Waist circumference-to-height ratio and body mass index for obesity classification in Irish children.

AIM: Waist circumference-to-height ratio (WHt) has been proposed as an alternative measure to BMI due to its focus on central weight distribution and its basic threshold for increased cardiometabolic risk. This study aimed to compare prevalence of overweight including obesity using BMI and WHt, and assess 10-year trends of WHt prevalence, in a representative sample of Irish children. METHODS: Children measured during rounds 2-5 of the Childhood Obesity Surveillance Initiative (n = 20037) were classified as healthy weight or overweight including obesity (International Obesity Task Force age and sex BMI cut-offs), and low or high WHt (WHt ≥ 0.5). Differences in prevalence of BMI and WHt classifications were determined for round five in younger (<9 years) and older (≥9 years) children. The prevalence of high WHt was assessed across rounds. RESULTS: Differences in prevalence between overweight including obesity and high WHt were apparent in younger (BMI: 16.7%, WHt: 8.9%; p < .001) and older (BMI: 21.3%, WHt: 12.1%; p < .001) children. An inverse trend for prevalence of high WHt was identified across rounds (p < .001). CONCLUSION: BMI overestimates overweight including obesity prevalence compared to WHt. Given its ease of use, consideration of the WHt as an additional measure in childhood surveillance and screening is warranted.

School sociodemographic characteristics and obesity in schoolchildren: does the obesity definition matter?

BACKGROUND: Existing evidence on the role of sociodemographic variables as risk factors for overweight and obesity in school-aged children is inconsistent. Furthermore, findings seem to be influenced by the obesity definition applied. Therefore, this study aimed to investigate if school sociodemographic indicators were associated with weight status in Irish primary schoolchildren and whether this association was sensitive to different obesity classification systems. METHODS: A nationally representative cross-sectional sample of 7542 Irish children (53.9% girls), mean age 10.4 (±1.2SD) years, participating in the Childhood Obesity Surveillance Initiative in the 2010, 2012/2013 or 2015/2016 waves were included. Height, weight and waist circumference were objectively measured. Five definitions of obesity were employed using different approaches for either body mass index (BMI) or abdominal obesity. Associations between overweight and obesity and sociodemographic variables were investigated using adjusted multilevel logistic regression analyses. RESULTS: Children attending disadvantaged schools were more likely to be overweight and obese than their peers attending non-disadvantaged schools, regardless of the obesity classification system used. Associations remained significant for the BMI-based obesity definitions when the sample was stratified by sex and age group, except for boys aged 8-10.5 years. Only boys aged ≥10.5 years in disadvantaged schools had higher odds of abdominal obesity (UK 1990 waist circumference growth charts: OR = 1.56, 95%CI = 1.09-2.24; waist-to-height ratio: OR = 1.78, 95%CI = 1.14-2.79) than those in non-disadvantaged schools. No associations were observed for school urbanisation level. CONCLUSIONS: School socioeconomic status was a strong determinant of overweight and obesity in Irish schoolchildren, and these associations were age- and sex-dependent. School location was not associated with overweight or obesity. There remains a need to intervene with school-aged children in disadvantaged schools, specifically among those approaching adolescence, to prevent a trajectory of obesity into adult life.

Alcohol consumption and risk of lymphoid and myeloid neoplasms: results of the Netherlands cohort study.

Results from epidemiological studies suggest that alcohol drinkers have a decreased risk of lymphoid neoplasms, whereas results for myeloid neoplasms are inconsistent. However, most of these studies have used retrospective data. We examined prospectively whether alcohol consumption decreases the risk of both lymphoid and myeloid neoplasms, including most common subtypes. Moreover, we investigated whether this decreased risk is due to ethanol or other contents of specific alcoholic beverages (i.e., beer, wine and liquor). The Netherlands cohort study consisted of 120,852 individuals who completed a baseline questionnaire in 1986. After 17.3 years of follow-up, 1,375 cases of lymphoid and 245 cases of myeloid neoplasms with complete exposure information were available for analysis. Compared with abstinence, we observed for plasma cell neoplasms hazard rate ratios (HR) of 1.66 (95% confidence interval (CI), 1.21-2.29), 1.63 (95% CI, 1.17-2.27), 1.11 (95% CI, 0.75-1.64) and 0.85 (95% CI, 0.51-1.42) with daily ethanol consumption of 0.1-<5, 5-<15, 15-<30 and ≥30 g, respectively. A similar pattern was observed for chronic lymphocytic leukemia/small lymphocytic lymphoma. No associations were observed for other subtypes and for myeloid neoplasms. When results were analyzed by beverage type, no clear associations were observed. In conclusion, our study did not show an inverse association between alcohol consumption and lymphoid neoplasms. Also, no inverse association was observed with myeloid neoplasms. If any association between alcohol consumption and lymphoid neoplasms exists, our study suggests an increased risk rather than a decreased risk.

