An exploration of the determinants of overweight and obesity and the capacity to intervene in North-West Tasmania: A stakeholder consultation.

ISSUE ADDRESSED: The capacity of communities to develop effective obesity prevention initiatives varies and should be a focus for obesity prevention intervention planning and investment. This research aimed at engaging and consulting local community stakeholders to identify determinants, needs, strategic priorities and capacity to act on overweight and obesity prevention in North-West (NW) Tasmania. METHODS: A series of semi-structured interviews and thematic analyses was implemented to explore the knowledge, insights, experiences and attitudes of stakeholders. RESULTS: Mental health and obesity were identified as major concerns and were often reported to share similar determinants. This study has identified health promotion capacity assets (existing partnerships, community capital, local leadership and some pockets of health promotion activity), and a range of capacity deficits (limited investment in health promotion, a small workforce, limited access to pertinent health information). CONCLUSIONS: This study has identified health promotion capacity assets (existing partnerships, community capital, local leadership and some pockets of health promotion activity), and a range of capacity deficits (limited investment in health promotion, a small workforce, limited access to pertinent health information). SO WHAT?: Broad upstream socio-economic, cultural and environmental determinants underpin the conditions by which the local community develops overweight/obesity and/or health and wellbeing outcomes. Including stakeholder consultations as a significant technique within a comprehensive plan of action aimed at achieving a sustainable, long-term strategy for obesity prevention and/or health promotion, should be considered in future programs.

Trends and associations between maternal characteristics and infant birthweight among Indigenous and non-Indigenous people in Tasmania, Australia: a population-based study.

OBJECTIVE: This study aimed to investigate the trends and associations of maternal characteristics and birthweight among Indigenous and non-Indigenous infants. STUDY DESIGN: This was a retrospective population-based study. METHODS: Fourteen years (2005-2018) of birthweight and perinatal health data of live-born singletons and their mothers obtained from the Tasmanian Data Linkage Unit were used to assess the trends and associations between maternal characteristics and infant birthweight using regression modelling. RESULTS: Compared with non-Indigenous mothers (n = 76,750), Indigenous mothers (n = 3805) had a significantly higher prevalence of risk factors during the 14-year period. Although the prevalence of prepregnancy obesity and gestational diabetes mellitus (GDM) markedly increased in both groups, the rate of increase was higher (P < 0.001) for Indigenous than non-Indigenous mothers. Smoking, alcohol consumption and illegal drug use during pregnancy reduced over the years, and there was no significant difference in the rate of reduction between the groups. Large-for-gestational-age (LGA) births increased while small-for-gestational-age (SGA) births decreased in both groups over time. In addition, high birthweight (HBW) births decreased while low birthweight (LBW) births increased. The rates of increase in LGA and LBW births and the rates of decrease in SGA and HBW births were significantly higher in Indigenous mothers compared with non-Indigenous mothers (P < 0.001 for all). The association between Indigenous ethnicity and LBW and SGA births weakened after adjusting for other confounding maternal and perinatal variables. LBW and SGA were positively associated with Indigenous ethnicity, age <18 years, smoking, alcohol consumption and illegal drug use, pre-eclampsia, underweight prepregnancy body mass index and low socio-economic status. Women with higher parity, pre-existing diabetes and prepregnancy overweight or obesity were more likely to give birth to an infant with HBW or LGA. CONCLUSIONS: The prevalence of risk factors for abnormal birthweight is higher among Tasmanian Indigenous mothers, contributing to a gap in birthweight outcomes between Indigenous and non-Indigenous infants. The dramatic increase in prepregnancy obesity and GDM in both groups highlight the importance of screening and management of GDM during pregnancy. Comprehensive programmes co-designed and co-managed in consultation with Indigenous people are needed to support healthy lifestyle choices among Indigenous women to address the barriers to individuals adopting behaviour change and to help close the health outcomes-related gap between Indigenous and non-Indigenous mothers and infants.

Why some do but too many don't? Barriers and enablers to physical activity in regional Tasmania - an exploratory, mixed-methods study.

