Validity of self-reported height and weight in a Japanese workplace population

In silico data-based comparison of the accuracy and error source of various methods for noninvasively estimating central aortic blood pressure

BACKGROUND AND OBJECTIVES

The higher clinical significance of central aortic blood pressure (CABP) compared to peripheral blood pressures has been extensively demonstrated. Accordingly, many methods for noninvasively estimating CABP have been proposed. However, there still lacks a systematic comparison of existing methods, especially in terms of how they differ in the ability to tolerate individual differences or measurement errors. The present study was designed to address this gap.

METHODS

A large-scale 'virtual subject' dataset (n = 600) was created using a computational model of the cardiovascular system, and applied to examine several classical CABP estimation methods, including the direct method, generalized transfer function (GTF) method, n-point moving average (NPMA) method, second systolic pressure of periphery (SBP2) method, physical model-based wave analysis (MBWA) method, and suprasystolic cuff-based waveform reconstruction (SCWR) method. The errors of CABP estimation were analyzed and compared among methods with respect to the magnitude/distribution, correlations with physiological/hemodynamic factors, and sensitivities to noninvasive measurement errors.

RESULTS

The errors of CABP estimation exhibited evident inter-method differences in terms of the mean and standard deviation (SD). Relatively, the estimation errors of the methods adopting pre-trained algorithms (i.e., the GTF and SCWR methods) were overall smaller and less sensitive to variations in physiological/hemodynamic conditions and random errors in noninvasive measurement of brachial arterial blood pressure (used for calibrating peripheral pulse wave). The performances of all the methods worsened following the introduction of random errors to peripheral pulse wave (used for deriving CABP), as characterized by the enlarged SD and/or increased mean of the estimation errors. Notably, the GTF and SCWR methods did not exhibit a better capability of tolerating pulse wave errors in comparison with other methods.

CONCLUSIONS

Classical noninvasive methods for estimating CABP were found to differ considerably in both the accuracy and error source, which provided theoretical evidence for understanding the specific advantages and disadvantages of each method. Knowledge about the method-specific error source and sensitivities of errors to different physiological/hemodynamic factors may contribute as theoretical references for interpreting clinical observations and exploring factors underlying large estimation errors, or provide guidance for optimizing existing methods or developing new methods.

Accuracy of self-reported height, weight, and waist circumference in poor, rural areas of China

Objectives

There are differing opinions and findings about the accuracy of self-reported data. This study sought to assess the accuracy of self-reported height, weight, and waist circumference (WC) data among adult residents in poor, rural areas of China.

Methods

Multi-stage stratified cluster random sampling was used to sample rural adult residents in Jinzhai County. Intraclass correlations (ICCs), Bland-Altman plots with limits of agreements (LOAs), and Cohen's kappa were used to examine the accuracy of self-reported data. Multiple linear regression was used to explore the effect of demographic and socioeconomic variables.

Results

Height was over-reported by an average of 0.67 cm, weight and WC were both under-reported, by an average of 0.004 kg and 1.09 cm, respectively. The ICC for height was 0.92, the ICC for weight was 0.93, and the ICC for WC was 0.93. Bland-Altman plots showed no trend in variability with increasing height, weight, and WC, but 95% of the LOAs were wide, especially for WC. The percentage agreement (kappa) for BMI was 82.10% (0.71), and the percentage agreement for WC was 83.56% (0.66). Overall, obesity, overweight, and increased WC were underestimated by 0.56%, 2.64%, and 6.89%, respectively. Assessments of which demographic and socioeconomic factors were associated with statistically significant differences between self-reported and measured data showed that education (junior school vs. primary or below: β = -0.56, 95% CI [-1.01 to -0.11]) and occupation (others vs. professionals: β = 2.16, 95% CI [0.62-3.70]) were associated with differences between measured and self-reported height; occupation (industrial and commercial service vs. professionals: β = 1.57, 95% CI [0.52-2.61]) was associated with differences between measured and self-reported weight; and gender (women vs. men: β = -1.74, 95% CI [-2.51 to -0.97]) and age (60- vs. 18-44: β = -1.62, 95% CI [-2.88 to -0.36]) were associated with differences between measured and self-reported WC.

Conclusions

Self-reported height and weight were shown to be reliable in poor, rural areas of China, but self-reported WC should be used with caution. To improve the accuracy of self-reported data, certain subgroups should be targeted for educational interventions.

Body mass index and breast cancer risk in premenopausal and postmenopausal East Asian women: a pooled analysis of 13 cohort studies

BACKGROUND

It has been suggested that the association between body mass index and breast cancer risk differs between Asian women and Western women. We aimed to assess the associations between body mass index and breast cancer incidence in East Asian women.

METHODS

Pooled analyses were performed using individual participant data of 319,189 women from 13 cohort studies in Japan, Korea, and China. Participants' height and weight were obtained by measurement or self-reports at cohort baseline. Breast cancer was defined as code C50.0-C50.9 according to the International Classification. Using a Cox proportional hazards model, hazard ratios of breast cancer were estimated for each body mass index category, with the reference group set as the group with a body mass index of 21 to < 23 kg/m2. The hazard ratio for a 5 kg/m2 increase in body mass index was also calculated.

RESULTS

During a mean 16.6 years of follow-up, 4819 women developed breast cancer. Similar to Westerners, a steady increase in breast cancer risk with increasing body mass index was observed in postmenopausal women, but the slope of the risk increase appeared to slow at a body mass index of 26-28 kg/m2. In premenopausal women, the inverse association seen in Westerners was not observed. The risk of developing breast cancer after 50 years of age increased slightly with increasing body mass index, which was more pronounced in the older birth cohort. There was no significant association between body mass index and the risk of developing breast cancer before 50 years of age, but the risk estimates changed from positive to negative as the birth cohort got younger.

CONCLUSIONS

In East Asia, the role of body mass index in breast cancer in premenopausal women may be changing along with the increase in obesity and breast cancer. The increased risk of postmenopausal breast cancer with a higher body mass index was as robust as that of Western women.

Development and validation of the gratitude for food scale for Japanese adults

Gratitude for food is a concept associated with various aspects of healthy and sustainable diet and originates from Buddhism and Shintoism in Japan. Against this background, a scale specifically targeting adults is essential for boosting studies concerning gratitude for food. This study aimed to adapt the Gratitude for Food Scale (GFS), originally developed for Japanese children, to Japanese adults and to examine the reliability and validity of GFS for adults (GFS-A). This cross-sectional study used baseline and one-week follow-up data from a longitudinal survey. The analysis included 1800 Japanese adults at baseline and 1380 at the one-week follow-up based on completion of self-administered questionnaires in February 2023. Construct validity was confirmed using exploratory and confirmatory factor analyses. Further, Spearman's and intraclass correlation coefficients and Cronbach's alpha were calculated to confirm criterion validity and reliability (test-retest and internal consistency). Participants' mean (SD) age was 40.2 (11.2) years (women: n = 900, 50.0%) at baseline. The analysis revealed a one-factor structure comprising five items with good model fit. Criterion validity was confirmed by the correlation coefficients between the total GFS score and the gratitude questionnaire and the sub-score of awareness and appreciation for food, which represents a subscale of the expanded mindful eating scale. Moreover, test-retest reliability and internal consistency were confirmed. From this study's results, we can see that the developed GFS-A is an appropriate scale with good reliability and validity for measuring Japanese adults' gratitude for food.

Optimization and validation of a suprasystolic brachial cuff-based method for noninvasively estimating central aortic blood pressure

Clinical studies have extensively demonstrated that central aortic blood pressure (CABP) has greater clinical significance in comparison with peripheral blood pressure. Despite the existence of various techniques for noninvasively measuring CABP, the clinical applications of most techniques are hampered by the unsatisfactory accuracy or large variability in measurement errors. In this study, we proposed a new method for noninvasively estimating CABP with improved accuracy and reduced uncertain errors. The main idea was to optimize the estimation of the pulse wave transit time from the aorta to the occluded lumen of the brachial artery under a suprasystolic cuff by identifying and utilizing the characteristic information of the cuff oscillation wave, thereby improving the accuracy and stability of the CABP estimation algorithms under various physiological conditions. The method was firstly developed and verified based on large-scale virtual subject data (n = 800) generated by a computational model of the cardiovascular system coupled to a brachial cuff, and then validated with small-scale in vivo data (n = 34). The estimation errors for the aortic systolic pressure were -0.05 ± 0.63 mmHg in the test group of the virtual subjects and -1.09 ± 3.70 mmHg in the test group of the patients, both demonstrating a good performance. In particular, the estimation errors were found to be insensitive to variations in hemodynamic conditions and cardiovascular properties, manifesting the high robustness of the method. The method may have promising clinical applicability, although further validation studies with larger-scale clinical data remain necessary.

