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OBJECTIVES: To quantify the mediating role of childhood diets in the association between maternal diets before pregnancy and offspring behavioral problems. METHODS: This study included 1448 mother-child pairs from the Australian longitudinal study on women's health and its sub-study mothers and their children's health. The healthy eating index score was constructed using a semi-quantitative and validated 101-item food-frequency questionnaire. Childhood behavioral problems were assessed using the strengths and difficulties questionnaire. Three dietary patterns were identified using principal component analysis to explore childhood dietary patterns (high fats and sugar; prudent diets; and diary). A causal inference framework for mediation analysis was used to quantify the mediating role of childhood diets in the association between pre-pregnancy diets and the risk of offspring behavioral problems. RESULTS: We found a 20% of the total effect of the poor adherence to pre-pregnancy diet quality on the risk of offspring behavioral problems was mediated through childhood high consumptions of fats and sugar. No clear mediating effect through prudent, and diary childhood diets was observed. CONCLUSIONS: This study suggests that childhood high fats and sugar consumption may contribute to the total effects of the pre-pregnancy diets on the risk of childhood behavioral problems. FUNDING SOURCES: The ALSWH is funded by the Australian Government Department of Health. MatCH is funded by the National Health and Medical Research Council (NHMRC) project grant. Dereje Gete is supported by the University of Queensland Research Training Scholarship. Gita Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship.

OBJECTIVES: To examine the association between maternal diet quality before pregnancy and childhood BMI in offspring. METHODS: We included 1936 mothers with 3391 children from the Australian Longitudinal Study on Women's Health (ALSWH) and the Mothers and their Children's Health study (MatCH). Maternal diet was assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). We used the healthy eating index (HEI-2015) score to explore maternal diet quality before pregnancy. Children over 2 years of age were categorized as underweight, normal, overweight, and obese based on age and sex-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses. RESULTS: Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring underweight after adjustment for potential confounders, highest vs lowest quartile (RRR = 0.68, 95% CI: 0.49, 0.96). Higher adherence to pre-pregnancy diet quality was also inversely associated with the risk of offspring obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, slightly attenuated by pre-pregnancy body mass index (BMI) in the full adjusted model. No significant association was observed between pre-pregnancy diet quality and offspring overweight. CONCLUSIONS: This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity. FUNDING SOURCES: The ALSWH is funded by the Australian Government Department of Health. MatCH is funded by the National Health and Medical Research Council (NHMRC) project grant. Dereje Gete is supported by the University of Queensland Research Training Scholarship. Gita Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship.

OBJECTIVES: To examine the relationship between pre-pregnancy diet quality and offspring behavioral problems among children aged 5–12 years. METHODS: 1554 mother-child dyads with mothers from the Australian longitudinal study on women's health (ALSWH) and children from the mothers and their children's health Study (MatCH). The healthy eating index (HEI-2015) score was used to explore maternal diet quality before pregnancy. Childhood total behavioral difficulties, internalizing (emotional and peer) and externalizing problems (hyperactivity and conduct) were assessed using the strengths and difficulties questionnaire (SDQ). Multivariable logistic regression analyses were used to examine the association between maternal diet quality and offspring behavioral problems. RESULTS: 211 children experienced a greater score on total behavioral difficulties (13.6%) among the 1554 children. Better pre-pregnancy diet quality was associated with lower odds of offspring total behavioral difficulties after adjustment for potential confounders, highest vs lowest tertile (AOR = 0.52, 95% CI: 0.32, 0.85) at P = 0.009. Greater adherence to the HEI-2015 score before pregnancy was also inversely associated with odds of offspring externalizing problems (AOR = 0.64, 95% CI: 0.43, 0.94). Among the four subscales, hyperactivity and peer problems were negatively associated with better diet quality, (AOR = 0.67, 95% CI: 0.47, 0.96) and (AOR = 0.63, 95% CI: 0.42, 0.96), respectively. CONCLUSIONS: We found that mothers who recorded the better quality of diets before pregnancy had children with a lower risk of behavioral disorders in childhood. Further well-powered prospective studies are warranted to confirm the findings. FUNDING SOURCES: The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women's Health by the University of Queensland and The University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. ...

