Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review.

Parents substantially influence children's diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3-12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3-12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research. PROSPERO registration: CRD42018095360.

Physical activity and weight gain after smoking cessation in postmenopausal women.

OBJECTIVE: Weight gain frequently occurs after smoking cessation. The objective of this study was to examine whether weight gain after smoking cessation was attenuated by physical activity (PA) in postmenopausal women. METHODS: A total of 4,717 baseline smokers from the Women's Health Initiative were followed for 3 years. One thousand two hundred eighty-two women quit smoking, and 3,435 continued smoking. Weight was measured at baseline and at the year 3 visit. PA was assessed at both times by self-report, summarized as metabolic equivalent task-hours per week. Multiple linear regression models were used to assess the association between PA and postcessation weight gain, adjusting for potential confounding factors. RESULTS: Compared with continuing smokers, quitters gained an average of 3.5 kg (SD = 5.6) between the baseline and year 3 visit. Quitters with decreased PA had the highest amount of weight gain (3.88 kg, 95% CI: 3.22-4.54); quitters with increased PA (≥15 metabolic equivalent task-hours /week) had the lowest weight gain (2.55 kg, 95% CI: 1.59-3.52). Increased PA had a stronger beneficial association for postcessation weight gain for women with obesity compared to normal weight women. Quitters who had low PA at baseline and high PA at year 3 and were also enrolled in a dietary modification intervention had nonsignificant weight gain (1.88 kg, 95% CI: -0.21-3.96) compared with continuing smokers. CONCLUSIONS: Our data demonstrate that even a modest increase in PA (equivalent to current recommendations) can attenuate weight gain after quitting smoking among postmenopausal women, especially in combination with improved diet.

Metabolic Obesity Phenotypes and Risk of Breast Cancer in Postmenopausal Women.

Background: Obesity and the metabolic syndrome (MetS) have both been linked to increased risk of postmenopausal breast cancer; however, their relative contributions are poorly understood.Methods: We examined the association of metabolic phenotypes of obesity defined by presence of the MetS (yes and no) and body mass index (BMI; normal, overweight, obese) with risk of postmenopausal breast cancer in a prospective analysis of a cohort of postmenopausal women (n ∼ 21,000) with baseline measurements of blood glucose, triglycerides, HDL-cholesterol, blood pressure, waist circumference, and BMI. Women were classified into 6 metabolic obesity phenotypes according to their BMI (18.5-<25.0, 25.0-<30.0, ≥30.0 kg/m2) and presence of the MetS (≥3 of the following: waist circumference ≥88 cm, triglycerides ≥150 mg/dL, HDL-C <50 mg/dL, glucose ≥100 mg/dL, and systolic/diastolic blood pressure ≥130/85 mmHg or treatment for hypertension). HRs for incident breast cancer and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards models.Results: Over 15 years of follow-up, 1,176 cases of invasive breast cancer were diagnosed. Obesity, regardless of metabolic health, was associated with increased risk of breast cancer. Being obese and metabolically unhealthy was associated with the highest risk: HR, 1.62; 95% CI, 1.33-1.96. These associations were stronger in women who had never used hormone therapy.Conclusions: Our findings suggest that both obesity and metabolic dysregulation are associated with breast cancer risk.Impact: Beyond BMI, metabolic health should be considered a clinically relevant and modifiable risk factor for breast cancer. Cancer Epidemiol Biomarkers Prev; 26(12); 1730-5. ©2017 AACR.

Physical activity, bowel function, and quality of life among rectal cancer survivors.

