A mediation analysis on the relationship between dietary glycemic load, obesity and cardiovascular risk factors in children.

BACKGROUND/OBJECTIVE: Adiposity may mediate the effect of dietary glycemic load (GL) on lipid profiles in children, as studies have shown an association between dietary GL and adiposity and between adiposity and lipid profiles. Our objective was to evaluate the role of adiposity as a mediator in the association between dietary GL and lipid profiles after 2 years. SUBJECTS/METHODS: The Quebec Adipose and Lifestyle InvesTigation in Youth study included 630 children, 8-10 years old at recruitment with at least one parent with overweight or obesity with 2-year follow-up. Three baseline 24-h dietary recalls were administered by a dietitian at baseline. Child and parent characteristics were obtained through direct measurement (blood lipids, anthropometrics) or questionnaires (socio-economic characteristics). Indicators of adiposity, including body mass index (BMI) z-score and percent body fat, were the mediators of interest. A conventional approach using the Baron and Kenny method was used. A causal approach using marginal structural models (MSM) was used to estimate the controlled direct effect. RESULTS: Mean age at baseline was 9.6 years and 33% were overweight or obese. Both methods revealed that the effect of GL on blood lipids was mediated by adiposity. The weighted MSM did not show evidence of a direct effect (TG: ß =;0.01, 95% CI = -0.01,0.02; HDL: ß = 0.005, 95%CI = -0.002,0.01), whereas the conventional method did for TG but not HDL (TG:ß = 0.04, 95%CI = 0.01,0.07; HDL: ß = -0.01, 95%CI = -0.03,0.01). CONCLUSION: Adiposity contributes substantially to the association between GL and blood lipids. The choice of approach for mediation analysis should be based on the fulfilment of conditions of each method.

Effects of dietary glycemic index and load on children's cardiovascular risk factors.

PURPOSE: Consumption of foods high in glycemic index (GI) and glycemic load (GL) is associated with cardiovascular (CV) diseases in adulthood. We examined whether GI and GL predict CV risk factors in children after 2 years of follow-up. METHODS: Three 24-hour recalls were administered at baseline, and individual average daily GI and GL scores were calculated in a cohort of 8-10 year-old children. CV risk factors included body mass index z-score (BMIz), percent fat mass, triglycerides (TGs), low-density lipoprotein and high-density lipoprotein (HDL) cholesterol, and systolic and diastolic blood pressure. Main analyses consisted of multiple linear regression adjusted for anthropometric, socioeconomic, and dietary factors. RESULTS: After 2 years, the highest dietary GL tertile compared with the lowest was associated with increased BMIz (mean difference [MD], 1.1; 95% CI, 0.88-1.31), fat mass (MD, 10.8%; 95% CI, 8.62-13.0), TGs (MD, 0.17 mmol/L; 95% CI, 0.07-0.28), and decreased HDL (MD, -0.13 mmol/L; 95% CI, -0.19 to -0.07). The GL-TG and the GL-HDL associations were mediated by BMIz. CONCLUSIONS: GL predicts increased BMIz, percent fat mass, and TGs and decreased HDL in young children after 2 years. Recommendations to decrease CV risk in children should include lowering foods high in GL.

The Cardiometabolic Risk Profile of Underreporters of Energy Intake Differs from That of Adequate Reporters among Children at Risk of Obesity.