BACKGROUND: The interconnectedness of physical inactivity and sedentarism, obesity, non-communicable disease (NCD) prevalence, and socio-economic costs, are well known. There is also strong research evidence regarding the mutuality between well-being outcomes and the neighbourhood environment. However, much of this evidence relates to urban contexts and there is a paucity of evidence in relation to regional communities. A better understanding of available physical activity (PA) infrastructure, its usage, and community perceptions regarding neighbourhood surroundings, could be very important in determining requirements for health improvement in regional communities. The aims of this research were to 1. Explore and evaluate the public's perception of the PA environment; and 2. Evaluate the quantity, variety, and quality of existing PA infrastructure in regional Northwest (NW) Tasmania. METHODS: A mixed methods approach guided data collection, analysis, and presentation. Quality of PA infrastructure was assessed using the Physical Activity Resource Assessment (PARA) instrument and public perception about PA environment was evaluated using the International Physical Activity Questionnaire - Environmental (IPAQ-E) module. Quantitative data were analysed using descriptive summative methods and a team-based researcher triangulation approach was utilised for qualitative data. RESULTS: Overall, a wide array of high-quality PA infrastructure (with minimal incivilities such as auditory annoyance, litter, graffiti, dog refuse, and vandalism etc.) was available. Survey respondents rated neighbourhoods positively. The overall quality of PA infrastructure, rated on a scale from 0 to 3, was assessed as high (all rated between 2 to 3) with minimal incivilities (rated between 0 and 1.5). Of note, survey respondents confirmed the availability of numerous free-to-access recreational tracks and natural amenities across the 3 local government areas (LGAs) studied. Importantly, most respondents reported minimal disruption to their routine PA practices due to the COVID-19 pandemic. CONCLUSION: This exploratory research confirmed the availability of a wide range of high-quality PA infrastructure across all three LGAs and there was an overwhelming public appreciation of this infrastructure. The challenge remains to implement place-based PA interventions that address extant barriers and further increase public awareness and utilisation of high-quality PA infrastructure.

Low responders to endurance training exhibit impaired hypertrophy and divergent biological process responses in rat skeletal muscle.

NEW FINDINGS: What is the central question of this study? The extent to which genetics determines adaptation to endurance versus resistance exercise is unclear. Previously, a divergent selective breeding rat model showed that genetic factors play a major role in the response to aerobic training. Here, we asked: do genetic factors that underpin poor adaptation to endurance training affect adaptation to functional overload? What is the main finding and its importance? Our data show that heritable factors in low responders to endurance training generated differential gene expression that was associated with impaired skeletal muscle hypertrophy. A maladaptive genotype to endurance exercise appears to dysregulate biological processes responsible for mediating exercise adaptation, irrespective of the mode of contraction stimulus. ABSTRACT: Divergent skeletal muscle phenotypes result from chronic resistance-type versus endurance-type contraction, reflecting the principle of training specificity. Our aim was to determine whether there is a common set of genetic factors that influence skeletal muscle adaptation to divergent contractile stimuli. Female rats were obtained from a genetically heterogeneous rat population and were selectively bred from high responders to endurance training (HRT) or low responders to endurance training (LRT; n = 6/group; generation 19). Both groups underwent 14 days of synergist ablation to induce functional overload of the plantaris muscle before comparison to non-overloaded controls of the same phenotype. RNA sequencing was performed to identify Gene Ontology biological processes with differential (LRT vs. HRT) gene set enrichment. We found that running distance, determined in advance of synergist ablation, increased in response to aerobic training in HRT but not LRT (65 ± 26 vs. -6 ± 18%, mean ± SD, P < 0.0001). The hypertrophy response to functional overload was attenuated in LRT versus HRT (20.1 ± 5.6 vs. 41.6 ± 16.1%, P = 0.015). Between-group differences were observed in the magnitude of response of 96 upregulated and 101 downregulated pathways. A further 27 pathways showed contrasting upregulation or downregulation in LRT versus HRT in response to functional overload. In conclusion, low responders to aerobic endurance training were also low responders for compensatory hypertrophy, and attenuated hypertrophy was associated with differential gene set regulation. Our findings suggest that genetic factors that underpin aerobic training maladaptation might also dysregulate the transcriptional regulation of biological processes that contribute to adaptation to mechanical overload.

