Effects of dietary glycemic index and load on children's cardiovascular risk factors

PURPOSE

Consumption of foods high in glycemic index (GI) and glycemic load (GL) is associated with cardiovascular (CV) diseases in adulthood. We examined whether GI and GL predict CV risk factors in children after 2 years of follow-up.

METHODS

Three 24-hour recalls were administered at baseline, and individual average daily GI and GL scores were calculated in a cohort of 8-10 year-old children. CV risk factors included body mass index z-score (BMIz), percent fat mass, triglycerides (TGs), low-density lipoprotein and high-density lipoprotein (HDL) cholesterol, and systolic and diastolic blood pressure. Main analyses consisted of multiple linear regression adjusted for anthropometric, socioeconomic, and dietary factors.

RESULTS

After 2 years, the highest dietary GL tertile compared with the lowest was associated with increased BMIz (mean difference [MD], 1.1; 95% CI, 0.88-1.31), fat mass (MD, 10.8%; 95% CI, 8.62-13.0), TGs (MD, 0.17 mmol/L; 95% CI, 0.07-0.28), and decreased HDL (MD, -0.13 mmol/L; 95% CI, -0.19 to -0.07). The GL-TG and the GL-HDL associations were mediated by BMIz.

CONCLUSIONS

GL predicts increased BMIz, percent fat mass, and TGs and decreased HDL in young children after 2 years. Recommendations to decrease CV risk in children should include lowering foods high in GL.

Understanding how Indigenous culturally-based interventions can improve participants' health in Canada

There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.

The Cardiometabolic Risk Profile of Underreporters of Energy Intake Differs from That of Adequate Reporters among Children at Risk of Obesity

Background

Misreporting of energy intake (EI) in nutritional epidemiology is a concern because of information bias, and tends to occur differentially in obese compared with nonobese subjects.

Objective

We examined characteristics of misreporters within a cohort of children with a parental history of obesity and the bias introduced by underreporting.

Methods

The QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort included 630 Caucasian children aged 8-10 y at recruitment with ≥1 obese parent [body mass index (BMI; in kg/m2) >30 or waist circumference >102 cm (men), >88 cm (women)] and free of diabetes or severe illness. Children on antihypertensive medications or following a restricted diet were excluded. Child and parent characteristics were measured directly or by questionnaire. Three 24-h dietary recalls were administered by phone by a dietitian. Goldberg's cutoff method identified underreporters (URs). Logistic regression identified correlates of URs. We compared coefficients from linear regressions of BMI after 2 y on total EI at baseline 1) in all participants; 2) in adequate reporters (ARs) (excluding URs); 3) in all participants statistically adjusted for underreporting; 4) excluding URs using individual physical activity level (PAL)-specific cutoffs; and 5) in all participants statistically adjusted for underreporting using PAL-specific cutoffs.

Results

We identified 175 URs based on a calculated cutoff of 1.11. URs were older, had a higher BMI z score, and had poorer cardiometabolic health indicators. Parents of URs had a lower family income and higher BMI. Child BMI z score (OR: 3.07; 95% CI: 2.38, 3.97) and age (OR: 1.46/y; 95% CI: 1.14, 1.87/y) were the strongest correlates of underreporting. The association between BMI and total EI was null in all participants but became significantly positive after excluding URs (ß = 0.62/1000 kcal; 95% CI: 0.33, 0.92/1000 kcal) and after adjustment for URs (ß = 0.85/1000 kcal; 95% CI: 0.55, 1.06/1000 kcal).

Conclusions

URs in 8- to 10-y-old children differed from ARs. Underreporting biases measurement of nutritional exposures and the assessment of exposure-outcome relations. Identifying URs and using an appropriate correction method is essential.

Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services

Background

Length measurements are important in growth, monitoring and promotion (GMP) for the surveillance of a child’s weight-for-length and length-for-age. These two indices provide an indication of a child’s risk of becoming wasted or stunted, and are more informative about a child’s growth than the widely used weight-for-age index (underweight). Although the introduction of length measurements in GMP is recommended by the World Health Organization, concerns about the reliability of length measurements collected in rural outreach settings have been expressed by stakeholders. Our aim was to describe the reliability and challenges associated with community health personnel measuring length for rural outreach GMP activities.

Methods

Two reliability studies (A and B), using 10 children less than 24 months each, were conducted in the GMP services of a rural district in Ghana. Fifteen nurses and 15 health volunteers (HV) with no prior experience in length measurements were trained. Intra- and inter-observer technical error of measurement (TEM), average bias from expert anthropometrist, and coefficient of reliability (R) of length measurements were assessed and compared across sessions. Observations and interviews were used to understand the ability and experiences of health personnel with measuring length at outreach GMP.

Results

Inter-observer TEM was larger than intra-observer TEM for both nurses and HV at both sessions and was unacceptably (compared to error standards) high in both groups at both time points. Average biases from expert’s measurements were within acceptable limits, however, both groups tended to underestimate length measurements. The R for lengths collected by nurses (92.3%) was higher at session B compared to that of HV (87.5%). Length measurements taken by nurses and HV, and those taken by an experienced anthropometrist at GMP sessions were of moderate agreement (kappa = 0.53, p < 0.0001).

Conclusions

The reliability of length measurements improved after two refresher trainings for nurses but not for HV. In addition, length measurements taken during GMP sessions may be susceptible to errors due to overburdened health personnel and crowded GMP clinics. There is need for both pre- and in-service training of nurses and HV on length measurements and procedures to improve reliability of length measurements.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2909-0) contains supplementary material, which is available to authorized users.

Rapid increase of overweight and obesity among primary school-aged children in the Caribbean; high initial BMI is the most significant predictor

BACKGROUND

To examine predictors of increasing overweight among children in two developing countries.

METHODS

Primary school children (6-10 y at baseline, n = 336) and their caregivers.Longitudinal data were collected in 2012, with follow-up 18 months later. Data on children's height, weight and dietary intake were collected within 8 primary public schools in Trinidad and 7 schools in St. Kitts. Caregivers' demographic and anthropometric data were also collected.

RESULTS

At baseline, children's age and sex and caregivers' BMI, age, and marital status and reported dietary intake were similar across all weight groups. The incidence of overweight and obesity among children was 8.8% and 8.1%, respectively. Dietary intake at baseline was not related to becoming overweight or obese. Similarly there were no differences in reported intake among children who became overweight or obese except that they consumed fewer fruits (0.54±0.92 vs. 0.98±1.66, p = 0.017). Misreporting of energy intake was higher among overweight/obese children as compared to those who were not overweight/obese (27% vs. 17%, p = 0.047). The baseline predictors of increasing BMI (adjusted) of the children were older age, higher baseline BMI z-score and higher height-for-age (HFA) z-score; caregiver BMI, children's energy intake (with adjustment for misreporting) did not predict changes in children's BMI.

