IntroductionIn Austria, a nationwide antigen-test-based screening program for all students and educational staff in combination with intensified non-pharmaceutical mitigation measures were initiated in February 2021. We analyzed the first 6 weeks of this program and its impact on the prevalence of asymptomatic SARS-CoV-2 carriers.MethodsDuring the study period, we evaluated the results of 1 million students and approximately 150,000 educational staff members performing self-collected anterior-nasal swabs for antigen self-tests (ANAST) 1 to 3 times a week. Prevalence of asymptomatic SARS-CoV-2 carriers was monitored by an RT-qPCR based surveillance study in a representative school cohort.ResultsDuring the 6 weeks period, 6.979 persons tested positive by ANAST, corresponding to a weekly positivity rate of median 0.08% (range 0.04–0.13) and 0.22% (range 0.12–0.30) for students and educational staff, respectively. Compared to students, staff members had a significantly higher chance of testing positive in all analyzed weeks with odds ratios (OR) up to 3.4 (95% CI: 3.0–3.8). Per week a total of 78.5–89.7% (median 84.1%) of positive ANASTs were reported as isolated cases. Evaluating the prevalence of asymptomatic SARS-CoV-2 carriers with a model adjusted for regional community incidence, the OR for having an RT-qPCR-detected SARS-CoV-2 infection after initiation of the screening program compared to earlier periods was 0.31 (95% CI 0.17–0.54; p < 0.001).DiscussionThe screening program detected a considerable number of screening-positive individuals. Their prevalence was significantly lower during the screening program consistent with a potential contribution of in-school screening programs to reducing the spread of SARS-CoV-2 in educational settings.

BackgroundPhysical activity (PA) protects against cardiovascular disease. However, previous research has shown that high PA is associated with an increased carotid intima-media-thickness (cIMT), an independent predictor for future cardiovascular disease. Our aim was to further investigate this unexpected association with two different measurement methods of PA and two established markers for Early Vascular Ageing: cIMT and carotid-femoral pulse-wave velocity (cfPWV).MethodsThe community-based Early Vascular Ageing-Tyrol cohort study included adolescents in western Austria and northern Italy. Medical examinations included anthropometric measurements, fasting blood analysis, a physician guided interview to assess lifestyle factors, measurement of cIMT and cfPWV. PA was rated by an in-person interview on the basis of average minutes of moderate- or vigorous sports per day and by the Baecke questionnaire expressed as Baecke score (BS).ResultsComplete data set was available for 1,001 adolescents with a mean age of 17.8 years (standard deviation ±0.9 years). 558 (55.7%) of participants were female. cIMT was positively associated with both measures of PA in univariate (minutes sports per day: p < 0.001; BS: p < 0.001) as well as multivariable analysis adjusting for established cardiovascular risk factors (minutes sports per day: p = 0.001; BS: p = 0.002). Using cfPWV in a multivariate model an inverse correlation with the BS (p = 0.023) was observed, but not for minutes sports per day (p = 0.554).ConclusionIn our large community-based cohort of adolescents, PA was associated with an increased cIMT but shows a trend towards lower aortic stiffness measured by cfPWV. We hypothesize that the association of PA with increased cIMT is not caused by early atherosclerotic vessel wall changes but is rather a physiologic adaptive process of the vessel wall. Trial Registration NumberThe EVA-Tyrol Study has been registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.

