title: Vitamins and iron blood biomarkers are associated with blood pressure levels in European adolescents. The HELENA study.
abstract: OBJECTIVE
  Previous research showed that low concentration of biomarkers in the blood during adolescence (i.e., iron status; retinol; and vitamins B6, B12, C, and D) may be involved in the early stages of development of many chronic diseases, such as hypertension. The aim was to evaluate if iron biomarkers and vitamins in the blood are associated with blood pressure in European adolescents.
  
  
  METHODS
  Participants from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (N = 1089; 12.5-17.5 y; 580 girls) were selected by complex sampling. Multilevel linear regression models examined the associations between iron biomarkers and vitamins in the blood and blood pressure; the analyses were stratified by sex and adjusted for contextual and individual potential confounders.
  
  
  RESULTS
  A positive association was found in girls between RBC folate concentration and systolic blood pressure (SBP) (β = 3.19; 95% confidence interval [CI], 0.61-5.77), although no association between the vitamin serum biomarkers concentrations and diastolic blood pressure (DBP) was found. In boys, retinol was positively associated with DBP (β = 3.84; 95% CI, 0.51-7.17) and vitamin B6 was positively associated with SBP (β = 3.82; 95% CI, 1.46-6.18). In contrast, holotranscobalamin was inversely associated with SBP (β = -3.74; 95% CI, -7.28 to -0.21).
  
  
  CONCLUSIONS
  Levels of RBC folate and vitamin B6 in blood may affect BP in adolescents. In this context, programs aimed at avoiding high BP levels should promote healthy eating behavior by focusing on the promotion of vegetable proteins and foods rich in vitamin B12 (i.e., white meat and eggs), which may help to achieve BP blood control in adolescents.
authors.affiliation: Department of Preventive Medicine, School of Medicine of the University of São Paulo, São Paulo, Brazil; GENUD-Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Sciences of the University of Zaragoza, Zaragoza, Spain. Electronic address: augustocesar.demoraes@usp.br.
authors.forename: Augusto César Ferreira
authors.initials: AC
authors.lastname: de Moraes
authors.affiliation: GENUD-Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain; University of Exeter, Children's Health and Exercise Research Centre, Sport and Health Sciences, Exeter, United Kingdom.
authors.forename: Luis
authors.initials: L
authors.lastname: Gracia-Marco
authors.affiliation: GENUD-Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Sciences of the University of Zaragoza, Zaragoza, Spain.
authors.forename: Iris
authors.initials: I
authors.lastname: Iglesia
authors.affiliation: Faculty of Physical Activity and Sport-INEF, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain; Universität Bonn, Institut für Ernährungs-und Lebensmittelwissenschaften-Humanernährung, Rheinische Friedrich-Wilhelms, Bonn, Germany.
authors.forename: Marcela
authors.initials: M
authors.lastname: González-Gross
authors.affiliation: Faculty of Physical Activity and Sport-INEF, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain; Universität Bonn, Institut für Ernährungs-und Lebensmittelwissenschaften-Humanernährung, Rheinische Friedrich-Wilhelms, Bonn, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Breidenassel
authors.affiliation: National Research Institute on Food and Nutrition, Rome, Italy.
authors.forename: Marika
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Medical Faculty, University of Pécs, Department of Paediatrics, Pécs, Hungary.
authors.forename: Dénes
authors.initials: D
authors.lastname: Molnar
authors.affiliation: Food Science and Technology and Nutrition Institute, Spanish National Research Council Immunonutrition-Research Group Department of Metabolism and Nutrition, Madrid, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gómez-Martínez
authors.affiliation: Department of Nutrition & Dietetics, Harokopio University, Athens, Greece.
authors.forename: Odysseas
authors.initials: O
authors.lastname: Androutsos
authors.affiliation: University of Crete School of Medicine, Preventive Medicine & Nutrition Unit, Heraklion, Crete, Greece.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kafatos
authors.affiliation: Department of Medical Physiology, School of Medicine of the University of Granada, Granada, Spain.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cuenca-García
authors.affiliation: Department of Biosciences, Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Sjöström
authors.affiliation: Unité Inserm U995 & Université Lille Nord de France, Lille, France; Centre d'Investigation Clinique, Lille, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Gottrand
authors.affiliation: Department of Pediatrics, Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Widhalm
authors.affiliation: Department of Preventive Medicine, School of Medicine of the University of São Paulo, São Paulo, Brazil.
authors.forename: Heráclito Barbosa
authors.initials: HB
authors.lastname: Carvalho
authors.affiliation: Department of Preventive Medicine, School of Medicine of the University of São Paulo, São Paulo, Brazil; GENUD-Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Sciences of the University of Zaragoza, Zaragoza, Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D004032:Diet; D004912:Erythrocytes / Q000378:metabolism; D005060:Europe; D005247:Feeding Behavior; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D007501:Iron / Q000097:blood*; D000090463:Iron Deficiencies; D008019:Life Style; D008297:Male; D009752:Nutritional Status; D012737:Sex Factors; D014801:Vitamin A / Q000097:blood*; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications; D025101:Vitamin B 6 / Q000097:blood*; D014815:Vitamins / Q000097:blood*
chemical_list: D015415:Biomarkers; D014815:Vitamins; D014801:Vitamin A; D025101:Vitamin B 6; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12
keywords: Adolescents; Blood pressure; Iron; Multicenter study; Vitamins