Study of How Adiposity in Pregnancy has an Effect on outcomeS (SHAPES): protocol for a prospective cohort study.

INTRODUCTION: Maternal obesity increases the risk of multiple maternal and infant pregnancy complications, such as gestational diabetes and pre-eclampsia. Current UK guidelines use body mass index (BMI) to identify which women require additional care due to increased risk of complications. However, BMI may not accurately predict which women will develop complications during pregnancy as it does not determine amount and distribution of adipose tissue. Some adiposity measures (eg, waist circumference, ultrasound measures of abdominal visceral fat) can better identify where body fat is stored, which may be useful in predicting those women who need additional care. METHODS AND ANALYSIS: This prospective cohort study (SHAPES, Study of How Adiposity in Pregnancy has an Effect on outcomeS) aims to evaluate the prognostic performance of adiposity measures (either alone or in combination with other adiposity, sociodemographic or clinical measures) to estimate risk of adverse pregnancy outcomes. Pregnant women (n=1400) will be recruited at their first trimester ultrasound scan (11+2-14+1 weeks') at Newcastle upon Tyne National Health Service Foundation Trust, UK. Early pregnancy adiposity measures and clinical and sociodemographic data will be collected. Routine data on maternal and infant pregnancy outcomes will be collected from routine hospital records. Regression methods will be used to compare the different adiposity measures with BMI in terms of their ability to predict pregnancy complications. If no individual measure performs better than BMI, multivariable models will be developed and evaluated to identify the most parsimonious model. The apparent performance of the developed model will be summarised using calibration, discrimination and internal validation analyses. ETHICS AND DISSEMINATION: Ethical favourable opinion has been obtained from the North East: Newcastle & North Tyneside 1 Research Ethics Committee (REC reference: 22/NE/0035). All participants provide informed consent to take part in SHAPES. Planned dissemination includes peer-reviewed publications and additional dissemination appropriate to target audiences, including policy briefs for policymakers, media/social-media coverage for public and conferences for research TRIAL REGISTRATION NUMBER: ISRCTN82185177.

Improved prediction equations for estimating height in adults from ethnically diverse backgrounds.

BACKGROUND & AIMS: When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice. METHODS: Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180). RESULTS: UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (Hp) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (Hp (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was -0.6 (-2.4, +1.2); Asian women, (Hp = 3.26 UL + 77.62), mean difference +0.5 (-1.4, 2.4) cm. For Black men, Hp = 3.14 UL + 85.80, -0.4 (-2.4, 1.7); Black women, Hp = 3.14 UL + 79.55, -0.8 (-2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height. CONCLUSIONS: The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations.

Protocol variations in arm position influence the magnitude of waist girth.

Waist girth is recognised as a better predictor of obesity, particularly abdominal obesity, compared to other measures. Although several protocols for waist girth exist, arm position is either ignored, or not specified in unambiguous terms. Therefore, the purpose of this study was to determine if arm position influenced anthropometric waist girth measurement. Waist girth was measured in 92 adults (19 males, 73 females) with arms relaxed, abducted, horizontal, folded across the chest (three variations) and raised vertically. Duplicate measures, in all positions, were recorded by a single International Society for the Advancement of Kinanthropometry (ISAK)-trained technician to a precision of 0.2% technical error of measurement (TEM). Arm position had a significant effect (P < 0.001) on waist girth. Male participants had greater waist girth than females (P < 0.001) and the waist girth differences across the varying arm positions exhibited a significant position-by-gender interaction (P < 0.001). The arm position-by-body mass index (BMI) category interaction was also significant (P = 0.016) with greater differences observed at higher BMI. These findings suggest caution in comparing results of different studies where arm position is not specified and indicate that the arm position corresponding to the ISAK protocol has the lowest error and is therefore recommended.

Video instructions improve accuracy of self-measures of waist circumference compared with written instructions.

OBJECTIVE: To determine whether video-based instructions improve the accuracy of self-measures of waist and hip circumference compared with written instructions. DESIGN: Population-based, cross-sectional study. Self-measurements of waist circumference (WC) and hip circumference (HC) of fifty-seven participants randomly allocated to receive either written instruction or video instruction were compared with those of a trained technician. SETTING: Aberdeen, Scotland, and Brussels, Belgium, between February and April 2010. SUBJECTS: Adults aged 18-62 years with a high level of English language and no prior training in anthropometry. RESULTS: WC was significantly overestimated by the written method (1·75 cm bias; P = 0·007) but not the video method (0·95 cm bias; P = 0·239). HC was significantly underestimated in both written (-0·35 cm bias; P = 0·009) and video methods (-0·75 cm bias; P = 0·046). Reliability was not significantly affected by age, sex, BMI or WC. Bland-Altman plots demonstrated wide limits of agreement for WC (-6·83, 6·08 cm for written method; -10·14, 6·72 cm for video method) and HC (-12·85, 1·60 cm for written method; -10·82, 2·50 cm for video method). CONCLUSIONS: Video technology can support more accurate self-measurements of anthropometric data in epidemiological studies. Further research is warranted using larger and more heterogeneous samples in order that results can be generalised.

Children's perceptions of parental emotional neglect and control and psychopathology.

BACKGROUND: Parental emotional neglect is linked to psychiatric disorder. This study explores the associations between children's perceptions of parental emotional neglect and future psychopathology. METHODS: In a school-based longitudinal study of nearly 1,700 children aged 11-15 we explored children's perceptions of parenting, as measured by the Parental Bonding Instrument (PBI) at age 11, and their associations with later psychiatric diagnosis at age 15, as measured by computerised psychiatric interview. Rather than using the traditional four-category approach to the PBI, we identified groups of children, classified according to their perceptions of parenting, using latent class analysis. RESULTS: A small group of children (3%) perceived their parents as almost always emotionally neglectful and controlling. This group had an increased odds of psychiatric disorder (OR 2.14; 95% CI 1.29-4.50), increased overall (standardised) psychiatric symptom scores (B=.46; 95% CI .16-.75) and increased scores in all psychiatric subscales except substance-use at age 15, despite no increase in psychiatric referral at age 11. Analyses controlled for key potential confounders (e.g., socioeconomic status). CONCLUSIONS: Although our findings are limited by having no objective evidence that children's perceptions of emotional neglect are directly associated with actual neglect, children's perceptions of neglect and control are associated with over twice the odds of psychiatric disorder at age 15. Children's perceptions that parents are emotionally neglectful and controlling are independently associated with later psychiatric disorder and should be taken seriously as a risk factor for future psychopathology.