Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population

Abdominal aortic aneurysm growth rates are not correlated to body surface area in screened men

BACKGROUND

Screening for abdominal aortic aneurysm (AAA) in 65-year-old males reduces aneurysm related mortality. Infrarenal aortic diameter (IAD) has been shown to correlate to body surface area (BSA) which could influence diagnostic criteria for AAA. This study investigates whether AAA growth rates are also dependent on BSA, as that might have potential effects on surveillance of small AAAs.

METHODS

We conducted a retrospective, single center cohort study of 301 men with screening detected AAA between 2010-2017 with surveillance to 2021. AAA growth rates were analyzed in relation to the subject's BSA, smoking habits, and diabetic disease using a linear mixed-effects model. All men were offered smoking cessation program, optimized medical treatment, and advice on physical activity.

RESULTS

The screening program included 28,784 men. Of the 22,819 (79%) attending the examinations, 374 men (1.6%) were found to have an AAA out of which 301 men had undergone two or more examinations during surveillance and were included with a median follow-up of 1846 days (IQR: 1 399). Mean unadjusted AAA growth rate was 1.60 mm/year (95% CI: 1.41-1.80). Diabetes mellitus had a statistically significant negative impact, smoking had a statistically significant positive impact on AAA growth rates whereas no correlation between AAA growth rate and BSA could be found.

CONCLUSIONS

Body surface area could not be found to have a statistically significant correlation to AAA growth rates. The impact of smoking and diabetes on AAA growth rates remains similar to previously reported.

Food Sales and Adult Weight Status: Results of a Cross-Sectional Study in England

Ecological studies often use supermarket location as a proxy measure of the food environment. In this study, we used data on sales at a leading mainstream supermarket chain to explore how area-level supermarket use is associated with overweight and obesity in English adults. Sales data were aggregated to local authority level and joined to a national dataset describing self-reported height and weight and fruit and vegetable consumption. Regression models showed a modest association between higher levels of unhealthy food sales relative to health food sales and increased odds of being overweight and obese. Although effect sizes were small, they persisted after adjustment for area-level deprivation. Supermarket sales data provide additional understanding in the study of food environments and their impact on increasing weight status. Future health policies should consider using ‘big data’ combined with other research methods to address the increasing consumption of unhealthy and highly processed foods.

The usage of different types of food outlets was not significantly associated with body mass index during the third COVID‐19 national lockdown in the United Kingdom

Background

The United Kingdom (UK) implemented several national lockdowns during the coronavirus pandemic during which restaurants were closed and people were advised to stay at home if possible. These restrictions were eased and reapplied multiple times between March 2020 and May 2021. The change in restaurant access and prolonged restriction of activity may have an impact on body weight.

Aim

The aim of this study was to examine the impact of multiple lockdowns on body mass index (BMI) change from pre‐pandemic till during the third lockdown and on the use of different types of food outlets and their association with BMI change.

Materials and Method

Surveys of usage of different types of food outlets were distributed online before the lockdown between 06 January and 12 December 2019 and during the third national lockdown between 29 March and 25 April 2021. The food outlet usage surveys were filled out for seven consecutive days. Self‐reported BMI was reported before the pandemic and during the third phase of the lockdown. The total number of individuals who started the study before the pandemic was 681, and 60 participants completed the surveys during the third phase of lockdown.

Results

For the 60 participants in both surveys mean BMI was significantly higher during the third lockdown (28.6 ± 5.9 kg.m²) in comparison with the mean BMI before the pandemic 2019 (28.0 ± 5.5 kg.m²) (paired T = 3.09, p < 0.003). There was a significant positive association between BMI change, total number of days spent in lockdown (β = 0.05, p < 0.01, R² = 9.99), and age (β = 0.06, p < 0.007, R² = 11.8). There was no significant association between change in BMI and change in the frequency of using fast food restaurants (FFRs), full‐service restaurants (FSRs), and delivery and takeaways.

Conclusion

BMI was increased significantly during the lockdown in comparison with prior to the pandemic. Individuals gained more weight the longer they stayed at home during lockdowns, and physical activity was reduced to approximately half. However, the BMI change was not related to the change in use of different types of food outlets. This pattern does not support the widespread belief that visiting restaurants or using delivery and takeaway services has a significant impact on body weight.

Dietary intake patterns, nutrient adequacy and associated factors in a multi-ethnic Caribbean population

Background: Diet is a significant contributor to health and wellbeing of individuals. Aim: In this study we investigated patterns of dietary intakes, levels of nutrient inadequacies and associated sociodemographic, anthropometric and lifestyle factors among adults in Trinidad and Tobago. Method: The study was cross-sectional in nature. A convenience sample of 11783 persons from districts throughout Trinidad and Tobago completed a self-administered questionnaire comprising socio-demographic and lifestyle items. Anthropometry was self-reported with 15% of participants having measurements done according to recommended procedures. Dietary patterns were determined by principal component analysis (PCA) while nutrient intakes and adequacy were assessed using the NutriGenie 7.0 software and nutrient adequacy ratio (MAR) respectively. Foods were categorised as unprocessed/minimally processed and processed/ultra-processed. The University of The West Indies Ethics Committee approved the study. Results: Approximately 72.5% of participants met the Goldberg criteria for plausible reporting. The three predominant dietary patterns 'Typical', 'Fruits and Vegetables', and 'High Fat' explained 45% of the total variance in foods consumed. Processed/ultra-processed foods accounted for most of the energy (80%) and nutrients consumed. Nutrient inadequacies were observed for potassium, vitamins B₁₂, D, E, K, fibre, magnesium; and iron among females. The mean adequacy ratio (MAR) for participants was 67%. MAR was positively associated with predominant dietary patterns independent of socioe demographic and lifestyle factors (p < 0.001). Conclusion: Irrespective of their nature, the predominant dietary pattern was associated with nutrient adequacy among participants. Reducing the risk of inadequate nutrient intakes may be addressed by increasing availability, access and consumption of appropriate sources of these micronutrients.

