Childhood hyperactivity, eating behaviours, and executive functions: Their association with the development of eating-disorder symptoms in adolescence.

BACKGROUND: Cross-sectional studies have shown that hyperactivity and impaired executive functioning are associated with symptoms of eating disorders in adolescence and adulthood. Whether hyperactivity and executive functions in early life can prospectively predict the emergence of eating disorder symptoms in adolescence remains unknown. The present study relies on a longitudinal design to investigate how hyperactivity at age 3, eating behaviours at age 3.5 and cognition at ages 3-6 were associated with the development of eating-disorder symptoms from 12 to 20 years old. METHODS: Using archival data collected since 1997 from the Quebec Longitudinal Study of Child Development cohort (N = 2, 223), we used Latent Curve Models to analyse predictors of youth's trajectories of eating-disorder symptoms at four timepoints. RESULTS: A quadratic (curvilinear) trajectory of eating-disorder symptoms was found to be most representative of the data. Higher hyperactivity at age 3 was associated with higher levels of eating-disorder symptoms at age 12, and this association was partially mediated by higher levels of overeating and cognitive inflexibility in childhood. Cognitive inflexibility in childhood also mediated the association between hyperactivity at age 3 and increases in eating-disorder symptoms during adolescence. Furthermore, working memory was indirectly related to eating-disorder symptoms via the mediational role of cognitive flexibility. CONCLUSIONS: Hyperactivity, overeating, cognitive inflexibility, and working memory early in life might precede the onset of eating-disorder symptoms in adolescence. Early behavioural and cognitive screening may help to identify children who are most at risk for eating disorders. This, in turn, could guide preventive interventions.

Eating-disorder symptoms, such as body image issues, maladaptive behaviors, and preoccupation with weight, tend to develop in adolescence. However, it is unclear whether early childhood characteristics or behaviours could be indicators of a risk of developing eating-disorder symptoms later. The current study examined the possible link between certain early behaviours (e.g., hyperactivity, childhood eating), early cognitive processes, and eating-disorder symptoms development in a community cohort followed from birth. Results showed that being hyperactive in early childhood predicts higher levels of eating-disorder symptoms at the beginning of adolescence (age 15), and that this is partially explained by a link between being hyperactive, being more rigid in our ways of thinking, and engaging in overeating behaviours. Additionally, more early rigid ways of thinking predicted the increase in symptoms over time. Our results demonstrate possible behaviours and characteristics that could be used to identify children at risk of eating disorders, which in future research could potentially help improve our preventive interventions.

Experiencing food insecurity in childhood: influences on eating habits and body weight in young adulthood.

OBJECTIVE: To examine how food insecurity in childhood up to adolescence relates to eating habits and weight status in young adulthood. DESIGN: A longitudinal study design was used to derive trajectories of household food insecurity from age 4·5 to 13 years. Multivariable linear and logistical regression analyses were performed to model associations between being at high risk of food insecurity from age 4·5 to 13 years and both dietary and weight outcomes at age 22 years. SETTING: A birth cohort study conducted in the Province of Quebec, Canada. PARTICIPANTS: In total, 698 young adults participating in the Québec Longitudinal Study of Child Development. RESULTS: After adjusting for sex, maternal education and immigrant status, household income and type of family, being at high risk (compared with low risk) of food insecurity in childhood up to adolescence was associated with consuming higher quantities of sugar-sweetened beverages (ßadj: 0·64; 95 % CI (0·27, 1·00)), non-whole-grain cereal products (ßadj: 0·32; 95 % CI (0·07, 0·56)) and processed meat (ßadj: 0·14; 95 % CI (0·02, 0·25)), with skipping breakfast (ORadj: 1·97; 95 % CI (1·08, 3·53)), with eating meals prepared out of home (ORadj: 3·38; 95 % CI (1·52, 9·02)), with experiencing food insecurity (ORadj: 3·03; 95 % CI (1·91, 4·76)) and with being obese (ORadj: 2·01; 95 % CI (1·12, 3·64)), once reaching young adulthood. CONCLUSION: Growing up in families experiencing food insecurity may negatively influence eating habits and weight status later in life. Our findings reinforce the importance of public health policies and programmes tackling poverty and food insecurity, particularly for families with young children.

