Appetite disinhibition rather than hunger explains genetic effects on adult BMI trajectory.

BACKGROUND/OBJECTIVES: The mediating role of eating behaviors in genetic susceptibility to weight gain during mid-adult life is not fully understood. This longitudinal study aims to help us understand contributions of genetic susceptibility and appetite to weight gain. SUBJECTS/METHODS: We followed the body-mass index (BMI) trajectories of 2464 adults from 45 to 65 years of age by measuring weight and height on four occasions at 5-year intervals. Genetic risk of obesity (gene risk score: GRS) was ascertained, comprising 92 BMI-associated single-nucleotide polymorphisms and split at a median (=high and low risk). At the baseline, the Eating Inventory was used to assess appetite-related traits of 'disinhibition', indicative of opportunistic eating or overeating and 'hunger' which is susceptibility to/ability to cope with the sensation of hunger. Roles of the GRS and two appetite-related scores for BMI trajectories were examined using a mixed model adjusted for the cohort effect and sex. RESULTS: Disinhibition was associated with higher BMI (ß = 2.96; 95% CI: 2.66-3.25 kg/m2), and accounted for 34% of the genetically-linked BMI difference at age 45. Hunger was also associated with higher BMI (ß = 1.20; 0.82-1.59 kg/m2) during mid-life and slightly steeper weight gain, but did not attenuate the effect of disinhibition. CONCLUSIONS: Appetite disinhibition is most likely to be a defining characteristic of genetic susceptibility to obesity. High levels of appetite disinhibition, rather than hunger, may underlie genetic vulnerability to obesogenic environments in two-thirds of the population of European ancestry.

Development of a tool to assess oral health-related quality of life in patients hospitalised in critical care.

AIMS AND OBJECTIVES: Oral health deteriorates following hospitalisation in critical care units (CCU) but there are no validated measures to assess effects on oral health-related quality of life (OHQoL). The objectives of this study were (i) to develop a tool (CCU-OHQoL) to assess OHQoL amongst patients admitted to CCU, (ii) to collect data to analyse the validity, reliability and acceptability of the CCU-OHQoL tool and (iii) to investigate patient-reported outcome measures of OHQoL in patients hospitalised in a CCU. METHODS: The project included three phases: (1) the development of an initial questionnaire informed by a literature review and expert panel, (2) testing of the tool in CCU (n = 18) followed by semi-structured interviews to assess acceptability, face and content validity and (3) final tool modification and testing of CCU-OHQoL questionnaire to assess validity and reliability. RESULTS: The CCU-OHQoL showed good face and content validity and was quick to administer. Cronbach's alpha was 0.72 suggesting good internal consistency. For construct validity, the CCU-OHQoL was strongly and significantly correlated (correlation coefficients 0.71, 0.62 and 0.77, p < 0.01) with global OHQoL items. In the validation study, 37.8% of the participants reported a deterioration in self-reported oral health after CCU admission. Finally, 26.9% and 31% of the participants reported considerable negative impacts of oral health in their life overall and quality of life, respectively. CONCLUSIONS: The new CCU-OHQoL tool may be of use in the assessment of oral health-related quality of life in CCU patients. Deterioration of OHQoL seems to be common in CCU patients.

Experimental models for contamination of titanium surfaces and disinfection protocols.

