Frequent use of selected sugary products associates with thinness, but not overweight during preadolescence: a cross-sectional study.

Convincing evidence suggests that diets laden with added sugar, specifically sugar-sweetened beverages, associate with excess weight in children. The relationships between sugar consumption frequency and BMI remain less well studied. We, therefore, evaluated children's consumption frequency of selected sugary products (n 8461; mean age 11·1 (sd 0·9) years) selected from the Finnish Health in Teens cohort study. Using a sixteen-item FFQ including six sugary products (chocolate/sweets, biscuits/cookies, ice cream, sweet pastry, sugary juice drinks and sugary soft drinks), we calculated a Sweet Treat Index (STI) for the frequency of weekly sugary product consumption and categorised children based on quartiles (Q) into low (Q1, cut-off < 4·0), medium (Q2 + Q3, range 4·0-10·5) and high STI (Q4, cut-off > 10·5), and as thin, normal and overweight/obese based on the measured BMI. Through multinomial logistic regression analyses, we found that subjects with a high STI exhibited a higher risk of being thin (OR 1·20, 95 % CI 1·02, 1·41) and lower risk of being overweight (OR 0·79, 95 % CI 0·67, 0·92), while subjects with a low STI were at higher risk of being overweight (OR 1·32, 95 % CI 1·14, 1·53). High consumption frequencies of salty snacks, pizza and hamburgers most closely were associated with a high STI. Our findings suggest that consuming sugary products at a high frequency does not associate with being overweight. The relationship between a low consumption frequency and being overweight suggests that overweight children's consumption frequency of sugary products may be controlled, restricted or underreported.

Eating habits and weight status in Finnish adolescents.

OBJECTIVE: To investigate the association between eating habits and weight status in adolescents in Finland. DESIGN: Cross-sectional study. SETTING: The Finnish Health in Teens (Fin-HIT) study is a cohort study conducted in adolescents attending third to sixth grade in 496 schools in forty-four municipalities in Southern, Middle and Northern Finland in 2011-2014. PARTICIPANTS: Analyses included 10 569 adolescents from the Fin-HIT study aged 9-14 years (5005 boys and 5564 girls). Adolescents were categorized by their eating habits: healthy eaters (44·1 %; n 4661), unhealthy eaters (12·3 %; n 1298), and fruit and vegetable avoiders (43·6 %; n 4610); and they were grouped into weight status: underweight (11·1 %), normal weight (73·6 %) and excess weight (15·3 %). RESULTS: We found an increased risk of underweight in fruit and vegetable avoiders (OR = 1·28; 95 % CI 1·12, 1·46). An irregular breakfast pattern showed an inverse association with underweight (OR = 0·70; 95 % CI 0·59, 0·84) and an increased risk of excess weight (OR = 1·56; 95 % CI 1·37, 1·77) compared with a regular breakfast pattern. An irregular dinner pattern was inversely associated with underweight (OR = 0·83; 95 % CI 0·69, 0·99) compared with a regular dinner pattern. CONCLUSIONS: Avoiding fruits and vegetables and following irregular breakfast and dinner patterns were associated with underweight and excess weight in adolescents.

Body dissatisfaction and disordered eating symptoms in Finnish preadolescents.

To evaluate whether body dissatisfaction is associated with disordered eating symptoms in Finnish preadolescents, and to assess the moderator effects of gender and body mass index on this association. We included 10,526 9- to 12-year-old preadolescents at baseline from the Finnish Health in Teens cohort. We used the Children's Eating Attitudes Test for assessing disordered eating symptoms and a pictoral instrument for evaluating body dissatisfaction, comparing self-assessment of wanted and current body shape. Odds ratio (OR) for disordered eating symptoms were estimated using unconditional logistic regression. A high percentage of preadolescents reported body dissatisfaction: 30.0% wanted a smaller body and 9.3% wanted a larger body. Only 2.2% of the participants had disordered eating symptoms. Preadolescents who wanted a larger (OR = 2.83; 95% confidence intervals (CI): 1.68-4.78) or smaller body (OR = 4.48; 95% CI: 3.20-6.26) had a higher risk of having disordered eating symptoms, compared to preadolescents satisfied with their body. Among preadolescents who wanted a smaller body, the effect of body dissatisfaction was more pronounced among girls (OR = 5.00; 95% CI: 3.25-7.70) than boys, and among normal-weight (OR = 6.82; 95% CI: 4.53-10.25) and underweight (OR = 23.23; 95% CI: 5.31-101.61) than overweight preadolescents. Body dissatisfaction is associated with disordered eating symptoms especially among girls, and those who are underweight and normal-weight. Our study suggests that, in the prevention of eating disorders, special attention should be given to preadolescents with body dissatisfaction.