PURPOSE:Oral contraception is one of the most popular contraceptive methods both in adults and adolescents. However, the effects of oral contraception on lipids in adolescents are not well studied. METHODS:Lipid profiles were measured and contraceptive use was assessed in 14- to 19-year-old female participants of the prospective population-based Early Vascular Ageing-Tyrol Study between 2015 and 2018, twice on average 22 months apart. RESULTS:For this analysis, data from 828 young women with a median age of 17.0 years were available. Of them, 317 (38%) used oral contraceptives (OCs). OC users had a slightly higher systolic and diastolic blood pressure and larger changes over time and were more likely to use cigarettes than nonusers. Total cholesterol (179.6 vs. 162.4 mg/dL), low-density lipoprotein-cholesterol (106.4 vs. 94.6 mg/dL), and triglycerides (104.0 vs. 67.0 mg/dL) were significantly higher in OC users after multivariable adjustment in linear regression models. No difference in high-density lipoprotein-cholesterol between the two groups was found. In 558 females, follow-up data were available. Those who initiated OC use had on average 15.4 mg/dL higher low-density lipoprotein-cholesterol and 36.2 mg/dL higher triglyceride level changes between baseline and follow-up than never users. Duration of OC use did not show a significant association with lipid levels and changes. DISCUSSION:We showed an independent association between OC use and blood lipids as well as lipid trajectories over time in a large cohort of healthy adolescents. These changes are especially relevant to consider in adolescents with other risk factors for dyslipidemia or other cardiovascular risk factors.

Background Homocysteine (Hcy) has been associated with an adverse cardiovascular risk profile in adolescents. Assessment of the association between plasma Hcy levels and clinical/laboratory factors might improve our understanding of the pathogenesis of cardiovascular disease. Methods Hcy was measured in 1,900 14- to 19-year-old participants of prospective population-based EVA-TYROL Study (44.3% males, mean age 16.4 years) between 2015 and 2018. Factors associated with Hcy were assessed by physical examination, standardized interviews, and fasting blood analysis. Results Mean plasma Hcy was 11.3 ± 4.5 µmol/L. Distribution of Hcy was characterized by extreme right skew. Males exhibited higher Hcy and sex differences increased with increasing age. Univariate associations with Hcy emerged for age, sex, body mass index, high-density lipoprotein cholesterol, and for factors pertaining to blood pressure, glucose metabolism, renal function, and diet quality, whereas the most important multivariate predictors of Hcy were sex and creatinine. Discussion Clinical and laboratory factors associated with Hcy in adolescents were manifold, with sex and high creatinine identified as strongest independent determinants. These results may aid when interpreting future studies investigating the vascular risk of homocysteine.

Non-typhoidal Salmonella infections (NTSI) can cause bacterial diarrhea, mostly leading to self-limiting gastroenteritis. However, in at-risk populations, NTSI can have severe complications. As transmission is most commonly foodborne, infection is rare in the breast- or bottle-fed very young. Another route is increasingly implicated, however, in newborns and infants especially: Contact with reptiles and amphibians. We describe infection with Salmonella enterica subsp. enterica ser. Monschaui (S. Monschaui), transmitted from bearded dragons, in a three-week-old boy. The boy initially appeared well, on the next morning deterioration was dramatic, with tachypnea, tachycardia, and mottled skin. Gram-negative sepsis was documented on day 2. His case prompted a review of published instances of reptile- and amphibian-associated salmonellosis (RAAS), summarized here. Association of S. Monschaui infection with exposure to reptiles and amphibians prompted inquiry into household pets. The parents had kept bearded dragons (Pogona sp.), the last of which died two weeks before the patient was born; confirmation of colonization with S. Monschaui was thus precluded. Among 63 reports (−5,000 cases) of RAAS or S. Monschaui, 62 appeared between 1995 and 2022, 10 were single case reports, and 53 were original articles with −5,000 cases; vectors included turtles, frogs, lizards, and snakes. RAAS is not a new phenomenon, but its incidence recently has risen due to the increased popularity of reptiles and amphibians as non-traditional pets. These animals can carry Salmonella sp. and transmit it to humans, posing a risk particularly to infants and other vulnerable persons. Risk mitigation requires that those bringing such pets into the home be informed of dangers associated with reptile and amphibian contact; that those selling reptiles and amphibians be mandated to inform customers comprehensively may be in order.

