Validation of Self-Reported Anthropometric Measures and Body Mass Index in a Subcohort of the DianaWeb Population Study

Toward a holistic understanding of cancer cachexia: Application of the human response to illness model

Cachexia is a commonly presenting multidimensional syndrome in individuals living with advanced cancer. Given its prevalence of between 50% and 80%, nurses are going to encounter individuals manifesting ongoing loss of skeletal muscle mass (with or without loss of fat mass) that can be partially but not entirely reversed by conventional nutritional support. Thus nurses require a comprehensive understanding of this complex clinical problem. Research suggests, however, that nurses receive minimal education about cachexia or its management. Limited understanding undermines the ability to confidently care for patients with cachexia and their families, thereby hampering effective practice. The human response to illness model provides nurses with an organizing framework to guide and make sense of their assessments in clinical practice when caring for patients with cancer cachexia and provides direction for appropriate intervention. This article illustrates the integration of the human response to illness model to clinical practice, thereby assisting nurses to develop a comprehensive understanding of the physiological, pathophysiological, behavioral, and experiential facets of cachexia in advanced cancer patients. Contemporary areas of further interest and research will be presented.

Measurement accuracy and reliability of self-reported versus measured weight and height among adults in Malaysia: Findings from a nationwide blood pressure screening programme

Most studies reporting prevalence of obesity use actual weight and height measurements. Self-reported weight and height have been used in epidemiological studies as they have been shown to be reliable, convenient, and inexpensive alternatives to actual measurements. However, the accuracy of self-reported weight and height might vary in different regions because of the difference in health awareness and social influences. This study aims to determine the accuracy and reliability of self-reported weight and height compared to actual measured weight and height among adults in Malaysia. This was a cross-sectional study conducted at the community level during blood pressure screening campaigns. Participants self-reported their weight and height in a questionnaire survey. Their weight and height were validated using measurements by researchers on the same setting. Body mass index (BMI) was defined as underweight (<18.5kg/m2), normal (18.5-22.9 kg/m2), overweight (23-27.4 kg/m2) and obesity (≥27.5 kg/m2). Bland-Altman analysis, intraclass correlation coefficients and weighted Kappa statistics were used to assess the degree of agreement between self-reported and measured weight and height. A total of 2781 participants were recruited in this study. The difference between the mean self-reported and measured weight and height were 0.4 kg and 0.4 cm respectively. Weighted Kappa statistics analysis showed that there was a substantial agreement between the BMI classifications derived from self-reported and actual measurement (ҡ = 0.920, p<0.001). There was no marked difference in the sensitivity and specificity of self-reported BMI among Malaysian adults by gender. We observed substantial agreement between self-reported and measured body weight and height within a sample of Malaysian adults. While self-reported body weight showed weaker agreement with actual measurements particularly for obese and overweight individuals, BMI values derived from self-reported weight and height were accurate for 88.53% of the participants. We thus conclude that self-reported height and weight measures may be useful for tracking and estimating population trends amongst Malaysian adults.

How the COVID-19 pandemic has affected eating habits and physical activity in breast cancer survivors: the DianaWeb study

Purpose

Breast cancer (BC) survivors are increasingly interested in learning about healthy lifestyles to reduce the risk of BC recurrence and mortality. The DianaWeb study, a community-based participatory research, offers BC patients a specific interactive website to help them in adopting and maintain correct lifestyles, in line with World Cancer Research Fund recommendations. However, to limit the spread of the COVID-19 pandemic, most countries introduced restrictions which, inevitably, caused sudden lifestyle changes.

The current study aimed at evaluating changes in lifestyle in BC survivors before, during, and after the first two waves of the COVID-19 pandemic.

Methods

We used data of 224 BC cancer survivors enrolled in the DianaWeb study. We evaluated the adherence to physical activity (PA) guidelines, to Mediterranean diet (MD), and WCRF recommendations, at baseline, during and after the first two waves of the COVID-19 pandemic. We estimated the association between PA, MD, and WCRF adherence with sociodemographic characteristics, years from enrolment in the DianaWeb study, and type of breast cancer.

Results

As expected, during confinement periods, we observed a significant decrease in walking activity and in the percentage of patients performing vigorous PA. In post-quarantine, total weekly energy expenditure increased significantly. BC patients participating in the DianaWeb study for more than 3 years were more likely to be more active. There were no changes in MD and WCRF adherence.

Conclusions

Our results show that the proposed interactive website was useful in achieving durable lifestyle changes, that have not been undermined either during the COVID-19 pandemic.

Implications for Cancer Survivors

Patient education is essential for guiding BC survivors toward improving their health outcomes; therefore, an interactive website like the one proposed by the DianaWeb study may be useful to improve healthy lifestyles.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11764-022-01294-w.

