Associations between growth and diet in adolescence

There is much interest in the nature and quality of the diet consumed by adolescents. To determine whether there are significant associations between diet and gain in height and weight in this age group, the present study analysed data on food intake and weight and height obtained on three occasions over a 30-month period from a total of 326 adolescents aged between 12 and 15 years. Information on sociodemographic and other lifestyle factors, including an indicator of physical activity, was also obtained. Energy intake was found to be a significant positive predictor of both height and weight gain. In addition intake of fat, calcium and riboflavin were found to be significant positive predicators of height gain and intake of carbohydrate and starch significant positive predictors of weight gain. After controlling for energy intake only riboflavin approached significance as a positive predictor of height gain. A food group analysis identified intake of dairy foods as a significant predictor of height gain. Although statistically significant the dietary predictors explained only a small proportion of the variability in height and weight (≤3.5%). Given the difficulties in obtaining complete dietary records from this age group and the generally adequate nature of the diet in the study group, the small proportion of height and weight gain explained by diet is not unexpected. Nevertheless the nutrient predictors identified are consistent with nutrient requirements for growth during adolescence and highlight the importance, for this age group, of an adequate intake of nutrients specifically provided by dairy foods. Few significant associations were found between growth rates and the sociodemographic and the lifestyle factors measured in this study. The ethnic diversity of the study sample may have contributed to this outcome.

Characterization of the moisture absorption and thermal ageing behaviour of polymeric composite systems using Raman spectroscopy

Advanced polymeric materials and their respective composites are fast becoming one of the world's most frequently used engineering materials. They find application in the manufacture of e.g. boat hulls, high performance motor vehicles, aircraft components and sports goods. Their high specific strength and specific stiffness give them the edge in applications where weight savings are critical, but their long-term durability is often questioned. These materials are susceptible to environmental conditions such as temperature and humidity. There is also a lack of relevant data, due to the long time-scales required for testing. In this study, the Raman technique has been used to monitor the degradation of two composite systems, namely: a rubber toughened vinylester material used in the marine industry and a high temperature bismaleimide/carbon fibre aerospace composite. Preliminary Raman studies show that the toughening rubber particles dispersed in the cured vinylester resin are leached out during hygrothermal ageing. The weight gain during ageing suggests that this leaching process occurs concurrently with the absorption of water molecules. An increase in the degree of cross-linking is observed when bismaleimide/carbon fibre composite is aged at high temperature. This cross- linking tendency decreases with increasing depth within the carbon fibre bundle.

Anti-tumour necrosis factor-α therapy for severe enteropathy in patients with common variable immunodeficiency (CVID)

We present three common variable immunodeficiency (CVID) patients with
severe inflammatory bowel disease of unknown aetiology, resistant to steroid
treatment, treated with infliximab.After exclusion of any infection, infliximab
was given at a dose of 5 mg/kg every 4 weeks for a 3 month induction followed
by every 4–8 weeks depending on clinical response. Two of these patients had
predominantly small bowel disease; they both showed clinical response to
infliximab with weight gain and improvement of quality of life scores. The
third patient had large bowel involvement with profuse watery diarrhea; this
patient improved dramatically within 48 hours of having infliximab
treatment. All three patients have been maintained on infliximab treatment
for between 5 and 53 months (mean 37 months) with no evidence of increased
susceptibility to infections in the patients with small bowel disease, although
the third patient developed two urinary tract infections and a herpes zoster
infection following therapy. This is the first small case series to show that
infliximab is a useful addition to current therapy in this rare group of patients
with potentially life threatening enteritis.

Nursing care of clients treated with atypical antipsychotics who have a risk of developing metabolic instability and/or type 2 diabetes

Objective : The aim of this article is to present a current discussion related to the nursing care of clients treated with atypical antipsychotic medicines and who have a risk of developing metabolic instability and/or Type 2 diabetes. The importance of such a discussion is to provide both the novice and the experienced nurse with additional knowledge of this current health issue with which to inform their nursing practice.

