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Background: Higher maternal preconception body mass index (BMI) is associated with lower breastfeeding duration, which may contribute to the development of poor child eating behaviours and dietary intake patterns (components of nutritional risk). A higher maternal preconception BMI has been found to be associated with higher child nutritional risk. This study aimed to determine whether breastfeeding duration mediated the association between maternal preconception BMI and child nutritional risk. Methods: In this longitudinal cohort study, children ages 18 months to 5 years were recruited from The Applied Research Group for Kids (TARGet Kids!) in Canada. The primary outcome was child nutritional risk, using The NutriSTEP®, a validated, parent-reported questionnaire. Statistical mediation analysis was performed to assess whether total duration of any breastfeeding mediated the association between maternal preconception BMI and child nutritional risk. Results: This study included 4733 children with 8611 NutriSTEP® observations. The mean (SD) maternal preconception BMI was 23.6 (4.4) and the mean (SD) breastfeeding duration was 12.4 (8.0) months. Each 1-unit higher maternal preconception BMI was associated with a 0.081 unit higher nutritional risk (95% CI (0.051, 0.112); p < 0.001) (total effect), where 0.011(95% CI (0.006, 0.016); p < 0.001) of that total effect or 13.18% (95% CI: 7.13, 21.25) was mediated through breastfeeding duration. Conclusion: Total breastfeeding duration showed to mediate part of the association between maternal preconception BMI and child nutritional risk. Interventions to support breastfeeding in those with higher maternal preconception BMI should be evaluated for their potential effect in reducing nutritional risk in young children. [ABSTRACT FROM AUTHOR]

Background: Children with underweight in the first 2 years have lower body mass index z‐score (zBMI) and height‐for‐age z‐score (HAZ) in later childhood. It is not known if underweight in the first 2 years is associated with nutrition risk in later childhood. Objective: (1) Determine the relationship between underweight (zBMI < −2) in the first 2 years and nutrition risk measured by the Nutrition Screening for Toddlers and Preschoolers (NutriSTEP) score from 18 months to 5 years. (2) Explore the relationship between underweight in the first 2 years and the NutriSTEP subscores for eating behaviours and dietary intake from 18 months to 5 years. Methods: This was a prospective study, including healthy full‐term children in Canada aged 0–5 years. zBMI was calculated using measured heights and weights and the WHO growth standards. NutriSTEP score was measured using a parent‐completed survey and ranged from 0 to 68. Nutrition risk was defined as a score ≥21. Linear mixed effects models were used. Results: Four thousand nine hundred twenty‐nine children were included in this study. At enrolment, 51.9% of participants were male. The prevalence of underweight children was 8.8%. Underweight in the first 2 years was associated with higher NutriSTEP (0.79, 95% CI: 0.29,1.29), higher eating behaviour subscore (0.24, 95% CI: 0.03, 0.46) at 3 years and higher odds of nutrition risk (OR: 1.39, 95% CI: 1.07,1.82) at 5 years. Conclusions: Children with underweight in the first 2 years had higher nutrition risk in later childhood. Further research is needed to understand the factors which influence these relationships. Key points: In this prospective cohort study of 4929 children aged 0–5 years, children with underweight in the first 2 years of life had higher odds of nutrition risk at 5 years of age compared to children without underweight in the first 2 years (p = 0.02). Further research is needed to understand the factors which influence these relationships. [ABSTRACT FROM AUTHOR]

Medication-induced diabetes (MID) is common during induction therapy for pediatric acute lymphoblastic leukemia (ALL) and has potentially significant negative consequences. Reported risk factors for MID are variable with limited data comparing patients treated with standard-risk (SR) vs. high-risk (HR) regimens. This study aims to evaluate the incidence and risk factors for MID during induction in patients with ALL from the Maritimes over a 20-year period. We performed a retrospective single-center study of 262 patients (142 males, 120 females) diagnosed with ALL at IWK Health in Halifax, Nova Scotia, Canada, from 2000 to 2019. Older age, higher body mass index, greater central nervous system status, Trisomy 21, and prednisone steroid type were risk factors associated with MID in our cohort. HR patients developed significantly more complications than SR patients including MID and infection. Screening for MID should be routine during ALL induction treatment, particularly in those with HR disease. [ABSTRACT FROM AUTHOR]

Background: Understanding which children are at highest risk for high blood pressure (HBP) can inform surveillance and treatment. This study evaluated sex differences in childhood HBP and its associations with socioeconomic status. Methods: This retrospective cross-sectional study assessed 74,233 children with data from a national primary care electronic medical record database. Differences between sex and material and social deprivation scores for children with and without HBP were examined. Covariates included age, BMI z-score, diabetes, hyperlipidemia, and depression. HBP was defined as > 90th percentile for < 13-year-olds, and ≥ 120/80 for age ≥ 13 years on 2 separate occasions between 2010 and 2017. Results: The prevalence of HBP was 10.2% in males and 7.6% in females (p < 0.0001). Children with HBP had higher BMI z-scores (0.66 vs. 0.18, p < 0.0001), and higher rates of diabetes (1.31 vs. 0.54%, p < 0.0001), depression (9.89 vs. 7.11%, p < 0.0001), and hyperlipidemia (2.82 vs. 0.86%, p < 0.0001). In univariate regression analyses, boys in the most materially deprived quintile had increased odds of HBP (OR 1.24 (95% CI 1.08–1.43)), whereas females did not (OR 1.11 (95% CI 0.95–1.29)). In multivariate regression, male sex was associated with HBP with adjusted OR of 1.39 (95% CI 1.24–1.55). After statistical adjustment, material deprivation was no longer significant (aOR 1.05, 95% CI 0.94–1.17). Conclusions: Male sex is associated with HBP in Canadian children. This study also suggests a possible association between material deprivation and HBP, particularly in boys. Further study is required to better understand this relationship. [ABSTRACT FROM AUTHOR]

Background Obesity is a global public health concern. Given the widespread disruption caused by the SARS-CoV-2 pandemic, it is important to evaluate its impact on children with chronic health conditions. This study examines the health of paediatric patients with obesity enrolled in a tertiary hospital weight management program, before and 1 year into the COVID-19 pandemic. Methods This is a retrospective chart review of patients aged 2 to 17 years enrolled in a paediatric weight management clinic. Mental health outcomes (i.e. new referrals to psychologist, social work, eating disorder program, incidence of dysregulated eating, suicidal ideation, and/or self-harm) and physical health (anthropometric measures) were compared before and 1 year into the pandemic. Results Among the 334 children seen in either period, there was an increase in referrals to psychologist (12.4% versus 26.5%; P=0.002) and the composite mental health outcome (17.2% versus 30.2%; P=0.005) during the pandemic compared with pre-pandemic. In a subset of children (n=30) with anthropometric measures in both periods, there was a lower rate of decline in BMIz score (–1.5 [2.00] versus –0.3 [0.73]/year; P=0.002) and an increase in adiposity (–0.8 [4.64] versus 2.7 [5.54]%/year; P=0.043) during the pandemic. Discussion The pandemic has impacted the mental and physical health of children with obesity engaged in a weight management clinic. While our study provides evidence of a negative impact on mental health outcomes and less improvement in anthropometric measures, future research when patients return to in-person care will enable further examination of our findings with additional objective measures. [ABSTRACT FROM AUTHOR]

