Authors: Forbes, C., Yu, Z.M., Cui, Y., DeClercq, V., Dummer, T.J.B., Grandy, S., Keats, M., Parker, L., Sweeney, E., Keats, M. (2019) Abstract PURPOSE: To describe and compare the sociodemographic and lifestyle characteristics of urban and rural residents in Atlantic Canada. METHODS: Cross-sectional analyses of baseline data from the Atlantic Partnership for Tomorrow’s Health cohort were conducted. Specifically, 17,054 adults (35-69 years) who provided sociodemographic characteristics, measures of obesity, and a record of chronic disease and health behaviors were included in the analyses. Multiple linear regression and logistic regression models were used to calculate the multivariable-adjusted beta coefficients (β), odds ratios (OR), and related 95% confidence intervals (CI). FINDINGS: After adjusting for age, sex, and province, when compared to urban participants, rural residents were significantly more likely to: be classified as very active (OR: 1.19, CI: 1.11-1.27), be obese (OR: 1.13, 1.05-1.21), to present with abdominal obesity (OR: 1.08, CI: 1.01-1.15), and have a higher body fat percentage (β: 0.40, CI: 0.12-0.68) and fat mass index (β: 0.32, CI: 0.19-0.46). Rural residents were significantly less likely to be regular or habitual drinkers (OR: 0.83, CI: 0.78-0.89). Significant differences remained after further adjustment for confounding sociodemographic, lifestyle, and health characteristics. No significant differences in smoking behavior, fruit and vegetable intake, multimorbidity, or waist circumference were found. CONCLUSIONS: As expected, obesity prevalence was higher in rural Atlantic Canadians. In contrast to much of the existing literature, we found that rural participants were more likely to report higher levels of total physical activity and lower alcohol consumption. Findings suggest that novel obesity prevention strategies may be needed for rural populations. Link: https://doi: 10.1111/jrh.12363

Authors: DeClercq, V., Limbergen, J.V., Langille, M.G.I. Abstract The objective of the current study was to characterize the relationship between diet quality and body composition in participants living with IBD, specifically Crohn’s disease (CD) or ulcerative colitis (UC), in Atlantic Canada. Participants from the Atlantic Partnership for Tomorrow’s Health (PATH) study are residents of one of the four Atlantic Canada provinces. Participants who completed the dietary questionnaire and had body composition measured were included in the study (n = 12,462 without IBD, n = 111 CD, n = 119 UC). A greater number of participants with IBD reported having multiple chronic conditions compared to those without IBD. Those with UC had statistically higher body weight and body mass index (BMI) compared to those without IBD. Overall, significant positive correlations were observed between adiposity and servings of refined grains, and meats and alternatives such as eggs and fish, whereas negative correlations were observed with servings of vegetables, fruit, whole grains, and alternatives such as tofu, and nuts/seeds. Participants with IBD (both CD and UC) consumed more refined grains than those without IBD. Using logistic regression analysis, participants consuming more servings of vegetables and whole grains were less likely to have CD where as those consuming more serving of fruit and bean/legumes were less likely to have UC. In the Atlantic PATH cohort, which includes a region of the world with a high incidence of IBD, distinct differences in adiposity and diet quality were observed in individuals with specific types of IBD compared to those without. There is a need for collaborative efforts to address weight management and diet quality issues in those living with IBD in the Atlantic Canadian region. Link: https://doi.org/10.1371/journal.pone.0200580