Childhood Overeating and Disordered Eating From Early Adolescence to Young Adulthood: A Longitudinal Study on the Mediating Role of BMI, Victimization and Desire for Thinness.

Eating disorders have early origins, and there could be a continuum between childhood eating behaviors, such as overeating, and long-term disordered eating, but this remains to be shown. BMI, desire for thinness and peer victimization could influence this continuum, but their interactions are unknown. To fill this gap, the study used data from the Quebec Longitudinal Study of Child Development (N = 1511; 52% girls), in which 30.9% of youth presented a trajectory associated with high disordered eating from 12 to 20 years. The results support an indirect association between overeating at age 5 and disordered eating trajectories, with different mediation processes observed between boys and girls. The findings underscore the importance of promoting healthy body images and eating behaviors among youths.

Eating behaviors, dietary patterns and weight status in emerging adulthood and longitudinal associations with eating behaviors in early childhood.

BACKGROUND: Eating behaviors may contribute to differences in body weight and diet over time. Our study aims to examine how eating behaviors of young adults relate to their current weight status and dietary patterns and to explore longitudinal associations with eating behaviors in early childhood. METHODS: Study participants are young adults (n = 698) taking part in the Quebec Longitudinal Study of Child Development. At age 22, eating behaviors were assessed using the Adult Eating Behavior Questionnaire. Dietary patterns were derived from information collected by food frequency questions. Weight status was based on self-reported data. Information on eating behaviors in childhood had been collected when participants were 2.5 to 6 years old. Pearson's correlations were used to determine associations between adult eating behaviors and body mass index. Simple and multivariate linear regression analyses were used to examine associations between eating behaviors and dietary patterns at age 22, and longitudinal associations with behaviors in early childhood. Ordinal logistic regression analyses were used to assess associations between overeating and fussy eating in childhood and weight status at age 22. RESULTS: Body mass index was positively correlated with Emotional overeating, Enjoyment of food, and Food responsiveness and negatively correlated with Satiety responsiveness, Emotional undereating, Slowness in eating and Hunger. A Healthy dietary pattern was positively associated with both Enjoyment of food and Hunger, and negatively associated with Food fussiness. Inversely, a Beverage-rich dietary pattern was negatively associated with Enjoyment of food and positively associated with Food fussiness. A Protein-rich pattern was positively associated with Enjoyment of food, while a High energy density pattern was positively associated with Food fussiness. Young adults with higher scores for fussy eating in early childhood were more likely to manifest Food fussiness and Emotional undereating, and less likely to adopt a Healthy dietary pattern. Young adults with higher scores for overeating in early childhood were less likely to show traits such as Slowness in eating and more likely to be overweight. CONCLUSIONS: Our findings suggest that eating behaviors in childhood have long-term influence on diet and weight status, thereby reinforcing the importance of early interventions that promote healthy eating.

Changing genetic architecture of body mass index from infancy to early adulthood: an individual based pooled analysis of 25 twin cohorts.

