Publications by authors named "Clare H Llewellyn"

57 Publications

Shared genetic architecture underlying sleep and weight in children.

Sleep Med 2021 Jul 26;83:40-44. Epub 2021 Apr 26.

Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.

Meta-analyses suggest shorter sleep as a risk factor for obesity in children. The prevailing hypothesis is that shorter sleep causes obesity by impacting homeostatic processes. Sleep duration and adiposity are both heritable, and the association may reflect shared genetic aetiology. We examined the association between a body mass index (BMI) genetic risk score (GRS) and objectively-measured total sleep time (TST) in a cohort of Norwegian children (enrolled at age four in 2007-2008) using cross-sectional data at age six. The analytical sample included 452 six-year old children with complete genotype and phenotype data. The outcome was actigraphic total sleep time (TST) measured at age six years. Genetic risk of obesity was inferred using a 32-single nucleotide polymorphism (SNP) weighted GRS of BMI. Covariates were BMI-Standard deviation scores (SDS) (which takes into account age and sex) and, in a sensitivity analysis socioeconomic status. Analyses consisted of Pearson's correlations and linear regressions. In our sample, 54% of participants were male; mean (SD) TST, age and BMI were 9.6 (0.8) hours, 6.0 (0.2) years and 15.3 (1.2) kg/m, respectively. BMI and TST were not correlated, r = -0.003, p = 0.946. However, the BMI GRS was associated with TST after adjusting for BMI-SDS, standardised β = -0.11; 95% confidence interval (CI) = -0.22, -0.01. To our knowledge, this is the first study to establish a relationship between genetic risk of obesity and objective sleep duration in children. Findings suggest some shared genetic aetiology underlying these traits. Future research could identify the common biological pathways through which common genes predispose to both shorter sleep and increased risk of obesity.
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http://dx.doi.org/10.1016/j.sleep.2021.04.021DOI Listing
July 2021

Examining the validity and consistency of the Adult Eating Behaviour Questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population.

Eat Weight Disord 2021 May 8. Epub 2021 May 8.

Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.

Purpose: Appetitive traits in adults and their associations with weight can be measured using the Adult Eating Behaviour Questionnaire (AEBQ). The aim of this study was to confirm the factor structure of the Spanish AEBQ (AEBQ-Esp) in a Mexican sample and explore associations between the eight traits with body mass index (BMI).

Method: A sample of 1023 adults, mean age of 36.8 ± 12.8 years, was recruited from Guadalajara, Mexico. Researchers weighed and measured participants, and they completed the AEBQ-Esp either online or in paper format and reported sociodemographic data. To test two alternative factor structures (eight factors including Hunger; seven factors excluding Hunger), confirmatory factor analysis (CFA) was used. Internal reliability was assessed using Cronbach's alpha; test-retest reliability was assessed using intra-class correlation coefficients. Multivariate linear regressions were used to test for associations between the AEBQ subscales and BMI, adjusted for age, sex, format of AEBQ responses, education, marital and employment status.

Results: A seven-factor structure was the best model fit using CFA, excluding the Hunger subscale but similar to the original AEBQ. Internal reliability was good for all subscales (Cronbach's α = 0.70-0.86), and the intra-class correlation coefficient (0.70-0.91) reflected good test-retest reliability. In the fully adjusted models, Satiety Responsiveness [β = - 0.61; (- 1.01, - 0.21)] and Slowness in Eating [β = - 0.70; (- 1.01, - 0.39)] were negatively associated with BMI, and Emotional Over-Eating [β = 0.94; (0.62, 1.27)] was positively associated with BMI.

Conclusions: The AEBQ-Esp (excluding Hunger) appears to be a valid and reliable psychometric questionnaire for measuring appetitive traits in a Mexican Spanish-speaking population. Some traits appear to be associated with BMI in adulthood and warrant further exploration.

Level Of Evidence: Level III evidence obtained from well-designed cohort or case-control analytic studies. Although this was just an observational study, it was well designed and provided new evidence.
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http://dx.doi.org/10.1007/s40519-021-01201-9DOI Listing
May 2021

The retail food environment and its association with body mass index in Mexico.

Int J Obes (Lond) 2021 Jun 17;45(6):1215-1228. Epub 2021 Feb 17.

Research Department of Epidemiology and Public Health, University College London, London, UK.

Background/objective: Mexico has one of the highest rates of obesity and overweight worldwide, affecting 75% of the population. The country has experienced a dietary and food retail transition involving increased availability of high-calorie-dense foods and beverages. This study aimed to assess the relationship between the retail food environment and body mass index (BMI) in Mexico.

Subjects/methods: Geographical and food outlet data were obtained from official statistics; anthropometric measurements and socioeconomic characteristics of adult participants (N = 22,219) came from the nationally representative 2012 National Health and Nutrition Survey (ENSANUT). Densities (store count/census tract area (CTA)) of convenience stores, restaurants, fast-food restaurants, supermarkets and fruit and vegetable stores were calculated. The association of retail food environment variables, sociodemographic data and BMI was tested using multilevel linear regression models.

Results: Convenience store density was high (mean (SD) = 50.0 (36.9)/CTA) compared with other food outlets in Mexico. A unit increase in density of convenience stores was associated with a 0.003 kg/m (95% CI: 0.0006, 0.005, p = 0.011) increase in BMI, equivalent to 0.34 kg extra weight for an adult 1.60 m tall for every additional 10% store density increase (number of convenience stores per CTA (km)). Metropolitan areas showed the highest density of food outlet concentration and the highest associations with BMI (β = 0.01, 95% CI: 0.004-0.01, p < 0.001). A 10% store density increase in these areas would represent a 1 kg increase in weight for an adult 1.60 m tall.