The Australian Longitudinal Study on Women's Health was established to track the health of three age cohorts of Australian women - 40,000 in total - over a twenty year period. It provides opportunities for research into health and related issues for women. In this paper, we investigate (1) baseline data from the young cohort of 1400 survey participants and (2) follow up in-depth interview data from a small sample of 57 of the original respondents. The focus of the paper is on the aspirations of young women (aged 18-23) for work, their ideal job, relationships (including children) and further education, particularly in the context of gender inequality in labour markets.Through an analysis of the data, we look at the extent to which gender inequalities are the result of free choices and preferences and to what extent they are conditioned by socio-economic structures and processes that reproduce inequalities over time. This issue is further explored through a classification of women by socio- economic status. In this way, we can analyse the gender dimension of labour market inequality in general as well as the relationship of gender inequality to class inequality in the areas of work, work choice and the ability to combine work and family responsibilities. Analysis of the two data sets sheds light on debates about women's workforce participation as well as establishing baseline data for future research on the options chosen and available for this group of young women. The results will have significance for policy debates in several areas, including those concerned with worker entitlements, childcare, access to higher education and workforce planning. More particularly, it makes a significant contribution to the current debate, initiated by Catherine Hakim, about women's supposed preference for part-time rather than full-time work.

IntroductionLinked health record collections, when combined with large longitudinal surveys, are a rich research resource to inform policy development and clinical practice across multiple sectors.
Objectives and ApproachThe Australian Longitudinal Study on Women's Health (ALSWH) is a national study of over 57,000 women in four cohorts. Survey data collection commenced in 1996. Over the past 20 years, ALSWH has also established an extensive data linkage program.
The aim of this poster is to provide an overview of ALSWH's program of regularly up-dated linked data collections for use in parallel with on-going surveys, and to demonstrate how data are made widely available to research collaborators.
ResultsALSWH surveys collect information on health conditions, ageing, reproductive characteristics, access to health services, lifestyle, and socio-demographic factors. Regularly updated linked national and state administrative data collections add information on health events, health outcomes, diagnoses, treatments, and patterns of service use.
ALSWH's national linked data collections, include Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, the National Death Index, the Australian Cancer Database, and the National Aged Care Data Collection. State and Territory hospital collections include Admitted Patients, Emergency Department and Perinatal Data. There are also substudies, such as the Mothers and their Children's Health Study (MatCH), which involves linkage to children's educational records.
ALSWH has an internal Data Access Committee along with systems and protocols to facilitate collaborative multi-sectoral research using de-identified linked data.
Conclusion / ImplicationsAs a large scale Australian longitudinal multi-jurisdictional data linkage and sharing program, ALSWH is a useful model for anyone planning similar research.

Population ageing and its future implications for governments and individuals have been central to much policy debate and research targeted to retain older people in the workforce. This study identified workforce participation patterns across the adult life course for women and men entering later life, and explored the influences of various early and adult life socio-demographic circumstances. Data were collected from 1261 men and women aged 60 to 64 years in the Life History and Health (LHH) Survey (a sub-study of the Sax Institute's 45 and Up Study, Australia) in 2010–11. LHH provides detailed information on personal histories of paid work, socio-economic resources from childhood (number of books and father's occupation) and adult life factors such as educational attainment, marital histories, childcare and informal caring. Latent class analysis (LCA) was undertaken to identify patterns of workforce participation for participants across their adult life. Significant gender differences were confirmed. Further analysis (LCA with covariates) showed that women who reported having books during childhood, and those who had post-school qualification, were more likely to have mostly been in paid work and less likely to have not been in paid work; while ever partnered women had significantly higher odds of increasing part time work over time. Men who had reported ever having had informal caring activities were likely to have had decreasing participation in paid work over time, and were highly likely to be not in paid work after 55 years. Ever partnered status was protective for being in paid work for men. These findings indicate the need for gender-specific policies and strategies to enable continued workforce participation throughout adult life and into later working years, particularly for people who had fewer social or economic opportunities earlier in life. ; This research was supported by the Australian Research Council Centre of Excellence in Population Ageing Research (project number CE110001029).