CONCLUSIONS

The increasing prevalence of overweight/obesity among children is a serious problem in the Caribbean. Heavier children are at elevated risk of continued rapid increase in their weight status, pointing to the need for early intervention.

Empowering women to breastfeed: Does the Baby Friendly Initiative make a difference?

The Baby-Friendly Hospital Initiative (BFI) is currently presented worldwide as the gold standard model of care for promoting and supporting breastfeeding. However, there is a lack of understanding about the ways in which health services, including the BFI, address the cultural change from a disembodied practice (formula feeding) to an embodied one (breastfeeding) in contexts where formula feeding is the norm. We used a qualitative case study methodology to compare the embodied experience of breastfeeding and the maternal experience of breastfeeding promotion and support services between mothers receiving care from institutions with low and high levels of BFI implementation in Québec, Canada. A total of 11 focus groups were conducted with mothers from six institutions-three with high and three with low levels of BFI implementation. We found the flexible approach to breastfeeding duration, characteristic of BFI services in our study, helped to avoid maternal guilt and shame; the shift to focusing on potential barriers and strategies for overcoming them empowered women to negotiate changes in infant feeding with others and self by addressing the embodied experience of a practice that may not feel natural at the beginning. Findings have implications for the concept of habitus and the construction of the breastfeeding body; we suggest that habitus can change if agents are provided with discursive tools to negotiate this embodied change. Implications for BFI services include the need to implement the 10 steps in a flexible, family-centred way that focuses on empowering women rather than simply reaching outcomes.

Relation between mealtime distribution of protein intake and lean mass loss in free-living older adults of the NuAge study

BACKGROUND

Studies have shown that an even protein intake distribution across meals increased 24-h muscle protein synthesis in young adults compared with a skewed intake. Whether this short-term result translates into long-term preservation of lean mass (LM) in older adults remains unknown.

OBJECTIVE

The aim was to examine the extent to which protein quantity and distribution are associated with LM and appendicular LM (aLM), and their 2-y decline, in community-dwelling older adults.

DESIGN

Baseline and 2-y follow-up data from 351 men and 361 women (aged 67-84 y) in the NuAge study (Quebec Longitudinal Study on Nutrition as a Determinant of Successful Aging) with available body-composition data (by dual-energy X-ray absorptiometry) were used. Food intake was assessed with the use of three 24-h food recalls collected at baseline and 3 collected at the 2-y follow-up. Protein distribution across meals was calculated as the CV of protein ingested per meal, with lower values reflecting evenness of protein intake. Linear mixed-model analysis was performed to examine changes in LM and aLM across time, by sex, as conditioned by the quantity and distribution of protein intake, adjusted for potential covariates.

RESULTS

Over 2 y, LM declined in both men (-2.5% ± 4.0%) and women (-2.0% ± 3.4%) (P < 0.05), whereas aLM loss was not significant (men: -1.5% ± 4.8%; women: -1.2% ± 5.3%; P > 0.05). The decline in LM was not independently affected by the quantity and distribution of protein intake. Yet men and women with evenly distributed protein intakes and men with high protein intakes showed higher LM or aLM throughout the entire follow-up period, even after potential confounders were controlled for (P < 0.05).

CONCLUSIONS

Our results suggest that greater protein intakes and a more even distribution across meals are modifiable factors associated with higher muscle mass in older adults but not with losses over 2 y. Interventional studies should determine longer-term effects on preserving LM with aging.

Associations between added sugar (solid vs. liquid) intakes, diet quality, and adiposity indicators in Canadian children

Little is known about the influence of different forms of added sugar intake on diet quality or their association with obesity among youth. Dietary intake was assessed by three 24-h recalls in 613 Canadian children (aged 8-10 years). Added sugars (mean of 3-day intakes) were categorized according to source (solid or liquid). Dietary intake and the Canadian Healthy Eating Index (« HEI-C ») were compared across tertiles of solid and liquid added sugars separately as were adiposity indicators (body mass index (BMI), fat mass (dual-energy X-ray absorptiometry), and waist circumference). Cross-sectional associations were examined in linear regression models adjusting for age, sex, energy intake, and physical activity (7-day accelerometer). Added sugar contributed 12% of total energy intake (204 kcal) on average, of which 78% was from solid sources. Higher consumption of added sugars from either solid or liquid source was associated with higher total energy, lower intake of micronutrients, vegetables and fruit, and lower HEI-C score. Additionally liquid sources were associated with lower intake of dairy products. A 10-g higher consumption of added sugars from liquid sources was associated with 0.4 serving/day lower of vegetables and fruit, 0.4-kg/m(2) higher BMI, a 0.5-kg higher fat mass, and a 0.9-cm higher waist circumference whereas the associations of added sugars from solid sources and adiposity indicators tended to be negative. In conclusion, higher consumption of added sugar from either solid or liquid sources was associated with lower overall diet quality. Adiposity indicators were only positively associated with added sugars from liquid sources.

Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond

OBJECTIVES

To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle.

OUTCOMES

Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter.

EVIDENCE

Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document.

VALUES

The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.

Influence of Adiposity, Physical Activity, Fitness, and Screen Time on Insulin Dynamics Over 2 Years in Children

IMPORTANCE

Despite extensive evidence showing that lifestyle habits play a critical role in preventing or delaying the onset of type 2 diabetes in adults, little is known regarding the impact of lifestyle habits on type 2 diabetes risk in childhood.

OBJECTIVE

To assess whether adiposity, fitness, moderate-to-vigorous physical activity, and screen time predict insulin sensitivity or insulin secretion during a 2-year period in children with a family history of obesity.

DESIGN, SETTING, AND PARTICIPANTS

This is a prospective longitudinal cohort study of 630 children, having at least 1 obese parent, recruited from schools in Quebec, Canada, between July 2005 and December 2008 in the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort. Children were assessed at baseline (ages 8-10 years) and 2 years later. Fitness was measured by peak oxygen consumption, percentage of body fat (adiposity) by dual-energy x-ray absorptiometry, moderate-to-vigorous physical activity using accelerometry, and screen time by average daily hours of self-reported television, video game, or computer use. Regression models were adjusted for age, sex, season, and pubertal stage. The current analysis was completed in October 2015.

