Self-Report and Contemporaneously Recorded Running Agreement in Recreational Athletes.

ABSTRACT: Leech RD, Grunseit A, and Edwards KL. Self-report and contemporaneously recorded running agreement in recreational athletes. J Strength Cond Res 36(7): 1922-1929, 2022-Accurate assessment of running exposure in research or clinical practice relies on the ability to measure the behavior validly and reliably. Self-reported physical activity (PA) (including running), although commonly used, is subject to bias. User-owned wearable technological devices provide a potential contemporaneously collected data source for validating retrospective running-specific questionnaires. This study assesses agreement between self-reported running and contemporaneously collected running data. Self-reported running and corresponding contemporaneously recorded for current (at the time of questionnaire completion) and historical (6 months prior) was collected. Concordance Correlations and Bland-Altman Limits of Agreement measured extent of agreement. Categories for Metabolic Equivalent Task (MET) hours per week were calculated from total running distance. Unweighted and weighted Kappas were used to compare classification of levels of running by the 2 data sources. Running data were collected from 139 subjects (mean age 51.1 years). Self-report data were higher than contemporaneous data. Average estimated pace from both sources were similar, with high variance in some individuals. Differences of 43.5-57.1% were reported for current mean weekly running distances for 7-day, 4-week, and 12-week running periods. The level of agreement in classification between self-report and contemporaneous running data MET/HR categories was fair (unweighted K = 0.24-0.33) to moderate (weighted K = 0.46-0.63). Compared with contemporaneous running data, runners over-estimate the frequency, distance, and duration of running in self-report. Runners tend to discount nonrunning periods and unusual runs when estimating current and historical "average" running. The opportunities and limitations of different contemporaneous running data collection methods as a PA comparator must be acknowledged.

Childhood consumption of fruit and vegetables across England: a study of 2306 6-7-year-olds in 2007.

The School Fruit and Vegetable Scheme (SFVS) provides children in government-run schools in England with a free piece of fruit or a vegetable each school day for the first 3 years of school. The present study examines the impact of the SFVS, in terms of its contribution towards the total daily intake of fruit and vegetables by children across England. Quantitative dietary data were collected from 2306 children in their third year of school, from 128 schools, using a 24 h food diary. The data were examined at different spatial scales, and variations in the impact of the scheme across areas with different socio-economic characteristics were analysed using a deprivation index and a geodemographic classification. The uptake of the SFVS and the total intake of fruit and vegetables by children varied across different parts of England. Participation in the SFVS was positively associated with fruit and vegetable consumption. That is, in any one area, those children who participated in the SFVS consumed more fruit and vegetables. However, children living in deprived areas still consumed less fruit and vegetables than children living in more advantaged areas: the mean daily frequency of fruit and vegetables consumed, and rates of consumption of fruit or vegetables five times or more per d, decreased as deprivation increased (r -0.860; P = 0.001; r -0.842; P = 0.002). So the SFVS does not eliminate the socio-economic gradient in fruit and vegetable consumption, but it does help to increase fruit and vegetable consumption in deprived (and affluent) areas.

Management of metastatic sacral tumours.

PURPOSE: Metastatic involvement of the sacrum is rare and there is a paucity of studies which deal with the management of these tumours since most papers refer to primary sacral tumours. This study aims to review the available literature in the management of sacral metastatic tumours as reflected in the current literature. METHODS: A systematic review of the English language literature was undertaken for relevant articles published over the last 11 years (1999-2010). The PubMed electronic database and reference lists of key articles were searched to identify relevant studies using the terms "sacral metastases" and "metastatic sacral tumours". Studies involving primary sacral tumours only were excluded. For the assessment of the level of evidence quality, the CEBM (Oxford Centre of Evidence Based Medicine) grading system was utilised. RESULTS: The initial search revealed 479 articles. After screening, 16 articles identified meeting our inclusion criteria [1 prospective cohort study on radiosurgery (level II); 2 case series (level III); 4 retrospective case series (level IV) and 9 case reports (level IV)]. CONCLUSION: The mainstay of management for sacral metastatic tumours is palliation. Preoperative angioembolisation is shown to be of value in cases of highly vascularised tumours. Radiotherapy is used as the primary treatment in cases of inoperable tumours without spinal instability where pain relief and neurological improvement are attainable. Minimal invasive procedures such as sacroplasties were shown to offer immediate pain relief and improvement with ambulation, whereas more aggressive surgery, involving decompression and sacral reconstruction, is utilised mainly for the treatment of local advanced tumours which compromise the stability of the spine or threaten neurological status. Adjuvant cryosurgery and radiosurgery have demonstrated promising results (if no neurological compromise or instability) with local disease control.

