Hours spent and energy expended in physical activity domains: Results from The Tomorrow Project cohort in Alberta, Canada

<p>Abstract</p> <p>Background</p> <p>Knowledge of adult activity patterns across domains of physical activity is essential for the planning of population-based strategies that will increase overall energy expenditure and reduce the risk of obesity and related chronic diseases. We describe domain-specific hours of activity and energy expended among participants in a prospective cohort in Alberta, Canada.</p> <p>Methods</p> <p>The <it>Past Year Total Physical Activity Questionnaire </it>was completed by 15,591 <it>Tomorrow Project</it>^®participants, between 2001 and 2005 detailing physical activity type, duration, frequency and intensity. Domain-specific hours of activity and activity-related energy expenditure, expressed as a percent of total energy expenditure (TEE) (Mean (SD); Median (IQR)) are reported across <it>inactive </it>(<1.4), <it>low active </it>(1.4 to 1.59), <it>active </it>(1.6 to 1.89) and <it>very active </it>(≥ 1.9) Physical Activity Level (PAL = TEE:REE) categories.</p> <p>Results</p> <p>In <it>very active </it>women and amongst all men except those classified as <it>inactive</it>, activity-related energy expenditure comprised primarily occupational activity. Amongst <it>inactive </it>men and women in <it>active, low active </it>and <it>inactive </it>groups, activity-related energy expenditure from household activity was comparable to, or exceeded that for occupational activity. Leisure-time activity-related energy expenditure decreased with decreasing PAL categories; however, even amongst the most active men and women it accounted for less than 10 percent of TEE. When stratified by employment status, leisure-time activity-related energy expenditure was greatest for retired men [mean (SD): 10.8 (8.5) percent of TEE], compared with those who were fully employed, employed part-time or not employed. Transportation-related activity was negligible across all categories of PAL and employment status.</p> <p>Conclusion</p> <p>For the <it>inactive </it>portion of this population, active non-leisure activities, specifically in the transportation and occupational domains, need to be considered for inclusion in daily routines as a means of increasing population-wide activity levels. Environmental and policy changes to promote active transport and workplace initiatives could increase overall daily energy expenditure through reducing prolonged sitting time.</p

Patterns and trajectories of gestational weight gain:a prospective cohort study

BACKGROUND: Gestational weight gain in excess of or below Health Canada's guidelines is known to increase the risk of adverse outcomes for both the woman and her baby. This study describes patterns and trajectories of total and rate of gestational weight gain in a large prospective cohort of pregnant women and adolescents in the Alberta Pregnancy Outcomes and Nutrition study. METHODS: We collected weight and height data for 1541 pregnant adolescents and women (mean age 31 years, < 27 weeks' gestation) recruited through advertisements and physicians' offices in Calgary and Edmonton between May 2009 and November 2012. Data were collected once during each trimester following enrolment and once at about 3 months post partum. The participants were categorized according to their prepregnancy body mass index (BMI) as underweight, of normal weight, overweight or obese. We calculated distributions of total and weekly rates of weight gain and determined trajectories of weight gain for each prepregnancy BMI category. RESULTS: Of the 1541 participants, 761 (49.4%) exceeded Health Canada's guidelines for total gestational weight gain, and 272 (17.6%) gained less weight than recommended. A total of 63 (19.2%) and 38 (23.6%) participants categorized as overweight or obese, respectively, exceeded the recommended upper limit by 5 to less than 10 kg, and 53 (16.2%) and 27 (16.8%), respectively, exceeded the upper limit by at least 10 kg. Ninety-five participants (30.3%) in the overweight group and 59 (39.6%) of those in the obese group gained weight at more than double the recommended rate between the second and third trimesters. The median weight gain for participants in the normal, overweight and obese categories had exceeded recommended upper limits by about 30, 20 and 18 weeks' gestation, respectively. INTERPRETATION: Adherence to Health Canada's guidelines for gestational weight gain was low. Excess gestational weight gain was most marked among those with a prepregnancy BMI in the overweight or obese category. The findings suggest that weight management in pregnancy is challenging and complex. Messages and supports that are tailored for women in different prepregnancy BMI categories may help to improve guideline-concordant gestational weight gain

