Longitudinal associations between family characteristics and measures of childhood obesity

Objectives

The objective of this study was to investigate cross-sectional and longitudinal associations between different family characteristics and body mass index (BMI) and waist-to-height ratio (WHtR) in children.

Methods

This was a prospective follow-up study conducted in Helsinki region with data collected in 2006 and 2008. The sample consisted of 550 children aged 9?C11 at baseline. Children were measured and weighed by research staff, and they completed a questionnaire about their family characteristics.

Results

More meals together with the family, more parenting practices at meals, less time home without adult company after school, and child??s perception of receiving care from mother in 2006 predicted a lower BMI in 2008 and partly a smaller increase in BMI from 2006 to 2008. Fewer associations were found to WHtR. Physical activity with either parent was not associated with BMI or WHtR.

Conclusions

Several family characteristics predicted child BMI and WHtR 2?years later. These results contribute new knowledge about parental influence on child weight and weight gain and should be taken into account when planning interventions on the matter.     

The impact of obesity on health-related quality-of-life in the general adult US population

BACKGROUND: The US Preventive Services Task Force recently recommended screening all adult patients for obesity due in part to the strong association between obesity and numerous chronic diseases. However, how obesity affects health-related quality-of-life (HRQL), particularly for persons without any chronic diseases, is less clear. METHODS: The relationship between obesity and HRQL was examined using data from the 2000 Medical Expenditure Panel Survey. Respondents > or =18 years were classified as underweight, normal weight, overweight, class I obesity, and class II obesity based on their BMI. HRQL was measured by the 12-item Short Form physical and mental summary scores (PCS-12 and MCS-12, respectively) and EuroQol EQ-5D index and visual analogue scale (EQ VAS). The impact of obesity on HRQL was examined through multivariate regression, adjusting for sociodemographics and disease status. RESULTS: After adjustment, HRQL decreased with increasing level of obesity. Compared to normal weight respondents, persons with severe obesity had significantly lower scores with scores on the PCS-12, MCS-12, EQ-5D index, and EQ VAS being 4.0, 1.1, 0.073, and 4.8 points lower, respectively. Such decrements of HRQL for severe obesity were similar to the decrements seen for diabetes or hypertension. Persons with moderate obesity or who were overweight also had significantly lower HRQL scores, particularly on the PCS-12 and EQ-5D index. Underweight persons also had lower MCS-12 and EQ VAS scores. CONCLUSIONS: Persons with obesity had significantly lower HRQL than those who were normal weight and such lower scores were seen even for persons without chronic diseases known to be linked to obesity.     

Assessing health-related quality-of-life and health state preference in persons with obesity: a validation study

The objective of this study was to assess the reliability, validity and responsiveness of a new health-related quality-of-life (HRQOL) measure containing global and obesity-specific domains and an obesity-specific health state preference (HSP) assessment. A total of 417 obese and ‘normal’ weight individuals completed these assessments. Internal consistency and test-retest reliability were demonstrated, with Cronbach's ?, intraclass correlation coefficient and ? values well above the acceptable level for most scales. Construct validity hypotheses were confirmed by examining scale correlations. The normal weight individuals reported statistically significantly better functioning and well-being on the majority of the HRQOL scales and HSP than obese individuals. Guyatt's statistic of responsiveness was moderate to high for all the scales and items in the weight-loss and weight-gain groups; however, many of the scales and items in the weight-stable group also displayed responsiveness. The results of this study support the reliability and validity of these assessments. However, further testing is needed to evaluate the responsiveness of both assessments in a weight-stable group.     

Health measures: differentiating associations with gender and socio-economic status

BACKGROUND: In a cohort survey on health-related lifestyles, four different measures of health were analysed with regard to their associations with gender, socio-economic and psychosocial factors. METHODS: The survey was carried out in Berne, Switzerland. Response rate was 64% in the initial interview and 83% in the second interview, from which the data presented were derived, resulting in 923 participants aged 56 to 66 years. Along with socio-economic and psychosocial parameters, four self-report health measures were obtained, namely self-rated health, physical fitness, number of medical conditions and restrictions caused by medical conditions. Regression analysis was used to investigate and compare their associations with gender, socio-economic and psychosocial factors and relevant interaction terms. RESULTS: Gender was statistically significantly associated with physical fitness, number of medical conditions and subsequent restrictions. Education and income showed statistically significant associations with self-rated health and fitness. Psychological factors were statistically significantly associated with all health measures. Gender showed to interact with education, income interacted with internal health locus of control. Analyses with separated genders showed that the association of socio-economic status with self-rated health and fitness was statistically significant in women only. CONCLUSION: The different health measures showed considerable variation in strengths of association with health-related factors, most noticeably so with gender and socio-economic status. The choice of health measures in population studies should comply with the intention to analyse its associations with any of those related factors, or, in reverse, with the wish to prevent their confounding properties.     

