Sleep and insulin sensitivity in adolescents at risk of type 2 diabetes: the Sleep Manipulation in Adolescents at Risk of Type 2 Diabetes (SMART2D)randomized crossover study.

STUDY OBJECTIVES: To investigate the effect of increasing sleep duration for 1 week, compared to a week of habitual and decreased sleep, on insulin sensitivity(IS) in adolescents at risk for type 2 diabetes(T2D). METHODS: Adolescents, 13-18y old, at risk for T2D, with obesity and other risk factors, were recruited for a randomized(1:1), open-label, sex-stratified crossover study, that manipulated time-in-bed to modify sleep duration (measured by actigraphy). Following a week of habitual(HB) sleep, time-in-bed was increased(IN) and decreased(DE) by 1h30min/night for 1 week, counterbalanced across participants(HBINDE or HBDEIN), and separated by a week of washout sleep. The main outcome measure was IS, obtained via 2-h oral-glucose-tolerance-test conducted after each sleep week. RESULTS: Of the 43 participants recruited, 36(84%) completed all sleep interventions (52.8% female, age=15.1y, body-mass-index=99.9th percentile, order: HBINDE=18 and HBDEIN=18). On average, during the HB week, participants slept 7h31min/night; sleep duration was 1h02min/night higher during the IN week and 1h19min/night lower during the DE week. We found a significant effect of sleep week on IS with a large effect size. Following the IN sleep week, IS was 20% higher compared to after the HB and DE sleep weeks, but there was no significant difference in IS following HB versus DE sleep weeks. CONCLUSION: Whenever possible, clinicians should empower youth at risk of T2D to improve their sleep duration, since even a modest increase in sleep duration of 1h/night for one-week can have a positive impact on IS in this population.

Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study.

BACKGROUND: Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group. METHODS: Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases). RESULTS: The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]). CONCLUSIONS: The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.

Associations between menopause and body image: A systematic review.

BACKGROUND: The menopausal transition involves multiple biological and psychosocial challenges that may render middle-aged women vulnerable to body image concerns. OBJECTIVE: The aim of this study was to summarize evidence on the associations between menopause and body image perception in healthy middle-aged women. DESIGN: This study is a systematic review of observational studies. DATA SOURCES AND METHODS: Menopause-related exposure measures included menopausal stages, menopausal symptoms, and reproductive hormone levels during the menopausal transition. Studies investigating body image as an outcome, including through a positive (e.g. body self-esteem) or negative (e.g. body dissatisfaction) lens, were considered eligible. Articles published before March 2023 were identified through MEDLINE, PsycINFO, and Embase and underwent double screening, extraction, and quality assessment by two independent investigators. Characteristics and results were summarized using narrative synthesis. RESULTS: A total of 820 non-duplicate records were identified, with 18 observational studies deemed eligible for inclusion after full-text screening. All studies investigating menopausal symptoms and body image (n = 6) found some significant association between them, with a higher frequency, intensity, or number of symptoms being associated with greater body image concern. Differences in body image perception between menopausal stages were inconsistent across studies (n = 12), while evidence of potential associations between reproductive hormones and body image was minimal (n = 2). Findings should be interpreted with caution as 17 of the included studies used a cross-sectional design, and not all studies adjusted their analyses for relevant confounders. CONCLUSION: Overall, menopausal symptoms showed relatively consistent associations with a more negative body image perception. Additional research is required to understand the potential role of menopausal stages and reproductive hormone levels in the body image perception of middle-aged women and to confirm the direction of reported associations. REGISTRATION: PROSPERO-CRD42021241637.

Diet and Depression during Peri- and Post-Menopause: A Scoping Review Protocol.

The aim of the proposed scoping review is to describe and summarize studies assessing the associations between diet-related variables and depression in peri- and post-menopausal women. Studies examining the associations between diet-related variables and mental health indicators in women undergoing menopausal transition or in the post-menopausal period will be systematically retrieved via Medline, EMBASE, PsycINFO, Web of Science, and Scopus databases. All articles identified through the database searches will be imported into Covidence. Following the removal of duplicates, two authors will independently perform title and abstract screening, as well as full-text assessment against eligibility criteria. Data will be extracted using tables developed for observational and experimental studies. The methodological quality of randomized trials, cohort and cross-sectional studies, and case-control studies, will be assessed using the Cochrane risk-of-bias (RoB-2) tool, the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the NHLBI Quality Assessment Tool for Case-Control studies, respectively. Data extraction tables will be used to produce two tables summarizing the main characteristics and findings of the studies included in the review. In the proposed review, we will systematically identify and summarize the currently available evidence on the association between diet-related variables and depression in peri- and post-menopausal women. To our knowledge, this is the first review focusing on this subgroup of the population. Protocol registration: osf.io/b89r6.