PURPOSE: Physical activity (PA) is positively associated with numerous health benefits among cancer survivors. This study examined insufficiently investigated relationships among PA, health-related quality of life (HRQOL), and bowel function (BF) in rectal cancer survivors. METHODS: RC survivors (n = 1063) ≥5 years from diagnosis in two Kaiser permanente regions were mailed a multidimensional survey to assess HRQOL and BF. PA was assessed by a modified Godin Leisure-Time Exercise Questionnaire. PA minutes were categorized into weighted categories based on guidelines: (1) not active (zero PA minutes); (2) insufficiently active (1-149 PA minutes); (3) meeting guidelines (150-299 PA minutes); and (4) above guidelines (≥300 PA minutes). Relationships of PA with HRQOL and BF were evaluated using multiple linear regression, stratified by sex and ostomy status for BF. Types of PA identified as helpful for BF and symptoms addressed were summarized. RESULTS: Response rate was 60.5%. Of 557 participants, 40% met or exceeded PA guidelines, 34% were not active, and 26% were insufficiently active. Aerobic activities, specifically walking and cycling, were most commonly reported to help BF. Higher PA was associated with better psychological wellbeing and multiple SF12 scales, worse BF scores in men with ostomies, and better BF scores in women. CONCLUSIONS: Meeting or exceeding PA guidelines was associated with higher HRQOL. Although the BF findings are exploratory, they suggest women may benefit from increased PA, whereas men with ostomies may face challenges that require more study. Identifying PA strategies that will lead to improved patient compliance and benefit are needed.

Changes in physical activity, sedentary time, and risk of falling: The Women's Health Initiative Observational Study.

Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n=93,676; Y3 n=76,598; Y6 n=75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N=6475). Falls per year (0, 1, 2, ≥3) were assessed annually by self-report questionnaire and then dichotomized as ≤1 and ≥2falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend <0.0001). Increasing sedentary time minimally decreased falling (1% Y3; 2% Y6; p<0.05). Increasing activity up to ≥9MET-h/wk. (OR: 1.12, 95% CI: 1.03-1.22) or maintaining ≥9MET-h/wk. (OR: 1.20, 95% CI: 1.13-1.29) increased falling at Y3 and Y6 (p for trend <0.001). Adding lean body mass to the models attenuated these relationships. Physically active lifestyles increased falling among post-menopausal women. Additional fall prevention strategies, such as balance and resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases.

Postmenopausal weight change and incidence of fracture: post hoc findings from Women's Health Initiative Observational Study and Clinical Trials.

OBJECTIVES: To determine associations between postmenopausal change in body weight and incidence of fracture and associations between voluntary and involuntary weight loss and risk of fracture. DESIGN: Post hoc analysis of data from the Women's Health Initiative Observational Study and Clinical Trials. SETTING: 40 clinical centers in the United States. PARTICIPANTS: 120,566 postmenopausal women, aged 50-79 at baseline (1993-98), followed through 2013 (mean fracture follow-up duration 11 years from baseline). EXPOSURES: Annualized percentage change in measured body weight from baseline to year 3, classified as stable (<5% change), weight loss (≥ 5%), or weight gain (≥ 5%). Self assessment of whether weight loss was intentional or unintentional. Cox proportional hazards regression models were adjusted for age, race/ethnicity, baseline body mass index (BMI), smoking, alcohol intake, level of physical activity, energy expenditure, calcium and vitamin D intake, physical function score, oophorectomy, hysterectomy, previous fracture, comorbidity score, and drug use. MAIN OUTCOMES: Incident self reported fractures of the upper limbs, lower limbs, and central body; hip fractures confirmed by medical records. RESULTS: Mean participant age was 63.3. Mean annualized percent weight change was 0.30% (95% confidence interval 0.28 to 0.32). Overall, 79,279 (65.6%) had stable weight; 18,266 (15.2%) lost weight; and 23,021 (19.0%) gained weight. Compared with stable weight, weight loss was associated with a 65% higher incidence rates of fracture in hip (adjusted hazard ratio 1.65, 95% confidence interval 1.49 to 1.82), upper limb (1.09, 1.03 to 1.16), and central body (1.30, 1.20 to 1.39); weight gain was associated with higher incidence rates of fracture in upper limb (1.10, 1.05 to 1.18) and lower limb (1.18, 1.12 to 1.25). Compared with stable weight, unintentional weight loss was associated with a 33% higher incidence rates of hip fracture (1.33, 1.19 to 1.47) and increased incidence rates of vertebral fracture (1.16, 1.06 to 1.26); intentional weight loss was associated with increased incidence rates of lower limb fracture (1.11, 1.05 to 1.17) and decreased incidence of hip fracture (0.85, 0.76 to 0.95). CONCLUSIONS: Weight gain, weight loss, and intentional weight loss are associated with increased incidence of fracture, but associations differ by fracture location. Clinicians should be aware of fracture patterns after weight gain and weight loss.

