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Background Observational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk. However, it remains uncertain whether this association is causal. Objective This study evaluated the feasibility of an intervention to increase cereal fiber intake in children using breakfast cereals. Methods The study was a 2-arm parallel group randomized controlled trial in 9–10-y-old children, who received free supplies of high-fiber breakfast cereals (g3.5 g/portion) or low-fiber breakfast cereals (l1.0 g/portion) to eat daily for 1 mo with behavioral support to promote adherence. Children provided baseline and 1-mo fasting blood samples, physical measurements, and 24-h dietary recalls. The primary outcome was the group difference in change in plasma total alkylresorcinol (AR) concentration; secondary outcomes were group differences in nutrient intakes and adiposity indices. Analyses (complete case and multiple imputation) were conducted by regressing the final AR concentration on baseline AR in models adjusted for sex, ethnicity, age, and school (random effect). Results Two-hundred seventy-two children were randomly assigned (137 receiving a low-fiber and 135 a high-fiber diet) and 193 (71%) provided fasting blood samples at baseline and follow-up. Among randomized participants, median (IQR) of baseline AR was 43.1 (24.6–85.5) nmol/L and of cereal fiber intake was 4.5 (2.7–6.4) g; 87% of participants reported consuming the cereal on most or all days. Compared with changes in the low-fiber group, the high-fiber group had greater increases in AR (40.7 nmol/L; 95% CI: 21.7, 59.8 nmol/L, P l 0.0001) and in reported cereal fiber intake (2.9g/d; 95% CI: 2.0, 3.7 g; P l 0.0001). There were no appreciable differences in other secondary outcomes. Conclusions We have developed a simple and acceptable nutritional intervention that increases markers of daily cereal fiber intake in children. This intervention could be used to test whether increases in cereal fiber intake in children might reduce insulin resistance. This trial was registered at www.isrctn.com as ISRCTN33260236.

The aim of this study was to assess whether adiposity or body composition relates to microvascular characteristics of the retina, indicative of cardiometabolic function. A fully automated QUARTZ software processed retinal images from 68,550 UK Biobank participants (aged 40-69 years). Differences in retinal vessel diameter and tortuosity with body composition measures from the Tanita analyzer were obtained by using multilevel regression analyses adjusted for age, sex, ethnicity, clinic, smoking, and Townsend deprivation index. Venular tortuosity and diameter increased by approximately 2% (P

Background/aims Human grading of digital images from diabetic retinopathy (DR) screening programmes represents a significant challenge, due to the increasing prevalence of diabetes. We evaluate the performance of an automated artificial intelligence (AI) algorithm to triage retinal images from the English Diabetic Eye Screening Programme (DESP) into test-positive/technical failure versus test-negative, using human grading following a standard national protocol as the reference standard. Methods Retinal images from 30 405 consecutive screening episodes from three English DESPs were manually graded following a standard national protocol and by an automated process with machine learning enabled software, EyeArt v2.1. Screening performance (sensitivity, specificity) and diagnostic accuracy (95% CIs) were determined using human grades as the reference standard. Results Sensitivity (95% CIs) of EyeArt was 95.7% (94.8% to 96.5%) for referable retinopathy (human graded ungradable, referable maculopathy, moderate-to-severe non-proliferative or proliferative). This comprises sensitivities of 98.3% (97.3% to 98.9%) for mild-to-moderate non-proliferative retinopathy with referable maculopathy, 100% (98.7%,100%) for moderate-to-severe non-proliferative retinopathy and 100% (97.9%,100%) for proliferative disease. EyeArt agreed with the human grade of no retinopathy (specificity) in 68% (67% to 69%), with a specificity of 54.0% (53.4% to 54.5%) when combined with non-referable retinopathy. Conclusion The algorithm demonstrated safe levels of sensitivity for high-risk retinopathy in a real-world screening service, with specificity that could halve the workload for human graders. AI machine learning and deep learning algorithms such as this can provide clinically equivalent, rapid detection of retinopathy, particularly in settings where a trained workforce is unavailable or where large-scale and rapid results are needed.

Background Adequate sleep duration in childhood has important implications for social, mental, and physical well-being. Recent evidence has demonstrated declining sleep durations in children; therefore effective interventions to improve sleep measures are needed. Despite some trials suggesting that multi-behavioural interventions promoting bed-time routines may be beneficial, the effectiveness of such interventions has not been adequately quantified. Moreover, specific themes and strategies which increase sleep duration, and by how much, have not been formally quantified. Methods We carried out a systematic review and meta-analysis to quantify the effectiveness of sleep interventions to improve sleep duration in children within community settings (PROSPERO ID CRD42019160089). Studies involving infants under 1 year, those using medications, and targeting children with behavioural problems were excluded. We screened 11621 randomised control trials (RCT), after carrying out a search using combined text words and MeSH criteria in CENTRAL, MEDLINE, EMBASE, PSYCHINFO, Web of science, clinicaltrials.gov, and WHO trials databases. Full text screening of 341 studies identified 39 studies for data extraction. All screening was carried out independently by two reviewers using a web-based platform for systematic reviews. Results Studies were categorised by age as follows: 20% in >1–5 years of age, 25% >5–10 years, 33% >10–15 years, 22% >15 years. The mode of delivery of most interventions was face to face (74%). The intervention setting was most commonly school based (54%), with 21% based at home. Intervention duration was less than one month in 49% of studies. Qualitative data to describe each intervention was collected using a framework based on the TIDieR checklist. We are mapping this onto behavioural frameworks (COM-B, theoretical domains framework), to categorise interventions. Our initial analysis, from 9911 participants (4719, intervention, 5192 control) from 33 studies, suggests that mean differences in interventions increase sleep duration by 11 minutes (95% CI 6, 17 mins). However, caution is needed in interpreting this overall effect size (pooled using random effects) given the considerable heterogeneity across studies (I2 = 91%). The influence of study design characteristics in explaining heterogeneity (including age of participants, duration and type of intervention) will be outlined. Conclusion This review furthers our understanding of the most effective interventions to improve sleep duration in children and provides a platform to develop population level health interventions to improve sleep. Given challenges assimilating data, an overarching aim is to develop approaches that could be used to homogenise reporting in future RCTs in order that evidence can be summarised more easily.

Purpose To examine retinal vasculometry associations with different glaucomas in older British people. Design Cross-sectional study. Methods A total of 8,623 European Prospective Investigation into Cancer-Norfolk Eye study participants were examined, who underwent retinal imaging, ocular biometry assessment, and clinical ascertainment of ocular hypertensive or glaucoma status (including glaucoma suspect [GS], high-tension open-angle glaucoma [HTG], and normal-tension glaucoma [NTG]). Automated measures of arteriolar and venular tortuosity, area, and width from retinal images were obtained. MainOutcomeMeasures: Associations between glaucoma and retinal vasculometry outcomes were analyzed using multilevel linear regression, adjusted for age, sex, height, axial length, intraocular and systemic blood pressure, and within-person clustering, to provide absolute differences in width and area, and percentage differences in vessel tortuosity. Presence or absence of within-person-between-eye differences in retinal vasculometry by diagnoses were examined. Results A total of 565,593 vessel segments from 5,947 participants (mean age 67.6 years, SD 7.6 years, 57% women) were included; numbers with HTG, NTG, and GS in at least 1 eye were 87, 82, and 439, respectively. Thinner arterioles (−3.2 μm; 95% confidence interval [CI] −4.4 μm, −1.9 μm) and venules (−2.7 μm; 95% CI −4.9 μm, −0.5 μm) were associated with HTG. Reduced venular area was associated with HTG (−0.2 mm2; 95% CI −0.3 mm2, −0.1 mm2) and NTG (−0.2 mm2; 95% CI −0.3 mm2, −0.0 mm2). Less tortuous retinal arterioles and venules were associated with all glaucomas, but only significantly for GS (−3.9%; 95% CI −7.7%, −0.1% and −4.8%; 95% CI −7.4%, −2.1%, respectively). There was no evidence of within-person-between-eye differences in retinal vasculometry associations by diagnoses. Conclusions Retinal vessel width associations with glaucoma and novel associations with vessel area and tortuosity, together with no evidence of within-person-between-eye differences in retinal vasculometry, suggest a vascular cause of glaucoma., Highlights • Retinal vessel measurements, including (as a first report) vessel tortuosity and area, were associated with high-tension glaucoma and other glaucoma-related outcomes. • Novel analyses showing that within-person-between-eye glaucoma diagnoses, intraocular pressure, and retinal vasculometry were uncorrelated provides further evidence that systemic microvascular changes may cause glaucoma.

AimTo examine the associations of air pollution with both self-reported age-related macular degeneration (AMD), and in vivo measures of retinal sublayer thicknesses.MethodsWe included 115 954 UK Biobank participants aged 40–69 years old in this cross-sectional study. Ambient air pollution measures included particulate matter, nitrogen dioxide (NO2) and nitrogen oxides (NOx). Participants with self-reported ocular conditions, high refractive error (< −6 or > +6 diopters) and poor spectral-domain optical coherence tomography (SD-OCT) image were excluded. Self-reported AMD was used to identify overt disease. SD-OCT imaging derived photoreceptor sublayer thickness and retinal pigment epithelium (RPE) layer thickness were used as structural biomarkers of AMD for 52 602 participants. We examined the associations of ambient air pollution with self-reported AMD and both photoreceptor sublayers and RPE layer thicknesses.ResultsAfter adjusting for covariates, people who were exposed to higher fine ambient particulate matter with an aerodynamic diameter 2.5, per IQR increase) had higher odds of self-reported AMD (OR=1.08, p=0.036), thinner photoreceptor synaptic region (β=−0.16 µm, p=2.0 × 10−5), thicker photoreceptor inner segment layer (β=0.04 µm, p=0.001) and thinner RPE (β=−0.13 µm, p=0.002). Higher levels of PM2.5 absorbance and NO2 were associated with thicker photoreceptor inner and outer segment layers, and a thinner RPE layer. Higher levels of PM10 (PM with an aerodynamic diameter x was associated with thinner photoreceptor synaptic region.ConclusionGreater exposure to PM2.5 was associated with self-reported AMD, while PM2.5, PM2.5 absorbance, PM10, NO2 and NOx were all associated with differences in retinal layer thickness.

