Obesity Trajectories Research Articles

OR14-2 Age of Onset of Obesity and Childhood BMI Trajectories in Rare Genetic Obesity Disorders

Abstract Introduction Early-onset obesity is a cardinal feature of rare genetic obesity disorders. According to the Endocrine Society guideline, genetic screening is indicated in selected cases with age of onset (AoO) of severe obesity (grade ≥2) <5 years. However, this cut-off is not validated. Aims To present the detailed BMI characteristics of children and adolescents with rare genetic obesity disorders; to evaluate whether the following growth chart characteristics can aid in assessing which children should be screened for genetic obesity disorders: AoO of obesity, AoO of severe obesity, BMI standard deviation scores (SDS) at yearly age intervals. Methods In this prospective observational study, children with non-syndromic and syndromic genetic obesity disorders treated at our tertiary obesity center were included. Growth measurements from birth onwards were collected. Children with obesity from a population-based cohort study with follow-up until age 10 years were included as an unselected reference cohort. Diagnostic performance (sensitivity [sens], specificity [spec], positive likelihood ratio [LR+], area-under-the-curve [AUC]) for AoO of obesity and severe obesity and for BMI-SDS at yearly age intervals was calculated. Results We included 64 children with genetic obesity disorders (32 non-syndromic, 32 syndromic) and 298 control children with obesity. At intake, median age of children with genetic obesity was 10.5 years (IQR 7.0–14.7) and mean BMI-SDS +3.1 ± 1.1. Median AoO of obesity was 1.2 years (IQR 0.6–3.7) in non-syndromic genetic obesity, 2.1 years (IQR 0.9–4.2) in syndromic genetic obesity, and 3.8 years (IQR 2.3–6.2) in the control population. For non-syndromic genetic obesity, optimal cut-off value for AoO of obesity was ≤1.5 years: sens 0.60, spec 0.88, LR+ 5.22, AUC 0.79 (p<0.001). For syndromic genetic obesity, optimal cut-off was ≤3.0 years: sens 0.68, spec 0.68, LR+ 2.06, AUC 0.67 (p=0.001). AoO of severe obesity showed worse diagnostic performance than AoO of obesity in both non-syndromic (AUC 0.58, p=0.20) and syndromic genetic obesity (AUC 0.58, p=0.21). Moreover, when the guideline cut-off <5 years was used, AoO of severe obesity showed a negative diagnostic performance (non-syndromic genetic obesity: sens 0.76, spec 0.13, LR+ 0.88; syndromic genetic obesity: sens 0.85, spec 0.14, LR+ 0.98). BMI-SDS showed good diagnostic performance for non-syndromic genetic obesity across the age intervals (AUCs 0.79-0.89, all P<0.001) but not for syndromic genetic obesity (AUCs 0.54-0.71, P-values ranging from <0.001-0.50). Conclusion This study shows that growth charts characteristics such as BMI-SDS and AoO of obesity (grade 1), but not AoO of severe obesity (grade ≥2), could be useful to distinguish between children with genetic obesity disorders and children with obesity from a population-based cohort study. However, all investigated growth charts characteristics showed misclassification, especially in syndromic genetic obesity, indicating that additional clinical features should be present to warrant genetic testing in these children. Presentation: Sunday, June 12, 2022 11:15 a.m. - 11:30 a.m.

Childhood body mass index trajectories and associations with adult-onset chronic kidney disease in Denmark: A population-based cohort study.