Adult Height and Risk of Colorectal Cancer: A Pooled Analysis of 10 Population-based Cohort Studies in Japan

BACKGROUND

While tall stature has been linked to an increase in the risk of colorectal cancer (CRC), its association with cancer in the colorectum and its subsites remains unclear among Asians.

METHODS

We conducted a pooled analysis of 10 population-based cohort studies among adults in Japan. Each study estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC incidence associated with adult height were estimated using Cox proportional hazards regression with adjustment of the same set of covariates were then pooled to estimate summary HRs incidence using random-effect models.

RESULTS

We identified 9,470 CRC incidences among 390,063 participants during 5,672,930 person-years of follow-up. Men and women with tall stature had a higher risk of CRC and colon cancer. HRs for CRC, colon cancer, and distal colon cancer for the highest versus lowest height categories were 1.23 (95% CI, 1.07-1.40), 1.22 (95% CI, 1.09-1.36), and 1.27 (95% CI, 1.08-1.49), respectively, in men and 1.21 (95% CI, 1.09-1.35), 1.23 (95% CI, 1.08-1.40), and 1.35 (95% CI, 1.003-1.81), respectively, in women. The association with proximal colon cancer and rectal cancer was less evident in both sexes.

CONCLUSION

This pooled analysis confirms the link between tall stature and a higher risk of CRC and colon cancer (especially distal colon) among the Japanese and adds evidence to support the use of adult height to identify those at a higher risk of CRC.

Ultra-Processed Food as Mediator of the Association between Birthweight and Childhood Body Weight Outcomes: A Retrospective Cohort Study

Previous studies have shown conflicting findings regarding the association between birthweight and childhood adiposity. We aimed to explore the interaction between ultra-processed food (UPF) and birthweight and its associations with bodyweight markers. The retrospective analysis of data from a Multicity Cohort Study across eastern China was conducted. UPF was computed as percentage of the energy intake and categorized into quartiles. Birthweight was categorized into low (LBW), normal (NBW) and high (HBW). The BMI z-score was calculated using the lambda-mu-sigma method. The sex- and age-specific BMI cutoff points were used to define weight status. Generalized linear models were used to examine modification effects and were performed after adjustment for covariates. The mean percentage of energy intake from UPF was 27.7% among 1370 children. Of all children, 2.3% and 21.4% were born with LBW and HBW, respectively. HBW was a permanent risk for high BMI measures, while LBW was associated with increased BMI measurements only by the addition of the interaction term. The subgroup analysis revealed that HBW and LBW were positively associated with BMI measurements in the lowest UPF intake (Q1), while HBW was related to high BMI measures in Q4. Our findings support efforts to recommend limiting UPF intake, especially for LBW children.

The Association Between Eating Quickly and Excessive Gestational Weight Gain

Objectives

Maintaining an appropriate gestational weight gain (GWG) is essential for a safe pregnancy and delivery. This study aimed to determine the association between the habit of eating quickly and the risk of excessive GWG.

Methods

We administered a questionnaire on eating habits to 1246 pregnant Japanese women in their second to third trimesters. We categorized the participants into three groups according to their answers to the question "Do you eat quickly?" Group 1, "always" or "usually"; Group 2, "sometimes"; and Group 3, "rarely" or "never." We assessed GWG according to the "The Optimal Weight Gain Chart" (Ministry of Health, Labor and Welfare, Japan), and those who exceeded the criteria were considered "excessive." Logistic regression analysis was performed with the risk of excess GWG as the dependent variable and quick food intake as the independent variable, to obtain relevant odds ratios (ORs) and 95% confidence intervals (CIs). Model 1 was unadjusted, and Model 2 was adjusted for age, prepregnancy body mass index, energy intake, mother's educational attainment, household income, exercise habits, and childbearing experience.

Results

The OR (95% CI) for Groups 2 and 3 in Model 1, compared with Group 1, was 0.80 (0.62-1.05) and 0.61 (0.43-0.88), respectively (p for trend = 0.047). In Model 2, the OR (95% CI) for Groups 2 and 3 were 0.73 (0.55-0.96) and 0.59 (0.40-0.86), respectively (p for trend = 0.003).

Conclusion

These results suggest that quick food ingestion increases the risk of excessive GWG.

How prepartum appearance-related attitudes influence body image and weight-control behaviors of pregnant Japanese women across pregnancy: Latent growth curve modeling analyses

A thin female physique is idealized in modernized societies, leading many pregnant women to experience body dissatisfaction and avoid weight gain, as pregnancy directs their body away from the sociocultural ideal of thinness. However, not all pregnant women report body dissatisfaction and/or weight-control behavior. We aimed to discern how prepartum weight-related attitudes-thin-ideal internalization, drive for thinness, and appearance comparison tendency-influence changes in negative attitudes toward a pregnant body, body image, and weight-control behavior across pregnancy. Data were longitudinally collected from 208 Japanese pregnant women (Mage = 27.0, SD = 1.74) across three pregnancy periods. Results indicated that overall, negative attitudes toward appearance change during pregnancy, weight-control behaviors, and restrained eating significantly changed across pregnancy. Moreover, those with higher prepartum thin-ideal internalization showed greater decreases in negative attitudes toward appearance change during pregnancy and greater increases in body dissatisfaction, whereas those with higher prepartum drive for thinness and appearance comparison tendency showed greater decreases in restrained eating across pregnancy. Our findings suggest that pregnant women with certain prepartum weight-related attitudes may experience an aggravation of body dissatisfaction while following dietary regimen during pregnancy. Thus, prevention programs may selectively help them reduce their negative body image during pregnancy.

The Association Between Adult Height and Stroke Incidence in Japanese Men and Women: A Population-based Case-Control Study

BACKGROUND

No studies have examined the associations between adult height and ischemic stroke subtypes.

METHODS

We conducted a population-based case-control study that included 2,451 thrombotic and 687 embolic stroke cases, as well as 1,623 intracerebral and 768 subarachnoid hemorrhage cases without history of stroke aged 40-79 years, and the same number of sex- and age-matched controls. Cases and controls were grouped according to the quintile cut-off values of height in controls, and the third quintile, which was approximately the average height group, was used as the reference group. Height divided by one standard deviation of height in controls was also examined as a continuous variable. The analyses were carried out separately for participants aged 40-59 years and 60-79 years.

RESULTS

In both younger and older men, height was linearly inversely associated with total and thrombotic strokes, and the shortest quintile compared to the reference group was associated with increased risks of these strokes. Although height was linearly inversely associated with embolic stroke and intracerebral hemorrhage in younger men, the shortest quintile did not show increased risks of these strokes. Height did not seem to be associated with total stroke and any stroke subtypes in younger women. In contrast, the tallest quintile was significantly associated with increased risks of total stroke and intracerebral hemorrhage, and height tended to be positively associated with these strokes in older women.

CONCLUSION

We reported the associations between adult height and ischemic stroke subtypes for the first time, which differed according to sex and age group.

Males With Traumatic Lower Limb Loss Differ in Body Fat Distribution Compared to Those Without Limb Loss

OBJECTIVES

The primary objective was to examine body fat composition in males with traumatic lower limb loss and a comparison group without limb loss. A secondary objective was to determine if there are differences in body fat composition by traumatic limb loss level.

RESEARCH METHODS AND PROCEDURES

Cross-sectional analyses of baseline in-person intake data was completed at a large military medical center. Data were collected from 2011 to 2020, and analysis was conducted in 2020. Participants (n = 89) included males who sustained traumatic lower limb loss (n = 50) and an age-matched comparison group without limb loss (n = 39). Mean age of participants was 36.0 ± 13.2 years. Main outcomes measured included age, height, body mass index, weight, body fat mass and percent, android fat mass and percent, gynoid fat mass and percent, and android/gynoid percent fat ratio. Differences between groups were assessed using t-tests or Mann-Whitney U tests. Differences between limb loss levels were assessed using one-way ANOVA or Wilcoxon signed-rank test.

RESULTS

Body fat percent (P = .001), gynoid fat percent (P = .010), android fat mass (P = .01), and percent (P = .02) were higher in the group with limb loss. There were no differences in body fat composition between limb loss levels (P > .05).

CONCLUSION

Males with traumatic lower limb loss had a higher body fat percent compared to those without limb loss. Given higher body fat composition in individuals with limb loss and the relationship between body fat composition and cardiovascular disease risk, including body composition analysis with clinical screening could identify changes and allow for early intervention.