Purpose To examine associations between retinal vessel morphometry and cardiometabolic risk factors in older British men and women. Design Retinal imaging examination as part of the European Prospective Investigation into Cancer—Norfolk Eye Study. Participants Retinal imaging and clinical assessments were carried out in 7411 participants. Retinal images were analyzed using a fully automated validated computerized system that provides novel measures of vessel morphometry. Methods Associations between cardiometabolic risk factors, chronic disease, and retinal markers were analyzed using multilevel linear regression, adjusted for age, gender, and within-person clustering, to provide percentage differences in tortuosity and absolute differences in width. Main Outcomes Measures Retinal arteriolar and venular tortuosity and width. Results In all, 279 802 arterioles and 285 791 venules from 5947 participants (mean age, 67.6 years; standard deviation [SD], 7.6 years; 57% female) were analyzed. Increased venular tortuosity was associated with higher body mass index (BMI; 2.5%; 95% confidence interval [CI], 1.7%–3.3% per 5 kg/m 2 ), hemoglobin A1c (HbA1c) level (2.2%; 95% CI, 1.0%–3.5% per 1%), and prevalent type 2 diabetes (6.5%; 95% CI, 2.8%–10.4%); wider venules were associated with older age (2.6 μm; 95% CI, 2.2–2.9 μm per decade), higher triglyceride levels (0.6 μm; 95% CI, 0.3–0.9 μm per 1 mmol/l), BMI (0.7 μm; 95% CI, 0.4–1.0 per 5 kg/m 2 ), HbA1c level (0.4 μm; 95% CI, –0.1 to 0.9 per 1%), and being a current smoker (3.0 μm; 95% CI, 1.7–4.3 μm); smoking also was associated with wider arterioles (2.1 μm; 95% CI, 1.3–2.9 μm). Thinner venules were associated with high-density lipoprotein (HDL) (1.4 μm; 95% CI, 0.7–2.2 per 1 mmol/l). Arteriolar tortuosity increased with age (5.4%; 95% CI, 3.8%–7.1% per decade), higher systolic blood pressure (1.2%; 95% CI, 0.5%–1.9% per 10 mmHg), in females (3.8%; 95% CI, 1.4%–6.4%), and in those with prevalent stroke (8.3%; 95% CI, –0.6% to 18%); no association was observed with prevalent myocardial infarction. Narrower arterioles were associated with age (0.8 μm; 95% CI, 0.6–1.0 μm per decade), higher systolic blood pressure (0.5 μm; 95% CI, 0.4–0.6 μm per 10 mmHg), total cholesterol level (0.2 μm; 95% CI, 0.0–0.3 μm per 1 mmol/l), and HDL (1.2 μm; 95% CI, 0.7–1.6 μm per 1 mmol/l). Conclusions Metabolic risk factors showed a graded association with both tortuosity and width of retinal venules, even among people without clinical diabetes, whereas atherosclerotic risk factors correlated more closely with arteriolar width, even excluding those with hypertension and cardiovascular disease. These noninvasive microvasculature measures should be evaluated further as predictors of future cardiometabolic disease.

ObjectivesTo examine the association of sociodemographic characteristics with attendance at diabetic eye screening in a large ethnically diverse urban population.DesignRetrospective cohort study.SettingScreening visits in the North East London Diabetic Eye Screening Programme (NELDESP).Participants84 449 people with diabetes aged 12 years or older registered in the NELDESP and scheduled for screening between 1 April 2017 and 31 March 2018.Main outcome measureAttendance at diabetic eye screening appointments.ResultsThe mean age of people with diabetes was 60 years (SD 14.2 years), 53.4% were men, 41% South Asian, 29% White British and 17% Black; 83.4% attended screening. Black people with diabetes had similar levels of attendance compared with White British people. However, South Asian, Chinese and 'Any other Asian' background ethnicities showed greater odds of attendance compared with White British. When compared with their respective reference group, high levels of deprivation, younger age, longer duration of diabetes and worse visual acuity, were all associated with non-attendance. There was a higher likelihood of attendance per quintile improvement in deprivation (OR, 1.06; 95% CI, 1.03 to 1.08), with increasing age (OR per decade, 1.17; 95% CI, 1.15 to 1.19), with better visual acuity (OR per Bailey-Lovie chart line 1.12; 95% CI, 1.11 to 1.14) and with longer time of NELDESP registration (OR per year, 1.02; 95% CI, 1.01 to 1.03).ConclusionEthnic differences in diabetic eye screening uptake, though small, are evident. Despite preconceptions, a higher likelihood of screening attendance was observed among Asian ethnic groups when compared with the White ethnic group. Poorer socioeconomic profile was associated with higher likelihood of non-attendance for screening. Further work is needed to understand how to target individuals at risk of non-attendance and reduce inequalities.

OBJECTIVE: With the increasing prevalence of diabetes, annual screening for diabetic retinopathy (DR) by expert human grading of retinal images is challenging. Automated DR image assessment systems (ARIAS) may provide clinically effective and cost-effective detection of retinopathy. We aimed to determine whether ARIAS can be safely introduced into DR screening pathways to replace human graders. DESIGN: Observational measurement comparison study of human graders following a national screening program for DR versus ARIAS. PARTICIPANTS: Retinal images from 20 258 consecutive patients attending routine annual diabetic eye screening between June 1, 2012, and November 4, 2013. METHODS: Retinal images were manually graded following a standard national protocol for DR screening and were processed by 3 ARIAS: iGradingM, Retmarker, and EyeArt. Discrepancies between manual grades and ARIAS results were sent to a reading center for arbitration. MAIN OUTCOME MEASURES: Screening performance (sensitivity, false-positive rate) and diagnostic accuracy (95% confidence intervals of screening-performance measures) were determined. Economic analysis estimated the cost per appropriate screening outcome. RESULTS: Sensitivity point estimates (95% confidence intervals) of the ARIAS were as follows: EyeArt 94.7% (94.2%-95.2%) for any retinopathy, 93.8% (92.9%-94.6%) for referable retinopathy (human graded as either ungradable, maculopathy, preproliferative, or proliferative), 99.6% (97.0%-99.9%) for proliferative retinopathy; Retmarker 73.0% (72.0 %-74.0%) for any retinopathy, 85.0% (83.6%-86.2%) for referable retinopathy, 97.9% (94.9%-99.1%) for proliferative retinopathy. iGradingM classified all images as either having disease or being ungradable. EyeArt and Retmarker saved costs compared with manual grading both as a replacement for initial human grading and as a filter prior to primary human grading, although the latter approach was less cost-effective. CONCLUSIONS: Retmarker and EyeArt systems achieved acceptable sensitivity for referable retinopathy when compared with that of human graders and had sufficient specificity to make them cost-effective alternatives to manual grading alone. ARIAS have the potential to reduce costs in developed-world health care economies and to aid delivery of DR screening in developing or remote health care settings.

Supplemental Digital Content is available in the text., To examine the baseline associations of retinal vessel morphometry with blood pressure (BP) and arterial stiffness in United Kingdom Biobank. The United Kingdom Biobank included 68 550 participants aged 40 to 69 years who underwent nonmydriatic retinal imaging, BP, and arterial stiffness index assessment. A fully automated image analysis program (QUARTZ [Quantitative Analysis of Retinal Vessel Topology and Size]) provided measures of retinal vessel diameter and tortuosity. The associations between retinal vessel morphology and cardiovascular disease risk factors/outcomes were examined using multilevel linear regression to provide absolute differences in vessel diameter and percentage differences in tortuosity (allowing within person clustering), adjusted for age, sex, ethnicity, clinic, body mass index, smoking, and deprivation index. Greater arteriolar tortuosity was associated with higher systolic BP (relative increase, 1.2%; 95% CI, 0.9; 1.4% per 10 mmHg), higher mean arterial pressure, 1.3%; 0.9, 1.7% per 10 mmHg, and higher pulse pressure (PP, 1.8%; 1.4; 2.2% per 10 mmHg). Narrower arterioles were associated with higher systolic BP (−0.9 µm; −0.94, −0.87 µm per 10 mmHg), mean arterial pressure (−1.5 µm; −1.5, −1.5 µm per 10 mmHg), PP (−0.7 µm; −0.8, −0.7 µm per 10 mmHg), and arterial stiffness index (−0.12 µm; −0.14, −0.09 µm per ms/m2). Associations were in the same direction but marginally weaker for venular tortuosity and diameter. This study assessing the retinal microvasculature at scale has shown clear associations between retinal vessel morphometry, BP, and arterial stiffness index. These observations further our understanding of the preclinical disease processes and interplay between microvascular and macrovascular disease.

Background Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents. Methods Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs. Results Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05). Conclusion Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.