Conclusions: Convenience store density was associated with higher mean BMI in Mexican adults. An excessive convenience store availability, that offers unhealthy food options, coupled with low access to healthy food resources or stores retailing healthy food, including fruits and vegetables, may increase the risk of higher BMI. This is the first study to assess the association of the retail food environment and BMI at a national level in Mexico.
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http://dx.doi.org/10.1038/s41366-021-00760-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159738PMC
June 2021

The relationship between the home environment and child adiposity: a systematic review.

Int J Behav Nutr Phys Act 2021 01 6;18(1). Epub 2021 Jan 6.

School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.

Background: Extensive research has demonstrated the role of the Home Environment (HE) in shaping children's energy balance behaviours. Less is known about direct relationships with bodyweight. This review examines associations between the social and physical aspects of three pre-defined Home Environment domains (food, physical activity and media) and adiposity measures in children ≤12 years.

Methods: Six electronic databases (PubMed, Medline, EBSCO CINAHL, EMBASE, Web of Science, PsycInfo) were systematically searched up to October 2020. Studies reporting at least one physical and/or social aspect of the food, physical activity and/or media domains of the Home Environment in relation to child adiposity outcomes were included (n = 62).

Results: Most studies examined one (n = 41) or two domains (n = 16). Only five studies assessed all three domains of the Home Environment. Most consistent relationships were observed for physical aspects of the home media environment; with greater availability of electronic devices associated with higher child adiposity (21/29 studies). Findings were less consistent for the smaller number of studies examining physical aspects of the home food or physical activity environments. 8/15 studies examining physical food environments reported null associations with adiposity. Findings were similarly mixed for physical activity environments; with 4/7 reporting null associations, 2/7 reporting negative associations and 1/7 reporting positive associations between access to physical activity equipment/garden space and adiposity. Fewer studies assessed social aspects (e.g. caregiver modelling or limit setting) of the Home Environment in relation to child adiposity and findings were again mixed; 9/16 media environment, 7/11 food environment and 9/13 physical activity environment studies reported null associations with child adiposity outcomes.

Conclusions: The home media environment was most consistently associated with adiposity in childhood. Findings were less consistent for the home food and physical activity environments. Greater agreement on definitions and the measurement of the obesogenic home environment is required in order to clarify the strength and direction of relationships with child adiposity. Robust longitudinal research using comprehensive measures of the holistic home environment is needed to better identify which aspects contribute to excess weight gain in childhood.

Trial Registration: PROSPERO Systematic review registration number:  CRD42018115139 .
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http://dx.doi.org/10.1186/s12966-020-01073-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788808PMC
January 2021

Experience of Using an Online Pre-Ordering System for A Workplace Canteen That Offers Lower-Energy Swaps: A Think-Aloud Study.

Nutrients 2020 Dec 18;12(12). Epub 2020 Dec 18.

Research Department of Behavioural Science and Health, Institute of Epidemiology & Public Health, 1-19 Torrington Pl, Fitzrovia, University College London, London WC1E 7HB, UK.

Online systems that allow employees to pre-order their lunch may help reduce energy intake. We investigated the acceptability of a pre-ordering website for a workplace canteen that prompts customers to swap to lower-energy swaps and the factors influencing swap acceptance. Employees ( = 30) placed a hypothetical lunch order through a pre-ordering website designed for their canteen while thinking aloud. Semi-structured interview questions supported data collection. Data were analysed using thematic analysis. Acceptability was generally high, but potentially context dependent. Practical considerations, such as reminders to pre-order, user-friendliness, provision of images of menu items and energy information while browsing, an ability to reserve pre-ordered meals, and a swift collection service facilitated acceptability. The restrictive timeframe within which orders could be placed, a lack of opportunity to see foods before ordering, and prompts to swap being perceived as threatening autonomy were barriers to acceptability. Swap acceptance was facilitated by the provision of physical activity calorie equivalents (PACE) information, and swap similarity in terms of taste, texture, and expected satiety as well as the perception that alternatives provided meaningful energy savings. Online canteen pre-ordering systems that prompt lower-energy swaps may be an acceptable approach to help reduce energy intake in the workplace.
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http://dx.doi.org/10.3390/nu12123878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767311PMC
December 2020

Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis.

JMIR Mhealth Uhealth 2020 07 10;8(7):e18255. Epub 2020 Jul 10.

University College London, London, United Kingdom.

Background: Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers.

Objective: This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement.

Methods: A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis.

Results: In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (-0.28 kg; 95% CI -1.43 to 0.87) or per-protocol data (-0.65 kg; 95% CI -1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement.

Conclusions: In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.
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http://dx.doi.org/10.2196/18255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382015PMC
July 2020

The obesity epidemic - Nature via nurture: A narrative review of high-income countries.

SAGE Open Med 2020 28;8:2050312120918265. Epub 2020 Apr 28.

Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.

