Validation of desk-based audits using Google Street View® to monitor the obesogenic potential of neighbourhoods in a pediatric sample: a pilot study in the QUALITY cohort.

BACKGROUND: The suitability of geospatial services for auditing neighbourhood features relevant to pediatric obesity remains largely unexplored. Our objectives were to (i) establish the measurement properties of a desk-based audit instrument that uses Google Street View ® to assess street- and neighbourhood-level features relevant to pediatric obesity (QUALITY-NHOOD tool, the test method) and (ii) comment on its capacity to detect changes in the built environment over an 8-year period. In order to do so, we compared this tool with an on-site auditing instrument (the reference method). METHODS: On-site audits of 55 street- and neighbourhood-level features were completed in 2008 in 512 neighbourhoods from the QUALITY cohort study. In 2015, both repeat on-site and desk-based audits were completed in a random sample of 30 of these neighbourhoods. RESULTS: Agreement between both methods was excellent for almost all street segment items (range 91.9-99.7%), except for road type (81.0%), ads/commercial billboards (81.7%), road-sidewalk buffer zone (76.1%), and road-bicycle path buffer zone (53.3%). It was fair to poor for perceived quality, safety and aesthetics items (range 59.9-87.6%), as well as for general impression items (range 40.0-86.7%). The desk-based method over-detected commercial billboards and road-sidewalk buffer zone, and generally rated neighbourhoods as less safe, requiring more effort to get around, and having less aesthetic appeal. Change detected over the 8-year period was generally similar for both methods, except that the desk-based method appeared to amplify the increase in the number of segments with signs of social disorder. CONCLUSIONS: The QUALITY-NHOOD tool is deemed adequate for evaluating and monitoring changes in pedestrian- and traffic-related features applicable to pediatric populations. Applications for monitoring the obesogenic nature of neighbourhoods appear warranted.

Body Mass Index Z Score vs Weight-for-Length Z Score in Infancy and Cardiometabolic Outcomes at Age 8-10 Years.

OBJECTIVES: To confirm that World Health Organization weight-for-length z scores (zWFL) and World Health Organization body mass index z scores (zBMI) in infancy are associated with adiposity and cardiometabolic measures at 8-10 years old and to compare the predictive ability of the 2 methods. STUDY DESIGN: zWFL and zBMI at 6, 12, and 18 months of age were computed using data extracted from health booklets, among participants in the Québec Adipose and Lifestyle InvesTigation in Youth prospective cohort (n = 464). Outcome measures at 8-10 years included adiposity, lipid profile, blood pressure, and insulin dynamics. The relationships between zWFL, zBMI, and each outcome were estimated using multivariable linear regression models. Outcome prediction at 8-10 years was compared between the 2 methods using eta-squared and the Lin concordance correlation coefficient. RESULTS: zWFL and zBMI were associated with all measures of adiposity at 8-10 years. Associations with other cardiometabolic measures were less consistent. For both zWFL and zBMI across infancy, eta-squared were highly similar and the Lin coefficients were markedly high (≥0.991) for all outcomes. CONCLUSIONS: There was no evidence that zBMI and zWFL in infancy differed in their ability to predict adiposity and cardiometabolic measures in childhood. This lends support to the sole use of zBMI for growth monitoring and screening of overweight and obesity from birth to 18 years. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03356262.

Lifestyle Habits, Dietary Factors, and the Metabolically Unhealthy Obese Phenotype in Youth.

OBJECTIVE: To determine whether lifestyle habits and dietary factors at age 8-10 years predict the development of metabolically unhealthy obesity 2 years later among children who were previously metabolically healthy obese. STUDY DESIGN: The QUebec Adipose and Lifestyle InvesTigation in Youth cohort comprises 630 youth with a parental history of obesity. Metabolically healthy obesity and metabolically unhealthy obesity were defined using cut-offs for the components of pediatric metabolic syndrome. Dietary factors, physical activity, fitness, sedentary behavior, screen time, and sleep duration were measured. Multivariable logistic regressions were used to examine associations. RESULTS: At baseline, 48 participants with metabolically healthy obesity were identified; 2 years later, 19 became metabolically unhealthy obese and 29 remained metabolically healthy obese. Every additional daily portion of fruits and vegetables decreased the risk of converting to metabolically unhealthy obesity by 39% (OR 0.61, 95% CI 0.40-0.94). Cumulating more hours of screen time and diets high in saturated fat and sugar-sweetened beverages and low in protein were associated with a tendency to develop metabolically unhealthy obesity. CONCLUSIONS: Fruit and vegetable intake and possibly screen time, saturated fat, sugar-sweetened beverages, and protein intake may be important targets for the prevention of cardiometabolic complications in obese children. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03356262.

'Life in the age of screens': parent perspectives on a 24-h no screen-time challenge.

Screens have become ubiquitous in modern society. Their use frequently underlies sedentary behaviour, a well-established determinant of obesity. As part of a family oriented clinic offering a 2-year lifestyle program for obese children and youth, we explored parents' experiences with a 24-h no screen-time challenge, an intervention designed to raise awareness of screen-time habits and to help families develop strategies to limit their use. In total, 15 parents representing 13 families participated. A focus group with nine parents and six phone interviews with those who could not join in person were conducted. Interviews were transcribed verbatim and analysed qualitatively. Key elements to successful completion of the 24-h no screen-time challenge emerged, namely: clear rules about permitted activities during the 24-h period; togetherness, i.e. involving all family members in the challenge; and busyness, i.e. planning a full schedule in order to avoid idleness and preclude the temptation to use screens. Our findings suggest that practitioners aiming to increase awareness of screen-time or to limit their use may be more likely to succeed if they include all family members, offer concrete alternatives to screen-based activities and provide tailored strategies to manage discretionary time.