Body Mass Index Trajectories Across the Adult Life Course and Pancreatic Cancer Risk

BACKGROUND

Body mass index (BMI) during adulthood has been associated with pancreatic ductal adenocarcinoma (PDAC), however, patterns of body size across the adult life course have not been studied extensively. We comprehensively evaluated the association between adiposity across adulthood and PDAC.

METHODS

We conducted a prospective analysis of 269 480 (162 735 males, 106 745 females) National Institutes of Health-AARP Diet and Health Study participants, aged 50-71 years (1995-1996) who self-reported height and weight history. Participants were followed through December 31, 2011. We examined associations between BMI (kg/m2) at ages 18, 35, 50, and 50-71 (baseline) years, their trajectories determined from latent-class trajectory modeling, and incident PDAC. Cox proportional hazard models were used to calculate multivariable adjusted hazards ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During up to 15.2 years of follow-up, 3092 (2020 males, 1072 females) patients with incident PDAC were identified. BMI at all 4 ages were statistically significantly associated with increased PDAC (per 5-unit increase, HR = 1.09-1.13) with higher magnitude associations in males than females at ages 35 years and older (Pinteraction < .05). Four BMI trajectories were created. Compared with normal-weight maintainers, normal-to-overweight, normal-to-obese class I, and overweight-to-obese class III trajectories had hazard ratios of 1.15 (95% CI = 1.06 to 1.25), 1.39 (95% CI = 1.25 to 1.54), and 1.48 (95% CI = 1.18 to 1.87), respectively (Pinteraction by sex = .07).

CONCLUSIONS

High BMI and BMI trajectories that result in overweight or obesity during adulthood were positively associated with PDAC, with stronger associations among those with early onset adiposity and those with male sex. Avoidance of excess body weight throughout the adult life course may prevent PDAC.

Altered Food Behavior and Cancer: A Systematic Review of the Literature

There is evidence of an association between cancer and certain types of altered eating behaviors, including orthorexia, food cravings, and food addiction. Given the growing interest in the topic throughout the scientific community we conducted a systematic review to summarize current evidence on the development of altered food behavior, including food addiction and cancer. The Cochrane Collaboration and the Meta-analysis Of Observational Studies in Epidemiology guidelines were followed to perform this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the process and results. The structured literature search was conducted on 19 April 2022, on PubMed/Medline and Scopus, combining free-text terms and medical subject headings. A total of seven articles were included once the selection process was completed. Food craving has been associated with different types of cancer in adults and young patients, as well as with orthorexia; conversely, compulsive eating has only been explored in patients with prolactinoma treated with dopamine agonists. This systematic review explored a new area of research that warrants further investigation. More research is required to better understand the relationship between cancer and food behavior.

Agreement between self-reported and researcher-measured height, weight and blood pressure measurements for online prescription of the combined oral contraceptive pill: an observational study

OBJECTIVES

To compare agreement between self-reported height, weight and blood pressure measurements submitted to an online contraceptive service with researcher-measured values and document strategies used for self-reporting.

DESIGN

An observational study.

SETTING

An online sexual health service which provided the combined oral contraceptive pill, free of charge, to users in Southeast London, England.

PARTICIPANTS

Between August 2017 and August 2019, 365 participants were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome, for which the study was powered, was the agreement between self-reported and researcher-measured body mass index (BMI) and blood pressure measurements, compared using kappa coefficients. Secondary measures of agreement included sensitivity, specificity and Bland Altman plots. The study also describes strategies used for self-reporting and classifies their clinical appropriateness.

RESULTS

327 participants fully described their process of blood pressure measurement with 296 (90.5%) classified as clinically appropriate. Agreement between self-reported and researcher-measured BMI was substantial (0.72 (95% CI 0.42 to 1.0)), but poor for blood pressure (0.06 (95% CI -0.11 to 0.23)). Self-reported height and weight readings identified 80.0% (95% CI 28.4 to 99.5) of individuals with a researcher-measured high BMI (≥than 35 kg/m²) and 9.1% (95% CI 0.23 to 41.3) of participants with a researcher-measured high blood pressure (≥140/90 mm Hg).

CONCLUSION

In this study, while self-reported BMI was found to have substantial agreement with researcher-measured BMI, self-reported blood pressure was shown to have poor agreement with researcher-measured blood pressure. This may be due to the inherent variability of blood pressure, overdiagnosis of hypertension by researchers due to 'white coat syndrome' or inaccurate self-reporting. Strategies to improve self-reporting of blood pressure for remote prescription of the combined pill are needed.