Over the last three decades, the prevalence of obesity has increased rapidly in populations around the world. Despite a wealth of research, the relative contributions of the different mechanisms underlying this global epidemic are not fully understood. While there is growing consensus that the rapid rise in obesity prevalence has been driven by changes to the environment, it is evident that biology plays a central role in determining who develops obesity and who remains lean in the current obesogenic environment. This review summarises evidence on the extent to which genes and the environment influence energy intake and energy expenditure, and as a result, contribute to the ongoing global obesity epidemic. The concept of genetic susceptibility to the environment driving human variation in body weight is discussed.
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http://dx.doi.org/10.1177/2050312120918265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222649PMC
April 2020

Genetic and environmental influences on human height from infancy through adulthood at different levels of parental education.

Sci Rep 2020 05 14;10(1):7974. Epub 2020 May 14.

Department of Epidemiology, School of Public Health, Seoul National University, Seoul, 08826, Korea.

Genetic factors explain a major proportion of human height variation, but differences in mean stature have also been found between socio-economic categories suggesting a possible effect of environment. By utilizing a classical twin design which allows decomposing the variation of height into genetic and environmental components, we tested the hypothesis that environmental variation in height is greater in offspring of lower educated parents. Twin data from 29 cohorts including 65,978 complete twin pairs with information on height at ages 1 to 69 years and on parental education were pooled allowing the analyses at different ages and in three geographic-cultural regions (Europe, North America and Australia, and East Asia). Parental education mostly showed a positive association with offspring height, with significant associations in mid-childhood and from adolescence onwards. In variance decomposition modeling, the genetic and environmental variance components of height did not show a consistent relation to parental education. A random-effects meta-regression analysis of the aggregate-level data showed a trend towards greater shared environmental variation of height in low parental education families. In conclusion, in our very large dataset from twin cohorts around the globe, these results provide only weak evidence for the study hypothesis.
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http://dx.doi.org/10.1038/s41598-020-64883-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224277PMC
May 2020

Socioeconomic status and changes in appetite from toddlerhood to early childhood.

Appetite 2020 03 16;146:104517. Epub 2019 Nov 16.

School of Psychology, University of Leeds, Leeds, United Kingdom; Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.

Understanding the mechanisms through which deprivation predisposes a child to increased obesity risk is key to tackling health inequality. Appetite avidity is a key driver of variation in early weight gain. Low socioeconomic status (SES) can be a marker of a more 'obesogenic' food environment which may encourage the behavioural expression of appetite avidity. The objective was to test the hypothesis that children of lower SES demonstrate increases in appetite avidity from toddlerhood to five years. Data were from the Gemini twin birth cohort, with one twin per family selected at random. Parents completed the Child Eating Behaviour Questionnaire (CEBQ) to assess appetitive traits at 16 months and five years. SES was defined using a weighted composite measure comprising seven key correlates. Linear regression models examined the cross-sectional and prospective associations between SES and appetite from 16 months to 5 years, controlling for appetite at 16 months, sex, birth weight and parental BMI. Cross-sectionally, lower SES was significantly associated with higher food responsiveness (β = -0.09 ± 0.024), higher enjoyment of food (β = -0.13 ± 0.024), lower satiety responsiveness (β = 0.09 ± 0.024), and lower food fussiness (β = 0.09, ±0.024) at 16 months. At age 5, lower SES was significantly associated with higher food responsiveness (β = -0.10 ± 0.032), higher desire to drink (β = -0.22 ± 0.031) and higher emotional overeating (β = -0.10 ± 0.032). Prospectively, lower SES predicted greater increases in two key weight-related appetitive traits, from 16 months to 5 years: emotional overeating (β = -0.10 ± 0.032; p < 0.01) and food responsiveness (β = -0.09, ±0.030; p < 0.01). The results indicate that appetite may be a behavioural mediator of the well-established link between childhood deprivation and obesity risk.
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http://dx.doi.org/10.1016/j.appet.2019.104517DOI Listing
March 2020

Parental Education and Genetics of BMI from Infancy to Old Age: A Pooled Analysis of 29 Twin Cohorts.

Obesity (Silver Spring) 2019 05 5;27(5):855-865. Epub 2019 Apr 5.

Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Objective: The objective of this study was to analyze how parental education modifies the genetic and environmental variances of BMI from infancy to old age in three geographic-cultural regions.

Methods: A pooled sample of 29 cohorts including 143,499 twin individuals with information on parental education and BMI from age 1 to 79 years (299,201 BMI measures) was analyzed by genetic twin modeling.

Results: Until 4 years of age, parental education was not consistently associated with BMI. Thereafter, higher parental education level was associated with lower BMI in males and females. Total and additive genetic variances of BMI were smaller in the offspring of highly educated parents than in those whose parents had low education levels. Especially in North American and Australian children, environmental factors shared by co-twins also contributed to the higher BMI variation in the low education level category. In Europe and East Asia, the associations of parental education with mean BMI and BMI variance were weaker than in North America and Australia.

Conclusions: Lower parental education level is associated with higher mean BMI and larger genetic variance of BMI after early childhood, especially in the obesogenic macro-environment. The interplay among genetic predisposition, childhood social environment, and macro-social context is important for socioeconomic differences in BMI.
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http://dx.doi.org/10.1002/oby.22451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478550PMC
May 2019

Additional Data to Explain Childhood Obesity-Reply.

JAMA Pediatr 2019 06;173(6):605-606

Department of Behavioural Science and Health, University College London, London, United Kingdom.

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http://dx.doi.org/10.1001/jamapediatrics.2019.0376DOI Listing
June 2019

Modeling the Distinct Negative-Reinforcement Mechanisms Associated with Alcohol Misuse and Unhealthy Snacking.