Background Vascular risk factors are implicated in the aetiology of polymyalgia rheumatica (PMR) but lack sensitivity as a screening tool to assess risk of future disease or disease progression. Retinal vascular measures from digital images of the retinal fundus provide a direct objective measure of vascular health and have potential value in estimating future disease risk. Objectives The aim of this study was to determine if quantitative changes on retinal vasculometric imaging could be detected prior to the onset of PMR among a large prospective population-based cohort with a view to assessing their clinical utility as a biomarker of disease risk. Methods Known risk factors for vascular disease were obtained at enrolment to the EPIC-Norfolk cohort in 1993, with data available on BMI, blood pressure, smoking status and blood drawn for cholesterol and high-sensitivity C-reactive protein. Eye screening took place between 2004 to 2011. Cases of PMR were identified retrospectively among 8112 volunteers by: (i) free text questionnaire responses at baseline, 18 months, 3, 10 and 13 years; (ii) linkage to hospital electronic discharge summaries containing ICD codes (iii) linkage to key word searches (polymyalgia or rheumatica) of out-patient clinic letters. Case definition conformed to validated methods. Measures of retinal vessel width were generated by an automated software programme (QUARTZ), using Gaussian modelling to determine vessel widths and an ensemble classifier of bagged decision trees to classify vessels into either venules or arterioles with greater than 80% probability. Stepwise Cox modelling was used to investigate vascular risk factors, including vasculometric characteristics, and subsequent development of PMR, within a multivariate adjusted model. Results We identified 71 cases of PMR (median age at diagnosis: 70.5 years, minimum 50.5 years, maximum 87.0 years; mean ESR at diagnosis: 52 mm/hr; 67.6% female) amongst 5130 participants who attended ocular screening and had high quality retinal images acceptable for analysis. There were 50 incident diagnosis of PMR with vascular risk data recorded at enrolment into EPIC-Norfolk prior to their diagnosis of PMR. Results from the univariate Cox modelling revealed positive associations for age, female sex, low-density lipoprotein (LDL) and retinal venular width. There were no associations for arteriolar measures. After adjustment a positive association remained for age and venular dilatation: the hazard ratio for age was 1.14 (95% CI 1.09, 1.18) p Conclusion Retinal venular dilatation is a marker of vascular health and within this data an independent risk factor for subsequent development of PMR. Retinal fundus images are easily captured in the clinical setting. While validation of these findings in other datasets is warranted, they provide a potential biomarker for assessment of PMR risk. Disclosure of Interests None declared

There is a need to accurately quantify levels of adiposity in order to identify overweight and obesity in children. This systematic review aimed to identify all diagnostic accuracy studies evaluating simple tests for obesity and adiposity, including body mass index (BMI), skin-fold thickness and waist circumference, compared against high-quality reference tests. Twenty-four cohort studies including 25,807 children were included. BMI had good performance when diagnosing obesity: a sensitivity of 81.9% (95% confidence interval [CI]: 73.0 to 93.8) for a specificity of 96.0% (95% CI: 93.8 to 98.1). It was less effective at diagnosing overweight (sensitivity: 76.3%, 95% CI: 70.2 to 82.4; specificity: 92.1% 95% CI: 90.0 to 94.3). When diagnosing obesity, waist circumference had similar performance (sensitivity: 83.8%; specificity: 96.5%). Skin-fold thickness had slightly poorer performance (sensitivity: 72.5%; specificity: 93.7%). Few studies considered any other tests. There was no conclusive evidence that any test was generally superior to the others. BMI is a good simple diagnostic test for identifying childhood adiposity. It identifies most genuinely obese and adipose children while misclassifying only a small number as obese. There was no conclusive evidence that any test should be preferred to BMI, and the extra complexity of skin-fold thickness tests does not appear to improve diagnostic accuracy.

Background There has been increasing interest in whether the built environmentinfluences health behaviours, but robust longitudinal evidence is limited. We assessed the effect of moving into East Village (the former London 2012 Olympic Games Athletes Village), a neighbourhood built on active design principles, on levels of physical activity (PA) and adiposity among adults. Methods A cohort of 1278 adults (16+) seeking to move into social, intermediate (a mixture of shared ownership, shared equity, affordable rent), and market-rent East Village accommodation were recruited in 2013–2015, and followed up after two years. Objective measures of PA using accelerometry (ActiGraph GT3X+), body mass index (BMI) and bioelectrical impedance (fat mass %) were made. We examined change in levels of PA and adiposity, using multilevel models adjusting for sex, age group, ethnicity, housing sector (fixed effects) and household (random effect), comparing those who moved to East Village (intervention group) with those who lived outside East Village (control group). Effects by housing sector and weekdays versus weekends for PA were also examined. Results 877 adults (69%) were followed-up, half had moved to East Village. Moving to East Village was associated with a small increase in daily steps (151, 95% CI −233, 534), more so in the intermediate sector (399, 95% CI −211, 1009) than in the social and market-rent sectors, but effects were not statistically significant. There were no differences in time spent in moderate-to-vigorous PA (MVPA) or any appreciable weekday versus weekend effects. There was no evidence of differences in time spent in light PA or sedentary time both overall and by housing sector with the exception of the market-rent group in whom moving to East Village was associated with a decrease in light PA (−13.0 mins, 95% CI −24.7,–1.2 mins). There were no effects of moving to East Village on BMI or fat mass% overall or by housing sector. Conclusion At two-year follow-up, moving to East Village, a neighbourhood designed for healthy active living, did not have beneficial, consistent effects on objectively measured physical activity or adiposity of public health importance.

The aim of this review was to quantify the global variation in childhood myopia prevalence over time taking account of demographic and study design factors. A systematic review identified population-based surveys with estimates of childhood myopia prevalence published by February 2015. Multilevel binomial logistic regression of log odds of myopia was used to examine the association with age, gender, urban versus rural setting and survey year, among populations of different ethnic origins, adjusting for study design factors. 143 published articles (42 countries, 374 349 subjects aged 1- 18 years, 74 847 myopia cases) were included. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence, reaching 69% (95% credible intervals (CrI) 61% to 77%) at 15 years of age (86% among Singaporean-Chinese). Blacks in Africa had the lowest prevalence; 5.5% at 15 years (95% CrI 3% to 9%). Time trends in myopia prevalence over the last decade were small in whites, increased by 23% in East Asians, with a weaker increase among South Asians. Children from urban environments have 2.6 times the odds of myopia compared with those from rural environments. In whites and East Asians sex differences emerge at about 9 years of age; by late adolescence girls are twice as likely as boys to be myopic. Marked ethnic differences in age-specific prevalence of myopia exist. Rapid increases in myopia prevalence over time, particularly in East Asians, combined with a universally higher risk of myopia in urban settings, suggest that environmental factors play an important role in myopia development, which may offer scope for prevention.

A systematic review and meta-analysis was performed to investigate the ability of simple measures of childhood obesity such as body mass index (BMI) to predict future obesity in adolescence and adulthood. Large cohort studies, which measured obesity both in childhood and in later adolescence or adulthood, using any recognized measure of obesity were sought. Study quality was assessed. Studies were pooled using diagnostic meta-analysis methods. Fifteen prospective cohort studies were included in the meta-analysis. BMI was the only measure of obesity reported in any study, with 200,777 participants followed up. Obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Around 55% of obese children go on to be obese in adolescence, around 80% of obese adolescents will still be obese in adulthood and around 70% will be obese over age 30. Therefore, action to reduce and prevent obesity in these adolescents is needed. However, 70% of obese adults were not obese in childhood or adolescence, so targeting obesity reduction solely at obese or overweight children needs to be considered carefully as this may not substantially reduce the overall burden of adult obesity.

Obese children are at higher risk of being obese as adults, and adult obesity is associated with an increased risk of morbidity. This systematic review and meta-analysis investigates the ability of childhood body mass index (BMI) to predict obesity-related morbidities in adulthood. Thirty-seven studies were included. High childhood BMI was associated with an increased incidence of adult diabetes (OR 1.70; 95% CI 1.30-2.22), coronary heart disease (CHD) (OR 1.20; 95% CI 1.10-1.31) and a range of cancers, but not stroke or breast cancer. The accuracy of childhood BMI when predicting any adult morbidity was low. Only 31% of future diabetes and 22% of future hypertension and CHD occurred in children aged 12 or over classified as being overweight or obese. Only 20% of all adult cancers occurred in children classified as being overweight or obese. Childhood obesity is associated with moderately increased risks of adult obesity-related morbidity, but the increase in risk is not large enough for childhood BMI to be a good predictor of the incidence of adult morbidities. This is because the majority of adult obesity-related morbidity occurs in adults who were of healthy weight in childhood. Therefore, targeting obesity reduction solely at obese or overweight children may not substantially reduce the overall burden of obesity-related disease in adulthood.

