QUESTIONS – does all the research need to be specific for Canada?

Can we use sources like health Canada or do tthey have to be scholarly articles

1. State your research question and provide a brief rationale for why your chosen
exposure-outcome association is plausible and why it is important to address; (hint: refer
to PICOT for your research question).

Exposure- ultra processed foods

Outcome – obesity

Population – Middle-aged adult Canadians (40 to 60 years) residing in urban areas of Canada
without prior history of obesity

Intervention- Regular consumption of ultra-processed foods ( measured through dietary

questionnaires)

Comparison – individuals with low consumption of ultra-processed food

Outcome – incidence of obesity ( measuring individuals BMI )

Time frame – over a span of 10 years

Research Question – In adults aged 40 to 60 years residing in urban areas of Canada without
prior history of obesity, does regular consumption of ultra-processed foods, assessed through
dietary questionnaires, compared to low consumption of ultra-processed foods increase the
incidence of obesity ( assessed by measuring BMI) over 10 years?

Rationale (reason for conducting the research , research gap? Or why is the research important) -

How rampant ultra-processed food is in Canada. Current research has shown that Ultra-
processed food accounts for nearly half (45%) of the daily calories consumed by Canadian adults
(consumption of Ultra-processed foods). Ultra-processed food consumption has been shown to
strongly correlate with obesity. To the extent that one in four adults in Canada is obese,
demonstrating that prevalence has almost doubled since the late 1900’s.

The investigation of the association between ultra-processed foods and obesity demands
immediate attention as obesity is not just a stand-alone issue. Obesity manifests as a risk factor
for several other chronic conditions such as type 2 diabetes, cardiovascular diseases, specific
types of cancer and premature mortality making it a pertinent issue. (determinants and
consequences of obesity).
1.Consumption of ultra processed food - doi: https://doi.org/10.17269/s41997-018-0130-x

2. Determinants and consequences of obesity - https://doi.org/10.2105/AJPH.2016.303326

How is the association between ultra processed foods and obesity plausible

The association between ultra-processed foods and obesity is plausible due to biological relation.
For instance, The specific composition of ultra-processed foods makes them "hyper-palatable" as
compared to less-processed versions of the same product, enhancing the desire to consume them
and putting individuals at a higher risk of getting diabetes (Perspective: a rich road map). An
additional reason supporting the plausibility of this association is the demographic composition
of the study participants, primarily middle-aged individuals—a group highly vulnerable to
obesity development, regardless of specific risk factors. This underscores the significance of
studying this population subset in understanding obesity etiology (higher age and obesity).

3.Perspective: a rich road map - https://doi.org/10.1016/j.advnut.2023.09.005

4.Higher age and obesity - https://doi.org/10.1016/j.bja.2019.11.026

Identify your chosen study design (case-control study OR prospective cohort study) and
describe the specific advantages and disadvantages of this design for your chosen topic;

For this particular research endeavour, the chosen study design is a prospective cohort study. The
study will involve following Canadian middle-aged adults living in urban areas of Canada
without a prior history of obesity. There are several advantages to a prospective study design, for
instance, it ensures that the exposure precedes the disease, allowing the establishment of
temporal precedence (pros cohor stu: ad and dis). In this case, exposure to ultra-processed foods
comes before the disease of obesity, allowing for the establishment of causality. Another
advantage of this study design is the fact that recall bias would be minimized since the
consumption of Ultra-processed foods would be recorded before participants were followed up.
Despite these advantages, it is important to consider the disadvantages of a prospective cohort
design. For instance, difficulty may arise when attempting to contact participants, there may be a
loss to follow up as this particular study spans 10 years, making it more likely that some people
may drop out of the study. Moreover, since this study’s outcome is obesity which is a disease
that may take a long to develop, there will be a long follow-up period. This may result in the
study being expensive and also leaves the door open for error with measurements, as they need
to be taken consistently over a long period of time(pros cohor stu: ad and dis).

