The “School Foodshed”: schools and fast-food outlets in a London borough

Purpose – The purpose of this paper is to explore the location of fast-food outlets around secondary schools and the influence of fast-food availability on the food choices of school children in an inner-London borough. Design/methodology/approach – A number of methods including: mapping of outlets relative to schools; sampling food; gathering data on secondary school food policies; observing food behaviour in fast food outlets and focus groups with young people. Findings were fed back to a committee consisting of representatives from nutrition, public health, planning services and local community groups. Findings – There are concentrations of fast-food outlets near schools and students reported use of these, including “stories” of skipping lunch in order to save money and eat after school at these outlets. Food from fast-food outlets was high in fat, saturated fat and salt, but these are not the only source of high such foods, with many of the students reporting buying from shops near the school or on the way to or from school. At lunchtime food outlets were less likely to be used by school students in areas near schools that have a “closed gate” policy. Research limitations/implications – The “snapshot” nature of the research limited what can be said about the food behaviours of the children outside school hours. Practical implications – The local policy context requires action to improve both the food offered in schools and the immediate environment around the school in order to tackle fast-food and other competitive foods on offer outside the school. Originality/value – This is one of the first studies in the UK to systematically map fast food outlets around schools and explore what might be done. This research shows how it is possible to link the findings of local research and develop local responses from both public health and local authority planning perspectives. The research moves away from a mere documenting of problems to devising integrated public health solutions. The findings show how public health and planning services can work together to the mutual benefit of each other

Gendered Dietary Supplements: Does the Marketing Reflect Different Formulations?

Many dietary supplements are marketed with gendered terms, such as “for her” and “for him.” However, whether these statements reflect different nutrient contents of products and a biological basis has not been systematically examined. PURPOSE: The purpose of this analysis was to compare the micronutrient content of dietary supplements that are sold in separate forms based on gendered marketing. METHODS: The National Institutes of Health Dietary Supplements Label Database (DSLD) was searched using gendered terms, such as “hers,” “her,” “women,” “his,” “him,” and “men.” Eighty-nine pairs of micronutrient-containing products that were commercially available as a women’s version and a men’s version were identified. Nutrients included in the analysis included common vitamins (biotin, choline, folate/folic acid, niacin, pantothenic acid, riboflavin, thiamine, and vitamins A, B12, B6, C, D, E, and K) and minerals (calcium, chloride, chromium, copper, iodine, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, and zinc). Nutrient quantities in units of % Daily Value (%DV) were compared between gendered marketing categories using independent-samples t-tests and calculation of effect sizes using Cohen’s d. Data were analyzed using R (v. 4.2.1) and the rstatix package. RESULTS: Statistically significant differences were observed between gendered marketing categories for iron (n=40 pairs; women’s: 85±42%; men’s: 6±14%; p\u3c0.001; effect size: 2.56 [large]) and calcium (n=62 pairs; women’s: 26±19%; men’s: 16±13%; p=0.03; effect size: 0.57 [moderate]), but no other nutrients. CONCLUSION: Micronutrient-containing supplements marketed specifically to women and men primarily had similar micronutrient content, except for higher iron and calcium in women’s products. For iron, this difference is reflective of anticipated biological need, as acknowledged by a higher Recommended Dietary Allowance (RDA) for adolescent and adult females up to age 50 (8 to 27 mg/d) as compared to males (8 mg/d). For calcium, the RDA is equivalent for males and females at all ages, except for ages 51-70 years (females: 1,200 mg/d; males: 1,000 mg/d). Therefore, the observed differences in iron and calcium appear to have a legitimate biological basis, although for specific age ranges. In conclusion, few differences in micronutrient content were seen between products marketed specifically as women’s or men’s products. However, the observed differences in iron and calcium may be reflective of biological need in select age groups

Body Fat Percentage and Hormonal Intrauterine Device Use Are Independently Associated with Self-Reported Menstrual Regularity in Young Adult Females