Young children's activity and sedentary time were simultaneously measured via the Actical method (i.e., Actical accelerometer and specific cut-points) and the ActiGraph method (i.e., ActiGraph accelerometer and specific cut-points) at both 15-s and 60-s epochs to explore possible differences between these 2 measurement approaches. For 7 consecutive days, participants (n = 23) wore both the Actical and ActiGraph side-by-side on an elastic neoprene belt. Device-specific cut-points were applied. Paired sample t tests were conducted to determine the differences in participants' daily average activity levels and sedentary time (min/h) measured by the 2 devices at 15-s and 60-s time sampling intervals. Bland-Altman plots were used to examine agreement between Aetieal and ActiGraph accelerometers. Regardless of epoch length, Actical accelerometers reported significantly higher rates of sedentary time (15 s: 42.7 min/h vs 33.5 min/h; 60 s: 39.4 min/h vs 27.1 min/h). ActiGraph accelerometers captured significantly higher rates of moderate-to-vigorous physical activity (15 s: 9.2 min/h vs 2.6 min/h; 60 s: 8.0 min/h vs 1.27 min/h) and total physical activity (15 s: 31.7 min/h vs 22.3 min/h; 60 s: = 39.4 min/h vs 25.2 min/h) in comparison with Actical accelerometers. These results highlight the present accelerometry-related issues with interpretation of datasets derived from different monitors. [ABSTRACT FROM AUTHOR]

In this study, we examined the psychometric properties of a French version of the Perceived Motor Competence in Childhood (PMC-C) questionnaire. The participants were 219 French-speaking children (aged 5-12 years), recruited from elementary schools in the Canadian Province of Quebec. Results supported the validity and reliability of a second-order confirmatory factor analytic (CFA) model, including one higher-order factor. Additional analyses supported the complete measurement invariance of the first- and second-order factor structure across sex and indicated no differential item functioning or latent mean differences in PMC-C factors as a function of selected predictors (i.e., age, body mass-index and physical activity/sport involvement). Thus, this French version of the PMC-C has satisfactory psychometric properties (i.e., factor validity and reliability, measurement invariance and differential item functioning) and can be used to assess French-speaking children's perceived motor competence. [ABSTRACT FROM AUTHOR]

Objective: Weight loss attempts occur as early as childhood. The impacts of weight loss attempts and weight‐related stress on the occurrence of obesity during childhood remain unknown. We aimed to: (a) assess the prevalence of self‐reported weight loss attempts and weight‐related stress in 8–10 year‐old children and (b) determine associations with adiposity 2 years later. Method: Data were collected from a cohort study of 564 Canadian children aged 8–10 years, having one or both biological parents with obesity (Quebec Adipose and Lifestyle Investigation in Youth cohort). Self‐reported weight loss attempts and weight‐related stress were assessed at baseline in the child's questionnaire. Adiposity was measured at baseline and 2 years later using body mass index z‐scores (zBMI), waist‐to‐height ratio (WHtR), and percentage of body fat (%BF) obtained from dual‐energy x‐ray absorptiometry. Linear and logistic regression analyses were used while adjusting for potential confounders. Results: Forty‐eight percent of children reported previous weight loss attempts and 20% reported weight‐related stress. Self‐reported weight loss attempts and weight‐related stress were associated with higher zBMI, WHtR, and %BF 2 years later in adjusted models, although estimates were attenuated when including baseline adiposity measures. Self‐reported weight loss attempts, but not weight‐related stress, increased the risk of becoming overweight among children who were normal weight at baseline. Discussion: Weight loss attempts are prevalent in children with parental obesity. Children reporting weight loss attempts and weight‐related stress tend to have higher adiposity 2 years later and are more likely to become overweight. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the prevalence of child and adolescent females at risk for Avoidant Restrictive Food Intake Disorder (ARFID) in a tertiary care pediatric and adolescent gynecology (PAG) clinic. Cross-sectional study design. Tertiary care PAG clinic at the Hospital for Sick Children in Toronto, Ontario, Canada. Females between 8 and 18 years of age presenting to the tertiary care PAG clinic. Between October 2017 and April 2019, eligible patients completed a 3-part, self-administered questionnaire that included demographic and anthropometric information, reason(s) for referral, medical history, menstrual history and function, and the Eating Disorders in Youth−Questionnaire (EDY-Q). The main outcome measure was the prevalence of child and adolescent females who were identified to be at risk for ARFID in a tertiary care PAG clinic. Seven (3.7%) of 190 patients were identified to be at risk for ARFID based on the EDY-Q. All patients at risk for ARFID had a significantly lower body mass index (17.4 ± 1.6 vs 24.4 ± 6.7, P <.001) than patients not at risk for ARFID. This study demonstrated that 3.7% of patients seeking treatment in a tertiary care PAG clinic were identified to be at risk for ARFID. Clinicians in tertiary care PAG clinics can play a pivotal role in the identification and referral of children and adolescents at risk for ARFID. Referral to the patients' primary care physician or to an eating disorder program is important so as not to delay the diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Summary: Background: Introducing complementary foods other than breastmilk or formula acutely changes the infant gut microbiota composition. However, it is unknown whether the timing of introduction to complementary foods (early vs. late) in infancy is associated with early childhood gut microbiota and BMI, and if these associations depend on breastfeeding duration. Objective: Our primary objective was to investigate whether timing of infant complentary feeding with solid foods is associated with early childhood gut microbiota composition and BMI‐z, and whether these associations differ by duration of breastfeeding. Methods: We used data from a Canadian pre‐birth cohort followed till age 5 years. We examined timing of introduction to solid foods with the gut microbiota, determined by 16S rRNA gene sequencing of stool collected at 5 years of age, and age‐and‐sex specific BMI‐z. We conducted analyses before and after stratifying by breastfeeding duration, and adjusted for delivery mode, gestational age and birth weight. Results: Of the 392 children in the analysis, 109 (27.8%) had early (≤4 months) solids. The association between early (vs later) solids and BMI‐z at 5 years was modified by breastfeeding status at 4 months (P =.06). Among children breastfed >4 months, early (vs later) solids were associated with differential relative abundance of 6 bacterial taxa, including lower Roseburia, and 0.30 higher BMI‐z (95% CI: 0.05, 0.55) at 5 years. In children breastfed <4 months, early solids were associated with differential relative abundance of 9 taxa, but not with child BMI‐z. Conclusions: Early (vs. later) introduction to solid foods in infancy is associated with altered gut microbiota composition and BMI in early childhood, however these associations differ by duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Summary: Background: Rapid growth is associated with increased cardiometabolic risk (CMR) in adolescence and adulthood. Little is known about whether the association between rapid growth and increased CMR originates in early childhood. Objectives: To identify age and sex standardized body mass index (zBMI) trajectories and to examine the association between zBMI trajectories and CMR outcomes in children 0 to 60 months. Study design A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) in Toronto, Canada. Participants had repeated measures of weight and length or height performed from birth to 60 months of age. Latent class mixed modelling was used to identify the zBMI trajectories. Linear regressions were performed to determine the association between zBMI trajectories and the primary outcome, a CMR score, quantified as the sum of age‐ and sex‐ standardized waist circumference, systolic blood pressure, glucose, log‐triglycerides and negative high‐density lipoprotein cholesterol (HDL‐C), divided by √5. Secondary outcomes were the individual components of the CMR formula as well as diastolic blood pressure and non‐HDL‐C. Results: Four BMI trajectories were identified among the 1166 children. After adjusting for all covariates, children in the rapidly accelerating trajectory had increased total CMR score (β = 1.38, 95% CI 0.77; 1.99, P <.001) and increased waist circumference score (β = 2.39, 95% CI 1.92; 2.86, P <.001) compared to the stable low group. Conclusions: Rapid growth during early childhood is associated with increased CMR in preschool children, largely driven by larger waist circumference. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Introduction: Overweight and obesity (OW/OB) rates are increasing among Canadian children and youth, with rates currently affecting one-third of 5–17 year olds. OW/OB is associated with numerous physical and psychosocial consequences, which are compounded when a child has a pre-existing disability. This is concerning considering children with disabilities experience OW/OB at two to three times the rate of their typically developing peers. While the number of weight management programs have been increasing, they are generally designed to meet the needs of typically developing children and often exclude children with disabilities. This review identifies existing weight management programs for youth with disabilities, and examines their characteristics and outcomes. Methods: A scoping review was conducted using rapid review principles. Three health and social science databases were searched using terms related to "disabilities", "obesity", and "weight management", limited to 2007–2017. Articles meeting the inclusion criteria were summarized and analyzed thematically. Results: Five articles met inclusion criteria, and described four separate weight management programs. All included children and youth with intellectual disabilities, with one including children with physical disabilities. Programs had three traits in common: (1) utilizing inter/multidisciplinary teams; (2) using technology to deliver the program; and (3) engaging the family during the entire program. All articles reported that the programs reduced body mass index. Conclusion: The scarcity of programs designed to meet the unique needs of youth with disabilities is alarming. Although a robust evidence base is lacking, current research provides some directions into components that should be considered when designing future interventions. 1. Clinicians should be aware of the high prevalence of overweight and obesity and the resultant consequences in children with disabilities. 2. The use of inter/multidisciplinary teams, technology, and family engagement all appear to be promising approaches to creating successful weight management programs: a. Weight-management programs should utilize inter/multidisciplinary teams to consider physical, social and psychological aspects of weight and health, to allow treatment plans to encompass a wider range of suggestions and recommendations. b. Health care providers should consider using technology as a platform to deliver weight-management programs and services and/or to directly track progress. c. Families are powerful agents of change, and should be consulted and involved in the delivery of weight-management programs. [ABSTRACT FROM AUTHOR]

