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Purpose: Patients treated with ongoing opioid therapy may be at an increased risk of respiratory depression or death, which may be mitigated through prompt administration of naloxone. The Centers for Disease Control (CDC) guidelines for prescribing opioids in primary care settings recommend patients treated with ongoing opioid analgesic therapy be offered a coprescription of naloxone based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. Opioid overdose risk is dose-dependent, yet other patient-specific factors contribute to this risk. The risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) incorporates additional risk factors to assess the risk of overdose or clinically relevant respiratory depression.Objectives: This study compared the frequency of meeting CDC, Veterans’ Health Administration (VA) RIOSORD, or civilian RIOSORD criteria for naloxone coprescribing.Methods: A retrospective chart review of 42 Federally Qualified Health Centers in Illinois was conducted for all CII-CIV opioid analgesic prescriptions. Ongoing opioid therapy was defined as patients who received seven or more CII-CIV opioid analgesic prescriptions during the 1-year study period. Patients aged 18-89, receiving opioids for nonmalignant pain, and meeting the criteria of ongoing opioid therapy were included in the analysis.Results: A total of 41,777 controlled substance analgesic prescriptions were prescribed during the study period. Data from 651 individual patient charts were evaluated. Of those, 606 patients met inclusion criteria. From these data, 57.9 percent of patients (N = 351) met civilian RIOSORD criteria, 36.5 percent (N = 221) met VA RIOSORD criteria, and 22.8 percent (N = 138) met CDC guideline recommendations for naloxone coprescribing. The percentage of patients who met RIOSORD criteria compared to CDC criteria was significantly higher (p < 0.001). Of all patients meeting ongoing opioid therapy criteria, only seven had been coprescribed naloxone.Conclusion: Coprescribing of naloxone is significantly underutilized in patients treated with opioid therapy for nonmalignant chronic pain and should not solely be based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. As risk assessment improves, consideration of other risk-conferring variables, such as gabapentinoids, skeletal muscle relaxants, and sleep hypnotics, should be considered.

Refereed/Peer-reviewed Background: Across the life course, socioeconomic disadvantage disproportionately afflicts those with genetic predispositions to inflammatory diseases. We describe how socioeconomic disadvantage and polygenic risk for high BMI magnify the risk of obesity across childhood, and using causal analyses, explore the hypothetical impact of intervening on socioeconomic disadvantage to reduce adolescent obesity. Methods: Data were drawn from a nationally representative Australian birth cohort, with biennial data collection between 2004 and 2018 (research and ethics committee approved). We generated a polygenic risk score for BMI using published genome-wide association studies. We measured early-childhood disadvantage (age 2–3 years) with a neighbourhood census-based measure and a family-level composite of parent income, occupation, and education. We used generalised linear regression (Poisson-log link) to estimate the risk of overweight or obesity (BMI ≥85th percentile) at age 14–15 years for children with early-childhood disadvantage (quintiles 4–5) versus average (quintile 3) and least disadvantage (quintiles 1–2), for those with high and low polygenic risk separately. Findings: For 1607 children (n=796 female, n=811 male; 31% of the original cohort [N=5107]), polygenic risk and disadvantage were both associated with overweight or obesity; effects of disadvantage were more marked as polygenic risk increased. Of children with polygenic risk higher than the median (n=805), 37% of children living in disadvantage at age 2–3 years had an overweight or obese BMI by adolescence, compared with 26% of those with least disadvantage. For genetically vulnerable children, causal analyses indicated that early neighbourhood intervention to lessen disadvantage (to quintile 1–2) would reduce risk of adolescent overweight or obesity by 23% (risk ratio 0·77; 95% CI 0·57–1·04); estimates for improving family environments were similar (0·59; 0·43–0·80). Interpretation: Actions addressing socioeconomic disadvantage could mitigate polygenic risk for developing obesity. This study benefits from population-representative longitudinal data but is limited by sample size.

The current study sought to examine the drivers of weight change in first-year university students. The study examined the moderating role of self-compassion in the relationship between stress, eating and weight change. Specifically, we expected that students low in self-compassion would respond to stress with unhealthy eating resulting in weight gain. We expected students high in self-compassion to be buffered from the negative effects of stress (moderated mediation model).First-year university students in New Zealand (Students gained a significant 1.45 kg (SD 3.67 kg) of body weight. Self-compassion moderated the relationship between stress and changes in: (a) unhealthy (but not healthy) food intake, and (b) body weight. For those with low self-compassion, perceived stress was significantly related to an increase in BMI and, unexpectedly, to a decrease in unhealthy food intake. Changes in food intake did not explain changes in BMI.Wellbeing interventions for university students to reduce negative effects of stress should incorporate concurrent training in self-compassion.

Inflammatory diets are increasingly recognised as a modifiable determinant of mental illness. However, there is a dearth of studies in early life and across the full mental well-being spectrum (mental illness to positive well-being) at the population level. This is a critical gap given that inflammatory diet patterns and mental well-being trajectories typically establish by adolescence. We examined the associations of inflammatory diet scores with mental well-being in 11–12-year-olds and mid-life adults. Throughout Australia, 1759 11–12-year-olds (49 % girls) and 1812 parents (88 % mothers) contributed cross-sectional population-based data. Alternate inflammatory diet scores were calculated from a twenty-six-item FFQ, based on the prior literature and prediction of inflammatory markers. Participants reported negatively and positively framed mental well-being via psychosocial health, quality of life and life satisfaction surveys. We used causal inference modelling techniques via generalised linear regression models (mean differences and risk ratios (RR)) to examine how inflammatory diets might influence mental well-being. In children and adults, respectively, a 1 sd higher literature-derived inflammatory diet score conferred between a 44 % (RR 95 % CI 1·2, 1·8) to 57 % (RR 95 % CI 1·3, 2·0) and 54 % (95 % CI 1·2, 2·0) to 86 % (RR 95 % CI 1·4, 2·4) higher risk of being in the worst mental well-being category (i.e.

Ecologically and economically harmful wood borers and bark beetles, which have the capacity to expand geographically through the international log trade, require mitigations to prevent their spread. Detailed phenological knowledge of these pests across the wood-product supply chain can support systems approaches to phytosanitary risk management. Forest insect activity from 3.5 years of monthly, fortnightly, and daily sampling in recent clearfells from eight Pinus radiata plantation regions throughout New Zealand is presented. Phenology varied regionally with some species absent from specific regions. Insect activity declined with postharvest duration to a hypothesised background activity level that may be determined by landscape dispersal processes. Maximum temperature was the strongest predictor of flight activity with a 15 °C threshold that increased the probability of flight. Probability of a flight event was calculated for each species at monthly, fortnightly, and daily periods. Although wintertime activity was low, operationally effective temporal periods of low pest prevalence could not be defined on a monthly basis. Assurance of temporal periods of low pest prevalence as part of a systems approach will require additional supporting evidence of the relationship between forecast weather on short temporal scales (days), the probability of flight, and the relationship between low-level flight activity and the risk of wood product infestation by dispersing insects.

