Self-reported Body Size Research Articles

Child-to-adult body size change and risk of type 2 diabetes and cardiovascular disease.

Childhood overweight increases the risk of type 2 diabetes and cardiovascular disease in adulthood. However, the impact of childhood leanness on adult obesity and disease risk has been overlooked. We examined the independent and combined influences of child and adult body size on the risk of type 2 diabetes and cardiovascular disease. Data from the UK Biobank on 364,695 individuals of European ancestry and free of type 2 diabetes and cardiovascular disease were divided into nine categories based on their self-reported body size at age 10 and measured BMI in adulthood. After a median follow-up of 12.8 years, 33,460 individuals had developed type 2 diabetes and/or cardiovascular disease. We used Cox regression models to assess the associations of body size categories with disease incidence. Individuals with low body size in childhood and high body size in adulthood had the highest risk of type 2 diabetes (HR 4.73; 95% CI 4.50, 4.99), compared to those with average body size in both childhood and adulthood. This was significantly higher than the risk in those with high body size in both childhood and adulthood (HR 4.05; 95% CI 3.84, 4.26). By contrast, cardiovascular disease risk was determined by adult body size, irrespective of childhood body size. Low body size in childhood exacerbates the risk of type 2 diabetes associated with adult obesity but not the risk of cardiovascular disease. Thus, promoting healthy weight management from childhood to adulthood, among lean children, is crucial.

Perceptions of Health, Body Size, and Nutritional Risk Factors for Obesity in People with HIV in South Africa.

Metabolic disease is increasing in people with HIV (PWH) in South Africa, but little is known about self-perceptions of body size, health, and nutritional behavior in this population. We performed a cross-sectional analysis of individual-level data from the 2016 South Africa Demographic and Health Survey. This survey measured HIV serostatus and body mass index (BMI). We categorized participants into six BMI groups: 18.5-22kg/m2, 22-25kg/m2, 25-27.5kg/m2, 27.5-30kg/m2, 30-35kg/m2, and ≥ 35kg/m2 and stratified them by HIV serostatus. Our outcomes were self-reported (1) body size and (2) health status among all participants, and intake of (3) chips and (4) sugar-sweetened beverages(SSB) in PWH. We described these metrics and used multivariable regression to evaluate the relationship between the nutritional behaviors and BMI ≥ 25kg/m2 in PWH only, adjusting for age, sex, educational attainment, and household wealth quintile. Of 6138 participants, 1163 (19.7%) were PWH. Among PWH, < 10% with a BMI 25-30kg/m2, < 20% with a BMI 30-35kg/m2 and < 50% with a BMI ≥ 35kg/m2 self-reported as overweight or obese. PWH reported being in poor health at higher rates than those without HIV at each BMI category except ≥ 35kg/m2. In adjusted models, SSB consumption was associated with BMI ≥ 25kg/m2 (1.13 [1.01-1.25], t-statistic = 2.14, p = 0.033) in PWH. Perceptions of body size may challenge efforts to prevent weight gain in PWH in South Africa. SSB intake reduction should be further explored as a modifiable risk factor for obesity.

Exposure to Starvation: Associations with HbA1c, Anthropometrics, and Trauma Symptoms Four Decades Later Among Cambodians Resettled in the USA.

Epidemiological data suggest that populations exposed to starvation show increased incidence of type 2 diabetes but these studies are limited by lack of person-level data. Cambodians resettled in the USA survived severe malnutrition during distinct historical eras. We examined the relationship of individual exposure to starvation with current HbA1c, anthropometrics, and trauma symptoms among Cambodian Americans. Participants were excluded for extant diabetes but all had elevated risk factors for type 2 diabetes and depression. Participants identified images on a 5-point scale that best depicted their body size during four distinct periods: before 1970 (peacetime), 1970-1975 (USA bombing campaign, widespread hunger), 1975-1979 (Pol Pot regime, mass starvation), and "now" (2016-2019, resettled in the USA).They reported trauma symptoms and provided anthropometrics and a blood sample. The n = 189 participants were mean = 55years old and had glycosylated hemoglobin (HbA1c) mean = 5.5%. Self-reported body size showed excellent validity by strong correlations between body thinness "now" and objectively measured waist circumference (r = -0.35), weight (r = -0.50), and body mass index (r = -0.50). Whereas there was some variability, modal self-reported body size started as normal during peacetime, became thinner during the USA bombing campaign, became emaciated during the Pol Pot regime, and rebounded to normal/slightly heavy "now." Body size during Pol Pot showed the strongest associations with long-term outcomes; thinner body size (greater starvation) was associated with higher trauma symptoms and higher HbA1c even after controlling for age, current waist circumference, and current body mass index. Greater degree of starvation was associated with higher HbA1c and trauma symptoms four decades later.

