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Background While weight gain during first year of university has been well documented in North America, literature on sex-specific effects is scarce and inconsistent. The objective of this investigation was to explore sex-specific changes in obesity traits during first year of university at McMaster University (Ontario, Canada). Methods 245 first-year students (80.4% females) were followed longitudinally with data collected early in the academic year and towards the end of the year. Obesity parameters including weight, waist and hip circumferences, BMI, and waist to hip ratio were investigated. The Mann-Whitney U test and the Wilcoxon signed-rank test were used for pairwise comparison of traits in the absence of adjustments. Additionally, the repeated-measures ANOVA test was used with covariate adjustments to investigate the interaction between sex and time. Results Overall sample trends indicated a significant increase in mean weight by 1.55 kg (95% CI: 1.24–1.86) over the school year (p0.05). Conclusion While our study confirms significant weight gain in both male and female first year university students in Ontario, Canada, it does not show sex specific differences within this context. Our investigation highlights the importance of accounting for sex and gender in health research and supports the need of further studies in this area.

Background Little is known about the impact of race/ethnicity on weight change at university. The objective of this study is to determine if ethnicity has an impact on obesity traits in a multiethnic cohort of first-year students at McMaster University in Ontario, Canada. Methods 183 first year students from the three most represented ethnic groups (South Asian, East Asian, and white-Caucasian) in our study sample were followed longitudinally with data collected early in the academic year and towards the end of the year. Obesity parameters including body weight, body mass index (BMI), waist and hip circumference, and waist hip ratio (WHR) were analyzed. The Wilcoxon signed-rank test was used for pairwise comparison of traits from the beginning to the end of the year in the absence of adjustments. Linear regression was used with covariate adjustments to investigate the effect of ethnicity on obesity traits. Results A significant increase in weight by 1.49 kg (95%CI: 1.13–1.85) was observed over the academic year in the overall analyzed sample. This was accompanied by significant gains in BMI, waist and hip circumferences, and WHR. Ethnicity stratified analysis indicated significant increase in all investigated obesity traits in East Asians and all traits, but WHR, in South Asians. White-Caucasians only displayed significant increases in weight and BMI. Body weight and hip circumference were significantly lower in East Asians compared to white-Caucasians at baseline. However, East Asians displayed a significantly larger increase in mean BMI and weight compared to white-Caucasians after first-year. South Asians displayed larger waist circumference at baseline compared to East Asians and larger WHR compared to white-Caucasians. Conclusion Our findings demonstrate that ethnicity has an impact on obesity traits in first-year university students. Universities should take ethnicity into account while implementing effective obesity prevention programs to promote healthy and active lifestyles for students.

Background Dietary recommendations and policies should be guided by rigorous systematic reviews. Reviews that are of poor methodological quality may be ineffective or misleading. Most of the evidence in nutrition comes from nonrandomized studies of nutritional exposures (usually referred to as nutritional epidemiology studies), but to date methodological evaluations of the quality of systematic reviews of such studies have been sparse and inconsistent. Objectives We aimed to investigate the quality of recently published systematic reviews and meta-analyses of nutritional epidemiology studies and to propose guidance addressing major limitations. Methods We searched MEDLINE (January 2018-August 2019), EMBASE (January 2018-August 2019), and the Cochrane Database of Systematic Reviews (January 2018-February 2019) for systematic reviews of nutritional epidemiology studies. We included a random sample of 150 reviews. Results Most reviews were published by authors from Asia (n = 49; 32.7%) or Europe (n = 43; 28.7%) and investigated foods or beverages (n = 60; 40.0%) and cancer morbidity and mortality (n = 54; 36%). Reviews often had important limitations: less than one-quarter (n = 30; 20.0%) reported preregistration of a protocol and almost one-third (n = 42; 28.0%) did not report a replicable search strategy. Suboptimal practices and errors in the synthesis of results were common: one-quarter of meta-analyses (n = 30; 26.1%) selected the meta-analytic model based on statistical indicators of heterogeneity and almost half of meta-analyses (n = 50; 43.5%) did not consider dose-response associations even when it was appropriate to do so. Only 16 (10.7%) reviews used an established system to evaluate the certainty of evidence. Conclusions Systematic reviews of nutritional epidemiology studies often have serious limitations. Authors can improve future reviews by involving statisticians, methodologists, and researchers with substantive knowledge in the specific area of nutrition being studied and using a rigorous and transparent system to evaluate the certainty of evidence.