AIM: The aim of this pilot study was to describe an in vitro model of peri-implantitis microcosm for contamination of titanium surfaces and an in vivo model for evaluating different disinfection strategies of titanium surfaces. MATERIALS AND METHODS: Biofilms were grown in vitro for 30 days on sandblasted large-grit acid-etched (SLA) Ti discs (n = 69) in a constant depth film fermentor (CDFF) associated with peri-implantitis conditions. Four Swedish loop rabbits were randomly allocated in three test groups (T1 , T2 , T3 ) and one control group (C). In group C, two sterile SLA Ti discs were implanted/fixed in each tibia. In the test groups (to evaluate the potential of different surface disinfection techniques), one sterile and three previously disinfected SLA Ti discs were placed following different disinfection protocols: group T1 : the discs were treated with a titanium brush - TiB; group T2 : the discs were treated with the combination of TiB and photodynamic therapy; and group T3 : the discs were treated with TiB and 1%NaOCl plus 0.2%CHX. Tensile strength test and qualitative histological analysis were performed on all 16 discs after 4 weeks of healing. RESULTS: Thirty days following CDFF emulating peri-implantitis microcosm, all SLA Ti discs had a mean total viable aerobes and facultative anaerobes count of 8.06 log10  CFU/biofilm and anaerobes 8.32 log10  CFU/biofilm. Before implantation/fixation on the tibia, differences of log10  CFU/biofilm counts between control and test groups after post hoc adjustment were highly significant (P < 0.001). In the in vivo analysis, group C exhibited the highest tensile strength (67.60 N [25.64-127.02]) and the histological sections revealed the presence of dense mature bone in direct contact with the disc surface. The analysis at the test groups showed that T2 presented with the highest tensile strength in comparison with the other two test groups. CONCLUSIONS: The in vitro model used in this study provides a valuable and reproducible tool for evaluating the in vitro dynamics of the peri-implantitis microcosm biofilm and for contaminating in a reproducible manner titanium surfaces. At the same time, the in vivo model used in this study provides a standardised mode of evaluating disinfection modalities of previously infected titanium surfaces.

Impact of nutritional-behavioral and supervised exercise intervention following bariatric surgery: The BARI-LIFESTYLE randomized controlled trial.

OBJECTIVE: The study's aim was to investigate the impact of a 12-month adjunctive lifestyle intervention on weight loss and health outcomes after bariatric surgery. METHODS: A total of 153 participants (78.4% females; mean [SD], age 44.2 [10.6] years; BMI 42.4 [5.7] kg/m2 ) were randomized to intervention (n = 79) and control (n = 74). The BARI-LIFESTYLE program combined 17 nutritional-behavioral tele-counseling sessions plus once-weekly supervised exercise for 12 weeks. The primary outcome was percentage weight loss at 6 months post surgery. Secondary outcomes included body composition, physical activity levels, physical function and strength, health-related quality of life, depressive symptomatology, and comorbidities. RESULTS: Longitudinal analysis of the entire cohort showed significant reductions in body weight, fat mass, fat-free mass, and bone mineral density at the total hip, femoral neck, and lumbar spine (all p < 0.001). The 6-minute walk test, sit-to-stand test, health-related quality of life, and depressive symptomatology improved significantly (all p < 0.001). The time spent in moderate-to-vigorous physical activity and sedentary behavior remained the same as before surgery (both p > 0.05). There was no significant difference in the primary outcome between the intervention versus control (20.4% vs. 21.2%; mean difference = -0.8%; 95% CI: -2.8 to 1.1; p > 0.05) and no between-group differences in secondary outcomes. CONCLUSIONS: An adjunctive lifestyle program implemented immediately after surgery had no favorable impact upon weight loss and health outcomes.

Neuroticism and cardiovascular disease mortality: socioeconomic status modifies the risk in women (UK Health and Lifestyle Survey).

OBJECTIVE: The association between personality traits and mortality might differ as a function of socioeconomic status (SES). Our aim was to evaluate the all-cause, cardiovascular disease (CVD), and cancer mortality risk associated with neuroticism or extraversion and their interactions with SES in a representative sample of the UK adult population. METHODS: A total of 5450 participants (2505 men) from the Health and Lifestyle Survey completed the Eysenck Personality Inventory at baseline and were monitored for vital status over 25 years. SES was defined as a latent variable comprising occupational social class, educational attainment, and income. RESULTS: A significant neuroticism-by-SES-by-sex interaction (p = .04) for CVD mortality revealed a neuroticism-by-SES interaction specific to women. Compared to women with average SES, those with both high neuroticism and low SES were at an increased risk for CVD mortality (hazard ratio = 2.02, 95% confidence interval = 1.45-2.80), whereas those with high neuroticism and high SES combined were at a decreased risk for CVD mortality (hazard ratio = 0.61, 95% confidence interval = 0.38-0.97, p for interaction = 0.003). The interaction term was not explained by health behaviors (10% attenuation) and physiological variables (11% attenuation). This interaction was not observed for all-cause and cancer mortality risks or among men for CVD mortality. CONCLUSIONS: High neuroticism is a risk factor for cardiovascular mortality in women with low SES, whereas in women with higher SES, it is protective. Further research is needed to replicate this finding and identify the mechanisms behind the modifying effect of SES on neuroticism.