Food addiction, orthorexia nervosa and dietary diversity among Bangladeshi university students: a large online survey during the COVID-19 pandemic

PURPOSE

Maladaptive eating behaviors like food addiction (FA) are common among students, and orthorexia nervosa (ON) is being evaluated as a new condition among eating disorders (EDs). Moreover, dietary diversity (DD) is recognized as an important component of a healthy diet. Thus, the current study sought to examine the prevalence of ON and FA as well as the factors associated with ON, FA, and DD among university students in Bangladesh during the COVID-19 pandemic.

METHODS

Four-thousand-and-seventy-six students were recruited and completed an online survey consisting of the Bratman Orthorexia test, the modified Yale Food Addiction Scale, and a questionnaire based on the Food and Agriculture Organizations' guidelines. Inferential statistics, bivariate and multivariable linear regression were used for analyzing data.

RESULTS

ON and FA were observed in 1.7% and 7.5% of participants, respectively, with 43.8% exhibiting Health Fanatic eating attitude. The mean DD score was 5.96 (SD = 1.56). Students with ON consumed more legumes, nuts, seeds, and vegetables including dark green leafy vegetables whereas students with FA consumed more organ meats and eggs. Students who were older-aged, married, formerly smoked, had fitness goals, and had guilty feelings about violating food rules were more likely to have ON, whereas those who were female, were married, actively smoked, and were overweight and obese were more likely to have FA.

CONCLUSIONS

The findings suggest that students from Bangladesh are at risk of FA, and less so for ON. These entities and low DD deserve more research attention in Bangladesh to increase awareness and ensure appropriate interventions.

Impact of Body Mass Index on Obesity-Related Cancer and Cardiovascular Disease Mortality; The Japan Collaborative Cohort Study

AIM

We aimed to examine the association of obesity-related cancer and cardiovascular disease (CVD) with body mass index (BMI) and the estimated population attributable fraction in lean Asians.

METHODS

We studied 102,535 participants aged 40-79 years without histories of cancer or CVD at baseline between 1988 and 2009. The cause-specific hazard ratios (csHRs) of BMI categories (＜18.5, 18.5-20.9, 21.0-22.9 [reference], 23.0-24.9, 25.0-27.4, and ≥ 27.5 kg/m2) were estimated for each endpoint. The events considered were mortalities from obesity-related cancer (esophageal, colorectal, liver, pancreatic, kidney, female breast, and endometrial cancer) and those from CVD (coronary heart disease and stroke). Population attributable fractions (PAFs) were calculated for these endpoints.

RESULTS

During a 19.2-year median follow-up, 2906 died from obesity-related cancer and 4532 died from CVD. The multivariable-adjusted csHRs (95% confidence interval) of higher BMI categories (25-27.4 and ≥ 27.5 kg/m2) for obesity-related cancer mortality were 0.93 (0.78, 1.10) and 1.18 (0.92, 1.50) in men and 1.25 (1.04, 1.50) and 1.48 (1.19, 1.84) in women, respectively. The corresponding csHRs for CVD mortality were 1.27 (1.10, 1.46) and 1.59 (1.30, 1.95) in men and 1.10 (0.95, 1.28) and 1.44 (1.21, 1.72) in women, respectively. The PAF of a BMI ≥ 25 kg/m2 for obesity-related cancer was -0.2% in men and 6.7% in women and that for CVD was 5.0% in men and 4.5% in women.

CONCLUSION

A BMI ≥ 25 kg/m2 is associated with an increased risk of obesity-related cancer in women and CVD in both sexes.

Doubly labelled water-calibration approach attenuates the underestimation of energy intake calculated from self-reported dietary assessment data in Japanese older adults

OBJECTIVE

Self-reported energy intake (EI) estimation may incur systematic errors that could be attenuated through biomarker calibration. We aimed to confirm whether calibrated EI was comparable to total energy expenditure (TEE) measured using the doubly labelled water (DLW) technique.

DESIGN

Cross-sectional study.

SETTING

General older population from the Kyoto-Kameoka Study, Japan.

PARTICIPANTS

This study included sub- and main cohorts of 72 and 8058 participants aged≥ 65 years, respectively. EI was evaluated using a validated FFQ, and calibrated EI was obtained using a previously developed equation based on the DLW method. TEE was considered representative of true EI and also measured using the DLW method. We used a Wilcoxon signed-rank test and correlation analysis to compare the uncalibrated and calibrated EI with TEE.

RESULTS

In the sub-cohort, the median TEE, uncalibrated EI and calibrated EI were 8559 kJ, 7088 kJ and 9269 kJ, respectively. The uncalibrated EI was significantly lower than the TEE (median difference = -1847 kJ; interquartile range (IQR): -2785 to -1096), although the calibrated EI was not (median difference = 463 kJ; IQR: -330 to 1541). The uncalibrated (r = 0·275) and calibrated EI (r = 0·517) significantly correlated with TEE. The reproducibility was higher for calibrated EI (interclass correlation coefficient (ICC) = 0·982) than for uncalibrated EI (ICC = 0·637). Similar findings were observed when stratifying the sample by sex. For medians, uncalibrated EI was lower (about 17 %) than calibrated EI in the main cohort.

CONCLUSIONS

Biomarker calibration may improve the accuracy of self-reported dietary intake estimation.

Food Choice Values and Food Literacy in a Nationwide Sample of Japanese Adults: Associations with Sex, Age, and Body Mass Index

This cross-sectional study of 2231 Japanese adults described food choice values and food literacy in relation to sex, age, and body mass index. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety, using a 25-item scale), as well as food literacy, which was characterized by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviors (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). Females had higher means of all the variables than males, except for food fussiness. Compared to participants aged 19-39 and/or 40-59 years, those aged 60-80 years had low means of some food choice values (accessibility, convenience, sensory appeal, and comfort), nutrition knowledge, and all the food approach behaviors (hunger, food responsiveness, emotional overeating, and enjoyment of food) and high means of other food choice values (tradition, organic, and safety) and slowness in eating. Age was inversely associated with cooking and food skills in males, whereas the opposite was observed in females. The associations with body mass index were generally weak. These findings serve as both a reference and an indication for future research.

Prevalence and correlates of diabetes distress and depressive symptoms among individuals with type-2 diabetes mellitus during Ramadan fasting: A cross-sectional study in Bangladesh amid the COVID-19

AIMS

Psychological concerns relating to "diabetes distress" (DD) and depressive symptoms (DS) in individuals with type-2 diabetes mellitus (T2DM) may negatively impact adherence to medical treatments and overall mental health. Thus, this study was undertaken to investigate DS and DD in relation to fasting during the month of Ramadan.

METHODS

A cross-sectional survey was conducted among 735 patients with T2DM in 2021. DD and DS were measured by the Problem Areas in Diabetes scale and Patient Health Questionnaire-9, respectively. Logistic regression and correlation analyses were executed.

RESULTS

More than one-third of the participants (41.2%) had DD and DS (36.9%). DS was significantly higher in participants who did not fast (p = 0.027). Participants who had higher dietary diversity were less likely to have DD (p = 0.004) and DS (p = 0.001). Females (AOR = 1.89, 95% CI: 1.25-2.85) and those who lived alone (AOR = 1.89, 95% CI: 1.25-2.85) were more likely to have DS. Participants with diabetes-related complications were more likely to experience DS (AOR = 2.17; 95% CI: 1.5-3.13) and DD (AOR = 3.46; 95% CI: 2.42-4.95). DD was also associated with being younger (p = 0.003), having hypertension (p = 0.030), having heart disease (p = 0.012), and taking insulin (p = 0.010).

CONCLUSIONS

Individuals with T2DM who were not fasting experienced more mental health concerns. Psychosocial support and other interventions from health professionals should be examined and empirical interventions should be implemented to promote the mental health and well-being of individuals with T2DM.

Inadequacies of gestational weight gain: prevalence and association with sociodemographic characteristics and the living environment

ABSTRACT Objective To assess the association of gestational weight gain inadequacies with sociodemographic indicators and characteristics of the living environment. Methods Cross-sectional study conducted in 2019 with a probabilistic sample of 3580 postpartum women who gave birth in maternity hospitals of the Unified Health System in the State of Santa Catarina. Prevalence was calculated and, using logistic regression models, odd ratios of inadequate and adequate gestational weight gain were estimated according to sociodemographic and health indicators (Body Mass Index, age, marital status, race/skin color and education); and characteristics of the neighborhood (violence, social cohesion, encouragement to practice physical activity and access to healthy food). Results It was observed that 29.6% of the mothers had adequate gestational weight gain, 29.3% insufficient and 41.1% excessive gestational weight gain. Lower chances of adequate weight gain were found in women with pre-pregnancy body mass index classified as overweight (43.0%) and obesity (58.0%) and who lived in an environment with social cohesion (25.0%). In contrast, the chances of adequate weight gain were 43.0% higher among women with 12 years of schooling or more when compared to those with 8 years or less. Conclusion Inadequate gestational weight gain is associated with high pre-pregnancy body mass index, with social cohesion in the living environment and with a low level of education of the pregnant woman, requiring public policies that go beyond prenatal care.