Background: Misreporting of energy intake (EI) in nutritional epidemiology is a concern because of information bias, and tends to occur differentially in obese compared with nonobese subjects. Objective: We examined characteristics of misreporters within a cohort of children with a parental history of obesity and the bias introduced by underreporting. Methods: The QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort included 630 Caucasian children aged 8-10 y at recruitment with ≥1 obese parent [body mass index (BMI; in kg/m2) >30 or waist circumference >102 cm (men), >88 cm (women)] and free of diabetes or severe illness. Children on antihypertensive medications or following a restricted diet were excluded. Child and parent characteristics were measured directly or by questionnaire. Three 24-h dietary recalls were administered by phone by a dietitian. Goldberg's cutoff method identified underreporters (URs). Logistic regression identified correlates of URs. We compared coefficients from linear regressions of BMI after 2 y on total EI at baseline 1) in all participants; 2) in adequate reporters (ARs) (excluding URs); 3) in all participants statistically adjusted for underreporting; 4) excluding URs using individual physical activity level (PAL)-specific cutoffs; and 5) in all participants statistically adjusted for underreporting using PAL-specific cutoffs. Results: We identified 175 URs based on a calculated cutoff of 1.11. URs were older, had a higher BMI z score, and had poorer cardiometabolic health indicators. Parents of URs had a lower family income and higher BMI. Child BMI z score (OR: 3.07; 95% CI: 2.38, 3.97) and age (OR: 1.46/y; 95% CI: 1.14, 1.87/y) were the strongest correlates of underreporting. The association between BMI and total EI was null in all participants but became significantly positive after excluding URs (ß = 0.62/1000 kcal; 95% CI: 0.33, 0.92/1000 kcal) and after adjustment for URs (ß = 0.85/1000 kcal; 95% CI: 0.55, 1.06/1000 kcal). Conclusions: URs in 8- to 10-y-old children differed from ARs. Underreporting biases measurement of nutritional exposures and the assessment of exposure-outcome relations. Identifying URs and using an appropriate correction method is essential.

Understanding how Indigenous culturally-based interventions can improve participants' health in Canada.

There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.

Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services.

BACKGROUND: Length measurements are important in growth, monitoring and promotion (GMP) for the surveillance of a child's weight-for-length and length-for-age. These two indices provide an indication of a child's risk of becoming wasted or stunted, and are more informative about a child's growth than the widely used weight-for-age index (underweight). Although the introduction of length measurements in GMP is recommended by the World Health Organization, concerns about the reliability of length measurements collected in rural outreach settings have been expressed by stakeholders. Our aim was to describe the reliability and challenges associated with community health personnel measuring length for rural outreach GMP activities. METHODS: Two reliability studies (A and B), using 10 children less than 24 months each, were conducted in the GMP services of a rural district in Ghana. Fifteen nurses and 15 health volunteers (HV) with no prior experience in length measurements were trained. Intra- and inter-observer technical error of measurement (TEM), average bias from expert anthropometrist, and coefficient of reliability (R) of length measurements were assessed and compared across sessions. Observations and interviews were used to understand the ability and experiences of health personnel with measuring length at outreach GMP. RESULTS: Inter-observer TEM was larger than intra-observer TEM for both nurses and HV at both sessions and was unacceptably (compared to error standards) high in both groups at both time points. Average biases from expert's measurements were within acceptable limits, however, both groups tended to underestimate length measurements. The R for lengths collected by nurses (92.3%) was higher at session B compared to that of HV (87.5%). Length measurements taken by nurses and HV, and those taken by an experienced anthropometrist at GMP sessions were of moderate agreement (kappa = 0.53, p < 0.0001). CONCLUSIONS: The reliability of length measurements improved after two refresher trainings for nurses but not for HV. In addition, length measurements taken during GMP sessions may be susceptible to errors due to overburdened health personnel and crowded GMP clinics. There is need for both pre- and in-service training of nurses and HV on length measurements and procedures to improve reliability of length measurements.

Rapid increase of overweight and obesity among primary school-aged children in the Caribbean; high initial BMI is the most significant predictor.

BACKGROUND: To examine predictors of increasing overweight among children in two developing countries. METHODS: Primary school children (6-10 y at baseline, n = 336) and their caregivers.Longitudinal data were collected in 2012, with follow-up 18 months later. Data on children's height, weight and dietary intake were collected within 8 primary public schools in Trinidad and 7 schools in St. Kitts. Caregivers' demographic and anthropometric data were also collected. RESULTS: At baseline, children's age and sex and caregivers' BMI, age, and marital status and reported dietary intake were similar across all weight groups. The incidence of overweight and obesity among children was 8.8% and 8.1%, respectively. Dietary intake at baseline was not related to becoming overweight or obese. Similarly there were no differences in reported intake among children who became overweight or obese except that they consumed fewer fruits (0.54±0.92 vs. 0.98±1.66, p = 0.017). Misreporting of energy intake was higher among overweight/obese children as compared to those who were not overweight/obese (27% vs. 17%, p = 0.047). The baseline predictors of increasing BMI (adjusted) of the children were older age, higher baseline BMI z-score and higher height-for-age (HFA) z-score; caregiver BMI, children's energy intake (with adjustment for misreporting) did not predict changes in children's BMI. CONCLUSIONS: The increasing prevalence of overweight/obesity among children is a serious problem in the Caribbean. Heavier children are at elevated risk of continued rapid increase in their weight status, pointing to the need for early intervention.

