Gregory A. Hand

Validity of U.S. Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971–2010

Importance Methodological limitations compromise the validity of U.S. nutritional surveillance data and the empirical foundation for formulating dietary guidelines and public health policies. Objectives Evaluate the validity of the National Health and Nutrition Examination Survey (NHANES) caloric intake data throughout its history, and examine trends in the validity of caloric intake estimates as the NHANES dietary measurement protocols evolved. Design Validity of data from 28,993 men and 34,369 women, aged 20 to 74 years from NHANES I (1971–1974) through NHANES 2009–2010 was assessed by: calculating physiologically credible energy intake values as the ratio of reported energy intake (rEI) to estimated basal metabolic rate (BMR), and subtracting estimated total energy expenditure (TEE) from NHANES rEI to create ‘disparity values’. Main Outcome Measures 1) Physiologically credible values expressed as the ratio rEI/BMR and 2) disparity values (rEI–TEE). Results The historical rEI/BMR values for men and women were 1.31 and 1.19, (95% CI: 1.30–1.32 and 1.18–1.20), respectively. The historical disparity values for men and women were −281 and −365 kilocalorie-per-day, (95% CI: −299, −264 and −378, −351), respectively. These results are indicative of significant under-reporting. The greatest mean disparity values were −716 kcal/day and −856 kcal/day for obese (i.e., ≥30 kg/m2) men and women, respectively. Conclusions Across the 39-year history of the NHANES, EI data on the majority of respondents (67.3% of women and 58.7% of men) were not physiologically plausible. Improvements in measurement protocols after NHANES II led to small decreases in underreporting, artifactual increases in rEI, but only trivial increases in validity in subsequent surveys. The confluence of these results and other methodological limitations suggest that the ability to estimate population trends in caloric intake and generate empirically supported public policy relevant to diet-health relationships from U.S. nutritional surveillance is extremely limited.

The effects of chronic treadmill and wheel running on behavior in rats

In order to better understand the behavioral adaptations induced by physical activity, this set of experiments assessed the effects of two modes of running exercise on a battery of behavioral tests. The effects of 8 weeks of forced treadmill running and voluntary wheel running on behavior measures in the elevated plus maze, open field, social interaction and conditioned freezing paradigms were investigated. Eight weeks of treadmill running did not alter behavior in any test paradigm. Rats given unrestricted access to running wheels (WR) had a lower percent open arm time (6.0+/-2.3%) compared to locked wheel controls (LC) (20.7+/-5.7%) in the elevated plus maze. WR also showed decreased entries into center (0.2+/-0.2) and crossed fewer lines (61.0+/-14.9) in the open field compared to control groups. Both WR and LC groups showed increased social interaction; however, these differences are attributed to housing conditions. The effects of 4 weeks of wheel running on elevated plus maze and open field behavior were also investigated to address the possibility of a temporal effect of exercise on behavior. Four weeks of wheel running produced behavioral changes in the open field similar to those found at 8 weeks, but not in the elevated plus maze suggesting a temporal effect of wheel running on plus maze behavior. The behavioral adaptations found after 4 and 8 weeks of wheel running were not due solely to enriched environment and appear to be indicative of enhanced defensive behavior.

Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial

BackgroundThe SenseWear™ Armband (SWA) (BodyMedia, Inc. Pittsburgh, PA) is a physical activity and lifestyle monitor that objectively and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake. The real-time feedback of the SWA can improve individual self-monitoring and, therefore, enhance weight loss outcomes.MethodsWe recruited 197 sedentary overweight or obese adults (age, 46.8 ± 10.8 y; body mass index (BMI), 33.3 ± 5.2 kg/m2; 81% women, 32% African-American) from the greater Columbia, South Carolina area. Participants were randomized into 1 of 4 groups, a self-directed weight loss program via an evidence-based weight loss manual (Standard Care, n = 50), a group-based behavioral weight loss program (GWL, n = 49), the armband alone (SWA-alone, n = 49), or the GWL plus the armband (GWL+SWA, n = 49), during the 9-month intervention. The primary outcome was change in body weight and waist circumference. A mixed-model repeated-measures analysis compared change in the intervention groups to the standard care group on weight and waist circumference status after adjusting for age, sex, race, education, energy expenditure, and recruitment wave.ResultsBody weight was available for 62% of participants at 9 months (52% standard care, 70% intervention). There was significant weight loss in all 3 intervention groups (GWL, 1.86 kg, P = 0.05; SWA-alone, 3.55 kg, P = 0.0002; GWL+SWA, 6.59 kg, P < 0.0001) but not in the Standard Care group (0.89 kg, P = 0.39) at month 9. Only the GWL+SWA group achieved significant weight loss at month 9 compared to the Standard Care group (P = 0.04). Significant waist circumference reductions were achieved in all 4 groups at month 9 (Standard Care, 3.49 cm, P = 0.0004; GWL, 2.42 cm, P = 0.008; SWA-alone, 3.59 cm, P < 0.0001; GWL+SWA, 6.77 cm, P < 0.0001), but no intervention group had significantly reduced waist circumference compared to the Standard Care group.ConclusionsContinuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults. This strategy, combined with a group-based behavioral intervention, may yield optimal weight loss.Trial RegistrationClinicalTrials.gov: NCT00957008