Menstrual regularity is a key indicator of energy availability, long-term bone density, and other important health information in females. The occurrence of a regular menstrual cycle indicates that an individual’s level of estrogen is supportive of strong bones and that they are achieving the caloric intake required to support their activity level. In contrast, an irregular menstrual cycle can be indicative of insufficient energy availability which may, over time, result in low bone mineral density and thus a higher risk of bone stress injuries. However, hormonal contraceptive use, including the rising use of intrauterine devices (IUDs), may mask these changes in menstrual regularity. PURPOSE: The purpose of this study was to examine factors related to self-reported menstrual regularity among a population of young, generally healthy females. METHODS: Participants were included if they were no more than 50 years of age at the time of enrollment and had less than 50% body fat as assessed via dual-energy x-ray absorptiometry (DXA). Participants were asked via questionnaire if they reported having a regular menstrual cycle, defined as menstrual periods occurring at predictable intervals and no missed periods in the past six months. Additionally, participants were asked if they were currently using any form of hormonal contraception, and if so, what type. A logistic regression was run with menstrual regularity (1 = regular; 0 = irregular) as the dependent variable and body fat percentage (BFP) and contraceptive type as the predictors. RESULTS: Out of the 76 participants (mean±SD age: 23.2±5.1 years; height: 164.5±6.5 cm; weight: 65.2±13.6 kg; BFP: 32.3±8.5%), 54 (71%) reported having a regular menstrual cycle. Of the 45 (59%) participants using hormonal contraception, 27 (60%) used a combined oral contraceptive pill, six (13%) used a progestin-only pill, nine (20%) used an IUD, two (4%) used a hormonal implant, and one (2%) used a vaginal ring. Overall, a higher BFP was associated with a greater likelihood of menstrual regularity (coefficient±SE: 0.08 ± 0.04; p = 0.04) while IUD use was associated with a lower likelihood (coefficient±SE: -1.8 ± 0.9; p = 0.04). No other hormonal contraception type was independently associated with self-reported menstrual regularity. CONCLUSION: These results collectively suggest, within a population of generally healthy, young adult females, that lower BFP and hormonal IUD use are both independently associated with a lower likelihood of having a regular menstrual cycle. When assessing the lack of a regular menstrual cycle, practitioners may consider hormonal IUD use as one potential factor in addition to a general assessment of body composition and energy availability. However, this analysis was limited by a relatively small sample size, which may have reduced the ability to detect the relationship between menstrual regularity and less commonly used contraceptive types. Future research is required to determine the relationship between these contraceptive types and menstrual regularity in generally healthy adult females

Exploring the Role of Mental Toughness in Bone Mineral Content: A Preliminary Study

Bone mineral content (BMC), a measure of the mineral content within a person’s bones, is an important parameter in the assessment of bone health. Changes in BMC can be indicative of bone-related conditions. Dual-energy X-ray absorptiometry (DXA) is one of the most widely used and accurate methods for measuring BMC. Sex, age, race, and BMI are known to influence BMC. Physical activity is positively related to BMC levels. Mental toughness (MT) is conceptualized as a state-like psychological resource conducive to goal-oriented pursuits and is positively linked to physical activity outcomes. The relationship between MT and BMC has not been explored. PURPOSE: To investigate the isolated effect of MT on BMC after eliminating the confounding effects of sex, age, race, and BMI. METHODS: A total of 95 individuals participated in the study across two study sites. The sample (Mage = 34.57, SD = 15.87) was predominantly White (64%), normal weight/overweight (MBMI = 25.96, SD = 4.88) males (54%). DXA scans were performed on calibrated scanners using standard procedures. MT was assessed via the Mental Toughness Index (MTI). To reduce measurement error, the MTI was administered twice, separated by a two-week interval. A linear regression model was used to analyze the relationship between BMC and the average of the two MTI scores, while controlling for sex, age, race, and BMI in MATLAB (R2023a). A Cohen’s d for MT and BMC was additionally conducted. RESULTS: The linear regression model was BMC ~ 1 + Sex + Age + Race + BMI + MT. The overall regression was statistically significant (R2 = 0.183, F(94, 88) = 2.78, p = .012). MT was found to significantly predict BMC (β = 0.093, p = .008, d = 2.7). CONCLUSION: The findings underscore the statistical significance of MT as a predictor of BMC, even when accounting for the influence of sex, age, race, and BMI. The effect size points to the practical significance of this relationship, suggesting that individuals with higher MT levels may exhibit greater BMC. Future investigations should consider incorporating demographic covariates to gain deeper insights into these relationships and conduct interventional studies to identify potential underlying mechanisms (e.g., how trainable MT could be linked, to some degree, with an increase in BMC)