BACKGROUND: Body mass index (BMI) shows strong continuity over childhood and adolescence and high childhood BMI is the strongest predictor of adult obesity. Genetic factors strongly contribute to this continuity, but it is still poorly known how their contribution changes over childhood and adolescence. Thus, we used the genetic twin design to estimate the genetic correlations of BMI from infancy to adulthood and compared them to the genetic correlations of height. METHODS: We pooled individual level data from 25 longitudinal twin cohorts including 38,530 complete twin pairs and having 283,766 longitudinal height and weight measures. The data were analyzed using Cholesky decomposition offering genetic and environmental correlations of BMI and height between all age combinations from 1 to 19 years of age. RESULTS: The genetic correlations of BMI and height were stronger than the trait correlations. For BMI, we found that genetic correlations decreased as the age between the assessments increased, a trend that was especially visible from early to middle childhood. In contrast, for height, the genetic correlations were strong between all ages. Age-to-age correlations between environmental factors shared by co-twins were found for BMI in early childhood but disappeared altogether by middle childhood. For height, shared environmental correlations persisted from infancy to adulthood. CONCLUSIONS: Our results suggest that the genes affecting BMI change over childhood and adolescence leading to decreasing age-to-age genetic correlations. This change is especially visible from early to middle childhood indicating that new genetic factors start to affect BMI in middle childhood. Identifying mediating pathways of these genetic factors can open possibilities for interventions, especially for those children with high genetic predisposition to adult obesity.

Diet quality during pregnancy and its association with social factors: 3D Cohort Study (Design, Develop, Discover).

Good diet quality during pregnancy provides adequate nutrition to support both the mothers and the fetus. The objective of this study is to describe the distribution of diet quality during pregnancy and to study the association between social factors and diet quality during pregnancy in a Canadian population. This study was based on 1535 pregnant women who provided dietary information in the 3D Cohort Study in Quebec, Canada. A 3-day food record was used to collect dietary intake in the second trimester of pregnancy. A Canadian adaption of the Healthy Eating Index (HEI-C) 2010 was used to quantify diet quality. Univariate and multiple linear regression models were used to calculate unadjusted and adjusted effect estimates and confidence intervals for the association between social factors and HEI-C. The mean HEI-C 2010 score in this study was 62.9 (SD: 11.2). Only 4.5% and 8.3% of the pregnant women consumed the recommended amounts of whole grains and 'greens and beans', respectively. Diet quality was lower in some subgroups of pregnant women. After multivariable adjustment, lower diet quality was observed in participants who were less educated, younger, overweight or obese before pregnancy, or parous. There was an interaction between ethnicity and immigration status on diet quality in pregnancy. These findings could be useful for health practitioners and policymakers in developing strategies to improve the diet quality of pregnant women.

Developmental trajectories of eating disorder symptoms: A longitudinal study from early adolescence to young adulthood.

BACKGROUND: Adolescence is a critical period for the development of eating disorders, but data is lacking on the heterogeneity of their evolution during that time-period. Group-based trajectories can be used to understand how eating disorders emerge and evolve over time. The aim of this study was to identify groups of individuals with distinct levels of eating disorder symptoms between 12 and 20 years and the onset of different types of symptoms. We also studied sex differences in the evolution and course of eating disorder symptoms from early adolescence to adulthood. METHODS: Using archival data from the QLSCD cohort, trajectories of eating disorder symptomatology were estimated from ages 12 to 20 years using semiparametric models. These trajectories included overall eating disorder symptomatology as measured by the SCOFF (Sick, Control, One Stone, Fat, Food), sex, and symptom-specific trajectories. RESULTS: Two groups of adolescents following distinct trajectories of eating disorder symptoms were identified. The first trajectory group included 30.9% of youth with sharply rising levels between 12 and 15 years, followed by high levels of symptoms between 15 and 20 years. The second trajectory group included 69.1% of youth with low and stable levels of symptoms between 12 and 20 years. Sex-specific models indicated that the proportion of girls in the high trajectory group was 1.3 times higher than the proportion of boys (42.8% girls vs. 32.3% boys). Trajectories of SCOFF items were similar for loss-of-control eating, feeling overweight, and attributing importance to food. The weight loss item had a different developmental pattern, increasing between 12 and 15 years and then decreasing between 17 and 20 years. CONCLUSIONS: The largest increase in eating disorder symptoms in adolescence is between the ages of 12 and 15 . Yet, most prevention programs start after 15 years of age. Our findings suggest that, unlike common practices, eating disorder prevention programs should aim to start before puberty.