Discussion : The potential for psychosis to be a chronic condition is very high, and often people require antipsychotic medicine for lengthy periods throughout their lives. Sometimes, treatment is for life. The second generation of antipsychotic medicines was greeted with much enthusiasm since it was better tolerated than the first generation. However, each medication has desired and adverse effects and, when taken for lengthy periods, these effects may produce physical illness. Studies show that the prevalence of Type 2 diabetes and the metabolic syndrome was significantly higher in clients with a chronic psychiatric disorder, particularly schizophrenia.

Conclusions : Metabolic instability, especially weight gain, is associated with some psychotropic medicines. Nursing interventions need to include care assessment, planning, intervention, and evaluation for clients treated with antipsychotic medicines in terms of risk minimization strategies in routine nursing care.

The process evaluation of it's your move!, an Australian adolescent community-based obesity prevention project

Background
Evidence on interventions for preventing unhealthy weight gain in adolescents is urgently needed. The aim of this paper is to describe the process evaluation for a three-year (2005-2008) project conducted in five secondary schools in the East Geelong/Bellarine region of Victoria, Australia. The project, 'It's Your Move!' aimed to reduce unhealthy weight gain by promoting healthy eating patterns, regular physical activity, healthy body weight, and body size perception amongst youth; and improve the capacity of families, schools, and community organisations to sustain the promotion of healthy eating and physical activity in the region.

Methods
The project was supported by Deakin University (training and evaluation), a Reference Committee (strategic direction, budgetary approval and monitoring) and a Project Management Committee (project delivery). A workshop of students, teachers and other stakeholders formulated a 10-point action plan, which was then translated into strategies and initiatives specific to each school by the School Project Officers (staff members released from teaching duties one day per week) and trained Student Ambassadors. Baseline surveys informed intervention development. Process data were collected on all intervention activities and these were collated and enumerated, where possible, into a set of mutually exclusive tables to demonstrate the types of strategies and the dose, frequency and reach of intervention activities.

Results
The action plan included three guiding objectives, four on nutrition, two on physical activity and one on body image. The process evaluation data showed that a mix of intervention strategies were implemented, including social marketing, one-off events, lunch time and curriculum programs, improvements in infrastructure, and healthy school food policies. The majority of the interventions were implemented in schools and focused on capacity building and healthy eating strategies as physical activity practices were seen by the teachers as already meeting students' needs.

Conclusions
While substantial health-promoting activities were conducted (especially related to healthy eating), there remain further opportunities for secondary schools to use a whole-of-school approach through the school curriculum, environment, policies and ethos to improve healthy eating, physical activity and healthy body perceptions in youth. To achieve this, significant, sustained leadership will be required within the education sector generally and within schools specifically.

Tolerance of larger body sizes by young adults living in Australia and Hawaii

Identifying the barriers to achieving an appropriate body size is important for health. This study investigated young adults' tolerance of excess weight in other adults. Participants were 172 students (65 male, 107 female) with a mean age of 22.24 years (SD = 1.61). Half the participants resided in Australia, and half in Hawaii. Students from both countries were found to be tolerant of body sizes larger than those recommended for good health. These results help inform our understanding of the factors that may influence weight gain, and have important implications for the worldwide obesity problem and related health issues.

The longitudinal influence of home and neighbourhood environments on children's body mass index and physical activity over 5 years : the CLAN study

Objective: To determine the independent contributions of family and neighbourhood environments to changes in youth physical activity and body mass index (BMI) z-score over 5 years.

Methods: In 2001, 2004 and 2006, 301 children (10–12 years at baseline) had their height and weight measured (BMI was converted to z-scores using Centers for Disease Control and Prevention reference charts; see http://www.cdc.gov/growthcharts) and moderate-to-vigorous physical activity (MVPA) assessed using accelerometers. In 2001, parents reported on the home environment (social support, role modelling, rules and restrictions, physical environment) and perceived neighbourhood environment (local traffic, road safety, sporting venues, public transport), and Geographic Information Systems were used to map features of the neighbourhood environment (destinations, road connectivity, traffic exposure). Generalized estimating equations were used to predict average BMI z-score and MVPA over time from baseline home and perceived and objective neighbourhood environment factors.

