Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario.

OBJECTIVES: International data suggest the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario. METHODS: A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n = 3713) and BORN Ontario (n = 768). Body mass index z score (zBMI) definitions were adapted from the World Health Organization (WHO) (z score > 3) and the US Centers for Disease Control (CDC) (> 120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories. RESULTS: A total of 1.1% (95% CI, 0.8-1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI, 0.2-0.6) using the CDC definition. Median neighbourhood household income (OR = 0.80, 95% CI, 0.69-0.93) and maternal pre-pregnancy BMI (OR = 1.08, 95% CI, 1.01-1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy BMI and severe obesity was 1.04 (95% CI, 0.94-1.15). CONCLUSION: More than 1% of Ontario children met the adapted WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence, and risk factors for severe obesity in young children across Canada.

Association of Metformin with Breast Cancer Incidence and Mortality in Patients with Type II Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis.

Background: Preclinical data suggest that metformin may reduce breast cancer incidence and improve cancer prognosis. However, the current evidence in observational studies is inconclusive. A systematic review and meta-analysis was conducted to assess the effect of metformin on the incidence of breast cancer and all-cause mortality in patients with type II diabetes (T2D).Methods: A literature search was performed on Medline, EMBASE, and the Cochrane library from inception to November 2016. Outcomes were incidence of breast cancer and all-cause mortality. Risk of bias and overall certainty of evidence was assessed using the Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. Meta-analyses were performed using the most fully adjusted ORs or HRs and 95% confidence intervals (95% CI) as effect measures.Results: A total of 12 observational studies were included for breast cancer incidence and 11 studies for all-cause mortality. No significant association was found between metformin exposure and incidence of breast cancer (OR = 0.93; 95% CI, 0.85-1.03; I2 = 35%). A 45% risk reduction was observed for all-cause mortality (HR = 0.55; 95% CI, 0.44-0.70; I2 = 81%). Presence of publication bias is strongly suspected for both outcomes using Egger's funnel plots.Conclusions: The use of metformin may improve overall survival in patients with T2D and breast cancer. No effect of metformin on the incidence of breast cancer was observed. Interpretation of results is limited by the observational nature of the studies and resulting biases.Impact: Clinical trials are warranted to determine the role of metformin in breast cancer risk reduction and prognosis. Cancer Epidemiol Biomarkers Prev; 27(6); 627-35. ©2018 AACR.

Health, growth and reproductive success of mice exposed to environmentally relevant levels of Ra-226 via drinking water over multiple generations.

PURPOSE: To assess health, growth and reproductive success of mammals exposed for multiple generations to levels of radium-226 known to occur in environments surrounding uranium mines and mills in Canada. METHODS: The study consisted of a control group and four treatment groups each containing 40 mice (20 males and 20 females) of the CBA/CaJ strain that were continuously exposed to a range of radium-226 levels via drinking water. Breeding was at 8-10 weeks of age and the study was concluded after three breeding cycles. RESULTS: When compared to control mice, constant consumption of drinking water containing 0.012, 0.076, 0.78 and 8.0 Bq/l of radium-226 over four generations of mice did not demonstrably affect physical condition, weight, pregnancy rate, number of pups per litter, sex ratio and bodyweight gain of pups. Between generations, the observed differences in pregnancy rates that were noted in all groups, including controls, seemed to directly correlate with the weight and age of the females at breeding. CONCLUSIONS: Based on the endpoints measured on four generations of mice, there is no indication that the consumption of radium-226 via drinking water (at activity concentrations up to 8.0 Bq/l) affects health, growth and reproductive fitness.