Eating for pleasure or profit: the effect of incentives on children's enjoyment of vegetables.

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children's intrinsic motivation. A cluster-randomized trial examined children's acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, 1 month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Multiple sclerosis, lymphoma and nasopharyngeal carcinoma: the central role of Epstein-Barr virus?

BACKGROUND: Multiple sclerosis (MS) and Hodgkin lymphoma (HL) share epidemiologic characteristics suggesting a possible common etiology. Epstein-Barr virus (EBV) is associated with HL, Burkitt lymphoma, some varieties of non-Hodgkin lymphoma (NHL) and nasopharyngeal carcinoma (NPC). METHOD: Patients were located through MS databases for (a) Barking and Havering, NE London; catchment approximately 400,000; MS patient number 751, and (b) Nottingham, catchment approximately 2,000,000; MS patient number 1,236. Search was undertaken for lymphoma or NPC and diagnosis of MS verified by McDonald criteria. RESULTS: We identified five UK-born and resident patients of interest: (1) male with onset HL aged 20 years developing relapsing-remitting MS 11 years later; (2) female with severe relapsing-remitting MS whose partner developed NHL, 5 years after MS diagnosis; (3) female with secondary progressive MS beginning at age 38 years who developed NHL 25 years later; (4) female diagnosed with MS aged 19 years who developed HL 4 years later, and (5) female with hereditary motor and sensory neuropathy developing cervical cancer at the age of 32 years, NPC at 33 years, and RR MS at 36 years. CONCLUSION: Our study supports a possible association between MS, HL, NHL, and perhaps NPC all of which are associated with EBV infection.

The teaching of occlusion in undergraduate dental schools in the UK and Ireland.

Aim This study investigated and evaluated the teaching of occlusion in undergraduate dental schools in the UK and Ireland, the thorough understanding of which would facilitate young graduates to become competent practitioners.Material and methods A mixed-methods approach was employed, with primary data generated and collected by using a cross-sectional, questionnaire-based survey which was followed-up by semi-structured interviews. The hard copy questionnaires enquired about: i) whether occlusion was taught; ii) how long was spent by schools teaching occlusion; iii) what teaching resources were employed; iv) tutors' perceptions of how well prepared for general practice new graduates were; and v) how was knowledge/skill assessed. Follow-up interviews were undertaken with volunteering respondents to triangulate responses. Quantitative data were analysed using descriptive statistics and qualitative data were stored using the Framework Method and analysis using a thematic approach.Results One hundred percent (n = 18) of schools responded to the questionnaire and 66.67% (n = 12) of the schools participated in follow-up interviews. All schools reported that they taught occlusion in their curriculum. Total hours reported teaching occlusion varied from 11 to 310 hours. Twenty-eight percent (n = 5) of respondents reported insufficient time for the teaching of occlusion in the curriculum. There was a marked variation in: i) teaching methods; ii) resources employed; iii) assessment strategies to evaluate competency in occlusion; and iv) how well prepared students were. Thematic analysis of the qualitative data identified several themes: i) variations in teaching pedagogy; ii) use of different resources; iii) variable assessment techniques; iv) evaluation of teaching; and v) barriers to teaching occlusion.Conclusion Recommendations for a coordinated teaching strategy with dedicated oversight to facilitate better student exposure to occlusion and promote student understanding of this topic is suggested.

Does psychosocial stress exacerbate avoidant responses to cancer information in those who are afraid of cancer? A population-based survey among older adults in England.

OBJECTIVE: Communication of cancer information is an important element of cancer control, but cancer fear may lead to information avoidance, especially when coping is low. We examined the association between cancer fear and cancer information avoidance, and tested whether this was exacerbated by psychosocial stress. DESIGN: Cross-sectional survey of 1258 population-based adults (58-70 years) in England. MAIN OUTCOME MEASURES: Cancer fear (intensity and frequency), perceived psychosocial stress and cancer information avoidance. Control variables were age, gender, ethnicity, marital status and education. RESULTS: A quarter (24%) of respondents avoided cancer information. Ordinal logistic regression analyses showed main effects of psychosocial stress (OR = 1.17, 95% CI 1.07-1.29) and cancer fear: cancer information avoidance was lowest in those with no cancer fear (13%), followed by those with moderate (24%; OR = 2.15, 95% CI: 1.49-3.12), and high cancer fear (35%; OR = 3.90, 95% CI: 2.65-5.73). In the adjusted model, the interaction between cancer fear and stress was significant (OR = 1.14, 95% CI 1.004-1.29, p < .05): 40% of those with high fear/high stress avoided cancer information compared with 29% with high fear/low stress. CONCLUSION: Cancer fear and psychosocial stress interact to produce disengagement with cancer-related information, highlighting the importance of affective processes to cancer control efforts.