Could Self-Reported Body Sizes Be an Alternative Tool for Assessing Breast Cancer Risk in Postmenopausal Women?

Background: The use of self-reported body size as an alternative tool to estimate body weight for health risk assessment is not widely reported, especially in relation to breast cancer. Therefore, we examined the association between breast cancer and body-mass index (BMI) and the usefulness of pictograms. Methods: The case–control study was conducted among postmenopausal women from 2015 to 2019. The study involved 151 women with breast cancer and 67 control subjects. Data were collected by a self-reported detailed questionnaire. Results: An increased, 4.13-fold risk of breast cancer (OR = 4.13; 95% CI [1.69, 10.28]) was observed for women with BMI 25.0–29.9 kg/m2 compared to women with normal BMI (18.5–24.9 kg/m2), whereas the association in the case of obese women was not statistically significant. An increased risk of breast cancer was observed for pictogram scores 3–4 (OR = 8.95; 95% CI [3.22, 24.88]) and for the highest level of self-reported body size, pictograms ≥ 5 (OR = 3.20; 95% CI [1.13, 9.09]). Conclusions: The risk of breast cancer is associated with an increased BMI and visual overweigh and obesity. The results suggest that a self-reporting alternative tool can be used to assess the prevalence of overweight/obesity, particularly in situations where no other tools are available.

Measured body size and serum estrogen metabolism in postmenopausal women: the Ghana Breast Health Study

BackgroundSeveral anthropometric measures have been associated with hormone-related cancers, and it has been shown that estrogen metabolism in postmenopausal women plays an important role in these relationships. However, little is known about circulating estrogen levels in African women, and the relevance to breast cancer or breast cancer risk factors. To shed further light on the relationship of anthropometric factors and estrogen levels in African women, we examined whether measured body mass index (BMI), waist-to-hip ratio (WHR), height, and self-reported body size were associated with serum estrogens/estrogen metabolites in a cross-sectional analysis among postmenopausal population-based controls of the Ghana Breast Health Study.MethodsFifteen estrogens/estrogen metabolites were quantified using liquid chromatography-tandem mass spectrometry in serum samples collected from postmenopausal female controls enrolled in the Ghana Breast Health Study, a population-based case–control study conducted in Accra and Kumasi. Geometric means (GMs) of estrogens/estrogen metabolites were estimated using linear regression, adjusting for potential confounders.ResultsMeasured BMI (≥ 30 vs. 18.5–24.9 kg/m2) was positively associated with parent estrogens (multivariable adjusted GM for unconjugated estrone: 78.90 (66.57–93.53) vs. 50.89 (43.47–59.59), p-value < 0.0001; and unconjugated estradiol: 27.83 (21.47–36.07) vs. 13.26 (10.37–16.95), p-value < 0.0001). Independent of unconjugated estradiol, measured BMI was associated with lower levels of 2-pathway metabolites and higher levels of 16-ketoestradriol. Similar patterns of association were found with WHR; however, the associations were not entirely independent of BMI. Height was not associated with postmenopausal estrogens/estrogen metabolite levels in African women.ConclusionsWe observed strong associations between measured BMI and parent estrogens and estrogen metabolite patterns that largely mirrored relations that have previously been associated with higher breast cancer risk in postmenopausal White women. The consistency of the BMI-estrogen metabolism associations in our study with those previously noted among White women suggests that estrogens likely explain part of the BMI-postmenopausal breast cancer risk in both groups. These findings merit evaluation in Black women, including prospective studies.

Early-Life Body Adiposity and the Breast Tumor Transcriptome.

Cumulative epidemiologic evidence has shown that early-life adiposity is strongly inversely associated with breast cancer risk throughout life, independent of adult obesity. However, the molecular mechanisms remain poorly understood. We assessed the association of early-life adiposity, defined as self-reported body size during ages 10-20 years from a validated 9-level pictogram, with the transcriptome of breast tumor (N = 835) and tumor-adjacent histologically normal tissue (N = 663) in the Nurses' Health Study. We conducted multivariable linear regression analysis to identify differentially expressed genes in tumor and tumor-adjacent tissue, respectively. Molecular pathway analysis using Hallmark gene sets (N = 50) was further performed to gain biological insights. Analysis was stratified by tumor estrogen receptor (ER) protein expression status (n = 673 for ER+ and 162 for ER- tumors). No gene was statistically significantly differentially expressed by early-life body size after multiple comparison adjustment. However, pathway analysis revealed several statistically significantly (false discovery rate < 0.05) upregulated or downregulated gene sets. In stratified analyses by tumor ER status, larger body size during ages 10-20 years was associated with decreased cellular proliferation pathways, including MYC target genes, in both ER+ and ER- tumors. In ER+ tumors, larger body size was also associated with upregulation in genes involved in TNFα/NFkB signaling. In ER- tumors, larger body size was additionally associated with downregulation in genes involved in interferon α and interferon γ immune response and Phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) signaling; the INFγ response pathway was also downregulated in ER- tumor-adjacent tissue, though at borderline statistical significance (false discovery rate = 0.1). These findings provide new insights into the biological and pathological underpinnings of the early-life adiposity and breast cancer association.