BackgroundAlthough excess adult adiposity is a strong risk factor for chronic kidney disease (CKD), evidence for associations with early life body size is limited. We investigated whether childhood body mass index (BMI) trajectories are associated with adult-onset CKD and end-stage kidney disease (ESKD) using a population-based cohort. Further, we examined the role of adult-onset type 2 diabetes (T2D) in these associations.Methods and findingsWe included 151,506 boys and 148,590 girls from the Copenhagen School Health Records Register, born 1930 to 1987 with information on measured weights and heights at ages 6 to 15 years. Five sex-specific childhood BMI trajectories were analyzed. Information on the main outcomes CKD and ESKD, as well as T2D, came from national health registers. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression adjusted for year of birth. During a median of 30.8 person-years of follow-up, 5,968 men and 3,903 women developed CKD and 977 men and 543 women developed ESKD. For both sexes, the rates of CKD and ESKD increased significantly with higher child BMI trajectories in comparison with the average BMI trajectory (40% to 43% of individuals) and the below-average BMI trajectory (21% to 23% of individuals) had the lowest rates. When including T2D, most associations were significant and men (IRR = 1.39, 95% CI: 1.13 to 1.72) and women (IRR = 1.54, 95% CI: 1.28 to 1.86) with the obese childhood BMI trajectory (2% of individuals) had significantly higher CKD rates than the average BMI trajectory, whereas for ESKD, the associations were positive, but nonsignificant, for men (IRR = 1.38, 95% CI: 0.83 to 2.31) but significant for women (IRR = 1.97, 95% CI: 1.25 to 3.11) with the obese BMI trajectory. A main study limitation is the use of only hospital-based CKD diagnoses.ConclusionsIndividuals with childhood BMI trajectories above average had higher rates of CKD and ESKD than those with an average childhood BMI trajectory. When including T2D, most associations were significant, particularly with CKD, emphasizing the potential information that the early appearance of above-average BMI growth patterns provide in relation to adult-onset CKD beyond the information provided by T2D development.

Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice.

Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.

Dissecting the clinical relevance of polygenic risk score for obesity-a cross-sectional, longitudinal analysis.

Obesity is a global pandemic disease whose prevalence is increasing worldwide. The clinical relevance of a polygenic risk score (PRS) for obesity has not been fully elucidated in Asian populations. We utilized a comprehensive health check-up database from the Korean population in conjunction with genotyping to generate PRS for BMI (PRS-BMI). We conducted a phenome-wide association (PheWAS) analysis and observed the longitudinal association of BMI with PRS-BMI. PRS-BMI was generated by PRS-CS. Adding PRS-BMI to a model predicting ten-year BMI based on age, sex, and baseline BMI improved the model's accuracy (p = 0.003). In a linear mixed model of longitudinal change in BMI with aging, higher deciles of PRS were directly associated with changes in BMI. In the PheWAS, significant associations were observed for metabolic syndrome, bone density, and fatty liver. In the lean body population, those having the top 20% PRS-BMI had higher BMI and body fat mass along with better metabolic trait profiles compared to the bottom 20%. A bottom-20% PRS-BMI was a risk factor for metabolically unhealthy lean body (odds ratio 3.092, 95% confidence interval 1.707-6.018, p < 0.001), with adjustment for age, sex and BMI. Genetic predisposition to obesity as defined by PRS-BMI was significantly associated with obesity-related disease or trajectory of obesity. Low PRS-BMI might be a risk factor associated with a metabolically unhealthy lean body. Better understanding the mechanisms of these relationships may allow tailored intervention in obesity or early selection of populations at risk of metabolic disease.

A Novel Technological Breakthrough in Effective Body Recomposition and Weight Management: A Therapeutic Strategy

Obesity and overweight are now defined as an epidemic. An array of evidence substantiates that existing weight loss strategies and programs have not worked. Fat is the lightest of macromolecules, the highest energy reserve of the body, and the last reservoir of survival insurance to be expended. Conventional weight loss concepts and therapies, for the most part, are based on two primary factors; people eat too much and don’t exercise enough. However, with the increase in gym memberships there has also been a significant increase in the purchase of more wholesome foods. The trajectory of obesity therefore should be decreasing; but it’s not. Furthermore, even the culturally ingrained term “weight loss” itself establishes “heaviness” as the primary criteria for evaluating body composition and size, i.e., scale weight, an inaccurate and erroneous measuring criterion owing to additional variables. An additional 10 factors that contribute to a reduction in metabolic rate and an increase in fat storage have been identified. Individually or in combination, these factors are almost totally ignored or omitted from considerations regarding the etiology of obesity. We developed TrimRox, a stimulant‐ and sugar‐free Prodosomed® TRCAP21 nutraceutical technology, utilizing six standardized extracts comprising of D‐ribose nicotinamide complex, Gynostemma pentaphyllum leaf extract, Myrciaria Dubia whole‐berry extract, Ilex guayusa Loes. (Guayusa) leaf extract, Purple Tea Camellia sinensis extract (PurpleForce™), and alpha Glyceryl phosphoryl choline that effectively addresses all the contributing factors. A 21‐day concept validation physician‐supervised pilot study on the TRCAP21 was conducted in 9 subjects to assess changes in various body parts, including chest, upper arms, waist/belly, hips, and thighs, as well as body weight. The results demonstrated that all subjects experienced a significant reduction in size of one or more of these body parts and significant reduction in body weight. A randomized double‐blind placebo‐controlled study is in progress.