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.

Gathering the Evidence on Diet and Depression: A Protocol for an Umbrella Review and Updated Meta-Analyses.

Our objectives are to perform (1) an umbrella review on diet and depression, (2) a systematic review update on dietary patterns and depression, and (3) updated meta-analyses using studies from the previous two objectives. Systematic reviews examining the relationships between diet and depression and primary studies on the relationship between dietary patterns and depression will be systematically retrieved via several databases. All articles identified through the database searches will be imported into Covidence. Following duplicates removal, two authors will independently perform title and abstract screening and full-text assessment against eligibility criteria. Data will be extracted using tables developed for both systematic reviews and primary studies. The methodological quality of systematic reviews will be assessed using the AMSTAR-2 tool. The risk of bias in randomized trials, cohort and cross-sectional studies, as well as case-control studies, will be assessed with the Cochrane risk-of-bias (RoB-2) tool, the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the NHLBI Quality Assessment Tool for Case-Control studies, respectively. For each dietary variable, data extracted will be used to produce: (1) a summary of systematic reviews' characteristics and results table, (2) a summary of the primary studies characteristics table, (3) a qualitative summary of results from the primary studies table, and (4) a quantitative summary of results in the form of forest plots. The certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Upon completion, this systematic review will be the most comprehensive and up-to-date synthesis of currently available evidence on the relationships between diet and depression. It will serve as a key reference to guide future research and as a resource for health professionals in the fields of nutrition and psychiatry. PROSPERO CRD42022343253.

Effects of the HEARTY exercise randomized controlled trial on eating behaviors in adolescents with obesity.

Background: There are well-recognized benefits of behavioral interventions that include exercise for children and adolescents with obesity. However, such behavioral weight management programs may precipitate unintended consequences. It is unclear if different exercise modalities impact eating behaviors differently in youth with obesity. Objectives: The purpose of this study was to examine the effects of aerobic, resistance, and combined aerobic and resistance exercise training on eating attitudes and behaviors (uncontrolled eating, restrained eating, emotional eating, external eating and food craving) among adolescents with overweight and obesity. Methods: N = 304 (70% female) adolescents with overweight and obesity participated in the 6-month Healthy Eating Aerobic and Resistance Training in Youth (HEARTY) randomized controlled trial. All participants were inactive post-pubertal adolescents (15.6 ± 1.4 years) with a mean BMI = 34.6 ± 4.5 kg/m2. The Food Craving Inventory (food cravings), Dutch Eating Behavior Questionnaire (restrained eating, emotional eating, external eating), and the Three-Factor Eating Questionnaire (uncontrolled eating) were used to assess eating attitudes and behaviors. Results: All exercise groups showed within-group decreases in external eating and food cravings. Participants randomized to the Combined training group and were more adherent showed the greatest improvements in eating behaviors and cravings. Conclusions: A 6-month exercise intervention produced improvements in disordered eating behaviors and food cravings, but effects may be gender and modality-specific. Findings highlight the need to tailor exercise intervention to participant characteristics for the promotion of healthier eating and weight management outcomes in youth with obesity.Clinical Trial Registration # and Date: ClinicalTrials.Gov NCT00195858, September 12, 2005.

Training and capacity development in patient-oriented research: Ontario SPOR SUPPORT Unit (OSSU) initiatives.