Serial cross-sectional analysis of prevalence of overweight and obese children between 1998 and 2003 in Leeds, UK, using routinely measured data.

OBJECTIVE: To monitor growth trends in young children in order to ascertain success (or otherwise) in halting the rapid rise in childhood obesity prevalence, and to assess the suitability of using routinely measured data for this purpose. DESIGN: Retrospective serial cross-sectional analyses of the proportion of obese children (logistic regression) and BMI standard deviation score (linear regression/maps) were undertaken. BMI coverage was calculated as percentage of sample with data ('usual'), percentage of total births and percentage of census values. BMI was standardised for age and sex (British reference data set). SETTING: Metropolitan Leeds, UK. SUBJECTS: Children aged 3 to 6 years. Weight, height, sex, age and postcode data were collected from Primary Care Trust records. RESULTS: Data were collected on 42 396 children, of whom 13 020 (31 %) were excluded due to missing data/data problems. Seventy-two per cent of 3-year-olds and 92 % of 5-year-olds had data recorded ('usual' coverage). From 1998 to 2003 there was a significant increase in the proportion of obese children (4.5 % to 6.6 %; P < 0.001); children were 1.5 times more likely to be obese in 2003 than in 1998. CONCLUSIONS: Childhood obesity rose significantly between 1998 and 2003. Routinely measured data are an important means of monitoring population-level obesity trends, although more effort is required to reduce the quantity of data-entry errors, for relatively low marginal cost.

Association of Sports Participation With Osteoarthritis: A Systematic Review and Meta-Analysis.

BACKGROUND: The association between participating in sport and osteoarthritis is not fully understood. PURPOSE: To investigate the association between osteoarthritis and participating in sports not listed in previous reviews: American football, archery, baseball, bobsleigh, curling, handball, ice hockey, shooting, skeleton, speed skating, and wrestling. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: We searched 4 electronic databases and hand searched recent/in-press editions of relevant journals. The criteria for study selection were case-control studies, cohort studies, nested case-control studies, and randomized trials with a control group that included adults to examine the effect of exposure to any of the included sports on the development of osteoarthritis. RESULTS: The search returned 6197 articles after deduplication. Nine studies were included in the final review, covering hip, knee, and ankle osteoarthritis. There were no studies covering archery, baseball, skeleton, speed skating, or curling. The 6 sports included in the review were analyzed as a collective; the results of the meta-analysis indicated that participation in the sports analyzed was associated with an increased risk of developing osteoarthritis of the hip (relative risk [RR] = 1.67 [95% confidence interval (CI), 1.15-2.41]; P = .04), knee (RR = 1.60 [95% CI, 1.23-2.08]; P < .001), and ankle (RR = 7.08 [95% CI, 1.24-40.51]; P = .03) as compared with controls. Meta-analysis suggested a significantly increased likelihood of developing hip osteoarthritis through participating in wrestling (RR = 1.78 [95% CI, 1.20-2.64]; P = .004) and ice hockey (RR = 1.70 [95% CI, 1.27-2.29]; P < .001), while there was no significant difference through participating in handball (RR = 2.50 [95% CI, 0.85-7.36]; P = .10). Likelihood of developing knee osteoarthritis was significantly increased in wrestling (RR = 2.22 [95% CI, 1.59-3.11]) and ice hockey (RR = 1.52 [95% CI, 1.18-1.96]; both P < .002). According to the meta-analysis, shooting did not have a significant effect on the RR of knee osteoarthritis as compared with other sports (RR = 0.43 [95% CI, 0.06-2.99]; P = .39). CONCLUSION: The likelihood of developing hip and knee osteoarthritis was increased for ice hockey and wrestling athletes, and the risk of developing hip osteoarthritis was increased for handball athletes. The study also found that participation in the sports examined, as a collective, resulted in an increased risk of developing hip, knee, and ankle osteoarthritis.