Background: Pediatric blood pressure (BP) levels are typically assigned to categories when they exceed sex-, age-, and height-specific 90th (elevated) and 95th percentile (high) cutoffs. Given the number of stratum, there are hundreds of cutoffs for defining elevated and high BP that make it cumbersome to use in clinical practice. In 2017 the American Academy of Pediatrics (AAP) recommended simplified cutoffs of ≥120/80 mmHg and ≥130/80 mmHg be used to diagnose elevated BP and high BP, respectively, in clinical practice for adolescents aged 13-17 years. Accordingly, we suggest cutoffs of ≥110/70 mmHg and ≥120/80 mmHg be used for elevated BP and high BP among children aged 6-12 years. The aim of this study was to evaluate the utility of the simplified cutoffs for pediatric BP in determining high carotid intima-media thickness (cIMT) in children and adolescents. Methods: Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain and the UK. A total of 4280 children and adolescents aged 6-17 years were included. High cIMT was defined as cIMT ≥sex-, age- and cohort-specific 90th percentile cutoffs. Logistic regression model, receiver operating characteristic (ROC) curve and net reclassification improvement (NRI) methods were used to compare the performance of the simplified definition with three established complex definitions (i.e. 2017 AAP guideline, 2004 Fourth Report, and 2016 international BP references) in determining high cIMT (≥sex-, age- and cohort-specific 90th percentile of cIMT) in children and adolescents. Results: Compared with those who had normal BP, participants with high BP defined using either of the three complex definitions or simplified definition had similar odds of high cIMT, with odds ratios and 95% confidence intervals of 1.46 (1.15-1.86), 1.47 (1.10-1.96), 1.42 (1.12-1.80), and 1.65 (1.25-2.17), respectively, after adjustment for sex, age, race/ethnicity, body mass index, high density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of all four high BP definitions in determining high cIMT were further confirmed by area under the ROC curve and NRI methods (all p for difference >0.05). Interpretation: The simplified BP definition performed similarly with three complex definitions in determining high cIMT in children and adolescents. The simplified definition offers a similarly accurate but more convenient means to identify pediatric high BP in clinical practice. Funding: Dr Bo Xi was supported by the National Natural Science Foundation of China (81673195). Dr. Costan G. Magnussen was supported by a National Heart Foundation of Australia Future Leader Fellowship (100849). Declaration of Interest: None Ethical Approval: Each study was approved by the corresponding institutional review board, and written informed consent was obtained from all study participants and their parents or guardians.

PURPOSE. We explored risk factors for myopia in 12- to 13-year-old children in Northern Ireland (NI). METHODS. Stratified random sampling was performed to obtain representation of schools and children. Cycloplegia was achieved using cyclopentolate hydrochloride 1%. Distance autorefraction was measured using the Shin-Nippon SRW-5000 device. Height and weight were measured. Parents and children completed a questionnaire, including questions on parental history of myopia, sociodemographic factors, childhood levels of near vision, and physical activity to identify potential risk factors for myopia. Myopia was defined as spherical equivalent ≤0.50 diopters (D) in either eye. RESULTS. Data from 661 white children aged 12-to 13-years showed that regular physical activity was associated with a lower estimated prevalence of myopia compared to sedentary lifestyles (odds ratio [OR] = 0.46 adjusted for age, sex, deprivation score, family size, school type, urbanicity; 95% confidence interval [CI], 0.23–0.90; P for trend = 0.027). The odds of myopia were more than 2.5 times higher among children attending academically-selective schools (adjusted OR = 2.66; 95% CI, 1.48–4.78) compared to nonacademically-selective schools. There was no evidence of an effect of urban versus nonurban environment on the odds of myopia. Compared to children with no myopic parents, children with one or both parents being myopic were 2.91 times (95% CI, 1.54–5.52) and 7.79 times (95% CI, 2.93– 20.67) more likely to have myopia, respectively. CONCLUSIONS. In NI children, parental history of myopia and type of schooling are important determinants of myopia. The association between myopia and an environmental factor, such as physical activity levels, may provide insight into preventive strategies.

Background The National Child Measurement Programme (NCMP) assesses patterns of overweight–obesity in English children. It uses body mass index (BMI), which overestimates body fatness in South Asian children and underestimates body fatness in black children of presumed African ethnicity. Using previously derived BMI adjustments, ensuring that adjusted BMI was similarly related to body fatness in South Asian, black, and white children, we reassessed population body fatness, overweight, and obesity patterns in these ethnic groups in the NCMP. Methods Analyses were based on 2012–13 NCMP data in 582 899 children aged 4–5 years and 485 362 children aged 10–11 years. Standard centile-based approaches defined weight status in each age-group before and after applying BMI adjustments, derived previously with the deuterium dilution method, for South Asian and black children. Findings Among white children, overweight–obesity prevalences were 23% (45 508/197 691) for boys and 21% (39 411/188 663) for girls in 4–5 year olds and 33% (52 635/160 278) and 30% (45 978/151 146), respectively, in 10–11 year olds. Before adjustment, South Asian children had lower overweight–obesity prevalences at 4–5 years (19% of boys [4485/23 191], 19% of girls [4176/22 109]; both p Interpretation Adjusted BMI data reveal a substantial excess of overweight–obesity among English South Asian children (at 4–5 years and especially at 10–11 years) and among black girls (aged 10–11 years), with important implications for prevention. These patterns are not apparent with the use of unadjusted BMI data, which systematically underestimated overweight–obesity prevalences in South Asian children and overestimated them in black children. Funding British Heart Foundation, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London & North Thames).

BACKGROUND: Associations between sleep duration and type 2 diabetes (T2D) risk markers in childhood have been little studied. We examined associations between self-reported sleep duration and T2D risk markers in children. METHODS: Cross-sectional study of 4525 multiethnic UK children aged 9 to 10 years. Sleep time was calculated from self-reported usual time of going to bed and getting up on a school day, validated in a subset using accelerometers. Fasting blood samples provided levels of serum lipids and insulin, plasma glucose, and HbA1c. Physical measures included height, weight, bioimpedance, and blood pressure. Multilevel linear regression models of anthropometric, T2D, and cardiovascular risk markers with sleep duration were adjusted for sex, age, month, ethnicity, socioeconomic position, observer (physical measures only), and random effect of school. RESULTS: On average, children slept 10.5 hours per night (95% range 8.0–12.0 hours). There were strong inverse graded relationships between sleep duration, adiposity, and diabetes risk markers. In adjusted models, a 1-hour-longer sleep duration was associated with 0.19 lower BMI (95% confidence interval [CI] 0.09 to 0.28), 0.03 kg/m5 lower fat mass index (95% CI 0.00 to 0.05 kg/m5), 2.9% lower homeostasis model assessment insulin resistance (95% CI 1.2% to 4.4%), and 0.24% lower fasting glucose (95% CI 0.03% to 0.44%); there was no association with HbA1c or cardiovascular risk. Associations with insulin and glucose remained after an additional adjustment for adiposity markers. CONCLUSIONS: The finding of an inverse association between sleep duration and T2D risk markers in childhood is novel. Intervention studies are needed to establish the causality of these associations, which could provide a simple strategy for early T2D prevention.

OBJECTIVE Energy intake, energy density, and nutrient intakes are implicated in type 2 diabetes risk in adults, but little is known about their influence on emerging type 2 diabetes risk in childhood. We examined these associations in a multiethnic population of children. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 2,017 children predominantly of white European, South Asian, and black African-Caribbean origin aged 9–10 years who had a detailed 24-h dietary recall and measurements of body composition and provided a fasting blood sample for measurements of plasma glucose, HbA1c, and serum insulin; homeostasis model assessment of insulin resistance was also derived. RESULTS Energy intake was positively associated with insulin resistance. After the removal of 176 participants with implausible energy intakes (unlikely to be representative of habitual intake), energy intake was more strongly associated with insulin resistance and was also associated with glucose and fat mass index. Energy density was also positively associated with insulin resistance and fat mass index. However, in mutually adjusted analyses, the associations for energy intake remained while those for energy density became nonsignificant. Individual nutrient intakes showed no associations with type 2 diabetes risk markers. CONCLUSIONS Higher total energy intake was strongly associated with high levels of insulin resistance and may help to explain emerging type 2 diabetes risk in childhood. Studies are needed to establish whether reducing energy intake produces sustained favorable changes in insulin resistance and circulating glucose levels.

OBJECTIVE Ethnic differences in type 2 diabetes risk between South Asians and white Europeans originate before adult life and are not fully explained by higher adiposity levels in South Asians. Although metabolic sensitivity to adiposity may differ between ethnic groups, this has been little studied in childhood. We have therefore examined the associations among adiposity, insulin resistance, and glycemia markers in children of different ethnic origins. RESEARCH DESIGN AND METHODS Cross-sectional study of 4,633 9- to 10-year-old children (response rate 68%) predominantly of South Asian, black African-Caribbean, and white European origin (n = 1,266, 1,176, and 1,109, respectively) who had homeostasis model assessments of insulin resistance (HOMA-IR), glycemia markers (HbA1c and fasting glucose), and adiposity (BMI, waist circumference, skinfold thicknesses, and bioimpedance [fat mass]). RESULTS All adiposity measures were positively associated with HOMA-IR in all ethnic groups, but associations were stronger among South Asians compared to black African-Caribbeans and white Europeans. For a 1-SD increase in fat mass percentage, percentage differences in HOMA-IR were 37.5% (95% CI 33.3–41.7), 29.7% (25.8–33.8), and 27.0% (22.9–31.2), respectively (P interaction < 0.001). All adiposity markers were positively associated with HbA1c in South Asians and black African-Caribbeans but not in white Europeans; for a 1-SD increase in fat mass percentage, percentage differences in HbA1c were 0.04% (95% CI 0.03–0.06), 0.04% (0.02–0.05), and 0.02% (−0.00 to 0.04), respectively (P interaction < 0.001). Patterns for fasting glucose were less consistent. CONCLUSIONS South Asian children are more metabolically sensitive to adiposity. Early prevention or treatment of childhood obesity may be critical for type 2 diabetes prevention, especially in South Asians.