BACKGROUND: In Canada, the Canadian Institutes of Health Research launched the Strategy for Patient-Oriented Research (SPOR) in 2011. The strategy defines 'patient-oriented research' as a continuum of research that engages patients as partners, focuses on patient priorities, and leads to improved patient outcomes. The overarching term 'patient' is inclusive of individuals with personal experience of a health issue as well as informal caregivers including family and friends. The vision for the strategy is improved patient experiences and outcomes through the integration of patient-oriented research findings into practice, policy, and health system improvement. Building capacity in patient-oriented research among all relevant stakeholders, namely patients, practitioners, organizational leaders, policymakers, researchers, and research funders is a core element of the strategy. MAIN BODY: The objective of this paper is to describe capacity building initiatives in patient-oriented research led by the Ontario SPOR SUPPORT Unit in Ontario, Canada over the period 2014-2020. CONCLUSION: The Ontario SPOR SUPPORT Unit Working Group in Training and Capacity Development has led numerous capacity building initiatives: developed a Capacity Building Compendium (accessed greater than 45,000 times); hosted Masterclasses that have trained hundreds of stakeholders (patients, practitioners, organizational leaders, policymakers, researchers, and trainees) in the conduct and use of patient-oriented research; funded the development of online curricula on patient-oriented research that have reached thousands of stakeholders; developed a patient engagement resource center that has been accessed by tens of thousands of stakeholders; identified core competencies for research teams and research environments to ensure authentic and meaningful patient partnerships in health research; and shared these resources and learnings with stakeholders across Canada, North America, and internationally.

In 2011, Canada developed a Strategy for Patient-Oriented Research. The aim of the strategy was to ensure that patients were included as equal partners in research, with the goal to improve the patient experience and enhance health outcomes using research findings to influence clinical care, policy, and health system improvement. Building capacity in patient-oriented research is a core element of the strategy. Since 2014, the Ontario SPOR SUPPORT Unit has led numerous initiatives to build capacity in patient-oriented research. Successes include a Capacity Building Compendium (a catalogue of resources that has been accessed greater than 45,000 times); courses on how to do and how to use patient-oriented research that have trained hundreds of patients, practitioners, organizational leaders, policymakers, and researchers; created online patient-oriented research materials; developed a patient engagement resource center; identified what is required to ensure authentic and meaningful patient partnerships in research; and shared these resources and learnings widely.

Facteurs influençant l'apport alimentaire en rations des soldats canadiens dans l'Arctique : un sondage national.

Purpose: To document Canadian Armed Forces (CAF) soldiers' perceptions of factors influencing their dietary intake of combat rations during Arctic field training.Methods: A bilingual digital questionnaire was sent nationally to soldiers who trained in the Arctic between 2015 and 2018. It consisted of 6 open-ended and 33 closed-ended questions on factors influencing ration intake and acceptability.Results: Of the 54 completed questionnaires (response rate: 31%), 6 were incomplete and were excluded. The final sample consisted of 48 military personnel from nine provinces with an average of 12.1 ± 6.8 years of CAF experience. Factors with the greatest negative impact on dietary intake were food temperature, eating on the move, exercise and activity schedules, and equipment needed for preparation and eating. Participants reported consuming between 61% and 71% of their rations. They noted that a considerable amount of time was required to prepare the rations since they were frozen. Sixty-five percent of soldiers reported weight loss while training in the Arctic.Conclusions: Multiple factors influenced soldiers' dietary intake and practices. These results will guide future research and assist in decision-making regarding possible changes to Arctic rations.

Objectif. Documenter la perception des soldats des Forces armées canadiennes (FAC) quant aux facteurs influençant leur apport alimentaire en rations de combat durant leur travail en Arctique.Méthodes. Un questionnaire bilingue électronique a été envoyé nationalement à des soldats s'étant entraînés dans l'Arctique entre 2015 et 2018. Il comportait 6 questions ouvertes et 33 fermées sur les facteurs influençant l'apport alimentaire et l'acceptabilité des rations.Résultats. Parmi les 54 questionnaires remplis (taux de réponse : 31 %), 6 étaient incomplets et ont été exclus. L'échantillon final était composé de 48 militaires de neuf provinces ayant en moyenne 12,1 ± 6,8 années d'expérience dans les FAC. Les facteurs ayant le plus d'effets négatifs sur l'apport alimentaire étaient la température des aliments, le fait de manger en se déplaçant, l'horaire des exercices et activités, ainsi que l'équipement nécessaire à la préparation et à la consommation. Les participants ont déclaré avoir consommé entre 61 et 71 % des rations. Ils ont noté qu'un temps considérable était nécessaire pour préparer les rations puisqu'elles étaient congelées. Soixante-cinq pour cent des soldats ont rapporté une perte de poids durant leur travail dans l'Arctique.Conclusions. Une multitude de facteurs a influencé l'apport et les pratiques alimentaires des soldats. Ces résultats guideront les recherches futures et aideront à la prise de décisions concernant de possibles changements aux rations en Arctique.