The effect of exercise interventions on resting metabolic rate: A systematic review and meta-analysis.

The systematic review and meta-analysis evaluated the effect of aerobic, resistance and combined exercise on RMR (kCal·day-1) and performed a methodological assessment of indirect calorimetry protocols within the included studies. Subgroup analyses included energy/diet restriction and body composition changes. Randomized control trials (RCTs), quasi - RCTs and cohort trials featuring a physical activity intervention of any form and duration excluding single exercise bouts were included. Participant exclusions included medical conditions impacting upon RMR, the elderly (≥65 years of age) or pregnant, lactating or post-menopausal women. The review was registered in the International Prospective Register of Systematic Reviews (CRD 42,017,058,503). 1669 articles were identified; 22 were included in the qualitative analysis and 18 were meta-analysed. Exercise interventions (aerobic and resistance exercise combined) did not increase resting metabolic rate (mean difference (MD): 74.6 kCal·day-1[95% CI: -13.01, 161.33], P = 0.10). While there was no effect of aerobic exercise on RMR (MD: 81.65 kCal·day-1[95% CI: -57.81, 221.10], P = 0.25), resistance exercise increased RMR compared to controls (MD: 96.17 kCal·day-1[95% CI: 45.17, 147.16], P = 0.0002). This systematic review effectively synthesises the effect of exercise interventions on RMR in comparison to controls; despite heterogenous methodologies and high risk of bias within included studies.

Influence of subject presentation on interpretation of body composition change after 6 months of self-selected training and diet in athletic males.

PURPOSE: High precision body composition assessment methods accurately monitor physique traits in athletes. The acute impact of subject presentation (ad libitum food and fluid intake plus physical activity) on body composition estimation using field and laboratory methods has been quantified, but the impact on interpretation of longitudinal change is unknown. This study evaluated the impact of athlete presentation (standardised versus non-standardised) on interpretation of change in physique traits over time. Thirty athletic males (31.2 ± 7.5 years; 182.2 ± 6.5 cm; 91.7 ± 10.3 kg; 27.6 ± 2.6 kg/m2) underwent two testing sessions on 1 day including surface anthropometry, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance spectroscopy (BIS) and air displacement plethysmography (via the BOD POD), with combinations of these used to establish three-compartment (3C) and four-compartment (4C) models. METHODS: Tests were conducted after an overnight fast (BASEam) and ~ 7 h later after ad libitum food/fluid and physical activity (BASEpm). This procedure was repeated 6 months later (POSTam and POSTpm). Magnitude of changes in the mean was assessed by standardisation. RESULTS: After 6 months of self-selected training and diet, standardised presentation testing (BASEam to POSTam) identified trivial changes from the smallest worthwhile effect (SWE) in fat-free mass (FFM) and fat mass (FM) for all methods except for BIS (FM) where there was a large change (7.2%) from the SWE. Non-standardised follow-up testing (BASEam to POSTpm) showed trivial changes from the SWE except for small changes in FFM (BOD POD) of 1.1%, and in FM (3C and 4C models) of 6.4 and 3.5%. Large changes from the SWE were found in FFM (BIS, 3C and 4C models) of 2.2, 1.8 and 1.8% and in FM (BIS) of 6.4%. Non-standardised presentation testing (BASEpm to POSTpm) identified trivial changes from the SWE in FFM except for BIS which was small (1.1%). A moderate change from the SWE was found for BOD POD (3.3%) and large for BIS (9.4%) in FM estimations. CONCLUSIONS: Changes in body composition utilising non-standardised presentation were more substantial and often in the opposite direction to those identified using standardised presentation, causing misinterpretation of change in physique traits. Standardised presentation prior to body composition assessment for athletic populations should be advocated to enhance interpretation of true change.

Increasing Protein Distribution Has No Effect on Changes in Lean Mass During a Rugby Preseason.