Association between circulating levels of heat-shock protein 27 and aggressive periodontitis.

Heat-shock protein (Hsp) 27 is a major intracellular molecular chaperone and controller of intracellular responses to inflammatory signals. In the extracellular space, recombinant Hsp27 has been described to exert anti-inflammatory activities. The aim of this study was to assess the association between circulating levels of Hsp27 and different types of periodontitis. Pro- and anti-inflammatory cytokines and the stress proteins Hsp27 and Hsp60 with proposed anti- and pro-inflammatory properties, respectively, were measured by two-site ELISA in the serum of patients with aggressive periodontitis (AgP, n = 30), chronic periodontitis (CP, n = 29) and periodontally healthy controls (H, n = 28). Furthermore, Hsp27 and Hsp60 levels were also measured longitudinally in 12 AgP patients at 6 time points up to 3 months after treatment. AgP patients had lower levels of Hsp27 compared to CP patients and healthy subjects (adjusted one-way ANOVA, p < 0.001, followed by post hoc Tukey HSD comparisons), while no differences in levels of Hsp60 or cytokines between the three groups were detected. In CP patients and H subjects, the systemic Hsp27 levels correlated with Hsp60 (r = 0.43, p < 0.001; r = 0.59, p < 0.001, respectively) and with pro-inflammatory cytokines TNF-α (r = 0.48, p < 0.001; r = 0.55, p < 0.001, respectively) and IL-6 (r = 0.44, p < 0.01). However, no such correlations were detected in AgP cases. No consistent temporal patterns of changes of Hsp27 concentration were detected across AgP patients following periodontal treatment. This study provides the first evidence that Hsp27 may be differentially expressed and regulated in AgP patients as compared with CP patients and healthy individuals.

Trends in physical activity and sedentary behaviour in adolescence: ethnic and socioeconomic differences.

OBJECTIVE: To assess developmental trends in physical activity and sedentary behaviour in British adolescents in relation to sex, ethnicity and socioeconomic status (SES). DESIGN: A 5-year longitudinal study of a diverse cohort of students aged 11-12 years at baseline in 1999. SETTING: 36 London schools sampled using a stratified random sampling procedure. PARTICIPANTS: A total of 5863 students categorised as white, black or Asian, and stratified for SES using the Townsend Index. MAIN OUTCOME MEASURES: Number of days per week of vigorous activity leading to sweating and breathing hard. Hours of sedentary behaviour, including watching television and playing video games. Data were analysed using multilevel, linear, mixed models. RESULTS: Marked reductions in physical activity and increases in sedentary behaviour were noticed between ages 11-12 and 15-16 years. Boys were more active than girls, and the decline in physical activity was greater in girls (46% reduction) than in boys (23%). Asian students were less active than whites, and this was also true of black girls but not boys. Black students were more sedentary than white students. Levels of sedentary behaviour were greater in respondents from lower SES. Most differences between ethnic and SES groups were present at age 11 years, and did not evolve over the teenage years. CONCLUSIONS: Physical activity declines and sedentary behaviour becomes more common during adolescence. Ethnic and SES differences are observed in physical activity and sedentary behaviour in British youth that anticipate adult variations in adiposity and cardiovascular disease risk. These are largely established by age 11-12 years, so reversing these patterns requires earlier intervention.

Investigation to test potential stereolithography materials for development of an in vitro root canal model.