The Feasibility of a Primary Care Based Navigation Service to Support Access to Health and Social Resources: The Access to Resources in the Community (ARC) Model.

Introduction: We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. Methods: We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. Results: Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). Conclusion: The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).

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.

Patient-physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada.

BACKGROUND: When patients and physicians speak the same language, it may improve the quality and safety of care delivered. We sought to determine whether patient-physician language concordance is associated with in-hospital and postdischarge outcomes among home care recipients who were admitted to hospital. METHODS: We conducted a population-based study of a retrospective cohort of 189 690 home care recipients who were admitted to hospital in Ontario, Canada, between 2010 and 2018. We defined patient language (obtained from home care assessments) as English (Anglophone), French (Francophone) or other (allophone). We obtained physician language from the College of Physicians and Surgeons of Ontario. We defined hospital admissions as language concordant when patients received more than 50% of their care from physicians who spoke the patients' primary language. We identified in-hospital (adverse events, length of stay, death) and post-discharge outcomes (emergency department visits, readmissions, death within 30 days of discharge). We used regression analyses to estimate the adjusted rate of mean and the adjusted odds ratio (OR) of each outcome, stratified by patient language, to assess the impact of language-concordant care within each linguistic group. RESULTS: Allophone patients who received language-concordant care had lower risk of adverse events (adjusted OR 0.25, 95% confidence interval [CI] 0.15-0.43) and in-hospital death (adjusted OR 0.44, 95% CI 0.29-0.66), as well as shorter stays in hospital (adjusted rate of mean 0.74, 95% CI 0.66-0.83) than allophone patients who received language-discordant care. Results were similar for Francophone patients, although the magnitude of the effect was smaller than for allophone patients. Language concordance or discordance of the hospital admission was not associated with significant differences in postdischarge outcomes. INTERPRETATION: Patients who received most of their care from physicians who spoke the patients' primary language had better in-hospital outcomes, suggesting that disparities across linguistic groups could be mitigated by providing patients with language-concordant care.

Interindividual Differences in Trainability and Moderators of Cardiorespiratory Fitness, Waist Circumference, and Body Mass Responses: A Large-Scale Individual Participant Data Meta-analysis.

Although many studies have assumed variability reflects variance caused by exercise training, few studies have examined whether interindividual differences in trainability are present following exercise training. The present individual participant data (IPD) meta-analysis sought to: (1) investigate the presence of interindividual differences in trainability for cardiorespiratory fitness (CRF), waist circumference, and body mass; and (2) examine the influence of exercise training and potential moderators on the probability that an individual will experience clinically important differences. The IPD meta-analysis combined data from 1879 participants from eight previously published randomized controlled trials. We implemented a Bayesian framework to: (1) test the hypothesis of interindividual differences in trainability by comparing variability in change scores between exercise and control using Bayes factors; and (2) compare posterior predictions of control and exercise across a range of moderators (baseline body mass index (BMI) and exercise duration, intensity, amount, mode, and adherence) to estimate the proportions of participants expected to exceed minimum clinically important differences (MCIDs) for all three outcomes. Bayes factors demonstrated a lack of evidence supporting a high degree of variance attributable to interindividual differences in trainability across all three outcomes. These findings indicate that interindividual variability in observed changes are likely due to measurement error and external behavioural factors, not interindividual differences in trainability. Additionally, we found that a larger proportion of exercise participants were expected to exceed MCIDs compared with controls for all three outcomes. Moderator analyses identified that larger proportions were associated with a range of factors consistent with standard exercise theory and were driven by mean changes. Practitioners should prescribe exercise interventions known to elicit large mean changes to increase the probability that individuals will experience beneficial changes in CRF, waist circumference and body mass.

In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients.

OBJECTIVE: Research examining the impact of language barriers on patient safety is limited. We conducted a population-based study to determine whether patients whose primary language is not English are more likely to experience harm when admitted to hospitals in Ontario, Canada. METHODS: We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2010 to 2015) who were subsequently admitted to hospital. Patient language (obtained from home care assessments) was coded as English, French, or other. Harmful events were identified using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. RESULTS: We included 190,724 patients (156,186 Anglophones, 5,110 Francophones, and 29,428 Allophones). There was no significant difference in the unadjusted risk of harm for Francophones compared with Anglophones (relative risk [RR], 0.94; 95% confidence interval [CI], 0.87-1.02). However, Allophones were more likely to experience harm when compared with Anglophones (RR, 1.14; 95% CI, 1.10-1.18). The risk of harm was even greater for Allophones with low English proficiency (RR, 1.18; 95% CI, 1.13-1.24). After adjusting for potential confounders, Anglophones and Allophones were equally likely to experience harm of any type, but Allophones more likely to experience harm from infections and procedures. CONCLUSIONS: Patients whose primary language was not English or French were more likely to experience harm after admission to hospital, especially if they had low English proficiency. For these patients, the risk of harm from infections and procedures persisted in the adjusted analysis, but the overall risk of harm did not.