Subst Use Misuse 2019 12;54(6):921-933. Epub 2019 Feb 12.

a Department of Psychological Sciences, University of Liverpool, Liverpool, UK.

Background: Negative personality characteristics have been implicated in promoting overconsumption of both alcohol and food. Furthermore, positive motivations (enhancement) and negative motivations (coping) may mediate the association between personality and alcohol or food (over)consumption.

Objectives: This study hypothesized that i.) drinking to cope and ii.) eating to cope would mediate the association between hopelessness/anxiety sensitivity and hazardous drinking/unhealthy snacking, respectively, and iii.) eating and drinking to cope would represent separate strategies.

Methods: Participants were recruited via opportunity sampling through university schemes, social media, email and web page advertisements. Questionnaires included the Alcohol Use Disorders Identification Test, Substance Use Risk Profile Scale, Modified Drinking Motives Questionnaire Short Form, Palatable Eating Motives Scale and Snack/Meal Food Intake Measure.

Results: Participants were 198 undergraduates, weight-related research volunteers and the public (83% female; 90% university educated). The hypothesized structural model fit the data well. As predicted, there were significant indirect associations between negative personality characteristics, hazardous drinking and unhealthy snacking via coping; specifically, individuals higher in anxiety sensitivity/hopelessness used food or alcohol to cope which, in turn, significantly predicted unhealthy snacking, and hazardous drinking, respectively. Importantly, drinking and eating to cope represented outcome-specific strategies, indicated by no significant association between eating to cope and hazardous drinking, or between drinking to cope and snacking.

Conclusions: This study demonstrates that coping motivations are critical to the relationship between negative personality characteristics and unhealthy behaviors and highlights the distinct negative-reinforcement pathways associated with hazardous drinking and unhealthy snacking in majority university-educated females from the UK.
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http://dx.doi.org/10.1080/10826084.2018.1552299DOI Listing
January 2020

Assessing potential shared genetic aetiology between body mass index and sleep duration in 142,209 individuals.

Genet Epidemiol 2019 03 26;43(2):207-214. Epub 2018 Nov 26.

Institute for Social and Economic Research, University of Essex, Colchester, UK.

Observational studies find an association between increased body mass index (BMI) and short self-reported sleep duration in adults. However, the underlying biological mechanisms that underpin these associations are unclear. Recent findings from the UK Biobank suggest a weak genetic correlation between BMI and self-reported sleep duration. However, the potential shared genetic aetiology between these traits has not been examined using a comprehensive approach. To investigate this, we created a polygenic risk score (PRS) of BMI and examined its association with self-reported sleep duration in a combination of individual participant data and summary-level data, with a total sample size of 142,209 individuals. Although we observed a nonsignificant genetic correlation between BMI and sleep duration, using LD score regression (r  = -0.067 [SE = 0.039], P = 0.092) we found that a PRS of BMI is associated with a decrease in sleep duration (unstandardized coefficient = -1.75 min [SE = 0.67], P = 6.13 × 10 ), but explained only 0.02% of the variance in sleep duration. Our findings suggest that BMI and self-reported sleep duration possess a small amount of shared genetic aetiology and other mechanisms must underpin these associations.
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http://dx.doi.org/10.1002/gepi.22174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492181PMC
March 2019

Evidence for gene-environment correlation in child feeding: Links between common genetic variation for BMI in children and parental feeding practices.

PLoS Genet 2018 11 20;14(11):e1007757. Epub 2018 Nov 20.

Department of Behavioural Science and Health, University College London, London, United Kingdom.

The parental feeding practices (PFPs) of excessive restriction of food intake ('restriction') and pressure to increase food consumption ('pressure') have been argued to causally influence child weight in opposite directions (high restriction causing overweight; high pressure causing underweight). However child weight could also 'elicit' PFPs. A novel approach is to investigate gene-environment correlation between child genetic influences on BMI and PFPs. Genome-wide polygenic scores (GPS) combining BMI-associated variants were created for 10,346 children (including 3,320 DZ twin pairs) from the Twins Early Development Study using results from an independent genome-wide association study meta-analysis. Parental 'restriction' and 'pressure' were assessed using the Child Feeding Questionnaire. Child BMI standard deviation scores (BMI-SDS) were calculated from children's height and weight at age 10. Linear regression and fixed family effect models were used to test between- (n = 4,445 individuals) and within-family (n = 2,164 DZ pairs) associations between the GPS and PFPs. In addition, we performed multivariate twin analyses (n = 4,375 twin pairs) to estimate the heritabilities of PFPs and the genetic correlations between BMI-SDS and PFPs. The GPS was correlated with BMI-SDS (β = 0.20, p = 2.41x10-38). Consistent with the gene-environment correlation hypothesis, child BMI GPS was positively associated with 'restriction' (β = 0.05, p = 4.19x10-4), and negatively associated with 'pressure' (β = -0.08, p = 2.70x10-7). These results remained consistent after controlling for parental BMI, and after controlling for overall family contributions (within-family analyses). Heritabilities for 'restriction' (43% [40-47%]) and 'pressure' (54% [50-59%]) were moderate-to-high. Twin-based genetic correlations were moderate and positive between BMI-SDS and 'restriction' (rA = 0.28 [0.23-0.32]), and substantial and negative between BMI-SDS and 'pressure' (rA = -0.48 [-0.52 - -0.44]. Results suggest that the degree to which parents limit or encourage children's food intake is partly influenced by children's genetic predispositions to higher or lower BMI. These findings point to an evocative gene-environment correlation in which heritable characteristics in the child elicit parental feeding behaviour.
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http://dx.doi.org/10.1371/journal.pgen.1007757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245504PMC
November 2018

Weight change increases the odds of psychological distress in middle age: bidirectional analyses from the Whitehall II Study.