45-Year Trends in Women’s Use of Time and Household Management Energy Expenditure

Context Relationships between socio-environmental factors and obesity are poorly understood due to a dearth of longitudinal population-level research. The objective of this analysis was to examine 45-year trends in time-use, household management (HM) and energy expenditure in women. Design and Participants Using national time-use data from women 19–64 years of age, we quantified time allocation and household management energy expenditure (HMEE) from 1965 to 2010. HM was defined as the sum of time spent in food preparation, post-meal cleaning activities (e.g., dish-washing), clothing maintenance (e.g., laundry), and general housework. HMEE was calculated using body weights from national surveys and metabolic equivalents. Results The time allocated to HM by women (19–64 yrs) decreased from 25.7 hr/week in 1965 to 13.3 hr/week in 2010 (P<0.001), with non-employed women decreasing by 16.6 hr/week and employed women by 6.7 hr/week (P<0.001). HMEE for non-employed women decreased 42% from 25.1 Mj/week (6004 kilocalories per week) in 1965 to 14.6 Mj/week (3486 kcal/week) in 2010, a decrement of 10.5 Mj/week or 1.5 Mj/day (2518 kcal/week; 360 kcal/day) (P<0.001), whereas employed women demonstrated a 30% decrement of 3.9 Mj/week, 0.55 Mj/day (923 kcal/week, 132 kcal/day) (P<0.001). The time women spent in screen-based media use increased from 8.3 hr/week in 1965 to 16.5 hr/week in 2010 (P<0.001), with non-employed women increasing 9.6 hr/week and employed women 7.5 hr/week (P<0.001). Conclusions From 1965 to 2010, there was a large and significant decrease in the time allocated to HM. By 2010, women allocated 25% more time to screen-based media use than HM (i.e., cooking, cleaning, and laundry combined). The reallocation of time from active pursuits (i.e., housework) to sedentary pastimes (e.g., watching TV) has important health consequences. These results suggest that the decrement in HMEE may have contributed to the increasing prevalence of obesity in women during the last five decades.

Physical Activity, Cardiorespiratory Fitness, and the Incidence of Type 2 Diabetes in a Prospective Study of Men

Objective To assess the independent and joint associations between self-reported physical activity (PA) and objectively measured cardiorespiratory fitness (CRF) from a maximal treadmill exercise test and the development of type 2 diabetes mellitus in a large cohort of men. Methods Participants for the current analysis were 23 444 men aged 20–85 years free of cardiovascular disease (CVD), cancer or diabetes at baseline. Incident diabetes were identified from mail-back surveys. Cox regression analysis was used to estimate hazard ratios (HRs), 95% confidence intervals (CIs) and diabetes incidence rates (per 10 000 man-years) according to exposure categories. Results During an average of 18 years of follow-up, 589 incident cases of diabetes were identified. After adjusting for age, examination year, survey response pattern, body mass index, smoking, drinking, fasting glucose, chronic diseases and family history of CVD or diabetes, the walking/jogging/running (WJR) and sport/fitness groups had a 40% and 28% lower risk of developing diabetes compared with the sedentary men, respectively (both p < 0.05). For CRF, diabetes incidence rates were 31.9, 14.5 and 6.5 for low-, moderate- and high-fitness groups, respectively. After adjustment for the above covariables, moderate and high CRF had a 38% and 63% lower risk of developing diabetes compared with the low CRF group (p trend<0.0001). Conclusion Our findings showed a lower risk of developing diabetes for men who participated in a WJR programme or sport/fitness activity, compared with those who were sedentary. Higher levels of fitness were associated with an inverse gradient of incident diabetes.

Counteracting muscle wasting in HIV-infected individuals

HIV‐infected persons often experience a loss of lean tissue mass, which includes decreases in skeletal muscle mass. This HIV‐associated wasting is significant because it has been associated with accelerated disease progression and increased morbidity. Signalling related to several circulating molecules, including tumour necrosis factor (TNF)‐α, growth hormone, insulin‐like growth factor (IGF)‐1 and testosterone, has been associated with the aetiology of muscle wasting. Additionally, nutritional status related to malnutrition and specific dietary deficiencies may be involved. In an attempt to counter muscle wasting in HIV‐infected persons, treatments have been suggested that target these mechanisms. Nutritional supplementation, cytokine reduction, hormone therapy and resistance exercise training are potential treatments for this condition. Resistance exercise training, which is more easily accessible to this population than other treatments, holds promise in counteracting the process of HIV wasting, as it has been successfully used to increase lean tissue mass in healthy and clinical populations. This review will explore the HIV/AIDS muscle‐wasting syndrome, its aetiology, and the treatments used to counteract wasting.