MAIN OUTCOMES AND MEASURES

Insulin sensitivity was measured by the homeostatic model assessment of insulin resistance and an oral glucose tolerance test-based index (Matsuda insulin sensitivity index). Insulin secretion was measured using the area under the curve of insulin to glucose during the first 30 minutes of the oral glucose tolerance test and using the area under the curve of insulin to glucose over 2 hours.

RESULTS

Of 630 children evaluated at baseline (mean [SD] age, 9.6 [0.9] years; 54.4% male; 56.2% normal weight, 19.2% overweight, and 22.7% obese), 564 were evaluated at 2-year follow-up. Adiposity and changes in adiposity were the central predictors of insulin dynamics over time. Every additional 1% of body fat at ages 8 to 10 years decreased insulin sensitivity by 2.9% (95% CI, -3.3% to -2.5%; P < .001) and led to a 0.5% (95% CI, 0.09% to 0.8%; P = .02) increased requirement in the area under the curve of insulin to glucose during the first 30 minutes of the oral glucose tolerance test 2 years later. Higher levels of moderate-to-vigorous physical activity and lower screen time appear to be beneficial to insulin sensitivity in part through their effect on adiposity levels.

CONCLUSIONS AND RELEVANCE

Adiposity plays a determining role in cardiometabolic health at a young age. Public health strategies that promote healthy body weight, notably physical activity, need to target school-aged and possibly younger children.

Muscle Mass Index and Animal Source of Dietary Protein Are Positively Associated with Insulin Resistance in Participants of the NuAge Study

OBJECTIVES

Contribute evidence towards the complex interrelationships of body composition, insulin sensitivity and protein intake independently from adiposity in an older population.

DESIGN

This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis.

SETTING

The loss of muscle mass has been implicated in the development of insulin resistance. We propose to test associations of muscle mass with insulin sensitivity and their respective associations with animal and vegetable sources of protein intake, independently from adiposity.

PARTICIPANTS

Non-diabetic participants aged 68-82 years from the NuAge study with all available measures (n=441) were included.

MEASUREMENTS

A model considering age, sex, chronic diseases, physical activity; smoking and sources of protein intake influencing body composition components and insulin sensitivity was created and tested with Path Analysis for their independent associations. Muscle mass index (MMI; kg/height in m2) and % body fat were derived from DXA and BIA. Insulin resistance was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score and physical activity by the Physical Activity Scale for the Elderly (PASE) questionnaire. Protein intakes were obtained from three non-consecutive 24h-diet recalls.

RESULTS

In the final model, direct positive associations were observed between HOMA-IR score and MMI (ß=0.42; 95%CI: 0.24; 0.6) and % body fat (ß=0.094; 95%CI: 0.07; 0.11). There were no direct associations between animal protein intake and MMI or with HOMA-IR. There was a significant direct negative association between plant protein intake and MMI (ß= -0.068; 95%CI: -0.13; -0.003) and significant indirect associations mediated through MMI and % body fat between HOMA-IR and animal protein intake (ß=0.0321; 95%CI: 0.01; 0.05), as well as plant protein intake (ß= -0.07; 95%CI: -0.1; 0.0).

CONCLUSIONS

Our final model indicated that MMI and HOMA score were significantly positively associated. Protein intake sources were related to HOMA-IR score differently through MMI and % body fat, respectively.

Predictors of Weight Loss in Young Adults

BACKGROUND

Increased understanding of weight loss among healthy young people in naturalistic settings could inform the development of effective weight control programs. The aim of this study was to describe loss in BMI over 7 years in a population-based sample of healthy young adolescents (mean age 17 years at beginning of follow-up) and identify determinants of BMI loss.

DESIGN AND METHOD

Data were available for 681 participants in the Nicotine Dependence in Teens Study (1999-2012), a longitudinal investigation of adolescents in Montreal (Canada). Loss in BMI was assessed between age 17 and 24 years. Potential predictors of BMI loss including age, sex, mother's education, worry about weight, physical activity, screen time, and cigarette smoking were studied in multivariable logistic regression.

RESULTS

Males and females gained 2.0 and 1.4 BMI units, respectively, on average, between age 17 and 24 years. However, 9% of males and 14% of females experienced a loss in BMI ≥1.0 unit. Female sex and a higher BMI at age 17 were associated with a higher probability of BMI loss, but none of age, mother's education, physical activity, screen time, or cigarette smoking were associated with BMI loss between ages 17 and 24.

CONCLUSIONS

Whereas BMI increased on average between age 17 and 24 years in a population-based sample of healthy young people, 12% of participants experienced a loss in BMI ≥1 unit. Weight loss was highest among the heaviest persons and did not affect the prevalence of underweight. No single behavior at age 17 stands out as associated with predicting BMI loss.

Screen time is associated with dietary intake in overweight Canadian children

Objectives

To describe the relationship between screen time and dietary intake among children, and to examine this association in relation to body weight.

Methods

A cross-sectional analysis of 630 Canadian children aged 8–10 years with at least one obese biological parent. Measurements included body mass index (BMI), screen time (television, video game, computer), physical activity (accelerometer over 7 days), and diet (three 24-hour recalls for the calculation of the Canadian Healthy Eating Index (HEI-C)). Multivariate linear regression models were used to describe the relationship between screen time (≥ 2 h/d vs. < 2 h/d) and intake of nutrients and foods among healthy weight and overweight/obese children.

Results

The overall median [interquartile range] daily screen time was 2.2 [2.4] hours and 43% of children had a BMI of ≥ 85th percentile. Longer screen time above the recommendation (≥ 2 h/d) was associated with higher intake of energy (74 kcal, SE = 35), lower intake of fiber (− 0.6 g/1000 kcal, SE = 0.2) and vegetables & fruit (− 0.3 serving/1000 kcal, SE = 0.1) among all participants and with higher estimates in the overweight subgroup. An overall lower HEI-C (− 1.6, SE = 0.8) was also observed among children with screen time of ≥ 2 h/d. Among children of < 85th BMI percentile, longer screen time was associated with lower intake of vegetables & fruit (− 0.3 serving/1000 kcal, SE = 0.1) only.

Conclusion

Screen time is associated with less desirable food choices, particularly in overweight children.

•

We examined cross-sectional association between screen time and dietary intake.

•

Longer screen time (≥ 2 h/d) was associated with poor food choices in youth.

•

Poor dietary quality included higher energy, lower fiber and vegetables & fruit.

•

This association was particularly evident in overweight children.

Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians

OBJECTIVES

To investigate the association of dietary patterns with a 3-year incidence of depression among healthy older adults.

