Although an increasing number of children and adolescents are becoming obese, the psychological morbidities associated with obesity are not well established. Existing reviews report modest associations between obesity and global self-esteem. However, none have examined how this affects multi-component assessments of self-esteem and quality of life in young people with defined obesity. A literature search identified 17 self-esteem and 25 quality of life studies of cross-sectional, longitudinal or intervention design published since 1994. Child-completed and parent-proxy assessments were consistent in showing significant reductions in global self-esteem and quality of life in obese youth. Competences particularly affected were physical competence, appearance and social functioning. There were no clear differences in effects between children and adolescents, and evidence on gender and ethnicity was lacking. Competency improvements occurred in the presence and absence of weight loss, suggesting their value as intervention outcomes and the need for further investigation.

Epidemiological studies of bone mineral determinants rely heavily on measurements made with absorptiometric techniques such as single-photon absorptiometry and dual-energy x-ray absorptiometry. In general, absorptiometric data are expressed as areal densities (bone mineral density, BMD), obtained by dividing bone mineral content (BMC) by bone area or width (BA, BW). This size correction assumes that BMC and BA (BW) are directly proportional to one another, such that a 1% change in BA (BW) is matched by a 1% change in BMC. This is rarely the case, and the exact relationship depends on the population group, skeletal site, body size, instrumentation, and scanning conditions. Size adjustment determined by using predefined indexes, such as BMD and body mass index (BMI, wt/ht2), may fail to correct BMC fully for bone and body size, and may lead to spurious associations with other size-related variables such as calcium intake, energy expenditure, and grip strength. A general approach to size adjustment is described, in which BA (BW), weight, and height are incorporated in all regression models of BMC. Although BMD plays a valuable role in fracture-risk assessment and clinical management, we advocate that its use in epidemiological research be discontinued.

Objectives To determine the influence of birth weight on body mass index at different stages of later life; whether this relation persists after accounting for potential confounding factors; and the role of indicators of fetal growth (birth weight relative to parental size) and childhood growth. Design Longitudinal study of the 1958 British birth cohort. Setting England, Scotland, and Wales.

Objectives To understand how device-measured sedentary behaviour and physical activity are related to all-cause mortality in older men, an age group with high levels of inactivity and sedentary behaviour. Methods Prospective population-based cohort study of men recruited from 24 UK General Practices in 1978 -1980 . In 2010 surviving men were invited to a follow-up, 1655 (aged 71-92 years) agreed. Nurses measured height and weight, men completed health and demographic questionnaires and wore an ActiGraph GT3x accelerometer. All-cause mortality was collected through National Health Service central registers up to 1 June 2016. results After median 5.0 years' follow-up, 194 deaths occurred in 1181 men without pre-existing cardiovascular disease. For each additional 30 min in sedentary behaviour, or light physical activity (LIPA), or 10 min in moderate to vigorous physical activity (MVPA), HRs for mortality were 1.17 (95% CI 1.10 to 1.25), 0.83 (95% CI 0.77 to 0.90) and 0.90 (95% CI 0.84 to 0.96), respectively. Adjustments for confounders did not meaningfully change estimates. Only LIPA remained significant on mutual adjustment for all intensities. The HR for accumulating 150 min MVPA/week in sporadic minutes (achieved by 66% of men) was 0.59 (95% CI 0.43 to 0.81) and 0.58 (95% CI 0.33 to 1.00) for accumulating 150 min MVPA/week in bouts lasting ≥10 min (achieved by 16% of men). Sedentary breaks were not associated with mortality. Conclusions In older men, all activities (of light intensity upwards) were beneficial and accumulation of activity in bouts ≥10 min did not appear important beyond total volume of activity. Findings can inform physical activity guidelines for older adults.Nearly all epidemiological evidence used to estimate the shape of the dose-response curve between physical activity (PA) and mortality is based on self-reported PA.1 Moderately active compared with inactive adults have 20%-30% reductions in all-cause mortality, with greater reductions in older (>65 years) than middle-aged adults.2 PA is a key determinant of longevity globally.3 Current activity guidelines suggest accumulating ≥150 min moderate to vigorous PA (MVPA) per week in bouts lasting ≥10 min.4 5 The 10 min bout requirement was based on trial data for cardiometabolic risk factors only, not clinical end points. 5 In order to test whether the accumulation of MVPA in ≥10 min bouts affects risk of mortality, prospective cohort studies with device-measured physical activity (which can provide minute by minute data for calculation of bouts) and mortality data are required, but few studies have such data. Such data can also inform whether accruing sedentary time in prolonged bouts is associated with adverse effects on mortality, as this has been identified as an important research gap. Many studies report that higher levels of self-reported sedentary time are associated with mortality, [6][7][8][9] although self-reported sedentary behaviours may suffer from measurement error or recall bias.10-14 Experimental studies suggest benefits...

