Looking back in time: conducting a cohort study of the long-term effects of treatment of adolescent tall girls with synthetic hormones

OBJECTIVE: Public health research is an endeavour that often involves multiple relationships, far-reaching collaborations, divergent expectations and various outcomes. Using the Tall Girls Study as a case study, this paper will present and discuss a number of methodological, ethical and legal challenges that have implications for other public health research. APPROACH: The Tall Girls Study was the first study to examine the long-term health and psychosocial effects of oestrogen treatment for tall stature. RESULTS: In undertaking this study the research team overcame many hurdles: in maintaining collaboration with treating clinicians and with the women they had treated as girls - groups with opposing points of view and different expectations; using private practice medical records to trace women who had been patients up to forty years earlier; and exploring potential legal issues arising from the collection of data related to treatment. CONCLUSION: While faced with complex challenges, the Tall Girls Study demonstrated that forward planning, ongoing dialogue between all stakeholders, transparency of processes, and the strict adherence to group-developed protocols were keys to maintaining rigour while undertaking pragmatic research. IMPLICATIONS: Public health research often occurs within political and social contexts that need to be considered in the planning and conduct of studies. The quality and acceptability of research findings is enhanced when stakeholders are engaged in all aspects of the research process

Takeaway food consumption and its associations with diet quality and abdominal obesity: a cross-sectional study of young adults

Background : Few studies have investigated the associations of takeaway food consumption with overall diet quality and abdominal obesity. Young adults are high consumers of takeaway food so we aimed to examine these associations in a national study of young Australian adults.Methods : A national sample of 1,277 men and 1,585 women aged 26&ndash;36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, usual daily frequency of fruit and vegetable consumption and usual weekly frequency of takeaway food consumption. Dietary intake was compared with the dietary recommendations from the Australian Guide to Healthy Eating. Waist circumference was measured for 1,065 men and 1,129 women. Moderate abdominal obesity was defined as &ge; 94 cm for men and &ge; 80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression. Takeaway food consumption was dichotomised, with once a week or less as the reference group.Results : Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%, P &lt; 0.001). Compared with those eating takeaway once a week or less, men eating takeaway twice a week or more were significantly more likely to be single, younger, current smokers and spend more time watching TV and sitting, whereas women were more likely to be in the workforce and spend more time watching TV and sitting. Participants eating takeaway food at least twice a week were less likely (P &lt; 0.05) to meet the dietary recommendation for vegetables, fruit, dairy, extra foods, breads and cereals (men only), lean meat and alternatives (women only) and overall met significantly fewer dietary recommendations (P &lt; 0.001). After adjusting for confounding variables (age, leisure time physical activity, TV viewing and employment status), consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR: 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR: 1.25; 95% CI: 1.04, 1.50).Conclusion : Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in young men and women.<br /

Cross-Sectional Associations between Dietary Fat-Related Behaviors and Continuous Metabolic Syndrome Score among Young Australian Adults

Dietary guidelines recommend removing visible fat from meat, choosing low-fat options and cooking with oil instead of butter. This study examined cross-sectional associations between fat-related eating behaviors and a continuous metabolic syndrome (cMetSyn) score among young adults. During 2004-2006, 2071 participants aged 26-36 years reported how often they trimmed fat from meat, consumed low-fat dairy products and used different types of fat for cooking. A fasting blood sample was collected. Blood pressure, weight and height were measured. To create the cMetSyn score, sex-specific principal component analysis was applied to normalized risk factors of the harmonized definition of metabolic syndrome. Higher score indicates higher risk. For each behavior, differences in mean cMetSyn score were calculated using linear regression adjusted for confounders. Analyses were stratified by weight status (Body mass index (BMI) < 25 kg/m(2) or 25 kg/m(2)). Mean cMetSyn score was positively associated with consumption of low-fat oily dressing (P-Trend = 0.013) among participants who were healthy weight and frequency of using canola/sunflower oil for cooking (P-Trend = 0.008) among participants who were overweight/obese. Trimming fat from meat, cooking with olive oil, cooking with butter, and consuming low-fat dairy products were not associated with cMetSyn score. Among young adults, following fat-related dietary recommendations tended to not be associated with metabolic risk

Muscular strength across the life course: The tracking and trajectory patterns of muscular strength between childhood and mid-adulthood in an Australian cohort

ObjectivesLow muscular strength is a risk factor for current and future adverse health outcomes. However, whether levels of muscular strength persist, or track, and if there are distinct muscular strength trajectories across the life course is unclear. This study aimed to explore muscular strength trajectories between childhood and mid-adulthood.DesignProspective longitudinal study.MethodsChildhood Determinants of Adult Health Study participants had their muscular strength (right and left handgrip, shoulder extension and flexion, and leg strength measured by hand-held, shoulder and leg-back dynamometers, and a combined strength score) assessed in childhood, young adulthood and mid-adulthood. The tracking of muscular strength was quantified between childhood and mid-adulthood (n = 385) and young- and mid-adulthood (n = 822). Muscular strength trajectory patterns were identified for participants who had their muscular strength assessed at least twice across the life course (n = 1280).ResultsLevels of muscular strength were persistent between childhood and mid-adulthood and between young- and mid-adulthood, with the highest tracking correlations observed for the combined strength score (childhood to mid-adulthood: r = 0.47, p ConclusionsWeak children are likely to become weak adults in midlife unless strategies aimed at increasing muscular strength levels are introduced. Whether interventions aimed at increasing muscular strength could be implemented in childhood to help establish favourable muscular strength trajectories across the life course and in turn, better future health, warrant further attention.</p