DESIGN

Multiple logistic regression models adjusted for age, sex, marital status, smoking, education, total energy intake, physical activity, body mass index, hypertension, functional autonomy, cognitive functioning, social activities, and stressful life events. Energy and macronutrient intakes were also analyzed as potential predictors of depression.

SETTING

Cities of Montréal, Laval, and Sherbrooke in Quebec, CA.

PARTICIPANTS

Community-dwelling older adults, free of depression at baseline (N=1,358, 67-84 y), followed for 3y in the Québec Longitudinal Study on Nutrition and Aging (NuAge).

MEASUREMENTS

Dietary patterns derived from principal components analysis of three 24 h-recalls at baseline, and depression incidence as measured by the 30-item Geriatric Depression Scale (≥11) and/or use of antidepressants at follow-up years.

RESULTS

170 people (63% women) became depressed over the 3 years. People in the highest tertile of adherence to the "varied diet" had lower risk of depression before adjustment (OR 0.58, 98% C.I. 0.38-0.86) but not significant once age and sex were controlled. No other dietary pattern was associated with the incidence of depression. The highest tertile of energy intake was associated with lower depression incidence after controlling for all confounders (OR 0.55, 95%CI 0.34-0.87).

CONCLUSION

Among healthy older adults, dietary patterns do not appear to be related to depression. Those who eat less, however, possibly reflecting declining health, are at higher risk of becoming depressed.

Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca).

Protein intake protects against weight loss in healthy community-dwelling older adults

Weight loss is prevalent in the elderly population, with deleterious health consequences, notably loss of lean body mass and subsequent functional decline. Protein intake below the current RDA [0.8 g/(kg · d)] is also common in older adults; however, the link between the 2 has received little attention. Our objective was to assess the relation between protein intake and incident 1-y weight loss ≥5% in community-dwelling older adults. We conducted a nested, prospective, case-control study in 1793 community-living elderly participants of the Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge). We studied 211 incident cases of 1-y weight loss (≥5%) and 211 weight-stable controls (±2%) matched by sex and age category (70 ± 2, 75 ± 2, and 80 ± 2 y). Diet was measured by 3 nonconsecutive 24-h recalls. ORs (95% CIs) for the association between protein intake and weight loss were computed by using conditional logistic regression. After adjustment for body mass index, energy intake, appetite, smoking status, physical activity level, physical function, chronic diseases and medications, depressive symptoms, and serum albumin and ultrasensitive C-reactive protein, the ORs of weight loss in participants with low protein intakes [<0.8 g/(kg · d)] were 2.56 (95% CI: 1.01, 6.50) compared with participants with very high protein intakes [≥1.2 g/(kg · d)]. Corresponding numbers were 2.15 (95% CI: 1.02, 4.56) in participants with moderate protein intakes [0.8-<1.0 g/(kg · d)] and 1.33 (95% CI: 0.77, 2.28) in participants with high protein intakes [1.0-1.2 g/(kg · d)]. Our results suggest that protein intakes >1.0 g/(kg · d) are protective against weight loss in healthy older adults. These findings add epidemiologic evidence in support of higher optimal protein intakes than the current guidelines for healthy older adults.

Insulin secretion and its association with physical activity, fitness and screen time in children

OBJECTIVES

To determine the independent associations of moderate to vigorous physical activity (MVPA), fitness, screen time, and adiposity with insulin secretion in children.

DESIGN AND METHODS

Caucasian youth (n = 423/630), 8-10 years old, with at least one obese biological parent, were studied (QUALITY cohort). Insulin secretion was measured using HOMA2-%B, area under the curve (AUC) of insulin to glucose over the first 30 minutes (AUC I/G(t30min)) of the OGTT and AUC I/G(t120min) over 2 hours. Fitness was measured by VO₂peak ; percent fat mass (PFM) by DXA; 7-day MVPA by accelerometry; self-reported screen time included television, video game, or computer use. Models were adjusted for age, sex, season, puberty, PFM, and insulin sensitivity [IS] (HOMA2-IS, Matsuda-ISI).

RESULTS

PFM was strongly associated with insulin secretion, even after adjustment for IS: for every 1% increase in PFM, insulin secretion increased from 0.3% to 0.8% across indices. MVPA was negatively associated with HOMA2-%B (P < 0.05), but not with OGTT-derived measures. Fitness was negatively associated with AUC I/G(t120min) (P < 0.05). Screen time showed a trend toward higher HOMA2-%B in girls (P = 0.060).

CONCLUSIONS

In children with an obese parent, lower insulin secretion is associated with lower adiposity, higher MVPA, better fitness, and possibly reduced screen time.

The association between food patterns and adiposity among Canadian children at risk of overweight

Identifying food patterns related to obesity can provide information for health promotion in nutrition. Food patterns and their relation with obesity among Canadian children have not been reported to date. Our aim was to identify and describe food patterns associated with obesity in children at risk of overweight. Caucasian children (n = 630) with at least 1 obese biological parent recruited into the Quebec Adiposity and Lifestyle Investigation in Youth (QUALITY) cohort were studied in cross-sectional analyses. Measures of adiposity (body mass index (BMI), waist circumference, body fat mass percentage measured by dual-energy X-ray absorptiometry), screen time, physical activity (accelerometer over 7 days), and dietary intake (three 24-h food recalls) were collected. Factor analysis was used to identify food patterns. The relationships between food patterns and overweight were investigated in logistic and multiple linear regression models. Three food patterns were retained for analysis: traditional food (red meats, main dishes–soups, high-fat dairy products, tomato products, dressings, etc.); healthy food (low-fat dairy products, whole grains, legumes–nuts–seeds, fruits, vegetables); and fast food (sugar-sweetened beverages, fried potatoes, fried chicken, hamburgers–hot dogs–pizza, salty snacks). Higher scores on the fast food pattern were associated with overweight (BMI ≥ 85th percentile), and other measures of adiposity (BMI, waist circumference, body fat mass percentage) after adjustment for age, sex, physical activity, screen time, sleep time, family income, and mother’s obesity (p < 0.05). Controlling for energy intake did not change these relationships. Our results provide further evidence of a link between fast food intake and obesity in children.