Study objectives: Sleep, physical activity and sedentary time are all known to play a role in cardiometabolic health. Compositional data analysis (CoDA) enables us to examine associations between 24-h use of time and health outcomes. Methods: Data were collected in the Child Health Check Point study, a one-off national population-cohortstudy conducted between February 2015 and March 2016. Wrist-worn actigraphy monitors (GENEActiv Original, Cambs, UK) were used to measure activity behaviours (sleep, physical activity and sedentary time) and sleep characteristics (sleep variability, midsleep, efficiency). CoDA was applied to determine the association between 24-h use of time and cardiometabolic risk markers (blood pressure; body mass index; apolipoprotein B/A1; glycoprotein acetyls; and composite metabolic syndrome score). Substitution modelling (one-for-remaining and one-for-one) examined the associations of reallocating sleep time with other activity behaviours. Results: Data were available for 1073 Australian children aged 11e12 years (50% male) and 1337 adults(13% male). Strong association was found between 24-h use of time and all cardiometabolic health outcomes. Longer sleep was associated with more favourable cardiovascular health. Sleep characteristics other than duration (efficiency, timing, variability) were weakly and inconsistently associated with outcomes. Reallocating time from sleep to moderate-vigorous physical activity (MVPA) had favourable associations with cardiometabolic health, but reallocating from sleep to sedentary time was associated with less favourable cardiometabolic health.Conclusion: The 24-h activity composition is strongly associated with cardiometabolic health in children and adults. Days with more sleep and MVPA are associated with improved cardiometabolic health. Refereed/Peer-reviewed

Background Inflammation is one of key mechanisms linking childhood experiences to later chronic disease risk. Childhood adversity is associated with inflammation, but little is known about positive experiences. We examine how adverse and positive experiences are associated with inflammatory markers in late childhood, and whether they have an interaction effect. Methods Data sources: Longitudinal Study of Australian Children (LSAC; N = 1237) and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3488). Exposures: Adverse and positive experiences assessed from 0 to 11 (LSAC) and 0-14 years (ALSPAC). Adversity indicators included parent legal problems, family violence, mental illness, substance abuse, harsh parenting, parental divorce, neighbourhood violence, family member death, and bullying victimization. Positive experiences included positive parenting practice, trusting and supportive relationships, supportive neighbourhood and home learning environments, social engagement and enjoyment. Outcomes: Inflammation quantified by high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA). Analyses: Linear regression was used to estimate relative change in inflammatory markers, adjusted for sociodemographics. Outcomes were log-transformed. Results Exposure to adversity was associated with higher levels of inflammation (e.g., CRP: β = 8.8%, 95% CI= -16.5% to 34.2% in LSAC), whereas exposure to positive experiences was associated with lower levels (e.g., CRP: β=-18.9%, 95% CI= -45.8% to 7.9% in LSAC), after adjusting for sociodemographics. There was no interaction effect of adverse and positive experiences on inflammation. Conclusions Adverse and positive experiences have independent and small effects on children’s inflammation across two cohorts. Key messages Positive experiences are critical to inform interventions to improve inflammatory outcomes for children who face adversity.

Background The home environment is the most important location in young children’s lives, yet few studies have examined the relationship between the outdoor home environment and child physical activity levels, and even fewer have used objectively measured exposures and outcomes. This study examined relationships between objectively assessed home yard size and greenness, and child physical activity and outdoor play. Methods Data were drawn from the HealthNuts study, a longitudinal study of 5276 children in Melbourne, Australia. We used cross-sectional data from a sample at Wave 3 (2013–2016) when participants were aged 6 years (n = 1648). A sub-sample of 391 children had valid accelerometer data collected from Tri-axial GENEActive accelerometers worn on their non-dominant wrist for 8 consecutive days. Yard area and greenness were calculated using geographic information systems. Objective outcome measures were minutes/day in sedentary, light, and moderate-vigorous physical activity (weekday and weekend separately). Parent-reported outcome measures were minutes/day playing outdoors (weekend and weekday combined). Multi-level regression models (adjusted for child’s sex, mother’s age at the birth of child, neighbourhood socioeconomic index, maternal education, and maternal ethnicity) estimated effects of yard size and greenness on physical activity. Results Data were available on outdoor play for 1648 children and usable accelerometer data for 391. Associations between yard size/greenness and components of physical activity were minimal. For example, during weekdays, yard size was not associated with daily minutes in sedentary behaviour (β: 2.4, 95% CI: − 6.2, 11.0), light physical activity (β: 1.4, 95% CI: − 5.7, 8.5) or MVPA (β: -2.4, 95% CI: − 6.5, 1.7), with similar patterns at weekends. There was no relationship between median annual yard greenness and physical activity or play. Conclusion In our study of young children residing in higher socio-economic areas of Melbourne yard characteristics did not appear to have a major impact on children’s physical activity. Larger studies with greater variation in yard characteristics and identification of activity location are needed to better understand the importance of home outdoor spaces and guide sustainable city planning.

We examined how combinations of clinical indicators at various ages predict overweight/obesity development, as well as resolution, by 10–11 and 14–15 years of age. Data were derived from Birth (N = 3469) and Kinder (N = 3276) cohorts of the Longitudinal Study of Australian Children, followed from ages 2–3 and 4–5 years, respectively. Every two years, 25 potential obesity-relevant clinical indicators were quantified. Overweight/obesity was defined using International Obesity Taskforce cutpoints at 10–11 years and 14–15 years. In both cohorts, three factors predicted both development and resolution of overweight/obesity in multivariable models. Among normal weight children, increased odds of developing overweight/obesity were associated with higher child (odd ratio (OR) 1.67–3.35 across different study waves) and maternal (OR 1.05–1.09) BMI, and inversely with higher maternal education (OR 0.60–0.62, when assessed at age 2–7 years). Lower odds of resolving existing overweight/obesity were related with higher child (OR 0.51–0.79) and maternal (OR 0.89–0.95) BMI, and inversely with higher maternal education (OR 1.62–1.92, when assessed at age 2–5 years). The prevalence of overweight/obesity at the age of 14–15 years was 13% among children with none of these risk factors at age 6–7 years, compared with 71% among those with all 3 risk factors (P

findings from systematic reviews into infant feeding and later adiposity are largely negative. World Health Organization (WHO) is auspicing Healthy Life Trajectories Initiative (HeLTI), a suite of trials aiming to prevent overweight/obesity in childhood. To inform planning, this narrative review sought to detail potentially effective components of nutrition-related interventions involving children aged 0 to 2 years. Systematic searches of PubMed and the Cochrane Library (2006-2016) identified 108 systematic reviews. These included 31 randomized trials in the age group of interest. Of these, 11 reported greater than or equal to 1 statistically significant (P

Despite known associations between eating disorders and obesity, little is known about the current prevalence of symptoms of eating disorders across the weight spectrum. This study therefore aimed to estimate the population prevalence of eating disorder symptoms in relation to weight status in adolescents.The sample comprised 3,270 participants (14-15 years; 52% boys) drawn from Wave 6 of the Longitudinal Study of Australian Children. Symptoms of anorexia nervosa (AN) and bulimia nervosa (BN) were assessed using self-report on the Branched Eating Disorder Test. This measure identifies clinically significant symptoms in the past 3 months according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Using study-derived cross-sectional population weights, the prevalence of each symptom was estimated for the total population and by sex and weight status.The estimated population prevalence was high (14.3-25.7%) for body image symptoms such as fear of weight gain and overvaluation of body weight but lower (0.5-3.7%) for behavioral symptoms such as binge eating and compensatory behaviors. Symptoms were more prevalent among adolescents with overweight or obesity. Although most symptoms tended to have higher prevalence among girls than boys, boys with obesity had higher prevalence of binge eating and excessive exercise than girls with obesity. The overall estimated population prevalence for AN and BN was 0.20% and 0.10%, respectively.The study highlights a need for clinicians to be cognizant of disordered eating behaviors regardless of weight status and has implications for both eating disorder and obesity prevention and intervention.

