Publications

No abstract is provided for this article.

Background To examine the relationship between reported high serum or red blood cell (RBC) folate status and adverse health outcomes. MethodsWe systematically searched PubMed/Medline and EMBASE (to May 2013), with no limits by study type, country or population, to identify studies reporting high folate concentrations in association with adverse health outcomes.Two reviewers screened studies and extracted data.Study quality was assessed. ResultsWe included 51 articles, representing 46 studies and 71 847 participants.Quantiles were used by 96% of studies to identify high folate concentrations.Eighty-three percent of serum folate and 50% of RBC folate studies reported a high folate cutoff that corresponded with a clinically normal concentration.Increasing values of reported high folate concentration did not demonstrate a consistent association with risk of adverse health outcomes.Overall, reported high folate concentrations appeared to be associated with a decreased risk of adverse health outcomes, though substantial methodological heterogeneity precluded complex analyses.Conclusions Our interpretation was complicated by methodological variability.High folate cutoffs varied and often corresponded with normal or desirable blood concentrations.In general, a negative association appeared to exist between reported high folate status and adverse health outcomes.Consistent methods and definitions are needed to examine high folate status and ultimately inform public health interventions.

We examined the association for rates of age- and sex-standardized body mass index (zBMI) gain between 0–3, 3–18, and 18–36 months with BP in children at 36–72 months of age. We collected repeated measures of zBMI and BP in 2502 children. zBMI was calculated using the World Health Organization standards. Each child's zBMI at birth and rates of zBMI gain in each period from birth to 36 months were estimated using linear spline multilevel models. Generalized estimating equations were used to determine whether zBMI at birth and zBMI gain between 0–3, 3–18, and 18–36 months were each associated with repeated measures of BP at 36–72 months of age. We sequentially conditioned on zBMI at birth and zBMI gain in each period prior to each period tested, as covariates, and adjusted for important socio-demographic, familial, and study design covariates. We examined whether these associations were modified by birthweight or maternal obesity, by including interaction terms. After adjusting for all covariates and conditioning on prior zBMI gains, a 1 standard deviation unit faster rate of zBMI gain during 0–3 months, (β = 0.59 mmHg; 95% CI 0.31, 0.86) and 3–18 months (β = 0.74 mmHg; 95% CI 0.46, 1.03) were each associated with higher systolic BP at 36–72 months. No significant associations were observed, however, for zBMI at birth or zBMI gain in the 18–36 month growth period. zBMI gains from 0–3 and 3–18 months were also associated with diastolic BP. Birthweight significantly modified the relationship during the 3–18 month period (p = 0.02), with the low birthweight group exhibiting the strongest association for faster rate of zBMI gain with higher systolic BP (β = 1.31 mmHg; 95% CI 0.14, 2.48). Given that long-term exposure to small elevations in BP are associated with subclinical cardiovascular disease, promoting interventions targeting healthy growth in infancy may be important.

To assess the feasibility of employing an ecologically guided childhood obesity relevant surveillance system.Cross-sectional qualitative and quantitative data were collected from 31 organizational representatives across 28 unique organizations and/or departments from three purposively sampled communities in the Capital Health Region in Alberta, Canada.All the organizational representatives surveyed reported awareness of childhood obesity and 36% reported participation in child obesity initiatives. Data to support a surveillance system are available but not in a suitable format, and privacy legislation present significant barriers. Interest in developing and sustaining an ecologically based surveillance system was low (18%).Due to the heterogeneity of available data and limited vision for the development and implementation of a surveillance system, the application of an ecologically based surveillance system relevant to childhood obesity may be constrained. Broad-based awareness of childhood obesity by a wide range of organizations could assist in establishing an effective coalition to address this issue over the long term by supporting the establishment of a surveillance system.

Independent mobility (IM) is associated with children's physical activity and indicators of social, motor, and cognitive development. We surveyed Canadian parents of 7- to 12-year-olds (n = 2291) about social-ecological correlates of IM in the second wave of COVID-19 (December 2020). We used multi-variable linear regression models to identify correlates of children's IM. Our final model (R2 = 0.353) included four individual-, eight family-, two social environment- and two built environment-level variables. The correlates of boys' and girls' IM were similar. Our findings suggest that interventions to support children's IM in a pandemic context should target multiple levels of influence.

