Role of dietary intake and physical activity in reducing weight social inequalities among adolescents: an application of G-formula to PRALIMAP-INÈS trial.

Interventions aiming to reduce social inequalities of weight status in adolescents usually focus on lifestyle behaviours, but their effectiveness is limited. This study analysed the effect of achieving levels of dietary intake (DI) and/or physical activity (PA) guidelines on reducing social inequalities in weight status among adolescents. We included adolescents from the PRomotion de l'ALIMentation et de l'Activité Physique - INÉgalité de Santé (PRALIMAP-INÈS) trial with weight status data available at baseline and 1-year follow-up (n=1130). PA and DI were measured using the International Physical Activity Questionnaire and a validated food frequency questionnaire, respectively. We estimated the likelihood of a 1-year reduction in body mass index z-score (BMIz) and population risk difference (PRD) under hypothetical DI and PA levels and socioeconomic status using the parametric G-formula. When advantaged and less advantaged adolescents maintained their baseline DI and PA, we found social inequalities in weight status, with a PRD of a 1-year reduction in BMIz of -1.6% (-3.0%; -0.5%). These inequalities were not observed when less advantaged adolescents increased their proportion of achieving DI guidelines by 30% (PRD=2.2% [-0.5%; 5.0%]) unlike the same increase in PA (PRD= -3.9% [-6.8%; -1.3%]). Finally, social inequalities of weight status were not observed when levels of achievement of both PA and DI guidelines increased by 30% (PRD= 2.2% [-0.5%; 4.0%]). Enhancing DI rather than PA could be effective in reducing social inequalities in weight status among adolescents. Future interventions aiming to reduce these inequalities should mostly target DI to be effective.

Quality-of-life measures and their psychometric properties used in African chronic kidney disease populations: a systematic review using COSMIN methodology.

BACKGROUND: If any benefit is to be derived from the use of the health-related quality of life (HRQoL) questionnaires in chronic kidney disease (CKD) patients, they should be validated and culturally adapted to the target population. We aimed to critically appraise the psychometric properties of HRQoL questionnaires used in African populations with CKD. METHODS: Web of Science, Embase, PubMed and PsycINFO databases were searched. Psychometric validation studies of HRQoL questionnaires reporting at least one psychometric property of the COSMIN checklist in CKD African population, published up to October 16, 2023 were included and independently assessed for methodological quality and level of measurement properties by using the COSMIN methodology. RESULTS: From 1163 articles, 5 full-text were included. Only the Kidney Disease Quality-of-Life questionnaire was translated and cross-culturally adapted for studies of patients with CKD. Internal consistency was of doubtful quality in 4 studies and very good in 1. Its measurement was sufficient in 1 study and insufficient in 4. Test-retest reliability was of doubtful quality in 4 studies. Its measurement was sufficient in 3 studies and insufficient in 1. Structural validity was of inadequate quality in 1 study and very good quality in 1. Its measurement was sufficient in both. Construct validity was of inadequate quality in all studies. Their measurement was insufficient in 4 studies and sufficient in 1. CONCLUSIONS: This review highlighted that only one HRQoL questionnaire used in studies of African populations with CKD underwent a small number of cultural adaptations and psychometric validations, generally of poor methodological quality. HRQoL validation studies in African CKD populations are needed to better take advantage of the benefits in patient care, population health management, and research.

The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria.

OBJECTIVE: To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS: This international multidisciplinary initiative included 4 phases: 1) Phase I, criteria generation by surveys and literature review; 2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; 3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS: The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-ß2 -glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%. CONCLUSION: These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.

2023 ACR/EULAR antiphospholipid syndrome classification criteria.

OBJECTIVE: To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS: This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS: The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-ß2-glycoprotein I antibodies). Patients accumulating at least three points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria vs the 2006 revised Sapporo classification criteria had a specificity of 99% vs 86%, and a sensitivity of 84% vs 99%. CONCLUSION: These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.

Prevalence of and Factors Associated with Respiratory Symptoms Among Patients with Inflammatory Bowel Disease: A Prospective Study.