Population ageing and its future implications for governments and individuals have been central to much policy debate and research targeted to retain older people in the workforce. This study identified workforce participation patterns across the adult life course for women and men entering later life, and explored the influences of various early and adult life socio-demographic circumstances. Data were collected from 1261 men and women aged 60 to 64 years in the Life History and Health (LHH) Survey (a sub-study of the Sax Institute's 45 and Up Study, Australia) in 2010–11. LHH provides detailed information on personal histories of paid work, socio-economic resources from childhood (number of books and father's occupation) and adult life factors such as educational attainment, marital histories, childcare and informal caring. Latent class analysis (LCA) was undertaken to identify patterns of workforce participation for participants across their adult life. Significant gender differences were confirmed. Further analysis (LCA with covariates) showed that women who reported having books during childhood, and those who had post-school qualification, were more likely to have mostly been in paid work and less likely to have not been in paid work; while ever partnered women had significantly higher odds of increasing part time work over time. Men who had reported ever having had informal caring activities were likely to have had decreasing participation in paid work over time, and were highly likely to be not in paid work after 55 years. Ever partnered status was protective for being in paid work for men. These findings indicate the need for gender-specific policies and strategies to enable continued workforce participation throughout adult life and into later working years, particularly for people who had fewer social or economic opportunities earlier in life. ; This research was supported by the Australian Research Council Centre of Excellence in Population Ageing Research (project number CE110001029).

This paper presents the results of the first two longitudinal historical cradle-to-grave datasets constructed in Australia: the Aboriginal population of the state of Victoria, reconstituted backwards using genealogical research and vital registrations, 1835-1930; and an impoverished European population born at the Melbourne Lying-In Hospital, 1857-1900 and traced until 1985. It investigates the hypothesis that the health transition in indigenous people was different from that of the dominant non-indigenous population. Both of these studied sub-populations were highly stressed, resulting in high infant mortality and persistent tuberculosis mortality. The Aboriginal population suffered the additional burdens of racism and social exclusion, even though after the passage of the 1886 'Half-Castes Act', the majority of Aboriginal Victorians were legally 'white'. The impact of that legislation and the systematic exclusion of Aboriginal Victorians from federal entitlements in the twentieth century sent the Aboriginal health transition into reverse. The contrasting fates of poor whites and 'unofficial blacks' during the health transition demonstrate the health burdens of inequality and racial discrimination, and reveal that 'the gap' in life expectancy between Indigenous and non-Indigenous Australians is a historical product of long-term government policy and exclusion from citizenship and its entitlements.

This paper presents the results of the first two longitudinal historical cradle-to-grave datasets constructed in Australia: the Aboriginal population of the state of Victoria, reconstituted backwards using genealogical research and vital registrations, 1835-1930; and an impoverished European population born at the Melbourne Lying-In Hospital, 1857-1900 and traced until 1985. It investigates the hypothesis that the health transition in indigenous people was different from that of the dominant non-indigenous population. Both of these studied sub-populations were highly stressed, resulting in high infant mortality and persistent tuberculosis mortality. The Aboriginal population suffered the additional burdens of racism and social exclusion, even though after the passage of the 1886 'Half-Castes Act', the majority of Aboriginal Victorians were legally 'white'. The impact of that legislation and the systematic exclusion of Aboriginal Victorians from federal entitlements in the twentieth century sent the Aboriginal health transition into reverse. The contrasting fates of poor whites and 'unofficial blacks' during the health transition demonstrate the health burdens of inequality and racial discrimination, and reveal that 'the gap' in life expectancy between Indigenous and non-Indigenous Australians is a historical product of long-term government policy and exclusion from citizenship and its entitlements.

IntroductionWith population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing.
Objectives and ApproachOur goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women's Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time.
ResultsThe major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43).
Conclusion / ImplicationsRecord linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.

Introduction: Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved. Aims: To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines. Materials and methods: Literature review and consensus of expert opinion. Results and conclusion: The recommended daily intake of calcium varies between 700 and 1200 mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000 mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful. ; Peer reviewed

Objective: There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful. Research design and methods: We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell's C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points. Results: Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79-0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol). Conclusions: In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes. ; This work was supported by the National Health and Medical Research Council of Australia (grant number 1103242). The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I. ES was supported by NIH/NIDDK grant K24DK106414. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is supported by contracts HHSN2682018000031, HHSN2682018000041, HHSN2682018000051, HHSN2682018000061 and HHSN2682018000071 from the National Heart, Lung, and Blood Institute (NHLBI). The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I) and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). The Melbourne Collaborative Cohort Study (MCCS) recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further augmented by Australian National Health and Medical Research Council grants 209057, 396414 and 1074383 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry and the Australian Institute of Health and Welfare, including the National Death Index and the Australian Cancer Database. The Multi-Ethnic Study of Atherosclerosis was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-TR-001079 from NCRR. The Population Study of Women in Gothenburg (PSWG) was financed in part by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement ALFGBG-720201. VIVA Study received grants 95/0029 and 06/90270 from the Instituto de Salud Carlos III, Spain. ; Sí