Long-Term Parallel Changes of Physical Activity and Body Mass Index in Different Predisposing Risk Trajectories of Obesity.

The long-term parallel changes of physical activity and body mass index (BMI) in the adult population are still unclear. The present study assessed the association between physical activity and BMI over time, considering obesity risk trajectory groups and sex strata. Total sample of 6897 adults was followed for an average of 12 years. The reliable and validated Iranian version of the Modifiable Activity Questionnaire measured physical activity. After determining the risk clusters in each reexamination using a 2-step cluster analysis, the latent growth curve modeling was used to identify distinct subgroups of individuals following a similar change of risk cluster over time. Latent growth curve modeling estimated the parameters of cross-sectional, prospective, and parallel associations. Three trajectories were identified, including stable low risk, unstable risk, and stable high risk. The results showed significant increases in BMI (kg/m2/year) for the stable low-risk trajectory group 0.478 (95% confidence interval [CI] 0.444 to 0.513), unstable risk 0.360 (95% CI, 0.324 to 0.396), and those in the stable high-risk trajectory group 0.255 (95% CI, 0.221 to 0.289). In cross-sectional -0.483kg/m2 (95% CI, -0.836 to -0.129) and parallel -0.93kg/m2 (95% CI, -1.862 to 0.00) estimations, significant statistical associations were observed in the stable high-risk trajectory group. The current results showed that changes in physical activity could slightly affect BMI only in stable high-risk adults.

Natural History of Obesity Due to POMC, PCSK1, and LEPR Deficiency and the Impact of Setmelanotide.

ContextRare homozygous or biallelic variants in POMC, PCSK1, and LEPR can disrupt signaling through the melanocortin-4 receptor (MC4R) pathway, resulting in hyperphagia and severe early-onset obesity. In pivotal Phase 3 clinical trials, treatment with the MC4R agonist setmelanotide reduced hunger and weight in patients with obesity due to proopiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) deficiency.ObjectiveTo characterize the historical weight trajectory in these patients.MethodsThis analysis included data from 2 pivotal single-arm, open-label, Phase 3 trials (NCT02896192, NCT03287960). These were multicenter trials. Patients had obesity due to POMC/PCSK1 or LEPR deficiency. During the trial, patients were treated with setmelanotide. Historical data on measured weight and height were obtained during screening.ResultsA total of 17 patients (POMC, n = 8; PCSK1, n = 1; LEPR, n = 8) with historical weight and height data were included in this analysis. Before setmelanotide treatment, patients with obesity due to POMC/PCSK1 or LEPR deficiency were above the 95th percentile for weight throughout childhood, demonstrated continuous weight gain, and did not show long-term weight loss upon interventions (eg, diet, surgery, exercise). Setmelanotide treatment attenuated weight and body mass index trajectories over the observation period of 1 year.ConclusionIn patients with POMC, PCSK1, or LEPR deficiency, traditional interventions for weight loss had limited impact on the trajectory of severe early-onset obesity. However, setmelanotide treatment attenuated weight and body mass index trajectories and led to weight loss associated with health benefits in most individuals.

Family Psychosocial Assets, Child Behavioral Regulation, and Obesity.