Relationship of self-reported body size and shape with risk for prostate cancer: A UK case-control study.

IntroductionPrevious evidence has suggested a relationship between male self-reported body size and the risk of developing prostate cancer. In this UK-wide case-control study, we have explored the possible association of prostate cancer risk with male self-reported body size. We also investigated body shape as a surrogate marker for fat deposition around the body. As obesity and excessive adiposity have been linked with increased risk for developing a number of different cancers, further investigation of self-reported body size and shape and their potential relationship with prostate cancer was considered to be appropriate.ObjectiveThe study objective was to investigate whether underlying associations exist between prostate cancer risk and male self-reported body size and shape.MethodsData were collected from a large case-control study of men (1928 cases and 2043 controls) using self-administered questionnaires. Data from self-reported pictograms of perceived body size relating to three decades of life (20’s, 30’s and 40’s) were recorded and analysed, including the pattern of change. The associations of self-identified body shape with prostate cancer risk were also explored.ResultsSelf-reported body size for men in their 20’s, 30’s and 40’s did not appear to be associated with prostate cancer risk. More than half of the subjects reported an increase in self-reported body size throughout these three decades of life. Furthermore, no association was observed between self-reported body size changes and prostate cancer risk. Using ‘symmetrical’ body shape as a reference group, subjects with an ‘apple’ shape showed a significant 27% reduction in risk (Odds ratio = 0.73, 95% C.I. 0.57–0.92).ConclusionsChange in self-reported body size throughout early to mid-adulthood in males is not a significant risk factor for the development of prostate cancer. Body shape indicative of body fat distribution suggested that an ‘apple’ body shape was protective and inversely associated with prostate cancer risk when compared with ‘symmetrical’ shape. Further studies which investigate prostate cancer risk and possible relationships with genetic factors known to influence body shape may shed further light on any underlying associations.

Disentangling relations between the desirability of the thin-ideal, body checking, and worry on college women's weight-loss dieting: A self-regulation perspective

The study used self-regulation theory to elucidate the relationships between the desirability of the thin-ideal goal, dispositional worry, body checking and weight-loss dieting (WLD) in college women. We hypothesized that body checking would mediate the relationship between the desirability of the thin-ideal goal and WLD: the desire to be thin would be associated with more WLD through more frequent body checking. We also hypothesized that dispositional worry would moderate this mediation pathway, such that the mediation pathway would be stronger for those higher in worry. Finally, all effects were expected to occur when controlling for self-reported body size. A paper and pencil survey was conducted on a convenience sample of 237 college women who completed measures of: thin-ideal desirability, dispositional worry, body checking, WLD, as well as providing height and weight. A bootstrap analysis using PROCESS (Hayes, 2013) supported the hypothesized moderated mediation model. Findings add to current knowledge by elucidating the nature and function of body checking, and by so doing may provide insight into the prevention and treatment of disordered eating.

Early obesity and risk of cholangiocarcinoma in the United States.