Race and preference-based health-related quality of life measures in the United States

Background  

Health-related quality of life instruments (HRQoL) are widely used to produce measures that summarize population health and to inform decision-making and health policy. Although the literature about the relationship between health and race in the United States is quite extensive, there is a lack of studies that comprehensively examine the relationship between race and preference-based HRQoL. Given the widespread use of these measures, it becomes important to understand the extent of the race differences in HRQoL scores and factors associated with any such differences.     

Two measures of health-related quality of life in morbid obesity

OBJECTIVE: To compare health-related quality of life (HRQOL) measures in obese presurgery patients with and without binge-eating disorder (BED) and to investigate the relationship between a generic [short form-36 (SF-36)] and a disease-specific HRQOL measure [Impact of Weight on Quality of Life Questionnaire (IWQOL)] and measures of eating-related and general psychopathology. RESEARCH METHODS AND PROCEDURES: One hundred ten patients ages 19 to 62 years with a mean body mass index of 48.4 +/- 8.3 kg/m(2) who were evaluated for gastric bypass surgery were asked to fill out questionnaires assessing eating-related and general psychopathology (depression, self-esteem), as well as the two HRQOL questionnaires. BED was assessed by self-report. RESULTS: Nineteen (17.3%) patients met criteria for BED. Significant differences between patients with and without BED were found for four of the eight subscales of the SF-36-with effect sizes ranging from 0.44 to 0.75-and for the total score and three of the five subscales of the IWQOL-Lite-with effect sizes from 0.57 to 0.74. The mental composite score of the SF-36 as well as the IWQOL total score correlated significantly with the measures of psychopathology. DISCUSSION: This is the first study comparing the results of HRQOL measures in morbidly obese presurgery patients with and without BED. The results indicate that BED has a profound negative impact on HRQOL that exceeds the influence of obesity. Both HRQOL measures were able to reliably discriminate between patients with and without BED. Depression and self-esteem influenced HRQOL in a similar way as binge eating.     

Comparison and correlates of three preference-based health-related quality-of-life measures among overweight and obese women with urinary incontinence

Purpose  

To compare three preference-based health-related quality-of-life (HRQL) measures and examine independent correlates of HRQL among overweight and obese women with urinary incontinence (UI) enrolled in a weight loss intervention trial.     

Measuring agreement between patient and proxy responses to multidimensional health-related quality-of-life measures in clinical trials. An application of psychometric profile analysis

When patients cannot provide responses to health-related quality-of-life (HRQOL) measures in clinical trials, family or friends may be asked to respond. We present a simple, comprehensive method for assessing agreement between patients with head injury and their proxy responders. In contrast to more traditional approaches, this method defines agreement separately for each patient-proxy pair, and compares HRQOL profiles along three dimensions-level, or the average of the ratings; scatter, or the variability in the ratings; and shape, or the ranks of the ratings. We demonstrate this method in the context of a clinical trial of a treatment for traumatic head injury and compare the results to those obtained using traditional analyses. Options for incorporating proxy responses into clinical trial analyses are discussed.     

Differential associations between interpersonal variables and quality-of-life in a sample of college students

Quality of Life Research - Humans are fundamentally social beings, and the relationships we form with others are crucial for our well-being. Research across a variety of domains has established the...     

Relationship between obesity and health-related quality of life in men

OBJECTIVE: Few studies examining the relationship between obesity and health-related quality of life (HRQOL) have used a medical outpatient population or demonstrated a relationship in men. Furthermore, most studies have not adequately considered comorbid illness. The goal of this study was to examine the relationship between body mass index (BMI) and HRQOL in male outpatients while considering comorbid illness. RESEARCH METHODS AND PROCEDURES: This cross-sectional study examined 1168 male outpatients from Durham Veterans' Affairs Medical Center. Multiple linear regression was used to examine the relationship of BMI with each subscale from the Medical Outcomes Study Short Form 36 while adjusting for age, race, comorbid illness, depression, and physical activity. RESULTS: Participants had a mean age of 54.7 +/- 5.6 years; 69% were white and 29% were African American. The distribution for BMI was as follows: 18.5 to <25 kg/m(2) (21%), 25 to <30 kg/m(2) (43%), 30 to <35 kg/m(2) (25%), 35 to <40 kg/m(2) (8%), and > or =40 kg/m(2) (3%). Mean Short Form 36 subscale scores were lower than U.S. norms by an average of 27%. Individuals with BMI > or =40 kg/m(2) had significantly lower scores compared with normal weight individuals on the Role-Physical and Vitality subscales. On the Physical Functioning and Physical Component subscales, lower scores were observed at BMI > or =35 kg/m(2). On the Bodily Pain subscale, lower scores were observed at BMI > or =25 kg/m(2). DISCUSSION: An inverse relationship between BMI and physical aspects of HRQOL exists in a population of male outpatients. Increased BMI was most prominently associated with bodily pain; this relationship should receive more attention in clinical care and research.     