Not All Play Equipment Is Created Equal: Associations Between Equipment at Home and Children's Physical Activity.

BACKGROUND: Play equipment at home could be targeted in interventions to increase children's physical activity (PA), but evidence is mixed, potentially because current methods do not reflect children's lived experience. This study investigated associations between combinations of equipment and PA. METHODS: Data were from the Mothers and their Children's Health study and the Australian Longitudinal Study on Women's Health. Mothers (n = 2409) indicated the types of fixed active (eg, trampolines), portable active (eg, bicycles), and electronic (eg, computers) equipment at home, and the number of days children (n = 4092, aged 5-12 y, 51% boys) met PA guidelines. Latent class analysis was used to identify combinations of equipment, and linear regressions were used to investigate associations with PA. RESULTS: Compared with children with high active (fixed and portable) and medium electronic equipment, children with portable active and medium (B = -0.53; 95% confidence interval, -0.72 to -0.34) or high (B = -0.58; 95% confidence interval, -0.83 to -0.33) electronic equipment met the guidelines on fewer days. Children with similar active equipment (but more electronic equipment) met the PA guidelines on fewer days (mean difference = -0.51, SE = 0.14, P = .002). CONCLUSION: Having the right combination of play equipment at home may be important for children's PA.

Radiographic appearance of the distal clavicle in relation to the acromion after acromioclavicular joint reconstruction using a braided polyester mesh.

ACJ stabilization using a braided polyester mesh has become popular in ACJ injuries. However, concerns have been raised about excessive anterior clavicle displacement. The purpose of this study was to report radiographic position of the distal clavicle in relation to the acromion after ACJ reconstruction using this device immediately postoperative and after 6 months follow-up compared with a healthy control group. Thirty-eight patients with ACJ instability treated with a braided polyester mesh were compared within group (pre-/postoperatively) and between groups (with age/sex matched controls). Biplane radiographic measurements by 2 observers were made preoperatively, immediate postoperatively and at 6 months follow-up. Inter-observer reliability was assessed and clinical outcome scores were recorded. ACJ stabilization significantly reduced vertical displacement immediately postoperatively (13.8 ±â€¯4.2 to 3.5 ±â€¯5.5 mm; p < 0.0001) towards controls (1.7 ±â€¯2.3 mm,p < 0.0873). Slight further superior displacement (4.4 mm) occurred at 6 months follow-up compared to immediately postoperative (p = 0.0029) and 6.2 mm more than mean controls (p < 0.0001). In the axial plane, significant early reduction of posterior displacement was achieved (10.3 ±â€¯8.0 to 1.1 ±â€¯5.1 mm,p = 0.0240) and the clavicle settled back to a more posterior position at 4.5 ±â€¯6.7  mm at 6 months post-surgery (p = 0.3062). At both time points, posterior displacement was comparable with the controls (3.4 ±â€¯3.0 mm,p = 0.4371 postoperative, p = 0.563 at 6 months follow-up). Excessive anterior displacement has been observed in 2 of the 5 available axial radiographs early postoperative and in 4 of 14 available axial radiographs at 6 months. Constant, Oxford Shoulder and Nottingham Clavicle scores significantly improved (25 ±â€¯12 to 43 ±â€¯7:p < 0.0001, 46 ±â€¯27 to 80 ±â€¯19:p = 0.0038, 53 ±â€¯14 to 80 ±â€¯17:p < 0.0001). ACJ stabilization using a braided polyester device in ACJ instability is effective at reducing both superior and posterior clavicle displacement with excellent clinical outcome. Overcorrection in the axial plane seems to occur, however this is of no clinical and radiographic significance. Posterior displacement is significantly reduced towards control values at 6 months follow-up.