Consumption of added sugars from liquid but not solid sources predicts impaired glucose homeostasis and insulin resistance among youth at risk of obesity

Little is known about longitudinal associations between added sugar consumption (solid and liquid sources) and glucose-insulin homeostasis among youth. Caucasian children (8-10 y) with at least one obese biological parent were recruited in the QUébec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort (n = 630) and followed-up 2 y later (n = 564). Added sugars were assessed by 3 24-h dietary recalls at baseline. Two-year changes were examined in multivariate linear regression models, adjusting for baseline level, age, sex, Tanner stage, energy intake, fat mass (dual-energy X-ray absorptiometry), and physical activity (7 d accelerometer). Added sugar intake in either liquid or solid sources was not related to changes in adiposity measures (fat mass, body mass index, or waist circumference). However, a higher consumption (10 g/d) of added sugars from liquid sources was associated with 0.04 mmol/L higher fasting glucose, 2.3 pmol/L higher fasting insulin, 0.1 unit higher homeostasis model assessment of insulin resistance (HOMA-IR), and 0.4 unit lower Matsuda-insulin sensitivity index (Matsuda-ISI) in all participants (P < 0.01). No associations were observed with consumption of added sugars from solid sources. Overweight/obese children at baseline had greater increases in adiposity indicators, fasting insulin, and HOMA-IR and decreases in Matsuda-ISI during those 2 y than normal-weight children. Consumption of added sugars from liquid or solid sources was not associated with changes in adiposity, but liquid added sugars were a risk factor for the development of impaired glucose homeostasis and insulin resistance over 2 y among youth at risk of obesity.

Do implant overdentures improve dietary intake? A randomized clinical trial

People wearing mandibular two-implant overdentures (IOD) chew food with less difficulty than those wearing conventional complete dentures (CD). However, there is still controversy over whether or not this results in better dietary intake. In this randomized clinical trials (RCT), the amounts of total dietary fiber (TDF), macronutrients, 9 micronutrients, and energy in diets consumed by persons with IOD and CD were compared. Male and female edentate patients ≥ 65 yrs (n = 255) were randomly divided into 2 groups and assigned to receive a maxillary CD and either a mandibular IOD or a CD. One year following prosthesis delivery, 217 participants (CD = 114, IOD = 103) reported the food and quantities they consumed to a registered dietician through a standard 24-hour dietary recall method. The mean and median values of TDF, macro- and micronutrients, and energy consumed by both groups were calculated and compared analytically. No significant between-group differences were found (ps > .05). Despite quality-of-life benefits from IODs, this adequately powered study reveals no evidence of nutritional advantages for independently living medically healthy edentate elders wearing two-implant mandibular overdentures over those wearing conventional complete dentures in their dietary intake at one year following prosthesis delivery.

Adiposity and glucose intolerance exacerbate components of metabolic syndrome in children consuming sugar-sweetened beverages: QUALITY cohort study

BACKGROUND

Sugar-sweetened beverage (SSB) consumption is linked to weight gain and metabolic syndrome (MetS) components in children, but whether these associations are modified by excess weight and glucose tolerance status in children is not known.

OBJECTIVE

The objective of this study was to examine the cross-sectional associations between SSB intake and MetS components among children above and below the 85th body mass index (BMI) percentile and those with and without impaired glucose tolerance (IGT).

METHODS

Data were from the QUébec Adiposity and Lifestyle InvesTigation in Youth study (2005-2008). Caucasian children aged 8-10 years (n = 632) were recruited from 1040 primary schools in Québec, Canada. SSB consumption was assessed by three 24-h dietary recalls, body fat mass by dual-energy absorptiometry, physical activity by 7-d accelerometer. Multivariate linear regressions were used, with age, sex, fat mass index and physical activity as covariates, including waist circumference (WC), systolic blood pressure (SBP), concentrations of triglyceride and high-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance (HOMA-IR) as outcome variables.

RESULTS

Among overweight children, a 100-mL higher SSB consumption was associated with a 0.1-unit higher HOMA-IR (P = 0.009) and a 1.1-mm Hg higher SBP (P = 0.001). In children with IGT, a 100-mL higher SSB consumption was associated with a 1.4-mm Hg higher SBP and a 4.0-cm higher WC (P < 0.001). These associations were not observed among children <85th BMI percentile.

CONCLUSIONS

Our results suggest that the association between higher SSB consumption and MetS components is more evident in overweight/obese and glucose-intolerant children.

Baseline determinants of global diet quality in older men and women from the NuAge cohort

Judicious food choices are of prime importance during aging.

OBJECTIVES

This study was conducted to identify individual and collective attributes determining global diet quality (DQ).

METHODOLOGY

Participants were 1,793 adults (52% women) from the NuAge study on nutrition and successful aging. Subjects aged 67 to 84 years in relatively good health were recruited from the Québec Medicare Database. Sociodemographic, affective, and cognitive data, health conditions, perceived physical health and functional status, dietary habits and dietary attributes and community resources were obtained using questionnaires. Body weight and height were measured and body mass index (BMI) was calculated. Three non-consecutive 24-hour diet recalls were collected at recruitment. DQ, assessed using the Canadian Healthy Eating Index (C-HEI, /100), was computed on the mean intakes from the diet recalls. Analyses were stratified by gender. Variables significantly related to DQ in bivariate analyses (p<.05) were entered into backward stepwise multiple regression analyses.

RESULTS

Among men, the final model showed higher education (β=0.23, p=.01), diet knowledge (β=0.96, p<.0001), number of daily meals (β=1.91, p=.02) and perceived physical health (β=0.06, p=.01) to be positive determinants of DQ, whereas alcohol consumption (β=-2.25, p=.05), wearing dentures (β=-2.31, p=.01) and eating regularly in restaurants (β=-1.65, p=.03) were negative determinants of DQ (adjusted R2 = 13.7%). Among women, higher education (β=0.29, p=.002), diet knowledge (β=0.54, p=.002), number of daily meals (β=3.61, p<.0001), and hunger (β=0.61, p<.0001) were positive determinants of global DQ; greater BMI (β=-0.16, p=.03) and chewing problems (β=-0.48, p=.03) were negative determinants of DQ (adjusted R2 = 7.8%).

DISCUSSION

These results point to several key factors influencing global DQ in older adults and also show gender-based differences. More research must be done to better understand how these factors change with aging and exert their impact on diet, particularly since variance in DQ was largely unexplained. As diet knowledge was an independent predictor for both genders, targeted, sustainable interventions are needed to ensure good diet quality as people age.

Associations between children's diets and features of their residential and school neighbourhood food environments

OBJECTIVES

Among studies of the built environment, few examine neighbourhood food environments in relation to children's diets. We examined the associations of residential and school neighbourhood access to different types of food establishments with children's diets.

METHODS

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity, were analyzed (n=512). Three 24-hour diet recalls were used to assess dietary intake of vegetables and fruit, and sugar-sweetened beverages. Questionnaires were used to determine the frequency of eating/snacking out and consumption of delivered/take-out foods. We characterized residential and school neighbourhood food environments by means of a Geographic Information System. Variables included distance to the nearest supermarket, fast-food restaurant and convenience store, and densities of each food establishment type computed for 1 km network buffers around each child's residence and school. Retail Food Environment indices were also computed. Multivariable logistic regressions (residential access) and generalized estimating equations (school access) were used for analysis.

