Shauna M. Downs

Vigorous physical activity and longitudinal associations with cardiometabolic risk factors in youth.

Objective:To examine the longitudinal associations between different physical activity (PA) intensities and cardiometabolic risk factors among a sample of Canadian youth.Methods:The findings are based on a 2-year prospective cohort study in a convenience sample of 315 youth aged 9–15 years at baseline from rural and urban schools in Alberta, Canada. Different intensities (light, moderate and vigorous) of PA were objectively assessed with Actical accelerometers. The main outcome measures were body mass index (BMI) z-score, waist circumference, cardiorespiratory fitness and systolic blood pressure at 2-year-follow-up and conditional BMI z-score velocity. A series of linear regression models were conducted to investigate the associations after adjusting for potential confounders.Results:At follow-up, cardiorespiratory fitness increased (quartile 1 vs quartile 4=43.3 vs 50.2; Ptrend<0.01) and waist circumference decreased (quartile 1 vs quartile 4=79.0 vs 72.6; Ptrend=0.04; boys only) in a dose-response manner across quartiles of baseline vigorous-intensity PA. A similar trend was observed for systolic blood pressure (quartile 1 vs quartile 4=121.8 vs 115.3; Ptrend=0.07; boys only). Compared with quartile 1 of vigorous-intensity PA, BMI z-score at follow-up and conditional BMI z-score velocity were significantly lower in the quartile 2 and 3 (P<0.05). Waist circumference at follow-up also decreased (quartile 1 vs quartile 4=75.3 vs 73.8; Ptrend=0.04) across quartiles of baseline moderate-intensity PA.Conclusions:Time spent in vigorous-intensity PA was associated with several positive health outcomes 2 years later. These findings suggest that high-intensity activities in youth help to reduce the risk for several chronic diseases.

Associations among the food environment, diet quality and weight status in Cree children in Québec

OBJECTIVE To explore the relationship among childrens diet quality, weight status and food environment in subarctic Canada. DESIGN In the cross-sectional study, childrens BMI was calculated, diet quality was assessed using three 24 h dietary recalls and children were asked about their home food environment and source of meals. SETTING Two Aboriginal Cree communities in northern Québec. SUBJECTS Two hundred and one children in grades 4-6. RESULTS The majority (64.2%) of children were overweight (29.9%) or obese (34.3%). Weight status was not associated with reported restaurant meal frequency or the home food environment. The 18% of children who consumed three or more restaurant meals in the three days of recall consumed, on average, 2004 kJ (479 kcal) more energy daily than children consuming no restaurant meals and had higher intakes of fat, saturated fat, Ca and soda. Most foods contributing to energy and dietary fat were energy-dense market foods of low nutritional value such as sweetened beverages and snack foods. Only 68% of children reported often having fruits and vegetables in the home and 98.5% of children consumed less than 5 fruits and vegetables daily. Many children (42.8%) were at risk of Zn inadequacy. Only 19% of children consumed 2 or more servings of milk daily, and the mean intakes of Ca and vitamin D were below the recommended adequate intake. Traditional game meat was consumed infrequently, but contributed significantly to Fe and Zn intake. CONCLUSIONS Childhood obesity in subarctic communities prevailed in a food environment typified by high-energy-density commercial foods of low nutritional value.

A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention.

Private‐sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private‐sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private‐sector policies and practices related to food environments, and their influence on obesity and non‐communicable disease (NCD) prevention. A step‐wise approach to data collection is recommended, in which the first (‘minimal’) step is the collation of publicly available food and nutrition‐related policies of selected private‐sector organizations. The second (‘expanded’) step assesses the nutritional composition of each organizations products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third (‘optimal’) step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private‐sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.

Central adiposity and associated lifestyle factors in Cree children

Aboriginal children are prone to central adiposity (CA), a component of the metabolic syndrome. The objective of this study was to determine if lifestyle factors were associated with CA in Canadian Cree children. Children aged 9-12 years were classified as having CA if their waist circumference met or exceeded the 85th percentile of the NHANES III reference. Weight status was determined using the CDC growth reference, dietary intake using three 24 h dietary recalls, physical activity using pedometers, and fitness by completion of the 20 m shuttle run test. Of the 178 children (79% participation rate), 32.6% were normal weight, 23.6% were overweight, and 43.8% were obese. Half (52.2%) of the children had CA (97.4% of obese children, 35.7% of overweight children, and 2.2% of normal weight children). Waist circumference was negatively correlated with pedometer step counts (r = -0.187, p = 0.012) and shuttle run time (r = -0.508, p < 0.001). In children with CA, waist circumference was positively correlated with sweetened beverage intake (r = 0.250, p = 0.016). The odds ratio (adjusted for age and sex) for CA for children consuming 3 or more fruits and vegetables per day was 0.43 (95% CI 0.18 - 0.98), for meeting step recommendations for a healthy body weight was 0.45 (95% CI 0.24 - 0.84), and for relative fitness was 0.12 (95% CI 0.04 - 0.33). CA was prevalent in children who were overweight and obese. Preventive strategies might include promoting a healthy diet, physical activity, and fitness.

From Denmark to Delhi: the multisectoral challenge of regulating trans fats in India.