Cohort profile: the Trivandrum non-alcoholic fatty liver disease (NAFLD) cohort.

PURPOSE: The Trivandrum non-alcoholic fatty liver disease (NAFLD) cohort is a population-based study designed to examine the interaction between genetic and lifestyle factors and their association with increased risk of NAFLD within the Indian population. PARTICIPANTS: Between 2013 and 2016, a total of 2222 participants were recruited to this cohort through multistage cluster sampling across the whole population of Trivandrum-a district within the state of Kerala, South India. Data were collected from all inhabitants of randomly selected households over the age of 25. FINDINGS TO DATE: Full baseline clinical and pathological data were collected from 2158 participants. This included detailed demographic profiles, anthropometric measures and lifestyle data (food frequency, physical activity and anxiety and depression questionnaires). Biochemical profile and ultrasound assessment of the liver were performed and whole blood aliquots were collected for DNA analysis.The NAFLD prevalence within this population was 49.8% which is significantly higher than the global pooled prevalence of 25%. This highlights the importance of robust, prospective studies like this to enable collection of longitudinal data on risk factors, disease progression and to facilitate future interventional studies. FUTURE PLANS: The complete analysis of data collected from this cohort will give valuable insights into the interaction of the phenotypic and genotypic profiles that result in such a dramatic increased risk of NAFLD within the Indian population. The cohort will also form the basis of future lifestyle interventional studies, aimed at improving liver and metabolic health.

Joint disease mapping using six cancers in the Yorkshire region of England.

OBJECTIVES: The aims of this study were to model jointly the incidence rates of six smoking related cancers in the Yorkshire region of England, to explore the patterns of spatial correlation amongst them, and to estimate the relative weight of smoking and other shared risk factors for the relevant disease sites, both before and after adjustment for socioeconomic background (SEB). METHODS: Data on the incidence of oesophagus, stomach, pancreas, lung, kidney, and bladder cancers between 1983 and 2003 were extracted from the Northern & Yorkshire Cancer Registry database for the 532 electoral wards in the Yorkshire region. Using postcode of residence, each case was assigned an area-based measure of SEB using the Townsend index. Standardised incidence ratios (SIRs) were calculated for each cancer site and their correlations investigated. The joint analysis of the spatial variation in incidence used a Bayesian shared-component model. Three components were included to represent differences in smoking (for all six sites), bodyweight/obesity (for oesophagus, pancreas and kidney cancers) and diet/alcohol consumption (for oesophagus and stomach cancers). RESULTS: The incidence of cancers of the oesophagus, pancreas, kidney, and bladder was relatively evenly distributed across the region. The incidence of stomach and lung cancers was more clustered around the urban areas in the south of the region, and these two cancers were significantly associated with higher levels of area deprivation. The incidence of lung cancer was most impacted by adjustment for SEB, with the rural/urban split becoming less apparent. The component representing smoking had a larger effect on cancer incidence in the eastern part of the region. The effects of the other two components were small and disappeared after adjustment for SEB. CONCLUSION: This study demonstrates the feasibility of joint disease modelling using data from six cancer sites. Incidence estimates are more precise than those obtained without smoothing. This methodology may be an important tool to help authorities evaluate healthcare system performance and the impact of policies.

Potential Effect Modifiers of the Association Between Physical Activity Patterns and Joint Symptoms in Middle-Aged Women.