(1) Background: Unhealthy dietary behaviors are estimated to be one of the leading causes of death globally and are often shaped at a young age. Here, we investigated adolescent diet quality and its predictors, including nutrition knowledge, in two large Central European cohorts. (2) Methods: In 3056 participants of the EVA-Tyrol and EVA4YOU prospective population-based cohort studies aged 14 to 19 years, diet quality was assessed using the AHEI-2010 and DASH scores, and nutrition knowledge was assessed using the questionnaire from Turconi et al. Associations were examined utilizing multivariable linear regression. (3) Results: The mean overall AHEI-2010 score was 42%, and the DASH score was 45%. Female participants (60.6%) had a significantly higher diet quality according to the AHEI-2010 and DASH score. AHEI-2010 and DASH scores were significantly associated (p < 0.001) with sex, school type, smoking, and total daily energy intake. The DASH score was additionally significantly associated (p < 0.001) with age, socioeconomic status, and physical activity. Participants with better nutrition knowledge were more likely to be older, to attend a general high school, to live in a high-income household, to be non-smokers, and to have a higher diet quality according to the AHEI-2010 and DASH score. (4) Conclusions: Predictors of better diet quality included female sex, physical activity, educational level, and nutrition knowledge. These results may aid focused interventions to improve diet quality in adolescents.

Background Migraine with aura is associated with an increased risk of cardiovascular disease, yet the pathophysiology is unknown. Suggested underlying mechanisms of aura formation point into the direction of an abnormal vasoreactivity that also extends to the extracranial vasculature. Methods In the Early Vascular Ageing Tyrol study, a community-based non-randomized controlled trial conducted in 45 schools and companies in Tyrol (Austria) and South-Tyrol (Italy) between May 2015 and September 2018 aiming to increase cardiovascular health in adolescents, headache syndromes were classified according to the International Classification of Headache Disorders in a face-to-face interview. Carotid-femoral pulse-wave-velocity was measured by applanation tonometry and carotid intima-media-thickness by high-resolution ultrasound of the distal common carotid arteries. Differences in pulse-wave-velocity and carotid intima-media-thickness in youngsters with migraine with aura were compared respectively to those without headache and with other headaches by multivariable linear regression analysis. Results Of the 2102 study participants 1589 were aged 14 to 19 (mean 16.8) years and had complete data. 43 (2.7%) reported migraine with aura and 737 (46.4%) other headaches. Mean pulse-wave-velocity was 6.17 m/s (± 0.85) for migraine with aura, 6.06 m/s (± 0.82) for all other headaches and 6.15 (0.95) m/s for participants without headaches. Carotid intima-media-thickness was 411.3 µm (± 43.5) for migraine with aura, 410.9 µm (± 46.0) for all other headaches and 421.6 µm (± 48.4) for participants without headaches. In multivariable linear regression analysis, we found no differences in carotid-femoral pulse-wave-velocity or carotid intima-media-thickness in young subjects with migraine with aura, all other headaches, or no headaches. Conclusions In line with previous large-scale studies in adults, we could not demonstrate relevant associations of migraine with aura with markers of arterial stiffness or subclinical atherosclerosis making early vascular ageing an unlikely pathophysiological link between migraine with aura and cardiovascular diseases. Trial registration First registered on ClinicalTrials.gov 29/04/2019 (NCT03929692).

Abstract Background and aims Preterm birth has been linked with an increased risk of cardiovascular (CV) disease from childhood into adolescence and early adulthood. In this study, we aimed to investigate differences in CV health profiles between former term- and preterm-born infants in a cohort of Tyrolean adolescents. Methods The Early Vascular Aging (EVA)-Tyrol study is a population-based non-randomized controlled trial, which prospectively enrolled 14- to 19-year-old adolescents in North Tyrol, Austria and South Tyrol, Italy between 2015 and 2018. Metrics of CV health (body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), smoking, physical activity, dietary patterns, total cholesterol and fasting blood glucose) were assessed and compared between former term- and preterm-born girls and boys. Results In total, 1,491 study participants (59.5% female, mean age 16.5 years) were included in the present analysis. SBP and DBP were significantly higher in former preterm-born adolescents (mean gestational age 34.6 ± 2.4 weeks) compared to term-born controls (p < 0.01). In the multivariate regression analysis these findings remained significant after adjustment for potential confounders in all models. No differences were found in all other CV health metrics. The number of participants meeting criteria for all seven health metrics to be in an ideal range was generally very low with 1.5% in former term born vs. 0.9% in former preterm born adolescents (p = 0.583). Conclusions Preterm birth is associated with elevated SBP and DBP in adolescence, which was even confirmed for former late preterm-born adolescents in our cohort. Our findings underscore the importance of promoting healthy lifestyles in former term- as well as preterm-born adolescents. In addition, we advise early screening for hypertension and long-term follow-up in the group of preterm-born individuals.

