Jean-Philippe Drouin-Chartier

Inter-individual variability in gVLM _B microbial metabolism and the short-excretion kinetics of SREM _B limit biomarkers reclassification of flavanol intake in the COSMOS trial, warranting dedicated validation for intended use.

Objectives: Given the limitations of body mass index (BMI), current guidance recommends combining BMI with a waist-based indicator to assess excess adiposity when adiposity cannot be pragmatically evaluated. We compared the prevalence of (1) excess adiposity and (2) clinical evidence of cardiovascular, hepatic, and/or metabolic dysfunction across different approaches to measuring excess adiposity in children and adolescents classified as having obesity based on BMI. Methods: This cross-sectional study included 549 children (2 to 17 years) with BMI >97th percentile followed at a paediatric obesity management clinic. The prevalences of (1) excess adiposity and (2) greater than or equal to one manifestation(s) of alterations in blood pressure, liver enzymes, and/or metabolic alterations affecting glucose homeostasis and plasma lipids were compared across six approaches to assess adiposity: (1) BMI >97th percentile, (2) waist circumference (WC) ≥90th percentile, (3) waist-to-height ratio (WHtR) >0.5, (4) BMI + WC, (5) BMI + WHtR, and (6) WC + WHtR, using logistic regressions. Results: Statistical differences in excess adiposity prevalence were found between some approaches: BMI (100.0%) >WHtR and BMI + WHtR (99.7%) >WC and BMI + WC (98.4%) and WC + WHtR (98.0%) (P = 0.0001). However, the prevalence of children having greater than or equal to one cardiovascular, hepatic, and/or metabolic dysfunction(s) was similar across the six approaches (minimum: 65.8% with BMI + WHtR; maximum: 66.6% with BMI + WC; P = 1.00). Conclusion: In this sample of children with obesity, we found no evidence that the adiposity assessment method led to clinically significant differences in detecting excess adiposity or cardiovascular, hepatic, and/or metabolic alterations. When anthropometric measurements are warranted, it is reasonable to prioritize, on an individual basis, the least stigmatizing approach.

Heterozygous familial hypercholesterolemia (HeFH) is a genetic disorder that accelerates atherosclerosis and leads to premature cardiovascular diseases (CVD). Whole food, plant-based diets (WFPB) are recommended worldwide for their cardioprotective properties but evidence regarding their effects in HeFH management remains unavailable. This study aims to evaluate the impact of a WFPB, in place of a standard American diet (SAD), on LDL-cholesterol (LDL-C) (primary outcome) and other CVD risk factors among adults with HeFH. In this randomized, two-period, two-treatment, crossover, controlled feeding trial, 50 adults with genetically confirmed HeFH, free of cholesterol-lowering medication, consumed a WFPB and a SAD for 4 weeks each in a random order, under fully controlled, isocaloric feeding conditions. The diets were separated by a two- to four-week washout period. LDL-C and other CVD risk factors were measured at the end of each diet. The WFPB induced a clinically significant reduction in LDL-C relative to the SAD ( − 17.9%, 95% CI: −21.7%, −14.3%; P < 0.0001). The study demonstrates the clinical significance of diet therapy in HeFH and supports its re-establishment as a cornerstone in clinical guidelines (clinicaltrials.gov registration: NCT05181553; funding: Canadian Institutes of Health Research).