Changes in Adolescents' Dietary Intake Following the Initiation of an 8-Week Exercise Program.

Purpose: To assess changes in dietary intake of adolescents following an 8-week aerobic exercise program.Methods: Twenty-six adolescents (14-18 years) participated in an 8-week aerobic exercise program on cycle ergometer at their high school in Quebec, Canada. Twenty-four hour recalls were collected pre- and post-intervention. A two-way repeated measures ANOVA and paired sample t-tests were used to assess differences in energy and dietary intake parameters (food quantity, diet quality, eating patterns) between pre- and postintervention.Results: A decrease in total daily energy intake (-287.8 kcal, P = 0.007), in meal size at lunch (-110.1 g, P = 0.02) and dinner (-143.7 g, P = 0.03), in food density at breakfast (-1.8 kcal/g, P = 0.04), in daily carbohydrate intake (-56.1 g, P = 0.005), and in percentage of energy intake consumed at school (-5.1%, P = 0.04) were observed following initiation of an aerobic exercise program. No change in healthy eating index scores or percentage of energy from processed foods was observed.Conclusions: Changes in energy intake, food quantity, and eating pattern but not diet quality (Healthy Eating Index or food processing scores) were observed following the initiation of an aerobic exercise program. Nutrition interventions may be needed, in addition to an exercise program, to target diet quality and promote healthy eating habits in adolescents.

Associations of the BDNF Val66Met Polymorphism With Body Composition, Cardiometabolic Risk Factors, and Energy Intake in Youth With Obesity: Findings From the HEARTY Study.

The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is functionally related to BDNF, and is associated with obesity and metabolic complications in adults, but limited research exists among adolescents. This study comparatively examined carriers and non-carriers of the BDNF Val66Met polymorphism on body composition, energy intake, and cardiometabolic profile among adolescents with obesity. The sample consisted of 187 adolescents with obesity; 99 were carriers of the homozygous Val (G/G) alleles and 88 were carriers of the Val/Met (G/A) or Met (A/A) alleles. Cardiometabolic profile and DNA were quantified from fasted blood samples. Body composition was assessed by magnetic resonance imaging (MRI). Compared to carriers of the homozygous Val (G/G) allele, carriers of the Val/Met (G/A) or Met/Met (A/A) variants exhibited significantly higher protein (p = 0.01) and fat (p = 0.05) intake, C-Reactive protein (p = 0.05), and a trend toward higher overall energy intake (p = 0.07), fat-free mass (p = 0.07), and lower HDL-C (p = 0.07) Results showed for the first time that among youth with obesity, carriers of the Val66Met BDNF Met-alleles exhibited significantly higher C-reactive protein and energy intake in the form of fat and protein compared to Val-allele carriers, thereby providing support for the possible role of BDNF in appetite, weight, and metabolic regulation during adolescence. Clinical Trial Registration: http://clinicaltrials.gov/, identifier NCT00195858.

The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients.

BACKGROUND: Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents' preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers. METHODS: We used administrative databases to establish a retrospective cohort study of home care recipients (2015-2017) in Ontario, Canada, where the predominant language is English. Residents' preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year. RESULTS: Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P<0.01) and hospitalizations (0.6 vs. 0.7; P<0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P<0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10-1.39) longer when compared with Anglophones without dementia. CONCLUSIONS: Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.

Screen time is independently associated with serum brain-derived neurotrophic factor (BDNF) in youth with obesity.