OBJECTIVE: Little is known about levels of physical fitness in children from different ethnic groups in the UK. We therefore studied physical fitness in UK children (aged 9-10 years) of South Asian, black African-Caribbean and white European origin. DESIGN: Cross-sectional study. SETTING: Primary schools in the UK. PARTICIPANTS: 1625 children (aged 9-10 years) of South Asian, black African-Caribbean and white European origin in the UK studied between 2006 and 2007. OUTCOME MEASURES: A step test assessed submaximal physical fitness from which estimated VO2 max was derived. Ethnic differences in estimated VO2 max were estimated using multilevel linear regression allowing for clustering at school level and adjusting for age, sex and month as fixed effects. RESULTS: The study response rate was 63%. In adjusted analyses, boys had higher levels of estimated VO2 max than girls (mean difference 3.06 mL O2/min/kg, 95% CI 2.66 to 3.47, p

BACKGROUND: UK estimates of age related macular degeneration (AMD) occurrence vary. AIMS: To estimate prevalence, number and incidence of AMD by type in the UK population aged ≥50 years. METHODS: Age-specific prevalence rates of AMD obtained from a Bayesian meta-analysis of AMD prevalence were applied to UK 2007-2009 population data. Incidence was estimated from modelled age-specific prevalence. RESULTS: Overall prevalence of late AMD was 2.4% (95% credible interval (CrI) 1.7% to 3.3%), equivalent to 513 000 cases (95% CrI 363 000 to 699 000); estimated to increase to 679 000 cases by 2020. Prevalences were 4.8% aged ≥65 years, 12.2% aged ≥80 years. Geographical atrophy (GA) prevalence rates were 1.3% (95% CrI 0.9% to 1.9%), 2.6% (95% CrI 1.8% to 3.7%) and 6.7% (95% CrI 4.6% to 9.6%); neovascular AMD (NVAMD) 1.2% (95% CrI 0.9% to 1.7%), 2.5% (95% CrI 1.8% to 3.4%) and 6.3% (95% CrI 4.5% to 8.6%), respectively. The estimated number of prevalent cases of late AMD were 60% higher in women versus men (314 000 cases in women, 192 000 men). Annual incidence of late AMD, GA and NVAMD per 1000 women was 4.1 (95% CrI 2.4% to 6.8%), 2.4 (95% CrI 1.5% to 3.9%) and 2.3 (95% CrI 1.4% to 4.0%); in men 2.6 (95% CrI 1.5% to 4.4%), 1.7 (95% CrI 1.0% to 2.8%) and 1.4 (95% CrI 0.8% to 2.4%), respectively. 71 000 new cases of late AMD were estimated per year. CONCLUSIONS: These estimates will guide health and social service provision for those with late AMD and enable estimation of the cost of introducing new treatments.

Objective— To examine the association between cardiovascular risk factors and retinal arteriolar tortuosity in a multi-ethnic child population. Methods and Results— Cross sectional study of 986 UK primary school children of South Asian, black African Caribbean, and white European origin aged 10 to 11 years. Anthropometric measurements and retinal imaging were carried out and a fasting blood sample collected. Digital images of retinal arterioles were analyzed using a validated semiautomated measure of tortuosity. Associations between tortuosity and cardiometabolic risk factors were analyzed using multi-level linear regression, adjusted for gender, age, ethnicity, arteriole branch status, month, and school. Levels of arteriolar tortuosity were similar in boys and girls and in different ethnic groups. Retinal arteriolar tortuosity was positively associated with levels of triglyceride, total and LDL cholesterol, and systolic and diastolic blood pressure. One standard deviation increases in these risk factors were associated with 3.7% (95% CI: 1.2%, 6.4%), 3.3% (0.9%, 5.8%), 3.1% (0.6%, 5.6%), 2.0% (−0.3%, 4.2%), and 2.3% (0.1%, 4.6%) increases in tortuosity, respectively. Adiposity, insulin resistance, and blood glucose showed no associations with tortuosity. Conclusion— Established cardiovascular risk factors, strongly linked to coronary heart disease in adulthood, may influence retinal arteriolar tortuosity at the end of the first decade of life.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • In vitro studies suggest that β-adrenoceptor blocker therapy inhibits cancer cell proliferation and migration leading to their consideration as novel therapeutic agents for cancer. • While trials in humans have suggested β-adrenoceptor blockers have no effect on cancer incidence, their effect on cancer survival has not been studied. • Recent limited evidence in breast cancer patients suggests that β-adrenoceptor blockers may improve cancer-specific survival. WHAT THIS STUDY ADDS • This study is the first to examine cancer survival in patients receiving β-adrenoceptor blockers across a range of common cancers in a large population-based sample. • For common tumour sites, including lung, breast and colon, there was no evidence that β-adrenoceptor blocker treatment modified overall survival but poorer survival was seen in patients with prostate and pancreatic cancer. • Our findings do not support development of clinical trials on β-adrenoceptor blocker therapy for cancer without further evidence of a beneficial effect in humans. AIMS To examine the effect of β-adrenoceptor blocker treatment on cancer survival. METHODS In a UK primary care database, we compared patients with a new cancer diagnosis receiving β-adrenoceptor blockers regularly (n= 1406) with patients receiving other antihypertensive medication (n= 2056). RESULTS Compared with cancer patients receiving other antihypertensive medication, patients receiving β-adrenoceptor blocker therapy experienced slightly poorer survival (HR = 1.18, 95% CI 1.04, 1.33 for all β-adrenoceptor blockers; HR = 1.21, 95% CI 0.94, 1.55 for non-selective β-adrenoceptor blockers). This poorer overall survival was explained by patients with pancreatic and prostate cancer with no evidence of an effect on survival for patients with lung, breast or colorectal cancer. Analysis in a cancer-free matched parallel cohort did not suggest selection bias masked a beneficial effect. CONCLUSION Our study does not support the hypothesis that β-adrenoceptor blockers improve survival for common cancers.

Objective Although obesity beginning early in life is becoming more common, its implications for coronary heart disease (CHD) risk in later life remain uncertain. We examined the relationship of body mass index (BMI) before 30 years of age to CHD risk in later life. Design Systematic review of published studies relating BMI between age 2-30 years to later CHD risk. Studies were identified using Medline (1950 onwards), Embase (1980 onwards) and Web of Science (1970 onwards) databases (to November 2007). Measurements Relative risks (RR) of CHD associated with a 1 standard deviation (SD) increase in BMI (most based on a narrow age-range at measurement) were extracted by 2 authors independently, and combined using random-effect models. Results Fifteen studies provided seventeen estimates (731,337 participants, 23,894 CHD events) of the association of early BMI to later CHD outcome. BMI in early childhood (2 to 6 years, 3 estimates) showed a weak inverse association with CHD risk (RR 0.94, 95% CI 0.82-1.07). BMI in later childhood (7 to

To examine trends and demographic factors affecting persistence with ocular hypotensive therapy, from a period before prostaglandins were available to when they were the most common therapy.Computerised patient records from 94 general practices across the United Kingdom, identified 5670 registered patients newly prescribed an ocular hypotensive drug (1993-2005). Persistence was defined as continuing therapy without a 90-day gap in prescription for (i) any ocular hypotensive and (ii) initial monotherapy. Time to failure with the treatment was compared using proportional hazard analyses, adjusted for age, gender, practice, year of initial treatment, and a sociodemographic indicator. Study findings were set in the context of a review of the literature.Percentage persistent at 1-year rose after 1997 when prostaglandins were introduced; from 61% in 1994-1996 to 70% in 2002-2004. Persistence with any treatment did not differ between those initiated on beta-blockers compared to prostaglandins (1.05, 95% CI 0.93-1.17). However, 20% of subjects initiated on beta-blockers received a prostaglandin by 1 year. Conversely, 8% of those initiated on prostaglandins received a beta-blocker. When failure with initial therapy was considered, beta-blockers appeared worse (1.35, 95% CI 1.21-1.50); this was consistent with findings from six studies in the review (1.40, 95% CI 1.34-1.46). Neither gender nor social factors were associated with persistence, but younger subjects (35-64 years) were significantly more likely to fail as were those over 85 years.Introduction of prostaglandins may explain an improvement in persistence over a decade. However, whether the higher cost of initiating patients on prostaglandins is justified remains questionable unless clinically indicated.

Diabetes is associated with loss of capillaries and macrovessel dilation in the conjunctiva, similar to well-known vessel changes in the retina. However, little is known about the effect of diabetes on the tortuosity of vessels of the conjunctiva. The authors examined the tortuosity of conjunctival vessels in participants with and without diabetes.Case-control study.Fifty-three patients with diabetes (17 with type 1 diabetes, 36 with type 2 diabetes) and 60 controls (all aged 20-94 years).Digital red-free images of conjunctivae were analyzed using an automated computer algorithm to identify vessel axes and to quantify vessel tortuosity. Differences in vessel tortuosity were adjusted for age, gender, blood pressure, and smoking status.Tortuosity was expressed in units of curve energy (the square of the radian angular change between subsequent locations identified by the algorithm, standardized by vessel length).A longer duration of diabetes was associated with a reduction in overall vessel tortuosity (-2.8%; 95% confidence interval [CI], -4.3% to -1.3% per decade). This inverse association was driven by changes in larger vessels (40 microm in width or more), whereas increased tortuosity was observed in capillary sized vessels (25 microm, 4.0%; 95% CI, -0.2% to 8.2% per decade). Compared with controls, those with type 1 diabetes (median duration of disease, 26 years) showed a 17.9% increase (95% CI, 4.7% to -31.0%) in capillary tortuosity. Conversely, those with type 1 diabetes showed a 7% decrease (95% CI, -11.8% to -2.3%) in tortuosity among vessels 40 to 80 microm or less in size and a 26.8% decrease (95% CI, -66.2% to 12.7%) in the fewer number of vessels more than 80 microm in size compared with controls. Similar, but smaller differences were seen in those with type 2 diabetes with shorter duration of diabetes (median, 7 years).Macrovessel dilation associated with diabetes may result in vessel engorgement and straightening, especially among those with longer durations of disease. Increased tortuosity associated with diabetes among conjunctival capillaries mirrors established vessel changes observed in the retina. Conjunctival angiopathy associated with diabetes may contribute to susceptibility to anterior eye disease among patients with diabetes.