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

Traditional and Novel Adiposity Indicators and Pancreatic Cancer Risk: Findings from the UK Women's Cohort Study

(1) Background: We studied the association of both conventional (BMI, waist and hip circumference and waist-hip ratio) and novel (UK clothing sizes) obesity indices with pancreatic cancer risk in the UK women's cohort study (UKWCS). (2) Methods: The UKWCS recruited 35,792 women from England, Wales and Scotland from 1995 to 1998. Cancer diagnosis and death information were obtained from the National Health Service (NHS) Central Register. Cox's proportional hazards regression was used to evaluate the association between baseline obesity indicators and pancreatic cancer risk. (3) Results: This analysis included 35,364 participants with a median follow-up of 19.3 years. During the 654,566 person-years follow up, there were 136 incident pancreatic cancer cases. After adjustments for age, smoking, education and physical activity, each centimetre increase in hip circumference (HR: 1.03, 95% CI: 1.01-1.05, p = 0.009) and each size increase in skirt size (HR: 1.12, 95% CI: 1.02-1.23, p = 0.041) at baseline increased pancreatic cancer risk. Baseline BMI became a significant predictor of pancreatic cancer risk (HR: 1.04, 95% CI: 1.00-1.08, p = 0.050) when latent pancreatic cancer cases were removed. Only baseline hip circumference was associated with pancreatic cancer risk (HR: 1.03, 95% CI: 1.00-1.05, p = 0.017) when participants with diabetes at baseline were excluded to control for reverse causality. (4) Conclusion: Hip circumference and skirt size were significant predictors of pancreatic cancer risk in the primary analysis. Thus, hip circumference is useful to assess body shape relationships. Additionally, standard skirt sizes offer an economical and objective alternative to conventional obesity indices for evaluating pancreatic cancer risk in women.

The impact of the novel coronavirus movement restrictions in the United Kingdom on food outlet usage and body mass index

Background

Many countries have implemented various levels of lockdown to mitigate the spread of the global SARS‐CoV‐2 pandemic. In the United Kingdom, the national lockdown restrictions were implemented between 26 March 2020 and 4 July 2020. These restrictions required all restaurants to close except for takeaway and delivery services. Moreover, individuals were instructed to largely stay in their homes, unless they were identified as essential workers, and to only leave home once per day for exercise. These restrictions might have an impact on energy intake and expenditure, thereby affecting their body weight.

Aims

The aim of this study was to investigate the impact of the movement restrictions in the United Kingdom on food outlet usage and body mass index (BMI).

Materials and Methods

Food outlet usage surveys were filled out for 7 consecutive days before and during the lockdown. Changes in BMI and food outlet usage before and during the lockdown were measured. A total of 206 participants were included in this study.

Results

The mean overall BMI prior to lockdown was 25.8 ± 5.2 kg·m², and during the lockdown, it was 25.9 ± 5.3 kg·m² (t= 0.19, p= 0.85). Restaurant usage fell to zero as all establishments were closed. There was a corresponding increase in the use of delivery services to 1.18 ± 0.13 times per week, compared to 0.50 ± 0.05 prior to lockdown (t= 4.44, p< 0.0001). No significant difference in the number of takeaway meals ordered was observed (0.67 ± 0.06 before the lockdown and 0.74 ± 0.12 times per week during the lockdown; t= 0.52, p = 0.60). There was no significant relationship between change in use of fast‐food restaurants and full‐service restaurants and the change in BMI, either alone or in combination (β = −0.012, p = 0.62, R² = 0.11%).

Discussion

Despite the large changes in behavior, there was no overall adverse effect of the lockdown with respect to obesity levels.

Conclusion

Lockdown in the United Kingdom modified restaurant use but had no effect on obesity levels.

A longitudinal study investigating change in BMI z-score in primary school-aged children and the association of child BMI z-score with parent BMI

Background

This paper aims to explore change in BMI z-score through childhood and the association between parent BMI and child BMI z-score. This is important to understand for the development of effective obesity interventions.

Methods

Data from the longitudinal B-ProAct1v study (1837 participants) were analysed. A paired sample t-test examined changes in child BMI z-score between Year 1 and 4. Multivariable linear regression models examined the cross-sectional associations between child BMI z-score and parent BMI in Year 1 and 4. The influence of change in parental BMI between Year 1 and Year 4 on child BMI z-score in Year 4 was explored through regression analyses, adjusted for baseline BMI z-score.

Results

There was a strong association between child BMI z-score at Year 1 and 4. Child mean BMI z-score score increased from 0.198 to 0.330 (p = < 0.005) between these timepoints. For every unit increase in parent BMI, there was an increase in child BMI z-score of 0.047 in Year 1 (p = < 0.005) and of 0.059 in Year 4 (p = < 0.005). Parental BMI change was not significantly associated with Year 4 child BMI z-score.

Conclusion

The key indicator of higher child BMI at Year 4 is high BMI at Year 1. Further studies are needed to explore the impact of parental weight change on child BMI z-score and whether interventions targeted at overweight or obese parents, can improve their child’s BMI z-score.

A health inequality impact assessment from reduction in overweight and obesity

Background

In recent years, social differences in overweight and obesity (OWOB) have become more pronounced. Health impact assessments provide population-level scenario evaluations of changes in disease prevalence and risk factors. The objective of this study was to simulate the health effects of reducing the prevalence of overweight and obesity in populations with short and medium education.

Methods

The DYNAMO-HIA tool was used to conduct a health inequality impact assessment of the future reduced disease prevalence (ischemic heart disease (IHD), diabetes, stroke, and multi-morbidity) and changes in life expectancy for the 2040-population of Copenhagen, Denmark (n = 742,130). We simulated an equalized weight scenario where the prevalence of OWOB in the population with short and medium education was reduced to the levels of the population with long education.

Results

A higher proportion of the population with short and medium education were OWOB relative to the population with long education. They also had a higher prevalence of cardiometabolic diseases. In the equalized weight scenario, the prevalence of diabetes in the population with short education was reduced by 8–10% for men and 12–13% for women. Life expectancy increased by one year among women with short education. Only small changes in prevalence and life expectancy related to stroke and IHD were observed.

Conclusion

Reducing the prevalence of OWOB in populations with short and medium education will reduce the future prevalence of cardiometabolic diseases, increase life expectancy, and reduce the social inequality in health. These simulations serve as reference points for public health debates.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09831-x.