Metabolic syndrome and risk of cancer mortality in men

BACKGROUND Metabolic syndrome (MetS) has been linked with an increased risk of developing cancer; however, the association between MetS and cancer mortality remains less clear. Little research has focused on pre-cancer risk factors that may affect the outcome of treatment. The purpose of this study was to examine the association between MetS and all-cancer mortality in men. METHODS The participants included 33,230 men aged 20-88 years who were enrolled in the Aerobics Centre Longitudinal Study and who were free of known cancer at the baseline. RESULTS At baseline 28% of all the participants had MetS. During an average of 14 years follow-up, there were a total of 685 deaths due to cancer. MetS at baseline was associated with a 56% greater age-adjusted risk in cancer mortality. CONCLUSION These data show that MetS is associated with an increased risk of all-cause cancer mortality in men. Based on these findings, it is evident that successful interventions should be identified to attenuate the negative effects of MetS.

The Association Between Cardiorespiratory Fitness and Risk of All-Cause Mortality Among Women With Impaired Fasting Glucose or Undiagnosed Diabetes Mellitus

OBJECTIVE To evaluate the independent and joint associations among cardiorespiratory fitness (CRF), body mass index, and risk of mortality from any cause among women with impaired fasting glucose (IFG) or undiagnosed diabetes mellitus (DM). PATIENTS AND METHODS Female patients (N=3044; mean age, 47.4 years) with IFG or undiagnosed DM completed a maximal exercise treadmill test (between January 26, 1971, and March 21, 2001). The women had no history of a cardiovascular disease event or diagnosed DM at baseline. Cardiorespiratory fitness was defined categorically as low (bottom 20%), moderate (middle 40%), or high (upper 40%) according to previously published Aerobics Center Longitudinal Study guidelines. Body mass index was calculated as the weight in kilograms divided by the height in meters squared (kg/m 2 ). RESULTS During a 16-year follow-up period, 171 deaths occurred. There was an inverse association between CRF and all-cause mortality risk. Women with moderate or high CRF were at lower risk of mortality (moderate CRF, 35% lower; high CRF, 36% lower; P trend =.03) than those with low CRF. An exercise capacity lower than 7 metabolic equivalents was associated with a 1.5-fold higher risk of death than an exercise capacity of 9 metabolic equivalents or higher ( P trend =.05). The multivariate adjusted hazard ratios (HRs), including adjustments for CRF, were higher for heavier patients than for patients of normal weight (overweight patients: HR, 0.86; 95% confidence interval, 0.57-1.30; obese patients: HR, 1.19; 95% confidence interval, 0.70-2.03; P trend =.84). Combined analyses showed that women who were overweight or obese and unfit (low CRF) were at more than twice the risk of death than women who were of normal weight and fit (moderate or high CRF). CONCLUSION Cardiorespiratory fitness, not body mass index, is a significant predictor of all-cause mortality among women with IFG or undiagnosed DM. Assessing CRF levels provides important prognostic information independent of traditional risk factors.

Physiological and Psychological Correlates of Fatigue in HIV Disease

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.

Effect of acupuncture administered in a group setting on pain and subjective peripheral neuropathy in persons with human immunodeficiency virus disease.

OBJECTIVES The present study was performed to determine the effect of 5 weeks of acupuncture treatment in a group setting on pain and symptoms of peripheral neuropathy in human immunodeficiency virus (HIV)infected individuals. DESIGN Twenty-one (21) subjects completed the study that consisted of a pretreatment and post-treatment case series design. The subjects completed the Pain Rating Scale and the Subjective Peripheral Neuropathy Screen (SPNS) before and after 5 weeks of acupuncture. The acupuncture treatments occurred two evenings per week. Each of the 10 sessions consisted of participants receiving 10-15 needle insertions in acupoints that addressed the individuals changing pattern of pain, sleep problems, or other health issues. The treatment utilized only main or common points located below the elbows and knees, and on the head, neck, and ears. Only reactive points were used in the acupuncture treatments. Needles were left in situ for 30-45 minutes. RESULTS Comparison of the pretreatment and post-treatment Pain Rating Scale results indicated a significant reduction in present pain (p = 0.0002), least and most pain in the last 24 hours (p < 0.0001 and p = 0.0004, respectively) and the total pain summary score (p < 0.0001). Symptoms reported in the SPNS were reduced during the 5 weeks of acupuncture. Scores for pain/aching/burning, pins and needles, and numbness in the hands and feet were reduced (all significant at less than p = 0.0065), as well as the total summary score (p = 0.0001). CONCLUSION The results of this study indicate that subjective pain and symptoms of peripheral neuropathy were reduced during the period of individual acupuncture therapy delivered in a group setting. While the study design did not allow for control of nonspecific placebo factors, the data support the hypothesis that acupuncture in a group setting can reduce pain and neuropathic symptoms in HIV-infected individuals.