Objectives: To assess physical activity (PA) levels measured objectively using accelerometers in community-dwelling older people and to examine the associations with health, disability, anthropometric measures and psychosocial factors. Design: Cross-sectional survey. Setting: Single general practice (primary care centre), United Kingdom. Participants: Random selection of 560 community-dwelling older people at least 65 years old, registered with the practice. 43% (238/560) participated. Assessment of risk factors: Participants completed a questionnaire assessing health, disability, psychosocial factors and PA levels; underwent anthropometric assessment; and wore an accelerometer (Actigraph) for 7 days. Main outcome measures: Average daily accelerometer step-counts and time spent in different PA levels. Associations between step-counts and other factors were examined using linear regression. Results: Average daily step-count was 6443 (95% CI 6032 to 6853). Men achieved 754 (84 to 1424) more steps daily than women. Step-count declined steadily with age. Independent predictors of average daily step-count were: age; general health; disability; diabetes; body mass index; exercise self-efficacy; and perceived exercise control. Activities associated independently with higher step-counts included number of long walks and dog-walking. Only 2.5% (6/238) of participants achieved the recommended 150 minutes weekly of at least moderate-intensity activity in ⩾10 minute bouts; 62% (147/238) achieved none. Conclusions: This is the first population-based sample of older people with objective PA and anthropometric measures. PA levels in older people are well below recommended levels, emphasising the need to increase PA in this age group, particularly in those who are overweight/obese or have diabetes. The independent effects of exercise self-efficacy and exercise control on PA levels highlight their role as potential mediators for intervention studies.

Previous studies examining the relationship between physical activity levels and broad-based measures of psychological wellbeing in adolescents have been limited by not controlling for potentially confounding variables. The present study examined the relationship between adolescents' self-reported physical activity level, sedentary behaviour and psychological wellbeing; while controlling for a broad range of sociodemographic, health and developmental factors.The study entailed a cross-sectional school-based survey in ten British towns. Two thousand six hundred and twenty three adolescents (aged 13-16 years) reported physical activity levels, patterns of sedentary behaviour (TV/computer/video usage) and completed the strengths and difficulties questionnaire (SDQ).Lower levels of self-reported physical activity and higher levels of sedentary behaviour showed graded associations with higher SDQ total difficulties scores, both for boys (P0.001) and girls (P0.02) after adjustment for age and town. Additional adjustment for social class, number of parents, predicted school examination results, body mass index, ethnicity, alcohol intake and smoking status had little effect on these findings.Low levels of self-reported physical activity are independently associated with diminished psychological wellbeing among adolescents. Longitudinal studies may provide further insights into the relationship between wellbeing and activity levels in this population. Ultimately, randomised controlled trials are needed to evaluate the effects of increasing physical activity on psychological wellbeing among adolescents.

OBJECTIVE. Nutrition in the first weeks of life may program disease risk in adulthood. We examined the influence of initial infant feeding on cardiorespiratory risk factors in adulthood. PATIENTS AND METHODS. A total of 9377 persons born during 1 week in 1958 in England, Scotland, and Wales were followed-up periodically from birth into adulthood. Infant feeding was recorded from a parental questionnaire at 7 years old as never breastfed, breastfed partially or wholly for 1 month. Height; waist circumference; hip circumference; waist/hip ratio; body mass index; blood pressure; forced expiratory volume; total, high-density, and low-density lipoprotein cholesterol; triglycerides; hemoglobin A1c; fibrinogen; fibrin D-dimer; C-reactive protein; von Willebrand factor; and tissue plasminogen activator antigen were measured at 44 to 45 years of age. RESULTS. Breastfeeding for >1 month was associated with reduced waist circumference, waist/hip ratio, von Willebrand factor, and lower odds of obesity compared with formula feeding after adjustment for birth weight, prepregnancy maternal weight, maternal smoking during pregnancy, socioeconomic position in childhood and adulthood, region of birth, gender, and current smoking status. Infant feeding status was not associated with other cardiorespiratory risk factors after adjustment, except for lower fibrinogen and C-reactive protein levels in women. CONCLUSIONS. The inverse associations of breastfeeding for >1 month with measures of central obesity and inflammatory markers in the current study are small and of little public health importance. Although there was no substantial long-term protective effect of breastfeeding for >1 month on other cardiorespiratory risk factors in adult life, further studies with contemporaneous data on exclusive breastfeeding are needed to confirm these findings.

OBJECTIVE: Allergic conjunctivitis (AC) is a common condition, especially in childhood. The extent to which it occurs concurrently with or independently from allergic rhinitis (AR) has not been well described. AIM: To examine the inter-relationship between rhinitis and conjunctivitis and the epidemiological risk factors for these conditions in a rural UK population. METHODS: Cross-sectional study of rural school children (aged 5-11 years). Parental questionnaires were used to diagnose allergic outcomes (including conjunctivitis, rhinitis and rhinoconjunctivitis), and to collect data on atopic history, demographic and environmental exposures. Odds ratios of allergic outcome by exposure were examined adjusted for age, sex, breastfeeding, family history of allergy, number of older and younger siblings. RESULTS: Prevalence of conjunctivitis was 17.5%, rhinitis 15.1% and rhinoconjunctivitis 13.0%. Seasonality of symptoms varied by condition: 64.7% of those with conjunctivitis had seasonal symptoms (April-Sept only), 46.7% of those with rhinitis and 92.2% of those with rhinoconjunctivitis. Living on a farm consistently reduced the risk of conjunctivitis (odds ratio 0.47, 95%CI 0.29-0.79, p = 0.004), rhinitis (OR 0.57, 95%CI 0.33-1.01, p = 0.05) and rhinoconjunctivitis (OR 0.57, 95%CI 0.32-1.03, p = 0.06). Exposure to farm animals (particularly in early life), current consumption of unpasteurised milk and playing in a barn or stable significantly reduced the risk of all three conditions. CONCLUSION: More children had parent-reported conjunctivitis than rhinitis. The majority of children with either condition also reported symptoms with the other condition. Farmers' children have less eye and/or nasal symptoms. A number of farming variables linked with the farm microbial environment are likely to be mediating the protective effect.

Aim To examine whether low circulating vitamin C concentrations and low fruit and vegetable intakes were associated with insulin resistance and other Type 2 diabetes risk markers in childhood. Methods We conducted a cross‐sectional, school‐based study in 2025 UK children aged 9–10 years, predominantly of white European, South‐Asian and black African origin. A 24‐h dietary recall was used to assess fruit, vegetable and vitamin C intakes. Height, weight and fat mass were measured and a fasting blood sample collected to measure plasma vitamin C concentrations and Type 2 diabetes risk markers. Results In analyses adjusting for confounding variables (including socio‐economic status), a one interquartile range higher plasma vitamin C concentration (30.9 μmol/l) was associated with a 9.6% (95% CI 6.5, 12.6%) lower homeostatic model assessment of insulin resistance value, 0.8% (95% CI 0.4, 1.2%) lower fasting glucose, 4.5% (95% CI 3.2, 5.9%) lower urate and 2.2% (95% CI 0.9, 3.4%) higher HDL cholesterol. HbA1c concentration was 0.6% (95% CI 0.2, 1.0%) higher. Dietary fruit, vegetable and total vitamin C intakes were not associated with any Type 2 diabetes risk markers. Lower plasma vitamin C concentrations in South‐Asian and black African‐Caribbean children could partly explain their higher insulin resistance. Conclusions Lower plasma vitamin C concentrations are associated with insulin resistance and could partly explain ethnic differences in insulin resistance. Experimental studies are needed to establish whether increasing plasma vitamin C can help prevent Type 2 diabetes at an early stage., What's new? We examined the cross‐sectional associations between intakes of fruit, vegetables and vitamin C, circulating vitamin C concentrations and insulin resistance in UK children.Circulating vitamin C concentration was inversely associated with insulin resistance, while intakes of fruit, vegetable and vitamin C were unrelated to insulin resistance.Low levels of circulating vitamin C concentrations in UK South‐Asian children could contribute to their higher insulin resistance.Further studies (including trials) are needed to examine the association of vitamin C with insulin resistance and its potential implications for Type 2 diabetes prevention.