Psychol Med 2019 11 20;49(15):2505-2514. Epub 2018 Nov 20.

Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.

Background: Mood disorders and adiposity are major public health challenges. Few studies have investigated the bidirectional association of weight and waist circumference (WC) change with psychological distress in middle age, while taking into account the potential U-shape of the association. The aim of this study was to examine the bidirectional association between psychological distress and categorical change in objectively measured weight and WC.

Methods: We analysed repeated measures (up to 17 522 person-observations in adjusted analyses) of psychological distress, weight and WC from the Whitehall II cohort. Participants were recruited at age 35-55 and 67% male. Psychological distress was assessed using the General Health Questionnaire. We used random-effects regressions to model the association between weight and WC changes and psychological distress, with and without a 5-year lag period.

Results: Psychological distress was associated with weight and WC gain over the subsequent 5 years but not the second 5-year period. Weight gain and loss were associated with increased odds for incident psychological distress in models with and without time-lag [odds ratio (OR) for incident psychological distress after 5-year time-lag: loss 1.20, 95% confidence interval (CI) 1.00-1.43; gain>5% 1.20, 95% CI 1.02-1.40]. WC changes were only associated with psychological distress in models without time-lag (OR for incident psychological distress: loss 1.29, 95% CI 1.02-1.64; gain>5% 1.33, 95% CI 1.11-1.58).

Conclusions: Weight gain and loss increase the odds for psychological distress compared with stable weight over subsequent 10 years. In contrast, the association between psychological distress and subsequent weight and WC changes was limited to the first 5 years of follow-up.
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http://dx.doi.org/10.1017/S0033291718003379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805986PMC
November 2019

Variation in the Heritability of Child Body Mass Index by Obesogenic Home Environment.

JAMA Pediatr 2018 12;172(12):1153-1160

Department of Behavioural Science and Health, University College London, London, United Kingdom.

Importance: The early obesogenic home environment is consistently identified as a key influence on child weight trajectories, but little research has examined the mechanisms of that influence. Such research is essential for the effective prevention and treatment of overweight and obesity.

Objective: To test behavioral susceptibility theory's hypothesis that the heritability of body mass index (BMI) is higher among children who live in more obesogenic home environments.

Design, Setting, And Participants: This study was a gene-environment interaction twin study that used cross-sectional data from 925 families (1850 twins) in the Gemini cohort (a population-based prospective cohort of twins born in England and Wales between March and December 2007). Data were analyzed from July to October 2013 and in June 2018.

Exposures: Parents completed the Home Environment Interview, a comprehensive measure of the obesogenic home environment in early childhood. Three standardized composite scores were created to capture food, physical activity, and media-related influences in the home; these were summed to create an overall obesogenic risk score. The 4 composite scores were split on the mean, reflecting higher-risk and lower-risk home environments.

Main Outcomes And Measures: Quantitative genetic model fitting was used to estimate heritability of age-adjusted and sex-adjusted BMI (BMI SD score, estimated using British 1990 growth reference data) for children living in lower-risk and higher-risk home environments.

Results: Among 1850 twins (915 [49.5%] male and 935 [50.5%] female; mean [SD] age, 4.1 [0.4] years), the heritability of BMI SD score was significantly higher among children living in overall higher-risk home environments (86%; 95% CI, 68%-89%) compared with those living in overall lower-risk home environments (39%; 95% CI, 21%-57%). The findings were similar when examining the heritability of BMI in the separate food and physical activity environment domains.

Conclusions And Relevance: These findings support the hypothesis that obesity-related genes are more strongly associated with BMI in more obesogenic home environments. Modifying the early home environment to prevent weight gain may be particularly important for children genetically at risk for obesity.
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http://dx.doi.org/10.1001/jamapediatrics.2018.1508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396810PMC
December 2018

Genetic susceptibility to the "obesogenic" environment: the role of eating behavior in obesity and an appetite for change.

Am J Clin Nutr 2018 09;108(3):429-430

Department of Behavioural Science & Health, University College London, London, United Kingdom.

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http://dx.doi.org/10.1093/ajcn/nqy210DOI Listing
September 2018

Emotional Over- and Undereating in Children: A Longitudinal Analysis of Child and Contextual Predictors.

Child Dev 2019 11 29;90(6):e803-e818. Epub 2018 Jun 29.

Norwegian University of Science and Technology.

Eating more or eating less in response to negative emotions, called emotional over- and undereating, is common in children, but research on the etiology of these behaviors is in its infancy. Drawing on a large, representative community sample of Norwegian children followed up on a biennial basis from 6 to 10 years of age (analysis sample: n = 802), child and contextual predictors (i.e., child temperament, depression symptoms, serious life events, family functioning, parental sensitivity and structuring) of change in emotional over- and undereating were examined. Results revealed that low (temperamental) soothability and less parental structuring at age 6 predicted increased emotional overeating at age 10 and that lower family functioning at age 6 predicted more emotional undereating during the same period.
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http://dx.doi.org/10.1111/cdev.13110DOI Listing
November 2019

Genetic and environmental factors affecting birth size variation: a pooled individual-based analysis of secular trends and global geographical differences using 26 twin cohorts.