Refereed/Peer-reviewed Background/objectives: Modelling genetic pre-disposition may identify children at risk of obesity. However, most polygenic scores (PGSs) have been derived in adults, and lack validation during childhood. This study compared the utility of existing largescale adult-derived PGSs to predict common anthropometric traits (body mass index (BMI), waist circumference, and body fat) in children and adults, and examined whether childhood BMI prediction could be improved by combining PGSs and non-genetic factors (maternal and earlier child BMI) Subjects/methods: Participants (n = 1365 children, and n = 2094 adults made up of their parents) were drawn from the Longitudinal Study of Australian Children. Children were weighed and measured every two years from 0–1 to 12–13 years, and adults were measured or self-reported measurements were obtained concurrently (average analysed). Participants were genotyped from blood or oral samples, and PGSs were derived based on published genome-wide association studies. We used linear regression to compare the relative utility of these PGSs to predict their respective traits at different ages. Results: BMI PGSs explained up to 12% of child BMI z-score variance in 10–13 year olds, compared with up to 15% in adults. PGSs for waist circumference and body fat explained less variance (up to 8%). An interaction between BMI PGSs and puberty (p =0.001–0.002) suggests the effect of some variants may differ across the life course. Individual BMI measures across childhood predicted 10–60% of the variance in BMI at 12–13 years, and maternal BMI and BMI PGS each added 1–9% above this Conclusion: Adult-derived PGSs for BMI, particularly those derived by modelling between-variant interactions, may be useful for predicting BMI during adolescence with similar accuracy to that obtained in adulthood. The level of precision presented here to predict BMI during childhood may be relevant to public health, but is likely to be less useful for individual clinical purposes.

Aims To investigate relationships between takeaway food and sugar-sweetened beverage (SSB) consumption with cardiometabolic phenotypes during childhood and mid-adulthood. Method Design: Cross-sectional Child Health CheckPoint within the national population-representative Longitudinal Study of Australian Children. Participants: 1838 children (mean age 11.5 years; 49.1% female) and 1846 adults (mean age 43.7 years; 87.6% female). Exposures: Self-reported takeaway food and SSB consumption (‘frequent’: ≥ weekly). Outcomes: Functional (pulse wave velocity (PWV), blood pressure (BP)) and structural (carotid intima-media thickness, retinal microvascular calibre) preclinical cardiovascular phenotypes; lipids (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides). Analysis: Linear regression (exposure: takeaway or SSB consumption, individually or together) adjusted for age, sex and socio-economic position; and mediation analysis for body mass index (BMI). Results Associations were small among children (standardized mean difference (SMD) ≤0.15). In adults, associations were stronger with functional, but not structural, cardiovascular phenotypes and lipids, particularly for frequent takeaway food consumption (e.g. PWV (0.20 m/s; 95% confidence interval (CI) 0.03 to 0.37); systolic (3.3 mmHg; 95% CI 1.3 to 5.3) and diastolic BP (1.4 mmHg; 95% CI 0.2 to 2.6); LDL (0.10 mmol/L; 95% CI 0.02 to 0.18); HDL (−0.14 mmol/L; 95% CI −0.19 to −0.10) and triglycerides (0.30 mmol/L; 95% CI 0.12 to 0.48)]. BMI mediated associations between takeaway food consumption and PWV, BP, HDL and TG (proportion of mediation 34% to 75%), while mediation effects were smaller for SSB consumption. Conclusions Frequent takeaway food consumption in adults was associated with adverse blood lipids and vascular function (mainly via BMI). Lack of strong associations in children highlights opportunities for prevention.

Background In Australia, the Socio-Economic Indexes for Areas (SEIFA), which includes the Index of Relative Socioeconomic Disadvantage (IRSD), captures the socioeconomic characteristics of areas. Because SEIFA rankings are relative to the country or state, the decile categorisations may not reflect an area’s socioeconomic standing relative to areas nearby. Aims The aim of the research was to explore whether IRSD rankings could be re-ranked to become locally sensitive. Data and methods Using existing SEIFA data to redistribute the membership of current decile IRSD groups, we tested three methods to re-rank all SA1 areas relative to the nearest areas capped at: (1) the nearest 99 neighbours, (2) a population threshold of 50,000 (3) a distance threshold of 10 km. Results The reclassification of SEIFA IRSD deciles was largest (up to 8 decile points of change) when comparing the nearest neighbour and population threshold local methods to current state-based rankings. Moreover, compared to using current national and state SEIFA IRSD rankings, the use of local rankings resulted in more evenly distributed deciles between cities, regional, and remote areas. Conclusions Because SEIFA IRSD rankings are used to allocate resources and health services, we encourage the combined use of a state and local ranking to refine areas considered the most disadvantaged.

Background: Bark- and wood-boring forest insects spread via international trade. Surveys frequently target new arrivals to mitigate establishment. Alternatively, monitoring pest activity in exporting countries can inform arrival and establishmentrisk. Methods: We report >3 years data from daily sampling of bark- and wood-boring insects that are associated with recently felled Pinus radiata D.Don at five New Zealand ports. Results: Average catch differed between ports and months with Arhopalus ferus (Mulsant), Hylurgus ligniperda F., and Hylastes ater (Paykull) comprising 99.6% of the total catch. Arhopalus ferus was absent during winter with Hylastes ater and Hylurgus ligniperda activity between June and August representing 3.5 and 3.7% of total catch, respectively. Maximum temperature and wind speed influenced flight activity of all three species but not universally across all ports. Flight activity transitioned to a nonlinear pattern above 20°C. Arhopalus ferus has a unimodal flight risk period between late-September and late-April. Hylastes ater was also unimodal except in Dunedin where it was bimodal like Hylurgus ligniperda was in all regions with spring and mid- to late-summer activity periods. Although Hylastes ater was observed during winter, the probability of a flight event during winter was between 0 and 0.02 per week. Hylurgus ligniperda flight probability was zero in Dunedin and low at all other ports from May to August. Conclusions: Modelling seasonal changes in flight probability can inform risk-based phytosanitary measures. We demonstrate the utility of maximum temperature and seasonality as a predictor of wood commodity infestation risk. Such predictors allow National Plant Protection Organisations to develop standards that protect the post-treatment phytosanitary security of individual consignments.

International audience; Portable electroantennograms (pEAG) can further our understanding of odor plume dynamics and complement laboratory-based electroantennogram tools. pEAG's can help to address important questions such as the influence of plume structure on insect behavior, the active space of semiochemical-baited traps, and the impact of biotic and abiotic factors on this active space. Challenges associated with pEAGs include their miniaturization and sensitivity, confounding environmental odors, and processing of data. Here, we describe a pEAG built with modern engineering hardware and techniques that is portable in being both light in weight (516 g) and smaller (12 x 12 x 8 cm, volume 1152 cm(3)) than earlier models. It is able to incorporate insects of a range of sizes (4 to 30 mm antennal length), has wireless communication (communication range of 600 m urban, 10 km line of sight), a stand-alone power supply, and uses both antennae of the test insect. We report normalized antennal responses fromEpiphyas postvittanain a dose response experiment where our pEAG compared favorably with traditional laboratory EAG equipment for this species. Dose-response comparisons betweenE. postvittana,Agrotis ipsilon, andLymantria dispar disparshowed mean detection limits from a pheromone source dose of 100, 100, and 1 ng, respectively, for our pEAG. This pEAG should allow future real-time analysis of EAG responses in the field in research on how insects interact with odor plumes and the factors that influence the active space of semiochemical-baited traps.