Frequency of Restaurant, Delivery and Takeaway Usage Is Not Related to BMI among Adults in Scotland

BACKGROUND

The frequency of visits to restaurants has been suggested to contribute to the pandemic of obesity. However, few studies have examined how individual use of these restaurants is related to Body Mass Index (BMI).

AIM

To investigate the association between the usage of different types of food outlets and BMI among adults in Scotland.

METHOD

The study was cross-sectional. Participants completed an online survey for seven consecutive days where all food purchased at food outlets was reported each day. We explored the relationship between BMI and usage of these food outlets.

RESULTS

The total number of participants that completed the survey was 681. The BMI of both males and females was not related to frequency of use of Full-Service Restaurants (FSRs), Fast-Food Restaurants (FFRs), delivery or takeaways, when assessed individually or combined (TFOs = total food outlets).

CONCLUSION

These cross-sectional data do not support the widespread belief that consumption of food out of the home at fast-food and full-service restaurants, combined with that derived from deliveries and takeaways, is a major driver of obesity in Scotland.

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.

Estimating the proportion of overweight soldiers in the Australian Army by combat uniform waist size

INTRODUCTION

Recent studies have shown an increasing number of overweight and obese members serving in many armies. Overweight and obesity can be estimated using either body mass index or waist circumference measures. The aim of this research was to estimate the proportion of the Australian Army considered to be overweight and obese by waist circumference using the proxy measure of issued combat uniform waist size.

METHOD

The Australian Army has been progressively replacing combat uniforms with a new uniform design and camouflage pattern since 2016. The total number of issued combat uniforms by size was obtained from the points of issue for the three Australian Army combat brigades from the first issue of the new uniform in January 2016 through to November 2019. The waist size of issued combat pants was collated from each of the three points of issue, adjusted for measured waist size accuracy and sex, and analysed to estimate the proportion of overweight and obese soldiers in the Australian Army.

RESULTS

There were a total of 155 735 combat pants issued across the three points of issue. The mean waist size based on combat uniform pant size was found to be 90.4 cm, with an SD of 7.5 cm. Based on these data, approximately 23.3% of the Australian Army population can be estimated to be overweight and an additional 4.5% to be obese.

CONCLUSIONS

The Australian Army, like many western armies, has a significant proportion of overweight personnel. This can negatively affect operational capability, health and future healthcare costs both within the military and to society after military service has concluded. This is the first study to use a uniform waist size as a proxy to estimate overweight and obesity. This technique has application for the military, emergency services or any other organisation in which uniforms are provided.

Validity of Recreational Marathon Runners' Self-Reported Anthropometric Data

While studies on large samples of recreational runners have often relied on participants' self-reported height and body mass, the validity of these data have not been investigated for this population. Hence, this study sought to examine the validity of self-reported anthropometric measures among recreational marathon runners. Female (n = 32) and male (n = 135) recreational marathon runners were requested to estimate their body mass and height (and we calculated their self-reported body mass index [BMI]), after which we took actual measures of their body mass and height and calculated their actual BMI. Participants' self-reported values underestimated their actual body mass by 0.65 kg (p < .001, η² = 0.222) and their actual BMI by 0.35 kg ⋅ m^-2 (p < .001, η² = 0.245). There was a significant Assessment Method × Sex Interaction for both body mass (p = .019, η² = 0.033) and BMI (p = .017, η² = 0.034), as women underestimated body mass values more than men. Participants overestimated their height by 0.44 cm (p < .001, η² = 0.075), but the interaction of sex and assessment method for height was not statistically significant. Underestimates of body mass correlated with marathon racing speed (r = .24, p = .006) and body fat percentage (r = -.29, p = .001) in men, but not in women (p > .05). The disagreement between self-reported and measured anthropometric data in the present sample was lower than has been previously reported for the general population, suggesting that marathon runners may more accurately self-perceive and/or report their anthropometric characteristics. These findings are of practical value for health professionals and researchers (e.g., nutritionists and exercise physiologists) questionnaires to recreational marathon runners.

The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease

BACKGROUND

Chronic liver disease (CLD) is usually asymptomatic but earlier detection is critical to permit life-saving interventions for those at risk due to high alcohol consumption and increased body mass index (BMI). The aim of this study was to estimate the association between the Enhanced Liver Fibrosis (ELF) test and liver-related events (LRE) and its performance in predicting LRE in postmenopausal women with risk factors in a nested case-control study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS).

METHODS

In a cohort of 95,126 we performed a case-control study measuring ELF in blinded samples from 173 participants with self-reported high alcohol use and / or BMI ≥25 kg/m2 comprising all 58 cases who developed LRE and 115 controls matched for age, alcohol and BMI who did not develop LRE during median follow-up of 8.5 years.

RESULTS

Using Cox regression at an ELF threshold of 10.51 hazard ratios (HR) for LRE were 4.88 (95% confidence interval (CI) 2.37-10.03) (unadjusted model) and 4.62 (95% CI 2.12-10.08) (adjusted for deprivation and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes). At a threshold of 9.8 HR for LRE were 2.21 (95% CI 1.22-3.97) (unadjusted model) and 2.18 (95% CI 1.19-4.01) (adjusted). ELF was evaluated as a time dependent variable by generating time-dependent Cox models; HRs at an ELF threshold of 10.51 were 1.94 (95% CI 1.10-3.39) (unadjusted) and 2.05 (95% CI 1.16-3.64) (adjusted) and at a threshold of 9.8 HRs were 1.85 (95% CI 1.09-3.15) (unadjusted) and 1.80 (95% CI 1.04-3.13) (adjusted). Area under the receiver operating characteristic curve for recruitment ELF predicting LRE was 0.58 (95% CI 0.49-0.68), and for second subsequent ELF 0.61 (95% CI 0.52-0.71).

CONCLUSION

This study demonstrates the association between ELF and CLD in postmenopausal women with risk factors for liver disease, creating the opportunity to intervene to reduce liver-related mortality and morbidity. Although larger studies are required, these results demonstrate the potential of ELF as a prognostic tool in health checks in primary care.

TRIAL REGISTRATION

This study is nested in UKCTOCS. UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.