Background: Whether children’s generational status ( i.e. , immigrant generation based on country of birth) or family structure ( i.e. , household composition) influences phenotypic obesity severity, or outcomes of its management, remains unclear. We investigated associations of generational status and family structure with phenotypic obesity severity, its change over time, and persistence in a lifestyle-modification program among children with obesity attending a pediatric obesity clinic in Montreal (Canada). Methods: This retrospective longitudinal analysis used medical records from children (2–17 years) who were followed between 2017 and 2023. We compared BMI z -score (BMIz) and clinical obesity prevalence at baseline and program persistence and changes in BMIz and blood pressure (BP) over follow-up, according to generational status and family structure. Results: Among the 568 included children, 362 (63.7%) had a first- or second-generation immigrant background, and 201 (35.4%) lived in non-two-parent families. At baseline, compared with children of third generation or more, those of first or second generation had lower BMIz (3.33 [95% CI: 3.22, 3.45] vs. 3.62 [95% CI: 3.47, 3.77]; p = 0.02) but a similar prevalence of clinical obesity (47.6% [95% CI: 42.6, 53.2] vs. 53.4% [95% CI: 47.0, 60.7]; p = 0.15). No differences were observed by family structure at baseline. Over follow-up (mean ± SD: 12.7 ± 12.8 months), program persistence and reductions in BMIz and BP were similar across groups. Conclusions: Although generational status and family structure remain relevant for tailoring counseling, we found no evidence that they are meaningfully associated with phenotypic obesity severity, its change over time, or persistence in this program.

Prostate cancer (PCa) is the second most common cancer in men and the fourth worldwide. Diet has been suspected as a contributor to PCa onset and progression; however, evidence remains inconsistent, because many studies focus on individual foods and use heterogeneous methods to derive dietary patterns. This systematic review evaluates the association between empirically derived dietary patterns and overall PCa risk in prospective cohort studies. A literature search was conducted on PubMed, Web of Science, Embase, the Cochrane Library, and Food Science and Technology Abstracts, following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk estimates comparing the highest versus lowest adherence categories were extracted. A random-effects meta-analysis using restricted maximum likelihood estimation pooled hazard ratios for overall PCa risk. Six eligible cohort studies were included. Two main dietary patterns were identified: a ‘western’ pattern, characterized by high intakes of red and processed meats, sweets, desserts, and a ‘prudent’ pattern characterized by high intakes of fruits, vegetables, fish, and seafood. No significant association with overall PCa was observed: prudent, hazard ratio _Pooled = 0.98; confidence interval _95% [0.91–1.06]; western, hazard ratio _Pooled = 1.07; confidence interval _95% [0.93–1.22]. Empirically derived dietary patterns were not significantly associated with overall PCa risk. Some evidence suggested an association between western dietary pattern and localized and aggressive PCa in populations with limited prior exposure, highlighting the role of dietary shifts. However, these findings were based on a limited number of studies, reflecting the scarcity of prospective cohort data. Future research should aim to standardize dietary pattern derivation and confounder selection to improve comparability across studies.

OBJECTIVES: We compared persistence in a lifestyle modification program and reductions in body mass index z-score (BMIz) among children with overweight or obesity attending a pediatric obesity management clinic based on their access to a family grant program (FGP) that fully subsidized multiprofessional health services for families with social vulnerabilities. METHODS: This is a retrospective, longitudinal analysis of medical records of children followed from April 8, 2021 (FGP implementation) to March 31, 2023. Children in youth centers, in foster families, with refugee status, or whose parents had a low income per Canada’s Revenue Agency were eligible for the FGP, which fully subsidized multiprofessional health services. The number of appointments, follow-up duration, and changes in BMIz over the study period were compared based on access to the FGP. RESULTS: Among the 198 included children, 62 received the FGP, and 136 were not eligible to it. Children with the FGP had longer follow-ups [10.3 (95% CI, 8.66–12.0) vs 6.55 (95% CI, 5.33–7.77) months; P = .0008] and a similar number of monthly appointments [0.81 (95% CI, 0.67–0.96) vs 0.90 (95% CI, 0.80–1.00); P = .69] compared with those without it. Over follow-up, children who received the FGP achieved similar BMIz reductions compared with those who were ineligible for it. CONCLUSIONS: Fully subsidizing multiprofessional health services for children with social vulnerabilities was associated with persistence in a lifestyle program and BMIz reductions comparable with those observed in children without such vulnerabilities. These findings suggest that free access to care may help overcome systemic barriers to managing childhood obesity.