The current investigation assessed the impact of active school transportation (AST) on average daily step counts, body mass index (BMI) and waist circumference in 315 children in Grades 4-6 who participated to Cycle 2 of the Canadian Assessmentof Physical Literacy (CAPL) pilot testing. T-tests revealed a significant association between AST and lower BMI values (18.7 ± 3.3 vs. 19.9 ± 3.8 kg/m2). The active commuters accumulated an average of 662 more steps per day, and their waist circumference was lower by an average of 3.1 cm, but these differences were not statistically significant. ANCOVA analyses controlling for age and step counts, found trends toward lower BMI and waist circumference values among the active commuters. These results suggest that AST may be a valid strategy to prevent childhood obesity; further research is needed to determine more precisely the impact of AST on body composition, and the direction of the relationship. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess fitness and gross motor performance of children with ADHD, including users and nonusers of methylphenidate medication. Seventy boys took part in the study. Fitness level of children with ADHD using medication or not, including body composition, flexibility, and muscular endurance, was similar to that of a control group. The only difference was observed for body mass index, which was lower in children with ADHD using medication. Aerobic capacity was also similar when measured by a treadmill test. A lower performance was observed when aerobic capacity was estimated using a field shuttle test, however, suggesting that the methodology used is important. Finally, both groups of children with ADHD presented significantly lower scores for locomotion skills. [ABSTRACT FROM AUTHOR]

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3–13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention. [ABSTRACT FROM AUTHOR]

Objectives: The Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1–12 years of age living within and outside Healthy Kids Community Challenge communities. Design: Cross-sectional analysis of a primary care patient cohort. Setting: Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Participants: A cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1–12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015. Outcome measure: Overweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization’s Growth Standards. Results: In Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6–26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9–27.5%) for children living outside of Healthy Kids Community Challenge communities. Conclusions: Despite some differences in sociodemographic characteristics, zBMI of children aged 1–12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch. [ABSTRACT FROM AUTHOR]

Abstract Objective The objective of the study is to examine whether the increased levels of non–high-density lipoprotein cholesterol (non-HDL-c) are associated with skipping breakfast among school children. Study design A cross-sectional survey was conducted among 539 school children aged 8–12 years from the Niagara Region of Canada. Methods Non-fasting finger blood was taken for total cholesterol (total-c) and HDL-c measurements. Non-HDL-c was calculated as the difference between total-c and HDL-c. The information of skipping breakfast in a week was obtained from a questionnaire, which was categorized into three groups, i.e., none, 1–3 times and 4 + times. Demographic information and other related variables were described by the three breakfast-skipping groups. Results Approximately 44% of children (n = 182) reported skipping breakfast. There were significant differences between the three groups in the means of total-c, non-HDL-c, body mass index, waist circumference, proportions of overall health excellent, eating dinner with parent and skipping breakfast that affects learning (P < 0.05). The number of days of skipping breakfast was weakly correlated to the level of non-HDL-c (r = 0.145, P < 0.0001). Multiple regression results indicated that every one more time of skipping breakfast would increase approximately 0.05 mmol/L level of non-HDL-c (P < 0.01), on average, after adjusting for those aforementioned potential confounding variables. The adjusted mean levels of non-HDL-c were 2.77, 2.94 and 3.07 mmol/L for none, skipping 1–3 times and skipping 4 + times of breakfast, respectively; the mean differences between none and the other two groups were statistical significant (P < 0.05). Conclusion Non-HDL-c levels is positively associated with the number of skipping breakfast among school children, and further research is needed to confirm this relationship. Highlights • This is a population-based study. • This was the first study to examine the association between skipping breakfast and the levels of non-HDL cholesterol among children. • Children who skip breakfast have a higher average level of non-HDL cholesterol. [ABSTRACT FROM AUTHOR]

Introduction: There is evidence that 25-hydroxyvitamin D levels are lower in overweight and obese youth. This study examined the relationship between weight status and 25-hydroxyvitamin D, while controlling for confounders, in Canadian youth. Methods: Plasma 25-hydroxyvitamin D from subjects aged 6 to 17 years from the Canadian Health Measures Survey cycles 1 (2007 to 2009) and 2 (2009 to 2011) was used. Sex-specific multiple linear regression and logistic regressions examined the relationship of overweight and obesity (body mass index = 85th percentile) with 25-hydroxyvitamin D levels and the odds of 25-hydroxyvitamin D <40 nmol/L and <50 nmol/L. Results: The prevalence of risk of vitamin D deficiency (25-hydroxyvitamin D < 30 nmol/L) was 6% (95% confidence interval [CI] 3.26% to 10.12%). Vitamin D inadequacy, estimated by levels <40 nmol/L, was 15% (95% CI 10.34% to 20.39%; 19% [95% CI 13.1 to 25.6] for teenagers). Seventy per cent (95% CI 63.59 to 75.17) had levels >50 nmol/L, consistent with achieving the Recommended Dietary Allowance. In adjusted analyses, overweight/obesity (1/3 of subjects) was independently associated with lower 25-hydroxyvitamin D for both sexes after adjustment for age, race, income, season, vitamin D supplementation and daily milk consumption. For 25-hydroxyvitamin D <40 nmol/L, the overweight/obese odds ratio for males was 2.63 (95% CI 1.34 to 5.18). For 25-hydroxyvitamin D <50 nmol/L, overweight/obese odds ratios were 2.19 (95% CI 1.46 to 3.28) for males and 1.39 (95% CI 1.05 to 1.84) for females. Conclusions: This study confirms the inverse association between adiposity and serum concentrations of 25-hydroxyvitamin D in Canadian youth and the independent association of overweight/obesity to 25-hydroxyvitamin D level and vitamin D status after adjustment for other factors. [ABSTRACT FROM AUTHOR]