Background/objectives: Microvascular changes may contribute to obesity-associated cardiovascular disease. We examined whether body mass index (BMI) and waist-to-height ratio (WHtR) (1) at multiple earlier time points and (2) decade-long trajectories predicted retinal microvascular parameters in mid-childhood/adulthood. Methods: Participants/design: 1288 11–12 year olds (51% girls) and 1264 parents (87% mothers) in the population-based Child Health CheckPoint (CheckPoint) module within the Longitudinal Study of Australian Children (LSAC). LSAC exposure measures: biennial BMI z-score and WHtR for children at five time points from age 2–3 to 10–11 years and self-reported parent BMI at six time points from child age 0–1 years to 10–11 years. CheckPoint outcome measures: retinal arteriolar and venular caliber. Analyses: BMI/WHtR trajectories were identified by group-based trajectory modeling; linear regression models estimated associations between BMI/WHtR at each time point/trajectories and later retinal vascular caliber, adjusted for age, sex, and family socioeconomic status. Results: In time point analyses, higher child BMI/WHtR from age 4 to 5 years was associated with narrower arteriolar caliber at the age of 11–12 years, but not venular caliber. For example, each standard deviation higher in BMI z-score at 4–5 years was associated with narrower arteriolar caliber at 11–12 years (standardized mean difference (SMD): −0.05, 95% confidence interval (CI): −0.10 to 0.01); by 10–11 years, associations had doubled to −0.10 (95% CI: −0.16 to −0.05). In adults, these finding were similar, except the magnitude of BMI and arteriolar associations were similar across all time points (SMD: −0.11 to −0.13). In child and adult BMI trajectory analyses, less favorable trajectories predicted narrower arteriolar (p-trend 0.1), caliber. Compared with those in the average BMI trajectory, SMDs in arterial caliber for children and adults in the highest trajectory were −0.25 (95% CI: −0.44 to −0.07) and −0.42 (95% CI: −0.73 to −0.10), respectively. Venular caliber showed late associations with child WHtR, but not with BMI in children or adults. Conclusions: Associations of decade-long high BMI trajectories with narrowed retinal arteriolar caliber emerge in children, and are clearly evident by midlife. Adiposity appears to exert its early adverse life course impacts on the microcirculation more via arteriolar than venular mechanisms.

Background Trimethylamine N-oxide (TMAO) is a microbiome- and diet-derived metabolite implicated in adverse cardiovascular outcomes. To date, studies of plasma TMAO concentrations have largely focused on individuals with metabolic disease. As such, data on TMAO concentrations in population settings and parent–child dyads are lacking. Objectives This study aimed to investigate parent–child concordance, age, and sex effects on plasma concentrations of TMAO and its precursors [l-carnitine, choline, betaine, and dimethylglycine (DMG)]. Associations between concentrations of TMAO and its precursors and self-reported dietary intakes of animal protein (i.e., red meat, meat products, chicken, fish, milk products, and cheese) and fast-food meals were also investigated. Methods A total of 1166 children (mean ± SD age: 11 ± 0.5 y, 51% female) and 1324 parents (mean ± SD age: 44 ± 5.1 y, 87% female) had a biomedical assessment as part of Growing Up in Australia's Child Health Checkpoint. Plasma TMAO and precursor concentrations were quantified using ultra-high-pressure LC coupled with tandem MS. Results Familial dyads significantly contributed to plasma TMAO and precursor concentrations (P, Age, sex, and shared family factors characterize the concentrations of plasma TMAO and those of its precursors in Growing Up in Australia's CheckPoint Study of children and adults.

OBJECTIVES: To examine how overweight and obesity at specific ages and overall BMI growth patterns throughout childhood predict cardiometabolic phenotypes at 11 to 12 years. METHODS: In a population-based sample of 5107 infants, BMI was measured every 2 years between ages 2 to 3 and 10 to 11 years. We identified 5 BMI trajectories using growth curve models. At ages 11 to 12 years, 1811 children completed assessments for metabolic syndrome risk scores, carotid-femoral pulse wave velocity, and carotid intima-media thickness. Multivariable regression models were used to estimate associations, adjusted for potential confounders (eg, age, sex, smoking exposure, and small for gestational age). RESULTS: Overweight and obesity from early childhood onward were strongly associated with higher cardiometabolic risk at 11 to 12 years of age. At age 6 to 7 years, compared with those with a healthy weight, children with overweight had higher metabolic syndrome risk scores by 0.23 SD units (95% confidence interval 0.05 to 0.41) and with obesity by 0.76 SD units (0.51–1.01), with associations almost doubling by age 10 to 11 years. Obese (but not overweight) children had higher outcome pulse wave velocity (0.64–0.73 SD units) from ages 6 to 7 years and slightly higher outcome carotid intima-media thickness (0.20–0.30 SD units) at all ages. Cumulative exposure to high BMI from 2 to 3 years of age carried the greatest cardiometabolic risk, with a gradient of risk across trajectories. CONCLUSIONS: High early-childhood BMI is already silently associated with the development of cardiometabolic risk by 11 to 12 years, highlighting the urgent need for effective action to reduce overweight and obesity in early childhood.

Obesity predicts adverse microvasculature from childhood, potentially via inflammatory pathways. We investigated whether inflammation mediates associations between obesity and microvascular parameters. In 1054 children (mean age 11 years) and 1147 adults (44 years) from a cross-sectional study, we measured BMI (z-scores for children) and WHtR, Glycoprotein acetyls (GlycA), an inflammatory marker, and retinal arteriolar and venular calibre. Causal mediation analysis methods decomposed a “total effect” into “direct” and “indirect” components via a mediator, considering continuous and categorical measures and adjusting for potential confounders. Compared to normal-weight BMI children, those with overweight or obesity had narrower arteriolar calibre (total effects −0.21 to −0.12 standard deviation (SD)): direct (not mediated via GlycA) effects were similar. Children with overweight or obesity had 0.25 to 0.35 SD wider venular calibre, of which 19 to 25% was mediated via GlycA. In adults, those with obesity had 0.07 SD greater venular calibre, which was completely mediated by GlycA (indirect effect: 0.07 SD, 95% CI −0.01 to 0.16). Similar findings were obtained with other obesity measures. Inflammation mediated associations between obesity and retinal venules, but not arterioles from mid-childhood, with higher mediation effects observed in adults. Interventions targeting inflammatory pathways may help mitigate adverse impacts of obesity on the microvasculature.

OBJECTIVES: Oropharyngeal dysphagia and aspiration may occur in infants and children. Currently, there is wide practice variation regarding when to feed children orally or place more permanent gastrostomy tube placement. Through implementation of an evidence-based guideline (EBG), we aimed to standardize the approach to these patients and reduce the rates of gastrostomy tube placement. METHODS: Between January 2014 and December 2018, we designed and implemented a quality improvement intervention creating an EBG to be used by gastroenterologists evaluating patients ≤2 years of age with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS). Our primary aim was to encourage oral feeding and decrease the use of gastrostomy tube placement by 10% within 1 year of EBG initiation; balancing measures included total hospital readmissions or emergency department (ED) visits within 6 months of the abnormal VFSS. RESULTS: A total of 1668 patients (27.2%) were found to have aspiration or penetration noted on an initial VFSS during our initiative. Mean gastrostomy tube placement in these patients was 10.9% at the start of our EBG implementation and fell to 5.2% approximately 1 year after EBG initiation; this improvement was sustained throughout the next 3 years. Our balancing measures of ED visits and hospital readmissions also did not change during this time period. CONCLUSIONS: Through implementation of this EBG, we reduced gastrostomy tube placement by 50% in patients presenting with oropharyngeal dysphagia and aspiration, without increasing subsequent hospital admissions or ED visits.