OBJECTIVE India has proposed legislating an upper limit of trans fat in partially hydrogenated vegetable oils and mandating trans fat labelling in an effort to reduce intakes. The objective of the present study was to examine the complexities of regulating trans fat in India by examining the policy processes involved and the perceived implementation challenges. DESIGN Semi-structured interviews (n 18) were conducted with key informants from various sectors. Interviewees were asked about sources of trans fat in the food supply, existing policies that may influence trans fats and perceived challenges related to the proposed trans fat regulation, in addition to questions tailored to their area of expertise. Interview data were organised based on common themes. SETTING Interviews were conducted in India. SUBJECTS Interviewees were key informants from various sectors including agriculture, trade, industry and health. RESULTS Several themes were identified related to the complexity of regulating trans fat in India. A lack of trans fat awareness, the large unorganised retail sector, a need for suitable alternative products that are both acceptable to consumers and affordable, and a need to build capacity were crucial factors affecting Indias ability to successfully regulate trans fat. The limited number of food inspectors will create an additional challenge in terms of enforcement of trans fat regulation. CONCLUSIONS Although India will face challenges in regulating trans fat, legislating an upper limit of trans fat in partially hydrogenated vegetable oils will likely be the most effective approach to reducing it in the food supply. Ongoing engagement with industry, agriculture, trade and processing sectors will prove essential in terms of product reformulation.

A Test of the Theory of Planned Behavior to Explain Physical Activity in a Large Population Sample of Adolescents From Alberta, Canada

PURPOSE To test the Theory of Planned Behavior (TPB) in a large population sample of adolescents from Alberta, Canada. METHODS 4,073 adolescents completed a self-administered web-based survey related to physical activity (PA). RESULTS TPB explained 59% and 43% of the variance for intention and behavior, respectively. Moderating (by gender) and mediating tests were supported. CONCLUSIONS TPB is useful for understanding PA in this population.

Improving children’s nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities

BackgroundAlthough the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release.MethodsA cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalghs model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study.ResultsOne half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability.ConclusionsIf fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities.

Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

BackgroundThere is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.Methods/DesignIntervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.DiscussionSalt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.

Factors and Barriers Associated with Early Adoption of Nutrition Guidelines in Alberta, Canada

OBJECTIVE To identify factors that influenced early adoption and implementation of the Alberta Nutrition Guidelines for Children and Youth (ANGCY) in schools in Alberta, Canada; and to identify healthy eating strategies that were implemented as a result of the guidelines. Barriers and facilitators were also investigated. DESIGN Multiple case study design (n = 3). Semi-structured interviews and direct observations were used to collect data. SETTING AND PARTICIPANTS Three schools in Alberta were selected for individual case studies. Eighteen key informants were interviewed from the 3 cases. PHENOMENON OF INTEREST To investigate how the motivation shown by school administration and stakeholders for the ANGCY influenced the early adoption and implementation of the guidelines. ANALYSIS Content analysis was used to analyze data. RESULTS Various healthy eating strategies were implemented within the 3 cases after uptake of the guidelines. Support from the school superintendent and the work of a health champion facilitated the adoption and implementation of the guidelines, whereas parents posed some barriers to the adoption and implementation of the ANGCY. CONCLUSIONS AND IMPLICATIONS This study reinforces the importance of identifying a health champion to oversee healthy eating strategies in schools, and of involving parents in the promotion of childrens healthy lifestyles.

Reformulating partially hydrogenated vegetable oils to maximise health gains in India: is it feasible and will it meet consumer demand?

BackgroundThe consumption of partially hydrogenated vegetable oils (PHVOs) high in trans fat is associated with an increased risk of cardiovascular disease and other non-communicable diseases. In response to high intakes of PHVOs, the Indian government has proposed regulation to set limits on the amount of trans fat permissible in PHVOs. Global recommendations are to replace PHVOs with polyunsaturated fatty acids (PUFAs) in order to optimise health benefits; however, little is known about the practicalities of implementation in low-income settings. The aim of this study was to examine the technical and economic feasibility of reducing trans fat in PHVOs and reformulating it using healthier fats.MethodsThirteen semi-structured interviews were conducted with manufacturers and technical experts of PHVOs in India. Data were open-coded and organised according to key themes.ResultsInterviewees indicated that reformulating PHVOs was both economically and technically feasible provided that trans fat regulation takes account of the food technology challenges associated with product reformulation. However, there will be challenges in maintaining the physical properties that consumers prefer while reducing the trans fat in PHVOs. The availability of input oils was not seen to be a problem because of the low cost and high availability of imported palm oil, which was the input oil of choice for industry. Most interviewees were not concerned about the potential increase in saturated fat associated with increased use of palm oil and were not planning to use PUFAs in product reformulation. Interviewees indicated that many smaller manufacturers would not have sufficient capacity to reformulate products to reduce trans fat.ConclusionsReformulating PHVOs to reduce trans fat in India is feasible; however, a collision course exists where the public health goal to replace PHVOs with PUFA are opposed to the goals of industry to produce a cheap alternative product that meets consumer preferences. Ensuring that product reformulation is done in a way that maximises health benefits will require shifts in knowledge and subsequent demand of products, decreased reliance on palm oil, investment in research and development and increased capacity for smaller manufacturers.