Background In recent years, there has been increasing evidence that asthma is associated with atherosclerosis and cardiovascular disease. However, data in children and adolescents are scarce and conflicting. We aimed to assess the impact of asthma with and without an allergic component on the carotid intima-media thickness in a large pediatric population. Methods The community-based early vascular ageing-Tyrol cohort study was performed between May 2015 and July 2018 in North, East (Austria) and South Tyrol (Italy) and recruited youngster aged 14 years and above. Medical examinations included anthropometric measurements, fasting blood analysis, measurement of the carotid intima-media thickness by high-resolution ultrasound, and a physician guided interview. Results The mean age of the 1506 participants was 17.8 years (standard deviation 0.90). 851 (56.5%) participants were female. 22 subjects had a physician diagnosis of non-allergic asthma, 268 had inhalative allergies confirmed by a positive radio-allergo-sorbent-test and/or prick test, and 58 had allergic asthma. Compared to healthy controls, participants with non-allergic asthma (411.7 vs. 411.7 µm; p = 0.932) or inhalative allergy (420.0 vs. 411.7 µm; p = 0.118) did not have significantly higher carotid intima-media thickness (cIMT). However, participants with allergic asthma had significantly higher cIMT (430.8 vs. 411.7; p = 0.004) compared to those without and this association remained significant after multivariable adjustment for established cardiovascular risk factors. Conclusion Allergic asthma in the youth is associated with an increased carotid intima-media thickness. Physicians should therefore be aware of allergic asthma as a potential cardiovascular risk factor in children and adolescents. Trial Registration Number The EVA-Tyrol Study has been retrospectively registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.

Background and aims: Assessment of comprehensive lipoprotein subclass profiles in adolescents and their relation to vascular disease may enhance our understanding of the development of dyslipidemia in early life and inform early vascular prevention.& nbsp;Methods: Nuclear magnetic resonance was used to measure lipoprotein profiles, including lipids (cholesterol, free cholesterol, triglycerides, phospholipids) and apolipoproteins (apoB-100, apoA1, apoA2) of 17 lipoprotein subclasses (from least dense to densest: VLDL-1 to-6, IDL, LDL-1 to-6, HDL-1 to-4) in n = 1776 14-to 19-year olds (56.6% female) and n = 3027 25-to 85-year olds (51.5% female), all community-dwelling. Lipoprotein profiles were related to carotid intima-media thickness (cIMT) as ascertained by sonography.& nbsp;Results: Adolescents compared to adults had lower triglycerides, total, LDL, and non-HDL cholesterol, and apoB, and higher HDL cholesterol. They showed 26.6-59.8% lower triglyceride content of all lipoprotein subclasses and 21.9-51.4% lower VLDL lipid content. Concentrations of dense LDL-4 to LDL-6 were 36.7-40.2% lower, with also markedly lower levels of LDL-1 to LDL-3, but 24.2% higher HDL-1 ApoA1. In adolescents, only LDL-3 to LDL5 subclasses were associated with cIMT (range of differences in cIMT for a 1-SD higher concentration, 4.8-5.9 mu m). The same associations emerged in adults, with on average 97 +/- 42% (mean +/- SD) larger effect sizes, in addition to LDL-1 and LDL-6 (range, 6.9-11.3 mu m) and HDL-2 to HDL-4, ApoA1, and ApoA2 (range,-7.0 to-17.7 mu m).& nbsp;Conclusions: Adolescents showed a markedly different , more favorable lipoprotein profile compared to adults. Dense LDL subclasses were the only subclasses associated with cIMT in adolescents, implicating them as the potential preferred therapeutic target for primary prevention of cardiovascular disease at this age. In adults, associations with cIMT were approximately twice as large as in adolescents , HDL-related measures were additionally associated with cIMT.