OBJECTIVE: To examine whether body mass index (BMI), menopausal status, and hormone therapy (HT) use modify the association between physical activity (PA) patterns throughout middle age and the incidence and prevalence of joint symptoms in women in later middle age. METHODS: Data were from 6,661 participants (born 1946-1951) in the Australian Longitudinal Study on Women's Health. Surveys, with questions on joint pain and stiffness, PA, height and weight, menopausal symptoms, and HT use, were completed every 3 years from 1998 to 2010. PA patterns were defined as none or low, low or meeting guidelines, fluctuating, or meeting guidelines at all times (reference pattern). Logistic regression was used to examine the association between PA patterns and prevalent (in 2010) and cumulative incident (1998-2010) joint symptoms and effect modification by patterns in BMI, menopausal status, and HT. RESULTS: The groups representing fluctuating PA (odds ratio [OR] 1.34 [99% confidence interval (99% CI) 1.04-1.72]) and no or low PA (OR 1.60 [99% CI 1.08-2.35]) had higher odds of incident joint symptoms than those described as meeting guidelines at all times. Stratification by BMI showed that this association was statistically significant in the obese group only. No evidence for effect modification by menopausal status or HT use was found. The findings were similar for prevalent joint symptoms. CONCLUSION: Maintaining at least low levels of PA throughout middle age was associated with a lower prevalence and incidence of joint symptoms later in life. This apparent protective effect of PA on joint symptoms was stronger in obese women than in under- or normal-weight women, and not related to menopause or HT status.

Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

BACKGROUND: Osteoarthritis (OA) is a chronic condition characterized by pain, impaired function, and reduced quality of life. A number of risk factors for knee OA have been identified, such as obesity, occupation, and injury. The association between knee OA and physical activity or particular sports such as running is less clear. Previous reviews, and the evidence that informs them, present contradictory or inconclusive findings. PURPOSE: This systematic review aimed to determine the association between running and the development of knee OA. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Four electronic databases were searched, along with citations in eligible articles and reviews and the contents of recent journal issues. Two reviewers independently screened the titles and abstracts using prespecified eligibility criteria. Full-text articles were also independently assessed for eligibility. Eligible studies were those in which running or running-related sports (eg, triathlon or orienteering) were assessed as a risk factor for the onset or progression of knee OA in adults. Relevant outcomes included (1) diagnosis of knee OA, (2) radiographic markers of knee OA, (3) knee joint surgery for OA, (4) knee pain, and (5) knee-associated disability. Risk of bias was judged by use of the Newcastle-Ottawa scale. A random-effects meta-analysis was performed with case-control studies investigating arthroplasty. RESULTS: After de-duplication, the search returned 1322 records. Of these, 153 full-text articles were assessed; 25 were eligible, describing 15 studies: 11 cohort (6 retrospective) and 4 case-control studies. Findings of studies with a diagnostic OA outcome were mixed. Some radiographic differences were observed in runners, but only at baseline within some subgroups. Meta-analysis suggested a protective effect of running against surgery due to OA: pooled odds ratio 0.46 (95% CI, 0.30-0.71). The I2 was 0% (95% CI, 0%-73%). Evidence relating to symptomatic outcomes was sparse and inconclusive. CONCLUSION: With this evidence, it is not possible to determine the role of running in knee OA. Moderate- to low-quality evidence suggests no association with OA diagnosis, a positive association with OA diagnosis, and a negative association with knee OA surgery. Conflicting results may reflect methodological heterogeneity. More evidence from well-designed, prospective studies is needed to clarify the contradictions.

A global perspective for managing obesity and improving health: conventional treatment and surgical options: 4th Annual Obesity Summit, London, April 2016.