Influence of age and gender on quality-of-life outcomes after cholecystectomy

Few studies have assessed the role of sociodemographic characteristics on outcomes after a cholecystectomy. Our goal was to evaluate the influence of age and gender on the health related quality of life (HRQoL) changes after cholecystectomy in this prospective observational study of consecutive patients undergoing cholecystectomy. Patients completed the SF-36 and the Gastrointestinal Quality of Life Index (GIQLI) before intervention and 3 months later. The influence of age, gender, and the pre-intervention health status on the HRQoL changes was studied by multivariate regression analysis. Older patients had poorer HRQoL and their post-intervention improvement was lower than younger patients. Compared with men, women had worse health status before the intervention measured with both HRQoL tools. In the unadjusted analysis women had greater improvements than men, measured by the GIQLI, but not with the SF-36. However, after controlling for other relevant variables, the SF-36 measured lower improvements in women more often than men, but the GIQLI showed similar results for both. For men and women, the lower the pre-intervention health status the higher the post-operative improvement. Women presented with worse health status before the intervention and less improvement post-operatively after adjustments. The pre-intervention health status has an important role explaining changes after the intervention. A gender-related difference exists between what a generic and a disease-specific HRQoL instrument captures when measuring HRQoL improvement after cholecystectomy.     

The effects of gender and age on associations between blood lipid levels and obesity in Danish men and women aged 35-65 years.

The purpose of the study was to assess the influence of gender and age on the associations between different measures of obesity, and blood lipid levels. Overall obesity (body fat, body fat percentage and body mass index) or abdominal obesity (waist/hip-ratio, waist/thigh-ratio and waist-circumference) and lipid levels [high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), total cholesterol and triglyceride level] were measured in 1987/88 in a random Danish population sample of men and women (N = 2987), aged 35, 45, 55 and 65 yr. All lipid levels were dependent on gender and age. The associations between most measures of obesity and HDL or LDL were independent of gender and age, whereas, with a few exceptions, associations between measures of obesity and total cholesterol, VLDL or triglycerides were dependent on gender and/or age. Compared to levels of HDL, LDL and total cholesterol, abdominal obesity specifically affected levels of VLDL or triglycerides, whereas overall obesity affected HDL, LDL, VLDL, total cholesterol and triglyceride levels more evenly. When men and women were compared, associations between the measures of obesity and blood lipids were stronger in men than in women of the same age, except for the associations between measures of abdominal obesity and VLDL or triglycerides in 45-year-old women. No age trend was found for associations between the measures of obesity and VLDL or triglycerides, whereas young age-groups showed stronger associations between obesity and total cholesterol than older age-groups. Failure to consider age/gender effects induces bias and may lead to misleading conclusions regarding the bivariate association between obesity and lipids, and further may make results from population studies incomparable.     

Item response theory detected differential item functioning between healthy and ill children in quality-of-life measures

OBJECTIVE: To demonstrate the value of item response theory (IRT) and differential item functioning (DIF) methods in examining a health-related quality-of-life measure in children and adolescents. STUDY DESIGN AND SETTING: This illustration uses data from 5,429 children using the four subscales of the PedsQL 4.0 Generic Core Scales. The IRT model-based likelihood ratio test was used to detect and evaluate DIF between healthy children and children with a chronic condition. RESULTS: DIF was detected for a majority of items but canceled out at the total test score level due to opposing directions of DIF. Post hoc analysis indicated that this pattern of results may be due to multidimensionality. We discuss issues in detecting and handling DIF. CONCLUSION: This article describes how to perform DIF analyses in validating a questionnaire to ensure that scores have equivalent meaning across subgroups. It offers insight into ways information gained through the analysis can be used to evaluate an existing scale.     