Low levels of brain derived-neurotrophic factor (BDNF) and excessive screen exposure are risk factors for neurocognitive deficits and obesity in youth, but the relationship between screen time and BDNF remains unknown. This study examined whether duration and/or type of sedentary screen time behaviour (TV viewing, video games, recreational computer use) are associated with serum BDNF levels in youth with obesity. The sample consisted of 250 inactive, postpubertal adolescents with obesity (172 females/78 males, aged 15.5 ± 1.4 years) at the baseline assessment of the Healthy Eating, Aerobic, Resistance Training in Youth Study. After controlling for self-reported age, sex, race, parental education, puberty stage, physical activity, and diet, higher total screen exposure was significantly associated with lower serum BDNF levels (ß = -0.21, p = 0.002). TV viewing was the only type of screen behaviour that was associated with BDNF levels (ß = -0.22, p = 0.001). Higher exposure to traditional forms of screen time was independently associated with lower serum BDNF levels, and this association appears to be driven primarily by TV viewing. Future intervention research is needed to determine whether limiting screen time is an effective way to increase BDNF and associated health benefits in a high-risk population of youth with obesity. Trial Registration: ClinicalTrials.Gov NCT00195858. Novelty: This study is the first to show that recreational screen time is inversely associated with serum BDNF levels. The inverse association between screen time and BDNF is driven primarily by TV viewing, indicating the type of screen might matter.

Exploring Differences in Cardiorespiratory Fitness Response Rates Across Varying Doses of Exercise Training: A Retrospective Analysis of Eight Randomized Controlled Trials.

OBJECTIVE: This study tested the hypothesis that greater mean changes in cardiorespiratory fitness (CRF), in either the absence or presence of reduced interindividual variability, explain larger CRF response rates following higher doses of exercise training. METHODS: We retrospectively analyzed CRF data from eight randomized controlled trials (RCT; n = 1590 participants) that compared at least two doses of exercise training. CRF response rates were calculated as the proportion of participants with individual confidence intervals (CIs) placed around their observed response that lay above 0.5 metabolic equivalents (MET). CIs were calculated using no-exercise control group-derived typical errors and were placed around each individual's observed CRF response (post minus pre-training CRF). CRF response rates, mean changes, and interindividual variability were compared across exercise groups within each RCT. RESULTS: Compared with lower doses, higher doses of exercise training yielded larger CRF response rates in eight comparisons. For most of these comparisons (7/8), the higher dose of exercise training had a larger mean change in CRF but similar interindividual variability. Exercise groups with similar CRF response rates also had similar mean changes. CONCLUSION: Our findings demonstrate that larger CRF response rates following higher doses of exercise training are attributable to larger mean changes rather than reduced interindividual variability. Following a given dose of exercise training, the proportion of individuals expected to improve their CRF beyond 0.5 METs is unrelated to the heterogeneity of individual responses.

Obesity among postmenopausal women: what is the best anthropometric index to assess adiposity and success of weight-loss intervention?

OBJECTIVES: First, to establish the respective ability of body mass index (BMI), waist circumference (WC), and relative fat mass index (RFM), to estimate body fat (BF%) measured by DXA (DXA-BF%) and correctly identify postmenopausal women living with obesity (BF% > 35). Second, to identify the best indicator of successful weight-loss intervention in postmenopausal women living with obesity. METHODS: A total of 277 women (age: 59.8 ±â€Š5.3 y; BF%: 43.4 ±â€Š5.3) from five weight-loss studies with complete data for anthropometric measurements [BMI = weight/height (kg/m2); WC (cm)] and BF% were pooled together. Statistical performance indicators were determined to assess ability of RFM [64-(20 × height/waist circumference) + (12 × sex)], BMI and WC to estimate BF% before and after weight-loss intervention and to correctly identify postmenopausal women living with obesity. RESULTS: Compared with RFM (r = 0.51; r2 = 0.27; RMSE = 4.4%; Lin's CCC = 0.46) and WC (r = 0.49; r2 = 0.25; RMSE = 4.8%; Lin's CCC = 0.41), BMI (r = 0.73; r2 = 0.52; RMSE = 3.7%; Lin's CCC = 0.71) was the best anthropometric index to estimate DXA-BF% and correctly identify postmenopausal women living with obesity (sensitivity + specificity: BMI = 193; RFM = 152; WC = 158), with lower misclassification error, before weight-loss intervention. After weight-loss, the change in BMI was strongly correlated with change in DXA-BF%, indicating that the BMI is the best indicator of success weight-loss intervention. CONCLUSION: In the absence of more objective measures of adiposity, BMI is a suitable proxy measure for BF% in postmenopausal women, for whom a lifestyle intervention is relevant. Furthermore, BMI can be used as an indicator to assess success of weight-loss intervention in this subpopulation.