Int J Epidemiol 2018 08;47(4):1195-1206

Department of Psychology, University of Minnesota, Minneapolis, MN, USA.

Background: The genetic architecture of birth size may differ geographically and over time. We examined differences in the genetic and environmental contributions to birthweight, length and ponderal index (PI) across geographical-cultural regions (Europe, North America and Australia, and East Asia) and across birth cohorts, and how gestational age modifies these effects.

Methods: Data from 26 twin cohorts in 16 countries including 57 613 monozygotic and dizygotic twin pairs were pooled. Genetic and environmental variations of birth size were estimated using genetic structural equation modelling.

Results: The variance of birthweight and length was predominantly explained by shared environmental factors, whereas the variance of PI was explained both by shared and unique environmental factors. Genetic variance contributing to birth size was small. Adjusting for gestational age decreased the proportions of shared environmental variance and increased the propositions of unique environmental variance. Genetic variance was similar in the geographical-cultural regions, but shared environmental variance was smaller in East Asia than in Europe and North America and Australia. The total variance and shared environmental variance of birth length and PI were greater from the birth cohort 1990-99 onwards compared with the birth cohorts from 1970-79 to 1980-89.

Conclusions: The contribution of genetic factors to birth size is smaller than that of shared environmental factors, which is partly explained by gestational age. Shared environmental variances of birth length and PI were greater in the latest birth cohorts and differed also across geographical-cultural regions. Shared environmental factors are important when explaining differences in the variation of birth size globally and over time.
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http://dx.doi.org/10.1093/ije/dyy081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124623PMC
August 2018

Birth size and gestational age in opposite-sex twins as compared to same-sex twins: An individual-based pooled analysis of 21 cohorts.

Sci Rep 2018 04 19;8(1):6300. Epub 2018 Apr 19.

Istituto Superiore di Sanità - Centre for Behavioural Sciences and Mental Health, Rome, Italy.

It is well established that boys are born heavier and longer than girls, but it remains unclear whether birth size in twins is affected by the sex of their co-twin. We conducted an individual-based pooled analysis of 21 twin cohorts in 15 countries derived from the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), including 67,850 dizygotic twin individuals. Linear regression analyses showed that boys having a co-twin sister were, on average, 31 g (95% CI 18 to 45) heavier and 0.16 cm (95% CI 0.045 to 0.274) longer than those with a co-twin brother. In girls, birth size was not associated (5 g birth weight; 95% CI -8 to -18 and -0.089 cm birth length; 95% CI -0.202 to 0.025) with the sex of the co-twin. Gestational age was slightly shorter in boy-boy pairs than in boy-girl and girl-girl pairs. When birth size was standardized by gestational age, the magnitude of the associations was attenuated in boys, particularly for birth weight. In conclusion, boys with a co-twin sister are heavier and longer at birth than those with a co-twin brother. However, these differences are modest and partly explained by a longer gestation in the presence of a co-twin sister.
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http://dx.doi.org/10.1038/s41598-018-24634-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908858PMC
April 2018

Associations between birth size and later height from infancy through adulthood: An individual based pooled analysis of 28 twin cohorts participating in the CODATwins project.

Early Hum Dev 2018 05 12;120:53-60. Epub 2018 Apr 12.

Department of Endocrinology, Odense University Hospital, Odense, Denmark.

Background: There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment.

Aim: To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors.

Methods: This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses.

Results: Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length.

Conclusion: Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight.
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http://dx.doi.org/10.1016/j.earlhumdev.2018.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532975PMC
May 2018

Genetic and Environmental Influences on Developmental Milestones and Movement: Results From the Gemini Cohort Study.

Res Q Exerc Sport 2017 Dec 19;88(4):401-407. Epub 2017 Oct 19.

c University College London.

Purpose: Variability in the timing of infant developmental milestones is poorly understood. We used a twin analysis to estimate genetic and environmental influences on motor development and activity levels in infancy.

Method: Data were from the Gemini Study, a twin birth cohort of 2,402 families with twins born in the United Kingdom in 2007. Parents reported motor activity level for each of the twins at age 3 months using the Revised Infant Behavior Rating Scale and reported the ages at which they first sat unsupported, crawled, and walked unaided.

Results: Activity level at 3 months and ages when first sitting and crawling were about equally influenced by the shared family environment (45%-54%) and genes (45%-48%). Genetic influences dominated for age when children took their first independent steps (84%).

Conclusion: Aspects of the shared family environment appear to be important influences on motor activity levels and early milestones, although the timing of walking may have a stronger genetic influence. Further research to identify the specific environmental and genetic factors that promote early activity may be important for longer-term health outcomes.
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http://dx.doi.org/10.1080/02701367.2017.1373268DOI Listing
December 2017

Education in Twins and Their Parents Across Birth Cohorts Over 100 years: An Individual-Level Pooled Analysis of 42-Twin Cohorts.

Twin Res Hum Genet 2017 10;20(5):395-405

Institute for Molecular Medicine FIMM,Helsinki,Finland.

Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990-1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
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http://dx.doi.org/10.1017/thg.2017.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5969906PMC
October 2017

Emotional over- and under-eating in early childhood are learned not inherited.

Sci Rep 2017 08 22;7(1):9092. Epub 2017 Aug 22.