Intake of vegetables, fruits, carotenoids and vitamins C and E and pancreatic cancer risk in The Netherlands Cohort Study.

Epidemiological data investigating the relation between fruit and vegetable consumption and pancreatic cancer risk have shown inconsistent results so far. Most case-control studies observed an inverse association with total fruit and vegetable consumption, whereas results from most cohort studies have largely been null. We examined prospectively the relation between pancreatic cancer risk and intake of vegetables, fruits, carotenoids and vitamins C and E. The Netherlands Cohort Study consisted of 120,852 men and women who completed a questionnaire at baseline in 1986, including a validated 150-item food-frequency questionnaire. After 16.3 years of follow-up, 423 cases were available for analysis. Total vegetable and total fruit consumption were not associated with pancreatic cancer risk (highest vs. lowest quintile, multivariable-adjusted hazard rate ratio = 1.23, 95% confidence interval: 0.86-1.75 and multivariable-adjusted hazard rate ratio = 0.90, 95% confidence interval: 0.66-1.24, respectively). Also, for cooked vegetables, raw vegetables and vegetables and fruits classified into subgroups, no associations were observed. Dietary carotenoids, vitamin C and E intake and supplements containing vitamin C or E were not associated with pancreatic cancer risk. The results were not modified by sex, smoking status and body mass index. In conclusion, we observed no association between a high consumption of vegetables and fruits and pancreatic cancer risk in this large cohort study, which is in agreement with previous prospective studies. Furthermore, we observed no association between the intake of carotenoids, vitamins and vitamin supplements and pancreatic cancer risk.

Evaluation of the PhunkyFoods intervention on food literacy and cooking skills of children aged 7-9 years: a cluster randomised controlled trial in Yorkshire Primary Schools UK.

BACKGROUND: Childhood obesity rates more than double during primary school in England. Acquiring competent cooking skills is a key part of children's education that can lead to improved knowledge of a healthy lifestyle and dietary behaviours. Evaluation of the impact of 'PhunkyFoods', a school-based food and nutrition education programme, will assess food literacy, cooking skills and dietary behaviour in primary-school children. METHODS: A cluster randomised controlled trial will be undertaken in 28 primary schools in North Yorkshire, UK, including a total population of children aged 7-9 years (n = 420). The trial has two arms: (a) the intervention group receiving PhunkyFoods programme (n = 210) and (b) the wait-list control group receiving the usual school curriculum (n = 210). The intervention 'PhunkyFoods' will be delivered by Purely Nutrition Ltd. The participating school staff are supported with training, policy development and access to resources to improve the delivery of nutrition education. Children participate through whole school assemblies, classroom activities, and after-school clubs about food preparation, cooking healthy meals and healthy living. Schools, parents and children have access to healthy meal recipes through the PhunkyFoods website. The primary outcomes are differences in food literacy and cooking skills scores between control and intervention arms after 12 months of the intervention and adjusted for baseline values. The secondary outcome is differences in fruit and vegetable intake between the arms after 12 months (adjusted for baseline). Treatment effects will be examined using mixed ANOVA and regression analysis. Primary analyses will adjust for baseline food literacy and cooking skills scores and secondary analysis will adjust for pre-specified baseline school and child level covariates. DISCUSSION: The PhunkyFoods programme is a flexible menu of options for schools to choose from, making this a highly complex intervention. Following Medical Research Council guidance, research perspectives will focus on effectiveness and theory-based approaches: to what extent the intervention produces the intended outcomes in real-world settings and what works in which circumstances. TRIAL REGISTRATION: ISRCTN ISRCTN68114155 . Prospectively registered on 22 October 2021.

Meeting report: plant-rich dietary patterns and health.

Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.

A Unified Theoretical Framework of Learning Theories to Inform and Guide Public Health Continuing Medical Education Research and Practice.

ABSTRACT: Continuing medical education (CME) emerged at the start of the 20th century as a means of maintaining clinical competence among health care practitioners. However, evidence indicates that CME is often poorly developed and inappropriately used. Consequently, there has been increasing interest in the literature in evaluating wider contexts at play in CME development and delivery. In this article, the authors present a unified theoretical framework, grounded in learning theories, to explore the role of contextual factors in public health CME for health care practitioners. Discussion with pedagogical experts together with a narrative review of learning theories within medical and social science literature informed the framework's development. The need to consider sociocultural theories of learning within medical education restricted suitable theories to those that recognized contexts beyond the individual learner; adopted a systems approach to evaluate interactions between contexts and learner; and considered learning as more than mere acquisition of knowledge. Through a process of rigorous critical analysis, two theoretical models emerged as contextually appropriate: Biggs principle of constructive alignment and Bronfenbrenner bioecological model of human development. Biggs principle offers theoretical clarity surrounding interactive factors that encourage lifelong learning, whereas the Bronfenbrenner model expands on these factor's roles across multiple system levels. The authors explore how unification into a single framework complements each model while elaborating on its fundamental and practical applications. The unified theoretical framework presented in this article addresses the limitations of isolated frameworks and allows for the exploration of the applicability of wider learning theories in CME research.