BackgroundIt is uncertain which simple measures of childhood obesity are best for predicting future obesity-related health problems and the persistence of obesity into adolescence and adulthood.ObjectivesTo investigate the ability of simple measures, such as body mass index (BMI), to predict the persistence of obesity from childhood into adulthood and to predict obesity-related adult morbidities. To investigate how accurately simple measures diagnose obesity in children, and how acceptable these measures are to children, carers and health professionals.Data sourcesMultiple sources including MEDLINE, EMBASE and The Cochrane Library were searched from 2008 to 2013.MethodsSystematic reviews and a meta-analysis were carried out of large cohort studies on the association between childhood obesity and adult obesity; the association between childhood obesity and obesity-related morbidities in adulthood; and the diagnostic accuracy of simple childhood obesity measures. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and a modified version of the Quality in Prognosis Studies (QUIPS) tool. A systematic review and an elicitation exercise were conducted on the acceptability of the simple measures.ResultsThirty-seven studies (22 cohorts) were included in the review of prediction of adult morbidities. Twenty-three studies (16 cohorts) were included in the tracking review. All studies included BMI. There were very few studies of other measures. There was a strong positive association between high childhood BMI and adult obesity [odds ratio 5.21, 95% confidence interval (CI) 4.50 to 6.02]. A positive association was found between high childhood BMI and adult coronary heart disease, diabetes and a range of cancers, but not stroke or breast cancer. The predictive accuracy of childhood BMI to predict any adult morbidity was very low, with most morbidities occurring in adults who were of healthy weight in childhood. Predictive accuracy of childhood obesity was moderate for predicting adult obesity, with a sensitivity of 30% and a specificity of 98%. Persistence of obesity from adolescence to adulthood was high. Thirty-four studies were included in the diagnostic accuracy review. Most of the studies used the least reliable reference standard (dual-energy X-ray absorptiometry); only 24% of studies were of high quality. The sensitivity of BMI for diagnosing obesity and overweight varied considerably; specificity was less variable. Pooled sensitivity of BMI was 74% (95% CI 64.2% to 81.8%) and pooled specificity was 95% (95% CI 92.2% to 96.4%). The acceptability to children and their carers of BMI or other common simple measures was generally good.LimitationsLittle evidence was available regarding childhood measures other than BMI. No individual-level analysis could be performed.ConclusionsChildhood BMI is not a good predictor of adult obesity or adult disease; the majority of obese adults were not obese as children and most obesity-related adult morbidity occurs in adults who had a healthy childhood weight. However, obesity (as measured using BMI) was found to persist from childhood to adulthood, with most obese adolescents also being obese in adulthood. BMI was found to be reasonably good for diagnosing obesity during childhood. There is no convincing evidence suggesting that any simple measure is better than BMI for diagnosing obesity in childhood or predicting adult obesity and morbidity. Further research on obesity measures other than BMI is needed to determine which is the best tool for diagnosing childhood obesity, and new cohort studies are needed to investigate the impact of contemporary childhood obesity on adult obesity and obesity-related morbidities.Study registrationThis study is registered as PROSPERO CRD42013005711.FundingThe National Institute for Health Research Health Technology Assessment programme.

Aims: To study trends in the prevalence of being treated for glaucoma and ocular hypertension from 1994 to 2003, and to examine factors determining treatment in 2002. Methods: Computerised data (the DIN-LINK database) from 131 general practices across the United Kingdom, in which half a million patients aged 40 years or more were registered annually, were used. On average 10 000 patients were treated for glaucoma and ocular hypertension annually. Results: Prevalence of being treated for glaucoma and ocular hypertension increased from 1.7% in 1994 to 2.3% in 2003. Those aged 85 years or more were 13 times (95% CI 12.2 to 13.8) more likely to be treated than those aged 40–64 years. Men were more likely to be treated than women (OR 1.24, 95% CI 1.19 to 1.28). Subjects “hard pressed” were less likely to be treated than “wealthy achievers” (OR 0.92, 95% CI 0.86 to 0.99). While use of topical β blocker only medications has declined since 1995, use of topical prostaglandins and combination therapies has increased. In 2003, use of prostaglandins overtook β blocker only medications. Conclusion: Prevalence of being treated for glaucoma has increased over time, and rises with age. Differences in treatment by sex and social status could be explained by use of or access to health care or by underlying prevalence of disease. Trends in treated glaucoma emphasise the shift from use of topical β blockers to newer therapies.

Purpose Determine whether a sex difference exists in the association between birth weight and total cholesterol later in life. Methods Meta-analysis of within-study differences in regression coefficients of cholesterol on birth weight. Results A total of 34 regression coefficients from 30 studies were included in the analyses; these provided data on 33,650 males and 23,129 females. There was evidence that the inverse association between birth weight and total cholesterol was stronger in males compared to females. The pooled within-study difference in age-adjusted regression coefficients was −0.03 mmol/l (−0.06, −0.01), p = 0.02 and the pooled within-study difference in age and body mass index adjusted regression coefficients was −0.04 mmol/l (−0.07, −0.02), p = 0.002. There was no evidence of heterogeneity in these meta-analyses (both p values > 0.6). Conclusions These results provide some evidence for a sex difference in the birth weight – total cholesterol association. This is consistent with studies of fetal growth which suggest that birth size reflects different biological processes for females and males. However, other very large studies are required to confirm this finding.

Objective. To examine the influence of initial infant feeding on obesity in later life.Methods. A systematic review of published studies investigating the association between infant feeding and a measure of obesity was performed with Medline (1966 onward) and Embase (1980 onward) databases, supplemented with manual searches. Data extraction was conducted by 2 authors. Analyses were based on odds ratios of obesity among initially breastfed subjects, compared with formula-fed subjects, pooled with fixed-effects models.Results. Sixty-one studies reported on the relationship of infant feeding to a measure of obesity in later life; of these, 28 (298900 subjects) provided odds ratio estimates. In these studies, breastfeeding was associated with a reduced risk of obesity, compared with formula feeding (odds ratio: 0.87; 95% confidence interval [CI]: 0.85–0.89). The inverse association between breastfeeding and obesity was particularly strong in 11 small studies of Conclusions. Initial breastfeeding protects against obesity in later life. However, a further review including large unpublished studies exploring the effect of confounding factors in more detail is needed.

Objective. To examine the relationship between birth weight and blood total cholesterol (TC) and to compare its strength with that of the relationship between current body mass index and TC.Methods. 1) Cross-sectional study of adolescents, with retrospective ascertainment of birth weight from birth records or parental recall; 2) systematic review of studies examining the relations between birth weight and cholesterol at all ages.Participants. 1) 1532 individuals (92% white, 55% male) in 10 British towns; 2) 28 studies with 32 observations showing the change in TC per 1 kg increase in birth weight—6 in infancy, 14 in adolescents, 12 in adults.Results. In the cross-sectional study, there was a weak inverse relation between birth weight and TC level (−.061 mmol/L fall in TC per kg increase in birth weight, 95% confidence interval −.131 to .008 mmol/L per kg) which was little affected by adjustment for current body size. The difference in TC corresponding to an interquartile range increase in birth weight (−.03 mmol/L) was approximately a quarter of that for an equivalent increase in body mass index (.11 mmol/L). In the systematic review, an inverse association between birth weight and TC of a similar size to that in the cross-sectional study was observed (−.048 mmol/L per kg, 95% confidence interval −.078 to −.018 mmol/L per kg) similar in strength at all ages.Conclusion. The relation of fetal nutrition to TC appears to be weak and is probably of limited public health importance when compared with the effects of childhood obesity.

Objective To investigate the relationship between the absolute area of certain optic disc parameters and a number of ocular dimensional characteristics and demographic factors in young, healthy subjects. Design Cross-sectional study. Participants One hundred twenty-one subjects, aged 16.5 to 35.4 years participated, encompassing a wide range of refractive error from +4 diopters (D) to −25.75 D. One eye from each subject was randomly selected for examination. Main outcome measures Absolute size of the optic disc parameters: optic disc area (DA), neuroretinal rim area (NRA), optic cup area (CA), and peripapillary atrophy area (PA). Methods Absolute sizes of optic disc parameters were determined from digitized photographic color transparencies, taking into consideration the magnification of the fundus camera and human eye. Relationships between the absolute size of the optic disc features and axial length, crystalline lens thickness, anterior chamber depth, ocular refraction, front surface keratometry, age, and gender were examined. Results Axial length, lens thickness, front surface keratometry, and age demonstrated positive associations with all optic disc parameters, and anterior chamber depth and ocular refraction demonstrated negative associations in all cases. Multiple regression analysis revealed that the associations observed univariately for age, anterior chamber depth, lens thickness, front surface keratometry, and ocular refraction were confounded by axial length for all disc parameters. After taking logs, DA and NRA exhibit an exponential relationship with axial length, whereas PA and CA exhibit a linear relationship with axial length. DA and NRA increase by approximately 3% per millimeter increase in axial length at 20 mm and up to 40% for DA and 50% for NRA at an axial length of 35 mm. PA and CA are estimated to increase by 26% (10%–44%) and 10% (5%–16%), respectively, per millimeter increase in axial length. Females have approximately 5% smaller DA and 7% smaller NRA than males, but these effects are not statistically significant ( P > 0.2). From the multiple regression analysis, females have 31% larger optic cup areas (1%–57%, P = 0.03) and 24% smaller PA (42% smaller to 5% larger P = 0.06) than males, but these effects are of borderline statistical significance at 5%. Conclusions Of the ocular biometric factors considered, axial length seems to be the most important predictor of the absolute area of the optic disc parameters. No association exists between any disc parameter and age in this sample of subjects less than 40 years of age. Females exhibited smaller values for DA, NRA, and PA than did males, differences that were not statistically significant, and larger CA ( P = 0.03).