Adherence to Canada's Food Guide Recommendations during Pregnancy:Nutritional Epidemiology and Public Health

Background: In Canada, pregnant women are typically referred to Canada's Food Guide (CFG), a set of national dietary recommendations designed to promote adequate nutrient intake. Pregnant women are also advised to gain weight within the Institute of Medicine guidelines, which differ by prepregnancy body mass index (BMI). However, CFG recommendations do not account for prepregnancy BMI and provide no guidance on "less healthy" (LH) foods. Objective: The aim of this study was to score women's diets according to adherence to CFG recommendations and consumption of LH foods and to examine differences between these diet scores by prepregnancy BMI. Methods: Participants enrolled in the APrON (Alberta Pregnancy Outcomes and Nutrition) prospective cohort study completed a 24-h recall in their second trimester (n = 1630). A score was created on the basis of each daily dietary CFG recommendation met, ranging from 0 to 9. The distribution of consumption (grams per day) of 8 LH food groups was given a score of 0 (none) or 1, 2, or 3 (representing the lowest, middle, or highest tertiles, respectively) and summed giving a total LH score of 0-24. Results: There were few differences in CFG recommendations met by prepregnancy BMI status, although fewer women who were overweight or obese prepregnancy met the specific recommendation to consume 7-8 servings of fruit or vegetables/d than did those who were under- or normal weight (47% and 41% compared with 50% and 54%, respectively). Although differences were small, women who were obese prepregnancy had lower CFG scores (β = -0.28; 95% CI:-0.53, -0.02) and higher LH scores (β = 0.45; 95% CI: 0.04, 0.86) than did those who were normal weight. Conclusion: The study results suggest that more attention may need to be paid to individualized counseling on dietary recommendations that take account of prepregnancy BMI

Fruit and vegetable consumption and bone mineral density; the Northern Ireland Young Hearts Project

BackgroundStudies examining the relation between bone mineral density (BMD) and fruit and vegetable consumption during adolescence are rare.ObjectiveOur objective was to determine whether usual fruit and vegetable intakes reported by adolescents have any influence on BMD.DesignBMD was measured by dual-energy X-ray absorptiometry at the nondominant forearm and dominant heel in a random sample of 12-y-old boys (n = 324), 12-y-old girls (n = 378), 15-y-old boys (n = 274), and 15-y-old girls (n = 369). Usual fruit and vegetable consumption was assessed by an interviewer-administered diet history method. Relations between BMD and fruit and vegetable intake were assessed by using regression modeling.ResultsUsing multiple linear regression to adjust for the potential confounding influence of physical and lifestyle factors, we observed that 12-y-old girls consuming high amounts of fruit had significantly higher heel BMD (β = 0.037; 95% CI: 0.017, 0.056) than did the moderate fruit consumers. No other associations were observed.ConclusionHigh intakes of fruit may be important for bone health in girls. It is possible that fruit's alkaline-forming properties mediate the body's acid-base balance. However, intervention studies are required to confirm the findings of this observational study

Tracking of physical activity, fitness, body composition and diet from adolescence to young adulthood: The Young Hearts Project, Northern Ireland