Self-reported reproductive health of athletic and recreationally active males in Ireland: potential health effects interfering with performance.

Introduction: The syndrome of Relative Energy Deficiency in Sport (RED-S) consensus statements recognise that male athletes might have impaired fertility in terms of the Exercise Hypogonodal Male Condition (ExHMC). Thus, the aims of this study were to (1) identify risk of ExHMC in active males in various sports and (2) determine if associations between risk of ExHMC and health problems interfering with training and competition exist. Methods: A questionnaire was distributed online (November 2018-January 2019) using questions derived from the "Androgen Deficiency in the Aging Male Questionnaire" (ADAM-Q) to assess risk of ExHMC. Additional questions were included to collect information on participant demographics, injury and illness history and dietary habits. Logistic regression analyses explored differences between groups. Results: Risk of ExHMC was identified in 23.3% (n = 185) of 794 questionnaire participants. Following multivariate analyses, risk of ExHMC was independently associated with a lower than normal sex drive rating within the last month (OR 7.62, 95%CI 4.99-11.63) and less than three morning erections per week within the last month (OR: 4.67, 95%CI 3.23-6.76). Risk of ExHMC was associated with 15-21 days absence from training or competition during the previous 6 months due to overload injuries in the univariate analysis (OR = 2.69, 95% CI = 1.24-5.84). Conclusion: Risk of ExHMC and associated symptoms in this heterogeneous sample may be indicative of RED-S. Confounding factors such as over-training, medication use, fatigue and psychological stress need to be considered. Identification of male athletes exhibiting physiological symptoms associated with RED-S requires more research.

Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress.

To meet the need for regular and reliable data on the prevalence of overweight and obesity among children in Europe, the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established in 2007. The resulting robust surveillance system has improved understanding of the public health challenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action on nutrition and physical activity in the region. This paper describes illustrative examples of how COSI data have fed into national and international policy, but the real scope of COSI's impact is likely to be much broader. In some countries, there are signs that policy responses to COSI data have helped halt the rise in childhood obesity. As the countries of the WHO European Region commit to pursuing United Action for Better Health in Europe in WHO's new European Programme of Work, COSI provides an excellent example of such united action in practice. Further collaborative action will be key to tackling this major public health challenge which affects children throughout the region.

Waist circumference and waist-to-height ratio in 7-year-old children-WHO Childhood Obesity Surveillance Initiative.

Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99 years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p < 0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8 ± 7.36 cm boys; 60.3 ± 7.48 cm girls), North Macedonia (60.4 ± 7.91 cm boys; 59.0 ± 8.01 cm girls), and Spain (59.7 ± 6.96 cm boys; 58.9 ± 6.77 cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.

Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6-9-year-old children from 19 countries from the WHO European region.

In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban-rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6-9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30-80% and 30-90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1-2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.

Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017.

In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017.

BACKGROUND: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. OBJECTIVES: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). METHOD: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. RESULTS: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. CONCLUSIONS: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.

Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017.

INTRODUCTION: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions. METHODS: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. RESULTS: Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries. DISCUSSION/CONCLUSION: Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance.

Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying "true" low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

A Snapshot of European Children's Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI).

Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.

Meat and fat intake and pancreatic cancer risk in the Netherlands Cohort Study.

Meat contains numerous carcinogens, such as heterocyclic amines, polycyclic aromatic hydrocarbons, and N-nitroso compounds, which can be derived either from natural food or during the process of food preparation. These carcinogens may increase pancreatic cancer risk. Furthermore, studies in animals showed that polyunsaturated fatty acids, especially linoleic acid, increase pancreatic cancer risk. We examined prospectively the relation between pancreatic cancer risk and intake of fresh meat, processed meat, fish, eggs, total fat, and different types of fat. The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 13.3 years of follow-up, 350 pancreatic cancer cases (66% microscopically confirmed) were available for analysis. A validated 150-item food-frequency questionnaire was used to calculate intake of fresh meat, processed meat, fish, eggs, fat and different types of fat. No association was found when examining the association between intake of fresh meat, other types of meat, fish, eggs, dietary intake of total fat and different types of fat and risk of pancreatic cancer. It is important for future studies to investigate the relation between different meat-cooking methods and pancreatic cancer.