Breastmilk is the preferred form of nourishment for an infant, although it may not always be feasible to provide. The immediate health benefits of breastfeeding are well established, especially in a developing world context, providing protection against infectious disease morbidity and mortality in early life. Breastfeeding has been associated with improved neural, cognitive and psychosocial development; it has also been suggested that it may program disease risk in the longer term. Largely observational evidence from the developed world suggests that breastfeeding is associated with lower cardiometabolic risk and cardiovascular outcome in adulthood. However, not all studies have been equally supportive, and inconsistencies in the literature exist. Systematic reviews of the literature provide a consensus view, and have shown that those breastfed have lower risk of type 2 diabetes, 1 lower levels of blood cholesterol 2 and marginally lower levels of adiposity 3 and blood pressure in later life. 4 However, there is a dearth of evidence from the developing world, particularly from lower

Contact lenses can be worn in a variety of environmental conditions and do not increase the wearers risk of injury. In many situations they offer significant corneal protection. Currently firefighters are prohibited from using contact lenses. To evaluate whether contact lenses are a safe form of visual correction 50 firefighters were fitted, and examined after 1, 4 and 10 months of contact lens wear. Twenty-nine were fitted with soft contact lenses, and 21 with rigid gas permeable contact lenses. Statistically significant increase in lid sulcus hyperaemia was found in both the SCL and RGPCL groups (P < 0.01, P = 0.02, respectively), as well as an increase in hyperaemia of the vertical quadrant of the bulbar conjunctivae (P = 0.01, P = 0.02, respectively). In addition the RGPCL group showed a statistically significant increase in hyperaemia of the lateral portion of the bulbar conjunctivae (P < 0.01), consistent with exposure epitheliopathy. The SCL group showed statistically significant increase in corneal staining in the vertical quadrant for all visits (P = 0.02, P = 0.01, P = 0.02 for all visits, respectively), indicative of lens dehydration. These findings although clinically significant are not unique to firefighting, and are found within a "normal" population of contact lens wearers. In conjunction with questionnaire data (Owen et all, 1996) we conclude that soft contact lenses can be worn safely by firefighters without additional risk.

The use of contact lenses by firefighters is currently prohibited. However, many firefighters may benefit from this form of visual correction, without predisposing themselves to additional risk. Visual benefits gained by contact lens wear may increase a firefighter's safety. To determine if it is safe to allow firefighters to use contact lenses 29 were fitted with soft contact lenses and 21 with rigid gas permeable contact lenses. Questionnaires were completed prior to fitting, after 1, 4 and 10 months of contact lens wear. Both soft contact lens (SCL) wearers, and rigid gas permeable contact lens (RGPCL) wearers showed a statistically significant reduction in the frequency with which they experienced irritable foreign bodies and irritant fumes in the eyes, compared to not wearing contact lenses. Firefighters felt that their performance on the fireground had been improved by the use of contact lenses. SCL wearers also benefited from a reduction in the frequency with which they experienced watery eyes and ocular discomfort. There were significantly fewer problems encountered with SCL wearers than RGPCL wearers. The frequency with which firefighters experienced lenses falling out, lens displacement, watery eyes, ocular discomfort, and operational difficulties was significantly less for the SCL group than the RGPCL group. SCL appear to offer considerable benefits for firefighters with refractive error, but their use cannot be sanctioned without assessment of their effect on the ocular adnexa.

Aim To examine whether plasma glucose, insulin resistance and markers of adiposity differed between British adolescents of South Asian and European origin. Methods School-based cross-sectional study (1998–2000), in which detailed measurements of adiposity, fasting plasma glucose and serum insulin were made in 90 South Asian and 1248 European pupils (overall 69% response rate). Results Compared with Europeans, South Asian subjects had higher mean fasting insulin levels (percentage mean difference 17.2%, 95% confidence interval 7.2–26.1%, P = 0.001), a higher mean fasting glucose (mean difference 0.19 mmol/l, 95% confidence interval 0.08–0.29 mmol/l, P = 0.0005) and a higher prevalence of impaired fasting glucose (≥ 6.1 mmol/l) (5.6% vs. 1.5%, odds ratio 3.9, 95% confidence interval 1.4–10.9, P = 0.004). Although South Asian children tended to have slightly higher indices of adiposity than Europeans (other than body mass index), the differences in glucose and insulin levels persisted after adjustment for adiposity and for pubertal status. Conclusions The predisposition to Type 2 diabetes observed in South Asian adults is apparent before adult life. Establishing the contributions of the childhood and fetal environments and of genetic factors to the development of these ethnic differences is an important priority. Prevention of Type 2 diabetes in British South Asians needs to begin before adult life.

Purpose. We describe the profile and associations of anisometropia and aniso-astigmatism in a population-based sample of children. Methods. The Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit a representative sample of children from schools in Northern Ireland. Examinations included cycloplegic (1% cyclopentolate) autorefraction, and measures of axial length, anterior chamber depth, and corneal curvature. ?2 tests were used to assess variations in the prevalence of anisometropia and aniso-astigmatism by age group, with logistic regression used to compare odds of anisometropia and aniso-astigmatism with refractive status (myopia, emmetropia, hyperopia). The Mann-Whitney U test was used to examine interocular differences in ocular biometry. Results. Data from 661 white children aged 12 to 13 years (50.5% male) and 389 white children aged 6 to 7 years (49.6% male) are presented. The prevalence of anisometropia =1 diopters sphere (DS) did not differ statistically significantly between 6- to 7-year-old (8.5%; 95% confidence interval [CI], 3.9–13.1) and 12- to 13-year-old (9.4%; 95% CI, 5.9–12.9) children. The prevalence of aniso-astigmatism =1 diopters cylinder (DC) did not vary statistically significantly between 6- to 7-year-old (7.7%; 95% CI, 4.3–11.2) and 12- to 13-year-old (5.6%; 95% CI, 0.5–8.1) children. Anisometropia and aniso-astigmatism were more common in 12- to 13-year-old children with hyperopia =+2 DS. Anisometropic eyes had greater axial length asymmetry than nonanisometropic eyes. Aniso-astigmatic eyes were more asymmetric in axial length and corneal astigmatism than eyes without aniso-astigmatism. Conclusions. In this population, there is a high prevalence of axial anisometropia and corneal/axial aniso-astigmatism, associated with hyperopia, but whether these relations are causal is unclear. Further work is required to clarify the developmental mechanism behind these associations.

Background Excess childhood body fatness, overweightness, and obesity are a major public health challenge in the UK. Accurate assessments, usually based on body-mass index (BMI), are crucial. However, recent studies have demonstrated that BMI underestimates body fatness in South Asian children and overestimates it in black African children. These errors are a concern in these ethnic minority populations, particularly UK South Asians, who are at high risk of obesity, type 2 diabetes, and cardiovascular disease. We aimed to develop BMI adjustments for these children to ensure that BMI relates to body fatness in the same way as for white European children. Methods Four recent UK population-based studies, which used deuterium dilution assessments of fat mass as a reference method, were pooled to include 1725 children (52% girls) aged 4–12 years (mean 9·3, SD 1·6) of white European, South Asian, and black African origins. A height-standardised fat-mass index (FMI) was derived to represent body fatness. Linear regression models were fitted, separately by sex, to quantify ethnic differences in BMI–FMI associations and to provide ethnic-specific BMI adjustments. Findings The FMI derived for this study population and used in analyses was fat mass/height 5 , which was independent of height for the 4–12-year age-group. BMI consistently underestimated body fatness in South Asians, requiring a BMI adjustment of +1·12 kg/m 2 (95% CI 0·83–1·41) for boys and +1·07 (0·74–1·39) for girls, irrespective of age and FMI. BMI overestimated body fatness in black Africans. However, adjustments for black African children were more complex, with statistically significant interactions between black African ethnicity and FMI (p=0·004 boys, p=0·003 girls) and between FMI and age-group (p 2 for boys and between −0·22 and −2·86 kg/m 2 for girls for unadjusted BMI values of 13 kg/m 2 in 10–12 year-olds and 25 kg/m 2 in 4–6 year-olds, respectively. Interpretation BMI underestimated body fatness in South Asians and overestimated it in black Africans. Ethnic-specific adjustments—increasing BMI in South Asians and reducing BMI in black Africans—can improve the accuracy of body fatness assessment in these children. Funding This work was supported by the British Heart Foundation (grant ref PG/15/19/31336) and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London) (grant ref CLAHRC-2013-10022). Primary data collection was funded by the British Heart Foundation (PG/11/42/28895), BUPA Foundation (TBF-S09-019), Child Growth Foundation (GR 10/03), and Wellcome Trust (WT094129MA). MF is supported by Great Ormond Street Hospital Childrens' Charity.

Purpose: The Examining Neighbourhood Activities in Built Living Environments in London (ENABLE London) project is a natural experiment which aims to establish whether physical activity and other health behaviours show sustained changes among individuals and families relocating to East Village (formerly the London 2012 Olympics Athletes’ Village), when compared with a control population living outside East Village throughout.Participants: Between January 2013 and December 2015, 1497 individuals from 1006 households were recruited and assessed (at baseline) (including 392 households seeking social housing, 421 seeking intermediate and 193 seeking market rent homes). The 2-year follow-up rate is 62% of households to date, of which 57% have moved to East Village. Findings to date: Assessments of physical activity (measured objectively using accelerometers) combined with Global Positioning System technology and Geographic Information System mapping of the local area are being used to characterise physical activity patterns and location among study participants and assess the attributes of the environments to which they are exposed. Assessments of body composition, based on weight, height and bioelectrical impedance, have been made and detailed participant questionnaires provide information on socioeconomic position, general health/health status, well-being, anxiety, depression, attitudes to leisure time activities and other personal, social and environmental influences on physical activity, including the use of recreational space and facilities in their residential neighbourhood.Future plans: The main analyses will examine the changes in physical activity, health and well-being observed in the East Village group compared withcontrols and the influence of specific elements of the built environment on observed changes. The ENABLE London project exploits a unique opportunity toevaluate a ‘natural experiment’, provided by the building and rapid occupation of East Village. Findings from the study will be generalisable to other urban residential housing developments, and will help inform future evidence-based urban planning.