Height and Mortality from Aortic Aneurysm and Dissection

AIMS

Reports on the association between height and aortic disease have been modest, and there are only a few studies investigating the association between height and mortality from specific aortic disease types or by sex.

METHODS

We conducted the Japan Collaborative Cohort Study, a prospective study of 99,067 Japanese (41,730 men and 57,337 women) aged 40-79 years old. Height was self-reported, and the participants were followed up from 1988-1989 to the end of 2009. Sex-specific hazard ratios (95% confidence intervals) of mortality from aortic disease type according to sex-specific quartiles of height were analyzed using the Cox proportional hazards model.

RESULTS

During the median follow-up period of 19.1 years, the numbers of deaths due to aortic aneurysm, thoracic aortic aneurysm, abdominal aortic aneurysm, and aortic dissection were 87, 29, 48, and 56 among men and 35, 17, 15, and 65 among women, respectively. The sex-specific multivariate hazard ratios (95% confidence intervals) and p for trend for the highest versus lowest quartiles of height were 1.10 (0.66-1.83), p=0.58 among men and 1.54 (0.85-2.79), p=0.06 among women for total aortic disease; 1.85 (0.80-4.28), p=0.16 among men and 5.67 (0.90-35.77), p=0.08 among women for abdominal aortic aneurysm; and 1.13 (0.48-2.64), p=0.65 among men and 1.70 (0.82-3.50), p=0.04 among women for aortic dissection. The positive association was observed for both sexes, albeit more prominent among women. No association was found between height and mortality from thoracic aortic aneurysms.

CONCLUSIONS

As per our findings, we were able to determine that height was positively associated with mortality from abdominal aortic aneurysm in the Japanese population.

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

Introduction: The study assessed whether self-reported height, weight and derived body mass index (BMI) can provide an accurate measure of anthropometric data in a multiethnic adult population in Singapore. Methods: Standardised anthropometric measurements were compared against the self-reported values from 5,132 adult residents in a cross-sectional, epidemiological survey. Discrepancies in self-reports from measurements were examined by comparing overall mean differences. Intraclass correlations, Cohen’s kappa and Bland-Altman plots with limits of agreement, and sub-analysis by sex and ethnicity were also explored. Results: Data were obtained from 5,132 respondents. The mean age of respondents was 43.9 years. Overall, the height was overestimated (0.2cm), while there was an underestimation of weight (0.8kg) and derived BMI (0.4kg/m2). Women had a larger discrepancy in height (0.35cm, 95% confidence interval [CI] 0.22 to 0.49), weight (-0.95kg, 95% CI -1.11 to -0.79) and BMI (-0.49kg/m2, 95% CI -0.57 to -0.41) compared with men. Height reporting bias was highest among Indians (0.28cm, 95% CI 0.12 to 0.44) compared with Chinese and Malays, while weight (-1.32kg, 95% CI -1.53 to -1.11) and derived BMI (-0.57kg/m2, 95% CI -0.67 to -0.47) showed higher degrees of underreporting among Malays compared with Chinese and Indians. Substantially high self-reported versus measured values were obtained for intraclass correlations (0.96–0.99, P<0.001) and kappa (0.74). For BMI categories, good to excellent kappa agreement was observed (0.68–0.81, P<0.0001). Conclusion: Self-reported anthropometric estimates can be used, particularly in large epidemiological studies. However, sufficient care is needed when evaluating data from Indians, Malays and women as there is likely an underestimation of obesity prevalence. Keywords: Body mass index, epidemiology, public health, self-report, validity

Validation of Obesity Status Based on Self-Reported Data among Filipina and Indonesian Female Migrant Domestic Workers in Macao (SAR), China

BACKGROUND

Migrant domestic workers are at high risk of overweight and obesity. It is crucial to assess the prevalence of obesity among this migrant population, for surveillance and intervention. Self-reported height and weight are commonly used to derive body mass index (BMI) and assess the prevalence of obesity. The accuracy of BMI from self-reported height and weight in migrant populations remains unknown. The aim of this study was to assess the accuracy of BMI from self-reported measures and identify the optimal adjustment to be made to overweight and obesity cut-off points when using self-reported body mass index among migrant workers.

METHODS

Self-reported and objectively measured height and weight were obtained from 1388 female Filipina domestic workers and 369 female Indonesian domestic workers recruited using respondent-driven sampling between November 2016 and August 2017. Self-reported BMI (based on self-reported height and weight) and measured BMI (based on objectively measured height and weight) were calculated as weight in kilograms divided by the square of height in meters for all participants (kg/m2).

RESULTS

BMI derived from self-reported height and weight was underestimated for both Filipina (z = -27.5, p < 0.001) and Indonesian (z = -9.9, p < 0.001) participants. Applying the gold standard of Asian BMI cut-off points to self-reported BMI, the sensitivity in identifying overweight or obesity was 64.4% for Filipina participants and 78.6% for Indonesian participants and the specificity was 97.9% for Filipina participants and 93.8% for Indonesian participants for overweight or obesity. When self-reported measures were used, the receiver operator characteristic (ROC) curves and the corresponding area under the curve (AUC) indicated optimal cut-off points of 22.0 kg/m2 and 22.3 kg/m2 for Filipina and female Indonesian participants for overweight or obesity.

CONCLUSIONS

Although BMI derived from self-reported height and weight allows for quick and low-cost obesity screening, a considerable underestimation of overweight or obesity prevalence was observed in Filipina and female Indonesian migrant domestic workers in Macao (Special Administrative Region, SAR), China. With the best compromise between sensitivity and specificity, the new cut-off points can be used in future studies to identify overweight or obesity in these two populations using self-reported height and weight.

Body mass index and mortality among middle-aged Japanese individuals with diagnosed diabetes: The Japan Public Health Center-based prospective study (JPHC study)

AIM

To examine the association between body mass index (BMI) and mortality among middle-aged people with diabetes in Japan.

METHODS

A total of 3032 men and 1615 women, aged 40-69 years, with diabetes were analyzed. Cox proportional hazards models, adjusted for potential confounding factors, were used to estimate mortality hazard ratios (HRs) across BMI categories at the baseline.

RESULTS

There were 1761 deaths during a mean follow-up period of 18.5 years. Increased all-cause mortality was observed at both ends of the BMI distribution; compared with the reference BMI category (23.0-24.9 kg/m²), the HRs were 1.25 (95% confidence interval [CI], 0.9997-1.56) in the lowest (14.0-18.9 kg/m²) and 1.36 (95% CI, 1.06-1.74) in the highest (30.0-39.9 kg/m²) categories (P = 0.001). Similar all-cause mortality trends were observed after excluding deaths within 3 years of follow-up, as well as for men and men who had ever smoked. While a similar non-linear pattern was observed for cancer-specific mortality, heart disease-specific mortality was only increased in the highest BMI category (HR, 1.86; 95% CI, 1.06-3.25).

CONCLUSION

This population-based prospective study demonstrated increased all-cause mortality at both ends of the BMI distribution among Japanese people with diabetes.

Gender differences and occupational factors for the risk of obesity in the Italian working population

BACKGROUND

Obesity is a multifactorial condition and a major risk factor associated with several non-communicable diseases, such as cardiovascular disease, and with a higher risk of premature death and disability. Sex-specific factors have key roles and must be taken into consideration in studying occupational factors associated with the risk of obesity. The aim of this study was to investigate gender differences in body mass index (BMI) in a large cohort representative of Italian workers and, correlating this index with several demographic and occupational variables, to verify sex- and work-dependent differences in the risk of obesity.

METHODS

We utilized data from INSuLa, a cross-sectional, nationally representative survey of the Italian worker population conducted in 2013 by the Italian Workers' Compensation Authority to investigate health and safety at work. Analyses were run on a sample of 8000 Italian workers, aged from 16 to 64 years. Logistic regression models were employed to assess gender differences in the relation between occupational characteristics and BMI. We adjusted for age, education, variables related to health protection at work, and chronic conditions and diseases.

RESULTS

There were several significant differences in the BMI between males and females, linked to some occupational factors. For instance, female shift workers were 1.32 times (95% CI 1.11-1.57) more likely to be overweight or obese than normal-weight workers, and this association was maintained when controlling for confounders. The likelihood of overweight or obesity among women who worked 1-2 night shifts per week was significantly higher - 1.5-1.6 times - than those on day shifts.

CONCLUSIONS

Gender-specific differences in occupational factors associated with the risk of obesity are useful with a view to characterizing this risk and helping identify workplace-targeted intervention strategies.