RESULTS

Residential and school neighbourhood access to supermarkets was not associated with children's diets. Residing in neighbourhoods with lower access to fast-food restaurants and convenience stores was associated with a lower likelihood of eating and snacking out. Children attending schools in neighbourhoods with a higher number of unhealthful relative to healthful food establishments scored most poorly on dietary outcomes.

CONCLUSIONS

Further investigations are needed to inform policies aimed at shaping neighbourhood-level food purchasing opportunities, particularly for access to fast-food restaurants and convenience stores.

Associations between children's diets and features of their residential and school neighbourhood food environments

OBJECTIVES

Among studies of the built environment, few examine neighbourhood food environments in relation to children's diets. We examined the associations of residential and school neighbourhood access to different types of food establishments with children's diets.

METHODS

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity, were analyzed (n=512). Three 24-hour diet recalls were used to assess dietary intake of vegetables and fruit, and sugar-sweetened beverages. Questionnaires were used to determine the frequency of eating/snacking out and consumption of delivered/take-out foods. We characterized residential and school neighbourhood food environments by means of a Geographic Information System. Variables included distance to the nearest supermarket, fast-food restaurant and convenience store, and densities of each food establishment type computed for 1 km network buffers around each child's residence and school. Retail Food Environment indices were also computed. Multivariable logistic regressions (residential access) and generalized estimating equations (school access) were used for analysis.

RESULTS

Residential and school neighbourhood access to supermarkets was not associated with children's diets. Residing in neighbourhoods with lower access to fast-food restaurants and convenience stores was associated with a lower likelihood of eating and snacking out. Children attending schools in neighbourhoods with a higher number of unhealthful relative to healthful food establishments scored most poorly on dietary outcomes.

CONCLUSIONS

Further investigations are needed to inform policies aimed at shaping neighbourhood-level food purchasing opportunities, particularly for access to fast-food restaurants and convenience stores.

How are physical activity, fitness, and sedentary behavior associated with insulin sensitivity in children?

OBJECTIVE

To describe the associations among moderate-to-vigorous physical activity (MVPA), fitness, sedentary behavior (SB), and insulin sensitivity (IS).

RESEARCH DESIGN AND METHODS

Data were drawn from the baseline assessment of the QUALITY cohort, which included 630 white youth (aged 8-10 years at recruitment), with at least one obese biological parent. IS was measured by two fasting indices (insulin, homeostasis model assessment of insulin resistance) and an oral glucose tolerance test (OGTT)-based index (Matsuda IS index [Matsuda-ISI]). Fitness was measured by Vo(2peak); percent fat mass (PFM) was measured by dual-energy X-ray absorptiometry; 7-day MVPA was measured with accelerometry. SB indicators included average hours daily of self-report screen time (SBst), and average minutes daily at <100 counts/min from accelerometry (SBacc). Multivariable linear regression models were adjusted for age, sex, season, and puberty.

RESULTS

MVPA and SBacc were independently associated with IS, but this was no longer statistically significant after accounting for PFM. SBst was negatively associated with IS in girls only, even after controlling for physical activity (PA), fitness, and adiposity; for each additional hour of SBst daily, IS decreased by 4.6-5.6% across all IS indices. Fitness was positively associated with IS (measured by Matsuda-ISI) after accounting for PA, SB, and PFM; for every 1 unit increase in Vo(2peak), Matsuda-ISI increased by approximately 1.0% (P < 0.05).

CONCLUSIONS

In children with an obese parent, PA and SBacc are associated with IS, but this association is mediated by adiposity. SBst is negatively associated with IS in girls, beyond its known impact on adiposity. Finally, fitness is independently associated with better IS measured by OGTT.

Implant overdentures and nutrition: a randomized controlled trial

We conducted a randomized clinical trial to determine whether providing simple mandibular implant overdentures (IODs) to elderly individuals would give them a significantly better nutritional profile than those who receive complete dentures (CDs). Two hundred fifty-five edentate patients > 65 yrs were randomly assigned to receive maxillary CDs and mandibular IODs (n = 128) or CDs (n = 127). Six-month and one-year post-treatment outcomes were blood plasma levels of homocysteine (tHcy), vitamin B12, vitamin B6, albumin, serum folate, and C-reactive protein concentrations, as well as dietary intake. The association between treatment and tHcy levels was not statistically significant. A decline of folate from baseline values in both study groups, as well as those of vitamins B6 and B12 and albumin, was observed. Significant between-group differences were detected in food preparation and in the individuals' ability to chew a variety of foods. This study suggests that implant overdentures do not have a more positive effect on the nutritional state of elderly edentate individuals at 6 and 12 mos post-treatment than new complete dentures. However, those wearing IODs are significantly more likely to take in their nutrients through fresh, whole fruits and vegetables.

Trajectories of physical function decline and psychological functioning: the Quebec longitudinal study on nutrition and successful aging (NuAge)

BACKGROUND

Decline of physical function with age is associated with substantial health consequences. Physical and psychological functioning is linked, but the temporal nature of this association remains unclear.

METHODS

Three-year follow-up data from men and women (n = 1,741), aged 68-82 years, in the longitudinal study on nutrition and successful aging (NuAge; Québec, Canada) were used. Growth curve modeling was performed to examine trajectories of a global physical performance score across time as conditioned by cognition and depression.

RESULTS

Significant decline in physical function was observed (p < .0001). Rate of decline in physical performance score was accelerated in the older participants (>77 years; age(2): p < .01) but not affected by slight decline in cognition or depression. Yet, people with lower cognition level and more depressive symptoms show lower physical capacity throughout the entire follow-up period (p < .0001).

CONCLUSIONS

Physical function significantly declined over 3 years, in particular in the oldest group. A subtle decline in psychological health paralleled decline in physical function but did not accelerate it.

Low physical function predicts either 2-year weight loss or weight gain in healthy community-dwelling older adults. the NuAge Longitudinal Study

OBJECTIVES

Weight change in older adults affects physical function (PF). However, data suggest that, conversely, PF may be a determinant of weight change. Our objective was to assess the role of baseline PF as a predictor of 2-year weight loss (WL) and weight gain (WG) ≥ 5% among healthy well-functioning community-dwelling older adults.

