range of children; methodological differences between studies make inter-study comparison of absolute values difficult. Therefore, we aimed to assess the severity of arteriosclerosis across childhood and adolescence using standardised application of age-appropriate and established methodologies. Methods: We prospectively recruited 97 healthy children aged 2 to 20 (mean age = 11.2 ± 5.12 years old; stratified into five sex-balanced age groups). cIMT and aIMT were assessed via high-resolution B-mode ultrasonography. cfPWV was assessed via a semi-automated cuff-based device (Sphygmocor XCEL; AtCor Medical, Australia). Results: aIMT increased with age (9 μm per year [95% CI: 6, 12], p < 0.0001), whereas cIMT did not meaningfully increase with age (2 μm per year [95% CI: −1, 5], p = 0.14). cfPWV remained relatively stable during early childhood, with an apparent increase from adolescence onwards. Conclusions: Carotid and aortic atherosclerosis both increase throughout childhood, although this increase is greatest in the aorta. The aorta begins to stiffen during adolescence. Assessment of aortic arteriosclerosis is feasible in childhood and adolescence, and should be prioritised over assessment of carotid atherosclerosis in this age group.

Carotid intima-media thickness (IMT), measured using high-resolution B-mode ultrasonography, is a widely utilized surrogate marker of subclinical atherosclerosis, the pathophysiological process underlying most clinical cardiovascular disease events. Atherosclerosis is a gradual disease that originates early in life, thus, there has been increased interest in measuring carotid IMT in childhood and adolescence to assess structural change in the arterial vasculature in response to adverse exposures. However, the timing of atherosclerosis varies across the vascular tree. Primordial atherosclerotic lesions are present in the abdominal aorta as early as infancy, compared to mid-adolescence for the common carotid. Measurement of IMT at either site is susceptible to several technical challenges that need to be considered, especially in younger children. In this paper, we provide a detailed stepwise method for high-quality assessment of IMT of the abdominal aorta and common carotid artery in the young. We also provide insight into the appropriateness of either site when exploring the associations between early-life exposures and later-life cardiovascular disease.

Evidence from animal models indicates that maternal diet during pregnancy affects offspring cardiometabolic health. Improving carbohydrate quality during high-risk pregnancies reduces aortic intima-medial thickness; a marker for early atherosclerosis; in the infant offspring. We sought to determine whether maternal carbohydrate quantity and quality are associated with newborn aortic intima-medial thickness in healthy pregnancies. Maternal diet throughout pregnancy was evaluated in 139 mother–child dyads using a validated food frequency questionnaire. Carbohydrate intake was expressed as quantity (% total energy), quality (fibre, glycaemic index), and glycaemic burden (glycaemic load). Aortic intima-medial thickness was measured by high-frequency ultrasound of the neonatal abdominal aorta. Neither quantity nor quality of maternal carbohydrate intake during pregnancy was associated with meaningful differences in offspring maximum aortic intima-medial thickness with the exception of fibre intake in women with overweight or obesity which was inversely associated (−8 μm [95% CI −14, −1] per g fibre, p = 0.04). In healthy pregnancy, the quantity and quality of maternal carbohydrate intake is likely not a meaningful modifiable lifestyle factor for influencing offspring vascular health. The effect of carbohydrate quality may only be evident in high-risk pregnancies, consistent with previous findings. These findings may be confirmed in prospective dietary trials in pregnancy.

Background: Excessive weight gain (EWG) in childhood may increase cardiovascular disease risk in adulthood, but its relationship to early vascular health remains poorly understood. This study investigated the relationship between EWG and aortic intima-media thickness (aIMT), a non-invasive ultrasound imaging marker of early vascular health, and explored maternal and child factors that may influence growth and aIMT during early childhood. Methods: Mother–child pairs from the BABY1000 pilot cohort were followed from early pregnancy to 24 months. Maternal and birth data were collected via questionnaires and medical records. Child anthropometry and aIMT were measured at 6 weeks and 24 months. EWG was defined as a > 0.67 SD increase in weight-for-length/height z-score from birth. Maternal pregnancy diet and child diet at 24-months was assessed with age-specific Australian Eating Survey® food frequency questionnaires. Linear regression was used to examine associations among growth, diet, and aIMT. Results: Of 182 births, 102 infants at 6 weeks and 83 children at 24 months had aIMT data. 26% of children at 6 weeks and 45% at 24 months had EWG, but it was not associated with aIMT at either follow-up. No associations were found between maternal or child diet and growth or aIMT. Conclusions: Measuring aIMT in early childhood is feasible; however, larger studies are needed to clarify early-life influences on cardiovascular health. Impact: Excessive weight gain (EWG) in childhood is associated with increased risk for later-life cardiovascular disease. Understanding these associations is complicated by confounding from maternal and perinatal factors and the long interval between exposure and disease outcomes. In this pilot study, we longitudinally measured aortic intima-media thickness (aIMT) in children, an age-appropriate marker of vascular health, and examined associations with early growth, maternal, and perinatal factors. EWG was not associated with aIMT during early childhood. Early childhood is important for long-term health promotion; however, more research is needed to clarify how exposures during this period affect later cardiovascular health.