Eating disorders, typically involving preoccupation with eating, excessive exercise, and body image issues, are particularly common in adolescence. However, their evolution over time remains unclear as certain signs and symptoms may appear sooner than others. The current study studied the development of eating disorder symptoms in a community cohort followed from birth to adulthood. This study describes trajectories of eating disorder symptoms and risk from age 12 to 20 in both boys and girls. Results showed that the largest increase in eating disorder symptoms occurs between 12 and 15 years of age, both in overall symptomatology as well as in specific symptoms such as loss-of-control when eating, feeling overweight, and attributing importance to food. Additionally, more girls than boys appeared at risk for eating disorders, although the patterns represented by the trajectories were similar in both sexes. Our results highlight the importance of starting early prevention programs before the beginning of adolescence, when symptoms usually start to manifest.

Breast-feeding, rapid growth in the first year of life and excess weight at the age of 2 years: the 3D Cohort Study.

OBJECTIVE: To assess relationships between breast-feeding, rapid growth in the first year of life and overweight/obesity status at the age of 2 years. DESIGN: As part of an observational, longitudinal study beginning in early pregnancy, multivariable logistic regressions were used to assess associations between breast-feeding duration (total and exclusive) and rapid weight gain (RWG) between birth and 1 year of age, and to determine predictors of overweight/obesity status at the age of 2 years. SETTING: Nine hospitals located in the province of Quebec, Canada. PARTICIPANTS: A sample of 1599 term infants who participated in the 3D Cohort Study. RESULTS: Children having RWG in the first year and those having excess weight at the age of 2 years accounted for 28 % and < 10 %, respectively. In multivariable models, children breastfed < 6 months and from 6 months to < 1 year were, respectively, 2·5 times (OR 2·45; 95 % CI 1·76, 3·41) and 1·8 times (OR 1·78; 95 % CI 1·29, 2·45) more likely to show RWG up to 1 year of age compared to children breastfed ≥ 1 year. Children exclusively breastfed < 3 months had significantly greater odds of RWG in the first year (OR 1·94; 95 % CI 1·25, 3·04) compared to children exclusively breastfed for ≥ 6 months. Associations between breast-feeding duration (total or exclusive) and excess weight at the age of 2 years were not detected. RWG in the first year was found to be the main predictor of excess weight at the age of 2 years (OR 6·98; 95 % CI 4·35, 11·47). CONCLUSIONS: The potential beneficial effects of breast-feeding on rate of growth in the first year of life suggest that interventions promoting breast-feeding are relevant for obesity prevention early in life.

Recherche sur la fin de vie, la nécessité d'un consensus : premiers résultats.

During the past 15 years, in France, like in many European countries, the attention paid to patients at the end of their lives has continued to grow. But in the meantime, only a few researchers have managed to collect reliable data on End-of-Life Care and to implement scientific studies describing the reality of these situations. This difficulty is due in particular to the lack of a recognized and operational definition of the end of life.Our objective is to explore the possibility of achieving consensus around a definition based on the isolated elements in the literature.A Delphi consensus approach has been conducted. A “Delphi” approach allows consensus to be achieved without the influence of leadership effects.The population of this study is the group of care providers who are members of the Société Française d’Accompagnement et de Soins Palliatifs (SFAP), whether they are professionals or volunteers. An electronic survey asked for the degree of approval of individuals for each of the proposed definitions on a Lickert scale. The first round of Delphi was proposed at the end of 2019 among palliative care actors. 1463 people responded to this questionnaire in one month. Two types of definition seem to dominate the other proposals. The first is related to an estimate of life expectancy: life expectancy of less than 15 days and less than one month. The second emerging definition is related to the evolution of a pathology: based on the fact of being in advanced or terminal phase of an incurable pathology.These results confirm that the end-of-life period can be seen from two points of view, the first in relation to the time left to live and the other in relation of the terminal phase of the disease which calls for a less clearly defined time.These two definitions are based on different approaches, one temporal and the other disease-centered. An alternative definition emerges from this study and will be tested in the second round of Delphi.

