Rhona M. Hanning

Weight gain in breast cancer survivors: prevalence, pattern and health consequences

Weight gain is a common and persistent problem for many breast cancer survivors and is associated with adverse health consequences. A comprehensive review of the English language literature was conducted to investigate the frequency, magnitude and pattern of weight gain among breast cancer survivors, to identify factors that are associated with these changes and to review the clinical significance of weight gain on disease free survival and overall health. While there appears to be a general trend toward a reduction in the magnitude of weight gain in recent years, as many as 50–96% of women experience weight gain during treatment and many, including some women who remain weight stable during treatment, report progressive weight gain in the months and years after diagnosis. Weight gain is more common in women receiving adjuvant chemotherapy, especially for women receiving longer duration treatments and seems to be especially pronounced in premenopausal women. With or without weight gain, unfavourable changes in body composition including fat gain and loss of lean tissue are prevalent. This unique pattern of weight gain and change in body composition is distressing for most women, poses significant risk for the development of co‐morbid conditions and may impact on long term disease‐free survival.

A review of family meal influence on adolescents' dietary intake.

Recent concerns about adolescent nutrition and unhealthy weights have prompted an examination of the myriad influences on dietary intake during adolescence. Included here are a summary of the literature on family influence on dietary intake, specifically during adolescence and within the family context, a summary of family meal patterns, and a systematic review of the known influences of family meals on dietary intake. Because of the complexity of families in todays society, models were developed to depict the broad context of familial influences on adolescent nutritional behaviours and attitudes and to describe what is known and not known about family meal influences on adolescent dietary intake and quality. A systematic review of the literature revealed seven articles specifically related to adolescents, family meals, and dietary intake, which were analyzed for strength of evidence and plausibility. In spite of data collection methods relying on self-report, results suggested that family meals were associated with improved dietary intakes. Families in todays societies are complex. Nevertheless, parents have the potential to influence positively, through family meals, what food is provided, where it is provided (e.g., home, restaurant), and within what type of atmosphere it is provided.

Self-reported dietary energy intake of normal weight, overweight and obese adolescents.

OBJECTIVE The purpose of the present paper was to assess dietary energy reporting as a function of sex and weight status among Ontario and Alberta adolescents, using the ratio of energy intake (EI) to estimated BMR (BMRest). DESIGN Data were collected using the FBQ, a validated web-based dietary assessment tool (including a 24 h dietary recall, FFQ, and food and physical activity behavioural questions). BMI was calculated from self-reported height and weight and participants were classified as normal weight, overweight or obese. BMR was calculated using the WHO equations (based on weight). Reporting status was identified using the ratio EI:BMRest. SETTING Data were collected in public, Catholic and private schools in Ontario and Alberta, Canada. SUBJECTS A total of 1917 (n 876 male and n 1041 female) students (n 934 grade 9 and n 984 grade 10) participated. RESULTS The mean EI:BMRest ratio across all participants was 1.4 (sd 0.6), providing evidence of under-reporting for the total sample. Females under-reported more than males (t = 6.27, P < 0.001), and under-reporting increased with increasing weight status for both males (F = 33.21, P < 0.001) and females (F = 14.28, P < 0.001). After removing those who reported eating less to lose weight, the EI:BMRest was 1.56 (sd 0.6) for males and 1.4 (sd 0.6) for females. CONCLUSION The present study highlights methodological challenges associated with self-reported dietary data. Systematic differences in under-reporting of dietary intake by gender and weight status were observed using a web-based survey, similar to observations made using paper-based 24 h recalls and dietitian interviews.

Barriers and supports for healthy eating and physical activity for first nation youths in northern Canada

Objectives. To investigate barriers and supports for healthy eating and physical activity in youths in a remote sub-arctic community, Fort Albany First Nation, Ontario, Canada. Study design. A qualitative multi-method participatory approach. Methods. The study included a purposive convenience sample of two adult (n = 22) and three youths (n = 30; students in grades 6 to 8) focus groups, unstructured one-on-one interviews with adult key informants (n = 7), and a scan of the community environment. Data were coded and analysed by hand and using NVivo software. Hurricane thinking and concept mapping were used to illustrate findings and relationships between concepts. Results. Dominant emerging themes included empowerment, trust, resources, barriers and opportunities, while major sub-themes included food security, cost, accessibility/availability, capacity building, community support, programs/training and the school snack/breakfast program. Conclusions. Numerous barriers to healthy nutrition and physical activity exist in this community and are possibly similar in other remote communities. Empowerment is a core issue that should be considered in the design of public health interventions for First Nations youths in remote sub-arctic communities.

Diet quality, nutrition and physical activity among adolescents: the Web-SPAN (Web-Survey of Physical Activity and Nutrition) project.

OBJECTIVE To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related. DESIGN A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canadas Food Guide to Healthy Eating (CFGHE). SETTING One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada. SUBJECTS Grade 7 to 10 Alberta students (n 4936) participated in the school-based research. RESULTS On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality. CONCLUSIONS Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.

Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping.

The objective was to describe weight concerns, dieting, and meal skipping of adolescents and to determine associations with the Healthy Eating Index-C (HEI-C). Data, that were collected using the Food Behaviour Questionnaire, revealed that participants (male=810, female=1016) in grades 9/10 reported weight concerns (n=518), dieting (n=364), and skipping breakfast (n=498), lunch (n=252), and/or dinner (n=129). Of those dieting or weight concerned (n=602), 61% were healthy weight and of those not dieting or weight concerned (n=1224), 13% were overweight/obese. The ordinal logistic regression analysis revealed that HEI-C was likely to be rated lower among those weight concerned and dieting (p<.001), and among those that skipped the breakfast meal (p<.001). The current study identified inappropriate weight concerns and dieting that compromised diet quality and has implications for future intervention and policy development.

Associations Between Family Dinner Frequency and Specific Food Behaviors Among Grade Six, Seven, and Eight Students from Ontario and Nova Scotia

PURPOSE Family dinner frequency has recently been associated in the literature with improved dietary profiles and healthy body weight in children and adolescents. However, it is not known whether family dinners are associated with other commonly reported food behaviors (fast food and soft drink consumption, breakfast skipping, and dieting) and attitudes (body weight concerns and self-efficacy for healthy eating) among Canadian students in grades 6, 7, and 8. METHODS A total of 3223 participants from Northern Ontario (Porcupine Region), Southern Ontario (Peel Region, Region of Waterloo, Toronto District), and Nova Scotia completed the Food Behavior Questionnaire during the 2005-2006 academic school year. Ordinal logistic regression analyses were used to determine the associations between family dinner frequency and food behaviors and attitudes. RESULTS Higher family dinner frequency was significantly associated with less soft drink consumption, consuming breakfast on the day of the survey, the absence of a high body weight concern, having higher self-efficacy for healthy eating when at home with family, and during social times with friends. CONCLUSIONS Researchers and clinicians should be aware of these associations when planning family based healthy eating strategies.

Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada.

BackgroundGrey literature is an important source of information for large-scale review syntheses. However, there are many characteristics of grey literature that make it difficult to search systematically. Further, there is no ‘gold standard’ for rigorous systematic grey literature search methods and few resources on how to conduct this type of search. This paper describes systematic review search methods that were developed and applied to complete a case study systematic review of grey literature that examined guidelines for school-based breakfast programs in Canada.MethodsA grey literature search plan was developed to incorporate four different searching strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with contact experts. These complementary strategies were used to minimize the risk of omitting relevant sources. Since abstracts are often unavailable in grey literature documents, items’ abstracts, executive summaries, or table of contents (whichever was available) were screened. Screening of publications’ full-text followed. Data were extracted on the organization, year published, who they were developed by, intended audience, goal/objectives of document, sources of evidence/resources cited, meals mentioned in the guidelines, and recommendations for program delivery.ResultsThe search strategies for identifying and screening publications for inclusion in the case study review was found to be manageable, comprehensive, and intuitive when applied in practice. The four search strategies of the grey literature search plan yielded 302 potentially relevant items for screening. Following the screening process, 15 publications that met all eligibility criteria remained and were included in the case study systematic review. The high-level findings of the case study systematic review are briefly described.ConclusionsThis article demonstrated a feasible and seemingly robust method for applying systematic search strategies to identify web-based resources in the grey literature. The search strategy we developed and tested is amenable to adaptation to identify other types of grey literature from other disciplines and answering a wide range of research questions. This method should be further adapted and tested in future research syntheses.

Effect of meal environment on diet quality rating.

PURPOSE Family meals have been associated with improved dietary quality in children and adolescents, and yet very little is known about family meals beyond their frequency. Specific aspects of the breakfast, lunch, and dinner meal environments were described and compared, and the associations with overall diet quality were investigated. METHODS Data on food intake and meal environments were obtained in northern Ontario, southern Ontario, and Nova Scotia grades six, seven, and eight classrooms over the 2005 to 2006 school year. Specific aspects of the meal environments described were where the meal was consumed, with whom participants consumed each meal, who prepared the meal, and where the food was originally purchased. Diet quality was assessed using the Canadian version of the Healthy Eating Index. Cluster K-means procedures were used to classify into groups observations about the four meal environment variables. RESULTS Three, eight, and six clusters of meal environments were identified for breakfast, lunch, and dinner, respectively. Diet quality was negatively associated with consuming/ purchasing meals outside the home, and with skipping breakfast, lunch, and/or dinner. CONCLUSIONS Results have immediate relevance for family-based and/or school programs and policies aimed at educating and feeding children and adolescents.

Giving voice to food insecurity in a remote indigenous community in subarctic Ontario, Canada: traditional ways, ways to cope, ways forward

BackgroundFood insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity.MethodsA trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach.ResultsFifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested.ConclusionsFindings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.