Temporal discounting does not influence body mass index

The prevalence of obesity has driven searches for cognitive or behavioural economic factors related to Body Mass Index (BMI). One candidate is delay discounting: those who prefer smaller sooner rewards over larger but later rewards are hypothesised to have higher BMI. The findings in the literature are mixed however, with meta analyses suggesting only a very small correlation between discounting and BMI. Here we present novel empirical data (N=381) and Bayesian analyses which suggest no such relationship between discounting of either monetary or weight loss rewards and BMI. We also find evidence against our novel proposal that discounting moderates the rate of BMI gain over time. We also present our data in the context of a random effects Bayesian meta-analytical result which does suggest the presence of a small correlation overall. The strength of the correlation is so weak (2.25% shared variance) that its practical significance may be minor to non existent. However because we found decisive evidence for unaccounted for study-level variance, due to study heterogeneity, we argue that we should treat such meta-analytic correlations with extreme caution. While the relationship between discounting and health outcomes such as BMI remain theoretically appealing, our empirical and meta-analytic results suggest we should be cautious in inferring a correlational, let alone a causal, role for discounting processes in driving BMI or moderating BMI gain with age.

Maternal dietary pattern characterised by high protein and low carbohydrate intake in pregnancy is associated with a higher risk of gestational diabetes mellitus in Chinese women: a prospective cohort study

Maternal dietary patterns and macronutrients intake have been shown to affect the development of gestational diabetes mellitus (GDM), but the findings are inconsistent. We aimed to identify maternal dietary patterns and examine their associations with GDM risk, and to evaluate the contributions of macronutrients intake to these associations. We included 2755 Chinese pregnant women from the Tongji Maternal and Child Health Cohort. Dietary intakes were assessed using a validated semi-quantitative FFQ 2 weeks before the diagnosis of GDM. GDM (n 248) was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24-28 weeks gestation. We derived five different dietary patterns from a principal component analysis. The results showed that high fish-meat-eggs scores, which were positively related to protein intake and inversely related to carbohydrate intake, were associated with a higher risk of GDM (adjusted OR for quartile 4 v. quartile 1: 1·83; 95 % CI 1·21, 2·79; P trend=0·007) and higher plasma glucose levels. In contrast, high rice-wheat-fruits scores, which were positively related to carbohydrate intake and inversely related to protein intake, were associated with lower risk of GDM (adjusted OR for quartile 3 v. quartile 1: 0·54; 95 % CI 0·36, 0·83; P trend=0·010) and lower plasma glucose levels. In addition, dietary protein and carbohydrate intake significantly contributed to the associations between dietary patterns and GDM risk or glucose levels. These findings suggest that a dietary pattern characterised by high protein and low carbohydrate intake in pregnancy was associated with a higher risk of GDM, which may provide important clues for dietary guidance during pregnancy to prevent GDM.

[Underestimation of obesity and overweight based on self-report measures in the general population: prevalence and a proposal for correction models]

The study's objectives: compare self-report measures of weight and height with direct measures; assess the impact of these discrepancies on body mass index (BMI) and prevalence of overweight and obesity; and apply correction models to the self-report measures and assess the degree of improvement in the corrected measures produced with the use of these models. A cross-sectional study was performed, assessing 4,151 adults (18 to 60 years) participating in the São Paulo Megacity Epidemiological Study. Linear regression models stratified by sex were proposed for correction of self-reported measures. Agreement was assessed with the intraclass correlation coefficient for the direct measures, self-report measures, and corrected measures, and kappa coefficient for BMI classification categories. Self-reported weight and the resulting BMI were underestimated, while height was overestimated, compared to direct measures. With all the correction models, the corrected measures were closer to the direct measures. Prevalence rates for excess weight, calculated by self-report measures, were underestimated by 24% in men and by 28% in women; with corrections, the underestimation decreased to 8% and 10%, respectively. The results showed moderate agreement for self-report measures and substantial agreement for corrected measures compared to direct measures. The use of correction equations for self-report data proved to be a useful method for producing more trustworthy estimates of prevalence of overweight and obesity in the general population, usually estimated from self-report measures of weight and height in population surveys.

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.

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.

Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS)

Background

We investigated the association between self-reported skirt size (SS) and change in SS, and incidence of chronic liver disease (CLD) in a prospective cohort study of women recruited to the UKCTOCS trial.

Methods

Women recruited to UKCTOCS in England without documented CLD self-reported their current UK SS during trial participation and were asked to recall their SS when aged in 20s (via completion of a questionnaire 3–5 years after recruitment). Participants were followed up via electronic health record linkage and hazard ratios (HR) calculated for incident liver-related events (LRE).

Results

Three hundred twenty-two (0.3%) of 94,124 women experienced a first LRE. Compared to SS ≤ 16, rates of LRE were higher in the SS ≥ 18 groups (both when aged in 20s and at questionnaire completion). Event rates were higher if there was no change in SS or an increase in SS, compared to a decrease in SS.

In the models adjusted for potential confounders, HRs for LRE were higher in the groups of women reporting SS ≥ 18 both when aged in 20s (HR = 1.39 (95% CI; 0.87–2.23)) and at questionnaire completion (HR = 1.37 (95% CI; 1.07–1.75)). Compared to a decrease in SS, HRs were higher in the no change (HR = 1.78 (95% CI; 0.95–3.34)) and increase (HR = 1.80 (95% CI; 1.01–3.21)) groups.

Conclusion

CLD is associated with high SS and an increase in SS over time. These data suggest SS can be used in simple public health messages about communicating the risk of liver disease.

Trial Registration

UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5308-x) contains supplementary material, which is available to authorized users.

Correction of self-reported BMI based on objective measurements: a Belgian experience

BACKGROUND

Based on successive Health Interview Surveys (HIS), it has been demonstrated that also in Belgium obesity, measured by means of a self-reported body mass index (BMI in kg/m2), is a growing public health problem that needs to be monitored as accurately as possible. Studies have shown that a self-reported BMI can be biased. Consequently, if the aim is to rely on a self-reported BMI, adjustment is recommended. Data on measured and self-reported BMI, derived from the Belgian Food Consumption Survey (FCS) 2014 offers the opportunity to do so.

METHODS

The HIS and FCS are cross-sectional surveys based on representative population samples. This study focused on adults aged 18-64 years (sample HIS = 6545 and FCS = 1213). Measured and self-reported BMI collected in FCS were used to assess possible misreporting. Using FCS data, correction factors (measured BMI/self-reported BMI) were calculated in function of a combination of background variables (region, gender, educational level and age group). Individual self-reported BMI of the HIS 2013 were then multiplied with the corresponding correction factors to produce a corrected BMI-classification.