Traditional retinal microvascular parameters (smaller arteriolar and greater venular caliber) are associated with cardiovascular risk factors, pre-clinical vascular phenotypes and clinical cardiovascular events in adults.Although novel retinal microvascular geometric parameters showed analogous associations in adults, less is known whether these parameters are associated with cardiovascular health from childhood. In a populationbasedcross-sectional study in children (n = 1126, mean age 11.4 years, 50.3% girls), we examined associations of cardiovascular risk factors and pre-clinical arterial phenotypes with retinal geometric parameters.Cardiovascular parameters included body mass index (BMI), an inflammatory marker (GlycA), low-density lipoprotein and high-density lipoprotein (HDL) cholesterol, systolic (SBP) and diastolic blood pressure, large artery functional (pulse wave velocity, PWV and carotid arterial elasticity) and structural (carotid intima-media thickness) phenotypes. Retinal geometric parameters (fractal dimension (Df) and tortuosity) were quantified from retinal images. Multivariable regression models were performed and adjusted for potential confounders.Higher values for BMI, SBP and PWV showed weak associations with lower (i.e. worse) arteriolar but not venularDf (standardized mean difference (SMD) ranging from −0.07 to −0.09, 95% CIs −0.15 to −0.01). Higher HDL was associated with greater arteriolar Df (SMD 0.07, 95% CI 0.01 to 0.13). Only higher SBP was associated with higher (i.e. worse) arteriolar but not venular tortuosity (SMD 0.09, 95% CI 0.02 to 0.16). In generally healthy children, some risk factors and pre-clinical arterial phenotypes show small associations with retinal geometric parameters. In childhood, emerging relationships between microvascular parameters and cardiometabolic risk may be better described by retinal vascular caliber than by geometric parameters. Refereed/Peer-reviewed

This study investigates how dietary patterns and scores are associated with subsequent BMI and waist:height ratio (WHtR), and how BMI and WHtR are associated with subsequent dietary patterns or scores, from 2–3 to 10–11 and 4–5 to 14–15 years of age. In the Longitudinal Study of Australian Children, height, weight and waist circumference were measured biennially in children, yielding BMI z-score and WHtR. Parents, latterly children, reported frequency of child consumption of 12–16 food/drink items during the previous 24 h. At each wave, we empirically derived dietary patterns using factor analyses, and dietary scores based on the 2013 Australian Dietary Guidelines. We used structural-equation modelling to investigate cross-lagged associations (n 1972–2882) between diet and body composition measures in univariable and multivariable analyses. Dietary scores/patterns did not consistently predict WHtR and BMI z-score in the next wave, nor did BMI z-score and WHtR consistently predict diet in the next wave. The few associations seen were weak and often in the opposite direction to that hypothesised. The largest effect, associated with each standard deviation increase in BMI in wave 5 of the K cohort (age 12–13 years), was a 0·06 standard deviation estimated mean increase in dietary score (higher quality diet) in the subsequent wave (95 % CI 0·02, 0·11, P=0·003). Associations between dietary patterns/scores and body composition were not strongly evident in either direction. Better quantitative childhood dietary tools feasible for large-scale administration are needed to quantify how dietary patterns, energy intake and anthropometry co-develop.

Objective: To detail studies investigating the efficacy/safety of semaglutide as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in the treatment of type 2 diabetes mellitus. Data Sources: A literature search in MEDLINE and ClinicalTrials.gov (January 2013 to May 2018) using the terms semaglutide, SUSTAIN, oral, and PIONEER resulted in 10 published articles and 14 ongoing/unpublished articles. Study Selection and Data Extraction: All English language phase 2 and 3 clinical trials evaluating efficacy/safety of semaglutide were included. Data Synthesis: In 9 phase 3, multicenter SUSTAIN trials, the efficacy and safety of semaglutide have been compared with placebo and other pharmacologic therapy for diabetes (PTD). In these trials, semaglutide resulted in lower hemoglobin A1c (HbA1c; approximately −1.5%) and weight reductions (approximately −4.5 kg) as comparable with dulaglutide for HbA1c lowering (approximately −1.5%). Semaglutide also has cardiovascular (CV) outcomes data that show significant reduction in risk of death from CV causes, nonfatal myocardial infarction, or nonfatal stroke (hazard ratio = 0.74; 95% confidence interval = 0.58-0.95). A safety finding that emerged from the CV outcomes trial was an association of semaglutide treatment with an increased risk of retinopathy complications in patients with preexisting diabetic retinopathy. Phase 3 trial data assessing semaglutide oral formulation have shown similar HbA1c (approximately −1.5% for 14 mg dose) and body weight (approximately −4.1 kg for 14 mg dose) reductions as compared with placebo. Across these studies, semaglutide was generally well tolerated with the most common adverse event reported as gastrointestinal side effects as seen in all GLP-1 RAs. Conclusions: These results suggest that semaglutide may have a place in therapy as a GLP-1 RA add-on therapy with higher weight loss as compared with other GLP-1 RAs and PTD and CV benefit.

Industrial roundwood is an important commodity with global trade of 125 million m3 in 2016. Fumigation is the main phytosanitary treatment for bulk wood commodities. Joule heating is a potential alternative phytosanitary treatment for export Pinus radiata D. Don (Pinaceae) logs, but its effectiveness against insects has not yet been confirmed experimentally. To define treatment parameters for Joule heating, we quantified the thermal tolerance of two forest insects, Hylurgus ligniperda (Fabricius) (Scolytinae) and Arhopalus ferus (Mulsant) (Cerambycidae) that are potentially present on P. radiata logs. Heat was applied using dry bath heat blocks to life stages present when phytosanitary treatments are applied. Arhopalus ferus eggs were the most heat-tolerant life stage with decreasing tolerance at 30 min of H. ligniperda adults > H. ligniperda larvae > A. ferus adults, > A. ferus larvae, H. ligniperda eggs, and H. ligniperda pupae. Additional testing of A. ferus eggs (in dry and humidified environments) determined that an upper LT99.99 with 95% confidence of 55.6 °C applied for 30-min controlled A. ferus and hence all other life stages. This is within the range of published studies of other bark- and wood-boring insects, which are reviewed. The LT99.99 and wood-borer biology are discussed in the context of Joule heating as a potential phytosanitary treatment for bulk wood exports. Joule heating of 32 test logs (3.3 m long) demonstrated temperatures exceeding 60 °C for at least 60 min. Ten logs infested with H. ligniperda were Joule-heated to the same profile, resulting in 100% mortality of adults and larvae. Our results are consistent with current ISPM 15 treatment parameters and show that Joule heating is an effective, non-chemical, alternative option to fumigation for quarantine pest control.