PURPOSE:A significant proportion of noncommunicable diseases in adults has its roots in adolescence, and this is particularly true for cardiovascular disease and stroke. Detection of vascular and metabolic risk factors at young ages may aid disease prevention. METHODS:In 2,088 adolescents sampled from the general population of Tyrol, Austria, and South Tyrol, Italy, we systematically assessed the frequency of yet unknown vascular and metabolic risk conditions that require further diagnostic workup or intervention (lifestyle counselling or pharmacotherapy). The health screening included medical history taking, fasting blood analysis, and blood pressure and body measurements and was performed at schools. To recruit a representative sample of adolescents, equal proportions (about 67%) of schools were invited per school type and region. RESULTS:Adolescents were on average 16.4 (standard deviation 1.1) years old, and 56.4% were female. A proportion of 22.8% (95% confidence interval [CI], 19.6-26.3) had previous or current physician-confirmed diseases. The health screening newly detected relevant medical conditions in 45.4% [95% CI, 41.5-49.4] (55.8% [95% CI, 52.7-58.7] in boys and 37.4% [95% CI, 35.0-39.8] in girls, p < .001). The most prevalent were elevated blood pressure and hypertension, metabolic syndrome, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and subclinical hypothyroidism. Detection of risk conditions did not depend on socioeconomic status but increased with age and body mass index. CONCLUSIONS:Vascular health screening in adolescents at schools has a high diagnostic yield and may aid guideline-recommended prevention in the youth. Implementation should carefully consider national differences in healthcare systems, resources, and existing programs.

Vorüber100JahrenwurdemitderAlkaptonurie erstmals eine angeborene Stoffwechselstörung beschrieben [1]. Inzwischensind fast 1500bekannt.Bei angeborenen Stoffwechselstörungen kommt es im Allgemeinen durch einen Gendefekt zu einer eingeschränkten oder vollständig fehlenden Funktion eines Enzyms und damit zu einer Störung eines Stoffwechselweges. Als Folge stauen sich die Substrate vor demEnzymdefekt an, während die Produkte nach dem Enzymdefekt fehlen [2].Nicht immer resultiert aus der Stoffwechselstörung eine Stoffwechselkrankheit. Dies ist auch das Ziel einer Therapie, sofern verfügbar.

This study evaluates the performance of the antigen-based anterior nasal screening programme implemented in all Austrian schools to detect SARS-CoV-2 infections. We combined nationwide antigen-based screening data obtained in March 2021 from 5,370 schools (Grade 1-8) with an RT-qPCR-based prospective cohort study comprising a representative sample of 244 schools. Considering a range of assumptions, only a subset of infected individuals are detected with the programme (low to moderate sensitivity) and non-infected individuals mainly tested negative (very high specificity).

Background Cardiovascular disease depends on the duration and time course of risk factor exposure. Previous reports on risk factors of progression of carotid intima‐media thickness (cIMT) in the young were mostly restricted to high‐risk populations or susceptible to certain types of bias. We aimed to unravel a risk factor signature for early vessel pathology based on repeated ultrasound assessments of the carotid arteries in the general population. Methods and Results Risk factors were assessed in 956 adolescents sampled from the general population with a mean age of 15.8±0.9 years, 56.2% of whom were female. cIMT was measured at baseline and on average 22.5±3.4 months later by high‐resolution ultrasound. Effects of baseline risk factors on cIMT progression were investigated using linear mixed models with multivariable adjustment for potential confounders, which yielded significant associations (given as increase in cIMT for a 1‐SD higher baseline level) for alanine transaminase (5.5 μm; 95% CI: 1.5–9.5), systolic blood pressure (4.7 μm; 0.3–9.2), arterial hypertension (9.5 μm, 0.2–18.7), and non‐high‐density (4.5 μm; 0.7–8.4) and low‐density lipoprotein cholesterol (4.3 μm; 0.5–8.1). Conclusions Systolic blood pressure, arterial hypertension, low‐density and non‐high‐density lipoprotein cholesterol, and alanine transaminase predicted cIMT progression in adolescents, even though risk factor levels were predominantly within established reference ranges. These findings reemphasize the necessity to initiate prevention early in life and challenge the current focus of guideline recommendations on high‐risk youngsters. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03929692.