Authors: Yu, Z.M., DeClercq, V., Cui, Y., Forbes, C., Grandy, S., Keats, M., Parker, L., Sweeney, E., Dummer, T.J.B. (2018). Abstract Objectives: The prevalence of obesity among populations in the Atlantic provinces is the highest in Canada. Some studies suggest that adequate fruit and vegetable consumption may help body weight management. We assessed the associations between fruit and vegetable intake with body adiposity among individuals who participated in the baseline survey of the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) cohort study. Methods: We carried out a cross-sectional analysis among 26 340 individuals (7979 men and 18 361 women) aged 35–69 years who were recruited in the baseline survey of the Atlantic PATH study. Data on fruit and vegetable intake, sociodemographic and behavioural factors, chronic disease, anthropometric measurements and body composition were included in the analysis. Results: In the multivariable regression analyses, 1 SD increment of total fruit and vegetable intake was inversely associated with body mass index (−0.12 kg/m2; 95% CI −0.19 to –0.05), waist circumference (−0.40 cm; 95% CI −0.58 to –0.23), percentage fat mass (−0.30%; 95% CI −0.44 to –0.17) and fat mass index (−0.14 kg/m2; 95% CI −0.19 to –0.08). Fruit intake, but not vegetable intake, was consistently inversely associated with anthropometric indices, fat mass, obesity and abdominal obesity. Conclusions: Fruit and vegetable consumption was inversely associated with body adiposity among the participant population in Atlantic Canada. This association was primarily attributable to fruit intake. Longitudinal studies and randomised trials are warranted to confirm these observations and investigate the underlying mechanisms. Link: http://bmjopen.bmj.com/content/8/4/e018060.full?ijkey=s8Si2uDe3SHk33b&keytype=ref

Authors: Lawrence LM, Stone MR, Rainham DG, Keats MR      Journal: Int J Behav Med. 2016 Jun 30 Abstract Purpose Physical activity (PA) is an effective intervention for improving the quality of life of colorectal cancer survivors (CRC) and may reduce the risk of cancer recurrence and cancer specific and all-cause mortality. However, most CRC survivors are not sufficiently active to receive these benefits. Sedentary behavior (SB) has also been linked to morbidity and mortality risk independent of activity level, thereby presenting an additional opportunity to improve health outcomes of CRC survivors. The built environment is known to influence PA and SB; however, little is known about where CRC survivors engage in PA and SB. The objective of this exploratory study was to objectively identify locations where CRC survivors engage in PA and SB in order to inform health promoting interventions. Method Activity and location of CRC survivors (n = 31) was monitored for 1 week between January 2014 and April 2015 in Nova Scotia, Canada. Bouts of PA and SB were time-matched with GPS data to attribute bouts to specific geographic locations. Results Participants’ home environment was the main location for both time spent in PA bouts (73.7 %) and time spent in SB bouts (90.5 %). Conclusion This study is the first to objectively identify environments where CRC survivors are active and sedentary. These findings highlight the importance of considering the home environment when developing intervention strategies to increase PA and reduce SB in CRC survivors. Keywords Behavioral medicine; Built environment; Cancer survivorship; Colorectal cancer; GPS; Physical activity; Sedentary behavior https://link.springer.com/article/10.1007%2Fs12529-016-9575-6

Date: 2013 | Authors: Tarra L Penney The prevention of chronic disease requires understanding and intervention related to both individual and environmental level determinants. However, traditional approaches to chronic disease prevention and management have primarily been focused at the individual level, with limited attention toward environmental level influences on health behaviour. This lack of comprehensiveness is partially due to a paucity of complex theoretical frameworks for clarifying the influences of personal cognitive, and broader environmental, variables on a range of health behaviours. Therefore, the purpose of this research was to expand and test a popular health behaviour theory, Social Cognitive Theory (SCT), to include influences of the perceived food environment on healthy eating behaviour. This study involved two phases. Phase 1 expanded SCT to include a perceived food environment construct through review of the food environment literature. Phase 2 conducted a cross-sectional study of 201 adults (age 35 to 69 years) using an online survey to test the expanded SCT informed by phase 1. Data analysis included descriptive statistics and structural equation modeling (SEM) to compare the traditional and expanded SCT model. Results demonstrated no significant model fit, with no improvement in oveall fit with the inclusion of the perceived food environment. However, the expansion of SCT to include perceived food environment attributes altered the pathways of influence within the social cognitive model, suggesting that the presence of perceived environment measures is important for understanding how perceived environments might mediate the effect of personal cognitive influences on eating behaviour. These findings have implications for food environment research, the development of ecological theories, the field of health promotion and the prevention of chronic disease.   http://dalspace.library.dal.ca/handle/10222/35463