AIM: Cardiovascular disease and mental illness commonly co-occur in later life, but it is unknown how early these associations arise. We aimed to determine the extent to which: (i) childhood mental health is associated with functional and structural cardiovascular risk phenotypes and adiposity in late childhood/adolescence, and (ii) associations between mental health and cardiovascular phenotypes may be explained by differential body mass index. METHODS: This cross-sectional study drew on three longitudinal community-based cohort studies (two enriched for overweight/obesity) in metropolitan Melbourne, Australia, with harmonized follow-up in 2014. Mental health exposures included emotional and behavioural problems (Strength and Difficulties Questionnaire) and psychosocial health and general well-being (Pediatric Quality of Life Inventory (PedsQL)), which were assessed by self- and parent-proxy report. Cardiovascular risk phenotypes and adiposity measures included mean arterial pressure, pulse wave velocity, carotid artery intima-media thickness, retinal arterioleto-venule ratio, waist circumference, % body fat, and BMI z-score. We used multivariable linear regression models, adjusting for age, sex and neighbourhood disadvantage, to examine associations. RESULTS: Of the 364 participants (mean age 14.7, standard deviation 2.0, years), 30% were overweight and 16% obese. All adiposity indicators were positively associated with higher behavioural/emotional problems and poorer psychosocial health and negatively associated with better ratings of positive general well-being, as reported by parents and children (all P ≤ 0.03). However, there was little evidence that cardiovascular functional or structural phenotypes varied by mental health. CONCLUSIONS: By late childhood/adolescence, mental health is strongly associated with adiposity but not with cardiovascular structure or function. This suggests that the known relationship between these constructs may not develop until early or mid-adulthood.

ObjectiveTo determine which parental health behaviours early in childhood most strongly predict whole-of-childhood dietary trajectories.DesignPopulation-based Longitudinal Study of Australian Children (LSAC, waves 1–6; 2004–2014). Exposures were parents’ fruit/vegetable consumption, alcohol, smoking and physical activity at child age 0–1 years (B Cohort) or 4–5 years (K Cohort). Outcomes, from repeated biennial short diet diaries, were group-based trajectories of (i) dietary scores and empirically derived patterns of (ii) healthful and (iii) unhealthful foods consumed, spanning ages 2–3 to 10–11 years (B Cohort) and 4–5 to 14–15 years (K Cohort). We investigated associations of baseline parental health behaviours with child dietary trajectories using multinomial logistic regression.SettingAustralian homes.SubjectsOf children, 4443 (87·0 %) from the B Cohort and 4620 (92·7 %) from the K Cohort were included in all trajectories. Multivariable analyses included 2719 to 2905 children and both parents.ResultsChildren whose primary caregiver reported the lowest fruit/vegetable consumption had markedly higher odds of belonging to the least healthy score and pattern trajectories (K Cohort: OR=8·7, 95 % CI 5·0, 15·1 and OR=8·4, 95 % CI 4·8, 14·7, respectively); associations were weaker (K Cohort: OR=2·3, 95 % CI 1·0, 5·2) for the unhealthiest pattern trajectory. Secondary caregiver fruit/vegetable associations were smaller and inconsistent. Parental alcohol, smoking and physical activity were not predictive in multivariable analyses. Results were largely replicated for the B Cohort.ConclusionsLow primary caregiver fruit/vegetable consumption increased nearly ninefold the odds of children being in the lowest intake of healthy, but only weakly predicted unhealthy, food trajectories. Healthy and unhealthy food intake may have different determinants.

Objective: The Food and Drug Administration recently updated metformin prescribing recommendations for patients with diabetes and renal disease. The American Diabetes Association as well as the American Association of Clinical Endocrinologists and American Clinical Endocrinologists also recommend periodic monitoring of vitamin B12 levels for patients using metformin. A review of the literature was conducted to assess data to evaluate the recent updates to metformin usage and provide rationales for these recommendations. Data Sources: PubMed MESH terms “Diabetes Mellitus, Type 2” and “Renal Insufficiency, Chronic” and “Metformin” were searched with an English limitation from 1990 to May 2017. A MEDLINE search was conducted using the terms “metformin” and “renal disease” from 1990 to May 2017. A PubMed search was conducted using the MESH terms “vitamin b12 deficiency” and “metformin” from 1970 to May 2017. A MEDLINE search was conducted using terms “metformin” and “vitamin B12 deficiency” with an English limitation from 1970 to May 2017. Study Selection and Data Extraction: Retrospective and prospective clinical trials, meta-analyses, and systematic reviews were considered for inclusion. Citations from identified articles were also reviewed for inclusion. Data Synthesis: The incidence of metformin-associated lactic acidosis is minimal. Data indicate metformin-treated patients with an estimated glomerular filtration rate above 30 mL/min/1.73 m2 have a reduction in mortality. Additionally, data suggest metformin may lead to vitamin B12 deficiency. Conclusion: Data support recommendations for metformin use in patients with diabetes and renal insufficiency with an estimated glomerular filtration rate above 30 mL/min/1.73 m2. Data also suggest that baseline and periodic testing of vitamin B12 levels are warranted and supported by clinical guidelines due to the risk of vitamin B12 deficiency in metformin-treated patients.

The authors were recently notified of an error in the way the child accelerometry data were processed in the Child Health CheckPoint study, and regret that some of the data reported need to be revised. Incorrect cutpoints were used when determining time spent in sedentary behaviour and light physical activity and moderate-to-vigorous physical activity. Details of the error and the steps taken to correct it have been reported elsewhere.1 We received the new, updated variables from CheckPoint and have repeated the analyses for the above paper. The new variables are very highly correlated with the old variables, so the overall message of the paper remains the same. However, (minimal) changes have been made to the manuscript's text and Table 1. Results presented in Table 2 and 4 have been updated. Figure 2 has been redrawn with the corrected data (and appears visually similar). Supplement files have also been updated. The authors would like to apologise for any inconvenience caused. 1. Davies, Sarah; Clifford, Susan; Gillespie, Alanna; Lange, Katherine; Muller, Josh; Wang, Yichao; et al. (2018): Longitudinal Study of Australian Children's Child Health CheckPoint Data Issues Paper – July 2021. Murdoch Childrens Research Institute. Journal contribution. https://doi.org/10.25374/MCRI.5821230.v2.

Background ‘Nudges' subtly alter the social and physical environment to enhance capacity for subconscious, self-interested behaviors, without actively restricting options. Nudges could offer a much-needed strategy to foster sustainable improvements in dietary behaviors and weight status. Aim To systematically review the effectiveness of nudge interventions designed to improve children's dietary behaviors within the family home (or another environment if judged transferable to the home). Methods English-language studies published January 1996–January 2015 were identified in MEDLINE, Embase, CINAHL, PsycINFO and PubMed, followed by dual screening and quality evaluation. Inclusion : controlled studies; nudge with in-home potential. Exclusion : medical health conditions. Results Of the 40 included studies, 33 (83%) showed improvement in dietary behaviors (e.g. more vegetables, smaller unhealthy portions) and were more effective in older children/adolescents. The quality of most studies was rated as weak (43%) or moderate (40%), with only six studies rated strong (15%), reflecting major issues with quality, effectiveness and generalizability. Nudges were typically assessed in isolation and examined immediate effects on behavior. Conclusion Despite substantial methodological limitations and inconsistencies, the literature indicates that nudges may improve children's immediate dietary behaviors. It is unclear whether these improvements could be sustained or affect body weight (PROSPERO, CRD42016036373).