Purpose The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity–related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries. Methods NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18–85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. Results The overall “walkability” index had a positive relationship with both walking for transportation (η2 = 0.020, P = 0.005) and recreation (η2 = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η2 = 0.020, P = 0.006 and η2 = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η2 = 0.016, P = 0.015), road/path connectivity (η2 = 0.025, P = 0.002), path infrastructure (η2 = 0.021, P = 0.005), and overall places for walking and cycling (η2 = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda. Conclusions Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.

The authors aimed to examine the association between meeting the integrative movement behavior guidelines (physical activity, screen viewing, and sleep) and cardiometabolic risk (CMR) factors in young children.In this cross-sectional study, physical activity, screen viewing, and sleep were assessed using parent-reported data. The 24-Hour Movement Guidelines for the Early Years (0-4 y) were defined as 180 minutes of physical activity/day (of which ≥60 min should be moderate-to-vigorous intensity), ≤1 hour of screen viewing/day, and 10 to 13 hours of sleep/night. Waist circumference, glucose, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure were measured in a clinical setting by trained staff. A total CMR score and individual CMR factors served as primary and secondary outcomes, respectively.Of the 767 participants (3-4 y), 26.4% met none of the guideline's recommendations, whereas 41.3%, 33.1%, and 10.6% of the sample met 1, 2, or all 3 recommendations, respectively. The number of recommendations met was not associated with the total CMR score or individual CMR factors (P > .05), with the exceptions of high-density lipoprotein (odds ratio = 1.61; 95% confidence interval, 1.11 to 2.33; P = .01).Meeting the 24-Hour Movement Guidelines in early childhood was not associated with overall CMR, but was associated with favorable cholesterol outcomes.

No abstract is provided for this article.

Background: There is a paucity of data from low- and middle-income countries on sedentary behaviour (SB) levels and patterns during early childhood. The purpose of this study was to examine how device-measured SB in young children differed across geographically, economically, and socio-demographically diverse populations, in an international sample.Methods: This multinational, cross-sectional pilot study included data from 1071 3–5-year-old children from 19 countries, collected between 2018 and 2020 (pre-COIVID). SB was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation and seated transport duration were calculated using PAL Analysis Algorithms and a custom-made analysis program. Linear mixed models were used to examine the differences in SB variables between sex, country-level income groups, caregiver education levels, urban/rural settings, and population density.Findings: Children spent 56% (7.4 hrs) of their waking time sedentary, and 42% accrued at least one sedentary bout/day lasting ≥60 min. The longest average bout duration was 81.1±45.4 min, and an average of 61.1±50.1 min/day was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, than children from low- and lower-middle-income countries. Few differences were found in SB patterns between urban/rural settings and caregiver education levels within each country-level income group, while multiple significant differences were found when comparing between country-level income groups. Higher population density was correlated with several higher SB measures.Interpretation: These data advance our understanding of young children’s SB patterns globally and the influences of country income, urban/rural setting, caregiver education levels, and population density. Country income levels and population density appear to be stronger drivers of the observed differences, than sex, rural or urban residential setting or caregiver educational attainment.Funding: American Council on Exercise, USA Beijing Health System High Level Talents Training Project, China 13 Biomedical Research Foundation, Dhaka, Bangladesh Canadian Institutes of Health Research Planning and Dissemination Grant Conselho Nacional de Pesquisa e Desenvolvimento Cientıfico e Tecnologico - CNPq Research Department of National Planning and Monitoring, PNG Government Early Start, University of Wollongong, Australia Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa Global Challenges Program, University of Wollongong, Australia Harry Crossley Foundation, South Africa National Health and Medical Research Council, Australia NIH - International Research Training Grant Pham Ngoc Thach University of Medicine, Vietnam Research University Grant (GUP), Universiti Kebangsaan Malaysia Sasakawa Sports Research Grant, Sasakawa Sports Foundation, Japan Stella de Silva Research Grant, Sri Lanka College of Paediatricians, Sri Lanka The DST-NRF Centre for Excellence in Human Development at the University of Witwatersrand, Johannesburg, South Africa The International Society of Behavioral Nutrition and Physical Activity, Pioneers ProgramDeclaration of Interest: The authors have no competing financial or personal interests to declare.Ethical Approval: Ethical approval was obtained from the University of Wollongong, Australia (ref: 2018/044) and the appropriate ethics committee(s) in each country.