Results: Among boys, maternal education and heavy traffic were inversely associated, and sibling physical activity, maternal role modelling of MVPA and the presence of dead-end roads were positively associated with MVPA. Having unmarried parents, maternal MVPA role modelling and number of home sedentary items were positively associated with BMI z-score among boys. Among girls, having siblings, paternal MVPA role modelling, physical activity rules and parental physical activity co-participation were positively associated with MVPA. Having unmarried parents and maternal sedentary behaviour role modelling were positively associated, and number of sedentary behaviour rules and physical activity items were inversely associated with BMI z-score among girls.

Conclusion: The home environment seems more important than the neighbourhood environment in influencing children's physical activity and BMI z-score over 5 years. Physical activity and weight gain programmes among youth should focus on parental role modelling, rules around sedentary and active pursuits, and parental support for physical activity. Intervention studies to investigate these strategies are warranted.

Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study

This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5–6-year-old and 188 10–12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, children's BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5–6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10–12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.

Obesity epidemiology

Although recognised clinically for some time as an important condition that increases risk of ill-health in affected individuals, it is only recently that obesity had been recognised as a population-wide problem that requires preventive action. Obesity is a major contributor to diseases and disability, the associated health costs are enormous and obesity has already reached epidemic proportions in many countries, and incidence is continuing to increase in children and adults. Disturbingly the epidemic is not confined to developed countries, with many developing countries and those in transition affected. While recognised as a major population health problem, our understanding of the causes of the epidemic is poor, there has been relatively little population-based research that has focused on the prevention of unhealthy weight gain, and as a consequence knowledge regarding how and where best to intervene is limited.Revised and updated and now part of the From Aetiology to Public Health series, Obesity Epidemiology provides a scholarly text that assists those concerned with understanding prevalence and trends in obesity; its health, social and economic consequences, the underlying causes of the obesity epidemic, the existing evidence regarding strategies to prevent obesity, and the potential of public health initiatives to impact on the population prevalence of obesity. This edition not only provides a thorough update of the material presented in the previous edition (entitled Obesity Prevention and Public Health), but also includes twelve new chapters that cover the epidemiology of obesity in children and adults, and the potential of public health approaches to its prevention. This book will be of interest to all those working in public health and epidemiology; health policy makers, and clinicians and health practitioners working in the related fields of nutrition, exercise and diabetes.About the seriesBy looking at public health issues from a unique condition-based approach, the innovative From Aetiology to Public Health series examines top public health issues from aetiology through to public health and prevention

Farming fit? Dispelling the Australian agrarian myth.

Background: Rural Australians face a higher mental health and lifestyle disease burden (obesity, diabetes and
cardiovascular disease) than their urban counterparts. Our ongoing research reveals that the Australian farming
community has even poorer physical and mental health outcomes than rural averages. In particular, farm men and
women have high rates of overweightness, obesity, abdominal adiposity, high blood pressure and psychological
distress when compared against Australian averages. Within our farming cohort we observed a significant
association between psychological distress and obesity, abdominal adiposity and body fat percentage in the
farming population.
Presentation of hypothesis: This paper presents a hypothesis based on preliminary data obtained from an
ongoing study that could potentially explain the complex correlation between obesity, psychological distress and
physical activity among a farming population. We posit that spasmodic physical activity, changing farm practices
and climate variability induce prolonged stress in farmers. This increases systemic cortisol that, in turn, promotes
abdominal adiposity and weight gain.
Testing the hypothesis: The hypothesis will be tested by anthropometric, biochemical and psychological analysis
matched against systemic cortisol levels and the physical activity of the subjects.
Implications of the hypothesis tested: Previous studies indicate that farming populations have elevated rates of
psychological distress and high rates of suicide. Australian farmers have recently experienced challenging climatic
conditions including prolonged drought, floods and cyclones. Through our interactions and through the media it is
not uncommon for farmers to describe the effect of this long-term stress with feelings of ‘defeat’. By gaining a
greater understanding of the role cortisol and physical activity have on mental and physical health we may
positively impact the current rates of psychological distress in farmers.