Background: Canada has recently released guidelines that include toddler-specific recommendations for physical activity, screen-based sedentary behaviour, and sleep. This study examined the proportions of toddlers meeting the new Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and associations with body mass index (BMI) z-scores in a sample from Edmonton, Canada.Methods: Participants included 151 toddlers (aged 19.0 ± 1.9 months) for whom there was complete objectively measured physical activity data from the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) project. Toddlers' physical activity was measured using ActiGraph wGT3X-BT monitors. Toddlers' screen time and sleep were measured using the PREPS questionnaire. Toddlers' height and weight were objectively measured by public health nurses and BMI z-scores were calculated using World Health Organization growth standards. Meeting the overall 24-Hour Movement Guidelines was defined as: ≥180 min/day of total physical activity, including ≥1 min/day of moderate- to vigorous-intensity physical activity; no screen time per day (for those aged 12-23 months) or ≤1 h/day of screen time per day (ages 24-35 months); and 11-14 h of sleep per 24-h period. Frequency analyses and linear regression models were conducted.Results: Only 11.9% of toddlers met the overall 24-Hour Movement Guidelines, but this finding was largely driven by screen time. The majority of toddlers met the individual physical activity (99.3%) and sleep (82.1%) recommendations, while only 15.2% of toddlers met the screen time recommendation. No associations were observed between meeting specific and general combinations of recommendations within the guidelines and BMI z-scores.Conclusions: Most toddlers in this sample were meeting physical activity and sleep recommendations but were engaging in more screen time than recommended. Consequently, only a small proportion of toddlers met the overall guidelines. Based on the findings of this study, identifying modifiable correlates of screen time to inform appropriate strategies to reduce screen time appears key for increasing the proportion of toddlers meeting the 24-Hour Movement Guidelines for the Early Years. Future research should examine the associations between meeting the new guidelines and other health indicators. Furthermore, future high-quality studies examining dose-response relationships between movement behaviours and health indicators are needed to inform guideline updates. [ABSTRACT FROM AUTHOR]

Background: To evaluate if there are departures from the WHO Child Growth Standards (WHO-CGS) in postnatal growth of healthy 'Canadian' children in Ontario up to age 2 years, including by infant feeding and ethnicity.Methods: We included data on 9964 healthy, singleton children born in Ontario, Canada. Smoothed weight, length and body mass index (BMI) percentile curves were generated using quantile regression for the Canadian cohort from birth to age 2 years. Differences in percentile values were calculated comparing Canadian children vs. the WHO-CGS.Results: Canadian children under age 2 years were longer than the WHO-CGS at the 10th (0.8 cm), 50th (1.3 cm) and 90th (1.9 cm) percentiles. Canadian children incrementally surpassed the WHO-CGS in weight after age 6 months, and in BMI after 9 months. By age 2 years, the 50th percentile weight of Canadian males was 823 g (95% confidence interval (CI) 680, 965) higher than the WHO-CGS 50th percentile. Weight differences were seen regardless of feeding practice, and were greatest among children of mothers born in Canada and Europe/Western nations, and least for those of East Asian/Pacific or South Asian heritage. Among Canadian breastfed males, 18% (95% CI 16, 19) of newborns and 26% (95% CI 20, 33) toddlers aged 2 years were classified by WHO-CGS as weighing >90th percentile - much higher than the expected rate of 10%. Similarities were seen for differences in BMI.Conclusions: Healthy Canadian infants/toddlers are longer and heavier than the WHO-CGS norms. Explanations for these discrepancies require further elucidation. [ABSTRACT FROM AUTHOR]

Background: Obesity, with its rising prevalence among Canadians and its estimated cost of $2 billion annually in Canada, is no longer considered a cosmetic issue, but a major health issue that imposes a great burden on the healthcare system and economy. This cross sectional study aims to evaluate the feasibility of identifying the weight status of 6 to 11 year-old children in a university dental clinic using a simplified overweight screening instrument.Methods: One hundred sixty eight healthy children were enrolled. Weight and height were measured and overweight/obesity status was assessed using two techniques: 1) the 2007 World Health Organization Body Mass Index (BMI)-for-age reference Tables, 2) simplified overweight screening instrument without BMI calculation. Measures of overall, positive, and negative percent agreement between the two approaches were computed.Results: The children's average weight, height, BMI and BMI z-score were respectively 32.6 ± 9.5 kg, 133.8 ± 10.7 cm, 17.8 ± 3.2, and 0.4 ± 1.0. The overall, positive, and negative percent agreement between the two screening approaches were respectively, 89%, 100%, and 83%.Conclusion: This study demonstrated the feasibility and parental acceptance of weight, height and BMI measurement in a dental setting and evidence that supports the validity of a new simplified approach to assess children's weight status without having to compute BMI.Trial Registration: NCT02637752 . Registered 18 December 2015. [ABSTRACT FROM AUTHOR]

The study objective was to examine whether meeting the new Canadian 24-hour movement guidelines was associated with health indicators in a representative sample of Canadian children and youth. Cross-sectional findings are based on 4157 (1239 fasting subsample) children and youth aged 6-17years from cycles 1-3 of the Canadian Health Measures Survey (CHMS). Sleep and screen time were subjectively measured while moderate- to vigorous-intensity physical activity (MVPA) was accelerometer-determined. Health indicators in the full sample (body mass index (BMI) z-scores, waist circumference, blood pressure, behavioral strengths and difficulties score (lower=better), and aerobic fitness) and fasting subsample (triglycerides, high-density lipoprotein (HDL)-cholesterol, C-reactive protein, and insulin) were measured. Meeting the overall guidelines was defined as: 9-11 hour/night (5-13years) or 8-10 hour/day (14-17years) of sleep, ≤2 hour/day of screen time, and ≥60 minute/day of MVPA. Compared to meeting all three recommendations, meeting none, one, and two recommendations were associated with a higher BMI z-score, waist circumference, and behavioral strengths and difficulties score and lower aerobic fitness in a gradient pattern (Ptrend<0.05). Additionally, compared to meeting all three recommendations, meeting none and one recommendation were associated with higher systolic blood pressure and insulin (Ptrend<0.05). Finally, compared to meeting all three recommendations, meeting no recommendations was associated with higher triglycerides and lower HDL-cholesterol (Ptrend<0.05). Collectively, meeting more recommendations within the 24-hour movement guidelines was associated with better overall health. Since a small proportion (17%) of this representative sample was meeting the overall guidelines, efforts to promote adoption are needed. [ABSTRACT FROM AUTHOR]