BACKGROUND: No large, prospective study has investigated respiratory symptoms in patients with inflammatory bowel diseases. We aimed to describe the prevalence of and factors associated with respiratory symptoms in patients with inflammatory bowel disease. METHODS: In an observational, prospective, cross-sectional study, we evaluated the frequency of respiratory symptoms using a validated self-reporting questionnaire from February 2019 to February 2021 during routine follow-up outpatient visits of patients with inflammatory bowel disease followed in the Gastroenterology Department of the Nancy University Hospital. In case of a positive questionnaire, patients were systematically offered a consultation with a pulmonologist in order to investigate a potential underlying respiratory disease. RESULTS: There were 325 patients included, and 180 patients had a positive questionnaire (144 with Crohn's disease). Of the included patients, 165 (50.8%) presented with respiratory symptoms, with dyspnea being the most frequent symptom (102 patients). There were 102 patients (56.7%) who benefited from a consultation in the pulmonology department: 43 (42.2%) were diagnosed with a respiratory disease, mainly asthma (n = 13) or chronic obstructive pulmonary disease (n = 10). Fourteen patients (13.7%) had obstructive sleep apnea. A body mass index increase, being a smoker or ex-smoker, and having articular extra-intestinal manifestations were independently associated with a higher prevalence of respiratory symptoms. CONCLUSIONS: Half of patients with inflammatory bowel disease reported respiratory symptoms in our study. Patients with inflammatory bowel disease should be systematically screened, as pulmonary disease is frequently present in this population, with specific attention being given to smokers or ex-smokers and patients with extra-articular intestinal manifestations.

We conducted a large-scale, prospective study, finding a high prevalence of respiratory symptoms in patients with inflammatory bowel disease, which led to a variety of respiratory diseases, including asthma and obstructive pulmonary disease. Patients should therefore be systematically screened for pulmonary manifestations.

Physical Activity and Eating Behavior Inequalities Mediating the Effects of Socioeconomic Status and Sex on Adolescent Quality of Life: Insights of the PRALIMAP Trial.

BACKGROUND: This study aimed to quantify the 2-year mediating effects of physical activity (PA) and eating behavior (EB) on socioeconomic and sex inequalities in quality of life (QoL) among French adolescents. METHODS: Adolescents from a 2-year school-based trial were included. PA and EB were assessed at baseline, 1 year, and 2 years using the International Physical Activity Questionnaire and an eating habits questionnaire, respectively. QoL was measured at 2 years using the Duke Health Profile questionnaire. The mediating effect of adherence to PA and EB guidelines in the associations between socioeconomic status or sex and QoL was analyzed with a counterfactual method. RESULTS: Among the 3562 included adolescents (mean age, 15.2 [0.6] y), being a boy and having a high socioeconomic status was associated with high QoL. Differences in QoL by socioeconomic status were mediated by adherence to guidelines for PA (up to 10.2%) and EB (up to 8.8%), and differences in QoL by sex were predominantly mediated by adherence to guidelines for PA (up to 163.8%). CONCLUSIONS: Policies, programs, and interventions designed to reduce socioeconomic and sex inequalities in QoL among adolescents could use PA and EB as leverage.

Sociodemographic and psychological characteristics associated with discrepancy between body satisfaction and weight change among adolescents.

This study aimed to describe the discrepancy between body satisfaction change and weight change among adolescents following a 2-year school-based intervention, to identify associated sociodemographic factors, and to explore possible associations with perceived health indicators. We used data from a northeastern France representative adolescents sample (14-18 years old) who participated in the PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) study (2006-2009). Weight change was measured by the change in body mass index z-score from the start to the end of the study. Body satisfaction and self-perceived health (anxiety, depression, eating disorder and quality of life) changes were assessed using self-administered questionnaires. Discrepancy between body satisfaction change and weight change was described with cross-tabulations, and subdivided into optimism/pessimism (i.e. positive/negative body satisfaction change compared to weight change). Sociodemographic factors associated with discrepancy were determined by multivariate logistic regression models. Adjusted linear regression models described 2-year change in weight and self-perceived health according to discrepancy. Among the 3279 adolescents included (aged 15.1 ± 0.6 years), the proportion of discrepancy was 74.8% (pessimism = 41.6%; optimism = 33.2%). Discrepancy, especially pessimism, was higher in boys than in girls (OR = 1.44 [1.19; 1.74], p = .0002), and in socially advantaged adolescents (OR = 1.82 [1.20; 2.74], p = .004) than in disadvantage ones. Body satisfaction change was rather in line with anxiety, depression and quality of life changes than weight change. Body satisfaction change should be considered in overweight and obesity prevention interventions alongside body weight change, and could be used as indicator of long-term behavior maintenance. Clinical trials registry and number:ClinicalTrials.gov (NCT01688453).

Longitudinal patterns of lifestyle behaviours in adolescence: a latent transition analysis.