A prospective evaluation of the depression-nutrient intake reverse causality hypothesis in a cohort of community-dwelling older Canadians.

Studies have investigated the potential protective effects that diet may have on late-life depression incidence. This disorder can, however, affect the person's food intake, widely known as the reverse causality hypothesis of depression. To test this hypothesis, we compared mean nutrient intakes from three 24-h recalls during the year depression was detected (Geriatric Depression Scale ≥11 or antidepressant medication) with intakes from 1 year earlier among community-dwelling older adults (67-83 years) followed up annually in the 4-year Québec Longitudinal Study on Nutrition and Aging, who were free of depression and cognitive impairment at baseline. Participants (n 158, 64·4 % female) who became depressed and had data available for all follow-up years were matched by age group and sex with non-depressed participants. General linear mixed models were adjusted for percentage changes in physical activity, functional autonomy and stressful life events reported at the time of positive screening. A significant group effect for the dietary intake of all three B-vitamins was observed, as depression cases had consistently lower dietary intakes than controls (P<0·01). Over time, intakes of dietary vitamin B12 declined within depressed participants in bivariate analysis, but there was no time×group effect for any nutrient tested in the multivariate analyses. Intakes of energy, protein, saturated fat and total dietary fibre did not change in cases v. CONTROLS: Among community-dwelling older adults, declines in dietary vitamins B6, B12 and folate may precede depression incidence. To help preventative efforts by programmes and practitioners, longitudinal cohorts of longer duration should investigate the extent of the decline in dietary intakes relative to the time of depression.

Diet quality as measured by the Diet Quality Index-International is associated with prospective changes in body fat among Canadian children.

OBJECTIVE: To quantify the association of dietary quality with prospective changes in adiposity. DESIGN: Children participating in the QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) study underwent examination at baseline and at 2-year follow-up. Dietary quality was assessed by the Diet Quality Index-International (DQII) using three non-consecutive 24 h diet recalls at baseline. The DQII has four main categories: dietary adequacy, variety, moderation and overall balance. Fat mass index (FMI; [fat mass (kg)]/[height (m)]2), central FMI (CFMI; [trunk fat mass (kg)]/[height (m)]2), percentage body fat (%BF; [total fat mass (kg)]/[total mass (kg)]) and percentage central BF (%CBF; [trunk fat mass (kg)]/[total mass (kg)]) were assessed through dual-energy X-ray absorptiometry. SETTING: Children were selected from schools in the greater Montreal, Sherbrooke and Quebec City metropolitan areas between 2005 and 2008, Quebec, Canada. SUBJECTS: A total of 546 children aged 8-10 years, including 244 girls and 302 boys. RESULTS: Regression analysis adjusting for age, sex, energy intake, physical activity and Tanner stage revealed that every 10-unit improvement in overall DQII score was associated with lower gain in CFMI (ß=-0·08; 95 % CI -0·17, -0·003) and %BF (ß=-0·55; 95 % CI -1·08, -0·02). Each unit improvement in dietary adequacy score was associated with lower gain in FMI (ß=-0·05; 95 % CI -0·08, -0·008), CFMI (ß=-0·03; 95 % CI -0·05, -0·007), %BF (ß=-0·15; 95 % CI -0·28, -0·03) and %CBF (ß=-0·09; 95 % CI -0·15, -0·02). CONCLUSIONS: Promotion of dietary quality and adequacy may reduce weight gain in childhood and prevent chronic diseases later in life.

Empowering women to breastfeed: Does the Baby Friendly Initiative make a difference?