Use of clinical scores in young Australian adults for prediction of atherosclerosis in middle age

We sought to apply a simple cardiovascular health tool not requiring laboratory tests (the Fuster-BEWAT score, FBS) to predict subclinical atherosclerosis. This study included 2657 young adults (</p

The metabolomic signatures of alcohol consumption in young adults

BackgroundMetabolomic analysis may help us to understand the association between alcohol consumption and cardio-metabolic health. We aimed to: (i) replicate a previous study of alcohol consumption and metabolic profiles, (ii) examine associations between types of alcoholic beverages and metabolites and (iii) include potential confounders not examined in previous studies.MethodsCross-sectional data of 1785 participants (age 26–36 years, 52% women) from the 2004–2006 Childhood Determinants of Adult Health study were used. Consumption of beer, wine and spirits was assessed by questionnaires. Metabolites were measured by a high-throughput nuclear magnetic resonance platform and multivariable linear regression examined their association with alcohol consumption (combined total and types) adjusted for covariates including socio-demographics, health behaviours and mental health.ResultsAlcohol consumption was associated with 23 out of 37 lipids, 12 out of 16 fatty acids and six out of 20 low-molecular-weight metabolites independent of confounders with similar associations for combined total alcohol consumption and different types of alcohol. Many metabolites (lipoprotein lipids in high-density lipoprotein (HDL) subclasses, HDL cholesterol, apolipoprotein A-1, phosphotriglycerides, total fatty acids, monounsaturated fatty acids, omega-3 fatty acids) had positive linear associations with alcohol consumption but some showed negative linear (low-density lipoprotein particle size, omega-6 fatty acids ratio to total fatty acids, citrate) or U-shaped (lipoprotein lipids in very-low-density lipoprotein (VLDL) subclasses, VLDL triglycerides) associations.ConclusionsOur results were similar to those of the only previous study. Associations with metabolites were similar for total and types of alcohol. Alcohol consumption in young adults is related to a diverse range of metabolomic signatures associated with benefits and harms to health.</p

Retrospectively Estimating Energy Intake and Misreporting From a Qualitative Food Frequency Questionnaire: An Example Using Australian Cohort and National Survey Data

Qualitative food frequency questionnaires (Q-FFQ) omit portion size information from dietary assessment. This restricts researchers to consumption frequency data, limiting investigations of dietary composition (i.e., energy-adjusted intakes) and misreporting. To support such researchers, we provide an instructive example of Q-FFQ energy intake estimation that derives typical portion size information from a reference survey population and evaluates misreporting. A sample of 1,919 Childhood Determinants of Adult Health Study (CDAH) participants aged 26-36 years completed a 127-item Q-FFQ. We assumed sex-specific portion sizes for Q-FFQ items using 24-h dietary recall data from the 2011-2012 Australian National Nutrition and Physical Activity Survey (NNPAS) and compiled energy density values primarily using the Australian Food Composition Database. Total energy intake estimation was daily equivalent frequency x portion size (g) x energy density (kJ/g) for each Q-FFQ item, summed. We benchmarked energy intake estimates against a weighted sample of age-matched NNPAS respondents (n = 1,383). Median (interquartile range) energy intake was 9,400 (7,580-11,969) kJ/day in CDAH and 9,055 (6,916-11,825) kJ/day in weighted NNPAS. Median energy intake to basal metabolic rate ratios were 1.43 (1.15-1.78) in CDAH and 1.35 (1.03-1.74) in weighted NNPAS, indicating notable underreporting in both samples, with increased levels of underreporting among the overweight and obese. Using the Goldberg and predicted total energy expenditure methods for classifying misreporting, 65 and 41% of CDAH participants had acceptable/plausible energy intake estimates, respectively. Excluding suspected CDAH misreporters improved the plausibility of energy intake estimates, concordant with expected body weight associations. This process can assist researchers wanting an estimate of energy intake from a Q-FFQ and to evaluate misreporting, broadening the scope of diet-disease investigations that depend on consumption frequency data

An age- and sex-specific dietary guidelines index is a valid measure of diet quality in an Australian cohort during youth and adulthood

Measuring diet quality over time is important due to health impacts, but to our knowledge, a Dietary Guidelines Index (DGI) with consistent scoring across childhood/adolescence (youth) and adulthood has not been validated. We hypothesized that a DGI that reflected age- and sex-specific guidelines would be a valid measure of diet quality in youth and adulthood. The DGI is based on the 2013 Australian Dietary Guidelines to reflect current understanding of diet quality and comprises 9 indicators, with a maximum score of 100 points. DGI scores were calculated for participants of the Australian Childhood Determinants of Adult Health study, which included a 24-hour food record during youth (1985, n = 5043, age: 10-15 years) and a 127-item food frequency questionnaire during adulthood (2004-2006, n = 2689, age: 26-36 years). We evaluated construct validity (distribution of scores, principal components analysis, correlation with nutrient density of intakes) and criterion validity (linear regression with population characteristics). DGI scores were multidimensional in underlying structure and normally distributed. Among youth, a lower DGI was significantly associated (P < .05) with smoking and with lower academic achievement and socioeconomic status. DGI scores were negatively correlated with energy, sugar, and fat and positively correlated with fiber, protein, and micronutrients. Among adults, a lower DGI was associated with lower education and self-reported health and higher waist circumference, insulin resistance, and total and low-density lipoprotein serum cholesterol. The DGI is an appropriate measure of diet quality in youth and adulthood because higher scores reflect nutrient-dense, rather than energy-dense, intake and discriminate between population characteristics consistent with the literature. (C) 2019 Elsevier Inc. All rights reserved