Little attention has been given to the study of early childhood factors that protect against the development of obesity and severe obesity. We investigated whether exposure to familial psychosocial assets and risks in infancy (1-15 months) and early childhood (24-54 months) and child behavioral regulation in early childhood predict longitudinal change in BMI (2 to 15 years). Participants included 1077 predominantly non-Hispanic, White, English-speaking mother-child dyads from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development dataset. Cumulative familial asset and risk indices were created using measures (eg, maternal parenting sensitivity, poverty) from 2 developmental periods (1-15 months, 24-54 months). A child behavioral regulation index was created on the basis of behavioral tasks and parent reports. Previously published BMI trajectories (nonoverweight [40th percentile], nonoverweight [70th percentile], overweight/obese, severely obese) were used as the outcome. All indices predicted membership in the overweight/obese trajectory; however, when entered into the same model, only familial assets continued to reduce the odds of membership in this trajectory. Familial assets and child behavioral regulation independently reduced the odds of membership in the severely obese trajectory. Furthermore, child behavioral regulation and familial assets buffered the negative effects of familial risk on BMI trajectory membership. Early exposure to familial assets and child behavioral regulation may have long-term protective effects on weight gain over early exposure to some familial risk factors (eg, poverty); thus, these indices may help foster obesity resilience.

Undernutrition and obesity trends in Brazilian adults from 1975 to 2019 and its associated factors.

Nutritional status has evolved in a dual trend worldwide: underweight has become a minor or local issue while overweight or obesity has risen to play a major role in the global burden of disease. In 2014, Brazil was ranked as the third country with the highest absolute number of obese men. Our aim was to estimate trends of underweight and obesity among Brazilian adults using a comprehensive set of surveys from 1974 to 2019. The data used in the study originate from subjects aged ≥ 18 in six Brazilian national surveys, presented in chronological order: Brazilian National Survey on Household Expenses (ENDEF 1974-1975); Brazilian National Survey on Health and Nutrition (PNSN 1989); Brazilian Household Budget Survey (POF 2002-2003, 2008-2009); and Brazilian National Health Survey (PNS 2013 and 2019). All six surveys were designed to sample household complexes that were representative of the Brazilian population. Body mass index was calculated (kg/m2). The nutritional status of individuals was classified following the standards. We have modeled obesity trend according to income and education strata. The trajectories of underweight and obesity over time in Brazil draw the classical "X" of nutrition transition. From 1975 to 2019 underweight has decreased from 9.1% to 2.5% among men and 12.2% to 3.4% among women. On the other hand, obesity trajectories have scaled up from 3% to 22% among men and from 9% to 30% among women. The increase in obesity rate is directly and negatively proportional to income quintiles. Sociodemographic (income and education) improvement is associated with an increase in obesity. All public policies intending to stop the obesity spread in Brazil have been ineffective or too small to be effective.

Abdominal volume index trajectories and risk of diabetes mellitus: Results from the China Health and Nutrition Survey.

Aims/IntroductionAbdominal obesity is a risk factor for developing diabetes mellitus, but trajectories of abdominal obesity over time and incident diabetes mellitus have not been considered. We derived trajectories of abdominal volume index (AVI) over 16 years of follow up, and examined the associations between AVI trajectories and risk of diabetes mellitus.Materials and MethodsData were used from the China Health and Nutrition Survey, and 5,267 participants were enrolled to fit the trajectory of AVI by using latent class growth models. Multivariate logistic regression models explored the relationship between different AVI trajectories and risk of diabetes mellitus. In addition, we examined the slope of the AVI trajectories in relation to age to identify appropriate life course intervention opportunities for the prevention of diabetes mellitus.ResultsThree trajectories were derived reflecting graded categories in the speed and slope of increase in AVI over time: slow, intermediate and fast increase group, respectively. After multivariate adjustment, the odds ratios for diabetes mellitus among those in the intermediate and fast increase groups were 1.81 (95% confidence interval 1.37–2.38, P < 0.001) and 2.80 (95% confidence interval 1.85–4.24, P < 0.001) respectively, relative to the slow increase group. The distribution of AVI slope in the slow increase group showed an inverted "U" shape, whereas the fast increase group presented a "U" shape.ConclusionsAVI trajectory is associated with an increased risk of diabetes mellitus. These results provide new insights on the relationship between abdominal adiposity and diabetes mellitus, which in turn can help improve clinical and public health intervention for diabetes mellitus prevention.