239 Background: In the United States, the incidence of intrahepatic cholangiocarcinoma (ICC) has been increasing over the last few decades. Despite the public health problem of obesity and the increasing incidence of ICC, the relationship between early adulthood obesity and ICC has never been examined in the American population. Methods: At the University of Texas MD Anderson Cancer Center we conducted a case-control study aimed at examining relationship between ICC and history of obesity after controlling for the potential confounding of several risk factors. Cases were patients with pathologically confirmed diagnosis of ICC. Controls were healthy subjects recruited from spouses of patients at MD Anderson who had cancers other than liver or gastrointestinal. Each case was frequency matched to 4 controls by age (± 5 years), sex, and race. Case patients and controls were interviewed for risk factors of liver cancer. A self-reported weight and body size pictogram at ages 20, 30, 40, 50, 60 was obtained from each participant. In 2016 we recruited 63 newly diagnosed patients with ICC who were compared to 252 healthy controls. Obesity was defined as body mass index (BMI) ≥ 30.0. Results: There was a significant 3 fold increase in ICC risk for obese individuals compared to those with normal weight. The estimated odds ratio (OR), 95%; confidence interval (CI) was 3.3 (1.3-9.1); P = .02. Obesity at the mid-20s, mid-30s, and mid- 40s was significantly associated with ICC risk; the estimated OR (95% CI) was 7.3 (2.8-19.7), 7 (2.4-20.9), and 4.8 (2-11.4), respectively. In addition, viral hepatitis, heavy alcohol use ( &gt; 40 ml ethanol/day), and family history of cancer were significantly associated with ICC. Underlying radiological, pathological, or clinical evidence of steatosis, fibrosis, and cirrhosis was significantly observed in 25% ICC patients with early obesity. Conclusions: We concluded that early adulthood obesity is a significant risk factor for ICC in USA where underlying fatty liver diseases can be a significant factor for ICC progression. Integration of obesity with other ICC risk factors into a risk model may lead to identify high-risk individuals. Future collaboration with other US institutions is highly warranted to highlight the mechanism of obesity-induced ICC.

Validity of silhouette showcards as a measure of body size and obesity in a population in the African region: A practical research tool for general-purpose surveys.

BackgroundThe purpose of this study is to validate the Pulvers silhouette showcard as a measure of weight status in a population in the African region. This tool is particularly beneficial when scarce resources do not allow for direct anthropometric measurements due to limited survey time or lack of measurement technology in face-to-face general-purpose surveys or in mailed, online, or mobile device-based surveys.MethodsA cross-sectional study was conducted in the Republic of Seychelles with a sample of 1240 adults. We compared self-reported body sizes measured by Pulvers’ silhouette showcards to four measurements of body size and adiposity: body mass index (BMI), body fat percent measured, waist circumference, and waist to height ratio. The accuracy of silhouettes as an obesity indicator was examined using sex-specific receiver operator curve (ROC) analysis and the reliability of this tool to detect socioeconomic gradients in obesity was compared to BMI-based measurements.ResultsOur study supports silhouette body size showcards as a valid and reliable survey tool to measure self-reported body size and adiposity in an African population. The mean correlation coefficients of self-reported silhouettes with measured BMI were 0.80 in men and 0.81 in women (P < 0.001). The silhouette showcards also showed high accuracy for detecting obesity as per a BMI ≥ 30 (Area under curve, AUC: 0.91/0.89, SE: 0.01), which was comparable to other measured adiposity indicators: fat percent (AUC: 0.94/0.94, SE: 0.01), waist circumference (AUC: 0.95/0.94, SE: 0.01), and waist to height ratio (AUC: 0.95/0.94, SE: 0.01) amongst men and women, respectively. The use of silhouettes in detecting obesity differences among different socioeconomic groups resulted in similar magnitude, direction, and significance of association between obesity and socioeconomic status as when using measured BMI.ConclusionsThis study highlights the validity and reliability of silhouettes as a survey tool for measuring obesity in a population in the African region. The ease of use and cost-effectiveness of this tool makes it an attractive alternative to measured BMI in the design of non-face-to-face online- or mobile device-based surveys as well as in-person general-purpose surveys of obesity in social sciences, where limited resources do not allow for direct anthropometric measurements.

Do people know whether they are overweight? Concordance of self-reported, interviewer-observed, and measured body size.

To evaluate associations among self-reported, interviewer-observed, and measured body size in a healthcare setting. A total of 543 adult men and women undergoing colonoscopy were enrolled into a cross-sectional study conducted from 2002 to 2008 at the Johns Hopkins Hospital Outpatient Center. Self-reported and interviewer-observed Stunkard body size figure numbers and measured body mass index (BMI) were collected and evaluated. The body size figures and BMI were categorized as normal weight, overweight, and obese. Correlation between self-reported and interviewer-observed body size figure numbers (r = 0.62) was lower than the correlation between self-reported (r = 0.72) or interviewer-observed (r = 0.84) body size figure number and BMI. Participants underestimated body size by about one figure compared with the interviewers (mean 0.92 ± 1.25). Agreement on normal weight, overweight, and obese between the interviewer-observed body size figures and BMI categories (kappa = 0.40) was higher than for the self-reported body size figures and BMI categories (kappa = 0.23). Among participants who judged themselves in the normal weight category by the figures, 38 and 13 % were overweight and obese, respectively, as measured by BMI. Among participants who judged themselves overweight by the body size figures, 57 % were obese as measured by BMI. Although self-reported body size and measured body size were well correlated, participants underestimated their body size in comparison with interviewers. Many individuals misperceive themselves as normal weight when they are overweight or obese by BMI, which may hinder prevention and control efforts.