BACKGROUND: The assumption that lifestyles formed early in life track into adulthood has been used to justify the targeting of health promotion programmes towards children and adolescents. The aim of the current study was to use data from the Northern Ireland Young Hearts Project to ascertain the extent of tracking, between adolescence and young adulthood, of physical activity, aerobic fitness, selected anthropometric variables, and diet. METHODS: Males (n 245) and females (n 231) were assessed at age 15 y, and again in young adulthood [mean (SD) age 22 (1.6) y]. At both timepoints, height, weight and skinfold thicknesses were measured, and physical activity and diet were assessed by questionnaire and diet history method respectively. At 15y, fitness was assessed using the 20 metre shuttle run, while at young adulthood, the PWC170 cycle ergometer test was used. For each measurement made at 15y, subjects were ranked into 'low' (L1; lowest 25%), 'medium' (M1; middle 50%) or 'high' (H1; highest 25%) categories. At young adulthood, similar categories (L2, M2, H2) were created. The extent of tracking of each variable over time was calculated using 3 × 3 matrices constructed using these two sets of categories, and summarised using kappa (κ) statistics. RESULTS: Tracking of diet and fitness was poor (κ ≤ 0.20) in both sexes, indicating substantial drift of subjects between the low, medium and high categories over time. The tracking of physical activity in males was fair (κ 0.202), but was poor in females (κ 0.021). In contrast, anthropometric variables such as weight, body mass index and sum of skinfolds tracked more strongly in females (κ 0.540, κ 0.307, κ 0.357 respectively) than in males (κ 0.337, κ 0.199, κ 0.216 respectively). CONCLUSIONS: The poor tracking of fitness and diet in both sexes, and physical activity in females, suggests that these aspects of adolescent lifestyle are unlikely to be predictive of behaviours in young adulthood. In contrast, the fair to moderate tracking of anthropometric variables, particularly in females, suggests that attempts to reduce the ever increasing incidence of overweight and obesity in adults, should probably begin in earlier life

Considerations for Dietary Assessment in the Canadian Partnership for Tomorrow Project

Dietary factors are leading contributors to chronic disease and mortality globally and in Canada (1–3), and have been recognized as modifiable risk factors for certain cancers (4). However, much remains to be learned about how dietary factors interact with other modifiable and nonmodifiable exposures and physiologic variables to influence disease risk in humans (5,6). Information collected from large prospective cohorts plays an important role in furthering our understanding of diet-disease relationships (7,8). To advance knowledge on how to promote health and prevent disease, it is critically important to use robust tools for collecting dietary information from participants in such cohorts (9). This guide is intended to be utilized by researchers designing nutritional epidemiological research and in particular, to guide the implementation of dietary assessment tools within the CPTP cohorts. The aim is to provide guidance on method selection, data collection, and analyses of dietary data, as well as stimulate discussions of harmonization of methods across cohorts to advance the evidence base. Because objective measures such as biomarkers of diet are currently few, burdensome, costly, and limited in the information they provide about the types of foods and beverages people consume (5,6), researchers typically rely upon self-report tools. However, it has long been recognized that self-reported dietary data are affected by error, including systematic error or bias (9,10), leading some commentators to suggest that research should no longer rely on selfreport approaches (11,12). However, much work has been conducted to better understand and address error in self-report dietary intake data (9,10). Such work has informed the development of novel technology-enabled tools to allow collection of the least-biased data possible, as well as the development of rigorous statistical approaches to mitigate the effects of error (13–16). Based on what is known about sources and types of error in data captured using different types of tools, it has been recommended that a combination of tools may be the optimal way forward for cohort studies. Specifically, multiple 24-hour recalls (24HRs), administered in combination with a food frequency questionnaire (FFQ), may allow researchers to leverage the strengths of each instrument (10,14,17). Data from 24HRs provide comprehensive detail on intake and measure consumption with less bias than FFQs. On the other hand, FFQs measure intake over a longer period (e.g. past month or year) (18–20), meaning they are better able to capture intake of foods and beverages that may be consumed more episodically (e.g., whole grains, dark-green vegetables) but that may be important to diet-disease relationships. The availability of weband mobile device-based dietary assessment tools for use in Canada and emerging statistical techniques to analyze the resulting data makes this multiple-tool scenario a realistic consideration for Alberta’s Tomorrow Project (21), other cohorts within the Canadian Partnership for Tomorrow Project (CPTP) (22), and other health-related studies. With comprehensive and standardized measurement of dietary exposures across cohorts, the identification of promising strategies to reduce diet-related disease risk among Canadians can be furthered (9)