Increasing the frequency of protein consumption is recommended to stimulate muscle hypertrophy with resistance exercise. This study manipulated dietary protein distribution to assess the effect on gains in lean mass during a rugby preseason. Twenty-four developing elite rugby athletes (age 20.1 ± 1.4 years, mass 101.6 ± 12.0 kg; M ± SD) were instructed to consume high biological value (HBV) protein at their main meals and immediately after resistance exercise while limiting protein intake between meals. To manipulate protein intake frequency, the athletes consumed 3 HBV liquid protein supplements (22 g protein) either with main meals (bolus condition) or between meals (frequent condition) for 6 weeks in a 2 × 2 crossover design. Dietary intake and change in lean mass values were compared between conditions by analysis of covariance and correlational analysis. The dietary manipulation successfully altered the protein distribution score (average number of eating occasions containing > 20 g of protein) to 4.0 ± 0.8 and 5.9 ± 0.7 (p < .01) for the bolus and frequent conditions, respectively. There was no difference in gains in lean mass between the bolus (1.4 ± 1.5 kg) and frequent (1.5 ± 1.4 kg) conditions (p = .91). There was no clear effect of increasing protein distribution from approximately 4-6 eating occasions on changes in lean mass during a rugby preseason. However, other dietary factors may have augmented adaptation.

Influence of habitual physical activity on gastric emptying in healthy males and relationships with body composition and energy expenditure.

Although a number of studies have examined the role of gastric emptying (GE) in obesity, the influences of habitual physical activity level, body composition and energy expenditure (EE) on GE have received very little consideration. In the present study, we compared GE in active and inactive males, and characterised relationships with body composition (fat mass and fat-free mass) and EE. A total of forty-four males (active n 22, inactive n 22; BMI 21-36 kg/m2; percentage of fat mass 9-42%) were studied, with GE of a standardised (1676 kJ) pancake meal being assessed by the [13C]octanoic acid breath test, body composition by air displacement plethysmography, RMR by indirect calorimetry, and activity EE (AEE) by accelerometry. The results showed that GE was faster in active compared with inactive males (mean half-time (t 1/2): active 157 (sd 18) and inactive 179 (sd 21) min, P< 0.001). When data from both groups were pooled, GE t 1/2 was associated with percentage of fat mass (r 0.39, P< 0.01) and AEE (r - 0.46, P< 0.01). After controlling for habitual physical activity status, the association between AEE and GE remained, but not that for percentage of fat mass and GE. BMI and RMR were not associated with GE. In summary, faster GE is considered to be a marker of a habitually active lifestyle in males, and is associated with a higher AEE level and a lower percentage of fat mass. The possibility that GE contributes to a gross physiological regulation (or dysregulation) of food intake with physical activity level deserves further investigation.

The effect of a whey protein supplement dose on satiety and food intake in resistance training athletes.

OBJECTIVE: Many athletes perform resistance training and consume dietary protein as a strategy to promote anabolic adaptation. Due to its high satiety value, the regular addition of supplemented dietary protein could plausibly displace other key macronutrients such as carbohydrate in an athlete's diet. This effect will be influenced by the form and dose of protein. Therefore, this study assessed the impact of liquid whey protein dose manipulation on subjective sensations of appetite and food intake in a cohort of athletes. DESIGN: Ten male athletes who performed both resistance and aerobic (endurance) training (21.2 ± 2.3 years; 181.7 ± 5.7 cm and 80.8 ± 6.1 kg) were recruited. In four counter-balanced testing sessions they consumed a manipulated whey protein supplement (20, 40, 60 or 80 g protein) 1 hour after a standardised breakfast. Subsequent energy intake was measured 3 hours after the protein supplement using an ad libitum test meal. Subjective appetite sensations were measured periodically during the test day using visual analogue scales. RESULTS: All conditions resulted in a significant decrease in ratings of hunger (50-65%; P < 0.05) at the time of supplement consumption. However, there were no significant differences between the conditions at any time point for subjective appetite sensations or for energy consumed in the ad libitum meal: 4382 ± 1004, 4643 ± 982, 4514 ± 1112, 4177 ± 1494 kJ respectively. CONCLUSION: Increasing whey protein supplement dose above 20 g did not result in a measurable increase in satiety or decrease in food intake. However, the inclusion of additional whey protein supplementation where not otherwise consumed could plausibly reduce dietary intake.

The association of early life supplemental nutrition with lean body mass and grip strength in adulthood: evidence from APCAPS.

