Helen Truby

Development of the Children's Body Image Scale

OBJECTIVE The aim of this study was to develop a gender-appropriate pictorial scale to measure body image in young children based on a measurable index of adiposity. METHOD Pictorial scales for boys and girls containing seven body pictures representing standard percentile curves for body mass index (BMI) for healthy children were developed. The Childrens Body Image Scale (CBIS) was administered to 312 children aged between 7 and 12 years. RESULTS Accuracy of body size perception, indicated by the correlation between actual and perceived BMI category figure, developed with age, girls acquiring accuracy earlier than boys. Whereas girls developed a good accuracy (r =.60, p <.001, 10-12 years), in boys, the correlation, though significant, was not strong (r =.35, p <.01, 10-12 years). There was a consistent bias towards underestimation of body size using this technique. There was a high frequency of body size dissatisfaction across all the age ranges, 48% girls and 36% boys wished to have a smaller body figure than their own, and only 10% of girls and 20% boys wished to have a larger body figure. Construct validity was assessed in a subset of 153 children in which additional measures of restrained eating (DEBQ-R) and body esteem were available. From the age of 8 years, the CBIS provides a good measure of body dissatisfaction. CONCLUSIONS The CBIS provides a good measure of body size perception in girls and an adequate measure in boys aged 8 years and older. It also provides a good measure of body size dissatisfaction in children. Internalization of a thin body ideal takes place at a young age, many children desiring a BMI below the average norm.

A review of the effects of exercise on appetite regulation: an obesity perspective

In this review, we discuss the role of inactivity and exercise on appetite regulation, both in the short and long term, and the potential mechanisms involved. A better short-term appetite control has been described in active compared to sedentary men, and an exercise intervention was shown to improve appetite control in previously sedentary individuals. The mechanisms whereby exercise improves short-term appetite control remain obscure and although the changes in the postprandial release of satiety peptides are attractive hypotheses, it remains unproven. The impact of exercise on habitual food intake is also controversial and likely to be dependent on restraint level and body weight. We hypothesize that the beneficial impact of exercise on appetite regulation can contribute to its well-established efficacy in the prevention of weight regain in obese individuals. However, more studies are needed in the obese population to clearly establish the role of exercise on appetite control in this group.

A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods

Hypertension is a public health priority in developed countries and worldwide, and is strongly associated with increased risk and progression of cardiovascular and renal diseases. A systematic review and meta-analysis were conducted to examine the association between dairy food intake during adulthood and the development of elevated blood pressure (EBP), specifically comparing the association of EBP with consumption of low-fat dairy foods versus high-fat dairy foods, as well as cheese versus fluid dairy foods (milk or yogurt). Seven databases were searched and five cohort studies selected for inclusion, involving nearly 45 000 subjects and 11 500 cases of EBP. Meta-analysis of consumption of dairy foods and EBP in adults gave a relative risk (RR) of 0.87 (95% confidence interval (CI) 0.81–0.94). Separation of high- and low-fat dairy foods, however, indicated a significant association with low-fat dairy foods only (RR of 0.84 (95% CI 0.74–0.95)). Additional analyses showed no association between EBP and cheese, although fluid dairy foods were significantly associated with a reduced development in EBP (RR of 0.92 (95% CI 0.87–0.98)). Little heterogeneity was observed among the data presented. This meta-analysis supports the inverse association between low-fat dairy foods and fluid dairy foods and risk of EBP. Understanding these relationships can aid in the development of public health messages involving dairy foods, and supports current recommendations.

Short-term appetite control in response to a 6-week exercise programme in sedentary volunteers

Previous cross-sectional studies have shown that sedentary males, unlike their active counterparts, are unable to compensate for previous energy intake (EI). The present study therefore investigated the effects of a 6-week moderate exercise programme (4 times per week, 65-75 % maximal heart rate) on appetite regulation in healthy sedentary volunteers using a longitudinal design. EI at a buffet meal 60 min after high-energy (HEP; 607 kcal) and low-energy (LEP; 246 kcal) preloads, together with 24 h cumulative EI, were measured in twenty-five healthy volunteers (eleven men; mean age 30 (SD 12) years, mean BMI 22.7 (SD 2.3) kg/m2), at baseline and after the exercise intervention. Subjective hunger and fullness were assessed throughout using visual analogue scales. ANOVA showed a significant preload x exercise interaction on 24 h cumulative EI, supporting an improvement in appetite control over this time period with the exercise programme. There was a trend towards improvement in energy compensation over the same period (8.9 (SD 118.5) % v. 79.5 (SD 146..4) %; P = 0.056). No preload x exercise interaction was observed for buffet EI. Secondary analysis, however, showed that although buffet EI after the two preloads was not significantly different at baseline, buffet EI after the HEP was significantly lower than after the LEP following the exercise intervention. The improvement in short-term appetite control with exercise was not explained by changes in subjective hunger or satiety. This longitudinal study supports the original cross-sectional findings and suggests that exercise may have a significant impact on short-term appetite control by leading to a more sensitive eating behaviour in response to previous EI. Further studies are needed to clarify the mechanisms involved.