Assessing cost-effectiveness in obesity : active transport program for primary school children— TravelSMART schools curriculum program

Background: To assess from a societal perspective the cost-effectiveness of a school program to increase active transport in 10- to 11-year-old Australian children as an obesity prevention measure.
Methods: The TravelSMART Schools Curriculum program was modeled nationally for 2001 in terms of its impact on Body Mass Index (BMI) and Disability-Adjusted Life Years (DALYs) measured against current practice. Cost offsets and DALY benefits were modeled until the eligible cohort reached age 100 or died. The intervention was qualitatively assessed against second stage filter criteria (‘equity,’ ‘strength of evidence,’ ‘acceptability to stakeholders,’ ‘feasibility of implementation,’ ‘sustainability,’ and ‘side-effects’) given their potential impact on funding decisions.
Results: The modeled intervention reached 267,700 children and cost $AUD13.3M (95% uncertainty interval [UI] $6.9M; $22.8M) per year. It resulted in an incremental saving of 890 (95%UI –540; 2,900) BMI units, which translated to 95 (95% UI –40; 230) DALYs and a net cost per DALY saved of $AUD117,000 (95% UI dominated; $1.06M).
Conclusions: The intervention was not cost-effective as an obesity prevention measure under base-run modeling assumptions. The attribution of some costs to nonobesity objectives would be justified given the program’s multiple benefits. Cost-effectiveness would be further improved by considering the wider school community impacts.

Olanzapine / fluoxetine combination for treatment resistant depression : efficacy and clinical utility

Antidepressant monotherapy is a first-line treatment for depression; however, not all sufferers will adequately respond to treatment. When treating a patient with treatment-resistant depression, the clinician needs to consider all factors which may contribute to an inadequate response to an antidepressant. These include accuracy of diagnosis and medication adherence, as well as the patient’s personality, lifestyle, life events and social circumstances. If it is determined that treatment resistance is due to failure of efficacy of antidepressant monotherapy, then an augmentation strategy using an atypical antipsychotic may be considered. Treatment using olanzapine/fluoxetine combination (OFC) is one of many options. Four randomized, acute-phase trials have suggested OFC is useful for reducing Montgomery–Åsberg Depression Rating Scale scores after inadequate response to antidepressant monotherapy. OFC has been useful at doses of olanzapine/fluoxetine 6/25, 6/50, 12/25 and 12/50 mg/day, with 1/5 mg/day suggested to be an ineffective dose. Treatment with OFC has been associated with some side effects, including weight gain and the metabolic syndrome, somnolence, dry mouth, increased appetite and headache. Treatment decisions therefore need to be made to balance the risks and benefits.

Predicting outcomes in the Dose Adjustment For Normal Eating (DAFNE) trial

Background: In the UK, DAFNE training in flexible intensive insulin therapy significantly reduced the negative impact of diabetes on quality of life (QoL) and improved blood glucose (BG) control without significantly increasing severe hypoglycaemia or body mass index (BMI). Analyses were conducted to predict who would benefit most from the generally highly successful DAFNE training and who might experience undesirable effects (e.g. weight gain).

Methods: Multiple regression was used to predict change in outcomes (6-months post-DAFNE) using baseline data: demographic, biomedical, ADDQoL (measure of the impact of diabetes on QoL), extended DTSQ (Diabetes Treatment Satisfaction Questionnaire), and other psychological measures including diabetes-specific well-being and locus of control.

Findings: Greatest improvement in ADDQoL scores was achieved by those reporting less dietary freedom and less treatment satisfaction at baseline (R2=0.21). BG improvement was predicted by higher baseline BG, lower perceived frequency of hypoglycaemia, greater expectations of DAFNE, and greater BMI (R2=0.30). Increase in BMI was predicted by less dietary freedom, DAFNE training centre, and less ‘satisfaction with insulin’ at baseline (R2=0.23).