In the present study, we examined the associations of early nutrition with adult lean body mass (LBM) and muscle strength in a birth cohort that was established to assess the long-term impact of a nutrition program. Participants (n = 1,446, 32% female) were born near Hyderabad, India, in 29 villages from 1987 to 1990, during which time only intervention villages (n = 15) had a government program that offered balanced protein-calorie supplementation to pregnant women and children. Participants' LBM and appendicular skeletal muscle mass were measured using dual energy x-ray absorptiometry; grip strength and information on lifestyle indicators, including diet and physical activity level, were also obtained. Ages (mean = 20.3 years) and body mass indexes (weight (kg)/height (m)(2); mean = 19.5) of participants in 2 groups were similar. Current dietary energy intake was higher in the intervention group. Unadjusted LBM and grip strength were similar in 2 groups. After adjustment for potential confounders, the intervention group had lower LBM (ß = -0.75; P = 0.03), appendicular skeletal muscle mass, and grip strength than did controls, but these differences were small in magnitude (<0.1 standard deviation). Multivariable regression analyses showed that current socioeconomic position, energy intake, and physical activity level had a positive association with adult LBM and muscle strength. This study could not detect a "programming" effect of early nutrition supplementation on adult LBM and muscle strength.

Assessment of body composition in Indian adults: comparison between dual-energy X-ray absorptiometry and isotope dilution technique.

Dual-energy X-ray absorptiometry (DXA) and isotope dilution technique have been used as reference methods to validate the estimates of body composition by simple field techniques; however, very few studies have compared these two methods. We compared the estimates of body composition by DXA and isotope dilution (18O) technique in apparently healthy Indian men and women (aged 19-70 years, n 152, 48 % men) with a wide range of BMI (14-40 kg/m2). Isotopic enrichment was assessed by isotope ratio mass spectroscopy. The agreement between the estimates of body composition measured by the two techniques was assessed by the Bland-Altman method. The mean age and BMI were 37 (sd 15) years and 23·3 (sd 5·1) kg/m2, respectively, for men and 37 (sd 14) years and 24·1 (sd 5·8) kg/m2, respectively, for women. The estimates of fat-free mass were higher by about 7 (95 % CI 6, 9) %, those of fat mass were lower by about 21 (95 % CI - 18, - 23) %, and those of body fat percentage (BF%) were lower by about 7·4 (95 % CI - 8·2, - 6·6) % as obtained by DXA compared with the isotope dilution technique. The Bland-Altman analysis showed wide limits of agreement that indicated poor agreement between the methods. The bias in the estimates of BF% was higher at the lower values of BF%. Thus, the two commonly used reference methods showed substantial differences in the estimates of body composition with wide limits of agreement. As the estimates of body composition are method-dependent, the two methods cannot be used interchangeably.

Reproducibility of subjective appetite ratings and ad libitum test meal energy intake in overweight and obese males.

BACKGROUND: To determine whether changes in appetite and energy intake (EI) can be detected and play a role in the effectiveness of interventions, it is necessary to identify their variability under normal conditions. We assessed the reproducibility of subjective appetite ratings and ad libitum test meal EI after a standardised pre-load in overweight and obese males. METHODS: Fifteen overweight and obese males (BMI 30.3 ± 4.9 kg/m(2), aged 34.9 ± 10.6 years) completed two identical test days, 7 days apart. Participants were provided with a standardised fixed breakfast (1676 kJ) and 5 h later an ad libitum pasta lunch. An electronic appetite rating system was used to assess subjective ratings before and after the fixed breakfast, and periodically during the postprandial period. EI was assessed at the ad libitum lunch meal. Sample size estimates for paired design studies were calculated. RESULTS: Appetite ratings demonstrated a consistent oscillating pattern between test days, and were more reproducible for mean postprandial than fasting ratings. The correlation between ad libitum EI on the two test days was r = 0.78 (P <0.01). Using a paired design and a power of 0.8, a minimum of 12 participants would be needed to detect a 10 mm change in 5 h postprandial mean ratings and 17 to detect a 500 kJ difference in ad libitum EI. CONCLUSION: Intra-individual variability of appetite and ad libitum test meal EI in overweight and obese males is comparable to previous reports in normal weight adults. Sample size requirements for studies vary depending on the parameter of interest and sensitivity needed.