BackgroundOlder adults have low physical activity(PA) and high sedentary behaviour(SB) levels. We investigate how total volume and specific patterns of moderate to vigorous PA(MVPA), light PA(LPA) and SB are related to adiposity and metabolic syndrome (MS). Then, with reference to physical activity guidelines which encourage MVPA in bouts > =10 min and avoiding “long” sedentary bouts, we investigate whether accumulating PA and SB in bouts of different defined durations are differently associated with these outcomes.MethodsCross-sectional study of men (71–91 years) recruited in UK primary care centres. Nurses made physical measures (weight, height, bio-impedance, blood pressure) and took fasting blood samples. 1528/3137 (49 %) surviving men had ≥3 valid days (≥600 min) accelerometer data. 450 men with pre-existing chronic disease were excluded. 1009/1078 (93.6 %) had complete covariate data.ResultsMen (n = 1009, mean age 78.5(SD 4.7) years) spent 612(SD 83), 202(SD 64) and 42(SD 33) minutes in SB, LIPA and MVPA respectively. Each additional 30 min/day of SB and MVPA were associated with 0.32 (95 % CI 0.23, 0.40)Kg/m2 higher Body Mass Index (BMI) and −0.72(−0.93, −0.51) lower BMI Kg/m2 respectively. Patterns for waist circumference (WC), fat mass index (FMI), fasting insulin and MS were similar. MVPA in bouts lasting <10 min or ≥10 min duration were not associated differently with outcomes. In models adjusted for total MVPA, each minute accumulated in SB bouts lasting 1–15 min was associated with lower BMI −0.012 kg/m2, WC −0.029 cm, and OR 0.989 for MS (all p < 0.05), and coefficients for LPA bouts 1–9 min were very similar in separate models adjusted for total MVPA. Minutes accumulated in SB bouts 1–15 min and LPA bouts 1–9 min were correlated, r = 0.62.ConclusionsObjectively measured MVPA, LPA and SB were all associated with lower adiposity and metabolic risk. The beneficial associations of LPA are encouraging for older adults for whom initiating MVPA and maintaining bouts lasting ≥10 min may be particularly challenging. Findings that short bouts of LPA (1–9 min) and SB (1–15 min), but that all MVPA, not just MVPA accumulated in bouts ≥10 min were associated with lower adiposity and better metabolic health could help refine older adult PA guidelines.

Aims With increasing age, physical inactivity and sedentary behaviour levels increase, as does cardiovascular disease (CVD) incidence. We investigate how device-measured sedentary behaviour and physical activity (PA) are related to CVD onset in men aged 70+; whether the total volume of activity is more important than pattern. Methods and results Prospective population-based cohort study of men recruited from 24 UK General Practices in 1978–80. In 2010–12, 3137 survivors were invited to complete questionnaires and wear an Actigraph GT3x accelerometer for 7 days. PA intensity was categorised as sedentary, light and moderate to vigorous (MVPA). Men were followed up for Myocardial Infarction, stroke and heart failure (ICD9 410–414, 430–438 and 428) morbidity and mortality from 2010 to 12 to June 2016. Hazard Ratios (HRs) for incident Cardiovascular Disease (CVD) were estimated. 1528/3137 (49%) men had sufficient accelerometer data. 254 men with pre-existing CVD were excluded. Participants' mean age was 78.4 (range 71–92) years. After median 4.9 years follow-up, 122 first CVD events occurred in 1181 men (22.7/1000 person-years) with complete data. For each additional 30 min in sedentary behaviour, light PA,10 min in MVPA, or 1000 steps/day, HRs for CVD were 1.09(95%CI 1.00, 1.19), 0.94(0.85, 1.04), 0.88(0.81, 0.96) and 0.86(0.78 to 0.95) respectively, adjusted for measurement-related factors, socio-demographics, health behaviours and disability. HRs for accumulating 150 min/week MVPA in bouts ≥1 min and bouts ≥10 min were 0.47(0.32 to 0.69), and 0.49(0.25, 0.98). Conclusions In older men, high volume of steps or MVPA rather than MVPA bouts was associated with reduced CVD risk.

It has been proposed that there are critical periods during childhood that influence the development of obesity, including gestation and early infancy, the period of adiposity rebound that occurs between ages 5 and 7 years, and adolescence. Despite an extensive literature, there is to date only modest evidence for most of the factors such as nutrition, physical activity and other behavioural factors that are suspected as playing a role in the development of obesity. A recent review of this evidence (Parsons et al. 1999) showed, however, a consistent relationship between socio-economic status (SES) of origin and adult obesity, whereby those from lower SES backgrounds were fatter subsequently in adulthood. This association appeared to apply to both men and women, a finding that contrasts with the trends observed in cross-sectional studies, of an association with SES for women only. There are several potential explanations for the SES of origin-adult obesity relationship. SES of origin may be confounded by parental body size; studies to date provide insufficient evidence of an independent association with SES after allowing for parental body size. Alternatively, environment in early life (for which SES of origin is a proxy measure) may have a long-term impact on obesity later in adulthood, through one or more of several processes. Three major potential explanations can be identified: (1) nutrition in infancy and childhood, either over-or undernutrition, followed subsequently by overnutrition; (2) psychological factors, possibly involving emotional deprivation in childhood; (3) cultural or social norms regarding dietary restraint and attitudes to fatness that may be acquired during childhood.Obesity: Socio-economic status: Longitudinal studies: Behaviour SES, socio-economic status.Increasingly, we are appreciating that risk factors occurring in adult life provide insufficient explanation for adult health outcomes, and that factors occurring at different life stages need to be considered. To some extent this life-course approach is better established in obesity research than in other areas, but even here the role of childhood factors is not well understood. Potentially, there are several early life factors that might be involved in the development of obesity in adulthood (Parsons et al. 1999). To date, the best documented relationships are between parental size and adiposity in their offspring, and between childhood and adult fatness . Evidence is less complete for other factors, such as childhood diet and physical (in)activity, and it is not clear whether these factors influence adult obesity because of their effect on behaviours in adulthood.Unravelling the different life-course relationships involved in the development of obesity will be challenging, since the influence of different factors could be affected by their timing and duration, and also whether other cofactors are present. For example, in relation to timing of exposure, a factor occurring in early life may create biological and/or psychological vulnerabi...

Current vitamin D status was associated with CWP in women but not in men. Follow-up studies are needed to evaluate whether higher vitamin D intake might have beneficial effects on the risk of CWP.