Body Composition and Anthropometric Changes During a 10-week Training Academy in Police Recruits

Obesity and cardiometabolic risk factors are often present in law enforcement personnel, which may compromise physical readiness and long-term health. As such, physical fitness interventions are warranted for promoting officers\u27 performance and wellbeing. PURPOSE: To determine the body composition and anthropometric changes experienced by police recruits undergoing a departmental training academy. METHODS: Twenty-one police recruits (20 M, 1 F; age: 25.1 ± 5.0 y; BMI: 27.8 ± 4.3 kg/m2) were tested before and after a 10-week training academy in Lubbock, Texas. Supervised physical training was conducted 5 times per week and consisted of ~1–1.5 hours of high-intensity, multi-modal (i.e., running, weightlifting, calisthenics), functional training following linear periodization. Dual-energy X-ray absorptiometry (DXA; GE Lunar iDXA) and 3-dimensional optical imaging (3DO; Size Stream SS20) were performed to assess body composition and anthropometry. Paired-samples t-tests were performed to compare values before and after the training academy, and Cohen’s d effect sizes were generated. After Bonferroni correction, statistical significance was accepted at p\u3c0.003. Changes are presented as mean ± SD. RESULTS: From DXA, statistically significant decreases in total fat mass (FM; -3.3 ± 3.1 kg, p\u3c0.001, d=1.1), trunk FM (-2.1 ± 2.2 kg, p\u3c0.001, d=1.0), arms FM (-0.3 ± 0.3 kg, p=0.001, d=1.1), legs FM (-0.9 ± 0.9 kg, p\u3c0.001, d=1.1), and body fat percentage (-3.1 ± 2.5%, p\u3c0.001, d=1.2) were observed. Increases in total lean soft tissue (LST; 1.3 ± 1.3 kg, p=0.002, d=1.0) and trunk LST (0.8 ± 0.9 kg, p\u3c0.001, d=0.9) were also noted, with trends for increases in leg LST (0.2 ± 0.7 kg, p=0.096, d=0.4) and arm LST (0.2 ± 0.4, p=0.04, d=0.5). Decreases in 3DO abdomen circumference (-3.5 ± 3.8 cm, p\u3c0.001, d=0.9) and hip circumference (-2.2 ± 2.2 cm, p\u3c0.001, d=1.0) were noted, with trends for decreases in the circumferences of the waist (-2.4 ± 3.6 cm, p=0.007, d=0.7) and upper arm (-0.9 ± 1.5 cm, p=0.02, d=0.6). No significant changes in thigh circumference (-0.7 ± 1.9 cm, p=0.12, d=0.4) or calf circumference (-0.2 ± 1.5 cm, p=0.52, d=0.1) were noted. A trend for a decrease in body mass (-2.0 ± 3.1 kg, p=0.007, d=0.7) was also observed. CONCLUSION: The present study indicates that police academy training significantly improves recruits\u27 body composition, both reducing FM and increasing LST, which has the potential to positively affect operational performance. Future studies should track these changes over time to help develop ongoing health and fitness strategies for career police officers, ultimately improving their long-term wellbeing and job readiness

Disclosure of Diagnosis and Prognosis to Cancer Patients in Traditional Societies: A Qualitative Assessment from Lebanon