The Baby-Friendly Hospital Initiative (BFI) is currently presented worldwide as the gold standard model of care for promoting and supporting breastfeeding. However, there is a lack of understanding about the ways in which health services, including the BFI, address the cultural change from a disembodied practice (formula feeding) to an embodied one (breastfeeding) in contexts where formula feeding is the norm. We used a qualitative case study methodology to compare the embodied experience of breastfeeding and the maternal experience of breastfeeding promotion and support services between mothers receiving care from institutions with low and high levels of BFI implementation in Québec, Canada. A total of 11 focus groups were conducted with mothers from six institutions-three with high and three with low levels of BFI implementation. We found the flexible approach to breastfeeding duration, characteristic of BFI services in our study, helped to avoid maternal guilt and shame; the shift to focusing on potential barriers and strategies for overcoming them empowered women to negotiate changes in infant feeding with others and self by addressing the embodied experience of a practice that may not feel natural at the beginning. Findings have implications for the concept of habitus and the construction of the breastfeeding body; we suggest that habitus can change if agents are provided with discursive tools to negotiate this embodied change. Implications for BFI services include the need to implement the 10 steps in a flexible, family-centred way that focuses on empowering women rather than simply reaching outcomes.

Relation between mealtime distribution of protein intake and lean mass loss in free-living older adults of the NuAge study.

BACKGROUND: Studies have shown that an even protein intake distribution across meals increased 24-h muscle protein synthesis in young adults compared with a skewed intake. Whether this short-term result translates into long-term preservation of lean mass (LM) in older adults remains unknown. OBJECTIVE: The aim was to examine the extent to which protein quantity and distribution are associated with LM and appendicular LM (aLM), and their 2-y decline, in community-dwelling older adults. DESIGN: Baseline and 2-y follow-up data from 351 men and 361 women (aged 67-84 y) in the NuAge study (Quebec Longitudinal Study on Nutrition as a Determinant of Successful Aging) with available body-composition data (by dual-energy X-ray absorptiometry) were used. Food intake was assessed with the use of three 24-h food recalls collected at baseline and 3 collected at the 2-y follow-up. Protein distribution across meals was calculated as the CV of protein ingested per meal, with lower values reflecting evenness of protein intake. Linear mixed-model analysis was performed to examine changes in LM and aLM across time, by sex, as conditioned by the quantity and distribution of protein intake, adjusted for potential covariates. RESULTS: Over 2 y, LM declined in both men (-2.5% ± 4.0%) and women (-2.0% ± 3.4%) (P < 0.05), whereas aLM loss was not significant (men: -1.5% ± 4.8%; women: -1.2% ± 5.3%; P > 0.05). The decline in LM was not independently affected by the quantity and distribution of protein intake. Yet men and women with evenly distributed protein intakes and men with high protein intakes showed higher LM or aLM throughout the entire follow-up period, even after potential confounders were controlled for (P < 0.05). CONCLUSIONS: Our results suggest that greater protein intakes and a more even distribution across meals are modifiable factors associated with higher muscle mass in older adults but not with losses over 2 y. Interventional studies should determine longer-term effects on preserving LM with aging.

Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond.

OBJECTIVES: To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle. OUTCOMES: Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter. EVIDENCE: Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document. VALUES: The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.

Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà.

OBJECTIFS: Doter les professionnels de la santé du Canada de connaissances et d'outils de base, afin qu'ils puissent prodiguer des conseils nutritionnels aux femmes tout au long de leur cycle de vie. RéSULTATS: L'alimentation optimale a fait l'objet d'une évaluation tout au long du cycle de vie de la femme. Elle a porté en particulier sur l'adolescence, la préconception, la grossesse, la période post-partum, la ménopause et au-delà. Le présent guide fournit d'abord des directives abrégées à l'intention de toutes les femmes. Elles sont suivies de chapitres proposant un examen des données probantes, ainsi que des recommandations sur la promotion d'une alimentation saine et d'un poids santé à chaque étape de la vie. Par ailleurs, tous les chapitres présentent une analyse de nutriments d'intérêt particulier, ainsi que d'autres aspects uniques à chaque étape de la vie. DONNéES PROBANTES: Des documents publiés, des rapports d'organismes gouvernementaux et de santé, des lignes directrices de pratique clinique, de la documentation parallèle et des extraits de manuels ont servi à étayer les recommandations formulées dans le présent document. VALEURS: L'évaluation de la qualité des données probantes repose sur les critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. CHAPITRE 2 : CONSEILS GéNéRAUX SUR L'ALIMENTATION FéMININE: Déclarations Sommaires Recommandations CHAPITRE 3 : ALIMENTATION DE L'ADOLESCENTE: Déclarations Sommaires Recommandations CHAPITRE 4 : ALIMENTATION PRéCONCEPTIONNELLE: Déclarations Sommaires Recommandations CHAPITRE 5 : ALIMENTATION PENDANT LA GROSSESSE: Déclarations Sommaires Recommandations CHAPITRE 6 : ALIMENTATION ET LACTATION POST-PARTUM: Déclarations Sommaires Recommandations CHAPITRE 7 : ALIMENTATION PENDANT LA MéNOPAUSE ET AU-DELà: Déclarations Sommaires Recommandations.