Physical Activity, Sport Practice and Cardiovascular Risk Factors in Workers From a Public Hospital: A Trajectory Analysis.

Background: Studies have demonstrated the positive effects of physical activity on cardiovascular risk factors. Longitudinal studies using modeled trajectories are necessary to understand patterns of physical activity and association with cardiovascular risk factors.Objective: To analyze the association between sports practice in young people and current physical activity with the trajectory of cardiovascular risk factors in workers at a public hospital.Methods: Four hundred and seventeen workers was followed for four years reporting Physical Activity, health status, lifestyle behaviors and socio-demographic characteristics. Group-based trajectory modeling identified the trajectories of PA and associations with time-stable and time-varying covariates. We considered a range of sociodemographic and health and lifestyle factors as potential covariates.Results: The results shows the association between participation in sports activities in youth and current physical activity and trajectories of cardiovascular risk, adjusted for sex and age (p < 0.05). Adults who reported having played sports in their youth and are currently active have a lower risk of having a history of obesity and low HDL-c than workers who did not play sports in their youth and are currently sedentary 0.690 (0.565–0.844) obesity, 0.647 (0.500–0.837) low HDL-c.Conclusion: The practice of sports in youth and current physical activity is a protective factor against the trajectory of obesity and low HDL-c, mainly in female workers. Programs to encourage the practice of physical activity should be carried out in order to reduce cardiovascular risk factors and prevent chronic diseases in workers.

Association between obesity and life courses in young adulthood. Results from the KiGGS cohort study

Abstract In the last decades, young adulthood has established as an independent phase of life with important biographical transitions impacting further life course and health. In turn, health in adolescence can also affect the transitions into young adulthood. So far, for Germany there are no analyses on the association between family-related and employment-related biographies and obesity in young adults. The analysis is based on data from the KiGGS cohort study on 3,100 participants aged 23-31 at second follow-up (t2). Using BMI measurements at t0 (2003-2006) and at t2 (2014-2017), obesity groups were formed (no obesity, incidence, remission, persistence). Sequence analysis was used to retrospectively determine family-related and education/employment-related individual trajectories. Differences in life courses between obesity groups were calculated using discrepancy tests. Young adults with incident obesity were more likely to have children or to be a single parent than young adults without obesity at t2. Young adults with obesity at t0 lived longer in the parental home than those without obesity. Young adults with incident or persistent obesity were less likely to attend university and had experienced longer periods of unemployment than those without obesity at t0 and t2. The employment sequences of those without obesity at t2 were not statistically different. Both family and employment biographies were associated with obesity trajectories in young people. However, based on the analysis, it cannot be clarified whether early parenthood led to obesity or early transitions into parenthood led to interruptions in education or employment and subsequently to obesity. The finding that young adults with obesity were less likely to attend university and more likely to be unemployed could be related to disadvantages or discrimination in school, education or work. Obesity in adolescence that did not persist into young adulthood had less adverse effects on education and employment. Key messages Young people’s obesity trajectories were linked to different family/employment biographies. The life courses of young adults with obesity were more often marked by early parenthood and unemployment.

Employment Status Transition Predicts Adult Obesity Trajectory: Evidence From a Cohort Study in South Korea.

To investigate the impact of employment status on health by describing obesity trajectories with employment status transitions. We used data from the Korean National Health Insurance Service - National Sample Cohort 2006-2015 data. Employment status transitions were measured using four categories: continuously non-employed, continuously employed, transition into employment, and transition out of employment. The time trends in the likelihood of obesity were examined both before and after employment status transition. The time trends of the likelihood of obesity showed a significantly increasing trend in the transition into employment group, especially in younger men, and increasing trends of obesity among the transition out of employment group, especially in older female participants. This study found increase in obesity prevalence of men after transition into employment and of women after transition out of employment.