Background: The issue of when, how, and whether to disclose full information about cancer diagnosis and prognosis to patients is still debated in some parts of the world, including Lebanon. Despite formal academic emphasis on a larger autonomy for Lebanese patients in deciding the course of their disease, there has been no apparent impact on either clinical practices nor public expectations.  The topic of full disclosure is rarely if ever discussed in open fora, or in mass media channels in Lebanon. Subjects and Method: Seven key stakeholders were identified and interviewed regarding obstacles to spelling out clear guidelines within our national context. The interviews were transcribed and subsequently analyzed for recurrent patterns and concepts.Results: Senior oncologists interviewed generally favored gradual disclosure and most perceived a changing trend among both patients and physicians towards more disclosure. They also agreed on a need for the formal training of residents and fellows to better communicate bad news to patients. All the interviewed physicians attested to the benefits of candid disclosure in terms of patient psychology and overall wellbeing. They also mentioned that psychological services, which may facilitate the disclosure process, are greatly under-utilized in oncology. Lawyers highlighted the vagueness of the current Lebanese legislation regarding the obligation of truthful disclosure in comparison to laws in developed countries and the implications on patient autonomy. Conclusion: The study identified the need for improvements at various levels, including interventions to modify the expectations of the Lebanese public regarding cancer disclosure and to clarify existing legislative texts.Keywords: Ethics; Legislation; Middle-East; DisclosureCorrespondence: James Feghali. Faculty of Medicine, American University of Beirut (AUB), Lebanon, 1101 North Calvert Street, 610, Baltimore, Maryland, 21202. E-mail: [email protected]. Telephone: +1-(267)-595-9995.Journal of Epidemiology and Public Health (2019), 4(2): 109-116https://doi.org/10.26911/jepublichealth.2019.04.02.0

The Effect of Body Composition Methodology on Resulting Energy Availability Assessments

Energy availability (EA) is defined as the total daily energy available to an individual after accounting for that expended during exercise and standardized to fat-free mass (FFM). Generally, EA values less than 30 kcal/kg FFM/day are considered “low” and have been associated with deleterious effects on reproductive and hormonal health in females. However, it is unclear whether the method used to estimate FFM influences the resulting EA values to a degree that may affect interpretation and clinical decision-making. PURPOSE: To determine the effect of FFM values derived from various methods of body composition assessment on the resulting range and interpretation of EA values. METHODS: Four EA estimates were generated in 38 healthy females (mean ± SD age: 25.6 ± 6.2 years; height: 163.6 ± 7.4 cm; weight: 64.7 ± 13.8 kg) using different combinations within a reasonable range of lower and higher (25 and 35 kcal/kg bodyweight, respectively) energy intake values and lower and higher (3.5 and 7 kcal/kg bodyweight, respectively) exercise energy expenditure values. Resulting estimates were then standardized to FFM values from air displacement plethysmography (ADP), bioelectrical impedance spectroscopy (BIS), and bioelectrical impedance analysis (BIA) from both a research-grade (multi-frequency) and consumer-grade (dual-frequency) device. Resulting EA values were then compared to those using FFM from dual-energy x-ray absorptiometry (DXA). Each estimate was assigned to one of three EA “zones”: “low” (less than 30 kcal/kg FFM), “reduced” (30-44.9 kcal/kg FFM), or “adequate” (≥45 kcal/kg FFM). Individual EA estimates that were in different zones when compared between two devices were considered discordant. RESULTS: When compared to DXA-derived estimates, EA values were discordant in up to 13-16% of individuals depending on body composition method used. Discordant values were generally more common in the plots assuming higher (35 kcal/kg bodyweight) energy intake values and were most likely to be considered “adequate” using DXA-derived FFM versus “reduced” using alternate methods. CONCLUSION: EA estimates are generally robust to the method of body composition assessment used. However, divergent interpretations may occur in a small minority of individuals in which alternate methods may provide lower EA values than DXA

Comparison of Laboratory-Grade and Consumer-Grade Hand-to-Foot Bioelectrical Impedance Analyzers for Body Composition Estimation