Influence of Adiposity, Physical Activity, Fitness, and Screen Time on Insulin Dynamics Over 2 Years in Children.

IMPORTANCE: Despite extensive evidence showing that lifestyle habits play a critical role in preventing or delaying the onset of type 2 diabetes in adults, little is known regarding the impact of lifestyle habits on type 2 diabetes risk in childhood. OBJECTIVE: To assess whether adiposity, fitness, moderate-to-vigorous physical activity, and screen time predict insulin sensitivity or insulin secretion during a 2-year period in children with a family history of obesity. DESIGN, SETTING, AND PARTICIPANTS: This is a prospective longitudinal cohort study of 630 children, having at least 1 obese parent, recruited from schools in Quebec, Canada, between July 2005 and December 2008 in the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort. Children were assessed at baseline (ages 8-10 years) and 2 years later. Fitness was measured by peak oxygen consumption, percentage of body fat (adiposity) by dual-energy x-ray absorptiometry, moderate-to-vigorous physical activity using accelerometry, and screen time by average daily hours of self-reported television, video game, or computer use. Regression models were adjusted for age, sex, season, and pubertal stage. The current analysis was completed in October 2015. MAIN OUTCOMES AND MEASURES: Insulin sensitivity was measured by the homeostatic model assessment of insulin resistance and an oral glucose tolerance test-based index (Matsuda insulin sensitivity index). Insulin secretion was measured using the area under the curve of insulin to glucose during the first 30 minutes of the oral glucose tolerance test and using the area under the curve of insulin to glucose over 2 hours. RESULTS: Of 630 children evaluated at baseline (mean [SD] age, 9.6 [0.9] years; 54.4% male; 56.2% normal weight, 19.2% overweight, and 22.7% obese), 564 were evaluated at 2-year follow-up. Adiposity and changes in adiposity were the central predictors of insulin dynamics over time. Every additional 1% of body fat at ages 8 to 10 years decreased insulin sensitivity by 2.9% (95% CI, -3.3% to -2.5%; P < .001) and led to a 0.5% (95% CI, 0.09% to 0.8%; P = .02) increased requirement in the area under the curve of insulin to glucose during the first 30 minutes of the oral glucose tolerance test 2 years later. Higher levels of moderate-to-vigorous physical activity and lower screen time appear to be beneficial to insulin sensitivity in part through their effect on adiposity levels. CONCLUSIONS AND RELEVANCE: Adiposity plays a determining role in cardiometabolic health at a young age. Public health strategies that promote healthy body weight, notably physical activity, need to target school-aged and possibly younger children.

Predictors of Weight Loss in Young Adults.

BACKGROUND: Increased understanding of weight loss among healthy young people in naturalistic settings could inform the development of effective weight control programs. The aim of this study was to describe loss in BMI over 7 years in a population-based sample of healthy young adolescents (mean age 17 years at beginning of follow-up) and identify determinants of BMI loss. DESIGN AND METHOD: Data were available for 681 participants in the Nicotine Dependence in Teens Study (1999-2012), a longitudinal investigation of adolescents in Montreal (Canada). Loss in BMI was assessed between age 17 and 24 years. Potential predictors of BMI loss including age, sex, mother's education, worry about weight, physical activity, screen time, and cigarette smoking were studied in multivariable logistic regression. RESULTS: Males and females gained 2.0 and 1.4 BMI units, respectively, on average, between age 17 and 24 years. However, 9% of males and 14% of females experienced a loss in BMI ≥1.0 unit. Female sex and a higher BMI at age 17 were associated with a higher probability of BMI loss, but none of age, mother's education, physical activity, screen time, or cigarette smoking were associated with BMI loss between ages 17 and 24. CONCLUSIONS: Whereas BMI increased on average between age 17 and 24 years in a population-based sample of healthy young people, 12% of participants experienced a loss in BMI ≥1 unit. Weight loss was highest among the heaviest persons and did not affect the prevalence of underweight. No single behavior at age 17 stands out as associated with predicting BMI loss.