Abstract C84: Body size across the lifecourse and risk of breast cancer in African American women, the Carolina Breast Cancer Study

Abstract Background: Body size is a modifiable risk factor associated with postmenopausal breast cancer in US White women. However, in African-Americans, there have been fewer studies and relationships are not well established. Aims and Methods: We investigated the association between breast cancer risk and body size in childhood, young adulthood, and near the time of breast cancer diagnosis using data from the Carolina Breast Cancer Study, a 1993-2001 population-based case-control study of African-American (AA) cases (343 premenopausal, 445 postmenopausal) and controls frequency-matched by age and race. We investigated whether a) self-reported body size at age 10, age 18, age 35, and a year before interview and b) nurse-measured BMI, waist circumference, and waist-to-hip ratio (WHR) at interview were associated with cancer risk. Logistic regression models were adjusted for age, family history of breast cancer, education level, alcohol use, age at menarche, parity, age at first birth, and lactation. Results: For premenopausal AA women, larger body size tended to be positively associated with cancer risk. The strongest results were for WHR (0.84+ vs &amp;lt;0.77): OR=2.00 [1.28, 3.13]). For postmenopausal women, body size was not significantly associated with risk, but weak inverse associations with higher adiposity were observed for nurse-measured BMI, weight at age 10, and possibly WHR (0.84+ vs &amp;lt;0.77) (OR=1.20 [0.76, 1.89]). Conclusions: Associations between body size and breast cancer risk varied by menopausal status, measure of adiposity, and timing in the lifecourse. Strikingly, associations were not in the direction expected from the previous literature, which is based predominantly on Caucasian women. In fact, body size associations for premenopausal AA women may be inverse of that observed in Whites. Impact: African-American women have higher risk of breast cancer at young ages (&amp;lt;40 years), but the causes of this disparity are not well understood. Given that the prevalence of obesity is high among African American women, understanding how body size relates to their risk of premenopausal breast cancer may offer insights for prevention. Citation Format: Whitney Robinson, Chiu Kit Tse, Andrew F. Olshan, Melissa Troester. Body size across the lifecourse and risk of breast cancer in African American women, the Carolina Breast Cancer Study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C84. doi:10.1158/1538-7755.DISP13-C84

Abstract 3275: Genome-wide association study of childhood body fatness as a risk factor of breast cancer

Abstract Girls with large body size have a 15-30% reduced risk of developing breast cancer independent of both birth weight and adult body mass index (BMI). The mechanisms underlying this association are poorly understood, especially since large body size at young age is correlated with earlier pubertal timing, a known risk factor for breast cancer. Self-reported childhood body size, a phenotype which is described in the literature as “childhood body fatness”, has an estimated heritability of 70-80% compared to 40-70% for adult BMI and the correlation between childhood body fatness and adult BMI is only modest (r=0.24-0.30). Still, the literature on genetic associations in pediatric body size-related phenotypes is very sparse. We conducted a genome-wide association study (GWAS) of childhood body fatness in 10,560 individuals within the Nurses’ Health Study (NHS) and the Health Professional Follow-up Study (HPFS). All subjects were imputed using the 1000 Genomes Phase I v3 reference panel. Analysis was adjusted for top principal components and study/gender. We observed three regions with p&amp;lt;10-7. Two of the regions (TNNI3K and BCDIN3D) have previously been identified as associated with BMI, the former in adolescents. The third region (1p35.2, p=4.8x10-8) constitutes a potential novel locus associated with childhood body fatness. Five additional regions (4 novel) showed suggestive association with childhood body fatness (p&amp;lt;10-6). We are currently replicating these new regions in additional 9,800 subjects from NHS, HPFS and SASBAC, a Swedish breast cancer case-control study. We will also assess the association between identified loci and breast cancer risk. Such analysis will help elucidate the shared genetic component between childhood body fatness and breast cancer and increase our understanding to why early life fatness decreases breast cancer risk. Citation Format: Sara Lindstrom, Jingmei Li, Hongyan Huang, Constance Chen, David J. Hunter, Per Hall, Peter Kraft, Rulla Tamimi. Genome-wide association study of childhood body fatness as a risk factor of breast cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3275. doi:10.1158/1538-7445.AM2014-3275

How adolescent subjective health and satisfaction with weight and body shape are related to participation in sports.