Body fat percentage and body mass index in a probability sample of an adult urban population in Brazil / Composição corporal e índice de massa corporal em amostra probabilística de adultos de Niterói, Rio de Janeiro, Brasil / Composición corporal e índice de masa corporal en una muestra probabilística de adultos en Niterói, Río de Janeiro, Brasil

The purpose of the present study was to measure body composition in a probability sample of adults (≥ 20 years) living in Niterói, State of Rio de Janeiro, Brazil, and to assess the adequacy of the World Health Organization (WHO) recommended body mass index (BMI) cut-offs values for identifying obesity in this population. Anthropometric measures and percentage body fat (%BF) assessments were taken with 550 fasted individuals (352 women). Obesity was classified according to the WHO recommended BMI cut-off values. %BF predictive equations were developed based on the inverse of BMI. BMI and %BF mean values (standard error) were: 25.3kg/m² (0.3) and 38% (0.4) for women and 25.1kg/m² (0.3) and 22.1% (0.6) for men. The predicted %BF values (regression of %BF on the inverse of BMI) for each BMI cut-offs of 18.5, 25 and 30kg/m² were: 26.3%, 38.6% and 44.5% for women and 5.6%, 23.2% and 31.5% for men, respectively. The BMI values for the %BF-estimated obesity cut-off values were 20.5 for men and 25.7kg/m² for women. Based on the BMI-%BF relationship, the BMI cut-off values recommended by the WHO are not adequate in identifying obesity in adults from this population.

O presente estudo mediu a composição corporal em uma amostra probabilística de adultos (≥ 20 anos) de Niterói, Rio de Janeiro, Brasil, e avaliou a adequação dos pontos de corte do índice de massa corporal (IMC) da Organização Mundial da Saúde (OMS) para obesidade nessa população. Medidas antropométricas e de percentual de gordura corporal (%GC) por impedância bioelétrica foram obtidas em 550 (352 mulheres) adultos em jejum. A obesidade foi diagnosticada segundo os pontos de corte de IMC da OMS. Equações de predição para %GC em função do inverso do IMC foram desenvolvidas. Os valores médios (erro padrão) de IMC e %GC foram: 25,3kg/m² (0,3) e 38% (0,4) para mulheres e 25,1kg/m² (0,3) e 22,1% (0,6) para os homens. Os valores preditos de %GC para IMC de 18,5, 25 e 30kg/m² foram: 26,3%, 38,6% e 44,5% para as mulheres e 5,6%, 23,2% e 31,5% para os homens, respectivamente. Os valores de IMC para os pontos de corte para a obesidade baseados no %GC foram 20,5 (homens) e 25,7kg/m² (mulheres). Baseado na relação IMC-%GC, os pontos de corte de IMC propostos pela OMS não são adequados para identificar obesidade em adultos de Niterói.