Weight Gain and Mental Health in the Canadian Prison Population.

Most inmates gain excessive bodyweight during incarceration in Canadian federal penitentiaries. It is currently unknown if the weight gain is related to participants' higher prevalence of mental illness and/or psychotropic medication use. This study examined how weight change (kg) and body mass index (BMI) change (kg/m2) of 1,420 participants were associated with mental health status and psychotropic medication use. Participants who took psychotropic medications did not gain more weight during incarceration compared to their counterparts who were not taking psychotropic medications (6.5 kg vs. 6.0 kg, p = 0.87, respectively). However, participants taking psychotropic medications were more likely to be overweight or obese, which means they already had higher BMI at the beginning of their incarceration as opposed to gaining more weight during incarceration. Weight gain of participants observed during incarceration in Canadian federal penitentiaries was not related to the higher prevalence of mental illness or psychotropic medication use.

Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obesity.

INTRODUCTION: Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk. METHODS AND ANALYSIS: This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study. ETHICS AND DISSEMINATION: The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie-CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation. TRIAL REGISTRATION NUMBER: ChiCTR1800017773. PROTOCOL VERSION: November 11, 2020 (Version #5).

Cord Blood IGF-I, Proinsulin, Leptin, HMW Adiponectin, and Ghrelin in Short or Skinny Small-for-Gestational-Age Infants.

CONTEXT: Small-for-gestational-age (SGA) is an indicator of poor fetal growth "programming" an elevated risk of type 2 diabetes in adulthood. Little is known about early-life endocrine characteristics in SGA subtypes. Stunting (short) and wasting (skinny) are considered distinct SGA phenotypes in neonatal prognosis. OBJECTIVES: This work aimed to assess whether SGA infants with stunting or wasting have similar alterations in neonatal endocrine metabolic health biomarkers. METHODS: This was a nested case-control study based on the 3D (Design, Develop, and Discover) birth cohort in Canada. The study subjects were 146 SGA (birth weight < 10th percentile) and 155 optimal-for-gestational age (OGA, 25th-75th percentiles) infants. Stunting was defined as birth length less than the 10th percentile, and wasting as body mass index less than the 10th percentile for sex and gestational age, respectively. Main outcome measures included cord plasma concentrations of insulin-like growth factor I (IGF-I), proinsulin, leptin, high-molecular-weight (HMW) adiponectin, and ghrelin. RESULTS: Comparing to OGA infants adjusted for maternal and neonatal characteristics, SGA infants with either stunting only or wasting only had lower cord plasma IGF-I and leptin concentrations. HMW adiponectin concentrations were lower in SGA infants with wasting only (P = .004), but similar in SGA infants with stunting only (P = .816). Only SGA infants with both stunting and wasting had substantially lower proinsulin (P < .001) and higher ghrelin concentrations (P < .001) than OGA infants. CONCLUSION: This study is the first to demonstrate that SGA infants with wasting only are characterized by low HMW adiponectin concentrations, whereas those with stunting only are not. SGA with both stunting and wasting are characterized by low proinsulin and high ghrelin concentrations.

Outer Foveal Microdefects.

PURPOSE: To report a spectral-domain (SD) OCT clinical sign, outer foveal microdefect (OFMD), corresponding to a focal disruption of the foveal photoreceptors in association with various macular conditions. DESIGN: Retrospective cohort study. PARTICIPANTS: Forty-five patients with OFMD. METHODS: All patients were imaged with color photography and SD OCT, and some were imaged with autofluorescence imaging, fluorescein angiography, indocyanine green angiography, or a combination thereof. Patient demographics, OFMD imaging, courses, and outcomes were analyzed retrospectively. MAIN OUTCOME MEASURES: Demographics, conditions associated with OFMD, and diameter of OFMD. RESULTS: Fifty-one eyes of 45 patients (15 men and 30 women; age range, 10-88 years) were included. Symptoms included central scotoma, metamorphopsia, and mild to moderate visual loss. Outer foveal microdefects were observed in association with various macular conditions: presumed posterior vitreous detachment, vitreomacular interface changes, or both (24 eyes); sequelae of macular edema (3 eyes); blunt trauma (2 eyes); retinal phototoxicity resulting from laser or solar maculopathy (5 eyes); and macular telangiectasia type 2 (2 eyes). An improvement with a reduction in OFMD diameter was documented in 9 of 14 eyes that could be followed up. CONCLUSIONS: We suggest renaming the condition outer foveal microdefect instead of macular microhole, which is usually associated with a vitreomacular disorder. The pattern indeed also was observed in traumatic or degenerative conditions. We assumed that various injuries led to changes in foveal morphologic features and that a full recovery of the foveal architecture could be altered, especially in eyes with findings suggestive of the pachychoroid spectrum of disorders.