Background. Physical exercise has positive effects on health. However, its associations with self-rated health and body image, which are important predictors for adolescents' wellbeing and later morbidity, are complex. Methods. Cross-sectional survey among 2527 Norwegian adolescents. We examined the relations between self-reported gender, body size, amount and type of exercise and measures of self-rated health, drive for thinness, and desire to change body, with binary logistic regression analyses. Results. Girls and overweight students reported to a greater extent than their peers impaired self-rated health, weight concerns, and desire to change their body. Increasing amount of time spent on sports was related to improved self-rated health in a dose-response manner. Both girls and boys who engaged in individual sports with an advantage of leanness, but only girls engaged in team sports, reported an increased desire to change the body. However, weight concern was not related to amount or type of sports. Conclusions. Physical exercise is positively related to self-reported health but has negative associations with body image for many adolescents. Health promotion efforts should consider this paradox and stimulate physical activity and sports along with body acceptance.

Abstract 130: Childhood and adolescent body size and risk of fatal breast cancer.

Abstract Background: Body size early in life is inversely associated with incidence of pre and postmenopausal breast cancer, but its relationship with fatal breast cancer is unclear. We prospectively examined the association between childhood and adolescent body size and risk of fatal breast cancer. Methods: Study participants include 76,261 women from Nurses’ Health Study (NHS) and 112,388 from Nurses’ Health Study II (NHS II). Self-reported body size at ages 5, 10 and 20 years was assessed with a validated 9-figure drawing in 1988 (NHS) and 1989 (NHSII). The outcome was defined as invasive breast cancer that led to breast cancer death. Cause of death was obtained from death certificates. We observed 922 cases of incident fatal breast cancer over 20 years of follow-up. Cox proportional hazards regression was used to calculate hazard ratios (HR) and confidence intervals (CI) for body size at each age, average childhood (ages 5 &amp; 10) and adolescent (ages 10 &amp; 20) body size, and change in body size up to age 20. Fatal and non-fatal cases were censored at the date of diagnosis. Results: Women who were largest at age 5 were 32% less likely to develop fatal breast cancer as compared to women that were leanest (HR: 0.68, 95% CI: 0.50, 0.91; p-trend &amp;lt;0.0001) adjusted for current body mass index (BMI) and key breast cancer risk factors. Similar results were seen for age 10 (HR: 0.56, 95% CI: 0.43, 0.72), 20 (HR: 0.54, 95% CI: 0.30, 0.97), childhood (HR: 0.56, 95% CI: 0.40, 0.78) and adolescent (HR: 0.42, 95% CI: 0.16, 1.07) body sizes. Increases in body size were associated with lower risk of fatal breast cancer while, from age 5 to 10 only, decreasing in size increased risk (HR: 1.16, 95% CI: 1.29, 2.01). We found no evidence that associations differed by estrogen receptor status (p-heterogeneity &amp;gt;0.15) or fatal vs. non-fatal (p-heterogeneity &amp;gt;0.20). Conclusion: Larger body size at ages 5, 10 and 20 is associated with lower risk of fatal breast cancer in adulthood independent of current BMI. The association does not appear to be driven by estrogen-related mechanisms. Cases N = 922 Person-years Age-adj. HR (95% CI) MV HR* (95% CI) MV +Current BMI HR (95% CI) Figure at age 5 years 1 370 1,034,245 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 2 243 922,357 0.92 (0.78, 1.09) 0.93 (0.79, 1.11) 0.93 (0.79, 1.10) 3 171 691,594 0.87 (0.73, 1.05) 0.89 (0.74, 1.07) 0.86 (0.71, 1.03) 4 84 390,941 0.72 (0.56, 0.91) 0.73 (0.57, 0.93) 0.69 (0.54, 0.87) ≥ 5 54 236,358 0.73 (0.55, 0.97) 0.73 (0.55, 0.98) 0.68 (0.50, 0.91) P for trend 0.001 0.002 &amp;lt;0.0001 Figure at age 10 years 1 286 784,729 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 2 286 944,240 1.00 (0.85, 1.19) 1.01 (0.86, 1.20) 1.00 (0.84, 1.18) 3 175 674,514 0.88 (0.72, 1.06) 0.90 (0.74, 1.09) 0.85 (0.70, 1.03) 4 101 479,532 0.70 (0.56, 0.88) 0.72 (0.57, 0.90) 0.65 (0.51, 0.82) ≥ 5 74 392,460 0.62 (0.48, 0.80) 0.63 (0.49, 0.81) 0.56 (0.43, 0.72) P for trend &amp;lt;0.0001 &amp;lt;0.0001 &amp;lt;0.0001 Figure at age 20 years 1 103 143,078 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 2 291 901,910 0.86 (0.56, 1.33) 0.87 (0.56, 1.35) 0.86 (0.55, 1.34) 3 324 1,175,790 0.79 (0.45, 1.36) 0.80 (0.46, 1.40) 0.75 (0.42, 1.34) 4 132 632,199 0.63 (0.48, 0.82) 0.64 (0.49, 0.84) 0.57 (0.43, 0.74) ≥ 5 72 322,528 0.65 (0.38, 1.12) 0.67 (0.39, 1.13) 0.54 (0.30, 0.97) P for trend 0.001 0.002 0.0005 *adjusted for age (months), time period (10 periods), birth weight (&amp;lt;5.5, 5.5–6.9, 7–8.4, 8.5–9.9, ≥ 10 lbs), height (inches), recent alcohol consumption (0, 0.1–1.4, 1.5–4.9, 5.0–9.9, ≥ 10 g/day),age at menopause (years), menopausal status and PMH use (premenopausal, postmenopausal-never PMH, postmenopausal-past PMH, postmenopausal-current PMH, postmenopausal -missing PMH), parity and age at first birth (nulliparous, 1–2 pregnancies with age at first birth &amp;lt;25, 1–2 pregnancies with age at first birth 25–29, 1–2 pregnancies with age at first birth ≥30, 3 or more pregnancies with age at first birth &amp;lt;25, 3 or more pregnancies with age at first birth ≥25), oral contraceptive duration (never, &amp;lt;12 months, 13–60 months, ≥60 months), history of benign breast disease (yes/no), first degree family history of breast cancer (yes/no), BMI (continuous). Citation Format: Erica T. Warner, A. Heather Eliassen, Wendy Y. Chen, Michelle D. Holmes, Walter C. Willett, Rulla M. Tamimi. Childhood and adolescent body size and risk of fatal breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 130. doi:10.1158/1538-7445.AM2013-130