The relationship between proxy reported health-related quality of life and parental distress: gender differences

Objective Although primary caregiver proxy reports of health‐related quality of life (HRQOL) are often used for healthcare decision making when child self‐reports are unable to be collected (because of a variety of reasons such as child illness, disability or age), we have little understanding of the correlates of parent‐proxy reports. The aim of this study was to examine the relationship between parental depression and parent‐proxy reported QOL for primary caregivers (mothers and fathers), using a multidimensional HRQOL instrument. It was hypothesized that maternal depression would be negatively correlated with maternal reported HRQOL, but that paternal depression would not be correlated with paternal reported HRQOL. Methods Data were from parents of children aged 4–5 years (n = 4983) involved in the Longitudinal Study of Australian Children. A questionnaire assessing parental depression (Kessler‐6) and proxy reported HRQOL (Pediatric Quality of Life Inventory) was completed by the primary caregiver. Results For maternal primary caregivers, maternal depression was negatively correlated with all domains of maternal proxy reports of HRQOL (r = ?0.24 to r = ?0.36). For paternal primary caregivers, there was no relationship between paternal depression and paternal proxy reports of HRQOL. Multiple regression analyses demonstrated that maternal depression was a significant predictor of total HRQOL, accounting for 12% of the variance. For paternal mental health, depression did not predict parent‐proxy reported total HRQOL. Conclusion These results highlight the importance of assessing maternal mental health when measuring proxy reported QOL. Further research is needed in this area to examine the relationship between parental depression and proxy reported HRQOL (including both mothers and fathers, where possible), as well as child self‐reported HRQOL.     

学龄前儿童饮食行为与超重/肥胖的相关性研究

目的 探讨学龄前儿童饮食行为与超重/肥胖间的关系,为学龄前儿童超重/肥胖防治措施的制订提供参考依据。方法 采用学龄前儿童饮食行为试用量表对387名3~6岁儿童的饮食行为进行调查,同时,测量儿童的身高、体重,并计算体质指数(body mass index,BMI);依据BMI将儿童分为正常体重、超重和肥胖组。运用单因素方差分析比较不同体重组间饮食行为的差异;采用阶层线性回归分析检验学龄前儿童饮食行为与BMI间的相关性。结果 单因素分析结果显示,不良进食习惯、外因性进食、挑食、情绪性进食、过饱响应和食物响应6个维度得分在不同体重组间差异具有统计学意义(P<0.01),食物喜好和主动进食维度得分在不同体重组间差异无统计学意义(P>0.05)。阶层回归分析显示,当排除性别、年龄、母亲文化程度影响后,量表6个维度得分与儿童BMI具有相关性(P<0.01)。反映食物趋向的各维度得分与BMI呈正相关(β:0.09~0.21),反映食物逃避各维度得分与BMI呈负相关(β:-0.47~-0.36)。 结论 学龄前儿童饮食行为与超重/肥胖密切相关,通过干预儿童饮食行为可降低学龄前儿童超重/肥胖的风险。     

小学生童年期不良经历与超重肥胖的关联

探讨童年期不良经历与超重、肥胖的关联及其可能的性别差异,为在童年期进行超重肥胖的有效干预提供参考依据.方法 整群选取安徽省蚌埠市某中心小学三~五年级学生1 770名,对自愿参加的所有学生进行问卷调查和体格检查.问卷调查主要包括童年期不良经历(adverse childhood experiences,ACEs)和视频时间、体力活动情况,根据体质量指数(body mass index,BMI)判定超重、肥胖.结果 不同性别学生超重(男生19.4%,女生19.5%)和肥胖检出率(男生17.7%,女生15.9%)差异均无统计学意义(x2值分别为0.001,0.993,P值均>0.05).肥胖男童ACEs、同伴欺侮、家庭不良事件报告率高于正常体重男童.多元Logistic回归分析表明,控制积极出行方式、户外活动30 min/d、高周末视频、独生子女等协变量,总体童年期不良经历(OR=1.801,95% CI=1.055~3.074)和高家庭不良事件(OR=2.003,95%CI=1.252 ~3.206)是男生肥胖的危险因素,而与女童超重、肥胖关联无统计学意义.结论 儿童青少年超重、肥胖受到童年期不良经历的影响.     

基于复杂网络理论的健康相关行为与慢性非传染性疾病关系研究进展

近年来,有关健康相关行为（健康行为）与慢性非传染性疾病（慢性病）的研究视角从专注多种健康行为与某个慢性病间“多因单果”的独立效应,逐渐转向多个健康行为与慢性病“多因多果”的复杂相互作用。复杂网络理论是系统科学的重要板块,该理论考虑了众多因素在同一网络中的博弈关系,可通过一系列复杂网络模型、指标,揭示健康行为与慢性病多个因素间如何相互作用。本文对复杂网络理论定义、发展及其在健康行为与慢性病领域的常用模型和指标、案例内容进行综述,旨在打开复杂网络理论在健康领域更广阔的运用场景,为后续健康行为与慢性病关系的研究提供可参考的思路和工具。