Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.
Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.
Lancet Child Adolesc Health. 2020 May;4(5):359-369. doi: 10.1016/S2352-4642(20)30059-6.
Primordial and primary prevention is the cornerstone for cardiometabolic health. In the randomised, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP; n=1116), a 20-year dietary counselling intervention was given to children biannually from infancy, and cardiometabolic health benefits had been observed among the participants in the intervention group. Here, we report on the key results of the first follow-up done 6 years after the end of the intervention, at age 26 years.
The randomised controlled STRIP study recruited children at age 5 months from well-baby clinics in Turku, Finland, and randomly assigned them to either an intervention or control group; group allocation was unmasked. The intervention introduced participants to a heart-healthy diet, characterised by low proportional intake of saturated fat and cholesterol, by dietary counselling and nutrition education sessions to parents and children from the age of 7 months to 20 years. Children in the control group received only the basic health education given at Finnish well-baby clinics and school health care. We assessed diet, lifestyle, and cardiometabolic risk factor data, including blood pressure, anthropometry, serum biochemistry (lipids, apolipoproteins, glucose, and insulin), and homoeostatic model assessment of insulin resistance (HOMA-IR) in the participants at age 26 years.
1116 children were included in the original STRIP study, of whom 551 provided data at the age 26 years follow-up, and data for 507 participants were analysed (243 in the intervention group and 264 in the control group). At follow-up, those who had been in the intervention group had slightly lower mean intake of saturated fat as a proportion of total energy intake than the control group (13·0% [SD 3·3] vs 13·7% [3·6], p=0·049). A higher proportion of participants in the intervention group achieved the targeted monounsaturated and polyunsaturated fat to saturated fat ratio of more than 2:1 than the control group (78 [39%] of 200 vs 70 [30%] of 235; risk ratio [RR] 1·16 [95% CI 1·01-1·33]; p=0·035). A higher proportion of intervention group participants met the ideal total cholesterol concentration of less than 5·17 mmol/L (194 [81%] of 240 vs 187 [72%] of 261; RR 1·45 [1·05-2·01], p=0·024) and optimal LDL cholesterol concentration of less than 3·0 mmol/L (166 [69%] of 240 vs 158 [61%] of 251; RR 1·30 [1·03-1·66], p=0·031). Those who received the intervention had lower glucose (5·00 mmol/L [SD 0·43] vs 5·07 mmol/L [0·46], p=0·040) and HOMA-IR (median 1·44 [IQR 1·09-1·91] vs 1·62 [1·22-2·09], p=0·037) than the participants in the control group.
Previously observed intervention effects during the 20-year counselling were largely maintained into adulthood 6 years after the withdrawal of the intervention. Dietary counselling introduced in infancy thus provided a sustained benefit to diet quality and cardiometabolic risk factor levels.
Academy of Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Ministry of Education and Culture, Finnish Cultural Foundation, Sigrid Jusélius Foundation, Special Governmental grants for Health Sciences Research (Turku University Hospital), Yrjö Jahnsson Foundation, Finnish Medical Foundation, and Turku University Foundation.
原发和一级预防是心脏代谢健康的基石。在随机对照的特殊图尔库心血管风险因素干预项目（STRIP；n=1116）中，从婴儿期开始，每隔两年对儿童进行 20 年的饮食咨询干预，干预组的参与者已经观察到了心脏代谢健康的益处。在这里，我们报告了干预结束后 6 年，即参与者 26 岁时进行的第一次随访的关键结果。
随机对照 STRIP 研究从芬兰图尔库的婴儿诊所招募了 5 个月大的儿童，并将他们随机分配到干预组或对照组；组分配是不设盲的。该干预向参与者介绍了一种心脏健康的饮食，其特点是饱和脂肪和胆固醇的比例较低，通过对 7 个月至 20 岁的父母和儿童进行饮食咨询和营养教育课程。对照组的儿童只接受芬兰婴儿诊所和学校保健提供的基本健康教育。我们评估了饮食、生活方式和心脏代谢风险因素的数据，包括血压、人体测量、血清生化（脂质、载脂蛋白、葡萄糖和胰岛素）和稳态模型评估的胰岛素抵抗（HOMA-IR），参与者在 26 岁时提供了这些数据。
1116 名儿童参加了原始的 STRIP 研究，其中 551 名在 26 岁随访时提供了数据，507 名参与者的数据进行了分析（干预组 243 名，对照组 264 名）。在随访时，干预组的参与者平均摄入的饱和脂肪作为总能量摄入的比例略低于对照组（13.0%[标准差 3.3]比 13.7%[3.6]，p=0.049）。与对照组相比，干预组中有更高比例的参与者达到了目标单不饱和和多不饱和脂肪与饱和脂肪的比例大于 2:1（78[39%]比 200[70%]；风险比[RR]1.16[95%CI 1.01-1.33]；p=0.035）。与对照组相比，干预组中有更高比例的参与者达到了理想的总胆固醇浓度低于 5.17mmol/L（194[81%]比 241[72%]；RR 1.45[1.05-2.01]，p=0.024）和最佳 LDL 胆固醇浓度低于 3.0mmol/L（166[69%]比 251[61%]；RR 1.30[1.03-1.66]，p=0.031）。接受干预的参与者血糖（5.00mmol/L[标准差 0.43]比 5.07mmol/L[0.46]，p=0.040）和 HOMA-IR（中位数 1.44[IQR 1.09-1.91]比 1.62[1.22-2.09]，p=0.037）均低于对照组的参与者。
在 20 年的咨询期间观察到的干预效果在干预结束后 6 年进入成年期时基本保持不变。因此，婴儿期开始的饮食咨询为改善饮食质量和心脏代谢风险因素水平提供了持续的益处。
芬兰科学院、尤霍·瓦宁基金会、芬兰心血管研究基金会、芬兰教育部和文化部、芬兰文化基金会、西格里德·尤塞利乌斯基金会、政府专项健康科学研究基金（图尔库大学医院）、约尔约·雅尼森基金会、芬兰医学基金会和图尔库大学基金会。