Interval training intensity affects energy intake compensation in obese men.

PURPOSE: Compensatory responses may attenuate the effectiveness of exercise training in weight management. The aim of this study was to compare the effect of moderate- and high-intensity interval training on eating behavior compensation. METHODS: Using a crossover design, 10 overweight and obese men participated in 4-week moderate (MIIT) and high (HIIT) intensity interval training. MIIT consisted of 5-min cycling stages at ± 20% of mechanical work at 45%VO(2)peak, and HIIT consisted of alternate 30-s work at 90%VO(2)peak and 30-s rests, for 30 to 45 min. Assessments included a constant-load exercise test at 45%VO(2)peak for 45 min followed by 60-min recovery. Appetite sensations were measured during the exercise test using a Visual Analog Scale. Food preferences (liking and wanting) were assessed using a computer-based paradigm, and this paradigm uses 20 photographic food stimuli varying along two dimensions, fat (high or low) and taste (sweet or nonsweet). An ad libitum test meal was provided after the constant-load exercise test. RESULTS: Exercise-induced hunger and desire to eat decreased after HIIT, and the difference between MIIT and HIIT in desire to eat approached significance (p = .07). Exercise-induced liking for high-fat nonsweet food tended to increase after MIIT and decreased after HIIT (p = .09). Fat intake decreased by 16% after HIIT, and increased by 38% after MIIT, with the difference between MIIT and HIIT approaching significance (p = .07). CONCLUSIONS: This study provides evidence that energy intake compensation differs between MIIT and HIIT.

Whole-body substrate metabolism is associated with disease severity in patients with non-alcoholic fatty liver disease.

OBJECTIVES: In non-alcoholic fatty liver disease (NAFLD), hepatic steatosis is intricately linked with a number of metabolic alterations. We studied substrate utilisation in NAFLD during basal, insulin-stimulated and exercise conditions, and correlated these outcomes with disease severity. METHODS: 20 patients with NAFLD (mean ± SD body mass index (BMI) 34.1 ± 6.7 kg/m(2)) and 15 healthy controls (BMI 23.4 ± 2.7 kg/m(2)) were assessed. Respiratory quotient (RQ), whole-body fat (Fat ox) and carbohydrate (CHO ox) oxidation rates were determined by indirect calorimetry in three conditions: basal (resting and fasted), insulin-stimulated (hyperinsulinaemic-euglycaemic clamp) and exercise (cycling at an intensity to elicit maximal Fat ox). Severity of disease and steatosis were determined by liver histology, hepatic Fat ox from plasma ß-hydroxybutyrate concentrations, aerobic fitness expressed as VO2 peak, and visceral adipose tissue (VAT) measured by computed tomography. RESULTS: Within the overweight/obese NAFLD cohort, basal RQ correlated positively with steatosis (r=0.57, p=0.01) and was higher (indicating smaller contribution of Fat ox to energy expenditure) in patients with NAFLD activity score (NAS) ≥ 5 vs <5 (p=0.008). Both results were independent of VAT, % body fat and BMI. Compared with the lean control group, patients with NAFLD had lower basal whole-body Fat ox (1.2 ± 0.3 vs 1.5 ± 0.4 mg/kg FFM/min, p=0.024) and lower basal hepatic Fat ox (ie, ß-hydroxybutyrate, p=0.004). During exercise, they achieved lower maximal Fat ox (2.5 ± 1.4 vs. 5.8 ± 3.7 mg/kg FFM/min, p=0.002) and lower VO2 peak (p<0.001) than controls. Fat ox during exercise was not associated with disease severity (p=0.79). CONCLUSIONS: Overweight/obese patients with NAFLD had reduced hepatic Fat ox and reduced whole-body Fat ox under basal and exercise conditions. There was an inverse relationship between ability to oxidise fat in basal conditions and histological features of NAFLD including severity of steatosis and NAS.

Global status of cardiorespiratory fitness and physical activity - Are we improving or getting worse?