Authors: Zhijie M Yu, Trevor J.B. Dummer, Aimee Adams, John D Murimboh and Louise Parker Journal: Journal of Exposure Science and Environmental Epidemiology | Volume: 24 | Pages: 135-44 |Date: 2014 | Abstract: Consumption of arsenic-contaminated drinking water is associated with increased cancer risk. The relationship between arsenic body burden, such as concentrations in human toenails, and arsenic in drinking water is not fully understood. We evaluated the relationship between arsenic concentrations in drinking water and toenail clippings among a cohort of Nova Scotians. A total of 960 men and women aged 35 to 69 years provided home drinking water and toenail clipping samples. Information on water source and treatment use and covariables was collected through questionnaires. Arsenic concentrations in drinking water and toenail clippings and anthropometric indices were measured. Private drilled water wells had higher arsenic concentrations compared with other dug wells and municipal drinking water sources (P<0.001). Among participants with drinking water arsenic levels ≥1 μg/l, there was a significant relationship between drinking water and toenail arsenic concentrations (r=0.46, P<0.0001). Given similar levels of arsenic exposure from drinking water, obese individuals had significantly lower concentrations of arsenic in toenails compared with those with a normal weight. Private drilled water wells were an important source of arsenic exposure in the study population. Body weight modifies the relationship between drinking water arsenic exposure and toenail arsenic concentrations.   https://www.nature.com/jes/journal/v24/n2/pdf/jes201388a.pdf

Authors: Heather Chappells, Norma Campbell, John Drage, Conrad V. Fernandez, Louise Parker, Trevor J.B. Dummer Journal: Science of The Total Environment | Volume: 505 | Pages: 1259-1273 |Date: February 2015 | Arsenic is a class I human carcinogen that has been identified as the second most important global health concern in groundwater supplies after contamination by pathogenic organisms. Hydrogeological assessments have shown naturally occurring arsenic to be widespread in groundwater across the northeastern United States and eastern Canada. Knowledge of arsenic risk exposure among private well users in these arsenic endemic areas has not yet been fully explored but research on water quality perceptions indicates a consistent misalignment between public and scientific assessments of environmental risk. This paper evaluates knowledge of arsenic risk exposure among a demographic cross-section of well users residing in 5 areas of Nova Scotia assessed to be at variable risk (high-low) of arsenic occurrence in groundwater based on water sample analysis. An integrated knowledge-to-action (KTA) methodological approach is utilized to comprehensively assess the personal, social and local factors shaping perception of well water contaminant risks and the translation of knowledge into routine water testing behaviors. Analysis of well user survey data (n = 420) reveals a high level of confidence in well water quality that is unrelated to the relative risk of arsenic exposure or homeowner adherence to government testing recommendations. Further analysis from the survey and in-depth well user interviews (n = 32) finds that well users’ assessments of risk are influenced by personal experience, local knowledge, social networks and convenience of infrastructure rather than by formal information channels, which are largely failing to reach their target audiences. Insights from interviews with stakeholders representing government health and environment agencies (n = 15) are used to reflect on the institutional barriers that mediate the translation of scientific knowledge into public awareness and stewardship behaviors. The utilization of local knowledge brokers, community-based networks and regulatory incentives to improve risk knowledge and support routine testing among private well users is discussed. http://www.sciencedirect.com/science/article/pii/S0048969713015982

Authors: Zhijie M. Yu, Bryan Fung, John D. Murimboh, Louise Parker, Trevor J.B. Dummer Journal: Environment International | Volume: 66 | Pages: 115-123 |Date: May 2014 | Consumption of arsenic contaminated drinking water causes a large variety of adverse health outcomes. Body mass index (BMI), which is linked to diet, is positively associated with arsenic methylation capacity. We investigated the association between an obesity-related diet and arsenic body burden from exposure to naturally contaminated drinking water among Nova Scotia residents. We collected home drinking water and toenail clipping samples among 960 men and women aged 35 to 69 years in Nova Scotia, Canada from 2009 through 2010. We measured body composition and arsenic concentrations in drinking water and toenails clipping samples and collected socio-demographic, behavioural, and dietary information via standardized questionnaires. We derived an obesity-related dietary pattern score using reduced rank regression. Across quartiles of the obesity-related dietary pattern score there were no significant differences in drinking water arsenic concentrations, but there was an inverse trend in arsenic concentrations in toenails across the dietary pattern score (P = 0.01). Compared with individuals in the first quartile of the dietary pattern score, those in the second through fourth quartiles had decreased likelihoods of high toenail arsenic (≥ 85 percentile). The corresponding odds ratios (95% confidence intervals [CI]) were 0.81 (95% CI, 0.49, 1.36), 0.57 (95% CI, 0.33, 0.99), and 0.55 (95% CI, 0.31, 0.98), respectively (P for trend = 0.02). We conclude that given similar levels of naturally occurring arsenic exposure via drinking water, an obesity-related dietary pattern was associated with significantly lower arsenic concentrations in toenails. Further studies to investigate the underlining mechanisms are warranted. http://www.sciencedirect.com/science/article/pii/S0160412014000403