Quantitative prediction error analysis to investigate predictive performance under predictor measurement heterogeneity at model implementation

BACKGROUND

When a predictor variable is measured in similar ways at the derivation and validation setting of a prognostic prediction model, yet both differ from the intended use of the model in practice (i.e., "predictor measurement heterogeneity"), performance of the model at implementation needs to be inferred. This study proposed an analysis to quantify the impact of anticipated predictor measurement heterogeneity.

METHODS

A simulation study was conducted to assess the impact of predictor measurement heterogeneity across validation and implementation setting in time-to-event outcome data. The use of the quantitative prediction error analysis was illustrated using an example of predicting the 6-year risk of developing type 2 diabetes with heterogeneity in measurement of the predictor body mass index.

RESULTS

In the simulation study, calibration-in-the-large of prediction models was poor and overall accuracy was reduced in all scenarios of predictor measurement heterogeneity. Model discrimination decreased with increasing random predictor measurement heterogeneity.

CONCLUSIONS

Heterogeneity of predictor measurements across settings of validation and implementation reduced predictive performance at implementation of prognostic models with a time-to-event outcome. When validating a prognostic model, the targeted clinical setting needs to be considered and analyses can be conducted to quantify the impact of anticipated predictor measurement heterogeneity on model performance at implementation.

Dietary Fiber Intake and Risk of Pancreatic Cancer: Systematic Review and Meta-Analysis of Observational Studies

The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population's awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study)

Abstract

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study)

Background

E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors.

Results

Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR= 0.51, 95% CI=(0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR=1.03, 95% CI=(1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI=(-3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI=(−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI=(2.27, 4.15), p < 0.001). As nutrition status declined, the distress score increased (95%CI=(0.88, 1.68), p < 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems.

Conclusion

Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.

Accuracy of self-reported BMI using objective measurement in high school students

Self-reported measures for body mass index (BMI) are considered a limitation in research design, especially when they are a primary outcome. Studies have found some populations to be quite accurate when self-reporting BMI; however, there is mixed research on the accuracy of self-reported measurements in adolescents. The aim of this study is to examine the accuracy of self-reported BMI by comparing it with measured BMI in a sample of U.S. adolescents and to understand gender differences. This cross-sectional study collected self-reported height and weight measurements of students from five high schools in four states (Tennessee, South Dakota, Kansas and Florida). Trained researchers took height and weight of students for an objective measurement. BMI was calculated from both sources and categorized (underweight, normal, overweight and obese) using the Centers for Disease Control and Prevention's BMI-for-age percentiles. Participants (n 425; 51⋅0 % female) had a mean age of 16⋅3 years old, and the majority were White (47⋅5 %). Limits of agreement (LOA) analysis revealed that BMI and weight were underreported, and height was overreported in the overall sample, in females, and in males. LOA analysis was fair for BMI in all three groups. Overall agreement in BMI categorisation was considered substantial (Κ 0⋅71, P < 0⋅001). As BMI increased, more height and weight inaccuracies led to decreased accuracy in BMI categorisation, and the specificity of obese participants was low (50⋅0 %). This study's findings suggest that using self-reported values to categorize BMI is more accurate than using continuous BMI values when self-reported measures are used in health-related interventions.

Use and reporting of Bland-Altman analyses in studies of self-reported versus measured weight and height

BACKGROUND/OBJECTIVES

Bland-Altman methods for assessing the agreement between two measures are highly cited. However, these methods may often not be used to assess agreement, and when used, they are not always presented or interpreted correctly. Our objective was to evaluate the use and the quality of reporting of Bland-Altman analyses in studies that compare self-reported with measured weight and height.

METHODS

We evaluated the use of Bland-Altman methods in 394 published articles that compared self-reported and measured weight and height data for adolescents or adults. Six reporting criteria were developed: assessment of the normality of the distribution of differences, a complete and correctly labeled Bland-Altman plot displaying the mean difference and limits of agreement (LOA), numerical values and confidence intervals, standard errors, or standard deviations for mean difference, numerical values of LOA, confidence intervals for LOA, and prespecified criteria for acceptable LOA.

RESULTS

Only 72/394 (18%) studies comparing self-reported with measured weight and height or BMI used some form of Bland-Altman analyses. No study using Bland-Altman analyses satisfied more than four of the six criteria. Of the 72 studies, 64 gave mean differences along with confidence intervals or standard deviations, 55 provided complete Bland-Altman plots that were appropriately labeled and described, 37 provided numerical values for LOA, 4 reported that they examined the normality of the distribution of differences, 3 provided confidence intervals for LOA, and 3 had prespecified criteria for agreement.

CONCLUSIONS

Bland-Altman methods appear to be infrequently used in studies comparing measured with self-reported weight, height, or BMI, and key information is missing in many of those that do use Bland-Altman methods. Future directions would be defining acceptable LOA values and improving the reporting and application of Bland-Altman methods in studies of self-reported anthropometry.