Maternal alcohol and tobacco consumption and the association with their 9 to 14-year-old children's Body Mass Index.

AIMS: Little is known about impact of maternal alcohol and tobacco consumption on adolescents' body size. The purpose of this study was to evaluate whether maternal alcohol or tobacco consumption is associated with their children's body size in adolescence, assessed by Body Mass Index (BMI). METHODS: This study was conduct in subjects recruited into the Finnish Health in Teens cohort (Fin-HIT) between 2011 and 2014. A total of 4525 subjects aged between 9 and 14 years and their mothers or female adults responsible for the children were analysed. Relative risks (RR) and 95% confidence intervals (CI) were estimated using Multinomial Logistic Regression. RESULTS: Most children were normal weight (74.5%), 10.6% were underweight and 14.9% were overweight or obese. Among mothers, 50.6% were never smokers, 35.7% were former smokers, and 13.7% were current smokers. Alcohol consumption was classified by Alcohol Use Disorders Identification Test (AUDIT), 12.7% were abstainers (score=0), 65.0% were low-moderate drinkers (scores 1-4) and 22.3% were harmful drinkers (scores ⩾5). There were statistically significant associations between currently smoking mothers and children's overweight (RR=1.36; 95% CI: 1.05-1.76). There was an inverse association between maternal former smoking and children's underweight (RR=0.70; CI: 0.56-0.87) compared with never smoker mothers. Among children in puberty, abstainer mothers were more likely to have underweight children compared with low-moderate mothers (RR=1.57; 95% CI: 1.03-2.41). CONCLUSIONS: Current smoker mothers were associated with children's overweight and former-smoker mothers were inversely associated with the children's underweight. Being an abstainer mother was associated with the children's underweight in puberty stage. If other studies confirm these results, public health interventions aiming at healthy weight of adolescents should target the whole family, not only the adolescents themselves.

Lifetime antimicrobial use is associated with weight status in early adolescence-A register-based cohort study.

BACKGROUND: Antimicrobial agents (AMs) are the most prescribed drugs to children. Early and repeated exposure to AMs in infancy is associated with increased risk of childhood overweight and obesity. AIMS: We extended the investigation of AMs use, from birth to early adolescence, and evaluated their association with weight status. MATERIALS & METHODS: A total of 10093 children from Finnish Health in Teens cohort (Fin-HIT) with register-based data on AMs purchases and measured weight status at the mean age of 11.2 y (SD 0.82) were included in the study. The key exposures were the number AM purchases at a given age or the sum of these during the entire follow-up time to describe lifetime exposure / use. Outcome was weight status in early adolescence defined with International Obesity Task Force cut-offs for the age- and sex-specific body mass index. Odds Ratio (OR) and 95% confidence intervals (CI) were estimated using Multinomial Logistic Regression. RESULTS: Of children, 73.7% were normal weight, 11.1% thin and 15.2% overweight/obese. AMs use was highest during the second year of life, when 65% of all children used AMs, but thereafter decreased with age. The highest mean purchases and prevalence at any given age along with the highest lifetime use were consistently seen among overweight children. Each episode of AMs use throughout life increased the risk of being overweight in adolescence [OR = 1.02 (1.02-1.03)]. However, there was an inverse association between AMs use and thinness [OR = 0.98 (0.97-0.99)]. DISCUSSION: Despite a high prevalence of AMs use during the early years, lifetime-use was associated with weight status in early adolescence in a dose response manner. CONCLUSION: Future studies should address mechanisms underlying the relationship between AM use and weight.

Meal Regularity Plays a Role in Shaping the Saliva Microbiota.