4th Annual Obesity Summit, London, 12-14 April 2016 There are more than 1.9 billion overweight people worldwide, culminating in high rates of Type 2 diabetes; and cardiovascular, digestive and other health problems. This makes obesity a startling phenomenon and a significant global health epidemic. To address this, The 2016 Obesity Summit, 4th in the series of obesity-related annual events organized by EuroSciCon, was held from 12 to 14 April 2016 at Cineworld, The O2 in London. This conference set the stage for three days of stimulating high-quality presentations on the advancements in obesity in an informal academic setting. Approximately 156 delegates including students, researchers, healthcare professionals and scientists from 36 countries around the world attended the event. This meeting report summarizes some of the most outstanding presentations.

Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management.

STUDY DESIGN: Narrative review. OBJECTIVE: The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. METHODS: The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term "spondylolysis AND athlete." The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. RESULTS: Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. CONCLUSION: There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis.

Reoperation rates in the surgical treatment of spinal metastases.

BACKGROUND CONTEXT: The surgical treatment in spinal metastases has been shown to improve function and neurologic outcome. Unplanned hospital readmissions can be costly and cause unnecessary harm. PURPOSE: Our aim was to first analyze the reoperation rate and indications for this revision surgery in spinal metastases from an academic tertiary spinal institute and, second, to make comparisons on outcome (neurology and survival) against patients who underwent single surgery only. STUDY DESIGN/SETTING: This was an ambispective review of all patients treated surgically over an 8-year period considering their neurologic and survival outcome data. Statistical analysis was performed using IBM SPSS 20. Because all scale values did not follow the normal distribution and significant outlier values existed, all descriptive statistics and comparisons were made using median values and the median test. Crosstabs and Pearson correlation were used to calculate differences between percentages and ordinal/nominal values. For two population proportions, the z test was used to calculate differences. The log-rank Mantel-Cox analysis was used to compare survival. PATIENT SAMPLE: During the 8 years' study period, there were 384 patients who underwent urgent surgery for spinal metastasis. Of these, 289 patients were included who had sufficient information available. There were 31 reoperations performed (10.7%; mean age, 60 years; 13 male, 18 female). Exclusion criteria included patients treated solely by radiotherapy, patients who had undergone surgery for spinal metastasis before the study period, and those who had other causes for neurologic dysfunction such as stroke. OUTCOME MEASURES: The outcomes considered in this study were revised Tokuhashi score, preoperative/postoperative Frankel scores, and survival. METHODS: We performed an ambispective review of all patients treated surgically from our comprehensive database during the study period (October 2004 to October 2012). We reviewed all patient records on the database, including patient demographics and reoperation rates. RESULTS: Reoperations were performed in the same admission in the majority of patients (n=20), whereas 11 patients had their second procedure in subsequent hospitalization. The reasons for their revision surgery were as follows: surgical site infection (SSI; 13 of 31 [42%]), failure of instrumentation (9 of 31 [29%]), local recurrence (5 of 31 [16%]), hematoma evacuation (2 of 31 [6%]), and others (2 of 31 [6%]).When comparing the "single surgery" and "revision surgery" groups, we found that the median preoperative and postoperative Frankel scores were similar at Grade 4 (range, 1-5) for both groups (preoperative, p=.92; postoperative, p=.87). However, 20 patients (8%) from the single surgery group and 7 (23%) from the revision group had a worse postoperative score, and this was significantly different (p=.01). No significant difference was found (p=.66) in the revised Tokuhashi score. The median number of survival days was similar (p=.719)-single surgery group: 250 days (range, 5-2,597 days) and revision group: 215 days (range, 9-1,352 days). CONCLUSION: There was a modest reoperation rate (10.7%) in our patients treated surgically for spinal metastases over an 8-year period. Most of these were for SSI (42%), failure of instrumentation (26%), and local recurrence (16%). Patients with metastatic disease could benefit from revision surgery with comparable median survival rates but relatively poorer neurologic outcomes. This study may help to assist with informed decision making for this vulnerable patient group.

What is the cost of a healthy diet? Using diet data from the UK Women's Cohort Study.