El presente estudio midió la composición corporal en una muestra probabilística de adultos (≥ 20 años) de Niterói, Río de Janeiro, Brasil, y evaluó la adecuación de los puntos de corte del índice de masa corporal (IMC) de la Organización Mundial de la Salud (OMS) para la obesidad en esta población. Las medidas antropométricas y de porcentaje de grasa corporal (%GC) por impedancia bioeléctrica se obtuvieron de 550 (352 mujeres) adultos en ayunas. La obesidad fue diagnosticada según los puntos de corte de IMC de la OMS. Se desarrollaron ecuaciones de predicción para %GC en función del inverso del IMC. Los valores medios (error patrón) de IMC y %GC fueron: 25,3kg/m² (0,3) y 38% (0,4) para mujeres y 25,1kg/m² (0,3) y 22,1% (0,6) para los hombres. Los valores previstos de %GC para IMC de 18,5, 25 y 30kg/m² fueron: 26,3%, 38,6% y 44,5% para las mujeres y 5,6%, 23,2% y 31,5% para los hombres, respectivamente. Los valores de IMC en los puntos de corte para obesidad basados en el %GC fueron 20,5 (hombres) y 25,7kg/m² (mujeres). Basado en la relación IMC-%GC, los puntos de corte de IMC - propuestos por la OMS - no son adecuados para identificar obesidad en adultos de Niterói.

Percent body fat and chronic disease risk factors in U.S. children and youth.

BACKGROUND: The dramatic increase in pediatric obesity has renewed interest in accurate methods and screening indexes for identifying at-risk children and youth. Whether age-specific standards are needed is a factor that remains uncertain. PURPOSE: This study was designed to describe the age-specific fatness-risk factor relationship in boys and girls across a wide age range. METHODS: Data were from 12,279 white, black, and Mexican-American children and adolescents from the National Health and Nutritional Examination Surveys (NHANES) III (1998-1994) and IV (1999-2004). Children were grouped based on percent fat, estimated from subscapular and triceps skinfolds, and the age-specific relationships between percent fat and chronic disease risk factors (e.g., blood pressure, lipids and lipoprotein levels, glucose, insulin, and circulating C-reactive protein levels) were described in boys and girls, aged 6-18 years. RESULTS: Percent fat was significantly related to risk factor levels. At higher levels of percent fat, the prevalence of adverse cardiovascular disease risk factors was higher, particularly above 20% fat in boys and above 30% fat in girls. In boys and girls, the interaction term age by percent fat was a significant predictor of risk factors, whereas the percent fat by race interaction term was nonsignificant. CONCLUSIONS: The results demonstrate a strong relationship between chronic disease risk factors and percent fat in children and youth that varies by age in boys and girls.

Depressive symptoms and changes in body weight exert independent and site-specific effects on bone in postmenopausal women exercising for 1 year.

BACKGROUND: Lower bone mineral density (BMD) has been documented in clinically depressed populations, and depression is the second most common chronic medical condition in general medical practice. Therefore, the purpose of this study was to determine whether depressive symptoms, vitality, and body weight changes were related to 1-year BMD changes after accounting for covariates. METHODS: Healthy postmenopausal women (n=320; 40-65 years) were recruited, and 266 women completed the study. Participants were 3-10 years postmenopausal, sedentary, and either taking hormone replacement therapy (1-3.9 years) or not taking it (at least 1 year). Exclusion criteria were: current smoking status, history of fractures, low BMD, body mass index>32.9 or <19.0, or use of bone altering medications. Regional BMD was measured from dual-energy x-ray absorptiometry at baseline and 1 year. Self-reported depressive symptoms and vitality were measured using standard questionnaires. RESULTS: Both the vitality and depressive symptoms scores were related to BMD changes at the femur neck but not at the greater trochanter or spine. Weight change was a predictor of BMD changes in the trochanter and spine but not in the femoral neck. Weight change and vitality and/or depressive symptoms had differential and site-specific effects on BMD changes at the hip. Vitality and depressive symptoms related to femoral neck changes and weight change related to greater trochanter changes. CONCLUSIONS: The negative impact of depressive symptoms on BMD in this population of postmenopausal women was independent of body weight or other behavioral factors such as calcium compliance or exercise.

Dietary iron positively influences bone mineral density in postmenopausal women on hormone replacement therapy.