Engaging stakeholders in the development of guidelines and plans for implementation is vital. The purpose of this study was to examine stakeholders’ (parents, teachers, exercise professionals, paediatricians, and youth) perceptions of the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth (“Movement Guidelines”). Stakeholders (n = 104) engaged in semi-structured focus groups or interviews to discuss the perceived acceptability of the guidelines, potential barriers to implementation, and preferred methods and messengers of dissemination. A thematic analysis was conducted. Overall, there was consistent support across all stakeholder groups, with the exception of youth participants, for the Movement Guidelines. Stakeholders identified a range of barriers to the uptake of the guidelines including concerns with accurately defining key terms such as “recreational” screen time; everyday challenges such as financial and time constraints; and the possibility of the Movement Guidelines becoming just another source of stress and guilt for already busy and overwhelmed parents. Participants identified a range of recommended methods and messengers for future dissemination. School and medical settings were the most commonly recommended settings through which dissemination efforts should be delivered. Overall, participants representing a range of stakeholder groups were receptive to the new Movement Guidelines and endorsed their value. In complementing the Movement Guidelines, messaging and resources will need to be developed that address common concerns participants had regarding their dissemination and implementation.

Surveillance of physical activity among Canadian adults has typically relied on questionnaire-based data, which have many limitations. The Canadian Health Measures Survey (CHMS) has been collecting objective, accelerometer-based physical activity data on a nationally representative sample of Canadian adults since 2007.Data are from Cycle 1 (2007 to 2009), Cycle 2 (2009 to 2011), Cycle 3 (2012 to 2013), Cycle 4 (2014 to 2015) and Cycle 5 (2016 to 2017) of the CHMS. The study sample included adults aged 18 to 79 years (Cycle 1: n = 2,952; Cycle 2: n = 2,959; Cycle 3: n = 2,517; Cycle 4: n = 2,390; Cycle 5: n = 2,355). Average daily minutes of moderate physical activity (MPA), vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPAALL) were derived from minute-by-minute accelerometer data captured over seven consecutive days. MVPA accumulated in bouts of at least 10 minutes (MVPABOUTS) were also calculated, and adherence to the Canadian Physical Activity Guidelines was assessed.No significant linear trend was observed in accelerometer-measured MVPA from 2007 to 2017. According to the most recent cycle of CHMS data (2016 and 2017), Canadian adults accumulated an average of 26 minutes of MVPAALL per day, less than half of which (12 minutes per day, on average) was accumulated in bouts of at least 10 minutes. Average daily VPA was less than five minutes. About 3% of Canadian adults accumulated no MVPA at all, while approximately 36% did not accumulate any MVPA in bouts of at least 10 minutes; 16% of Canadian adults met the current physical activity guidelines of 150 minutes of MVPA per week in bouts of at least 10 minutes.These results may be important to governments and other organizations for initiatives geared toward increasing physical activity levels in Canadian adults.

Current guidelines recommend children accumulate 60 min of daily physical activity; however, highly publicized sudden-death events among young athletes raise questions regarding activity safety. An expert group convened (June 2012) to consider the safety of promoting increased physical activity for children, and recommended the publication of an evidence-based statement of current knowledge regarding the benefits and risks of physical activity for children. Recommendations for encouraging physical activity while maximizing the opportunity to identify children who have been prescribed a physical activity restriction include (1) professionals and (or) researchers that encourage children to change the type of physical activity or to increase the frequency, intensity, or duration of their activity should inquire whether a child has primary healthcare provider-prescribed activity limitations before the child's activity participation changes; (2) physical activity researchers should prioritize the development of evidence regarding the benefits and risks of childhood physical activity and inactivity, particularly data on the risks of sedentary lifestyles and physical activity-associated injury risks that accounts for the amount of activity performed, and the effectiveness of current risk-management strategies and screening approaches; (3) professionals and researchers should prioritize the dissemination of information regarding the benefits of physical activity and the risks of sedentary behaviour in children; and (4) parents and professionals should encourage all children to accumulate at least 60 min of physical activity daily. The recommendations are established as a minimum acceptable standard that is applicable to all physical activity opportunities organized for children, whether those opportunities occur in a community, school, or research setting.