RESULTS

When compared with the measured BMI, the self-reported BMI in the FCS was underestimated (mean 0.97 kg/m2). 28% of the obese people underestimated their BMI. After applying the correction factors, the prevalence of obesity based on HIS data significantly increased (from 13% based on the original HIS data to 17% based on the corrected HIS data) and approximated the measured one derived from the FCS data.

CONCLUSIONS

Since self-reported calculations of BMI are underestimated, it is recommended to adjust them to obtain accurate estimates which are important for decision making.

Bias in Hazard Ratios Arising From Misclassification According to Self-Reported Weight and Height in Observational Studies of Body Mass Index and Mortality

Misclassification of body mass index (BMI) categories arising from self-reported weight and height can bias hazard ratios in studies of BMI and mortality. We examined the effects on hazard ratios of such misclassification using national US survey data for 1976 through 2010 that had both measured and self-reported weight and height along with mortality follow-up for 48,763 adults and a subset of 17,405 healthy never-smokers. BMI was categorized as <22.5 (low), 22.5-24.9 (referent), 25.0-29.9 (overweight), 30.0-34.9 (class I obesity), and ≥35.0 (class II-III obesity). Misreporting at higher BMI categories tended to bias hazard ratios upwards for those categories, but that effect was augmented, counterbalanced, or even reversed by misreporting in other BMI categories, in particular those that affected the reference category. For example, among healthy male never-smokers, misclassifications affecting the overweight and the reference categories changed the hazard ratio for overweight from 0.85 with measured data to 1.24 with self-reported data. Both the magnitude and direction of bias varied according to the underlying hazard ratios in measured data, showing that findings on bias from one study should not be extrapolated to a study with different underlying hazard ratios. Because of misclassification effects, self-reported weight and height cannot reliably indicate the lowest-risk BMI category.

Measured versus self-reported body height and body mass in patients after an acute coronary syndrome

The basic anthropometric data describing a person in the broadest context are body weight and height, two of the most frequently analyzed somatometric parameters. The same is true I in relation to clinical patients. The aim of the present study was to compare the self-reported and actual body weight, height and BMI in patients suffering from coronary artery disease and undergoing cardiac rehabilitation. The study sample consisted of 100 patients treated for coronary artery disease. The patients were asked to state their body weight and height. At the same time a three-person study team took measurements, which were later the basis for verification and objective assessment of the data provided by the patients. Statistical analysis was performed with Statistics 11.0 PL software. The analysis of mean results for the assessed group of patients has shown the presence of statistically significant differences between declared and actual data. The differences were observed for both male and female study population. It has been proven that the subjects declare greater body height (mean value 1.697 m vs. 1.666 m) and lower body weight (80.643 kg vs. 82.051 kg). Based on the data from surveys and direct measurements, the body mass index for the self-reported and actual data was calculated. A comparison of these values has shown considerable statistically significant differences. The differences between declared and actual data point to highly subjective self-assessment, which disqualifies the declared data in the context of monitoring of treatment and rehabilitation processes. The authors believe that actual data should be used in direct trial examination of patients suffering from coronary artery disease who presented with acute coronary syndrome.

Validity of self-reported weight, height, and BMI in mothers of the research Birth in Brazil

OBJECTIVE

To evaluate the accuracy of information on pre-gestational weight, height, pre-gestational body mass index, and weight at the last prenatal appointment, according to maternal characteristics and sociodemographic and prenatal variables.

METHODS

The study was developed using data from the face-to-face questionnaire and prenatal card (gold standard) of the study "Birth in Brazil, 2011-2012". To evaluate the differences between the measured and self-reported anthropometric variables, we used the the Kruskal-Wallis test for the variables divided into quartiles. For the continuous variables, we used the Wilcoxon test, Bland-Altman plot, and average difference between the information measured and reported by the women. We estimated sensitivity and the intraclass correlation coefficient.

RESULTS

In the study, 17,093 women had the prenatal card. There was an underestimation of pre-gestational weight of 1.51 kg (SD = 3.44) and body mass index of 0.79 kg/m2 (SD = 1.72) and overestimation of height of 0.75 cm (SD = 3.03) and weight at the last appointment of 0.22 kg (SD = 2.09). The intraclass correlation coefficients (ICC) obtained for the anthropometric variables were: height (ICC = 0.89), pre-gestational weight (ICC = 0.96), pre-gestational body mass index (ICC = 0.92), and weight at the last appointment (ICC = 0.98).

CONCLUSIONS

The results suggest that the mentioned anthropometric variables were valid for the study population, and they may be used in studies of populations with similar characteristics.

Trajectory modeling of gestational weight: A functional principal component analysis approach

Suboptimal gestational weight gain (GWG), which is linked to increased risk of adverse outcomes for a pregnant woman and her infant, is prevalent. In the study of a large cohort of Canadian pregnant women, our goals are to estimate the individual weight growth trajectory using sparsely collected bodyweight data, and to identify the factors affecting the weight change during pregnancy, such as prepregnancy body mass index (BMI), dietary intakes and physical activity. The first goal was achieved through functional principal component analysis (FPCA) by conditional expectation. For the second goal, we used linear regression with the total weight gain as the response variable. The trajectory modeling through FPCA had a significantly smaller root mean square error (RMSE) and improved adaptability than the classic nonlinear mixed-effect models, demonstrating a novel tool that can be used to facilitate real time monitoring and interventions of GWG. Our regression analysis showed that prepregnancy BMI had a high predictive value for the weight changes during pregnancy, which agrees with the published weight gain guideline.

Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Background

We investigated the risk of chronic liver disease (CLD) due to alcohol consumption and body mass index (BMI) and the effects of their interaction in a prospective cohort study of women recruited to the UKCTOCS trial.

Methods

95,126 post-menopausal women without documented CLD were stratified into 12 groups defined by combinations of BMI (normal, overweight, obese) and alcohol consumption (none, <1–15, 16–20 and ≥21 units/week), and followed for an average of 5.1 years. Hazard ratios (HR) were calculated for incident liver-related events (LRE).