The aims were to compare the physico-chemical properties (zeta-potential, wettability, surface free energy) of stereolithography materials (STL) (Photopolymer, Accura) to dentine and to evaluate the potential of each material to develop Enterococcus faecalis biofilm on their respective surfaces. Eighteen samples of each test material (Photopolymer, Accura, dentine) were employed (total n = 54) and sectioned to 1 mm squares (5 mm x 5 mm) (n = 15) or ground into a powder to measure zeta-potential (n = 3). The zeta-potential of the powder was measured using the Nano-Zetasizer technique. The contact angle (wettability, surface free energy tests) were measured on nine samples using goniometer. The biofilm attachment onto the substrate was assessed on the samples of each material using microscope and image processing software. The data were compared using one-way ANOVA with Dunnett post-hoc tests at a level of significance P ≤ 0.05. Both STL materials showed similar physico-chemical properties to dentine. The materials and dentine had negative charge (Accura: -23.7 mv, Photopolymer: -18.8 mv, dentine: -9.11 mv). The wettability test showed that all test materials were hydrophilic with a contact angle of 47.5°, 39.8°, 36.1° for Accura, Photopolymer and dentine respectively, and a surface free energy of 46.6, 57.7, 59.6 mN/m for Accura, Photopolymer and dentine, respectively. The materials and dentine proved suitable for attachment and growth of E. faecalis biofilm with no statistical differences (P > 0.05). Stereolithography materials show similar physico-chemical properties and growth of E. faecalis biofilm to dentine. Therefore, they may be an alternative to tests requiring dentine.

Meal size is a critical driver of weight gain in early childhood.

Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (ß = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: ß = 2.6 g/wk, p < 0.001; meal frequency: ß = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain.

Risk associated behavior in premorbid multiple sclerosis: A case-control study.

BACKGROUND: It is generally accepted that individuals who subsequently develop MS are more likely to be smokers, have suffered glandular fever and to have a low blood vitamin D level. Previous research suggested that a unifying premise is risk-associated behavior before MS onset. This survey explores several health-adverse premorbid behaviors using a case-control design. METHODS: A questionnaire was completed by 94 patients with clinically definite MS. Their responses were compared to a control group of 59 who were patients with benign headache. Questions explored pre-symptomatic experience of: (a) alcohol, smoking, substance abuse, glandular fever; (b) blood transfusion; (c) hazardous sport, gambling (d) sexual history, gynecologic infection, number of pregnancies, terminations of pregnancy. Data were adjusted for age of first symptoms, gender and smoking. RESULTS: Compared to the headache group, MS subjects showed significant differences prior to symptom onset, adjusted for age of first symptoms, gender and smoking, with odds ratios for reporting or means and 95% confidence intervals as follows: (a) consuming alcoholic drinks, OR 6.91 (1.74 to 27.45; p=0.006) and at an earlier age, mean 16.9y (16.4 to 17.5; p=0.046) (b) cigarette smoking, OR 2.24 (1.09 to 4.59; p=0.028) and to have smoked more per day, mean 9.45 (5.55 to 13.35; p=0.001) (c) history of glandular fever/infectious mononucleosis, OR 3.07 (1.11 to 8.49; p=0.031); (d) consumed recreational drugs, OR 3.90 (1.32 to 11.50; p=0.014), notably cannabis, OR 4.10 (1.40 to 12.09; p=0.011); (e) used a car seat belt, OR 4.45 (1.43 to 13.83; p=0.010); (f) attended all-night parties, OR 2.45 (1.12 to 5.36; p=0.025); (g) sunbathed, OR 2.770 (1.02 to 7.52; p=0.046); (h) had more sexual partners, mean 3.97 (2.00 to 5.95; p<0.001), more pregnancies, mean 1.43 (0.99 to 1.86; p=0.015) and one or more terminations of pregnancy, OR 5.05 (1.003 to 25.386; p=0.049). CONCLUSION: All but one of the statistically significant variables (use of car seat belt) supports our hypothesis that MS subjects lead a riskier premorbid lifestyle. Strong associations were found for smoking, alcohol and glandular fever as suggested by others. Novel associations were found for recreational drug use; attending all-night parties; gambling on the lottery; more sexual partners, more pregnancies and one or more terminations of pregnancy. Such behavior during the MS prodrome may expose an individual to a variety of hostile environmental agents.

Appetite and growth: a longitudinal sibling analysis.