Despite heightened recognition of the importance of cardiorespiratory fitness (CRF) to cardiovascular (CV) health, along with updated international consensus guidelines for physical activity (PA) and sedentary behavior (SB), significant proportions of the global adult population are physically inactive, and do not meet the threshold for CRF. Physical inactivity is considered a surrogate for low CRF given that the former is defined as not reaching the recommended minimum level of PA per week to derive a health benefit. Physical inactivity remains a major global public health problem despite decades of work by various United Nations agencies, and members of the international community to improve PA levels. Given the common coupling between physical inactivity and poor health status, it is reasonable to suggest that for a significant proportion of the global population, CRF is compromised by physical inactivity. This poses a longer-term risk to morbidity and mortality. Here we provide an indicative summary of the global status of CRF and PA and reference the implications for global health. We briefly reference opportunities moving forward, including reinforcement of the importance of engaging in movement from an early age, discouraging SB, and taking a life course approach to optimise healthy living for all.

Body composition assessment in 6-month-old infants: A comparison of two- and three-compartment models using data from the Baby-bod study.

BACKGROUND/OBJECTIVES: An appreciation of infant body composition is helpful to understand the 'quality' of growth in early life. Air displacement plethysmography (ADP) using PEA POD and the deuterium dilution (DD) technique are commonly used body composition approaches in infants. We evaluated the comparability of body composition assessed using both techniques with two-compartment (2C) and three-compartment (3C) models in 6-month-old infants. SUBJECTS/METHODS: Infant fat mass (FM) and percent fat mass (%FM) obtained from a 2C model using PEA POD (2C-PP) and a 2C model using the deuterium dilution technique (2C-DD) were compared to those derived from a 3C model, and to each other, using Bland-Altman analysis and Deming regression. RESULTS: Measurements were available from 68 infants (93% Caucasian, 53% male). The mean biases were not significant between any of the method comparisons. However, significant constant and proportional biases were identified in 2C-DD vs 3C and 2C-PP vs 2C-DD, but not in the 2C-PP vs 3C comparison. Furthermore, we observed significant associations between the mean differences and infants' percent total body water (%TBW). CONCLUSIONS: While no significant between-method mean differences were found in body composition estimates, some comparisons revealed significant constant and proportional biases and notable associations between the mean differences and %TBW were observed. Our results emphasise the importance of method choice, ensuring methodological uniformity in long-term studies, and carefully considering and regulating multiple pre-analytical variables, such as the hydration status of the participants.

Methodological considerations for meal-induced thermogenesis: measurement duration and reproducibility.

Meal-induced thermogenesis (MIT) research findings have been highly inconsistent, in part, due to the variety of durations and protocols used to measure MIT. In the present study, we aimed to determine the following: (1) the proportion of a 6 h MIT response completed at 3, 4 and 5 h; (2) the associations between the shorter durations and the 6 h measures; (3) whether shorter durations improved the reproducibility of the measurement. MIT was measured in response to a 2410 kJ mixed composition meal in ten individuals (five males and five females) on two occasions. Energy expenditure was measured continuously for 6 h post-meal using indirect calorimetry, and MIT was calculated as the increase in energy expenditure above the pre-meal RMR. On average, 76, 89 and 96 % of the 6 h MIT response was completed within 3, 4 and 5 h, respectively, and MIT at each of these time points was strongly correlated with the 6 h MIT response (range for correlations, r 0·990-0·998; P< 0·01). The between-day CV for the 6 h measurement was 33 %, but it was significantly lower after 3 h of measurement (CV 26 %; P= 0·02). Despite variability in the total MIT between days, the proportion of MIT that was completed at 3, 4 and 5 h was reproducible (mean CV: 5 %). While 6 h are typically required to measure the complete MIT response, the 3 h measures provide sufficient information about the magnitude of the MIT response and may be applicable for testing individuals on repeated occasions.

Development and validation of a pregnancy symptoms inventory.