Results

First LREs were reported in 325 (0.34%) participants. Compared to women with normal BMI, HR = 1.44 (95% CI; 1.10–1.87) in the overweight group and HR = 2.25 (95% CI; 1.70–2.97) in the obese group, adjusted for alcohol and potential confounders. Compared to those abstinent from alcohol, HR = 0.70 (95% CI; 0.55–0.88) for <1–15 units/week, 0.93 (95% CI; 0.50–1.73) for 16–20 units/week and 1.82 (95% CI; 0.97–3.39) for ≥21 units/week adjusted for BMI and potential confounders. Compared to women with normal BMI drinking no alcohol, HR for LRE in obese women consuming ≥21 units/week was 2.86 (95% CI; 0.67–12.42), 1.58 (95% CI; 0.96–2.61) for obese women drinking <1–15 units/week and 1.93 (95% CI; 0.66–5.62) in those with normal BMI consuming ≥21 units/week after adjustment for potential confounders. We found no significant interaction between BMI and alcohol.

Conclusion

High BMI and alcohol consumption and abstinence are risk factors for CLD in post-menopausal women. However, BMI and alcohol do not demonstrate significant interaction in this group.

Trial registration

UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4518-y) contains supplementary material, which is available to authorized users.

Estimating bias in derived body mass index in the Maternity Experiences Survey

INTRODUCTION

The objective of this study was to assess bias in the body mass index (BMI) measure in the Canadian Maternity Experiences Survey (MES) and possible implications of bias on the relationship between BMI and selected pregnancy outcomes.

METHODS

We assessed BMI classification based on self-reported versus measured values. We used a random sample of 6175 women from the MES, which derived BMI from self-reported height and weight, and a random sample of 259 women who had previously given birth from the Canadian Health Measures Survey (CHMS), which derived BMI from self-reported and measured height and weight. Two correction equations were applied to self-reported based BMI, and the impact of these corrections on associations between BMI and caesarean section, small-for-gestational age (SGA) and large-for-gestational age (LGA) births was studied.

RESULTS

Overall, 86.9% of the CHMS subsample was classified into the same BMI category based on self-reported versus measured data. However, misclassification had a substantial effect on the proportion of women in underweight and obese BMI categories. For example, 14.5% versus 20.8% of women were classified as obese based on self-reported data versus measured data. Corrections improved estimates of obesity prevalence, but over- and underestimated other BMI categories. Corrections had nonsignificant effects on the associations between BMI and SGA, LGA, and caesarean section.

CONCLUSION

While there was high concordance in BMI classification based on selfreported versus measured height and weight, bias in self-reported based measures may slightly over- or underestimate the risks associated with a particular BMI class. However, the general trend in associations is unaffected.

Metabolic and body composition changes in first year following traumatic amputation

Body composition and metabolism may change considerably after traumatic amputation because of muscle atrophy and an increase in adiposity. The purpose of this study was to quantify changes in weight, body composition, and metabolic rate during the first year following traumatic amputation in military servicemembers. Servicemembers without amputation were included for comparison. Participants were measured within the first 12 wk after amputation (baseline) and at 6, 9, and 12 mo after amputation. Muscle mass, fat mass, weight, and metabolic rate were measured at each time point. There was a significant increase in weight and body mass index in the unilateral group between baseline and all follow-up visits (p < 0.01). Over the 12 mo period, total fat mass and trunk fat mass increased in both unilateral and bilateral groups; however, these changes were not statistically significant over time. Muscle mass increased in both the unilateral and bilateral group despite percent of lean mass decreasing. No changes in resting metabolism or walking energy expenditure were observed in any group. The results of this study conclude that weight significantly increased because of an increase in both fat mass and muscle mass in the first year following unilateral and bilateral amputation.

Accuracy of self-reported height, weight, and waist circumference in a general adult Chinese population

Background

Self-reported height, weight, and waist circumference (WC) are widely used to estimate the prevalence of obesity, which has been increasing rapidly in China, but there is limited evidence for the accuracy of self-reported data and the determinants of self-report bias among the general adult Chinese population.

Methods

Using a multi-stage cluster sampling method, 8399 residents aged 18 or above were interviewed in the Jiangsu Province of China. Information on self-reported height, weight, and WC, together with information on demographic factors and lifestyle behaviors, were collected through structured face-to-face interviews. Anthropometrics were measured by trained staff according to a standard protocol.

Results

Self-reported height was overreported by a mean of 1.1 cm (95 % confidence interval [CI]: 1.0 to 1.2). Self-reported weight, body mass index (BMI), and WC were underreported by −0.1 kg (95 % CI: −0.2 to 0.0), −0.4 kg/m² (95 % CI: −0.5 to −0.3) and −1.5 cm (95 % CI: −1.7 to −1.3) respectively. Sex, age group, location, education, weight status, fruit/vegetable intake, and smoking significantly affected the extent of self-report bias. According to the self-reported data, 25.5 % of obese people were misclassified into lower BMI categories and 8.7 % of people with elevated WC were misclassified as normal. Besides the accuracy, the distribution of BMI and WC and their cut-off point standards for obesity of a population affected the proportion of obesity misclassification.

Conclusion

Amongst a general population of Chinese adults, there was rather high proportion of obesity misclassification using self-reported weight, height, and WC data. Self-reported anthropometrics are biased and misleading. Objective measurements are recommended.

Place matters: Mitigating obesity with the person-in-environment approach

Research demonstrates that environmental and community-level variables contribute to obesity. Many of these variables are outside of personal volitional control, such as the characteristics of the places in which people live. Social work's unique person-in-environment (PIE) approach is an ideal perspective from which to address obesity. This study employs the PIE perspective to examine sprawl, one environmental-level factor. We employed secondary data analysis to examine the effect of sprawl on obesity while controlling for covariates. Region of residence and sprawl significantly predicted obesity, net of covariates. Given that obesity varies among communities, social workers can respond with PIE-oriented solutions.

Self-reported and measured weights and heights among adults in Seattle and King County

Background

Self-reported weights and heights can be subject to gender, socio-economic, and other biases. On the other hand, obtaining measured anthropometric data can pose a significant respondent burden.