Department of Behavioural Science and Health, University College London, London, United Kingdom.

Emotional overeating (EOE) has been associated with increased obesity risk, while emotional undereating (EUE) may be protective. Interestingly, EOE and EUE tend to correlate positively, but it is unclear whether they reflect different aspects of the same underlying trait, or are distinct behaviours with different aetiologies. Data were from 2054 five-year-old children from the Gemini twin birth cohort, including parental ratings of child EOE and EUE using the Child Eating Behaviour Questionnaire. Genetic and environmental influences on variation and covariation in EUE and EOE were established using a bivariate Twin Model. Variation in both behaviours was largely explained by aspects of the environment completely shared by twin pairs (EOE: C = 90%, 95% CI: 89%-92%; EUE: C = 91%, 95% CI: 90%-92%). Genetic influence was low (EOE: A = 7%, 95% CI: 6%-9%; EUE: A = 7%, 95% CI: 6%-9%). EOE and EUE correlated positively (r = 0.43, p < 0.001), and this association was explained by common shared environmental influences (BivC = 45%, 95% CI: 40%-50%). Many of the shared environmental influences underlying EUE and EOE were the same (r = 0.50, 95% CI: 0.44, 0.55). Childhood EOE and EUE are etiologically distinct. The tendency to eat more or less in response to emotion is learned rather than inherited.
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http://dx.doi.org/10.1038/s41598-017-09519-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567210PMC
August 2017

Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study.

Sci Rep 2017 07 27;7(1):6287. Epub 2017 Jul 27.

Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK.

Intake of sweet food, beverages and added sugars has been linked with depressive symptoms in several populations. Aim of this study was to investigate systematically cross-sectional and prospective associations between sweet food/beverage intake, common mental disorder (CMD) and depression and to examine the role of reverse causation (influence of mood on intake) as potential explanation for the observed linkage. We analysed repeated measures (23,245 person-observations) from the Whitehall II study using random effects regression. Diet was assessed using food frequency questionnaires, mood using validated questionnaires. Cross-sectional analyses showed positive associations. In prospective analyses, men in the highest tertile of sugar intake from sweet food/beverages had a 23% increased odds of incident CMD after 5 years (95% CI: 1.02, 1.48) independent of health behaviours, socio-demographic and diet-related factors, adiposity and other diseases. The odds of recurrent depression were increased in the highest tertile for both sexes, but not statistically significant when diet-related factors were included in the model (OR 1.47; 95% CI: 0.98, 2.22). Neither CMD nor depression predicted intake changes. Our research confirms an adverse effect of sugar intake from sweet food/beverage on long-term psychological health and suggests that lower intake of sugar may be associated with better psychological health.
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http://dx.doi.org/10.1038/s41598-017-05649-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532289PMC
July 2017

Child and parent predictors of picky eating from preschool to school age.

Int J Behav Nutr Phys Act 2017 07 6;14(1):87. Epub 2017 Jul 6.

Department of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll, 7491, Trondheim, Norway.

Background: Picky eating is prevalent in childhood. Because pickiness concerns parents and is associated with nutrient deficiency and psychological problems, the antecedents of pickiness need to be identified. We propose an etiological model of picky eating involving child temperament, sensory sensitivity and parent-child interaction.

Methods: Two cohorts of 4-year olds (born 2003 or 2004) in Trondheim, Norway were invited to participate (97.2% attendance; 82.0% consent rate, n = 2475) and a screen-stratified subsample of 1250 children was recruited. We interviewed 997 parents about their child's pickiness and sensory sensitivity using the Preschool Age Psychiatric Assessment (PAPA). Two years later, 795 of the parents completed the interview. The Children's Behavior Questionnaire (CBQ) was used to assess children's temperament. Parent- child interactions were videotaped and parental sensitivity (i.e., parental awareness and appropriate responsiveness to children's verbal and nonverbal cues) and structuring were rated using the Emotional Availability Scales (EAS).

Results: At both measurement times, 26% of the children were categorized as picky eaters. Pickiness was moderately stable from preschool to school age (OR = 5.92, CI = 3.95, 8.86), and about half of those who displayed pickiness at age 4 were also picky eaters two years later. While accounting for pickiness at age 4, sensory sensitivity at age 4 predicted pickiness at age 6 (OR = 1.25, CI = 1.08, 2.23), whereas temperamental surgency (OR = 0.88, CI = 0.64, 1.22) and negative affectivity (OR = 1.17, CI = 0.75, 1.84) did not. Parental structuring was found to reduce the risk of children's picky eating two years later (OR = 0.90, CI = 0.82, 0.99), whereas parental sensitivity increased the odds for pickiness (OR = 1.10, CI = 1.00, 1.21).

Conclusions: Although pickiness is stable from preschool to school age, children who are more sensory sensitive are at higher risk for pickiness two years later, as are children whose parents display relatively higher levels of sensitivity and lower levels of structuring. Our findings suggest that interventions targeting children's sensory sensitivity, as well as parental sensitivity and structuring, might reduce the risk of childhood pickiness. Health care providers should support parents of picky eaters in repeatedly offering unfamiliar and rejected foods to their children without pressure and acknowledging child autonomy.
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http://dx.doi.org/10.1186/s12966-017-0542-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498871PMC
July 2017

Body composition impacts appetite regulation in middle childhood. A prospective study of Norwegian community children.

Int J Behav Nutr Phys Act 2017 05 30;14(1):70. Epub 2017 May 30.