In adulthood, conscientiousness and neuroticism are correlates of body weight and weight gain. The present research examines whether the childhood antecedents of these traits, persistence and negative reactivity, respectively, are associated with weight gain across childhood. We likewise examine sociability as a predictor of childhood weight gain and whether these three traits are associated with weight concerns and weight-management strategies in adolescence. Participants (N=4153) were drawn from the Longitudinal Study of Australian Children, an ongoing, population-based study of child and family health and well-being. At the baseline assessment, caregivers reported on their child’s temperament. At every assessment from ages 4–5 to 14–15 years, study children were weighed and measured by trained staff; there were up to six biennial assessments of body mass index and waist circumference. At ages 14–15 years, study children (n=2975) also self-reported on their weight concerns and weight-management strategies. Study children rated lower in persistence or higher in negative reactivity in early childhood gained more weight between the ages of 4 and 15 years. Sociability was associated with weight gain among girls but not among boys. Lower persistence and higher negative reactivity at ages 4–5 years were also associated with greater weight concerns, restrained eating and use of unhealthy weight-management strategies at ages 14–15 years. Childhood traits related to conscientiousness and neuroticism are associated with objective weight gain across childhood and with concerns and strategies to manage weight in adolescence. These results are consistent with a lifespan perspective that indicates that trait psychological functioning contributes to health-related markers from childhood through old age.

Objectives To determine which of multiple early-life exposures predict onset or resolution of overweight/obesity during a 9-year period. Methods Design: longitudinal cohort from three harmonised community-based cohorts enriched for overweight and obesity. Early-life exposures: child—gestational age; delivery; birth weight; breast feeding; solids introduction; baseline body mass index (BMI); waist circumference; diet; activity; global, physical and psychosocial health. Mother—baseline BMI; education; age; neighbourhood disadvantage; concern for child9s weight. Outcome: change in BMI category. Analyses: adjusted logistic regression. Results On average, the 363 children (57% retention) were 6 and 15 years old at baseline and follow-up. Children were classified as ‘never’ overweight/obese (38%), ‘resolving’ overweight/obese (15%), ‘becoming’ overweight/obese (8%) or ‘always’ overweight/obese (39%). Compared with ‘never overweight/obese’ children, odds of ‘becoming overweight/obese’ were greater with higher child (OR 2.33, 95% CI 1.02 to 5.29) and maternal BMI (OR 1.18, CI 1.07 to 1.31), and lower with higher maternal education (OR 0.09, CI 0.02 to 0.34). Compared with ‘always overweight/obese’ children, odds of ‘resolving overweight/obese’ were lower with higher maternal BMI (OR 0.87, CI 0.78 to 0.97), and higher with better child physical health (OR 1.06, CI 1.02 to 1.10) and higher maternal age (OR 1.11, CI 1.01 to 1.22) and education (OR 4.07, CI 1.02 to 16.19). Conclusions Readily available baseline information (child/maternal BMI, maternal age, education and child health) were the strongest predictors of both onset and resolution of overweight/obesity between the primary school and adolescent years. Perinatal, breastfeeding and lifestyle exposures were not strongly predictive. Results could stimulate development of algorithms identifying children most in need of targeted prevention or treatment.

Objectives: Snacks contribute to overconsumption of energy-dense foods and thence obesity. Previous studies in this area are limited by self-reported data and small samples. In a large population-based cohort of parent–child dyads, we investigated how modification of pre-packaged snack food, i.e. (a) item quantity and variety, and (b) dishware (boxed container) size affected intake. Methods: Design: Randomized trial nested within the cross-sectional Child Health CheckPoint of the Longitudinal Study of Australian Children, clustered by day of visit. Sample: 1299 11–12 year olds, 1274 parents. Exposure: 2 × 2 manipulation of snack box container size and item quantity/variety: (1) small box, few items, (2) large box, few items, (3) small box, more items, (4) large box, more items. Procedure: Participants received a snack box during a 15 min break within their 3.5 h visit; any snacks remaining were weighed. Outcomes: Consumed quantity (grams) and energy intake (kilojoules). Analyses: Unadjusted linear regression. Results: Children who were offered a greater quantity and variety of snack items consumed considerably more energy and a slightly higher food mass (main effect for energy intake: 349 kJ, 95% CI 282–416, standardized mean difference (effect size) 0.66; main effect for mass: 10 g, 95% CI 3–17, effect size 0.17). In contrast, manipulating box size had little effect on child consumption, and neither box size nor quantity/variety of items consistently affected adults’ consumption. Conclusion: In children, reducing the number and variety of snack food items available may be a more fruitful intervention than focusing on container or dishware size. Effects observed among adults were small, although we could not exclude social desirability bias in adults aware of observation. Refereed/Peer-reviewed

Background: Short sleep duration in childhood has often been linked with obesity in later childhood or adolescence. However, whether infant sleep duration affects body composition trajectories and cardiovascular health through to mid-adolescence remains unknown. Methods: Participants were 336 adolescents from a community-based prospective birth cohort in Melbourne, Australia. Mothers completed 24-hour time diaries, including infant sleep in 5-minute intervals at ages 2, 4, and 12 months. BMI and body composition outcomes were measured 6-monthly between 4 and 6.5 years and at 10 and 14 years. Cardiovascular outcomes at 14 years comprised blood pressure, pulse wave velocity, retinal arteriole-to-venule ratio, and carotid intima-media thickness. We used multivariable linear regression and multinomial logistic regression analyses adjusted for sex, age, BMI at birth, gestational age, ethnicity, maternal education, maternal BMI, and neighborhood socioeconomic position. Results: At 2 months, infants slept on average 14.1 hours [standard deviation (SD) 1.9], decreasing to 13.4 hours (SD 2.0) by 12 months. We observed no associations between the different sleep duration time points in infancy and later BMI or body composition. Moreover, a shorter sleep duration did not increase the odds of being on a high body composition trajectory compared with longer sleep (e.g., odds ratio per hour of sleep at 4 months is 0.85, 95% confidence interval 0.65-1.11). Infant sleep duration was also not associated with cardiovascular function or large or small artery structure at 14 years of age. Conclusions: We found no evidence that sleep duration very early in life affects adolescent body composition or cardiovascular health.

Background: Irradiation is accepted as a phytosanitary treatment for horticultural products by many countries. Irradiation is a potential alternative to chemical fumigation for wood products; however, data supporting its efficacy against potential forestry pests is limited. Methods: Irradiation efficacy data were obtained experimentally for Arhopalus ferus (Mulsant) and Hylurgus ligniperda (Gamma.). The results are compared to existing ionising-radiation treatment data for various bark and wood-boring beetles species as found in the International Database on Insect Disinfestation and Sterilization (IDIDAS) and the published literature. Results: Existing IDIDAS records suggest that the effective dose required to sterilise insects in the families Cerambycidae and Scolytinae is < 150 Gy. Estimated LD99 obtained here for the sterility of adult A. ferus were 44. 1 Gy (LD99, +/- 15.3, 95% CI) and eggs 40.4 Gy (+/- 9.8, 95% CI). Our results suggest that an effective sterilisation dose for A. ferus eggs will be from 20 to 40 Gy; however, LD99 dose estimates were not obtained for other life stages. Adult H. ligniperda were more tolerant of radiation with 1.6% of adults producing viable eggs at doses of between 100 and 150 Gy despite 100% sterility being recorded at 75 and 175 Gy. Conclusions: Our results are consistent with existing studies of other bark and wood-boring beetles. The doses tested here were equivalent to, or lower than, those used in previous studies. Arhopalus ferus adults were less tolerant to ionising radiation than the published literature for other Cerambycidae. Further studies with adult H. ligniperda are recommended as 150 Gy represents the upper limit currently reported in IDIDAS for other Scolytinae. An assessment of the potential cost-effectiveness of irradiation as a phytosanitary treatment at the range of doses identified in this study should be conducted before committing to further efficacy testing.