Predictive value of women\u2019s weight trajectories in determining familial cardiovascular disorders: a family-based longitudinal study

Considering the dynamic nature of body mass index (BMI) and its importance in determining cardiovascular risks, this study aimed to investigate the life-course trajectory pattern of women’s BMI and its association with cardiovascular risk factors. A total of 1356 couples with 2976 children were recruited and followed up for an average period of 20 years. Latent growth curve modeling was applied to determine women's BMI trajectories; logistic regression was used to investigate the associations between trajectory patterns and cardiovascular risk factors, including hypertension (HTN), dyslipidemia, diabetes mellitus (DM), and obesity. Women were classified into three trajectories, including normal, stage 1 obesity, and stage 2 obesity. Compared to women’s in the normal trajectory group, those in obesity trajectories had higher odds ratios for HTN, DM, and dyslipidemia. Men with obese spouses showed a higher rate of HTN 1.54 (95% CI 1.05–2.25) and DM 1.55; (95% CI 1.00–2.44). The odds of men’s obesity were higher in obese spouses (OR 1.70; 95% CI 1.10–2.62). Offspring of stage 2 obese (OR 2.39; 95% CI 1.67–3.44) and stage 1 obese (OR 4.81; 95% CI 3.16–7.34) mothers were more likely to be obese. Our findings emphasized paying more attention to women with excessive weight to promote familial cardiovascular health in the communities.

Modelling future trajectories of obesity and body mass index in England.

BackgroundObesity is a leading risk for poor health outcomes in England. We examined best- and worst-case scenarios for the future trajectory of the obesity epidemic.MethodsTaking the last 27 years of Health Survey for England data, we determined both position and shape of the adult body mass index (BMI) distribution and projected these parameters 20 years forward in time. For the best-case scenario, we fitted linear models, allowing for a quadratic relationship between the outcome variable and time, to reflect a potential reversal in upwards trends. For the worst-case scenario, we fitted non-linear models that applied an exponential function to reflect a potential flattening of trends over time. Best-fitting models were identified using Monte Carlo cross-validation on 1991–2014 data, and predictions of population prevalence across five BMI categories were then validated using 2015–17 data.ResultsBoth linear and non-linear models showed a close fit to observed data (mean absolute error <2%). In the best-case scenario, the proportion of the population at increased risk (BMI≥25kg/m2) is predicted to fall from 66% in 2017 to 53% (95% confidence interval: 41% to 64%) in 2035. In the worst-case scenario, this proportion is likely to remain relatively stable overall– 64% (37% to 90%) in 2035 –but with an increasing proportion of the population at highest risk (BMI≥35kg/m2).ConclusionsWhile obesity prediction depends on chosen modelling methods, even under optimistic assumptions it is likely that the majority of the English population will still be at increased risk of disease due to their weight until at least 2035, without greater allocation of resources to effective interventions.

Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood.

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003–2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009–2012) and KiGGS Wave 2 (2014–2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study ‘Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)’. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence.

General and abdominal obesity trajectories across adulthood, and risk of prostate cancer: results from the PROtEuS study, Montreal, Canada.

Greater body fatness is a probable cause of advanced prostate cancer (PCa). Body fat distribution and timing of exposure may be relevant. We investigated associations between body size trajectories and PCa incidence in a population-based case-control study in Montreal, Canada. Cases (n = 1,931), aged ≤ 75years, were diagnosed with PCa in 2005-2009; 1,994 controls were selected from the electoral list. Interviews were conducted to assess body mass index (BMI) and Stunkard's silhouette at ages 20, 40, 50, 60years, and before interview. Current waist and hip circumferences were measured, and a predictive model estimated waist circumference in the past. BMI and waist circumference trajectories were determined to identify subgroups. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between anthropometric indicators and PCa. Subjects with a current BMI ≥ 30kg/m2 had a lower risk of overall PCa (OR 0.71, 95% CI 0.59-0.85). Associations with adult BMI followed similar trends for less and more aggressive tumors, with stronger inverse relationships in early adulthood. Contrastingly, current waist circumference ≥ 102cm was associated with elevated risk of high-grade PCa (OR 1.33, 95% CI 1.03-1.71). Men with increasing BMI or waist circumference adult trajectories had a lower risk of PCa, especially low-grade, than those in the normal-stable range. This was especially evident among men in the obese-increase group for BMI and waist circumference. Abdominal obesity increased the risk of aggressive PCa. The inverse relationship between body size trajectories and PCa may reflect PSA hemodilution, lower detection, and/or a true etiological effect.