BACKGROUND: Physical symptoms are common in pregnancy and are predominantly associated with normal physiological changes. These symptoms have a social and economic cost, leading to absenteeism from work and additional medical interventions. There is currently no simple method for identifying common pregnancy related problems in the antenatal period. A validated tool, for use by pregnancy care providers would be useful. The aim of this study was to develop and validate a Pregnancy Symptoms Inventory for use by health professionals. METHODS: A list of symptoms was generated via expert consultation with health professionals. Focus groups were conducted with pregnant women. The inventory was tested for face validity and piloted for readability and comprehension. For test-re-test reliability, the tool was administered to the same women 2 to 3 days apart. Finally, midwives trialled the inventory for 1 month and rated its usefulness on a 10cm visual analogue scale (VAS). RESULTS: A 41-item Likert inventory assessing how often symptoms occurred and what effect they had, was developed. Individual item test re-test reliability was between .51 to 1, the majority (34 items) scoring ≥0.70. The top four "often" reported symptoms were urinary frequency (52.2%), tiredness (45.5%), poor sleep (27.5%) and back pain (19.5%). Among the women surveyed, 16.2% claimed to sometimes or often be incontinent. Referrals to the incontinence nurse increased > 8 fold during the study period. CONCLUSIONS: The PSI provides a comprehensive inventory of pregnancy related symptoms, with a mechanism for assessing their effect on function. It was robustly developed, with good test re-test reliability, face validity, comprehension and readability. This provides a validated tool for assessing the impact of interventions in pregnancy.

Food consumption of Sri Lankan adults: an appraisal of serving characteristics.

OBJECTIVE: The main aim of the present study was to identify food consumption in Sri Lankan adults based on serving characteristics. DESIGN: Cross-sectional study. Fruits, vegetables, starch, meat, pulses, dairy products and added sugars in the diet were assessed with portion sizes estimated using standard methods. SETTING: Twelve randomly selected clusters from the Sri Lanka Diabetes and Cardiovascular Study. SUBJECTS: Six hundred non-institutionalized adults. RESULTS: The daily intake of fruit (0·43), vegetable (1·73) and dairy (0·39) portions were well below national recommendations. Only 3·5 % of adults consumed the recommended 5 portions of fruits and vegetables/d; over a third of the population consumed no dairy products and fewer than 1 % of adults consumed 2 portions/d. In contrast, Sri Lankan adults consumed over 14 portions of starch and 3·5 portions of added sugars daily. Almost 70 % of those studied exceeded the upper limit of the recommendations for starch intake. The total daily number of meat and pulse portions was 2·78. CONCLUSIONS: Dietary guidelines emphasize the importance of a balanced and varied diet; however, a substantial proportion of the Sri Lankan population studied failed to achieve such a recommendation. Nutrition-related diseases in the country may be closely correlated with unhealthy eating habits.

High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores.

BACKGROUND: Dietary diversity is recognized as a key element of a high quality diet. However, diets that offer a greater variety of energy-dense foods could increase food intake and body weight. The aim of this study was to explore association of diet diversity with obesity in Sri Lankan adults. METHODS: Six hundred adults aged > 18 years were randomly selected by using multi-stage stratified sample. Dietary intake assessment was undertaken by a 24 hour dietary recall. Three dietary scores, Dietary Diversity Score (DDS), Dietary Diversity Score with Portions (DDSP) and Food Variety Score (FVS) were calculated. Body mass index (BMI) ≥ 25 kg.m⁻² is defined as obese and Asian waist circumference cut-offs were used diagnosed abdominal obesity. RESULTS: Mean of DDS for men and women were 6.23 and 6.50 (p=0.06), while DDSP was 3.26 and 3.17 respectively (p=0.24). FVS values were significantly different between men and women 9.55 and 10.24 (p=0.002). Dietary diversity among Sri Lankan adults was significantly associated with gender, residency, ethnicity, education level but not with diabetes status. As dietary scores increased, the percentage consumption was increased in most of food groups except starches. Obese and abdominal obese adults had the highest DDS compared to non obese groups (p<0.05). With increased dietary diversity the level of BMI, waist circumference and energy consumption was significantly increased in this population. CONCLUSION: Our data suggests that dietary diversity is positively associated with several socio-demographic characteristics and obesity among Sri Lankan adults. Although high dietary diversity is widely recommended, public health messages should emphasize to improve dietary diversity in selective food items.