IMPORTANCE: Identifying early markers of future obesity risk can help target preventive interventions. Several studies have shown that a heartier appetite in infancy is a risk factor for more rapid weight gain, but to date no investigations have been able to rule out familial confounding. OBJECTIVES: To use a sibling design (data from same-sex, dizygotic twin pairs) to test the hypothesis that sibling differences in infant appetite predicted differential weight gain during childhood. DESIGN, SETTING, AND PARTICIPANTS: Gemini is a population-based twin cohort among the general United Kingdom population born between March 1, 2007, and December 15, 2007. Growth trajectories were analyzed from birth to age 15 months. Appetite-discordant pairs were selected from 800 nonidentical, same-sex twin pairs. EXPOSURES: Appetite during the first 3 months of life was assessed with the food responsiveness (FR) and satiety responsiveness (SR) subscales from the Baby Eating Behaviour Questionnaire. Discordance was defined as a within-pair difference of at least 1 SD. MAIN OUTCOMES AND MEASURES: A mean of 11.5 weight measurements per child were available between birth and age 15 months. Multilevel models, adjusted for sex and birth weight, compared growth curves for the higher-appetite vs lower-appetite twins. RESULTS: In total, 172 pairs were discordant for SR and 121 pairs for FR. Within-pair analyses showed that those with higher FR and those with lower SR grew faster than their sibling. At age 6 months, those with higher FR were 654 (95% CI, 395-913) g heavier and at age 15 months were 991 (95% CI, 484-1498) g heavier. For sibling pairs discordant for SR, the weight differences between siblings were 637 (95% CI, 438-836) g at age 6 months and 918 (95% CI, 569-1267) g at age 15 months. CONCLUSIONS AND RELEVANCE: A heartier appetite (indexed with higher FR or lower SR) in early infancy is prospectively associated with more rapid growth up to age 15 months in a design controlling for potential familial confounding, supporting a causal role for appetite in childhood weight gain. Appetite could be an early marker for risk of weight gain in the current obesogenic environment and might be a potential target for preventive interventions.

An international measure of awareness and beliefs about cancer: development and testing of the ABC.

OBJECTIVES: To develop an internationally validated measure of cancer awareness and beliefs; the awareness and beliefs about cancer (ABC) measure. DESIGN AND SETTING: Items modified from existing measures were assessed by a working group in six countries (Australia, Canada, Denmark, Norway, Sweden and the UK). Validation studies were completed in the UK, and cross-sectional surveys of the general population were carried out in the six participating countries. PARTICIPANTS: Testing in UK English included cognitive interviewing for face validity (N=10), calculation of content validity indexes (six assessors), and assessment of test-retest reliability (N=97). Conceptual and cultural equivalence of modified (Canadian and Australian) and translated (Danish, Norwegian, Swedish and Canadian French) ABC versions were tested quantitatively for equivalence of meaning (≥4 assessors per country) and in bilingual cognitive interviews (three interviews per translation). Response patterns were assessed in surveys of adults aged 50+ years (N≥2000) in each country. MAIN OUTCOMES: Psychometric properties were evaluated through tests of validity and reliability, conceptual and cultural equivalence and systematic item analysis. Test-retest reliability used weighted-κ and intraclass correlations. Construction and validation of aggregate scores was by factor analysis for (1) beliefs about cancer outcomes, (2) beliefs about barriers to symptomatic presentation, and item summation for (3) awareness of cancer symptoms and (4) awareness of cancer risk factors. RESULTS: The English ABC had acceptable test-retest reliability and content validity. International assessments of equivalence identified a small number of items where wording needed adjustment. Survey response patterns showed that items performed well in terms of difficulty and discrimination across countries except for awareness of cancer outcomes in Australia. Aggregate scores had consistent factor structures across countries. CONCLUSIONS: The ABC is a reliable and valid international measure of cancer awareness and beliefs. The methods used to validate and harmonise the ABC may serve as a methodological guide in international survey research.

The intergenerational transmission of thinness.