METHODS

The NuAge cohort (67-84 years) was classified into three groups according to the percent weight change over a 2-year follow-up: weight stable (weight change ≤ 2%; n = 629), WL ≥ 5% (n = 189), and WG ≥ 5% (n = 111). A summary measure of baseline PF was computed (sum of biceps, quadriceps, and grip strength, timed up and go, chair stand, normal and maximal gait speed, and balance performance scores [individual test score range = 0-4]; PF score range = 0-32). Multivariable logistic regression models separately assessed the relationships between baseline PF and 2-year WL and WG ≥ 5%.

RESULTS

Baseline PF was worse in both the WL (p < .001) and the WG (p = .001) groups compared with the weight stable group. In models adjusting for sex, age, body mass index, energy intake, depressive symptoms, and other significantly associated covariates, each 1-unit increase in standard deviation of PF was associated with decreased risk of either 2-year WL (odds ratio = 0.79, 95% CI = 0.63-0.99, p = .043) or WG (odds ratio = 0.74, 95% CI = 0.55-0.99, p = .041).

CONCLUSIONS

Low baseline PF was an independent common predictor of 2-year WL and WG ≥ 5% in the healthy well-functioning community-dwelling elderly population. Whether PF is an early cause or marker of weight change in this population remains to be determined.

Community-based participatory research: lessons from sharing results with the community: Kahnawake Schools Diabetes Prevention Project

BACKGROUND

Kahnawake Schools Diabetes Prevention Project (KSDPP) is an ongoing, community-based participatory research project with an Aboriginal community in Canada, promoting healthy lifestyles to prevent type 2 diabetes.

OBJECTIVES

To document lessons learned from sharing results with the community, and analyzing feedback from attendees.

METHODS

In 2004, a researcher-community team delivered 16 sessions of a contextualized presentation of data collected from 1994 to 2002. The team documented the resulting questions and discussions, attendees completed anonymous questionnaires including open-ended questions, and presenters summarized their impressions.

RESULTS

One hundred eighty-one people attended the presentations and question/discussion periods were summarized. One hundred sixty-two (82%) of attendees (87% female), completed the questionnaires; 99% understood the presentations and 142 (88%) stated they intended to improve their lifestyles. Qualitative analysis of discussions and open-ended comments categorized attendees' comments about KSDPP, the 1994 through 2002 results, the community, and lifestyle habits. Lessons learned included the time needed to develop and make the presentations, the importance of using community knowledge to guide the experience, ways of attracting an audience, difficulty of reaching men, use of feedback from those attending the presentations, and the need to plan prospectively for analyzing attendee feedback.

CONCLUSIONS

Community feedback was used to improve interventions and finalize interpretation of the results.

Vitamin D status is modestly associated with glycemia and indicators of lipid metabolism in French-Canadian children and adolescents

In addition to its recognized role in bone health, recent studies point to vitamin D functions in other tissues, including the pancreas. We tested the association between the vitamin D status and glucose and lipid homeostasis in a school-based, cross-sectional survey of a representative sample of youth. We measured fasting plasma insulin, glucose, total cholesterol (TC), triglycerides (TG), HDL cholesterol (HDL-C) apolipoproteins (apo) A1 and B, and 25-hydroxyvitamin D [25(OH)D] concentrations in 878 boys and 867 girls. The 25(OH)D concentrations (mean +/- SD) were 45.9 +/- 12.2 nmol/L in boys and 45.9 +/- 13.0 nmol/L in girls. More than 93% of youth had suboptimal (<75 nmol/L) vitamin D concentrations. There was a slightly lower glycemia, -0.5% (P = 0.015) and -0.4% (P = 0.025), and homeostasis model assessment of insulin resistance, -2.8% (P = 0.043) and -2.3% (P = 0.050), for each 10-nmol/L increase in plasma 25(OH)D in boys and girls, respectively. In contrast, in girls only there were modest increases in plasma TC (1.1%; P = 0.017), TG (2.9%; P = 0.004), apoA1 (1.2%; P < 0.001), and apoB (1.5%; P = 0.023). We observed no association between the presence of at least 2 cardiometabolic risk factors (borderline/unfavorable fasting concentrations of apoB, HDL-C, TG, insulin, and glucose) and 25(OH)D concentrations in either boys or girls. Although the observed associations between 25(OH)D concentrations and fasting glucose, and variables of lipid metabolism are modest, they may have a potential long-term impact on cardiovascular risk.

Vitamin D supplement consumption is required to achieve a minimal target 25-hydroxyvitamin D concentration of > or = 75 nmol/L in older people

Population level data on how older individuals living at high latitudes achieve optimal vitamin D status are not fully explored. Our objective was to examine the intake of vitamin D among healthy older individuals with 25-hydroxyvitamin D [25(OH)D] concentrations > or =75 nmol/L and to describe current sources of dietary vitamin D. We conducted a population-based, cross-sectional study of 404 healthy men and women aged 69 to 83 y randomly selected from the NuAge longitudinal study in Québec, Canada. Dietary intakes were assessed by 6 24-h recalls. We examined the contribution of foods and vitamin/mineral supplements to vitamin D intake. Serum 25(OH)D was assessed by RIA. We assessed smoking status, season of 25(OH)D measurement, physical activity, and anthropometric and sociodemographic variables. Vitamin D status was distributed as follows: 7% (<37.5 nmol/L), 48% (37.5-74.9 nmol/L), and 45% (> or = 75 nmol/L). Vitamin D intake from supplements varied across the 3 vitamin D status groups: 0.5, 4.1, and 8.9 microg/d, respectively (P < 0.0001). Adding food sources, these total intakes were 4.6, 8.7, and 14.1 microg/d, respectively. In multivariate analysis, vitamin D from foods and supplements and by season was associated with vitamin D status. These healthy, community-dwelling older men and women with 25(OH)D concentrations >75 nmol/L had mean intakes of 14.1 microg/d from food and supplements. Supplement use is an important contributor to achieve a minimal target of 25(OH)D concentration > or = 75 nmol/L.

Does the "healthy immigrant effect" extend to smoking in immigrant children?

The "healthy immigrant effect" may apply to lifestyle-related behaviors in immigrant children. In a cross-sectional study of 1,959 children aged 9-12 years, the number of years lived in Canada was related to an increased risk of smoking among immigrant children. Interventions may be needed for immigrant children to prevent the adoption of unhealthy behaviors prevalent in their new host environments.

When adolescents drop the ball: sustainability of physical activity in youth

BACKGROUND

A majority of youth do not attain the recommended levels of physical activity. To develop interventions that will be more efficient at enabling healthy levels of physical activity during adolescence, a better understanding is needed about which specific types of physical activity adolescents are more likely to sustain and when they tend to stop participating in each specific type of activity.