Background: The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Methods: Cross-sectional results were based on 6128 children aged 9-11 years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kg ⋅ m-2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations. Results: The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower. Conclusions: For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children. Trial registration: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012). [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown an increase in the prevalence of overweight and obesity among Canadian children from 23.3% to 34.7% during 1978-2004. We examined the most recent trends by applying current definitions of overweight and obesity based on World Health Organization (WHO) body mass index (BMI) thresholds and recently validated norms for waist circumference and waist:height ratio.Methods: We examined directly measured height and weight data from the Canadian Community Health Survey (2004-2005) and the Canadian Health Measures Survey (2009-2013). We calculated z scores for BMI, height and weight based on the 2014 WHO growth charts for Canada, including the new extension of weight-for-age beyond 10 years. To calculate z scores for waist circumference and waist:height ratios, we used new charts from the reference population in the US NHANES III (National Health and Nutrition Examination Survey, 1988-1994).Results: Data were available for 14 014 children aged 3-19 years for the period 2004-2013. We observed a decline in the prevalence of overweight or obesity, from 30.7% (95% confidence interval [CI] 29.7% to 31.6%) to 27.0% (95% CI 25.3% to 28.7%) (p < 0.001) and stabilization in the prevalence of obesity at about 13%. These trends persisted after we adjusted for age, sex and race/ethnicity. Although they declined, the median z scores for BMI, weight and height were positive and higher than those in the WHO reference population. The z scores for waist circumference and waist:height ratio were negative, which indicated that the Canadian children had less central adiposity than American children in historic or contemporary NHANES cohorts.Interpretation: After a period of dramatic growth, BMI z scores and the prevalence of overweight or obesity among Canadian children decreased from 2004 to 2013, which attests to progress against this important public health challenge. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to determine the role of religious involvement and related indicators such as religious coping, intrinsic religiosity and forgiveness in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors.

The purpose of this study was to examine the relationships between movement behaviours (sleep duration, sedentary time, physical activity) and health indicators in a representative sample of children and youth using compositional analyses. Cross-sectional findings are based on 4169 children and youth (aged 6-17 years) from cycles 1 to 3 of the Canadian Health Measures Survey. Sedentary time (SB), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived. Sleep duration was subjectively measured. Body mass index z scores, waist circumference, blood pressure, behavioural strengths and difficulties, and aerobic fitness were measured in the full sample. Triglycerides, high-density lipoprotein-cholesterol, C-reactive protein, and insulin were measured in a fasting subsample. The composition of movement behaviours was entered into linear regression models via an isometric log ratio transformation and was found to be associated with all health indicators (p < 0.01). Relative to other movement behaviours, time spent in SB or LPA was positively associated (p < 0.04) and time spent in MVPA or sleep was negatively associated (p < 0.02) with obesity risk markers. Similarly, LPA was positively associated (p < 0.005) and sleep was negatively associated (p < 0.03) with unfavourable behavioural strengths and difficulties scores and systolic blood pressure. Relative to other movement behaviours, time spent in SB was negatively associated (p < 0.001) and time spent in MVPA (p < 0.001) was positively associated with aerobic fitness. Likewise, MVPA was also negatively associated with several cardiometabolic risk markers (p < 0.008). Compositional data analyses provide novel insights into collective health implications of 24-h movement behaviours and can facilitate interesting avenues for future investigations. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is fundamental for bone health. A high proportion of Canadian 2- to 8-y-olds do not meet the Estimated Average Requirement (EAR) of 400 IU/d. Objective: The objective was to determine whether vitamin D intakes consistent with the EAR or Recommended Dietary Allowance (RDA), through fortification of additional dairy products, would result in higher vitamin D status in young children. Design: Participants aged 2-8 y (n = 77; Montreal, Canada) were randomly assigned to 1 of 3 dietary vitamin D targets (control; EAR: 400 IU/d; or RDA: 600 IU/d) for 12 wk (January to April 2014). Anthropometric measurements, demographic characteristics, dietary intakes, fasting serum parathyroid hormone, 25-hydroxyvitamin D [25(OH)D], and ionized calcium were compared by using mixed-model ANOVA. Results: Participants' mean ± SD age was 5.1 ± 1.9 y; 54.5% were boys with body mass index z scores of 0.50 ± 0.85. Compliance was 85% overall. No differences were observed in baseline dietary vitamin D intakes or serum 25(OH)D. At 12 wk, the EAR and RDA groups had significantly higher vitamin D intakes [median (IQR): control, 227 (184-305) IU/d; EAR, 410 (363-516) IU/d; and RDA, 554 (493-653) IU/d; P < 0.05] and serum 25(OH)D concentrations (control: 55.8 ± 12.3 nmol/L; EAR: 64.1 ± 10.0 nmol/L; and RDA: 63.7 ± 12.4 nmol/L; P < 0.05) than the control group. Ninety-six percent of children in the EAR and RDA groups and 67% of the control group had 25(OH)D concentrations ≥50 nmol/L. Conclusion: Increasing the vitamin D intakes of young children through fortification of alternative dairy products results in significantly higher serum concentrations of 25(OH)D and a significantly greater proportion of children with serum 25(OH)D ≥50 nmol/L during periods of minimal ultraviolet B radiation exposure. This trial was registered at clinicaltrials.gov as NCT02097160 and had Health Canada Temporary Marketing Authorization Letters for both products (TM-13-0432 and TM-13-0433). [ABSTRACT FROM AUTHOR]

Purpose Underestimating body size hinders healthy behavior modification needed to prevent obesity. However, initiatives to improve body size misperceptions may have detrimental consequences on self-esteem and self-efficacy. Methods Using sex-specific multiple mixed-effect logistic regression models, we examined the association of underestimating versus accurate body size perceptions with self-esteem and self-efficacy in a provincially representative sample of 5075 grade five school children. Body size perceptions were defined as the standardized difference between the body mass index (BMI, from measured height and weight) and self-perceived body size (Stunkard body rating scale). Self-esteem and self-efficacy for physical activity and healthy eating were self-reported. Results Most of overweight boys and girls (91% and 83%); and most of obese boys and girls (93% and 90%) underestimated body size. Underestimating weight was associated with greater self-efficacy for physical activity and healthy eating among normal-weight children (odds ratio: 1.9 and 1.6 for boys, 1.5 and 1.4 for girls) and greater self-esteem among overweight and obese children (odds ratio: 2.0 and 6.2 for boys, 2.0 and 3.4 for girls). Conclusions Results highlight the importance of developing optimal intervention strategies as part of targeted obesity prevention efforts that de-emphasize the focus on body weight, while improving body size perceptions. [ABSTRACT FROM AUTHOR]

Childhood obesity is a global health concern, but children with spina bifida in particular have unique interacting risk factors for increased weight. PURPOSE: To identify and explore current clinical practices around weight assessment and management in pediatric spina bifida clinics. METHODS: An online, self-report survey of healthcare professionals (HCPs) was conducted in all pediatric spina bifida clinics across Canada (15 clinics). Summary and descriptive statistics were calculated and descriptive thematic analysis was performed on free text responses. RESULTS: 52 responses across all 15 clinics indicated that weight and height were assessed and recorded most of the time using a wide variety of methods, although some HCPs questioned their suitability for children with spina bifida. Weight and height information was not routinely communicated to patients and their families and HCPS identified considerable barriers to discussing weight-related information in consultations. CONCLUSION: Despite weight and height reportedly being measured regularly, HCPs expressed concern over the lack of appropriate assessment and classification tools. Communication across multi-disciplinary team members is required to ensure that children with weight-related issues do not inadvertently get overlooked. Specific skill training around weight-related issues and optimizing consultation time should be explored further for HCPs working with this population. [ABSTRACT FROM AUTHOR]