Authors: DeClercq, V., Cui, Y., Dummer, T.J.B., Forbes, C., Grandy, S., Keats, M., Parker, L., Sweeney, E., Yu, Z.M., McLeod, R. (2017) Journal: Journal of the Endocrine Society, 1(12). Doi: https://doi.org/10.1210/js.2017-00339 Abstract: Context: The increasing prevalence of obesity and diabetes greatly influences the risk for cardiovascular (CV) comorbidities and affects the quality of life of many people. However, the relationship among diabetes, obesity, and cardiovascular risk is complex and requires further investigation to understand the biological milieu connecting these conditions. Objective: The aim of the current study was to explore the relationship between biological markers of adipose tissue function (adiponectin) and CV risk (apolipoprotein B) in body mass index (BMI)–matched participants with and without diabetes. Design: Nested case-control study. Setting: The Atlantic Partnership for Tomorrow’s Health (PATH) cohort represents four Atlantic Canadian provinces: Newfoundland and Labrador, New Brunswick; Nova Scotia; and Prince Edward Island. Participants: The study population (n = 480) was aged 35 to 69 years, 240 with diabetes and 240 without diabetes. Main Outcome Measures: Groups with and without diabetes were matched for sex and BMI. Both measured and self-reported data were used to examine disease status, adiposity, and lifestyle factors. Immunoassays were used to measure plasma markers. Results: In these participants, plasma adiponectin levels were lower among those with diabetes than those without diabetes; these results were sex-specific, with a strong relationship seen in women. In contrast, in participants matched for sex and adiposity, plasma apoB levels were similar between participants with and those without diabetes. Conclusion: Measures of adiposity were higher in participants with diabetes. However, when matched for adiposity, the adipokine adiponectin exhibited a strong inverse association with diabetes. Link: https://academic.oup.com/jes/article/doi/10.1210/js.2017-00339/4604936?guestAccessKey=e0fbf6e4-8449-4fb0-9c4f-6b89e62368ef

Authors: DeClercq, V., Cui, Y., Forbes, C., Grandy, S., Keats, M., Parker, L., Sweeney, E., Yu, Z.M., Dummer, T.J.B. (2017) Journal: Mediators of Inflammation, 2017. doi: https://doi.org/10.1155/2017/4302412 Abstract: The objective of this study was to examine the relationship between adipokines and adiposity in individuals with rheumatoid and osteoarthritis in the Atlantic PATH cohort. Using a nested case-control analysis, participants in the Atlantic PATH cohort with rheumatoid or osteoarthritis were matched for measures of adiposity with participants without a history of arthritis. Both measured and self-reported data were used to examine disease status, adiposity, and lifestyle factors. Immunoassays were used to measure plasma markers. BMI was positively correlated with percentage body fat, fat mass index (FMI), and a change in BMI from 18 years of age in all 3 groups. There were no statistical differences between levels of plasma adipokines; adiponectin levels were 6.6, 7.9, and 8.2 μg/ml, leptin levels were 10.3, 13.7, and 11.5 ng/ml, and resistin levels were 10.0, 12.1, and 10.8 ng/ml in participants without arthritis, with rheumatoid arthritis, and with osteoarthritis, respectively. Those with higher levels of adiponectin were more likely to have osteoarthritis (but not rheumatoid arthritis). No association was found between arthritis types and leptin or resistin. This study demonstrates differences in measures of adiposity and adipokines in specific types of arthritis and highlights the need for more research targeting specific adipokines during arthritic disease progression. Link: https://www.hindawi.com/journals/mi/2017/4302412/