The associations of specific school- and individual-level characteristics with obesity among primary school children in Beijing, China

OBJECTIVE

We aimed to investigate the associations between school-level characteristics and obesity among Chinese primary school children with consideration of individual-level characteristics.

DESIGN

This cross-sectional study was conducted in 2015/2016. School-level characteristics were assessed using an interviewer-administered school questionnaire, and a 'school-based obesity prevention index' was further developed. Individual-level characteristics were collected by self-administered questionnaires. Objectively measured height and weight of students were collected, and obesity status was classified according to the International Obesity Task Force criteria for Asian children. Generalised linear mixed models were used to estimate the associations among the school- and individual-level characteristics and obesity of students.

SETTING

Thirty-seven primary schools from an urban and a rural district of Beijing, China.

PARTICIPANTS

School staffs, 2201 students and their parents.

RESULTS

The school-based obesity prevention index involved the number of health professionals, availability of students' health records, monitoring students' nutrition status, frequency of health education activities, reporting achievements of obesity prevention activities to parents, duration of physical activity during school time and availability of playground equipment. The prevalence of obesity was lower in schools with the higher index value compared with that in schools with the lower index value (OR 0·56; 95 % CI 0·40, 0·79). Some individual-level characteristics were negatively associated with childhood obesity: liking sports, duration of screen time ≤2 h/d, perceived lower eating speed, parental non-overweight/obesity.

CONCLUSIONS

Irrespective of individual-level characteristics, the specific school-level characteristics had a cumulative effect on obesity among Chinese primary school children. Further school-based obesity intervention should consider these characteristics simultaneously.

Association between Food Preferences, Eating Behaviors and Socio-Demographic Factors, Physical Activity among Children and Adolescents: A Cross-Sectional Study

The prevalence of overweight and obesity is a serious health issue among children and adolescents worldwide. This study aimed to investigate factors influencing weight status-associated food preferences and eating behaviors. A cross-sectional study was conducted to collect data from 2578 pairs of Chinese children and parents in five cities from December 2018 to March 2019. There was an increase in consumptions of processed seafood, nuts and dried fruit/vegetables, and fruit/vegetable juice, but a reduction of consuming puffed and processed meat products, sugar/artificially sweetened beverages and milk tea, and picky eating. These food preferences differentiate between sexes. Picky eating behavior was greatly presented in children of lower educated mothers or heavy-smoking fathers. Children of the lower educated fathers consumed less processed seafood and dairy products, and those of the heavy-smoking fathers consumed more puffed products, but less fruit/vegetable juice, and had greater snack preference. The father’s body mass index(BMI)status was also positively associated with unhealthy behaviors. Those who exercised daily longer showed better eating behaviors, and picky eating and fast-food lovers likely occurred in higher-income families. Our study provides an insight into that fathers being educated for health-conscious advice and physical activity may be the potential strategies to foster their children’s healthy eating patterns. Their efficacy needs to be further investigated.

Adiposity, Weight Change, and Risk of Cognitive Impairment: The Singapore Chinese Health Study

BACKGROUND

Few prospective studies with long duration of follow-up have assessed the relations of body mass index (BMI) and weight change with cognitive function, especially in Asian populations.

OBJECTIVE

To investigate whether BMI and weight change in midlife are associated with cognitive impairment in old age.

METHODS

We used data from 14,691 participants in the Singapore Chinese Health Study and computed weight change as the difference between weight reported at baseline (1993-1998) at mean age of 53.0 years and follow-up 1 (1999-2004) at mean age of 58.6 years. Cognitive impairment was determined using education-specific cut-offs of the Singapore Modified Mini-Mental State Examination at follow-up 3 (2014-2016) at mean age of 72.9 years. We used multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations.

RESULTS

Obesity (as defined BMI ≥27.5 kg/m2) was associated with a higher risk of cognitive impairment at baseline (OR 1.33, 95% CI 1.12-1.58) and follow-up 1 (OR 1.30, 95% CI 1.10-1.54) compared to BMI of 18.5-22.9 kg/m2. Underweight (BMI <18.5 kg/m2) was not associated with a significant risk either at baseline (OR 0.91, 95% CI 0.73-1.13) or follow-up 1 (OR 1.05, 95% CI 0.85-1.28). Compared to participants with <5% weight change, the ORs (95% CIs) of cognitive impairment were 1.20 (1.03-1.41) for those with 5-9.9% weight loss, 1.53 (1.29-1.81) for ≥10% weight loss, 1.00 (0.85-1.17) for 5-9.9% weight gain, and 1.50 (1.28-1.75) for ≥10% weight gain.

CONCLUSION

Obesity, weight loss, and excessive weight gain at midlife were associated with an increased risk of cognitive impairment at old age.

Periodontal status and self-reported systemic health of periodontal patients regularly visiting dental clinics in the 8020 Promotion Foundation Study of Japanese Dental Patients

This nationwide cross-sectional survey investigated the association between periodontal disease and self-reported systemic health in periodontal patients who regularly visited private dental clinics in Japan. Data from 999 patients of 444 dental clinics were analyzed; the patients were aged 40 years or older, regularly visited dentists, and had diagnosed periodontal disease (defined as two or more teeth with a clinical attachment level ≥6 mm). Medical history was collected with a self-reported questionnaire. Number of teeth with a probing pocket depth (PPD) ≥5 mm was used to define periodontal status, and the highest quartile was used as the dependent variable. A Poisson regression model showed that histories of diabetes and hypertension were associated with a larger number of teeth with a PPD ≥5 mm (diabetes: prevalence rate ratio [PRR] 1.36, 95% confidence interval [CI] 1.00-1.85; hypertension: PRR 1.27, 95% CI 1.02-1.58) after adjusting for potential periodontal risk factors. These findings suggest that diabetes and hypertension are associated with worse periodontal disease. Dentists should confirm the diabetes and hypertension status of patients who receive maintenance care, because these conditions could affect periodontal management of patients.

Examining validity of body mass index calculated using height and weight data from the US driver license

BACKGROUND

Driver license departments in many US states collect data on individuals' height and weight. These data can be useful to researchers in epidemiological and public health studies. As height and weight on driver license are self-reported, they may be prone to reporting bias. We compare height and weight obtained from driver license records and clinically measured height and weight, as well as body mass index (BMI) values calculated using the two data sources for the same individual.

METHODS

We linked individual height and weight records obtained from the Driver License Division (DLD) in the Utah Department of Public Safety to clinical records from one of the largest healthcare providers in the state of Utah. We then calculated average differences between height, weight and BMI values separately for women and men in the sample, as well as discrepancies between the two sets of measures by age and BMI category. We examined how well self-reported height and weight from the driver licenses classify individuals into specific BMI categories based on clinical measures. Finally, we used two sets of BMI values to estimate individuals' relative risk of type II diabetes.

RESULTS

Individuals, on average, tend to overestimate their height and underestimate their weight. Consequently, the value of BMI calculated using driver license records is lower than BMI calculated using clinical measurements. The discrepancy varies by age and by BMI category. Despite the discrepancy, BMI based on self-reported height and weight allows for accurate categorization of individuals at the higher end of the BMI scale, such as the obese. When used as predictors of relative risk of type II diabetes, both sets of BMI values yield similar risk estimates.

CONCLUSIONS

Data on height and weight from driver license data can be a useful asset for monitoring population health in states where such information is collected, despite the degree of misreporting associated with self-report.

Body Mass Index and Risks of Incident Ischemic Stroke Subtypes: The Japan Public Health Center-Based Prospective (JPHC) Study

BACKGROUND

The association of body mass index (BMI) with risks of ischemic stroke subtypes have not been established.

METHODS

Cumulative average BMI was calculated using self-reported body weight and height obtained from baseline (Cohort I in 1990, and Cohort II from 1993-1994) and 5- and 10-year questionnaire surveys of Japan Public Health Center-based prospective (JPHC) study. A total of 42,343 men and 46,413 women aged 40-69 years were followed-up for the incidence of lacunar, large-artery occlusive, and cardioembolic strokes. A sub-distribution hazard model was used to estimate sub-distribution hazard ratios (SHRs) and the 95% confidence intervals (CIs).

RESULTS

During a median of 20.0 years of follow-up, we documented 809 and 481 lacunar, 395 and 218 large-artery occlusive, and 568 and 298 cardioembolic strokes in men and women, respectively. After adjustment for baseline age, updated smoking, alcohol consumption, leisure-time physical activity, and histories of hypertension, dyslipidemia, and diabetes mellitus, cumulative average BMI was positively linearly associated with lacunar (trend P = 0.007), large-artery occlusive (trend P = 0.002), and cardioembolic (trend P < 0.001) strokes in men, and with lacunar (trend P < 0.001) and large-artery occlusive (trend P = 0.003) strokes in women. There were approximately two-fold excess risk of cardioembolic stroke in both sexes and of lacunar and large-artery occlusive strokes in women for cumulative average BMI ≥30 kg/m² compared to BMI 23-<25 kg/m².