Life-long body mass index trajectories and mortality in two generations

To identify life-long body mass index (BMI) trajectories across two related generations and estimate their associated mortality risks and population attributable deaths. We use prospective cohort data from the Framingham Heart Study (1948-2011) original (4576 individuals, 3913 deaths) and offspring (3753 individuals, 967 deaths) cohorts and latent trajectory models to model BMI trajectories from age 31 to 80 years. Survival models are used to estimate trajectory-specific mortality risk. We define seven BMI trajectories among original cohort and six among offspring cohort. Among original cohort, people who are normal weight at age 31 years and gradually move to overweight status in middle or later adulthood have the lowest mortality risk even compared to those who maintain normal weight throughout adulthood, followed by overweight stable, lower level of normal weight, overweight downward, class I obese upward, and class II/III upward trajectories. Mortality risks associated with obesity trajectories have declined across cohorts, while the prevalence of high-risk trajectories has increased. The mortality impact of weight gain depends on an individual's BMI trajectory. Population attributable deaths associated with unhealthy weight trajectories have grown over generations because the prevalence has increased, offsetting the decline in trajectory-specific mortality risks.

A Mediation Analysis of the Association between Fundamental Motor Skills and Physical Activity during Middle Childhood.

The purposes of the study were: (1) to investigate the associations between fundamental motor skills (FMS), health-related fitness (HRF) and physical activity (PA) during middle childhood; and (2) to examine whether HRF serves as a mediator in these pathways. The participants were 342 children (156 girls; Mage = 8.40, SD = 0.50) recruited in Texas. Children’s FMS (locomotor and ball skills) were assessed. School-based PA that included light, moderate, and vigorous PA was captured by accelerometers. The FITNESSGRAM battery was used to measure children’s HRF, including body composition, cardiorespiratory fitness, and muscular fitness. Structural equation models were used to evaluate two proposed models (model-1 = FMS»HRF»PA; model-2 = PA»HRF»FMS). Both locomotor and ball skills were associated with all components of HRF (p < 0.01), but not PA. The SEM analyses supported associations between FMS, HRF and PA, with sound goodness-of-fit indices: (1) model-1: CFI = 0.95; RMSEA = 0.072; and (2) model-2: CFI = 0.95; RMSEA = 0.071, respectively. The relationship between FMS and PA was fully mediated by the HRF in both directions. The behavioral mechanism (e.g., maintaining appropriate levels of HRF) provides meaningful insights to understand the obesity trajectory during middle childhood.

Associations of caesarean section with body mass and waist circumference trajectories from age 2 to 13 years: A nationally representative birth cohort study in Australia.

Measuring obesity at a single time point does not explain the independent association between C-section birth and obesity in a child's life course. This study aimed to explore the longitudinal link between C-section with obesity trajectories during childhood. We analysed data from a nationally representative birth cohort study named "Longitudinal Study of Australian Children (LSAC)", commenced in 2004. General obesity was measured through the Body Mass Index (BMI) and abdominal obesity by the Waist Circumference (WC) using the biennially collected data from age 2 to 13 years (2006-2016). Group-based trajectory modelling was applied to identify the distinct pattern of BMI & WC trajectories. Multivariable multinomial logistic regression models were used to assess the association between C-section and obesity trajectories after adjusting for perinatal factors. Of the 3524 study children, 30% were born by C-section. Three distinct BMI trajectory groups emerged: stable normal (60%), moderately rising (33%) and accelerated (7%). The WC trajectories were, stable normal (58%), moderate (34%) and accelerated (8%). Compared with the stable normal group, children born through C-section had a higher risk to follow accelerated trajectories for both BMI (OR:1.72; 95% CI: 1.28-2.32) and WC (OR: 1.51; 95% CI: 1.15-1.98) with P-value <0.01. Adjustment of potential confounders did not alter these associations substantially. C-section birth significantly increases the risk of having an accelerated obesity trajectory in children. Limiting the C-section for absolute clinical causes and early institution of preventive approach can reduce the obesity burden among children delivered through C-section.