Piecing together the Labrador Inuit food security policy puzzle in Nunatsiavut, Labrador (Canada): a scoping review.

Inuit in Canada experience greater social and economic inequities than the general Canadian population. Food security exemplifies this inequity and is a distinct determinant of Inuit health. This scoping review focuses on food security-related policies implemented in Nunatsiavut, located in Northern Labrador. The primary objective was to identify the range of existing policies that pertain to food security in Nunatsiavut. The secondary objective was to complete a directed content analysis to map each policy against the applicable dimension of food security. This scoping review followed the Johanna Briggs methodology. The search strategy included the databases: Medline (via Ovid), EMBASE (via Ovid), CINAHL, and Scopus, and a hand search of the relevant journals, conference abstracts and grey literature. This search was undertaken from April 2019 - October 2019. A content analysis mapped each policy against the applicable dimension of food security. Results: The results showed that twenty five policies were identified, spanning three levels of government, that explicitly or implicitly addressed at least one dimension of food security. Accessibility was the most frequent food security dimension identified. The Government of Canada developed 60% of policies and the Nunatsiavut Government implemented 48% of policies. Most policies focused on proximal factors for food security. Identifying distal policies for food security and understanding the impact of existing policies in Nunatsiavut remain as areas of further investigation. Ethics and Dissemination:This project was reviewed by the Nunatsiavut Government Research Advisory Committee.

The Association Between Isolated Maternal Hypothyroxinemia in Early Pregnancy and Preterm Birth.

Background: The association between isolated maternal hypothyroxinemia (IMH) during pregnancy and preterm birth (PTB), especially for subtypes of PTB, is unclear. This study aimed at determining the association between IMH diagnosed in early pregnancy and PTB, with further investigation into various subtypes of PTB. Methods: This study included 41,911 pregnant women (963 with IMH and 40,948 euthyroid women) who underwent first-trimester prenatal screening at the International Peace Maternity and Child Health Hospital (IPMCH) in Shanghai, China between January 2013 and December 2016. PTB was defined as birth before 37 weeks of gestation. PTB was further classified into three clinically relevant groups to investigate the clinical heterogeneity of PTB: (a) preterm birth with premature rupture of membranes (PROM-PTB); (b) spontaneous preterm birth with intact membranes (S-PTB); and (c) medically-induced preterm birth (MI-PTB). The overall and sex-specific effect of IMH on PTB and various subtypes of PTB were estimated by using logistic regression in crude and adjusted models. Results: Pregnant women with IMH had an increased risk of PTB (odds ratio [OR]: 1.32 [95% confidence interval; CI: 1.02-1.70], p = 0.03) compared with women with euthyroid function. The increased risk of PTB is mainly driven by S-PTB (OR: 1.57 [CI: 1.11-2.24], p = 0.01), while women with early pregnancy IMH had no statistically significant increased risk of PROM-PTB and MI-PTB. The effect of IMH on PTB was modified by fetal sex (p-values for interaction = 0.04). More prominent effects were observed in women carrying a female fetus, while no statistically significant effects were found in women carrying a male fetus. Conclusions: This study revealed that pregnant women with IMH in early pregnancy have a higher risk of PTB compared with euthyroid women. The effect of IMH on PTB is mainly driven by S-PTB and is modified by fetal sex.