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population. [ABSTRACT FROM AUTHOR]

Objective To investigate the role of acculturation, as measured by generational status, on body mass index (BMI) in a sample of Canadian youth. Methods Population-based data from the National Longitudinal Survey of Children and Youth were used. Participants were divided into 2 age ranges: children aged 6–11 years (n = 14,287) and adolescents aged 12–17 years (n = 12,155). Youth were classified into one of five generations of immigration: first-generation, second-generation, mixed-generation, third-generation, and Aboriginal. Parent- and self-report height and weight were used to calculate BMI Z-scores. Results Generation of immigration was significantly related to BMI Z-score in both childhood and adolescence. First-generation immigrants had more weight gain compared to other groups during adolescence, but not during childhood. Conclusions Acculturation, as measured by generation of immigration, is an important predictor of BMI in Canadian children and adolescents. [ABSTRACT FROM PUBLISHER]

Sex differences in the effects of sleep duration on dietary intake and eating behaviours were examined prospectively in relation to overweight/obesity at ages 6 and 7. Using data from a representative sample (QLSCD 1998-2010) of children born in the province of Québec (Canada), 1106 children were followed to age 6 and 1015 to 7 years. Average nocturnal sleep duration was surveyed annually from 2.5-6 years, food-frequency and eating behaviour questionnaires were administered at age 6, and body weight and height were measured at 6 and 7 years. Associations were examined longitudinally and mediation examined with adjustments for potential confounders. In boys and girls, shorter sleep duration patterns were associated significantly with less favourable dietary intakes at 6 years: boys consumed vegetables and fruits less frequently and meats/alternatives more frequently than boys with longer sleep patterns; and girls consumed vegetables, fruits and milk products less frequently and soft-drinks more frequently than girls with longer sleep patterns. However, boys with shorter sleep patterns were also more likely to eat at irregular hours or to eat too much/fast at 6 years. These behaviours, and not dietary intake, mediated an inverse association between sleep duration and overweight/obesity in boys. Sleep duration did not associate with any problem eating behaviours or overweight/obesity in girls. Shorter sleep in early childhood appears to associate with problematic eating behaviours in boys and diet quality in both sexes, regardless of an association with overweight/obesity. This is important for public health and should be considered in relation to other diet-related diseases. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether leg-length to height ratio (LLHR) measured in children can be used to assess overweight and obese status 3 years later. Methods: A total of 1166 children from South Ontario, Canada, were assessed in grade five and again in grade eight were included in this analysis. On the basis of LLHR gender-specific quartile cutoffs in grade five, children were categorized into four groups (Q1[low]–Q4). Gender and age specific cutoffs of body mass index were used to categorize children as overweight/obese or normal weight in grade eight. Multiple logistic regression models were used to examine the overweight/obesity risk association with LLHR. Results: In comparing those in Q1 of LLHR, we found the odds ratios (OR, 95% confidence interval) of overweight/obese for those in the Q2–Q4 were 0.60 (0.29–1.21), 0.43 (0.21–0.89), and 0.32 (0.15–0.70) for boys and 0.77 (0.36–1.64), 0.60 (0.28–1.29), and 0.27 (0.12–0.62) for girls, respectively. The overweight/obesity risk association with LLHR remains after removing those who were considered overweight/obese at grade five. Conclusions: LLHR is associated with risk of childhood overweight/obesity. Further studies are warranted to investigate the role of LLHR on development of obesity. [ABSTRACT FROM AUTHOR]

Objectives. Investigate the effects of selected factors associated with quantitative ultrasound parameters among Inuit preschoolers living in Arctic communities (56° 32'-72° 40'N). Materials and methods. Children were selected randomly in summer and early fall (n=296). Dietary intake was assessed through the administration of a 24-h dietary recall (24-h recall) and a food frequency questionnaire (FFQ). Anthropometry was measured using standardized procedures. Plasma 25-hydroxy vitamin D (25(OH)D) and parathyroid hormone (PTH) were measured using a chemiluminescent assay (Liaison, Diasorin). Quantitative ultrasound parameters were measured using Sahara Sonometer, (Hologic Inc.). Results. Children divided by speed of sound (SoS) and broadband ultrasound attenuation (BUA) quartiles were not different for age (years), sex (M/F), calcium (mg/d) and vitamin D intake (μg/d) and plasma 25(OH)D concentration (nmol/L). However, children in the highest BUA and SoS quartile had higher body mass index (BMI) compared to those in quartile 1. Using multivariate linear regression, higher BMI, older age and monounsaturated fatty acids (MUFA) intake were predictors of BUAwhile only BMI was a predictor of SoS. Conclusions. Further investigation assessing intakes of traditional foods (TF) and nutrients affecting bone parameters along with assessment of vitamin D status of Inuit children across seasons is required. [ABSTRACT FROM AUTHOR]

Background: We sought to determine if the rate of increase in body mass index (BMI) differs between first generation immigrant children (child and both parents born outside Canada); second generation immigrant children (child born in Canada with at least one parent born outside Canada); and native-born children (child and both parents born in Canada), and if the rate of increase varies across ethnic groups. Methods: Data were available from the evaluation of a 5-year heart health promotion program targeted to elementary school children from 24 schools in multi-ethnic, disadvantaged, inner-city neighborhoods in Montreal, Canada. Participants were 6392 children aged 9–12 years born in and outside of Canada. Height and weight were measured annually according to a standardized protocol. BMI increases with age were examined using individual growth models stratified by immigrant status grouping (first generation immigrant, second generation immigrant, native-born). Results: On average, BMI increased by 0.59, 0.73, and 0.82 kg/m2 with each year of age among first generation immigrant, second generation immigrant, and native-born children, respectively. These differences held across four family origin grouping (Europe, Asia, Central/South America, and Other). Conclusion: The protective effect of immigrant status on BMI increases with age dissipated in second generation immigrant children, whose rate of increase was similar to that of native-born children. Because immigrants constitute the fastest growing segment of the Canadian population, it is important to understand the causes of the higher BMI increases with successive generations. [ABSTRACT FROM AUTHOR]

Aims: Prenatal tobacco exposure (PTE) is an important public health concern for the offspring of teen mothers. We examined whether PTE is associated with baseline cortisol levels in four-month-old infants of teenage mothers. Methods: We assessed salivary cortisol levels of 212 infants. PTE was measured by using self-reports of cigarette smoking during pregnancy. We used a propensity scores matching analysis to compare infants with PTE and those without. Results: Of 212 mothers, 151 smoked during pregnancy. However, there was no association between PTE and infant cortisol levels. Conclusions: We could not support a relation between PTE and cortisol levels in a sample of four-month-old infants of teenage mothers. [ABSTRACT FROM AUTHOR]