Comparing “Apples and pears”: how well do women perceive their body size and shape?

Obesity is associated with reproductive disorders, such as PCOS, and chronic disease risk. Increasing evidence suggests body shape (i.e., regional fat distribution, abdominal adiposity) is independently associated with risk. However, it is unknown whether women accurately perceive their shape so that information can be reliably collected. This study assessed the validity of self-reported body size and shape when compared to anthropometric measures. Interview responses and anthropometry were compared among 131 adult women enrolled as population controls for the operative cohort within a larger study on endometriosis. Body size was ascertained by self-report using the Stunkard 9-level figure drawings and body shape using stylized pear, hourglass, rectangle, and apple figures. Anthropometry (height, weight, waist and hip circumferences) was taken by trained researchers. Body size and body mass index (BMI) were compared using Spearman's correlation coefficient. Fat distribution indicators were compared across body shapes for all and non-obese women using ANOVA and Fisher's exact test. Women were primarily Caucasian (81%), aged 32 years, with an average BMI of 27.1 kg/m2. No one reported being the smallest or largest figure size. The correlation between figure size and BMI was 0.85 (P<0.001). Among non-obese women, waist-hip ratios (WHR) were 0.75, 0.75, 0.80, and 0.82 for pear, hourglass, rectangle, and apple, respectively (P<0.001). Women who reported being pear- compared to apple-shaped were less likely to have a WHR>0.8 (13% vs. 70%, respectively, P=0.002). Self-reported figure size and shape were consistent with anthropometric measures commonly used to assess obesity and fat distribution, respectively. Body shape may be a useful proxy measure in addition to self-reported size in large-scale surveys to determine reproductive and chronic disease risk.

Body Mass Index and Body Size Perception

The present study investigated actual body size as measured by the Body Mass Index in comparison to self-reported body size among diverse college student population. The study was conducted at a large public university in the western United States. Of the random sample of 15,000 enrolled students selected to receive an electronic survey, a total of 1,798 students elected to participate. Normalizing of overweight and obesity was found among study participants. The results from this survey indicate that, despite the fact that the majority of participants engaged in weight management methods, all gender and ethnic groups underreported instances of overweight and obesity, as well as discrepancies between perceived body image and actual body size. Implications for health promotion and future research are highlighted.