BACKGROUND: Diet may influence health directly or indirectly via the human microbiota, emphasizing the need to unravel these complex relationships for future health benefits. Associations between eating habits and gut microbiota have been shown, but less is known about the association between eating habits and saliva microbiota. OBJECTIVE: The aim of this study was to investigate if eating habits and meal patterns are associated with the saliva microbiota. METHODS: In total, 842 adolescents, aged 11-14 years, from the Finnish Health in Teens (Fin-HIT) study cohort were included in this study. Eating habits and breakfast and dinner patterns were derived from a web-based questionnaire answered in school. Three major eating habit groups were identified: fruit and vegetable avoiders (FV avoiders), healthy and unhealthy. Microbiota profiles were produced from 16S rRNA gene (V3-V4) sequencing of DNA from the saliva samples. Statistical models were adjusted for gender, age, parental language, body mass index (BMI) categories, and sequencing depth. RESULTS: Regular breakfast eaters had a higher alpha diversity (Shannon index with mean (standard error of means) 2.27 (0.03) vs. 2.22 (0.03), p = 0.06, inverse Simpson's index with 6.27 (0.17) vs. 5.80 (0.02), p = 0.01), and slight differences in bacterial composition (PERMANOVA: p = 0.001) compared with irregular breakfast eaters. A similar trend in alpha diversity was observed between regular and irregular dinner eaters (Shannon index with 2.27 (0.03) vs. 2.22 (0.03), p = 0.054, inverse Simpson's index with 6.23 (0.17) vs. 6.04 (0.22), p = 0.28), while no difference was found in composition (PERMANOVA: p = 0.08). No differences were identified between eating habit groups and saliva microbiota diversity (Shannon index p = 0.77, inverse Simpson's index p = 0.94) or composition (PERMANOVA: p = 0.13). FV avoiders, irregular breakfast eaters and irregular dinner eaters had high abundances of Prevotella. CONCLUSION: Regularity of eating, especially breakfast eating, was associated with more diverse saliva microbiota and different composition compared with irregular eaters. However, the dissimilarities in composition were small between regular and irregular breakfast eaters. Our results suggest that Prevotella abundances in saliva were common in FV avoiders and meal skippers. However, the clinical implications of these findings need to be evaluated in future studies.

There Is No Impact of Diabetes on the Endothelial Function of Chronic Kidney Disease Patients.

BACKGROUND: Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Several studies have separately analyzed endothelial function in these populations. However, data of patients with both CKD and DM are scarce. The aim of this study was to evaluate whether the presence of DM has any additional effect on the endothelial dysfunction of CKD patients. METHODS: We measured endothelial progenitor cells (EPCs), stromal-derived factor 1 alpha (SDF-1α), serum and urinary nitric oxide (NO), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in 37 CKD patients with DM (CKD-DM group) and in 37 without DM (CKD group). RESULTS: CKD-DM group had a higher prevalence of obesity (P < 0.01), previous myocardial infarction (P = 0.02), myocardial revascularization (P = 0.04), and a trend for more peripheral artery disease (P = 0.07). Additionally, CKD-DM group had higher EPC (P = 0.001) and PWV (P < 0.001) values. On the other hand, no difference in SDF-1α and serum or urinary NO and FMD was observed between the groups. CONCLUSIONS: Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition.

Diabetes mellitus, metformin and head and neck cancer.

INTRODUCTION: Diabetes mellitus (DM (Diabetes Mellitus)) is directly associated with some cancers. However, studies on the association between diabetes mellitus and head and neck cancer (HNC (Head and Neck Cancer)) have rendered controversial results. The objective of this study was to evaluate the association between DM and HNC, as well as the impact of metformin use on the risk of HNC. MATERIAL AND METHODS: This case-control study was conducted within the framework of the Brazilian Head and Neck Genome Project in 2011-2014. The study included 1021 HNC cases with histologically confirmed squamous cell carcinoma of the head and neck admitted to five large hospitals in São Paulo state. A total of 1063 controls were selected in the same hospitals. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression. RESULTS: Diabetic participants had a decreased risk of HNC (OR=0.68; 95% CI: 0.49-0.95) than non-diabetic participants, and this risk was further decreased among diabetic metformin users (OR=0.54; 95% CI: 0.29-0.99). Diabetic metformin users that were current smokers (OR=0.13; 95% CI: 0.04-0.44) or had an alcohol consumption of >40g/day (OR=0.31; 95% CI: 0.11-0.88) had lower risk of HNC than equivalent non-diabetic participants. CONCLUSION: The risk of HNC was decreased among diabetic participants; metformin use may at least partially explain this inverse association.

Communication and access to information in assessing the quality of multiprofessional care of patients.

OBJECTIVE: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case). METHODS: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. RESULTS: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%), appropriate use of the Plan of Care form (97.0%), and formalized discussions with physicians (88.2%). In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. CONCLUSIONS: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.