Conclusions/Discussion: DAFNE has important benefits to offer. Lifting dietary restrictions had substantial benefits for QoL. BG improvement was predicted by baseline BG but also by expectations (perhaps reflecting greater optimism or determination). Prediction of weight gain was more complex. The influence of training centre will have involved implicit messages conveyed by Educators before and during DAFNE. While DAFNE was successful overall, outcomes are likely to be maximised for individuals if their expectations and personal goals are considered by DAFNE Educators.

Obstacles in the optimization of bone health outcomes in the female athlete triad

Maintaining low body weight for the sake of performance and aesthetic purposes is a common feature among young girls and women who exercise on a regular basis, including elite, college and high-school athletes, members of fitness centres, and recreational exercisers. High energy expenditure without adequate compensation in energy intake leads to an energy deficiency, which may ultimately affect reproductive function and bone health. The combination of low energy availability, menstrual disturbances and low bone mineral density is referred to as the ‘female athlete triad’. Not all athletes seek medical assistance in response to the absence of menstruation for 3 or more months as some believe that long-term amenorrhoea is not harmful. Indeed, many women may not seek medical attention until they sustain a stress fracture.
This review investigates current issues, controversies and strategies in the clinical management of bone health concerns related to the female athlete triad. Current recommendations focus on either increasing energy intake or decreasing energy expenditure, as this approach remains the most efficient strategy to prevent further bone health complications. However, convincing the athlete to increase energy availability can be extremely challenging.
Oral contraceptive therapy seems to be a common strategy chosen by many physicians to address bone health issues in young women with amenorrhoea, although there is little evidence that this strategy improves bone mineral density in this population. Assessment of bone health itself is difficult due to the limitations of dual-energy X-ray absorptiometry (DXA) to estimate bone strength. Understanding how bone strength is affected by low energy availability, weight gain and resumption of menses requires further investigations using 3-dimensional bone imaging techniques in order to improve the clinical management of the female athlete triad.

Does an increase in body mass index over 10 years affect knee structure in a population-based cohort study of adult women?

Introduction : Although obesity is a modifiable risk factor for knee osteoarthritis (OA), the effect of weight gain on knee structure in young and healthy adults has not been examined. The aim of this study was to examine the relationship between body mass index (BMI), and change in BMI over the preceding 10-year period, and knee structure (cartilage defects, cartilage volume and bone marrow lesions (BMLs)) in a population-based sample of young to middle-aged females.

Methods : One hundred and forty-two healthy, asymptomatic females (range 30 to 49 years) in the Barwon region of Australia, underwent magnetic resonance imaging (MRI) during 2006 to 2008. BMI measured 10 years prior (1994 to 1997), current BMI and change in BMI (accounting for baseline BMI) over this period, was assessed for an association with cartilage defects and volume, and BMLs.

Results : After adjusting for age and tibial plateau area, the risk of BMLs was associated with every increase in one-unit of baseline BMI (OR 1.14 (95% CI 1.03 to 1.26) P = 0.009), current BMI (OR 1.13 (95% CI 1.04 to 1.23) P = 0.005), and per one unit increase in BMI (OR 1.14 (95% CI 1.03 to 1.26) P = 0.01). There was a trend for a one-unit increase in current BMI to be associated with increased risk of cartilage defects (OR 1.06 (95% CI 1.00 to 1.13) P = 0.05), and a suggestion that a one-unit increase in BMI over 10 years may be associated with reduced cartilage volume (-17.8 ml (95% CI -39.4 to 3.9] P = 0.10). Results remained similar after excluding those with osteophytes.

Conclusions : This study provides longitudinal evidence for the importance of avoiding weight gain in women during early to middle adulthood as this is associated with increased risk of BMLs, and trend toward increased tibiofemoral cartilage defects. These changes have been shown to precede increased cartilage loss. Longitudinal studies will show whether avoiding weight gain in early adulthood may play an important role in diminishing the risk of knee OA.