Associations between added sugar (solid vs. liquid) intakes, diet quality, and adiposity indicators in Canadian children.

Little is known about the influence of different forms of added sugar intake on diet quality or their association with obesity among youth. Dietary intake was assessed by three 24-h recalls in 613 Canadian children (aged 8-10 years). Added sugars (mean of 3-day intakes) were categorized according to source (solid or liquid). Dietary intake and the Canadian Healthy Eating Index (« HEI-C ¼) were compared across tertiles of solid and liquid added sugars separately as were adiposity indicators (body mass index (BMI), fat mass (dual-energy X-ray absorptiometry), and waist circumference). Cross-sectional associations were examined in linear regression models adjusting for age, sex, energy intake, and physical activity (7-day accelerometer). Added sugar contributed 12% of total energy intake (204 kcal) on average, of which 78% was from solid sources. Higher consumption of added sugars from either solid or liquid source was associated with higher total energy, lower intake of micronutrients, vegetables and fruit, and lower HEI-C score. Additionally liquid sources were associated with lower intake of dairy products. A 10-g higher consumption of added sugars from liquid sources was associated with 0.4 serving/day lower of vegetables and fruit, 0.4-kg/m(2) higher BMI, a 0.5-kg higher fat mass, and a 0.9-cm higher waist circumference whereas the associations of added sugars from solid sources and adiposity indicators tended to be negative. In conclusion, higher consumption of added sugar from either solid or liquid sources was associated with lower overall diet quality. Adiposity indicators were only positively associated with added sugars from liquid sources.

Drastic increases in overweight and obesity from 1981 to 2010 and related risk factors: results from the Barbados Children's Health and Nutrition Study.

OBJECTIVE: To examine overweight and obesity (OWOB), changes in prevalence and potential risk factors in Barbadian children. DESIGN: A cross-section of students were weighed and measured. The WHO BMI-for-age growth references (BAZ), the International Obesity Task Force cut-offs and the US Centers for Disease Control and Prevention growth percentiles were used to determine OWOB prevalence. Harvard weight-for-height-for-age growth standards were used to estimate differences in OWOB prevalence from 1981 to 2010. Samples of parents and students were interviewed to describe correlates of OWOB. SETTING: Barbados. SUBJECTS: Public-school students (n 580) in class 3. RESULTS: Based on WHO BAZ, the overall prevalence of OWOB was 34·8 % (95 % CI 30·9, 38·7 %). A trend of higher OWOB prevalence was seen for girls across cut-offs, with significant sex differences noted using the International Obesity Task Force cut-offs. According to Harvard growth standards, OWOB has increased dramatically, from 8·52 % to 32·5 %. Children were more likely to be OWOB when annual household income was below BBD 9000 (OR=2·69; 95 % CI 1·21, 5·99). Eating dinner with the family every night was associated with a lower prevalence of OWOB (OR=0·56; 95 % CI 0·36, 0·87). CONCLUSIONS: The sharp increase of OWOB rates in Barbados warrants attention. Sex disparities in OWOB prevalence may emerge at a young age. Promoting family meals may be a feasible option for OWOB prevention. Understanding familial and sociodemographic factors influencing OWOB will be useful in planning successful intervention or prevention programmes in Barbados.

Screen time is associated with dietary intake in overweight Canadian children.