METHODS

From 1999 to 2005, 1276 adolescents, initially aged 12-13 years, completed a 7-day physical activity recall every 3 months during each of 5 years of secondary school. The prevalence of participation in each of 29 specific physical activities in each of Grades 7-11 was computed. Survival analyses were used to estimate when adolescents who reported each activity at baseline tended to discontinue the activity. All analyses were conducted in 2008.

RESULTS

The prevalence of participation in most activities declined over the 5 years; it did not increase for any activity. Within 2 years of baseline, the majority of adolescents discontinued participation in most activities in which they had reported participation at baseline. Sustained participation in a specific activity related both to its intensity (90%, 73%, and 40% of girls and 77%, 86%, and 60% of boys sustained participation in light-, moderate-, and vigorous-intensity activities, respectively) and its format (41% and 89% of girls and 69% and 90% of boys sustained participation in team and individual physical activities, respectively).

CONCLUSIONS

Participation in almost all physical activities declined during adolescence. The time of discontinuation varied across activity types. Promoting activities that attract and sustain secondary school students may improve physical activity levels throughout adolescence.

Calcium and vitamin D intakes in an adult Canadian population

PURPOSE

Calcium and vitamin D intakes from food and supplements were estimated in Canadian men and women.

METHODS

Calcium intakes from both diet and supplements and vitamin D intakes from fortified milk and supplements were estimated using cross-sectional data from 9423 randomly selected subjects aged 25 years or older, who were participating in a longitudinal study on osteoporosis. Subjects completed an abbreviated food frequency questionnaire administered by a trained interviewer between July 1995 and December 1997.

RESULTS

The mean (standard deviation) daily intake for calcium was estimated to be 1038 (614) mg for women and 904 (583) mg for men; for vitamin D, mean intakes were 5.6 (5.9) microg and 4.8 (5.5) microg for women and men, respectively.

CONCLUSIONS

Mean intakes for calcium and vitamin D in men and women under age 51 were close to the adequate daily intake levels. Older adults, however, may be at risk of deficiency.

Participation in organised sports does not slow declines in physical activity during adolescence

Background

Among youth, participation in extracurricular physical activities at school and organised physical activities in the community is associated with higher physical activity levels. The objective was to determine if participation in organised physical activities during early adolescence protects against declines in physical activity levels during adolescence.

Methods

Every 3 months for 5 years, students initially in grade 7 (aged 12–13 years) completed a 7-day physical activity recall and provided data on the number and type of (extracurricular) physical activities organised at school and in the community in which they took part. To study rates of decline in physical activity, only adolescents who reported an average of ≥5 moderate-vigorous physical activity sessions per week in grade 7 (n = 1028) were retained for analyses. They were categorised as to whether or not they were involved in organised physical activities in grade 7. We used generalized estimating equation Poisson regression to compare the rate of decline in number of moderate-vigorous physical activity sessions per week during adolescence between initially physically active students who participated in organised physical activity in grade 7 and those who did not.

Results

In grade 7, about 87% of physically active adolescents reported taking part in at least one organised physical activity. Compared to active adolescents not involved in organised physical activities, baseline involvement in physical activity was 42% (95% CI 26–59%) higher among those involved in organised physical activity (mean number of moderate-vigorous physical activity sessions per week = 14.6 ± 13.1 vs 10.4 ± 9.0). Physical activity declined by 8% per year in both groups. Results were similar in analyses that examined the effect of school or community-based physical activities separately.

Conclusion

Although participation in organised physical activities during early adolescence is associated with more physical activity throughout secondary school, participation in such activities does not protect against declines in physical activity over time.

Researching the impact of oral health on diet and nutritional status: methodological issues

OBJECTIVES

Assessment of the impact of dental function on diet and nutritional status requires robust methodologies and a standardised approach to increase accuracy of results and to facilitate cross study comparisons. The objectives of this paper are: to report the outcomes of a consensus workshop that critically reviewed publications reporting on dietary methodologies in relation to the impact of oral health on nutrition; to highlight future directions for research and; to make recommendations for appropriate use of methodologies for future research.

DATA

Data relevant to nutrition and dental status published from 1980 to 2005 in English were presented at the consensus workshop for discussion and appraisal.

SOURCES

Relevant papers were retrieved through PubMed. Relevant texts were obtained from the library at Newcastle University, UK.

STUDY SELECTION

A purposive sample of original articles that illustrated the application of a range of nutritional methodologies to the study of oral health impacts was identified. Original flagship texts on nutritional methodologies were reviewed.

CONCLUSIONS

Numerous studies have shown an association between loss of teeth and inferior diet. Further research is required to elucidate the impact of novel approaches to prosthetic rehabilitation and the impact of contemporaneous dietary and dental intervention on diet, nutritional status, disease progression and quality of life. The recommendation of the consensus workshop was that future studies should adopt a comprehensive approach to the assessment of nutrition that encompasses measurement of diet, body composition, biochemical indices of intake and levels of nutrients, and functional biomarkers of disease.

The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status

OBJECTIVES

To estimate the prevalence of malnutrition in frail elders undergoing rehabilitation and the association between their nutritional status and physical function.

DESIGN

Observational study of new participants undergoing ambulatory rehabilitation.

SETTING

Two Geriatric Day Hospitals (GDH) in Montreal, Quebec.

PARTICIPANTS

121 women and 61 men.

INTERVENTION

Evaluation of nutritional status, body composition and physical function.

MEASUREMENTS

The nutritional status was assessed with a composite index based on anthropometric measurements and serum albumin, as well as using the Mini Nutritional Assessment (MNA) questionnaire. Patients were classified as well-nourished, having mild/at risk of malnutrition or malnourished. Body composition was estimated by bioimpedance and handgrip strength and gait speed by standard methods.

RESULTS

13% of patients were found to be mildly malnourished, whereas 6% were malnourished. Malnourished patients were older and had worse cognition, lower BMI, and % body fat (all p<0.05). Malnourished patients and those with mild malnutrition had lower weight, triceps skinfold thickness, muscle and fat mass (all, p<0.003). Handgrip strength was different according to the nutritional status (p=0.034) and correlated with muscle mass (r=0.65, p<0.001). MNA classified 53% of patients as being at risk whereas 3% were malnourished and it correlated with gait speed (r=0.26, p=0.001).

CONCLUSION

There is a high prevalence of patients in GDH at risk or with mild malnutrition. Being malnourished was associated with worse physical performance, which suggests that a nutritional intervention may be of benefit in improving their physical function.