Diabetes mellitus e câncer de cabeça e pescoço / Diabetes mellitus and head and neck cancer

O diabetes mellitus (DM) está associado com alguns tipos de câncer. No entanto, estudos realizados sobre a associação entre DM e câncer de cabeça e pescoço (CCP) apresentaram resultados controversos. Na avaliação da associação entre DM e câncer, destaque deve ser dado à metformina, medicamento utilizado no DM tipo 2, que se mostra inversamente associado a alguns tumores. O objetivo deste estudo foi avaliar a associação entre DM e CCP, bem como o impacto do uso de metformina no risco de CCP. Este estudo caso-controle incluiu 1021 casos de CCP com confirmação histológica de carcinoma espino celular selecionados em cinco hospitais de grande porte no estado de São Paulo entre 2011 e 2014. Os 1063 controles foram recrutados nos mesmos hospitais, pareados por frequência com os casos por sexo e idade (em grupos de 5 anos). Para avaliar o risco de CCP associado ao DM, odds ratios (OR) e intervalos com 95 por cento de confiança (IC 95 por cento ) foram estimados por meio de regressão logística não condicional. Os participantes diabéticos tiveram associação inversa com o CCP (OR = 0,68; IC 95 por cento : 0,49-0,95), e a proteção foi maior entre diabéticos usuários metformina (OR = 0,54; IC 95 por cento : 0,29-0,99)

Diabetes mellitus (DM) is directly associated with some cancers. However, studies on the association between DM and head and neck cancer (HNC) have rendered controversial results. Assessing DM and cancer, emphasis should be given to metformin, a medication used for DM type 2, which is shown to be inversely associated with some cancers. The objective of this study was to evaluate the association between DM and HNC, as well as the impact of metformin use on the risk of HNC. This case-control study included 1021 HNC cases with squamous cell carcinoma, histologically confirmed, and admitted in five large hospitals in the state of São Paulo, from 2011 to 2014. A total of 1063 controls were selected in the same hospitals and were frequency-matched to cases by sex and age (in 5-year groups). In order to assess the risk of CCP associated with DM, odds ratios (OR) and 95 per cent confidence intervals (CI 95 per cent ) were estimated using unconditional logistic regression. Diabetic participants had an inverse risk of HNC (OR=0.68; 95 per cent CI: 0.49 0.95), and this inverse association was more intense among diabetic metformin users (OR=0.54; 95 per cent CI: 0.29-0.99)

Communication and access to information in assessing the quality ofmultiprofessional care of patients / Comunicação e acesso a informações na avaliação da qualidade de assistência multiprofissional a pacientes internados

Objective: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case). Methods: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. Results: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%), appropriate use of the Plan of Care form (97.0%), and formalized discussions with physicians (88.2%). In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. Conclusions: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.

Objetivo: Avaliar a qualidade de um modelo de assistência a pacientes internados por meio de dois índices de desempenho (comunicação e conhecimento do caso) das equipes multiprofissionais. Métodos: Foi realizado um corte transversal para avaliação do conhecimento dos profissionais a respeito das informações clínicas do paciente e o uso de estratégias de comunicação intraequipe. Foi utilizado o formato de entrevistas feitas com profissionais durante o período de trabalho. Sete categorias profissionais foram entrevistadas e foram sorteados para entrevista 199 prontuários. Foram avaliados 312 profissionais das diversas categorias. A amostra foi caracterizada pela predominância do envolvimento dos profissionais de enfermagem e fisioterapia nos prontuários entrevistados. Resultados: Não houve diferenças estatisticamente significativas entre os grupos do modelo de desempenho esperado e do modelo de desempenho abaixo do esperado para as variáveis: sexo, situação e cargo dos profissionais. No grupo modelo de desempenho abaixo do esperado, evidenciou-se que quanto maior o número de profissionais envolvidos, menor o grau de conhecimento. A comunicação foi melhor quando o enfermeiro teve as informações relevantes sobre a assistência interdisciplinar (97,4%), utilizou de forma adequada o impresso denominado Plano Assistencial (97,0%) e formalizou a discussão com o médico (88,2%). No grupo do modelo de desempenho esperado, evidenciou-se que quanto maior o número de profissionais envolvidos, maior o grau de comunicação. Conclusões: Neste modelo assistencial, baseado no desempenho dos índices do conhecimento do caso e comunicação da equipe multiprofissional, pôde-se avaliar a qualidade da assistência. Portanto, essa avaliação é mensurável e é possível determinar o nível de qualidade da assistência prestada.