BACKGROUND: A healthy diet is important to promote health and well-being while preventing chronic disease. However, the monetary cost of consuming such a diet can be a perceived barrier. This study will investigate the cost of consuming a range of dietary patterns. METHODS: A cross-sectional analysis, where cost of diet was assigned to dietary intakes recorded using a Food Frequency Questionnaire. A mean daily diet cost was calculated for seven data-driven dietary patterns. These dietary patterns were given a healthiness score according to how well they comply with the UK Department of Health's Eatwell Plate guidelines. This study involved ∼35 000 women recruited in the 1990s into the UK Women's Cohort Study. RESULTS: A significant positive association was observed between diet cost and healthiness of the diet (p for trend >0.001). The healthiest dietary pattern was double the price of the least healthy, £6.63/day and £3.29/day, respectively. Dietary diversity, described by the patterns, was also shown to be associated with increased cost. Those with higher education and a professional or managerial occupation were more likely to consume a healthier diet. CONCLUSIONS: A healthy diet is more expensive to the consumer than a less healthy one. In order to promote health through diet and reduce potential inequalities in health, it seems sensible that healthier food choices should be made more accessible to all.

The association between the geography of fast food outlets and childhood obesity rates in Leeds, UK.

OBJECTIVE: To analyse the association between childhood overweight and obesity and the density and proximity of fast food outlets in relation to the child's residential postcode. DESIGN: This was an observational study using individual level height/weight data and geographic information systems methodology. SETTING: Leeds in West Yorkshire, UK. This area consists of 476 lower super-output areas. PARTICIPANTS: Children aged 3-14 years who lived within the Leeds metropolitan boundaries (n=33,594). MAIN OUTCOME MEASURES: The number of fast food outlets per area and the distance to the nearest fast food outlet from the child's home address. The weight status of the child: overweight, obese or neither. RESULTS: 27.1% of the children were overweight or obese with 12.6% classified as obese. There is a significant positive correlation (p<0.001) between density of fast food outlets and higher deprivation. A higher density of fast food outlets was significantly associated (p=0.02) with the child being obese (or overweight/obese) in the generalised estimating equation model which also included sex, age and deprivation. No significant association between distance to the nearest fast food outlet and overweight or obese status was found. CONCLUSIONS: There is a positive relationship between the density of fast food outlets per area and the obesity status of children in Leeds. There is also a significant association between fast food outlet density and areas of higher deprivation.

The design and validation of a spatial microsimulation model of obesogenic environments for children in Leeds, UK: SimObesity.

Obesogenic environments are a major explanation for the rapidly increasing prevalence in obesity. Investigating the relationship between obesity and obesogenic variables at the micro-level will increase our understanding about local differences in risk factors for obesity. SimObesity is a spatial microsimulation model designed to create micro-level estimates of obesogenic environment variables in the city of Leeds in the UK: consisting of a plethora of health, environment, and socio-economic variables. It combines individual micro-data from two national surveys with a coarse geography, with geographically finer scaled data from the 2001 UK Census, using a reweighting deterministic algorithm. This creates a synthetic population of individuals/households in Leeds with attributes from both the survey and census datasets. Logistic regression analyses identify suitable constraint variables to use. The model is validated using linear regression and equal variance t-tests. Height, weight, age, gender, and residential postcode data were collected on children aged 3-13 years in the Leeds metropolitan area, and obesity described as above the 98th centile for the British reference dataset. Geographically weighted regression is used to investigate the relationship between different obesogenic environments and childhood obesity. Validation shows that the small-area estimates were robust. The different obesogenic environments, as well as the parameter estimates from the corresponding local regression analyses, are mapped, all of which demonstrate non-stationary relationships. These results show that social capital and poverty are strongly associated with childhood obesity. This paper demonstrates a methodology to estimate health variables at the small-area level. The key to this technique is the choice of the model's input variables, which must be predictors for the output variables; this factor has not been stressed in other spatial microsimulation work. It also provides further evidence for the existence of obesogenic environments for children.