CONCLUSION

Cumulative average BMI showed a positive linear effect on sub-distribution hazards of lacunar, large-artery occlusive, and cardioembolic strokes in both sexes, except for cardioembolic stroke in women.

Accuracy of self-reported heights and weights in a predominately low-income, diverse population living in the USA

OBJECTIVES

This study explored the accuracy of self-reported heights and weights and factors associated with self-reported bias in a diverse American sample.

METHODS

Demographic, self-reported, and measured height and weight data from different studies with the same PI were compiled into one SPSS file and analyzed with paired t-tests to detect differences between self-reported and actual values. Kruskal-Wallis tests followed by pairwise t-tests detected differences among age, ethnicity, sex, income, and education. Stepwise regression analyses were done using anthropometric differences as the dependent variable and age category, sex, and ethnicity as independent variables to explore which variable was most predictive of anthropometric differences.

RESULTS

Individuals over-reported height and under-reported weight leading to an under-calculated BMI from self-reported height and weight by 0.6-1 kg/m² . These under-calculations of BMI led to misclassifications of obesity by 3, 6, 8, and 4% for African American, Euro-American, Native American women, and total women, and by 5, 6, 8, and 8% by African American, Euro-American, Native American men, and total men. Older individuals and males over-reported height more than younger individuals and females. African American females over-reported height to a lesser extent than other ethnicities. Asian males over-reported height to a lesser extent than other ethnicities.

CONCLUSIONS

Self-reported heights and weights lead to invalid results. Most individuals over-report height and under-report weight, resulting in an inaccurate underweight and obesity prevalence. Being misclassified into the incorrect BMI category could result in inappropriate healthcare treatment. Age, ethnicity, and sex appear to influence the misreporting of height and weight.

Self-Reported vs. Measured Height, Weight, and BMI in Young Adults

Self-reported height and weight, if accurate, provide a simple and economical method to track changes in body weight over time. Literature suggests adults tend to under-report their own weight and that the gap between self-reported weight and actual weight increases with obesity. This study investigates the extent of discrepancy in self-reported height, weight, and subsequent Body Mass Index (BMI) versus actual measurements in young adults. Physically measured and self-reported height and weight were taken from 1562 students. Male students marginally overestimated height, while females were closer to target. Males, on average, closely self-reported weight. Self-reported anthropometrics remained statistically correlated to actual measures in both sexes. Categorical variables of calculated BMI from both self-reported and actual height and weight resulted in significant agreement for both sexes. Researcher measured BMI (via anthropometric height and weight) and sex were both found to have association with self-reported weight while only sex was related to height difference. Regression examining weight difference and BMI was significant, specifically with a negative slope indicating increased BMI led to increased underestimation of weight in both sexes. This study suggests self-reported anthropometric measurements in young adults can be used to calculate BMI for weight classification purposes. Further investigation is needed to better assess self-reported vs measured height and weight discrepancies across populations.

Thirteen-Year Trends in Dietary Patterns among Japanese Adults in the National Health and Nutrition Survey 2003⁻2015: Continuous Westernization of the Japanese Diet

We examined 13-year trends in dietary patterns, using data from the National Health and Nutrition Survey, Japan 2003–2015. In repeated, independent cross-sectional studies, dietary intake was assessed with a one-day weighed dietary record in 88,527 Japanese adults aged ≥20 years. Using principal component analysis based on the daily consumption of 31 food groups, we identified three dietary patterns, the “plant food and fish”, “bread and dairy”, and “animal food and oil” patterns. In the whole sample, the “plant food and fish” pattern score decreased while the “bread and dairy” and “animal food and oil” pattern scores increased. The decreasing trends in the “plant food and fish” pattern were observed in all subgroups considered. The increasing trends in the “bread and dairy” pattern were similar across sexes and by current smoking status. However, in terms of age, occupation, and weight status, the increasing trends were only evident in particular subgroups (i.e., age 50–64 and ≥65 years; security/transportation/labor occupation and nonworker; and normal weight and overweight participants). For the “animal food and oil” pattern, the increasing trends were observed in all subgroups, except for the youngest age group (20–34 years old). This study suggests continuous Westernization of the Japanese diet.

Gene-diet interaction effects on BMI levels in the Singapore Chinese population

BACKGROUND

Recent genome-wide association studies (GWAS) have identified 97 body-mass index (BMI) associated loci. We aimed to evaluate if dietary intake modifies BMI associations at these loci in the Singapore Chinese population.

METHODS

We utilized GWAS information from six data subsets from two adult Chinese population (N = 7817). Seventy-eight genotyped or imputed index BMI single nucleotide polymorphisms (SNPs) that passed quality control procedures were available in all datasets. Alternative Healthy Eating Index (AHEI)-2010 score and ten nutrient variables were evaluated. Linear regression analyses between z score transformed BMI (Z-BMI) and dietary factors were performed. Interaction analyses were performed by introducing the interaction term (diet x SNP) in the same regression model. Analysis was carried out in each cohort individually and subsequently meta-analyzed using the inverse-variance weighted method. Analyses were also evaluated with a weighted gene-risk score (wGRS) contructed by BMI index SNPs from recent large-scale GWAS studies.

RESULTS

Nominal associations between Z-BMI and AHEI-2010 and some dietary factors were identified (P = 0.047-0.010). The BMI wGRS was robustly associated with Z-BMI (P = 1.55 × 10^- 15) but not with any dietary variables. Dietary variables did not significantly interact with the wGRS to modify BMI associations. When interaction analyses were repeated using individual SNPs, a significant association between cholesterol intake and rs4740619 (CCDC171) was identified (β = 0.077, adjP_interaction = 0.043).

CONCLUSIONS

The CCDC171 gene locus may interact with cholesterol intake to increase BMI in the Singaporean Chinese population, however most known obesity risk loci were not associated with dietary intake and did not interact with diet to modify BMI levels.

Accuracy of self-reported height, weight and waist circumference in a Japanese sample

Objective

Inconsistent results have been found in prior studies investigating the accuracy of self‐reported waist circumference, and no study has investigated the validity of self‐reported waist circumference among Japanese individuals. This study used the diagnostic standard of metabolic syndrome to assess the accuracy of individual's self‐reported height, weight and waist circumference in a Japanese sample.

Methods

Study participants included 7,443 Japanese men and women aged 35–79 years. They participated in a cohort study's baseline survey between 2007 and 2011. Participants' height, weight and waist circumference were measured, and their body mass index was calculated. Self‐reported values were collected through a questionnaire before the examination.

Results

Strong correlations between measured and self‐reported values for height, weight and body mass index were detected. The correlation was lowest for waist circumference (men, 0.87; women, 0.73). Men significantly overestimated their waist circumference (mean difference, 0.8 cm), whereas women significantly underestimated theirs (mean difference, 5.1 cm). The sensitivity of self‐reported waist circumference using the cut‐off value of metabolic syndrome was 0.83 for men and 0.57 for women.

Conclusions

Due to systematic and random errors, the accuracy of self‐reported waist circumference was low. Therefore, waist circumference should be measured without relying on self‐reported values, particularly in the case of women.

Self-reported and measured weight, height and body mass index for the diagnosis of the nutritional status in people living with HIV/AIDS

ABSTRACT Objective To validate self-reported weight and height data for people living with HIV/AIDS. Methods This cross-sectional study involved 481 people living with HIV/AIDS seen at a reference unit in João Pessoa, state of Paraíba, Brazil, between September and December 2015, 99 (20.5%) of whom had their weight and height measured. The intraclass correlation coefficient was calculated to determine the relationship between the self-reported and measured weight, height and body mass index values, and linear regression analysis was used to generate equations to predict weight and height. It were significant p-value under 5% for statistic tests applied. Results In the sample with measured values, 57.6% of men, with a mean age of 44 years old and a mean income per capita equivalent to US$145.50, high correlations (r>0.90) between the self-reported and measured values for weight, height and body mass index were observed. The accuracy was 92.6%, and the Kappa coefficient was greater than 0.85. Women tended to underestimate weight and overestimate height. The men overestimated weight and underestimated height. The intraclass correlation coefficients were greater than 0.95. Conclusion The use of self-reported measures of weight, height and body mass index for nutritional assessment of people living with HIV/AIDS is valid and must be considered for similar populations when time and resources are limiting factors.