The interdependence among eating behaviour (EB), physical activity (PA) and sedentary time (ST) suggests simultaneously identifying homogeneous profiles and describing their changes. This study aimed to (1) identify cross-sectional lifestyle behaviour profiles and their 2-year changes among French school-age adolescents and (2) identify factors associated with these profiles and changes. Longitudinal data from adolescents who participated in the PRomotion de l'ALIMentation et de l'Activité Physique trial were used. PA and ST were assessed with the International Physical Activity Questionnaire and EB with a FFQ. Profiles at baseline and their changes were identified by latent transition analysis. Multinomial logistic regression models were used to identify factors associated with profiles and their changes. Among 2390 adolescents included (14-18 years), five baseline profiles that differed mainly in EB were identified: 'healthy diet and high PA (7·9 %)', 'big eater and moderate to high PA (23·8 %)', 'healthy diet and low PA (31·2 %)', 'restrictive diet and moderate PA (20·6 %)' and 'sugar products, nibbling and moderate PA (16·5 %)'. Young adolescents, those who were overweight or obese and socially advantaged, were more in the 'healthy diet and low PA' than others. Boys, older and socially less advantaged adolescents exhibited more 'unfavourable' than 'mixed' changes, while adolescents with overweight or obesity had less 'unfavourable' than 'mixed' changes. In conclusion, adolescents were twice the number in the least than the most favourable profile. Findings highlighted the importance of EB among adolescents and suggest taking adolescents' sociodemographic and weight characteristics into account in interventions aimed at acting on adolescents' behaviours.

Physical activity rather than sedentary behaviour is socially determined in French adolescents with overweight and obesity.

Social differences in prevalence of overweight and obesity among adolescents, known as the weight social gradient, could be explained by differences in behaviours between social classes. This study examined the respective association of physical activity (PA), sedentary behaviour (SB) and weight status with adolescents' socioeconomic status. We used cross-sectional data for 1935 adolescents (13-18 years old) with overweight or obesity who participated in the PRALIMAP-INÉS (PRomotion de l'ALImentation et de l'Activité Physique - INÉgalités de Santé) trial conducted in northeastern France between 2012 and 2015. Adolescents completed the International Physical Activity Questionnaire for PA and SB and the Family Affluence Scale for socioeconomic status. Weight status was assessed by the body mass index (BMI) and BMI z-score. Social gradient of weight status, PA and SB were described according to the Family Affluence Scale (slopes) and evidenced by the linear trend test (p). Adolescents' socioeconomic status was positively associated with PA practice (frequency, vigorous PA and leisure-time PA), but there was no association with their SB. The results confirmed a significant weight social gradient: BMI (ß = 0.37, p < .0001) and BMI z-score (ß = 0.07, p = .0001). The weight social gradient in adolescents was mostly associated with PA (5.7% to 8.1%) rather than SB (2.7% to 5.7%). Nearly 14% of BMI z-scores could be related to a combined PA and SB effect. PA was found an important factor of weight social gradient in adolescence. Actions aimed at preventing weight social inequalities among adolescents could include PA promotion as lever. CLINICAL TRIALS REGISTRY AND NUMBER: ClinicalTrials.gov (NCT01688453).

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents.

Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The "indice de position sociale des élèves" was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (ß = -0.06; p < 0.0001), overweight and obesity prevalence (ß = -2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (ß = -0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (ß = -0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.

The impact of physical activity on fatigue and quality of life during and after adjuvant treatment for breast cancer.

BACKGROUND: Although physical activity (PA) can alleviate fatigue and improve quality of life (QoL) in patients with breast cancer (BC), not all domains of PA may have equal impact. The objective of the current study was to examine the longitudinal impact of PA components on the evolution of fatigue and QoL during and after adjuvant treatment for BC. METHODS: The women included in the study were participants in the 2-year longitudinal FATSEIN ("Fatigue dans le cancer du Sein") study. Fatigue and QoL were measured using the Multidimensional Fatigue Inventory and the European Organization for Research and Treatment of Cancer 30-item QoL questionnaire, respectively. Group-based trajectory analysis was used to determine patterns of PA evolution (frequency, duration, and intensity). Cross-sectional and longitudinal associations between PA patterns and fatigue and QoL were analyzed by using multivariable linear regression and a mixed model. RESULTS: Among the 424 women who were included (mean ± standard deviation age, 57.1 ± 10.4 years), 2 trajectories were identified for each of the 3 PA components: low and insufficient frequency (51.2%) or regular and moderate frequency (48.8%), low and insufficient duration (47.6%) or regular and moderate duration (52.4%), and low intensity (47.2%) or low to moderate intensity (52.8%). Overall, during treatment, fatigue was increased and QoL was decreased, and the reverse was observed after treatment. During treatment, increased fatigue and decreased QoL were limited by regular PA frequency (ß = -8.71 for total fatigue; ß = 14.59 for emotional function), but the results were less significant after treatment. CONCLUSIONS: PA, especially its frequency, is an important determinant of fatigue and QoL during adjuvant treatment for BC. The promotion of regular PA among women who are receiving treatment for BC may be an effective way to reduce fatigue and improve QoL. Cancer 2018;124:797-806. © 2017 American Cancer Society.