5.Prospective cohort studies: ad and dis -

doi: https://doi-org.myaccess.library.utoronto.ca/10.1136/bmj.f6726
2. Outline, in detail, the main elements of the selected study design:

1. For prospective cohort studies, this should be: the source population, exposed and
unexposed definitions, outcome definition, and the chosen source(s) of data for
each.

Population – The main elements of the prospective cohort study include a source
population, which consists of Canadian adults aged 40- 60 living in urban areas in
Canada without a prior history of obesity. This age group was chosen to focus on middle-
aged adults who are more likely to develop obesity due to a variety of factors such as
lifestyle, metabolism, and aging-related hormonal changes (obesity in middle age).
Moreover, urban areas were chosen due to the ready availability of ultra-processed foods
and the widespread presence of fast-food restaurants. The study's exclusion criteria will
include pregnant women who were pregnant at the start of the study or became pregnant
during the follow-up period, as well as people who reported a pre-existing diagnosis of
chronic conditions such as diabetes, cancer, or cardiovascular disease at baseline (ultra
processed food consu).

- if saying number of participant in the study- we have to include the number and for men
and female and justify why

6.Obesity in middle age - http://www.jstor.org/stable/25459898

7.Ultra processed food consumption -

https://www.sciencedirect.com/science/article/pii/S0002916522046767

Exposure and unexposed groups –

The exposed group will comprise both males and females from the study population who
regularly consume ultra-processed foods. At baseline, dietary exposures were measured
using a self-administered 136-item semiquantitative food-frequency questionnaire.
Frequencies of consumption were measured in 9 categories (ranging from never or rarely
to >6 servings per day, with the questionnaire containing a typical portion size for each
item. These dietary evaluations were used to divide individuals into exposure groups
based on their use of ultra-processed foods, as determined by the NOVA categorization
system. According to NOVA, ultra-processed foods are classed depending on the level
and purpose of applied food processing, and those in the exposure group will have >6
servings per day of processed food (ultra-processed food consu). Individuals in the
unexposed group would consume limited amounts of ultra-processed foods or follow a
minimally processed diet, which includes whole, unprocessed, or slightly processed
 foods. Those in the unexposed group will be defined as individuals who answer the
questionnaire as never or rarely consuming ultra-processed foods. (ultra-processed food
consu)

7.Ultra processed food consumption -

https://www.sciencedirect.com/science/article/pii/S0002916522046767

Outcome measure - The prevalence of obesity is determined by measuring body mass index
(BMI) during a 10-year period. Obesity is characterized as having a BMI of 30 kg/m² or greater,
which aligns with commonly recognized standards for adult obesity. BMI will be computed
using self-reported height and weight data obtained at baseline and follow-up evaluations. The
follow ups will take place every year for a period of 10 years. ( Obesity In Middle Age And
Future Risk Of Dementia: A 27 Year Longitudinal)

6.Obesity in middle age - http://www.jstor.org/stable/25459898

3. Describe the potential roles of one source of selection bias, one source of measurement
bias, and one source of confounding in your specific study design. [Tip: You are not
required to provide an analytical plan, or how you will analyze the data]

One source of selection bias, one source of measurement bias, and one source of confounding are
identified and explained in detail. Discussion uses specific examples from the study design.

One source of selection bias for this study - One potential source of selection bias in this
study design is loss of follow-up during a 10-year period. Given the study's longitudinal
nature, individuals may lose out or become lost to follow-up for a variety of reasons,
including relocation, lack of interest, or noncompliance. Individuals who are lost to
follow-up may differ systematically from those who remain in the research, thereby
biasing the results. For example, if people who eat more healthily or exercise more and
are less likely to be obese continue to participate in the study, and the people who are
more likely to be obese are lost to follow-up, the real connection between ultra-processed
food intake and obesity prevalence may be underestimated (Bias from self selection)

Bias from self selection - Doi: HTTPs://doi.org/10.1007/s10654-019-00550-1

Measurement bias might arise when assessing dietary exposures or BMI. In this study, dietary
exposures are measured using self-administered food-frequency questionnaires that rely on
individuals' memory and reporting of their eating patterns. Individuals may misreport their
dietary intake due to social desirability bias or difficulty recalling earlier consumption habits
known as recall bias. This might lead to inaccurate categorization of exposure status, resulting in
measurement bias. Similarly, BMI readings may be biased if individuals misreport their height or
weight, or if measurements are not done regularly across follow-up evaluations. The quality of
the information collected in the exposed and unexposed groups needs to be comparable to avoid
measurement bias (ultra processed food consumption).