To the Editor: Emerging in China in December 20191 and classified by the World Health Organization as causing pandemic disease in March 2020,2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major challenge in most nations. Austria, especially the region of Tyrol, is no exception. Currently, within a Tyrolean pediatric population of ≈132 000 aged <18 years,3 63 (0.05%) have had SARSCoV-2 detected by PCR. Only two have been admitted to our pediatric department. In general, COVID-19 in children is rare, specifically in thoseaged<10years, and its courseappearsmilder than in adults.4-6 However, some severe and even fatal cases in children have been reported.7,8 Systemic immunosuppression renders adult patients with cancer more susceptible to infection,9 possibly conferring an adverse prognosis in COVID-19. Due to lack of literature, reassurance that SARS-CoV-2 infection per se is not life threatening to the most vulnerable children with aggressive cancer therapy is of immediate general interest. Hence, we report the case of a 7-year-old female patient with proven SARS-CoV2 infection duringmaintenance therapy of acute lymphocytic leukemia (ALL). ALL, diagnosed at age 6 years inOctober 2018, was treated according to the AIEOP-BFM 2009 protocol,10 with reinduction completed in May 2019. Since then the child has received maintenance therapy (daily 6-mercaptopurine, weekly methotrexate). In December 2019, fever during bone marrow suppression prompted hospital admission, with discharge early in January 2020. Maintenance therapy was continued in a reduced dosage and gradually increased (target dosage, methotrexate 20mg/m2 bymouth onceweekly, and 6-mercaptopurine 50mg/m2 bymouth once daily). In mid-March, leukopenia, 1.5 G/L, and thrombocytopenia, 50 000G/L, prompted a reduction inmaintenance therapy. Three days later, COVID-19was diagnosed in the patient’s mother and the patient was reportedly febrile at night. Maintenance therapy was immediately suspended; as the patient’s general health was good, she remained at home. Another 3 days later (day 4 of illness), high nonremitting fever with malaise prompted the child’s hospital admission to a special isolation ward. On evaluation, the patient’s vital signs were unremarkable (heart rate 100 bpm, blood pressure 100/67 mm Hg, eupnea, temperature 36.0◦C). On room air, oxygen saturation was 100%. Mild rhinitis was evident; her skin was pale, without petechiae or purpura, although small hematomata were present. Pneumonia was not clinically suspected, and roentgenograms were not obtained. Pancytopenia was present (leukocytes 0.8 G/L with neutrophils 0.5 G/L and lymphocytes 0.22 G/L, thrombocytes 5 G/L, hemoglobin 102 g/L); C-reactive protein (CRP) and interleukin-6 values were elevated at 21.7 mg/L and 20.6 ng/L, respectively. A blood culture yielded no growth. SARS-CoV-2 genomic sequences were detected in a nasopharyngeal sample by PCR testing. Cefuroxime, begun on admission, was replaced the same day by meropenem (60 mg/kg/day in three doses) and gentamicin (5 mg/kg/day in one dose). Thrombocyte concentrates were transfused (15 mL/kg). Small blisters developed on the tongue, and acyclovir was begun (30 mg/kg/day in three doses; day 1). Lassitudeworsened (day5),with upward fluctuation inCRPvalues, and vancomycin was begun (40 mg/kg/day in two doses), with thereafter a fall in CRP and rise in leukocyte numbers (Figure 1). Fever resolved (Figure S1) andgentamicin andacyclovirwere terminated (day 7), as was vancomycin (day 8). SARS-CoV-2 RNA sequences were no longer detectable in the nasopharyngeal sample on day 9 (day 13 of illness). Laboratory findings on day 10 demonstrated improvement of blood counts (leukocytes 1.4 G/L, thrombocytes 63 G/L, and hemoglobin 91 g/L, with CRP 4.9 mg/L). On day 10, as the patient had been without signs or symptoms of COVID-19 for 4 days, meropenem was stopped and she was discharged home in good general condition. ALLmaintenance therapy was resumed oneweek after discharge. Of interest is that both parents worked in Tyrolean “hot spots” for COVID-19. The patient’s brother was mildly ill when COVID-19 was diagnosed in the mother; he was not tested. The father was tested twice, without infection found. Our experience with this patient—so far as we know, the first child with COVID-19 during pancytopenia induced bymaintenance therapy for ALL—suggests reassuringly that the course of COVID-19 in pediatric patients can bemild even if assessed risk for complications is high, as with immunosuppression and pancytopenia. Our patient had only mild rhinitis with remitting fever and lingual blisters. Antibiotic and antiviral therapy was associated with swift improvement. Most importantly, her pulmonary status was clinically stable throughout her illness.