Diet quality during preconception or pregnancy and gestational weight gain: protocol for a systematic review and meta-analysis.

INTRODUCTION: Inappropriate gestational weight gain (GWG), including inadequate and excessive GWG, has become pandemic across nations and continents. This review aims to synthesise the evidence on the correlation between diet quality and GWG. If this association is confirmed, improving diet quality could become an intervention target in the efforts to reduce inappropriate GWG. METHODS AND ANALYSIS: We will conduct a systematic review of all prospective cohort studies on diet quality in preconception or pregnancy and GWG. Our secondary outcomes include gestational diabetes, pre-eclampsia and birth weight. A comprehensive search of all published articles in MEDLINE ALL (Ovid), Embase (Ovid), Food Science and Technology Abstracts (Ovid) and CINAHL (EBSCOHost), from database creation to 20 April 2019, will be conducted. Studies will be screened for eligibility by title, abstract and full text in duplicate by two independent reviewers. Study quality and risk of bias will be assessed using the adapted Newcastle-Ottawa Scale. Results will be reported following the meta-analysis of observational studies in epidemiology guidelines. If sufficient data are available, a meta-analysis will be conducted to synthesise the effect size reported as OR with 95% CI using both fixed-effect and random-effect models. I2 statistics and visual inspection of the forest plots will be used to assess heterogeneity and identify the potential sources of heterogeneity. Publication bias will be assessed by visual inspections of funnel plots and Egger's test. ETHICS AND DISSEMINATION: Formal ethical approval is not required as no primary data will be collected. We aim to publish the results of this study in a peer-reviewed journal and present them at conferences and scientific meetings to promote knowledge transfer. PROSPERO REGISTRATION NUMBER: CRD42019128732.

Prevalence and correlates of objectively measured weight status among urban and rural Mozambican primary schoolchildren: A cross-sectional study.

BACKGROUND: The coexistence of undernutrition (thinness) and overnutrition (overweight/obesity) among children and adolescents is a public health concern in low-middle-income countries. Accurate prevalence estimates of thinness and overweight/obesity among children and adolescents are unavailable in many low-middle-income countries due to lack of data. Here we describe the prevalences and examine correlates of objectively measured weight status among urban and rural schoolchildren in Mozambique. METHODS: A cross-sectional study design was applied to recruit 9-11-year-old schoolchildren (n = 683) from 17 urban and rural primary schools in Mozambique. Body mass index (BMI) was computed from objectively measured height and weight and participants' weight categories were determined using the World Health Organization cut-points. Actigraph GT3X + accelerometers were worn 24 hours per day for 7 days to assess movement behaviours. Multilevel multivariable modelling was conducted to estimate odds ratios and confidence intervals. RESULTS: Combined prevalence of overweight/obesity (11.4%) was significantly higher among urban participants compared to rural participants (5.7%; χ2 = 7.1; p = 0.008). Conversely, thinness was more prevalent among rural (6.3%) compared to urban (4.2%) participants. Passive school commute, not meeting daily moderate- to vigorous-intensity physical activity (MVPA) guidelines, and maternal BMI >25 kg/m2 were associated with overweight/obesity while possessing one or more functional cars at home, maternal BMI >25 kg/m2 and being an older participant were associated with thinness in the present sample. The proportion of total variance in the prevalences of obesity and/or thinness occurring at the school level was 8.7% and 8.3%, respectively. CONCLUSION: Prevalences of thinness, overweight/obesity and other key variables differ between urban and rural schoolchildren in Mozambique. MVPA, active transport and mother's BMI are important modifiable correlates of weight status among Mozambican schoolchildren. Results from this study demonstrate important differences between urban and rural schoolchildren that should not be ignored when designing interventions to manage malnutrition, formulating public health strategies, and interpreting findings.