Alcohol consumption and risk of pancreatic cancer in the Netherlands cohort study.

To examine prospectively the relation between alcohol consumption and pancreatic cancer risk, the authors analyzed data from the Netherlands Cohort Study. Participants were 120,852 persons who completed a baseline questionnaire in 1986. After 13.3 years of follow-up, 350 cases of pancreatic cancer (67% microscopically confirmed) were available for analysis. Compared with abstention, the highest category of alcohol consumption (> or =30 g/day of ethanol) was positively associated with pancreatic cancer risk (for all cases, rate ratio = 1.57, 95% confidence interval: 1.03, 2.39; P(trend) = 0.12; for microscopically confirmed cases, rate ratio = 1.54, 95% confidence interval: 0.94, 2.54; P(trend) = 0.22). In a subgroup of stable alcohol users (no change during the 5 years before baseline), a similarly increased risk of pancreatic cancer was found. This increased risk was limited to the first 7 years of follow-up. No associations were observed between consumption of specific alcoholic beverages and risk of pancreatic cancer. The associations were not modified by folate intake or smoking. Overall, these findings suggest an increased pancreatic cancer risk for persons with a high ethanol intake (> or =30 g/day). However, this increased risk was observed only during the first 7 years of follow-up.

Serum antioxidants and skin cancer risk: an 8-year community-based follow-up study.

BACKGROUND: Antioxidant nutrients can help prevent skin damage caused by ultraviolet radiation from sunlight, but it is not clear whether serum concentrations of such nutrients influence skin cancer risk. METHODS: We carried out a prospective study of the associations between serum concentrations of antioxidant nutrients and incidence (person-based and tumor-based) of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin among a random subsample of 485 adults from an Australian community. Participants were divided into thirds, ranked according to their serum concentrations of carotenoids, alpha-tocopherol, and selenium measured in 1996 and were monitored for incident, histologically confirmed BCC and SCC tumors until 2004. RESULTS: Although there were no associations between baseline serum carotenoids or alpha-tocopherol concentrations and incidence of BCC or SCC, baseline serum selenium concentrations showed strong inverse associations with both BCC and SCC tumor incidence. Compared with participants with lowest selenium concentrations at baseline (0.4-1.0 micromol/L), those with the highest serum selenium concentrations (1.3-2.8 micromol/L) had a decreased incidence of BCC tumors (multivariate relative risk, 0.43; 95% confidence interval, 0.21-0.86; P(trend) = 0.02) and SCC tumors (multivariate relative risk, 0.36; 95% confidence interval, 0.15-0.82; P(trend) = 0.02). CONCLUSION: Relatively high serum selenium concentrations are associated with an approximately 60% decrease in subsequent tumor incidence of both BCC and SCC, whereas serum concentrations of carotenoids or alpha-tocopherol are not associated with later skin cancer incidence. A possible U-shaped association between serum selenium concentrations and SCC of the skin needs confirmation.

Predictors of weight status in school-aged children: a prospective cohort study.

BACKGROUND/OBJECTIVES: To prospectively investigate the predictors of overweight/obesity and of body mass index (BMI) change in schoolchildren. SUBJECTS/METHODS: A cohort of 2755 Irish children (53.7% girls), aged 6-10 years at baseline, participating in the Childhood Obesity Surveillance Initiative were included. Height and weight were objectively measured and BMI was calculated. Overweight/obesity were defined according to the International Obesity Task Force cut-offs. Prevalence of overweight/obesity at baseline and follow-up, incidence of overweight/obesity and changes in BMI over time were computed. Lifestyle indicators were parentally reported with a questionnaire. Predictors of overweight/obesity were investigated by multivariate mixed logistic regression models. RESULTS: Baseline BMI (OR = 6.46, 95% CI = 4.56-9.17) and school socioeconomic level (OR = 2.12, 95% CI = 1.16-3.86) were associated with higher risk of becoming overweight/obese. Children with no savoury snacks consumption (OR = 0.22, 95% CI = 0.07-0.69), or with frequent sports/dancing clubs attendance (OR = 0.41, 95% CI = 0.19-0.88) had lower odds of overweight/obesity at follow-up. Poor fruit intake was associated with higher risk of overweight/obesity (OR = 2.16, 95% CI = 1.23-3.78). CONCLUSIONS: Initial BMI was the main predictor of subsequent overweight/obesity in schoolchildren, followed, to a lesser extent, by school socioeconomic status. Although lifestyle behaviours appeared to have lower effect as compared with prior BMI, children with healthier lifestyle behaviours were at reduced risk of overweight/obesity at follow-up. Programmes that aim at preventing the onset of overweight and obesity need to be a priority given the existing difficulties to reverse this condition later in life.