Plant-feeding insects use visual and olfactory cues (shape, color, plant volatiles) for host location, but the relative importance of different cues and interactions with non-host-plant volatiles in ecosystems of varying plant biodiversity is unclear for most species. We studied invasive bark beetles and wood borers associated with pine trees to characterize interactions among color, host and non-host volatiles, by employing traps that mimic tree trunks. Cross-vane flight intercept traps (black, green, red, white, yellow, clear) and black funnel traps were used with and without attractants (α-pinene + ethanol), repellents (non-host green leaf volatiles, 'GLV'), and attractant/repellent combinations in four pine forests in New Zealand. We trapped 274,594 Hylurgus ligniperda, 7842 Hylastes ater, and 16,301 Arhopalus ferus. Trap color, attractant, and color × attractant effects were highly significant. Overall, black and red traps had the highest catches, irrespective of the presence of attractants. Alpha-pinene plus ethanol increased trap catch of H. ligniperda 200-fold but only 6-fold for H. ater and 2-fold for A. ferus. Green leaf volatiles had a substantial repellent effect on trap catch of H. ligniperda but less on H. ater and A. ferus. Attack by H. ligniperda was halved when logs were treated with GLV, and a similar effect was observed when logs were placed among broadleaved understory shrubs emitting GLV. Overall, H. ligniperda was most strongly affected by the olfactory cues used, whereas H. ater and A. ferus were more strongly affected by visual cues. Collectively, the results support the semiochemical diversity hypothesis, indicating that non-host plant volatiles from diverse plant communities or artificial dispensers can contribute to resistance against herbivores by partly disrupting host location.

We examined how combinations of clinical indicators at various ages predict overweight/obesity development, as well as resolution, by 10-11 and 14-15 years of age.Data were derived from Birth (N = 3469) and Kinder (N = 3276) cohorts of the Longitudinal Study of Australian Children, followed from ages 2-3 and 4-5 years, respectively. Every two years, 25 potential obesity-relevant clinical indicators were quantified. Overweight/obesity was defined using International Obesity Taskforce cutpoints at 10-11 years and 14-15 years.In both cohorts, three factors predicted both development and resolution of overweight/obesity in multivariable models. Among normal weight children, increased odds of developing overweight/obesity were associated with higher child (odd ratio (OR) 1.67-3.35 across different study waves) and maternal (OR 1.05-1.09) BMI, and inversely with higher maternal education (OR 0.60-0.62, when assessed at age 2-7 years). Lower odds of resolving existing overweight/obesity were related with higher child (OR 0.51-0.79) and maternal (OR 0.89-0.95) BMI, and inversely with higher maternal education (OR 1.62-1.92, when assessed at age 2-5 years). The prevalence of overweight/obesity at the age of 14-15 years was 13% among children with none of these risk factors at age 6-7 years, compared with 71% among those with all 3 risk factors (P 0.001).From early childhood onwards, child and maternal BMI and maternal education predict overweight/obesity onset and resolution by adolescence. A simple risk score, easily available to child health clinicians, could help target treatment or prevention.

Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition-related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition-related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P

Snacks contribute to overconsumption of energy-dense foods and thence obesity. Previous studies in this area are limited by self-reported data and small samples. In a large population-based cohort of parent-child dyads, we investigated how modification of pre-packaged snack food, i.e. (a) item quantity and variety, and (b) dishware (boxed container) size affected intake.Design: Randomized trial nested within the cross-sectional Child Health CheckPoint of the Longitudinal Study of Australian Children, clustered by day of visit.1299 11-12 year olds, 1274 parents.2 × 2 manipulation of snack box container size and item quantity/variety: (1) small box, few items, (2) large box, few items, (3) small box, more items, (4) large box, more items.Participants received a snack box during a 15 min break within their 3.5 h visit; any snacks remaining were weighed.Consumed quantity (grams) and energy intake (kilojoules).Unadjusted linear regression.Children who were offered a greater quantity and variety of snack items consumed considerably more energy and a slightly higher food mass (main effect for energy intake: 349 kJ, 95% CI 282-416, standardized mean difference (effect size) 0.66; main effect for mass: 10 g, 95% CI 3-17, effect size 0.17). In contrast, manipulating box size had little effect on child consumption, and neither box size nor quantity/variety of items consistently affected adults' consumption.In children, reducing the number and variety of snack food items available may be a more fruitful intervention than focusing on container or dishware size. Effects observed among adults were small, although we could not exclude social desirability bias in adults aware of observation.

ObjectiveWith the intention to inform future public health initiatives, we aimed to determine the extent to which typical childhood dietary trajectories predict adolescent cardiovascular phenotypes.DesignLongitudinal study. Exposure was determined by a 4 d food diary repeated over eight waves (ages 4–15 years), coded by Australian Dietary Guidelines and summed into a continuous diet score (0–14). Outcomes were adolescent (Wave 8, age 15 years) blood pressure, resting heart rate, pulse wave velocity, carotid intima-media thickness, retinal arteriole-to-venule ratio. Latent class analysis identified ‘typical’ dietary trajectories from childhood to adolescence. Adjusted linear regression models assessed relationships between trajectories and cardiovascular outcomes, adjusted for a priori potential confounders.SettingCommunity sample, Melbourne, Australia.SubjectsChildren (n 188) followed from age 4 to 15 years.ResultsFour dietary trajectories were identified: unhealthy (8 %); moderately unhealthy (25 %); moderately healthy (46 %); healthy (21 %). There was little evidence that vascular phenotypes associated with the trajectories. However, resting heart rate (beats/min) increased (β; 95 % CI) across the healthy (reference), moderately healthy (4·1; −0·6, 8·9; P=0·08), moderately unhealthy (4·5; −0·7, 9·7; P=0·09) and unhealthy (10·5; 2·9, 18·0; P=0·01) trajectories.ConclusionsDecade-long dietary trajectories did not appear to influence macro- or microvascular structure or stiffness by mid-adolescence, but were associated with resting heart rate, suggesting an early-life window for prevention. Larger studies are needed to confirm these findings, the threshold of diet quality associated with these physiological changes and whether functional changes in heart rate are followed by phenotypic change.

BACKGROUND AND OBJECTIVES: Parents often do not accurately perceive overweight and/or obesity in their children. Changing this is widely considered an essential first step to reducing child overweight, but recent research suggests that, in fact, this could promote greater weight gain. We aimed to determine the directionality over time between higher child adiposity and parental perception of child overweight. METHODS: Participants were from 2 cohorts of the population-based Longitudinal Study of Australian Children followed biennially since 2004. Repeated measures of BMI z scores and parental perceptions of overweight were available for the kindergarten cohort at 6 waves (ages 4–5, 6–7, 8–9, 10–11, 12–13, and 14–15 years; n = 4632) and for the birth cohort at 4 waves (ages 2–3, 4–5, 8–9, and 10–11 years; n = 4445). Bidirectionality between overweight perception and BMI z score was examined by using cross-lagged regression models. RESULTS: In both cohorts, wave-on-wave lagged effects were strong (all: P < .001) but much larger from BMI z score to parent perception. For every unit increase in the BMI z score, the odds of a child being perceived as overweight in the next wave ranged from 2.9 (birth cohort: age 2–3 years) to 10.4 (kindergarten cohort: age 6–7 years). These effects were ∼3 to 12 times larger than the reverse, whereby the perception of overweight predicted 0.2 to 0.5 higher BMI z score in the next wave. CONCLUSIONS: Higher child BMI z scores strikingly predicted a subsequent parental perception of child overweight. Parent-perceived overweight preceded rising (not falling) BMI, but these effects were small. Clinician efforts to make parents aware of overweight may not be harmful but seem unlikely to improve children’s BMI status.