Introduction Vaccination against influenza on an annual basis is widely recommended, yet recent studies suggest consecutive vaccination may reduce vaccine effectiveness (VE). Purpose To assess whether when examining the entirety of existing data consecutive influenza vaccination reduces VE compared to current season influenza vaccination. Data sources MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 26, 2017; citations of included studies. Study selection Randomized, controlled trials (RCTs) and observational studies of children, adults and/or the elderly that reported laboratory-confirmed influenza infection over 2 or more consecutive influenza seasons were eligible. Data extraction Data related to study characteristics, participant demographics, cases of influenza infection by vaccination group and risk of bias assessment was extracted in duplicate. Data synthesis Five RCTs involving 11,987 participants did not show a significant reduction in VE when participants vaccinated in two consecutive seasons (VE 71%, 95% CI 62–78%) were compared to those vaccinated in the current season (VE 58%, 95% CI 48–66%) (odds ratio [OR] 0.88, 95% CI 0.62–1.26, p = 0.49, I2 = 39%). Twenty-eight observational studies involving 28,627 participants also did not show a reduction (VE for two consecutive seasons 41%, 95% CI 30–51% compared to VE for current season 47%, 95% CI 39–54%; OR 1.14, 95% CI 0.98–1.32, p = 0.09, I2 = 63%). Results from subgroup analyses by influenza type/subtype, vaccine type, age, vaccine match and co-morbidity support these findings; however, dose–response results were inconsistent. Certainty in the evidence was assessed to be very low due to unexplained heterogeneity and imprecision. Limitations The inclusion of studies with relatively small sample sizes and low event rates contributed to the imprecision of summary VE and OR estimates, which were based on unadjusted data. Conclusion Available evidence does not support a reduction in VE with consecutive influenza vaccination, but the possibility of reduced effectiveness cannot be ruled out due to very low certainty in this evidence. Funding source CIHR Foundation Grant (PROSPERO: CRD42017059893).

This scoping review identifies factors associated with obesity traits including body mass index, weight, and body fat percentage in undergraduate students. We searched CINAHL, EMBASE, MEDLINE, and PsycINFO for original studies of undergraduate students where an obesity trait was associated with a risk factor. Two-hundred sixty-eight articles were included comprising of 251 studies: 186 cross-sectional, 50 cohort, 11 interventional, and 4 qualitative. We extracted data on risk/protective factors, obesity traits, and the direction of effect between them. We identified a variety of factors including age, sex, ethnicity, socioeconomic status, religion, diet, eating habits, physical activity, sedentary activity, sleep, stress, university campus life, alcohol use, smoking, psychiatric disorders, body image, eating attitude, eating regulation, personality, sociocultural influences, and genetics. The majority of associations were cross-sectional. For longitudinal findings, usually only one study investigated each trait. This review identifies a need for higher quality evidence to support results from cross-sectional studies and replication of findings of longitudinal studies. This review identifies gaps in the literature, generates hypotheses, guides researchers to plan future studies, and helps decision-makers design obesity-prevention programs in universities.

Background: Recent approval and adoption of pangenotypic direct acting antivirals (DAAs) necessitated a revision of the 2015 World Health Organization guidelines for the management of persons with hepatitis C virus (HCV) infection. Methods: We searched MEDLINE, EMBASE, CENTRAL, and relevant conference proceedings to identify randomized and non-randomized trials, as well as prospective observational studies of DAAs. The proportions of persons with events were pooled for sustained virological response at 12 weeks post-treatment (SVR12), discontinuations due to adverse events (DAEs), serious adverse events (SAEs), and all-cause mortality. Analyses were stratified by HCV genotype and antiviral treatment experience, with subgroup analyses based on presence of cirrhosis and HIV-HCV coinfection. Findings: The evidence base consisted of 238 publications describing 142 studies. In the overall analysis, which included all persons irrespective of treatment experience or comorbidities, the pooled proportion achieving SVR12 exceeded 0.94 for all pangenotypic regimens across genotypes 1, 2, and 4. Some heterogeneity may have led to lower SVR rates in persons with genotype 3 infection. High SVR12 (>0.90) was observed in persons with genotype 1 infection with cirrhosis, though evidence varied and was limited for genotypes 2–4. Evidence was sparse for persons with HIV–HCV coinfection. All regimens were associated with small proportions of persons with DAEs, SAEs, or all-cause mortality. Interpretation: Based on this and other supporting evidence, the WHO issued updated guidelines with a conditional recommendation, based on moderate quality evidence, for the use of pangenotypic DAA regimens for persons with chronic HCV infection aged 18 years and older (July 2018). Funding: This study was funded by the World Health Organization. Keywords: Direct-acting antivirals, Hepatitis C, Pangenotypic, SVR12, Systematic review

