Phylloquinone Intake Is Associated with Cardiac Structure and Function in Adolescents

Abstract

Background: Associations between childhood vitamin K consumption and cardiac structure and function have not been investigated.

Objective: We determined associations between phylloquinone (vitamin K-1) intake and left ventricular (LV) structure and function in adolescents.

Methods: We assessed diet with three to seven 24-h recalls and physical activity (PA) by accelerometry in 766 adolescents (aged 14-18 y, 50% female, 49% black). Fat-free soft tissue (FFST) mass and fat mass were measured by dual-energy X-ray absorptiometry. LV structure [LV mass (g)/height (m)2.7 (LV mass index) and relative wall thickness] and function [midwall fractional shortening (MFS) and ejection fraction] were assessed by echocardiography. Associations were evaluated by comparing the LV structure and function variables across tertiles of phylloquinone intake. Prevalence and OR of LV hypertrophy (LV mass index >95th percentile for age and sex) were also assessed by phylloquinone tertiles.

Results: The prevalence of LV hypertrophy progressively decreased across tertiles of phylloquinone intake (P-trend < 0.01). Multinomial logistic regression-adjusting for age, sex, race, Tanner stage, systolic blood pressure, FFST mass, fat mass, socioeconomic status, PA, and intakes of energy, fiber, calcium, vitamin C, vitamin D, and sodium-revealed that compared with the highest phylloquinone intake tertile (reference group), the adjusted OR for LV hypertrophy was 3.3 (95% CI: 1.2, 7.4) for those in the lowest phylloquinone intake tertile. When LV structure variables were compared across phylloquinone intake tertiles adjusting for the same covariates, there were significant linear downward trends for LV mass index (6.5% difference, tertile 1 compared with tertile 3) and relative wall thickness (9.2% difference, tertile 1 compared with tertile 3; both P-trend ≤ 0.02). Conversely, significant linear upward trends across phylloquinone intake tertiles were observed for MFS (3.4% difference, tertile 1 compared with tertile 3) and ejection fraction (2.6% difference, tertile 1 compared with tertile 3; both P-trend < 0.04).

Conclusion: Our adolescent data suggest that subclinical cardiac structure and function variables are most favorable at higher phylloquinone intakes.

Keywords: cardiovascular disease; children; echocardiography; left ventricular hypertrophy; left ventricular mass; phylloquinone.

Conflict of interest statement

Author disclosures: MKD, MEF, JTN, CFW, AHJ, BG, and NKP, no conflicts of interest.

© 2017 American Society for Nutrition.

Figures

FIGURE 1

Probability of LV hypertrophy across tertiles of daily phylloquinone intake in 766 adolescents aged 14–18 y. Median (range) intakes of phylloquinone were as follows: tertile 1 = 32 μg/d (8–42 μg/d), n = 255; tertile 2 = 54 μg/d (43–65 μg/d), n = 255; and tertile 3 = 90 μg/d (66–386 μg/d), n = 256. OR (95% CI) values were adjusted for age, sex, race, Tanner stage, systolic blood pressure, fat-free soft tissue mass, fat mass, socioeconomic status, moderate and vigorous physical activity, and dietary intakes of total energy, fiber, calcium, vitamin C, vitamin D, and sodium. LV, left ventricular; Ref, reference group.

FIGURE 2

Cardiac structure variables, including LV mass index (A), relative wall thickness (B), septal wall thickness in diastole (C), posterior wall thickness in diastole (D), LV internal diameter in diastole (E), LV internal diameter in systole (F), end-diastolic volume (G), and end-systolic volume (H), across tertiles of daily phylloquinone intake in 766 adolescents aged 14–18 y. Median (range) intakes of phylloquinone were as follows: tertile 1 = 32 μg/d (8–42 μg/d), n = 255; tertile 2 = 54 μg/d (43–65 μg/d), n = 255; and tertile 3 = 90 μg/d (66–386 μg/d), n = 256. Values are adjusted means ± SEMs. Means were adjusted for age, sex, race, Tanner stage, systolic blood pressure, fat-free soft tissue mass, fat mass, socioeconomic status, moderate and vigorous physical activity, and dietary intakes of total energy, fiber, calcium, vitamin C, vitamin D, and sodium. Labeled means without a common lowercase letter differ, P < 0.05. LV, left ventricular.

FIGURE 3

Cardiac function variables, including endocardial fractional shortening (A), midwall fractional shortening (B), and ejection fraction (C), across tertiles of daily phylloquinone intake in 766 adolescents aged 14–18 y. Median (range) intakes of phylloquinone were as follows: tertile 1 = 32 μg/d (8–42 μg/d), n = 255; tertile 2 = 54 μg/d (43–65 μg/d), n = 255; and tertile 3 = 90 μg/d (66–386 μg/d), n = 256. Values are adjusted means ± SEMs. Means were adjusted for age, sex, race, Tanner stage, systolic blood pressure, fat-free soft tissue mass, fat mass, socioeconomic status, moderate and vigorous physical activity, and dietary intakes of total energy, fiber, calcium, vitamin C, vitamin D, and sodium. Labeled means without a common lowercase letter differ, P < 0.05.