OBJECTIVES: To examine intergenerational associations for thinness and to compare maternal and paternal effects. DESIGN: Population-based, cross-sectional design using data from the Health Survey for England from January 1, 2001, through December 31, 2006. SETTING: The Health Survey for England, an annual, national survey representative of the population living in private households in England. PARTICIPANTS: Families with children and adolescents aged 2 to 15 years with anthropometric data available for children and adolescents and 2 parents (N = 4423 families, N = 7078 children and adolescents). MAIN EXPOSURE: Trained interviewers collected height and weight measurements. MAIN OUTCOME MEASURE: Child/adolescent thinness, categorized using International Obesity Task Force criteria. RESULTS: Of 7078 children and adolescents, 402 (5.7%) were categorized as being thin. Thinness was more common in 2- to 5-year-olds (odds ratio, 1.61; 95% confidence interval, 1.22-2.13) than in 11- to 15-year-olds and in children and adolescents from ethnic minority (black: 2.28; 1.22-4.26; and Asian: 3.65; 2.76-4.83) than white backgrounds, but no differences were observed by sex or socioeconomic status. The strongest predictor of child/adolescent thinness was parental weight status. The prevalence of thinness was highest (16.2%) when both parents were thinner and progressively lower when both parents were in the upper half of the healthy-weight range (7.8%) or were overweight (5.3%) or obese (2.5%), with no differences in the magnitude of maternal and paternal influences. CONCLUSIONS: These results are consistent with the idea that many cases of thinness are likely to represent the low end of the healthy distribution of weight and, as such, are likely to have a primarily genetic origin.

Comparing maternal and paternal intergenerational transmission of obesity risk in a large population-based sample.

BACKGROUND: Previous research showed childhood obesity to be more strongly associated with maternal weight than with paternal weight. However, confidence in this finding is limited by the lack of objectively measured data from both parents. OBJECTIVE: We quantified the individual and combined effects of maternal and paternal overweight/obesity on obesity risk in children. DESIGN: Data were pooled from the annual Health Surveys for England carried out between 2001 and 2006. Families with < or =2 children aged 2-15 y with anthropometric data available for both parents and children were included (n = 4432 families, n = 7078 children). Weights and heights were measured by a trained nurse. RESULTS: Having 2 overweight parents was associated with an increased risk of child obesity [odds ratio (OR): 2.2; 95% CI: 1.3, 3.7; P < 0.001] compared with having 2 normal-weight parents. Having 2 obese (including severely obese) parents was associated with a higher risk of child obesity (OR: 12.0; 95% CI: 7.2, 20.1; P < 0.01), and having 2 severely obese parents was associated with an even higher risk of child obesity (OR: 22.3; 95% CI: 10.3, 48.4; P < 0.01) independent of age, sex, socioeconomic status, and ethnicity. Mother-child associations (r = 0.27) for body mass index were significantly stronger than father-child associations (r = 0.23), even after adjustment for plausible levels (< or =4%) of undisclosed nonpaternity. Associations were the same for sons and daughters but increased with age. CONCLUSIONS: There is a strong and graded association between parental weight status and risk of childhood obesity, which is significantly stronger for maternal weight. Parental obesity could be used to target preventive interventions in the preschool years to avoid serious adverse effects on the future health of children.

Perceived stress and weight gain in adolescence: a longitudinal analysis.

Although perceived stress has been hypothesized to be a risk factor for obesity, epidemiological studies relating stress to weight gain have shown mixed results. We examined prospective associations between perceived stress and changes in waist circumference and BMI in a large study of adolescents. As part of the Health and Behaviour in Teenagers Study (HABITS), height, weight, and waist circumference were measured annually in 4,065 adolescents aged from 11 to 16. Waist and BMI standard deviation scores (SDS) were used as indices of adiposity. Adolescents completed a measure of perceived stress each year, from which mean stress scores over the 5-year period were also calculated and divided by tertile into lower, moderate, and higher stress. Associations between perceived stress at each year and adiposity 1-4 years later and also adiposity trajectories over the whole period in relation to mean stress were investigated. Analyses were adjusted for age, sex, ethnicity, socioeconomic deprivation, pubertal timing, and smoking. Perceived stress in any year was not related prospectively to increases in waist or BMI SDS 1-4 years later, nor was there any evidence that higher stress over the whole period was associated with greater gains in waist or BMI SDS. However, waist and BMI SDS were significantly higher in the moderate- and higher-stress groups than the lower-stress group across the whole 5-year period. Persistent stress was associated with higher waist circumference and BMI in adolescence, but did not lead to differential changes over 5 years.