Outcome body size of gastrostomy tube (g-tube)-fed children with chronic kidney disease (CKD) was investigated. CKD patients, stages 2–5, who had a g-tube inserted and removed between 1985 and 2007 were retrospectively reviewed ( n = 20) for anthropometrics, lab values, and steroid use from insertion to latest date. CKD patients never having had a g-tube placed ( n = 82) acted as the comparison population with similar data collection at start and end of the latest 5-year period. Body mass index (BMI)-for-age, weight (Wt)-for-age, and height (Ht)-for-age z scores were calculated and compared between groups. Median age at insertion and duration of g-tube treatment was 1.7 years (range 0.9–15.6), and 2.9 years (range 0.9–11.8), respectively. There was a significant increase in Wt- ( p < 0.01), and BMI-for-age ( p < 0.03) z score, but not for Ht-for-age between insertion and removal for subjects. There were no significant differences in Ht-, Wt-, or BMI-for-age z scores, from removal to 5 years post-removal. In the comparison population, there were no significant differences in Ht-, Wt-, or BMI-for-age z scores over the 5-year period. Approximately 36% of the non-tube-fed comparison population and 50% of the tube-fed subjects were overweight or obese at the most recent evaluation. In both subjects and the comparison group, overweight and obesity is associated with transplant status and steroid use. G-tube feeding is an effective method for achieving catch-up weight and moderate height gain in pediatric CKD patients, and does not apparently predispose patients to obesity after removal; however, overweight and obesity may pose problems to children with CKD whether or not they are tube fed. [ABSTRACT FROM AUTHOR]

Objective. This article compares prevalence estimates of excess weight among Canadian children and youth according to three sets of body mass index (BMI) reference cut-points. The cut-points are based on growth curves generated by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control (CDC). A secondary objective is to compare estimates by method of data collection. Methods. Prevalence estimates of overweight and obesity were produced for 2- to 17-year-olds using the three sets of BMI cut-points. Estimates are based on data from 8 661 respondents from the 2004 Canadian Community Health Survey and 1 840 respondents from the 1978/79 Canada Health Survey. In both surveys, the height and weight of children were measured. Results. The 2004 prevalence estimate for the combined overweight/obese category is higher (35%) when based on the WHO cut-points compared with the IOTF (26%) or CDC (28%) cut-points. Estimates of the prevalence of obesity are similar based on WHO and CDC cut-points (13%), but lower when based on IOTF cut-points (8%). Absolute differences in excess weight estimates between 1978/79 and 2004 are similar based on the three sets of cut-points, but the relative increase is greater when based on the IOTF cut-points. Estimates vary substantially by method of data collection. Conclusion. When interpreting prevalence estimates of overweight and obesity for children and youth, it is important to consider the definitions used and the method of data collection. [ABSTRACT FROM AUTHOR]

This section offers news briefs related to public health as of Sepember 2019. Researchers at McMaster University found that physical activity in children can prevent early risk indicators that lead to adult heart diseases. Scientists from Swansea University found early warning conditions that could herald the development of eating disorders. A study by Alex Kwong of the University of Bristol found that a mix of genetic and environmental factors could put people at greater risk of depression.

OBJECTIVES: Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada. METHODS: Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables. RESULTS: The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables. CONCLUSIONS: Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years. [ABSTRACT FROM AUTHOR]

Childhood exposure to phthalates, a class of chemicals with known reproductive and developmental effects, has been hypothesized to increase the risk of obesity, but this association is not well understood in preschool children. We examined the association between urinary concentrations of phthalate metabolites and concurrently measured body mass index (BMI) and skinfolds among children between the ages of two and five years. We collected anthropometric measures and biomonitoring data on approximately 200 children enrolled in the Maternal-Infant Research on Environmental Chemicals Child Development Plus study. We measured 22 phthalate metabolites in children's urine and used the 19 metabolites detected in at least 40% of samples. Our primary outcome was BMI z-scores calculated using the World Health Organization growth standards. Skinfold z-scores were secondary outcomes. We used multivariable linear regression to evaluate the association between tertiles of phthalate concentrations and each anthropometric measure. We also used weighted quantile sum regression to identify priority exposures of concern. Our analytic sample included 189 singleton-born children with complete anthropometric data. Children with concentrations of the parent compound di-n-butyl phthalate (∑DnBP) in the third tertile had 0.475 (95% CI: 0.068, 0.883) higher BMI z-scores than those in the lower tertile. ∑DnBP was identified as a priority exposure in the weighted quantile sum regression BMI model. In this population of Canadian preschool aged children, we identified DnBP as a potential chemical of concern in regard to childhood obesity. Future research with serial phthalate measurements and anthropometric measurements in young children will help confirm these findings. [ABSTRACT FROM AUTHOR]

Background: The Canadian Assessment of Physical Literacy (CAPL) is a 25-indicator assessment tool comprising four domains of physical literacy: (1) Physical Competence, (2) Daily Behaviour, (3) Motivation and Confidence, and (4) Knowledge and Understanding. The purpose of this study was to re-examine the factor structure of CAPL scores and the relative weight of each domain for an overall physical literacy factor. Our goal was to maximize content representation, and reduce construct irrelevant variance and participant burden, to inform the development of CAPL-2 (a revised, shorter, and theoretically stronger version of CAPL).Methods: Canadian children (n = 10,034; Mage = 10.6, SD = 1.2; 50.1% girls) completed CAPL testing at one time point. Confirmatory factor analysis was used.Results: Based on weak factor loadings (λs < 0.32) and conceptual alignment, we removed body mass index, waist circumference, sit-and-reach flexibility, and grip strength as indicators of Physical Competence. Based on the factor loading (λ < 0.35) and conceptual alignment, we removed screen time as an indicator of Daily Behaviour. To reduce redundancy, we removed children's activity compared to other children as an indicator of Motivation and Confidence. Based on low factor loadings (λs < 0.35) and conceptual alignment, we removed knowledge of screen time guidelines, what it means to be healthy, how to improve fitness, activity preferences, and physical activity safety gear indicators from the Knowledge and Understanding domain. The final refined CAPL model was comprised of 14 indicators, and the four-factor correlated model fit the data well (r ranged from 0.08 to 0.76), albeit with an unexpected cross-loading from Daily Behaviour to knowledge of physical activity guidelines (mean- and variance-adjusted weighted least square [WLSMV] χ2(70) = 1221.29, p < 0.001, Comparative Fit Index [CFI] = 0.947, root mean square error of approximation [RMSEA] = 0.041[0.039, 0.043]). Finally, our higher-order model with Physical Literacy as a factor with indicators of Physical Competence (λ = 0.68), Daily Behaviour (λ = 0.91), Motivation and Confidence (λ = 0.80), and Knowledge and Understanding (λ = 0.21) fit the data well.Conclusions: The scores from the revised and much shorter 14-indicator model of CAPL can be used to assess the four correlated domains of physical literacy and/or a higher-order aggregate physical literacy factor. The results of this investigation will inform the development of CAPL-2. [ABSTRACT FROM AUTHOR]