Background The transition to university often involves a change in living arrangement for many first-year students. While weight gain during first year of university has been well documented, Canadian literature on the impact of living arrangement within this context is limited. The objective of this investigation was to explore the effect of living arrangement on anthropometric traits in first-year university students from Ontario, Canada. Methods 244 first-year undergraduate students were followed longitudinally with data collected early in the academic year and towards the end of the year. Anthropometric parameters including weight, waist and hip circumference, body mass index (BMI), and waist-to-hip ratio (WHR) were examined. The Wilcoxon signed-rank test was used for pairwise comparison of traits from the beginning to end the year in the absence of adjustments. Additionally, linear regression models with covariate adjustments were used to investigate effect of the type of living arrangement (i.e. on-campus, off-campus, or family home) on the aforementioned traits. Results In the overall sample, a significant weight increase of 1.55kg (95% CI: 1.24–1.86) was observed over the school year (p Conclusion Our findings indicate that living arrangement is associated with different weight gain trajectories in first-year university students.

Background Observational studies provide important information about the effects of exposures that cannot be easily studied in clinical trials, such as nutritional exposures, but are subject to confounding. Investigators adjust for confounders by entering them as covariates in analytic models. Objective The aim of this study was to evaluate the reporting and credibility of methods for selection of covariates in nutritional epidemiology studies. Methods We sampled 150 nutritional epidemiology studies published in 2007/2008 and 2017/2018 from the top 5 high-impact nutrition and medical journals and extracted information on methods for selection of covariates. Results Most studies did not report selecting covariates a priori (94.0%) or criteria for selection of covariates (63.3%). There was general inconsistency in choice of covariates, even among studies investigating similar questions. One-third of studies did not acknowledge potential for residual confounding in their discussion. Conclusion Studies often do not report methods for selection of covariates, follow available guidance for selection of covariates, nor discuss potential for residual confounding.

IntroductionObesity is a global epidemic and is a risk factor for developing other comorbidities. Young adulthood is a critical period for body weight change and establishing healthy lifestyle behaviours. The ‘Freshman 15’ suggests that undergraduate students gain 15 lbs (6.8 kg) during their first year of university, although evidence estimates a more modest weight gain of approximately 3–5 lbs (1.4–2.3 kg). Previous studies have only investigated weight change in the first year and do not study potential risk factors. Genetic and EnviroNmental Effects on weight in University Students (GENEiUS) is a prospective observational study which will investigate the environmental and biological determinants of weight change in undergraduate students over 4 years.Methods and analysisThe GENEiUS study will recruit 2500 multiethnic undergraduates aged 17–25 years at McMaster University at the start of their first year and will follow them every 6 months for 4 years. Primary outcomes are obesity traits: body mass index, waist circumference, waist-to-hip ratio, body fat mass and body fat percentage. The contribution of well-established and novel genetic variants for obesity traits and heritability values will be derived from whole-genome single-nucleotide polymorphism genotyping arrays. Civil status, age, sex, ethnicity, length of residence in Canada, religiosity, energy intake, physical activity, exercise motivation, electronic screen time, sleep patterns, history of assault, smoking status, alcohol consumption, medication and drug use, stress, impulsivity, body image perception, self-esteem, anxiety, eating disorders and depression will be investigated for their effect on obesity traits. The findings of the GENEiUS study will be used to help design obesity prevention programme in North American universities with multiethnic populations.Ethics and disseminationEthical approval of the study protocol has been obtained from the Hamilton Integrated Research Ethics Board. Study results will be disseminated through scientific publications, scholarly meetings, and collaborative meetings with university administration and student groups.