The associations of dietary intakes of iron and calcium on change in bone mineral density (BMD) were examined over 1 y in healthy nonsmoking postmenopausal women (mean age 55.6 +/- 4.6 y) stratified by hormone replacement therapy (HRT) use (HRT, n = 116; no HRT, n = 112). BMD was measured at lumbar spine L(2)-L(4), trochanter, femur neck, Ward's triangle, and total body using dual-energy X-ray absorptiometry at baseline and 1 y. Mean nutrient intakes were assessed using 8-d diet records. All women received 800 mg/d of supplemental elemental calcium. Regression analyses examined the effects of iron and calcium intakes on BMD change adjusting for years past menopause, baseline BMD, weight change, exercise, and energy intake. The interaction of iron with calcium on BMD change was assessed using tertiles of iron and calcium intake and estimated marginal mean change in BMD. Iron was associated (P < or = 0.05) with greater positive BMD change at the trochanter and Ward's triangle in women using HRT. Calcium was associated (P < or = 0.05) with BMD change at the trochanter and femur neck for women not using HRT. In women using HRT in the lowest tertile of calcium intake, change in femur neck BMD increased linearly as iron intake increased. In women not using HRT, BMD increased in the women in the highest tertile of calcium intake. We conclude that HRT use appears to influence the associations of iron and calcium on change in BMD.

Dietary iron is associated with bone mineral density in healthy postmenopausal women.

Healthy nonsmoking postmenopausal women (n = 242; ages 40-66 y) were included in the Bone, Estrogen, and Strength Training (BEST) Study. Bone mineral density (BMD) was measured at five sites (lumbar spine L2-L4, trochanter, femur neck, Ward's triangle and total body) using dual energy X-ray absorptiometry (DXA). Mean nutrient intakes were assessed using a 3-d diet record. Regression models were calculated using each BMD site as the dependent variable and iron as the independent variable. Covariates included in the models were years past menopause, fat-free mass, fat mass, use of hormone replacement therapy, total energy intake and dietary intake of protein and calcium. Using linear models, iron was associated with greater BMD at all sites (P < or = 0.01), even after adjusting for protein and/or calcium. Increasing levels of iron intake (>20 mg) were associated with greater BMD at several bone sites among women with a mean calcium intake of 800-1200 mg/d. Elevated iron intake was not associated with greater BMD among women with higher (>1200 mg/d) or lower calcium intakes (<800 mg/d). Dietary iron may be a more important factor in bone mineralization than originally thought and, its combined effect with calcium on BMD warrants exploration in future studies.

Body composition modulates the effects of hormone replacement therapy on growth hormone and insulin-like growth factor-I levels in postmenopausal women.

OBJECTIVE: To examine the relationships of body composition with basal serum estrone, estradiol, androstenedione, cortisol, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in 73 postmenopausal women. DESIGN: Cross-sectional study of hormone levels and body composition determined by dual-energy X-ray absorptiometry and anthropometry in women who were not taking oral hormone replacement therapy (HRT) and women taking HRT. Because high adiposity may modify hormone levels, subjects were grouped by fatness into obese (BMI >25 kg/m(2) and waist circumference >80 cm) and lean groups, as well as by HRT use. RESULTS: Total levels of estrone, estradiol, GH and cortisol were significantly higher and IGF-1 was lower in HRT users. In HRT users, estradiol levels were higher and GH levels were lower in obese than lean women. IGF-1 levels were lower in obese HRT users than lean nonusers. Total cortisol levels were significantly higher in lean HRT users than lean nonusers and obese users. GH and IGF-1 were significantly inversely correlated with trunk fat and percent body fat. Multiple regression revealed that only trunk fat was a significant (negative) determinant of GH and IGF-1 levels, whereas HRT use positively and negatively predicted GH and IGF-1, respectively. Percent body fat significantly predicted estradiol levels. Body composition did not differ by HRT use. CONCLUSIONS: Our results suggest that trunk fat attenuates the HRT-induced increase on GH levels. In addition, trunk fat is a significant determinant of low IGF-1 levels in postmenopausal women, and IGF-1 levels decline more with HRT use.