Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

"Too much of that stuff can't be good": Canadian teens, morality, and fast food consumption

Recently, public health agents and the popular media have argued that rising levels of obesity are due, in part, to "obesogenic" environments, and in particular to the clustering of fast food establishments in Western urban centers that are poor and working class. Our findings from a multi-site, cross-national qualitative study of teenaged Canadians' eating practices in urban and rural areas offer another perspective on this topic, showing that fast food consumption is not simply a function of the location of fast food outlets, and that Canadian teens engage in complex ways with the varied dimensions of choosing (or rejecting) fast foods. Drawing on evidence gleaned from semi-structured interviews with 132 teenagers (77 girls and 55 boys, ages 13-19 years) carried out between 2007 and 2009, we maintain that no easy relationship exists between the geographical availability of fast food and teen eating behaviors. We use critical obesity literature that challenges widely accepted understandings about obesity prevalence and etiology, as well as (Lamont, 1992) and (Lamont, 2000) concept of "moral boundary work," to argue that teen fast food consumption and avoidance is multifaceted and does not stem exclusively nor directly from spatial proximity or social class. Through moral boundary work, in which teens negotiated with moralistic notions of healthy eating, participants made and re-made themselves as "good" and successful subjects by Othering those who were "bad" in references to socially derived discourses of healthy eating.Canada "Obesogenic" environments Teenagers Fast food Moral boundary work Obesity Diet Social class

Associations between socio-economic status and school-day dietary intake in a sample of grade 5–8 students in Vancouver, Canada

Objective: To examine associations between students’ socio-economic status (SES) and school-day dietary intake, and the roles of parents and peers in shaping these associations. Design: A cross-sectional survey measured school-day intake of vegetables, whole grains, low-fat milk, packaged snack foods and sugar-sweetened beverages. Logistic regression models examined associations between SES (parental education and food insecurity status) and dietary outcomes during or en route to or from school, and examined whether peer modelling or parental norms potentially mediated the associations between SES and dietary outcomes. Setting: Twenty-six public schools in Vancouver, Canada in 2012. Subjects: Nine hundred and fifty students in grades 5–8. Results: Students whose parents completed some college, compared with those completing high school or less, were significantly more likely to consume vegetables daily (unadjusted OR = 1⋅85; 95 % CI 1⋅06, 3⋅22) and students whose parents completed college or university were significantly less likely to consume sugarsweetened beverages daily (unadjusted OR = 0⋅67; 95 % CI 0⋅47, 0⋅94). Food secure students were also significantly less likely to consume sugar-sweetened beverages daily compared with food insecure students (unadjusted OR = 0⋅52; 95 % CI 0⋅29, 0⋅92). Parental norms, but not peer modelling, emerged as a potential mediator of the association between SES and vegetable intake. SES was not significantly associated with the remaining dietary outcomes. Conclusions: Higher SES was significantly associated with two of five school-day dietary outcomes and predicted higher likelihood of daily nutritious food choices at school. The study suggests that there is room for improvement in school-day dietary quality for students from all SES backgrounds in Vancouver.Land and Food Systems, Faculty ofReviewedFacultyGraduat

Men, food, and prostate cancer: Gender influences on men’s diets

Although healthy eating might enhance long-term survival, few men with prostate cancer make diet changes to advance their well-being. Men's typically poor diets and uninterest in self-health may impede nutrition interventions and diet change. Food choice behavior is complex involving many determinants, including gender, which can shape men's health practices, diets, and prostate cancer experiences. Developing men-centered prostate cancer nutrition interventions to engage men (and where appropriate their partners) in promoting healthy diets can afford health benefits. This article presents an overview and synthesis of current knowledge about men's food practices and provides an analysis of diet and diet change behaviors for men with prostate cancer. Masculinity and gender relations theory are discussed in the context of men's food practices, and suggestions for future applications to nutrition and prostate cancer research and diet interventions are made

Gender relations, prostate cancer and diet: re-inscribing hetero-normative food practices