Department of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll, 7491, Trondheim, Norway.

Background: Research suggests a role for both fat mass and muscle mass in appetite regulation, but the longitudinal relationships between them have not yet been examined in children. The present study therefore aimed to explore the prospective relationships between fat mass, muscle mass and the appetitive traits food responsiveness and satiety responsiveness in middle childhood.

Methods: Food responsiveness and satiety responsiveness were measured using the parent-reported Children's Eating Behavior Questionnaire in a representative sample of Norwegian 6 year olds, followed up at 8 and 10 years of age (n = 807). Body composition was measured by bioelectrical impedance.

Results: Applying a structural equation modeling framework we found that higher fat mass predicted greater increases in food responsiveness over time, whereas greater muscle mass predicted decreases in satiety responsiveness. This pattern was consistent both from ages 6 to 8 and from ages 8 to 10 years.

Conclusions: Our study is the first to reveal that fat mass and muscle mass predict distinct changes in different appetitive traits over time. Replication of findings in non-European populations are needed, as are studies of children in other age groups. Future studies should also aim to reveal the underlying mechanisms.
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http://dx.doi.org/10.1186/s12966-017-0528-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450304PMC
May 2017

Association between birthweight and later body mass index: an individual-based pooled analysis of 27 twin cohorts participating in the CODATwins project.

Int J Epidemiol 2017 10;46(5):1488-1498

Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.

Background: There is evidence that birthweight is positively associated with body mass index (BMI) in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment. We analysed the association between birthweight and BMI from infancy to adulthood within twin pairs, which provides insights into the role of genetic and environmental individual-specific factors.

Methods: This study is based on the data from 27 twin cohorts in 17 countries. The pooled data included 78 642 twin individuals (20 635 monozygotic and 18 686 same-sex dizygotic twin pairs) with information on birthweight and a total of 214 930 BMI measurements at ages ranging from 1 to 49 years. The association between birthweight and BMI was analysed at both the individual and within-pair levels using linear regression analyses.

Results: At the individual level, a 1-kg increase in birthweight was linearly associated with up to 0.9 kg/m2 higher BMI (P < 0.001). Within twin pairs, regression coefficients were generally greater (up to 1.2 kg/m2 per kg birthweight, P < 0.001) than those from the individual-level analyses. Intra-pair associations between birthweight and later BMI were similar in both zygosity groups and sexes and were lower in adulthood.

Conclusions: These findings indicate that environmental factors unique to each individual have an important role in the positive association between birthweight and later BMI, at least until young adulthood.
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http://dx.doi.org/10.1093/ije/dyx031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837357PMC
October 2017

Behavioural Susceptibility Theory: Professor Jane Wardle and the Role of Appetite in Genetic Risk of Obesity.

Curr Obes Rep 2017 Mar;6(1):38-45

Department of Behavioural Science and Health, University College London, London, UK.

Purpose Of Review: There is considerable variability in human body weight, despite the ubiquity of the 'obesogenic' environment. Human body weight has a strong genetic basis and it has been hypothesised that genetic susceptibility to the environment explains variation in human body weight, with differences in appetite being implicated as the mediating mechanism; so-called 'behavioural susceptibility theory' (BST), first described by Professor Jane Wardle. This review summarises the evidence for the role of appetite as a mediator of genetic risk of obesity.

Recent Findings: Variation in appetitive traits is observable from infancy, drives early weight gain and is highly heritable in infancy and childhood. Obesity-related common genetic variants identified through genome-wide association studies show associations with appetitive traits, and appetite mediates part of the observed association between genetic risk and adiposity. Obesity results from an interaction between genetic susceptibility to overeating and exposure to an 'obesogenic' food environment.
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http://dx.doi.org/10.1007/s13679-017-0247-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359365PMC
March 2017

Investigating the Bidirectional Associations of Adiposity with Sleep Duration in Older Adults: The English Longitudinal Study of Ageing (ELSA).

Sci Rep 2017 01 9;7:40250. Epub 2017 Jan 9.

Department of Epidemiology &Public Health, University College London, UK.

Cross-sectional analyses of adiposity and sleep duration in younger adults suggest that increased adiposity is associated with shorter sleep. Prospective studies have yielded mixed findings, and the direction of this association in older adults is unclear. We examined the cross-sectional and potential bi-directional, prospective associations between adiposity and sleep duration (covariates included demographics, health behaviours, and health problems) in 5,015 respondents from the English Longitudinal Study of Ageing (ELSA), at baseline and follow-up. Following adjustment for covariates, we observed no significant cross-sectional relationship between body mass index (BMI) and sleep duration [(unstandardized) B = -0.28 minutes, (95% Confidence Intervals (CI) = -0.012; 0.002), p = 0.190], or waist circumference (WC) and sleep duration [(unstandardized) B = -0.10 minutes, (95% CI = -0.004; 0.001), p = 0.270]. Prospectively, both baseline BMI [B = -0.42 minutes, (95% CI = -0.013; -0.002), p = 0.013] and WC [B = -0.18 minutes, (95% CI = -0.005; -0.000), p = 0.016] were associated with decreased sleep duration at follow-up, independently of covariates. There was, however, no association between baseline sleep duration and change in BMI or WC (p > 0.05). In older adults, our findings suggested that greater adiposity is associated with decreases in sleep duration over time; however the effect was very small.
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http://dx.doi.org/10.1038/srep40250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220373PMC
January 2017