Methods

Seattle Obesity Study II (SOS II) participants (n = 419) provided self-reported height, weight, and demographic data through an interviewer-assisted behavior survey. Participants were then weighed and measured by trained staff. The entire process was repeated 12 months later. At the follow up visit, participants were also asked to recall their weight from 12 months ago. The concordance between measured and self-reported data was assessed using Bland-Altman plots.

Results

Some weight underreporting by obese individuals was observed. Gender or socio-economic status (SES) did not affect self-reports. Bland-Altman plots provided 95 % limits of agreement of −3.13 to 5.83 for weight (kg), and 1.21 to 2.52 for BMI (kg/m²). The concordance between measured and self-reported BMI categories was excellent (Kappa = 0.82 for men, and 0.86 for women). At the follow up visit, participants estimated their weight 12 months ago more accurately than their current weight.

Conclusions

Self-reported heights and weights were highly correlated with objective measures at two points in time. No gender or SES biases were observed. Minor, yet statistically significant under-reporting (<1.5 kg) was observed for obese participants. Caution should be used when using self-reported data in obese populations.

Electronic supplementary material

The online version of this article (doi:10.1186/s40608-016-0088-2) contains supplementary material, which is available to authorized users.

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.

Morbid obesity increases the risk for systemic complications in patients with femoral shaft fractures

OBJECTIVES

To determine whether morbidity and mortality were increased in morbidly obese patients who had reamed intramedullary nailing of closed femoral shaft fractures compared with similar patients of normal weight.

DESIGN

Retrospective case-control study.

SETTING

Level I trauma center.

PATIENTS/PARTICIPANTS

All patients with closed femoral shaft fractures treated with reamed intramedullary nailing over a 5-year period were identified. Normal-weight patients (BMI < 25) were compared with overweight (25 ≤ BMI < 30), obese (30 ≤ BMI < 40), and morbidly obese patients (BMI ≥ 40).

INTERVENTION

Reamed intramedullary nailing.

MAIN OUTCOME MEASUREMENTS

Occurrence of postoperative complications.

RESULTS

Of 507 patients with 526 femoral shaft fractures (AO/OTA-32), 184 (36.3%) were of normal weight, 170 (33.5%) were overweight, 114 (22.5%) were obese, and 39 (7.7%) were morbidly obese. There were no significant differences in complications when comparing normal-weight patients with overweight and obese patients. Systemic complications occurred in 23% of morbidly obese and 9% of normal-weight patients [odds ratio (OR) = 3.15, P = 0.013]. Morbid obesity increased odds of adult respiratory distress syndrome (OR = 35.38, P = 0.019) and sepsis (OR = 6.49, P = 0.0015). Overall, morbidly obese patients with a femoral fracture had a mortality rate of 10%, but a subset of polytraumatized patients (Injury Severity Score > 17) had a mortality rate of 20%. Morbid obesity significantly increased the odds of mortality (OR = 46.77, P = 0.01). Body mass index was found to be an independent predictor of adult respiratory distress syndrome, sepsis, and death.

CONCLUSIONS

Morbid obesity is a significant risk factor for systemic complications in patients with closed femoral shaft fractures, especially in polytraumatized patients. Patients and their families need to be counseled regarding the high risk of morbidity and mortality.

LEVEL OF EVIDENCE

Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.

Conflict over reasons to eat tasty food predicts weight fluctuation over 6 weeks

Several theories suggest that goal conflict leads to loss of control, but few studies have tested this proposal objectively. A transdiagnostic approach to CBT based on Perceptual Control Theory proposes that conflict between superordinate goals is at the heart of loss of control, and in turn, psychological distress. This study used the example of goal conflict around eating in a non-clinical sample as proof-of-concept to test whether it predicted loss of control. We examined whether the conflict regarding reasons to eat tasty food (e.g. ‘Eating tasty food helps me feel better’) versus reasons not to eat tasty food (e.g. ‘I want to lose weight’) correlated with weight fluctuations over 6 weeks in 33 students. At baseline, higher levels of goal conflict were associated with greater state and trait food cravings, and more problems with control over eating. As predicted, people with higher levels of goal conflict showed greater weight fluctuation. The effect diminished when controlling for trait food craving, and exercise fluctuation remained an independent predictor. We discuss the implications for future research on goal conflict, and for interventions that raise awareness of goal conflict to improve wellbeing via the enhancement of self-control.

Validity of self-reported height and weight in elderly Poles

BACKGROUND/OBJECTIVES

In nutritional epidemiology, collecting self-reported respondent height and weight is a simpler procedure of data collection than taking measurements. The aim of this study was to compare self-reported and measured height and weight and to evaluate the possibility of using self-reported estimates in the assessment of nutritional status of elderly Poles aged 65 + years.

SUBJECTS/METHODS

The research was carried out in elderly Poles aged 65 + years. Respondents were chosen using a quota sampling. The total sample numbered 394 participants and the sub-sample involved 102 participants. Self-reported weight (non-corrected self-reported weight; non-cSrW) and height estimates (non-corrected self-reported height; non-cSrH) were collected. The measurements of weight (measured weight; mW) and height (measured height; mH) were taken. Using multiple regression equations, the corrected self-reported weight (cSrW) and height (cSrH) estimates were calculated.

RESULTS

Non-cSrH was higher than mH in men on average by 2.4 cm and in women on average by 2.3 cm. In comparison to mW, non-cSrW was higher in men on average by 0.7 kg, while in women no significant difference was found (mean difference of 0.4 kg). In comparison to mBMI, non-cSrBMI was lower on average by 0.6 kg/m² in men and 0.7 kg/m² in women. No differences were observed in overweight and obesity incidence when determined by mBMI (68% and 19%, respectively), non-cSrBMI (62% and 14%, respectively), cSrBMI (70% and 22%, respectively) and pcSrBMI (67% and 18%, respectively).

CONCLUSIONS

Since the results showed that the estimated self-reported heights, weights and BMI were accurate, the assessment of overweight and obesity incidence was accurate as well. The use of self-reported height and weight in the nutritional status assessment of elderly Poles on a population level is therefore recommended. On an individual level, the use of regression equations is recommended to correct self-reported height, particularly in women.