Background: The Canadian Assessment of Physical Literacy (CAPL) is divided into four domains (Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding) and provides a robust and comprehensive assessment of physical literacy. As weight status is known to influence health-related behaviours such as physical fitness and activity, it is important to investigate whether the associations between the domains of physical literacy vary among children of different weight status. The aim of this study was to determine the associations among the four domains of physical literacy stratified by weight status.Methods: Canadian children aged 8 to 12 years (n = 8343, 63.6% healthy-weight) completed the CAPL. Differences in domain scores and overall physical literacy score by weight status (children of healthy weight versus children with overweight/obese) were assessed using MANOVA (multivariate analysis of variance). Partial correlations between the four domains were calculated, adjusting for gender and age, and correlation coefficients of both weight status groups were compared using the Steiger test.Results: For all four domains as well as overall physical literacy, healthy-weight children had higher scores than their overweight/obese peers (Cohen's d ranged from 0.05 to 0.44). Weak to moderate correlations were found between all of the domains for both groups. Correlation coefficients for Physical Competence and Daily Behaviour as well as for Physical Competence and Knowledge and Understanding were generally stronger in the healthy-weight children (r = 0.29 and 0.22, respectively) compared with the overweight/obese children (r = 0.23 and 0.17, respectively).Conclusions: All of the domains of the CAPL correlate positively with each other regardless of weight status, with a trend for these correlation coefficients to be slightly stronger in the healthy-weight children. The overall weak to moderate correlations between the domains in both groups suggest that the CAPL domains are not measuring the same constructs, thus providing support for CAPL's psychometric architecture in both healthy-weight and overweight/obese children. [ABSTRACT FROM AUTHOR]

Background: The current physical literacy level of Canadian children is unknown. The Royal Bank of Canada (RBC) Learn to Play - Canadian Assessment of Physical Literacy (CAPL) project, which is anchored in the Canadian consensus statement definition of physical literacy, aimed to help establish the current physical literacy level of Canadian children.Methods: The CAPL was used to assess the physical literacy (and component domains: Daily Behaviour, Physical Competence, Knowledge and Understanding, and Motivation and Confidence) of Canadian children aged 8-12 years. Data were collected from 11 sites across Canada, yielding a sample of 10,034 participants (5030 girls). Descriptive statistics by age and gender were calculated and percentile distributions of physical literacy scores, including each domain and individual measure, were derived.Results: The mean age of participants was 10.1 ± 1.2 years. Total physical literacy scores (out of 100) were on average 63.1 ± 13.0 for boys and 62.2 ± 11.3 for girls. For boys and girls respectively, domain scores were 19.9 ± 4.7 and 19.3 ± 4.1 (out of 32) for Physical Competence; 18.6 ± 7.9 and 18.5 ± 7.4 (out of 32) for Daily Behaviour; 12.7 ± 2.8 and 12.2 ± 2.6 (out of 18) for Motivation and Confidence; and 11.8 ± 2.8 and 12.2 ± 2.6 (out of 18) for Knowledge and Understanding. Physical Competence measures were on average 28.1 ± 8.4 cm (sit-and-reach flexibility), 33.5 ± 9.4 kg (grip strength, right + left), 23.4 ± 14.1 laps (Progressive Aerobic Cardiovascular Endurance Run [PACER] shuttle run), 61.8 ± 43.8 s (isometric plank), 19.0 ± 3.8 kg/m2 (body mass index), 67.3 ± 10.8 cm (waist circumference), and 20.6 ± 3.9 out of 28 points for the Canadian Agility and Movement Skill Assessment (CAMSA), with scores for boys higher than girls and older children higher than younger children for grip strength, PACER, plank, and CAMSA score. Girls and younger children had better scores on the sit-and-reach flexibility than boys and older children. Daily pedometer step counts were higher in boys than girls (12,355 ± 4252 vs. 10,779 ± 3624), and decreased with age.Conclusions: These results provide the largest and most comprehensive assessment of physical literacy of Canadian children to date, providing a "state of the nation" baseline, and can be used to monitor changes and inform intervention strategies going forward. [ABSTRACT FROM AUTHOR]

Background: Quality physical education (PE) contributes to the development of physical literacy among children, yet little is known about how teacher training relates to this development. We assessed the association between teacher training, and the likelihood that children met recommended achievement levels for components of physical literacy as defined by the Canadian Assessment of Physical Literacy (CAPL).Methods: Canadian children (n = 4189; M = 10.72 years, SD = 1.19) from six provinces completed the CAPL. Logistic regression was used to examine the relationship between teacher training (generalist/PE specialist), adjusting for children's age and gender, and physical competence protocols (sit and reach, handgrip, plank, Progressive Aerobic Cardiovascular Endurance Run [PACER], body mass index [BMI], waist circumference, Canadian Agility and Movement Skill Assessment [CAMSA]), the four CAPL domain scores, and the total CAPL score.Results: Teacher training, in addition to children's age and gender, explained only a very small proportion of variance in each model (all R2 < 0.03). Children taught by a generalist were less likely to reach recommended levels of motivation and confidence (OR = 0.83, 95% CI, 0.72-0.95) or CAMSA scores (OR = 0.77, 95% CI, 0.67-0.90), even when accounting for a significant increase in CAMSA score with age (OR = 1.18, 95% CI, 1.12-1.26). All other associations between measures of components of physical literacy and teacher training were not significant.Conclusions: While teacher training is hypothesized to contribute to the development of physical literacy among elementary school students, the observed effects in this study were either small or null. Children taught by PE specialists were more likely than those taught by generalists to demonstrate recommended levels of motivation and confidence, and to have better movement skills, which are hypothesized to be critical prerequisites for the development of a healthy lifestyle. Further research with more robust designs is merited to understand the impact of teachers' training on the various components of physical literacy development. [ABSTRACT FROM AUTHOR]

Objective Determine how parental nutrition label use, label literacy, and nutrition knowledge may be associated with cardiovascular health in parents and their children. Design and Setting Cross-sectional analyses of 2006 data from the Healthy Heart Project in Montreal, Canada. Participants Among community recruited families, parents were predominantly mothers (n = 127 [80%]; mean age, 45.0 years) and half of their children were female (44%; mean age, 12.5 years). Main Outcome Measures Blood pressure, lipids, and weight. Nutrition label use, label literacy, and nutrition knowledge among parents were collected using existing scales. Analyses Multivariable linear regression models. Results Among parents, nutrition label use was associated with lower total cholesterol (B[SE] = −.53 [.20]; P = .009), lower low-density lipoprotein (B[SE] = −.57 [.21]; P = .007), and lower total cholesterol/high-density lipoprotein cholesterol ratio (B[SE] = −.82 [.30]; P = .008) but was not associated with adiposity. Among children, greater parental nutrition knowledge was associated with lower body mass index percentiles (B[SE] = −3.6 [1.49]; P = .02), lower waist circumference (B[SE] = −1.27 [.55]; P = .02), and lower percent body fat (B[SE] = −1.28 [.47]; P = .008). Parental nutrition label use or nutrition knowledge was not associated with children's lipids. Conclusions and Implications Parents with greater nutrition label use had more favorable lipids, but children's lipids were unaffected. Children of parents with greater nutrition knowledge had lower adiposity. Further research on the correlates of label use and health is needed. [ABSTRACT FROM AUTHOR]

This section offers research news briefs as of June 2016. The use of electronic cigarettes (e-cigarettes) can reduce cigarette smoking based on research by David Levy of Georgetown University in Washington, D.C. and colleagues. A study from the journal "Pediatrics" has found that packets or capsules are more dangerous than traditional detergent for children. Another study has discovered obesity risk in infants with a high body mass index (BMI) at two months.