Bioelectrical impedance analysis (BIA) is a simple and effective technique to estimate body composition, including body fat percentage (BFP). While these analyzers are a popular method of describing a person’s body composition, laboratory-grade devices are expensive and inaccessible to most people. As a result, they may be an unrealistic method for consumers to use. However, consumer-grade devices are increasingly available. PURPOSE: The purpose of this study was to compare laboratory-grade and consumer-grade bioelectrical impedance analyzers. METHODS: Seventy-five adults (40 F, 35 M) were evaluated using a laboratory-grade, hand-to-foot, multifrequency bioelectrical impedance analyzer (BIALAB; Seca mBCA 515) and a consumer-grade, hand-to-foot, single frequency bioelectrical impedance analyzer (BIACON; Omron HBF-516). Both devices administer undetectable electrical pulses through one extremity that are measured at another extremity, where the voltage drop (impedance) is determined. This information is used to estimate body fluids and composition. RESULTS: A strong, statistically significant correlation between devices was observed for BFP (r: 0.93, R2: 0.87, pCON overestimated BFP by 3.5 ± 3.4% (mean ± SD) relative to BIALAB (BIACON: 28.3 ± 9.6%; BIALAB: 24.8 ± 9.3%; pCONCLUSION: These results collectively suggest that while the laboratory-grade and consumer-grade analyzers in our study exhibit strong correlations when assessing a group of individuals, the consumer-grade device overestimates BFP. Additionally, the SEE indicates that 3.4% error can be expected with the consumer-grade device. Overall, the Omron HBF-516 consumer-grade device may be an adequate and affordable option to estimate body composition in some contexts, but results should be interpreted cautiously when used in individuals

A Between-sex Comparison of the Validity of Body Fat Percentage Estimates From Four Bioelectrical Impedance Analyzers

Bioelectrical impedance analysis (BIA) devices administer electrical currents through surface electrodes in contact with the hands and/or feet. The measured reactance and resistance of various bodily tissues to these currents are then used to estimate body fat percentage (BFP) and other body composition values of interest based on algorithms derived from validation data. Owing to different patterns of fat distribution between sexes, it is unclear whether the configuration of electrodes (i.e., hand-to-hand, foot-to-foot, or hand-to-foot) may affect the validity of these devices in males versus females. PURPOSE: The purpose of this study was to determine the validity of BFP values across four BIA devices – one consumer-grade foot-to-foot device (RENPHO Smart Bathroom Scale), one consumer-grade hand-to-hand device (Omron HBF-306), one consumer-grade octapolar device (InBody H20N), and one research-grade octapolar device (Seca mBCA 515/514) – against a criterion four-compartment model (4C), and to compare these values between males and females. METHODS: Seventy-four healthy participants (35 males and 39 females) were included in this analysis. Participants abstained from all food, fluid, caffeine, and alcohol for at least 8 hours prior to each visit. Total error (TE) was calculated as the root mean square error between the estimate of each BIA device and that of the 4C model. Standard error of the estimate (SEE) was defined as the residual standard error value from ordinary least squares regression. Constant error (CE) was calculated as the average difference between the estimate of each BIA device and that of the 4C model. RESULTS: Participants had a mean ±SD age of 27.2 ±7.3 years, height of 168.1 ±8.9 cm, weight of 72.2 ±16.7 kg, and 4C BFP of 24.9 ±9.2%. In the entire sample, ranges for validity metrics of interest were as follows: TE: 3.2% (Seca) to 7.2% (RENPHO); SEE: 3.3% (Seca) to 5.7% (RENPHO); CE: -0.02 ±3.4% (InBody) to -3.46 ±4.1% (Omron). Across all devices, both TE and SEE were lower in females, with the largest between-sex differences observed for the InBody and RENPHO. Both octapolar devices (InBody and Seca) exhibited low group-level error in males and females (all CE within ±0.32%). Meanwhile, the RENPHO and Omron devices generally underestimated BFP with a greater degree of underestimation in females (CE of -2.6% and -3.7%, respectively) than males (CE of -0.1% and -3.2%, respectively), particularly for the RENPHO. CONCLUSION: Among the four BIA devices investigated, octapolar devices tended to have higher validity overall. All devices demonstrated lower TE and SEE in females, with the greatest between-sex differences observed in the InBody and RENPHO models. Users should be aware that commercially available hand-to-hand or foot-to-foot BIA devices such as the Omron and RENPHO models used in this study may systematically underestimate BFP compared to a criterion 4C model. In contrast, hand-to-foot octapolar analyzers exhibit strong group-level validity in both sexes