Impact of optical coherence tomography angiography on the non-invasive diagnosis of neovascular age-related macular degeneration.

PURPOSE: To investigate the changes in imaging tool practice for the diagnosis of neovascular age-related macular degeneration (nAMD). METHODS: Retrospective analysis of consecutive patients diagnosed with nAMD in a tertiary care center, over a 6-month period in 2014, 2016, and 2018. Patient demographics were compared. Imaging modalities used in 2014 were fundus photography, fluorescein angiography (FA), and structural spectral-domain optical coherence tomography (SD-OCT), while OCT-angiography (OCT-A) was available from 2015. Imaging tools used in our practice were compared in the 3 cohorts. RESULTS: The 3 cohorts included 163, 99, and 167 patients, respectively. There was no difference in age or gender (mean age 81.7 years). OCT-A images were analyzable in 60.5% and 89.7% of patients respectively in 2016 and in 2018. In the 3 cohorts, all patients were imaged with fundus photography and structural OCT. FA was performed in 70.2, 28.8, and 22.1% of patients, respectively. CONCLUSION: This study showed a shift in practice of imaging tools used for the diagnosis of nAMD, non-invasive tools being increasingly used as the first-line imaging, and FA as the second-line imaging.

Piecing together the Inuit food security policy puzzle in Nunatsiavut, Labrador (Canada): protocol for a scoping review.

INTRODUCTION: Inuit Nunangat is the Inuit homeland in Canada. It is comprised of four Inuit regions. Inuit residing in these areas experience greater social and economic inequities than the general Canadian population. Food security exemplifies this inequity and is a distinct determinant of Inuit health. Policy can play an integral role in health equity. However, demonstrating this role can be a complex task, especially when there are both national and regionally specific policies pertaining to each of the Inuit regions. This scoping review will focus on Nunatsiavut, located in northern Labrador. This region is situated within a complex policy space due to the national, provincial and regional governance structures, geographical location and the breadth of factors pertaining to food security. This scoping review aims to identify the range of policies pertaining to food security in Nunatsiavut and complete a directed content analysis to code each policy against the applicable dimension of food security. METHODS AND ANALYSIS: The researchers will conduct a search strategy on the following four databases: MEDLINE (via Ovid), Embase (via Ovid), CINHAL and Scopus. A hand search of the relevant journals, conference abstracts and grey literature will be completed from April to October 2019. The following parameters will be extracted: a description of the policy, the organisation/institution that developed the policy, the definition of food security used or implied, and any stated intended targets or outcomes. The results will be compiled in a tabular form. ETHICS AND DISSEMINATION: Ethics approval is not required as primary data will not be collected. The findings from this scoping review will be disseminated through peer-reviewed journals and public presentations. The results of this scoping review will be validated by a Nunatsiavut Government Advisory Group.

The Quebec Newborn Twin Study at 21.

This paper is a revised and updated edition of a previous description of the Quebec Newborn Twin Study (QNTS), an ongoing prospective longitudinal follow-up of a birth cohort of twins born between 1995 and 1998 in the greater Montreal area, Québec, Canada. The goal of QNTS is to document individual differences in the cognitive, behavioral, and social-emotional aspects of developmental health across childhood, their early genetic and environmental determinants, as well as their putative role in later social-emotional adjustment, school, health, and occupational outcomes. A total of 662 families of twins were initially assessed when the twins were aged 6 months. These twins and their family were then followed regularly. QNTS now has 16 waves of data collected or planned, including 5 in preschool. Over the last 24 years, a broad range of physiological, cognitive, behavioral, school, and health phenotypes were documented longitudinally through multi-informant and multimethod measurements. QNTS also entails extended and detailed multilevel assessments of proximal (e.g., parenting behaviors, peer relationships) and distal (e.g., family income) features of the child's environment. QNTS children and a subset of their parents have been genotyped, allowing for the computation of a variety of polygenic scores. This detailed longitudinal information makes QNTS uniquely suited for the study of the role of the early years and gene-environment transactions in development.