Comparison of measured and self-reported anthropometric information among firefighters: implications and applications

This study evaluated the accuracy of self-reported body weight and height compared to measured values among firefighters and identified factors associated with reporting error. A total of 863 male and 88 female firefighters in four US regions participated in the study. The results showed that both men and women underestimated their body weight ( - 0.4 ± 4.1, - 1.1 ± 3.6 kg) and overestimated their height (29 ± 18 , 17 ± 16 mm). Women underestimated more than men on weight (p = 0.022) and men overestimated more than women on height (p < 0.001). Reporting errors on weight were increased with overweight status (p < 0.001) and were disproportionate among subgroups. About 27% men and 24% women had reporting errors on weight greater than ± 2.2 kg, and 59% men and 28% women had reporting errors on height greater than 25 mm.

Self-reported anthropometric information cannot vouch for the accurate assessment of obesity prevalence in populations of middle-aged and older Korean individuals

While there are strong correlations between self-reported and directly measured anthropometric data, the discrepancy and systematic errors associated with these, particularly among middle-aged and older persons residing in South Korea, remain a contentious issue. All participants were selected from the Korean Longitudinal Study of Aging (KLoSA), a panel study conducted by the Korea Labor Institute; data from 510 participants (290 females; 56.9%) were analyzed. We considered general characteristics, including sex, age, education, marital status, employment, income, and residential region, and used self-rated health (SRH) as a generic indicator of health status. One-way ANOVA, t-test, and Scheffé's test (α=0.1) were employed to explore the difference between directly measured and self-reported values. Sensitivity and specificity values were used to assess the validity of obesity diagnoses based on self-reported body mass index (BMI: body weight in kilograms divided by the square of height in meters). The means of BMI differences were 1.3 (±1.2)kg/m(2) among men and 1.8 (±1.5)kg/m(2) among women. In men, the difference could be attributed to measured BMI and residential region; among women, age and education level influenced the discrepancy in BMI. Scheffé's test (α=0.1) for multiple comparisons of group means revealed that women over the age of 65 years, with lower than middle-school education, who lived in rural areas, and had a measured BMI of 25kg/m(2) or more, were more likely to have significant BMI discrepancies. In contrast, for men, significant predictors were living in rural areas and being obese. Although adequate correlations were seen in self-reported BMI, they indicated low sensitivity, with 46.5% and 60.1% among males and females, respectively. However, specificities were very high, at 97.8% and 98.0% for males and females, respectively. The diagnostic performance of self-reported BMI is insufficient for assessing obesity prevalence among middle-aged or older Koreans.

Cross-sectional association between cigarette smoking and abdominal obesity among Austrian bank employees

OBJECTIVES

There is increasing evidence that smoking is associated with abdominal obesity and other risk factors for the metabolic syndrome. The aim of this study is to investigate these associations in a sample of healthy Austrian adults.

SETTING AND PARTICIPANTS

Data of 986 employees of an Austrian company (405 men and 581 women; participation rate approximately 80%) obtained during their annual medical check-up at the workplace were analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Information on smoking status, education level, physical activity, diet, body weight, height, body mass index (BMI), waist circumference and biochemical parameters was obtained. The influence of smoking on health and anthropometric measures was investigated.

RESULTS

No differences in total body fat and/or body fat distribution were found between non-smokers, smokers and former smokers; however, among daily smokers, the number of cigarettes smoked per day was significantly associated with higher body weight (p=0.001) and BMI (p=0.009). Male and female smokers had significantly higher white cell count than non-smokers and former smokers. Heavy smokers also had an unhealthier lipid profile (lower high-density lipoprotein cholesterol) and higher fasting glucose levels even after controlling for physical activity and calorie intake.

CONCLUSIONS

Contrary to the beliefs of many smokers, heavy smoking is associated with higher body weight and unfavourable metabolic changes.

Correction of body-mass index using body-shape perception and socioeconomic status in adolescent self-report surveys

Objectives

To propose a simple correction of body-mass index (BMI) based on self-reported weight and height (reported BMI) using gender, body shape perception and socioeconomic status in an adolescent population.

Methods

341 boys and girls aged 17–18 years were randomly selected from a representative sample of 2165 French adolescents living in Paris surveyed in 2010. After an anonymous self-administered pen-and-paper questionnaire asking for height, weight, body shape perception (feeling too thin, about the right weight or too fat) and socioeconomic status, subjects were measured and weighed. BMI categories were computed according to Cole’s cut-offs. Reported BMIs were corrected using linear regressions and ROC analyses and checked with cross-validation and multiple imputations to handle missing values. Agreement between actual and corrected BMI values was estimated with Kappa indexes and Intraclass correlation coefficients (ICC).

Results

On average, BMIs were underreported, especially among girls. Kappa indexes between actual and reported BMI were low, especially for girls: 0.56 95%CI = [0.42–0.70] for boys and 0.45 95%CI = [0.30–0.60] for girls. The regression of reported BMI by gender and body shape perception gave the most balanced results for both genders: the Kappa and ICC obtained were 0.63 95%CI = [0.50–0.76] and 0.67, 95%CI = [0.58–0.74] for boys; 0.65 95%CI = [0.52–0.78] and 0.74, 95%CI = [0.66–0.81] for girls. The regression of reported BMI by gender and socioeconomic status led to similar corrections while the ROC analyses were inaccurate.

Conclusions

Using body shape perception, or socioeconomic status and gender is a promising way of correcting BMI in self-administered questionnaires, especially for girls.

Longitudinal associations of obesity with affective disorders and suicidality in the Baltimore epidemiologic catchment area follow-up study

Our aim was to examine the longitudinal associations between obesity and mental health variables (psychiatric diagnoses and suicidal behaviors). Data were from waves 3 and 4 of the Baltimore Epidemiologic Catchment Area study (N = 1071). Participants were aged 30 to 86 years at wave 3 (mean, 47.6 years; SD, 12.8). The prevalence of obesity increased from 27.6% to 39.1% during the follow-up. Logistic regression analyses revealed no associations between baseline obesity and onset of mental disorders or suicidal behaviors between waves 3 and 4 in fully adjusted models; however, baseline obesity predicted new-onset suicide attempts in models adjusted for sociodemographics and mental disorders. Baseline depression predicted weight gain during the 11-year follow-up period (F = 4.014, p < 0.05), even after controlling for important confounders. Overall, most mental health variables were not associated with obesity, suggesting that clinicians and others should be wary of "weight-ism" and avoid making the assumption that higher body weight relates to mental health problems.