Validating the waist‐height ratio and developing centiles for use amongst children and adolescents

Aim: To assess the statistical validity of the waist‐height ratio (WHtR) as an appropriate method of adjusting waist circumference (WC) for height in children and adolescents.

A comparison and validation of child versus parent reporting of children's energy intake using food frequency questionnaires versus food records: Who's an accurate reporter?

BACKGROUND & AIMS The aim of this study was to (i) to compare the accuracy of reporting for childs total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW. METHODS Healthy weight children (mean ± SD age 9.8 ± 1.3 years, n = 6 girls/3 boys) and their parents independently completed an FFQ about childrens intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW. RESULTS The mean difference (limits of agreement LOA, ± 2SD) when compared to DLW was; child 130 (-1518, 1258) kcal or (113 ± 35% of TEE); father 398 (0,796) kcal or (121 ± 13%); mother 807 (-213, 1824) kcal or (144 ± 26%) and for the WFR -153 (1089, -1395) kcal or 95 ± 32%. CONCLUSIONS Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years.

The reciprocal interaction between obesity and obstructive sleep apnoea

Obesity is a significant risk factor in the pathogenesis of obstructive sleep apnoea (OSA) altering airway anatomy and collapsibility, and respiratory control. The association between obesity and OSA has led to an increasing focus on the role of weight loss as a potential treatment for OSA. To date, most discussion of obesity and OSA assumes a one-way cause and effect relationship, with obesity contributing to the pathogenesis of OSA. However, OSA itself may contribute to the development of obesity. OSA has a potential role in the development and reinforcement of obesity via changes to energy expenditure during sleep and wake periods, dietary habits, the neurohormonal mechanisms that control satiety and hunger, and sleep duration arising from fragmented sleep. Thus, there is emerging evidence that OSA itself feeds back into a complex mechanism that leads either to the development or reinforcement of the obese state. Whilst current evidence does not confirm that treatment of OSA directly influences weight loss, it does suggest that the potential role OSA plays in obesity and weight loss deserves further research.

The Children's Body Image Scale: Reliability and use with international standards for body mass index

OBJECTIVE To test the reliability of the Childrens Body Image Scale (CBIS) and assess its usefulness in the context of new body size charts for children. METHOD Participants were 281 primary schoolchildren with 50% being retested after 3 weeks. The CBIS figure scale was compared with a range of international body mass index (BMI) reference standards. RESULTS Children had a high degree of body image dissatisfaction. The test-retest reliability of the CBIS was supported. CONCLUSIONS The CBIS is a useful tool for assessing body image in children with sound scale properties. It can also be used to identify the body size of children, which lies outside the healthy weight range of BMI.

Dietary Management of Infantile Colic: A Systematic Review

Infantile colic, the cause of 10–20% of all early paediatrician visits, can lead to parental exhaustion and stress. A systematic review was conducted to examine whether dietary change provides an effective therapy for infantile colic. Six databases were searched from 1960, and 24 studies selected for inclusion. In breastfed infants, evidence suggests that a hypoallergenic maternal diet may be beneficial for reducing symptoms of colic. In formula-fed infants, colic may improve after changing from a standard cow’s milk formula to either a hydrolysed protein formula or a soy-based formula. Fibre-supplemented formulae had no effect. Removal of poorly digested carbohydrates from the infant’s diet has promise, but additional clinical studies must be conducted before a recommendation can be made. Use of a universal definition to measure symptoms of infantile colic and consistent analysis of urine and faecal samples would improve the evidence in this area.

Weight loss from lifestyle interventions and severity of sleep apnoea: A systematic review and meta-analysis

BACKGROUND Excess body weight is a risk factor for obstructive sleep apnoea (OSA). The aim of the systematic review was to establish whether weight loss via lifestyle interventions such as diet and exercise are useful in the treatment of OSA. METHODS A literature search was conducted between 1980 and February 2012. Systematic reviews and randomised controlled trials (RCTs) with participants who had OSA, were overweight or obese, and who had undergone lifestyle interventions with the aim of improving sleep apnoea were included. Meta analyses were conducted for a subset of RCTs with appropriate data. RESULTS Two systematic reviews and eight RCTs were included. Meta-analyses were conducted for four RCTs comparing intensive lifestyle interventions to a control. The overall weighted mean differences for weight change, change in apnoea -hypopnoea index (AHI) and change in oxygen desaturation index of ≥4% were as follows: -13.76 kg (95% confidence interval (CI) -19.21, --8.32), -16.09 (95% CI -25.64, -6.54) and -14.18 (95% CI -24.23, -4.13), respectively. Although high heterogeneity within the meta analyses, all studies favoured the interventions. Long-term follow-up data from three RCTs suggest that improvements in weight and AHI are maintained for up to 60 months. CONCLUSIONS Intensive lifestyle interventions are effective in the treatment of OSA, resulting in significant weight loss and a reduction in sleep apnoea severity. Weight loss via intensive lifestyle interventions could be encouraged as a treatment for mild to moderate OSA.