Self-reported teenage body size and heart failure in adults ≥ 65 years of age

Overweight during childhood and young adulthood has been associated with higher rates of all-cause and cardiovascular mortality in later adulthood [ 1 Must A. Jacques P.F. Dallal G.E. Bajema C.J. Dietz W.H. Long-term morbidity and mortality of overweight adolescents. N Engl J Med. 1992; 327: 1350-1355 Crossref PubMed Scopus (1858) Google Scholar , 2 Gunnell D. Frankel S. Nanchahal K. Peters T. Davey Smith G. Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort. Am J Clin Nutr. 1998; 67: 1111-1118 PubMed Google Scholar , 3 Nieto F.J. Szklo M. Comstock G.W. Childhood weight and growth rate as predictors of adult mortality. Am J Epidemiol. 1992; 136: 201-213 PubMed Google Scholar , 4 Hoffmans M.D. Kromhout D. Coulander C.D. Body mass index at the age of 18 and its effects on 32-year-mortality from coronary heart disease and cancer. A nested case-control study among the entire 1932 Dutch male birth cohort. J Clin Epidemiol. 1989; 42: 513-520 Abstract Full Text PDF PubMed Scopus (87) Google Scholar ]. However, the relationship between body size in early life and incidence of heart failure (HF) in later adulthood is not known. We hypothesized that self-reported heavier-than-average teenage body size as an early teenager (ages 11–14) would be associated with a higher rate of incident HF in adulthood. We examined this hypothesis in a cohort of community dwelling older adults.

Lifetime body size and reproductive factors: comparisons of data recorded prospectively with self reports in middle age

BackgroundData on lifetime exposures are often self-reported in epidemiologic studies, sometimes many years after the relevant age. Validity of self-reported data is usually inferred from their agreement with measured values, but few studies directly quantify the likely effects of reporting errors in body size and reproductive history variables on estimates of disease-exposure associations.MethodsThe MRC National Survey of Health and Development (NSHD) and the Million Women Study (MWS) are UK population-based prospective cohorts. The NSHD recruited participants at birth in 1946 and has followed them at regular intervals since then, whereas the MWS recruited women in middle age. For 541 women who were participants in both studies, we used statistical measures of association and agreement to compare self-reported MWS data on body size throughout life and reproductive history, obtained in middle age, to NSHD data measured or reported close to the relevant ages. Likely attenuation of estimates of linear disease-exposure associations due to the combined effects of random and systematic errors was quantified using regression dilution ratios (RDRs).ResultsData from the two studies were very strongly correlated for current height, weight and body mass index, and age at menopause (Pearson r = 0.91-0.95), strongly correlated for birth weight, parental heights, current waist and hip circumferences and waist-to-height ratio (r = 0.67-0.80), and moderately correlated for age at menarche and waist-to-hip ratio (r = 0.52-0.57). Self-reported categorical body size and clothes size data for various ages were moderately to strongly associated with anthropometry collected at the relevant times (Spearman correlations 0.51-0.79). Overall agreement between the studies was also good for most quantitative variables, although all exhibited both random and systematic reporting error. RDRs ranged from 0.66 to 0.86 for most variables (slight to moderate attenuation), except weight and body mass index (1.02 and 1.04, respectively; little or no attenuation), and age at menarche, birth weight and waist-to-hip ratio (0.44, 0.59 and 0.50, respectively; substantial attenuation).ConclusionsThis study provides some evidence that self-reported data on certain anthropometric and reproductive factors may be adequate for describing disease-exposure associations in large epidemiological studies, provided that the effects of reporting errors are quantified and the results are interpreted with caution.

Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study: research design and methodology.

BackgroundBuilt environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study.Methods and designThe URBAN Study is a multi-centered, stratified, cross-sectional research design, collecting data across four New Zealand cities. Within each city, 12 neighborhoods were identified and selected for investigation based on higher or lower walkability and Māori demographic attributes. Neighborhoods were selected to ensure equal representation of these characteristics. Within each selected neighborhood, 42 households are being randomly selected and an adult and child (where possible) recruited into the study. Data collection includes: objective and self-reported PA engagement, neighborhood perceptions, demographics, and body size measures. The study was designed to recruit approximately 2,000 adults and 250 children into the project. Other aspects of the study include photovoice, which is a qualitative assessment of built environment features associated with PA engagement, an audit of the neighborhood streetscape environment, and an individualized neighborhood walkability profile centered on each participant's residential address. Multilevel modeling will be used to examine the individual-level and neighborhood-level relationships with PA engagement and body size.DiscussionThe URBAN Study is applying a novel scientifically robust research design to provide urgently needed epidemiological information regarding the associations between the built environment and health outcomes. The findings will contribute to a larger, international initiative in which similar neighborhood selection and PA measurement procedures are utilized across eight countries. Accordingly, this study directly addresses the international priority issues of increasing PA engagement and decreasing obesity levels.