7.Ultra processed food consumption -

https://www.sciencedirect.com/science/article/pii/S0002916522046767

Confounding is an issue in this study, since unmeasured or insufficiently controlled

variables may impact both ultra-processed food intake and obesity incidence. For
example, socioeconomic position and physical activity levels may complicate the link
between ultra-processed food intake and obesity. If these variables are not considered in
the study, they may obscure the underlying link between exposure and result. For
instance, High physical activity levels could result in a lower risk of obesity as well as
higher socioeconomic position may result in access to healthier food options (ultra
processed food consumption).

7.Ultra processed food consumption -

https://www.sciencedirect.com/science/article/pii/S0002916522046767

4. Impact statement: Briefly, provide an explanation or reasoning as to why this research

is important and what impact will this research have on the population’s health and
wellbeing.

This study is relevant because it tackles the widespread issue of ultraprocessed food consumption
in Canada, where such foods account for approximately half of people' daily calorie intake.
Understanding the relationship between ultra-processed foods and obesity is critical, as obesity
rates are rising and one in every four persons is affected. Obesity not only poses immediate
health hazards, but it also serves as a precursor to several chronic disorders, including type 2
diabetes, cardiovascular disease, and certain forms of cancer, all of which contribute to early
death. The plausibility of the association between ultra-processed foods and obesity is supported
by their hyper-palatable composition, which heightens the desire for consumption and raises the
risk of developing diabetes ( determinants and consequences of obesity). Furthermore,
concentrating on middle-aged adults, who are particularly susceptible to obesity regardless of
specific risk factors, underscores the necessity of investigating this population subset in
unravelling the cause of obesity (higher age and obesity). The study's findings will help to shape
future initiatives and policies targeted at encouraging healthy eating habits and enhancing the
population's general health and well-being.

2.Determinants and consequences of obesity - https://doi.org/10.2105/AJPH.2016.303326

4.Higher age and obesity - https://doi.org/10.1016/j.bja.2019.11.026

Exposure-outcome association options

Your assignment must be on one of the following exposure-outcome associations:

Stress and chronic diseases (you can keep it broad or choose a specific chronic disease of your
choice)

Ultra-processed foods and chronic diseases (you can keep it broad or choose a specific chronic
disease of your choice)

Substance abuse and mental illness

The proposed study should take place in a Canadian context of your choosing. Be sure to
describe this fully when you describe your source population

Could be included in part 1 – research gap

Several prospective studies have been conducted to determine the relationship between dietary
components and obesity.

However, the relationship between the consumption of foods classified by their degree of
processing (i.e., ultraprocessed foods) and excess weight has just lately been investigated.
Citation - Ultraprocessed food consumption and risk of overweight and obesity: the University of
Navarra Follow-Up (SUN) cohort stud

Exposure – smoking
Outcome – lung cancer

Study design – cohort study

1. Population – ( this cannot be this, this has to be about population eg - Canadians, sex,
age
Intervention/ exposure – smoking ( this is individuals that do smoke)
Comparison - non-smokers
Outcome – incidence of lung cancer
Time frame – 20 years

2. Does smoking increase the risk of developing lung cancer over time among individuals
who smoke compared to those that don’t smoke . should have everything from picot. The
research question should include the time frame and everthing in PICOT

3. Data sources – exposure - medical records that show smoking history

Outcome – hospital records showing how many people have lung cancer

4. One source of measurement bias in a cohort study could be an inaccurate or incomplete

recording of smoking status or history. This could occur if participants misreport their
smoking habits or if there are discrepancies between self-reported smoking and actual
smoking behaviour.