Male-Taller and Male-Not-Too-Tall Norms in Taiwan

This study proposed ordered probit models as a methodology to verify the male-taller norm and the male-not-too-tall norm while controlling for other factors. This study confirmed the prevalence of the male-taller and the male-not-too-tall norms in Taiwan. The frequency of the height difference between a husband and wife within the range of 5–15 cm was higher than what would be expected by chance. This range in Taiwan was smaller than the range in the United Kingdom, which may imply that there are preferred height differences between couples that vary across populations.

The associations between lifestyles and mental health using the General Health Questionnaire 12-items are different dependently on age and sex: a population-based cross-sectional study in Kanazawa, Japan

OBJECTIVES

The aim of this study was to examine potential differences of the associations between mental health and lifestyle factors across a wide range of age.

METHODS

In August/September 2011, data were collected from 4693 males (age 51.6 ± 19.5) and 5678 females (age 52.4 ± 19.4) living in Kanazawa, Japan. A cross-sectional community-based survey was conducted with self-administered questionnaire including the General Health Questionnaire (GHQ) 12-item version, sociodemographic, and lifestyle factors. Associations between the GHQ scores and other variables were examined using two-way analysis of variance (ANOVA) followed by multiple comparisons and logistic regression stratified by age and gender.

RESULTS

Multiple comparisons indicated that people aged 20-39 or 40-64 had higher GHQ scores than older aged. The two-way ANOVA revealed significant interaction between body mass index and age group, and between exercise and age group. Overweight or underweight males aged 40-64 had poorer mental health than those at normal weight. In the elderly, being underweight was significantly associated with poor mental health. There were no significant effects of exercise on mental health for young adults. The logistic regression showed significant negative effects of short-time sleep in adults.

CONCLUSIONS

The associations between mental health and lifestyles differ across age groups. Further study is needed to reveal effects of aging on lifestyle and mental health with a longitudinal design.

Uso de medidas autorreferidas de peso e altura na determinação do estado nutricional de trabalhadores

RESUMO Objetivo Avaliar o uso de medidas autorreferidas de peso e altura na avaliação do estado nutricional de trabalhadores de um frigorífico do Sul do Brasil. Métodos Foi conduzido um estudo transversal, com 902 trabalhadores com idade entre 18 e 50 anos. As variáveis so-ciodemográficas, assim como peso e altura autorreferidos foram obtidos por um questionário pré-testado e padronizado. Posteriormente, foram aferidos peso e altura, calculado o índice de massa corporal e classificado o estado nutricional. Foi utilizada a estatística de Bland-Altman para determinar as diferenças médias e os limites de concordância entre medidas autorreferidas e aferidas. O percentual de concordância na classificação do estado nutricional foi avaliado de acordo com o sexo, idade e escolaridade dos trabalhadores. Resultados A diferença média da altura autorreferida, em relação à aferida, foi de 0,55 cm (limite inferior; limite superior: -7,41; 6,29) (p<0,001) e o do índice de massa corporal foi - 0,14 (limite inferior; limite superior: -2,72; 2,99) (p=0,005). Com relação ao diagnóstico nutricional, o excesso de peso foi subestimado em 12,4% entre as mulheres, 9,6% entre os mais velhos (³32 anos) e 7,2% entre os menos escolarizados. Conclusão A utilização de medidas autorreferidas para avaliação do estado nutricional em trabalhadores deve ser realizada com atenção, principalmente em indivíduos cujos relatos têm a tendência ao erro, como mulheres e trabalhadores com maior idade e menor escolaridade.

Associations between anthropometric factors and peripheral neuropathy defined by vibrotactile perception threshold among industrial vibrating tool operators in Japan

OBJECTIVES

The effect of anthropometric factors on the fingertip vibrotactile perception threshold (VPT) of industrial vibrating tool operators (IVTOs) is not well known. The purpose of this study was to investigate the associations between anthropometric factors and fingertip VPT.

METHODS

We included for analysis two groups of IVTOs: Group 1, predominantly forestry workers (n=325); and Group 2, public servants (n=68). These IVTOs regularly received medical examinations to evaluate hand-arm vibration syndrome. In the examination, measurements of their fingertip VPTs were taken before and after cold-water immersion (10 minutes at 10°C for Group 1 and 5 minutes at 12°C for Group 2). Their body height and weight were measured to calculate the body mass index (BMI). The presence of peripheral neuropathy (PN) was defined as a VPT ≥17.5 dB at 10 minutes after finishing immersion.

RESULTS

In the univariate analysis, weight and BMI were associated with a decreased risk of PN in both Groups 1 and 2. The negative association between BMI and PN remained in the multivariate analysis consistently, but weight reached marginal significance only in the multivariate analysis without BMI in both the groups. Age was positively associated with PN consistently in Group 1 but not in Group 2. Years exposed to vibration showed positive association with PN only in the univariate analysis of Group 1.

CONCLUSIONS

Among IVTOs, factors reflecting body heat production, such as weight and BMI, were associated with a decreased risk of VPT-defined PN, regardless of the task engaged.

Maternal Recall Versus Medical Records of Metabolic Conditions from the Prenatal Period: A Validation Study

To assess validity of maternally-reported diabetes and hypertensive disorders, and reliability of BMI measurements during periconception and pregnancy compared with medical records when mothers are interviewed 2-5 years after delivery. To investigate whether reporting accuracy differed by child's case status (autism, delays, typical development). Participants were mothers of 2-5 year old children with and without neurodevelopmental disorders from the CHARGE (CHildhood Autism Risks from Genetics and the Environment) Study who had both prenatal/delivery records and telephone interviews. Sensitivity and specificity of self-report in telephone interview was assessed by comparison with medical records; agreement was evaluated by kappa statistics. Deviations in reported BMI were evaluated with Bland-Altman plots and concordance correlation coefficient (CCC). Mothers of children with neurodevelopmental disorders (autism or developmental delay) reported metabolic conditions slightly more accurately than control mothers. For diabetes, sensitivity ranged from 73 to 87% and specificity was ≥98% across groups. For hypertensive disorders, sensitivity ranged from 57 to 77% and specificity from 93 to 98%. Reliability of BMI was high (CCC = 0.930); when grouped into BMI categories, a higher proportion of mothers of delayed children were correctly classified (κ(wt) = 0.93) compared with the autism group and controls (κ(wt) = 0.85 and κ(wt) = 0.84, respectively; P = 0.05). Multiparity was associated with higher discrepancies in BMI and misreporting of hypertensive disorders. For purposes of etiologic studies, self-reported diabetes and hypertensive disorders during periconception and pregnancy show high validity among mothers irrespective of child's case status. Recall of pre-pregnancy BMI is reliable compared with self-reported values in medical records.

Association between Parental Workaholism and Body Mass Index of Offspring: A Prospective Study among Japanese Dual Workers

The purpose of the study was to investigate the association between parental workaholism and child body mass index (BMI) among Japanese dual-income families. In 2011, 379 dual-income families from urban Tokyo with children aged 0-5 years were recruited for a baseline survey, and 160 (42.2%) were followed up in 2012. Demographics, workaholism, work demands, work control, time spent with children, and parental and child weights and heights were assessed using a questionnaire. Structural equation modeling was performed to determine the association between maternal and paternal workaholism in 2011 and child BMI in 2012, considering the mediating effects of time spent with children. Paternal workaholism showed a direct significant positive association with child BMI after 1 year (standardized coefficient: 0.19; p < 0.001), while maternal workaholism was not associated with child BMI. Both maternal and paternal time spent with children did not mediate the association. Paternal work demands showed a strong positive association with workaholism but paternal work control did not. Paternal, but not maternal, workaholism was associated with an increase in child BMI over 1 year. Interventions that target workaholism by reducing paternal work demands might be effective in preventing overweight in offspring.

Validity of Self-Reports of Height and Weight among the General Adult Population in Japan: Findings from National Household Surveys, 1986

Background/Objectives

Growing evidence indicates that self-reported height and weight are biased, but little is known about systematic errors in the general adult population in Japan. This study takes advantage of the unique opportunity to examine this issue provided by the 1986 National Nutrition Survey.

Subjects/Methods

Individual-level data on a nationally representative sample aged 20–89 years from the National Nutrition Survey (November 1986) were merged with Comprehensive Survey of Living Conditions (September 1986) data to obtain a dataset containing both self-reported and measured data on height and weight for each person (n = 10,469). Discrepancies between self-reported and measured means of height, weight, and body mass index (BMI) were tested across measured BMI categories (<18.5, 18.5–24.9, 25.0–27.4, 27.5–29.9, and ≥30.0 kg/m²), age groups (20–44, 45–64, and 65–89 years), and sexes. Reporting bias in mean BMI was decomposed into the contributions of misreporting height and weight. The sensitivity and specificity of self-reported BMI categories were estimated.