Towards refining WCRF/AICR cancer prevention recommendations for red and processed meat intake: Insights from Alberta\u27s Tomorrow Project cohort

Current cancer prevention recommendations advise limiting red meat intake to \u3c500g/week and avoiding consumption of processed meat, but do not differentiate the source of processed meat. We examined the associations of processed meat derived from red vs. non-red meats with cancer risk in a prospective cohort of 26,218 adults who reported dietary intake using the Canadian Diet History Questionnaire. Incidence of cancer was obtained through data linkage with Alberta Cancer Registry with median (IQR) follow-up of 13.3 (5.1) years. Multivariable Cox proportional hazards regression models were adjusted for covariates and stratified by age and gender. The median (IQR) consumption (g/week) of red meat, processed meat from red meat and processed meat from non-red meat were 267.9 (269.9), 53.6 (83.3), and 11.9 (31.8), respectively. High intakes (4th Quartile) of processed meat from red meat was associated with increased risk of gastro-intestinal cancer Adjusted Hazard Ratio (AHR) (95% CI): 1.68 (1.09-2.57) and colorectal cancers AHR (95% CI): 1.90 (1.12-3.22), respectively in women. No statistically significant associations were observed for intakes of red meat or processed meat from non-red meat. Results suggests that the carcinogenic effect associated with processed meat intake may be limited to processed meat derived from red meats. The findings provide preliminary evidence toward refining cancer prevention recommendations for red and processed meat intake

Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications

Few studies have explored pre-pregnancy diet and its relationship with pregnancy outcomes. The objectives of this study were to: (1) derive pre-pregnancy dietary patterns for women enrolled in a prospective cohort in the province of Alberta, Canada; (2) describe associations between dietary patterns and socio-demographic characteristics; and (3) describe associations between dietary patterns and pregnancy complications. Upon enrolment into the Alberta Pregnancy Outcomes and Nutrition (APrON) study (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed "in the 12 months prior to pregnancy". Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis. Scores were calculated to represent adherence with each dietary pattern retained. Four dietary patterns were retained, accounting for 22.9% of the variation in the overall diet. Dietary patterns were named the "healthy", "meat and refined carbohydrate", "beans, cheese and salad" or "tea and coffee" patterns. Higher "healthy" pattern scores prior to pregnancy were associated with lower odds of developing gestational hypertension during pregnancy (adjusted Odds Ratio (OR): 0.6, 95% Confidence Intervals (CI): 0.4, 0.9). Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension during pregnancy

Applying suggested new terminology and definitions for human milk feeding in the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal pregnancy cohort

The complexity of human milk-feeding behaviours may not be captured using simpler definitions of “exclusive” and “non-exclusive” breastfeeding. New definitions have been suggested to describe variation in these behaviours more fully but have not been widely applied. We applied the new definitions to data derived from 3-day human milk-feeding diaries. Participants (n = 1091) recorded the number, beginning/end time, and modes of feeding of infants aged 3 months. Data were used to create six exclusive groups according to feeding mode(s): (1) human milk at-breast only; (2) human milk at-breast and human milk in a bottle; (3) human milk at-breast and infant formula in a bottle; (4) human milk at-breast and human milk and infant formula mixed in the same bottle; (5) human milk at-breast, human milk in a bottle, and infant formula in a bottle (not mixed); and (6) a bottle that sometimes contained human milk and sometimes infant formula (not mixed), never at-breast. Differences in maternal and infant characteristics were examined among groups. Fifty-seven percent fed at-breast only (Group 1). Those in Group 1 spent a similar amount of time feeding directly at-breast (median 132 (IQR 98–172) min/day) as those in Groups 2 (124 (95–158)), 3 (143 (100–190)), and 5 (114 (84–142)) (p > 0.05), indicating that adding bottle feeding did not always reduce the time infants were fed at-breast. Applying new suggested definitions to describe human milk-feeding behaviours from the mothers’ perspective highlights the complexity of patterns used and warrants further application and research to explore impacts on health outcomes