OBJECTIVES: To describe the relationship between screen time and dietary intake among children, and to examine this association in relation to body weight. METHODS: A cross-sectional analysis of 630 Canadian children aged 8-10 years with at least one obese biological parent. Measurements included body mass index (BMI), screen time (television, video game, computer), physical activity (accelerometer over 7 days), and diet (three 24-hour recalls for the calculation of the Canadian Healthy Eating Index (HEI-C)). Multivariate linear regression models were used to describe the relationship between screen time (≥ 2 h/d vs. < 2 h/d) and intake of nutrients and foods among healthy weight and overweight/obese children. RESULTS: The overall median [interquartile range] daily screen time was 2.2 [2.4] hours and 43% of children had a BMI of ≥ 85th percentile. Longer screen time above the recommendation (≥ 2 h/d) was associated with higher intake of energy (74 kcal, SE = 35), lower intake of fiber (- 0.6 g/1000 kcal, SE = 0.2) and vegetables & fruit (- 0.3 serving/1000 kcal, SE = 0.1) among all participants and with higher estimates in the overweight subgroup. An overall lower HEI-C (- 1.6, SE = 0.8) was also observed among children with screen time of ≥ 2 h/d. Among children of < 85th BMI percentile, longer screen time was associated with lower intake of vegetables & fruit (- 0.3 serving/1000 kcal, SE = 0.1) only. CONCLUSION: Screen time is associated with less desirable food choices, particularly in overweight children.

Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study.

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca).

Interrelated factors favoring physical performance and activity in older adults from the NuAge cohort study.

OBJECTIVES: Contribute evidence towards the complex interrelationships of body composition, physical performance and physical activity (PA) in an older population to assist in decisions for maintaining functional capacity in older adults. DESIGN: This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis. A proposed model with age, sex, energy intake and chronic diseases as predictors associated with body composition components, while the latter associated with physical performance and with PA acting both as a predictor and as an outcome of physical performance. PARTICIPANTS: A sample of 847, community dwellers, non-diabetic older men and women from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge Study). MEASUREMENTS: Physical performance tests were reduced to two indices: strength and mobility. Muscle mass index (MMI; kg/height(2)) and % body fat were derived from DXA and bioimpedance analysis (BIA). PA was assessed by the Physical Activity Scale for the Elderly (PASE) and energy intakes were calculated from 24-hour food recalls. Data from the NuAge dataset served to test the relationships. The proposed model was evaluated using indices of fit. RESULTS: Significant associations were found for MMI and % body fat with mobility (ß -0.11 and -0.02, respectively), and for MMI with strength (ß=0.60). PA was associated with MMI (ß=0.02) and negatively with % body fat (ß=-0.16), while mobility associated with PA (ß=0.65). Our hypothesized model, with some paths added, fit the data: chi-square=4.64, root mean square error of approximation (RMSEA)=0. CONCLUSIONS: PA has desirable associations with body composition in older adults and mobility is associated with PA. These results stress the importance of taking into account the prior level of mobility when recommending PA for this age group. This model could explain in part the complex interrelationships that occur with aging and the potential factors that could be targeted to assist older individuals in maintaining functional capacity.

The association between food patterns and adiposity among Canadian children at risk of overweight.

Identifying food patterns related to obesity can provide information for health promotion in nutrition. Food patterns and their relation with obesity among Canadian children have not been reported to date. Our aim was to identify and describe food patterns associated with obesity in children at risk of overweight. Caucasian children (n = 630) with at least 1 obese biological parent recruited into the Quebec Adiposity and Lifestyle Investigation in Youth (QUALITY) cohort were studied in cross-sectional analyses. Measures of adiposity (body mass index (BMI), waist circumference, body fat mass percentage measured by dual-energy X-ray absorptiometry), screen time, physical activity (accelerometer over 7 days), and dietary intake (three 24-h food recalls) were collected. Factor analysis was used to identify food patterns. The relationships between food patterns and overweight were investigated in logistic and multiple linear regression models. Three food patterns were retained for analysis: traditional food (red meats, main dishes-soups, high-fat dairy products, tomato products, dressings, etc.); healthy food (low-fat dairy products, whole grains, legumes-nuts-seeds, fruits, vegetables); and fast food (sugar-sweetened beverages, fried potatoes, fried chicken, hamburgers-hot dogs-pizza, salty snacks). Higher scores on the fast food pattern were associated with overweight (BMI ≥ 85th percentile), and other measures of adiposity (BMI, waist circumference, body fat mass percentage) after adjustment for age, sex, physical activity, screen time, sleep time, family income, and mother's obesity (p < 0.05). Controlling for energy intake did not change these relationships. Our results provide further evidence of a link between fast food intake and obesity in children.