Although diet might be a valuable adjunct to prostate cancer care, men typically have poorer diets than women and are less likely to change the way they eat after a cancer diagnosis. Gender theory suggests that dominant ideals of masculinity shape men's health and food practices; however, the role of female partners in men's diets is poorly understood. Through qualitative analysis of in-depth interviews, this article explores accounts of 14 Canadian couples' food practices guided by a gender relations framework to expose how tacit performances of masculinity and femininity interact to shape the diets of men with prostate cancer. Findings show that many men became more interested and involved in their diets after a prostate cancer diagnosis, practices that might be theorized as a counter hegemonic project or 'feminization', adding to other prostate cancer induced emasculations (i.e., treatment induced incontinence and impotence). At the same time, however, couples mutually limited men's engagement with diet while concurrently reinforcing women's traditional femininities in nurturing the men in their lives through food provision. Also embedded here were women's attempts to mitigate subordinate productions of masculinity by catering to their partner's tastes as well as monitoring their diets. Most couples mutually maintained traditional gender food 'roles' by positioning women as proficient leaders in domestic food provision and men as unskilled 'try-hard' and sometimes uninterested assistants. Findings also revealed complex gender power dynamics that predominated as complicit in sustaining hegemonic masculinity through women's deference to men's preferences and careful negotiation of instrumental support for men's diet changes. Overall men and women jointly worked to re-inscribe hetero-normative family food practices that shaped men's diets and nutritional health

A Comparison of Dietary Practices At or En Route to School between Elementary and Secondary School Students in Vancouver, Canada

Background: There is evidence that dietary quality declines as children age in North America, but few studies have explored whether food environment exposures in secondary schools as opposed to elementary schools are associated with changes in students’ school-day food choices. Methods: This study examined differences in dietary practices (at or en route to and/or from school) between students in their last years of elementary school (grades 5-7) and first year of secondary school (grade 8) in Vancouver, Canada, controlling for socio-demographic characteristics and school-level socio-economic status. Demographic characteristics and dietary data were collected through a cross-sectional survey (n=950 from 26 schools) and combined with school-level socioeconomic data derived from the 2006 Canadian Census. Results: Multi-level logistic regression analyses indicated that secondary school students were significantly more likely to report daily consumption of fast foods (Odds Ratio (OR)=1.92; 95% Confidence Interval (CI)=1.18-3.12) and minimally nutritious packaged snacks (e.g., candy or chocolate bars) (OR=1.60; CI=1.05-2.45), and to report regular purchases from off-campus retailers (OR=1.63; CI=1.10-2.42). Gender, food insecurity, lower acculturation to Canada, and access to more weekly spending money were associated with nutritionally-poor practices. Students attending schools drawing from lower income neighborhoods were also significantly more likely to consume fast foods and packaged snacks daily. The majority of students sampled did not report consuming healthy foods such as fruit and vegetables daily at or en route to and/or from school. Intake of fruit, vegetables and low fat milk did not differ significantly between elementary and secondary school students. Conclusions: Findings suggest that research and intervention strategies should address modifiable school-level exposures and policies to improve dietary practices for both elementary and secondary school-aged youth, while at the same time, addressing socio-cultural factors associated with eating behavior.Land and Food Systems, Faculty ofNon UBCReviewedFacult

Prostate cancer, masculinity and food. Rationales for perceived diet change

Research indicating that certain diets can lower prostate-specific antigen levels suggests that diet change might be a beneficial treatment adjunct for low-grade prostate cancer. However, few men with prostate cancer adopt significant diet change, indicating a need to better understand how and why they make food choices. This qualitative study explored men's perceptions of their diets following a prostate cancer diagnosis, and the rationales underpinning diet changes (or lack thereof). Individual semi-structured interviews were conducted with 14 men ages 48-78 years who had been diagnosed with prostate cancer within the previous 5 years. Findings show that participants exhibited varied dietary patterns, which we labeled 'eating as usual', 'intensifying efforts', 'adding-on', and 'overhauling diets'. Four main domains informed rationales for diet changes or lack thereof: perception of pre-prostate cancer diet, diet and health understandings, orientation towards prostate cancer, and the need for " doing something." Dietary ideals framed as masculine, important, action-oriented and autonomous endeavors contributed to participants' food choice behaviors, suggesting that their alignment to masculine dietary ideals influenced if and how they engaged in diet change. A better understanding of how masculine food ideals shape food choice might be useful in expanding food choice models and in developing effective nutrition education interventions for this group