OBJECTIVE:To assess the time point during infancy and early childhood at which greater than expected weight gain is associated with overweight in adolescence. STUDY DESIGN:Current height, weight, and body mass index (BMI) were assessed in 1520 adolescents (mean age of boys, 15.52 ± 0.84 years; mean age of girls, 15.37 ± 0.77 years). Information on weight and height trajectories during infancy and early childhood (birth and 6 other time points) was extracted from mother-child booklets. Conditional relative weights were computed to estimate greater or lower than expected weight gain (ie, soft tissue gain at a specific age independent of linear growth), and their association with BMI in adolescence was investigated using linear regression analysis. RESULTS:The mean BMI in adolescence was 21.77 ± 3.69 in boys and 21.70 ± 3.50 in girls. The proportion of overweight was 14.8% in each group. Overweight adolescents had significantly higher weight z-scores at birth, 1.2 month, 3.3 months, 7.6 months, 1 year, 2 years, and 4 years of age as compared with normal-weight adolescents. There were significant positive associations of weight z-scores and conditional relative weights with adolescent BMI at all ages except birth, which were strongest after the first year of life. In a majority of overweight adolescents, overweight had manifested within the first 4 years of life. CONCLUSIONS:Greater than expected weigh gain at any time in the first years of life is associated with an increased BMI in adolescence. The effect is strongest after the first year.

Introduction: Atherosclerosis begins in early life. Assessment of comprehensive lipoprotein subclass profiles in adolescents and their relation to atherosclerosis may enhance our understanding of the development of dyslipidemia in early life and inform early vascular prevention Hypothesis: Lipoprotein subclass profiles in adolescents are distinct from those in adults and associate with carotid intima-media thickness (cIMT). Methods: Content of lipids (cholesterol, free cholesterol, triglycerides, phospholipids) and apolipoproteins (apoB-100, apoA1, apoA2) of 17 lipoprotein subclasses (from least dense to densest: VLDL1-6, IDL, LDL1-6, HDL1-4) was measured in plasma of n=1776 14- to 19-year olds (56.6% female) and of n=3217 adults (51.5% female) by nuclear magnetic resonance. cIMT was ascertained by sonography in adolescents. Results: Adolescents compared to adults featured lower triglycerides, total, LDL, and non-HDL cholesterol, and apoB, and higher HDL cholesterol. They showed 27.2 to 60.5% lower triglyceride content of all lipoprotein subclasses and 21.7 to 50.0% lower VLDL lipid content. Concentrations of LDL-4 and LDL-5 were 40.7 to 47.3% lower, with markedly lower levels also of LDL-6 and LDL-3, but 24.3% higher HDL-1 ApoA1. In adolescents, LDL-3, LDL-4, and LDL-5 subclasses were associated with cIMT (difference in cIMT for a 1-SD higher concentration, 4.76 to 5.93μm), whereas no significant association with cIMT was observed for VLDL or HDL. Conclusions: Adolescents showed a markedly different and more favorable lipoprotein profile compared to adults. Dense LDL subclasses were the only subclasses associated with cIMT, implicating them as the potential preferred therapeutic target for primary prevention of cardiovascular disease in adolescents.