Results

Mean self-reported BMI was substantially underestimated in older women (P<0.001; Cohen’s d, -0.4), and the major contributor to the bias was their over-reported height. Mean self-reported BMI was also considerably underestimated in both men and women who were overweight and obese (P<0.001; Cohen’s d, -1.0 to -0.6), due mainly to their underreported weight. In contrast, mean self-reported BMI was considerably overestimated in underweight men (P<0.001; Cohen’s d, 0.5), due largely to their over-reported weight. The sensitivity of self-reported BMI categories was particularly low for individuals who had a measured BMI of 27.5–29.9 kg/m² (40.9% for men and 26.8% for women).

Conclusions

Self-reported anthropometric data were not sufficiently accurate to assert the validity of their use in epidemiological studies on the general adult population in Japan in the late 1980s.

Interactive Effects of Early Exclusive Breastfeeding and Pre-Pregnancy Maternal Weight Status on Young Children's BMI - A Chinese Birth Cohort

Objectives

To assess if the maternal pre-pregnancy weight status (MPWS) alters the association of early infant feeding pattern (at one and third months) with infant body mass index (BMI) in the first two years of life.

Methods

A cohort of 2,220 neonates were recruited in a community-based study conducted in China. Body weight and length were measured at birth, at age one and two, with BMI calculated accordingly. The BMI z-scores (BMI-Z) were computed according to the World Health Organization Growth Standard (2006). Feeding patterns were classified as exclusive breastfeeding (EBF), mixed feeding (MF), and formula feeding (FF). General linear models (GLM) were employed to estimate main and interaction effects of EBF and MPWS on children’s BMI-Z.

Results

No main effect of MPWS was found on child BMI-Z at ages one and two, nor the feeding patterns. An interaction between MPWS and feeding patterns was detected (p<0.05). For children who were formula fed during the first month, those who were born to overweight/obesity (OW/OB) mothers had a significantly greater BMI-Z at ages one and two, compared with those with underweight/normal weight (UW/NW) mothers. FF children had greater BMI-Z at ages one and two compared with their EBF and MF counterparts, when they were born to OW/OB mothers.

Conclusions

Maternal pre-pregnancy weight control and early initiation of EBF for children are essential for healthy development in children’s BMI, hence the prevention of early life obesity.

Determinant factors of the difference between self-reported weight and measured weight among Japanese

OBJECTIVES

To assess the difference between self-reported and measured weight values in Japanese men and women and to determine the underlying determinants of the differences between self-reported and measured values.

METHODS

The data were collected from 363 general Japanese individuals aged 16-88 years living in Kumamoto prefecture. Participants completed a self-administered questionnaire designed for this study with self-reported weight and height values. Measured weight and height were measured immediately after questionnaire completion. Paired t-tests identified differences between self-reported and measured values by sex. Multiple-stepwise regression analysis examined the independent variables' effects on the differences between self-reported and measured weights.

RESULTS

Significant differences were found between self-reported and measured values for both sexes (p < 0.001). There was a significant negative relationship between the difference in an individual's self-reported and measured weight in each sex, with higher measured weight individuals more likely to underestimate their weight. Multiple-stepwise regression analysis models explained 12.1 % (p < 0.01), 11.3 % (p < 0.01), and 5.6 % (p < 0.01) of the variance in all participants, men, and women, respectively. Significant effects were found for age, weight measurement frequency, and measured weight in total participants, weight measurement frequency, and measured weight for men, and age for women.

CONCLUSIONS

In this study, the mean absolute value of the weight and height variances proved the unreliability of self-reported weight and height values. This study's findings suggest self-reported weight inaccuracy especially for obese populations. This should be adjusted when using it in epidemiological studies and healthcare planning.

Association between body mass index and risk of total knee replacement, the Singapore Chinese Health Study

PURPOSE

Data on the association between body mass index (BMI) and risk of knee osteoarthritis (KOA) are sparse for Asian populations who are leaner than Western populations. We evaluated the association between BMI and risk of total knee replacement (TKR) due to severe KOA among Chinese in Singapore.

METHODS

We used data from the Singapore Chinese Health Study (SCHS), a population-based prospective cohort of 63,257 Chinese men and women, aged 45-74 years at enrollment from 1993 to 1998. Information on height, weight, diet and lifestyle factors were obtained via in-person interviews. TKR cases for severe KOA were identified via linkage with the nationwide hospital discharge database through 2011. Cox regression and weighted least squares regression were used in the analysis.

RESULTS

The mean BMI among cohort participants was 23.1 kg/m(2), and more than two-thirds had BMI below 25 kg/m(2). A total of 1649 had TKR attributable to severe KOA. Risk of TKR increased in a strong dose-dependent manner with increasing BMI throughout the 15-32 kg/m(2) range and became less clear at BMI >32 kg/m(2). In the BMI range 16-27 kg/m(2), there was a 27% increase in TKR risk for each unit increase in BMI (P for trend < 0.001). Compared to BMI 19-20 kg/m(2), the risk estimates of TKR were all statistically significant with increasing unit of BMI ≥21 kg/m(2). Results were similar for men and women.

CONCLUSION

Our results provided evidence for a constant mechanical mechanism underlying BMI and KOA initiation and/or progression.

Alcohol Consumption and the Risk for Developing Pancreatitis: A Case-Control Study in Japan

OBJECTIVE

This study aimed to estimate the association of alcohol consumption and pancreatitis in Japan.

METHODS

We performed a nationwide case-control study, which included 982 patients (574 patients with acute pancreatitis and 408 patients with chronic pancreatitis) and 1015 controls who were individually matched for sex, age, hospital, and time of their first hospital visit. Conditional logistic regression was used to assess the association of alcohol consumption and smoking with pancreatitis.

RESULTS

The patients had a mean (SD) age of 57.6 (17.0) years; 71.8% were male. Compared with nondrinkers, alcohol consumption of less than 20 g/d was not associated with the risk for total pancreatitis (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.7-1.4). In patients with acute pancreatitis, the ORs (95% CI) for alcohol consumption of 20 ≤ ∼ < 40 g/d, 40 ≤ ∼ < 60 g/d, 60 ≤ ∼ < 80 g/d, 80 ≤ ∼ < 100 g/d, and 100 g/d or greater were 1.7 (0.9-3.0), 3.1 (1.6-5.9), 4.2 (2.1-8.2), 5.3 (2.4-12.0), and 6.4 (3.4-12.4), respectively. In patients with chronic pancreatitis, the ORs (95% CI) for alcohol consumption of 20 ≤ ∼ < 40 g/d, 40 ≤ ∼ < 60 g/d, 60 ≤ ∼ < 80 g/d, 80 ≤ ∼ < 100 g/d, and 100 g/d or greater were 2.6 (1.2-5.5), 3.2 (1.5-7.1), 9.2 (4.1-20.3), 13.0 (5.3-31.6), and 19.6 (8.2-46.8), respectively.

CONCLUSIONS

Our study precisely measured the quantitative effect of alcohol on the risk for developing pancreatitis.

Glycated hemoglobin and all-cause and cause-specific mortality in Singaporean Chinese without diagnosed diabetes: the Singapore Chinese Health Study

OBJECTIVE

Glycated hemoglobin (HbA₁c) is a robust biomarker of the preceding 2 to 3 months average blood glucose level. The aim of this study was to examine the association between HbA₁c and mortality in a cohort of Southeast Asians.

RESEARCH DESIGN AND METHODS

Analysis of 7,388 men and women, mean age 62 years, from the Singapore Chinese Health Study who provided a blood sample at the follow-up I visit (1999-2004) and reported no history of diabetes, previous adverse cardiovascular events, or cancer. A total of 888 deaths were identified through 31 December 2011 via registry linkage. Participants represented a random study sample of potential control subjects for a nested case-control genome-wide association study of type 2 diabetes in the population. Hazard ratios (HRs) for all-cause and cause-specific mortality by six categories of HbA1c were estimated with Cox regression models.

RESULTS

Relative to participants with an HbA₁c of 5.4-5.6% (36-38 mmol/mol), participants with HbA₁c ≥6.5% (≥48 mmol/mol) had an increased risk of all-cause, cardiovascular, and cancer mortality during an average of 10.1 years of follow-up; HRs (95% CIs) were 1.96 (1.56-2.46), 2.63 (1.77-3.90), and 1.51 (1.04-2.18), respectively. No level of HbA1c was associated with increased risk of respiratory mortality. Levels <6.5% HbA₁c were not associated with mortality during follow-up. The results did not materially change after excluding observation of first 3 years post-blood draw.

CONCLUSIONS

HbA₁c levels consistent with undiagnosed type 2 diabetes (≥6.5%) are associated with an increased risk of all-cause and cause-specific mortality in Chinese men and women.