Julia H. Goedecke

Prediction of energy expenditure from heart rate monitoring during submaximal exercise

The aims of this study were to quantify the effects of factors such as mode of exercise, body composition and training on the relationship between heart rate and physical activity energy expenditure (measured in kJ · min−1) and to develop prediction equations for energy expenditure from heart rate. Regularly exercising individuals (n  =  115; age 18 – 45 years, body mass 47 – 120 kg) underwent a test for maximal oxygen uptake ([Vdot]O2max test), using incremental protocols on either a cycle ergometer or treadmill; [Vdot]O2max ranged from 27 to 81 ml · kg−1 · min−1. The participants then completed three steady-state exercise stages on either the treadmill (10 min) or the cycle ergometer (15 min) at 35%, 62% and 80% of [Vdot]O2max, corresponding to 57%, 77% and 90% of maximal heart rate. Heart rate and respiratory exchange ratio data were collected during each stage. A mixed-model analysis identified gender, heart rate, weight, [Vdot]2max and age as factors that best predicted the relationship between heart rate and energy expenditure. The model (with the highest likelihood ratio) was used to estimate energy expenditure. The correlation coefficient (r) between the measured and estimated energy expenditure was 0.913. The model therefore accounted for 83.3% (R 2) of the variance in energy expenditure in this sample. Because a measure of fitness, such as [Vdot]O2max, is not always available, a model without [Vdot]O2max included was also fitted. The correlation coefficient between the measured energy expenditure and estimates from the mixed model without [Vdot]O2max was 0.857. It follows that the model without a fitness measure accounted for 73.4% of the variance in energy expenditure in this sample. Based on these results, we conclude that it is possible to estimate physical activity energy expenditure from heart rate in a group of individuals with a great deal of accuracy, after adjusting for age, gender, body mass and fitness.

Weight changes, medical complications, and performance during an Ironman triathlon

Background: Subjects exercising without fluid ingestion in desert heat terminated exercise when the total loss in body weight exceeded 7%. It is not known if athletes competing in cooler conditions with free access to fluid terminate exercise at similar levels of weight loss. Objectives: To determine any associations between percentage weight losses during a 224 km Ironman triathlon, serum sodium concentrations and rectal temperatures after the race, and prevalence of medical diagnoses. Methods: Athletes competing in the 2000 and 2001 South African Ironman triathlon were weighed on the day of registration and again immediately before and immediately after the race. Blood pressure and serum sodium concentrations were measured at registration and immediately after the race. Rectal temperatures were also measured after the race, at which time all athletes were medically examined. Athletes were assigned to one of three groups according to percentage weight loss during the race. Results: Body weight was significantly (p<0.0001) reduced after the race in all three groups. Serum sodium concentrations were significantly (p<0.001) higher in athletes with the greatest percentage weight loss. Rectal temperatures were the same in all groups, with only a weak inverse association between temperature and percentage weight loss. There were no significant differences in diagnostic indices of high weight loss or incidence of medical diagnoses between groups. Conclusions: Large changes in body weight during a triathlon were not associated with a greater prevalence of medical complications or higher rectal temperatures but were associated with higher serum sodium concentrations.

Dual-Energy X-Ray Performs as Well as Clinical Computed Tomography for the Measurement of Visceral Fat

Visceral adipose tissue (VAT) is associated with adverse health effects including cardiovascular disease and type 2 diabetes. We developed a dual‐energy X‐ray absorptiometry (DXA) measurement of visceral adipose tissue (DXA‐VAT) as a low cost and low radiation alternative to computed tomography (CT). DXA‐VAT was compared to VAT assessed using CT by an expert reader (E‐VAT). In addition, the same CT slice was also read by a clinical radiographer (C‐VAT) and a best‐fit anthropomorphic and demographic VAT model (A‐VAT) was developed. Whole body DXA, CT at L4–L5, and anthropometry were measured on 272 black and white South African women (age 29 ± 8 years, BMI 28 ± 7 kg/m2, waist circumference (WC) 89 ± 16 cm). Approximately one‐half of the dataset (n = 141) was randomly selected and used as a training set for the development of DXA‐VAT and A‐VAT, which were then used to estimate VAT on the remaining 131 women in a blinded fashion. DXA‐VAT (r = 0.93, standard error of the estimate (SEE) = 16 cm2) and C‐VAT (r = 0.93, SEE = 16 cm2) were strongly correlated to E‐VAT. These correlations with E‐VAT were significantly stronger (P < 0.001) than the correlations of individual anthropometry measurements and the A‐VAT model (WC + age, r = 0.79, SEE = 27 cm2). The inclusion of anthropometric and demographic measurements did not substantially improve the correlation between DXA‐VAT and E‐VAT. DXA‐VAT performed as well as a clinical read of VAT from a CT scan and better than anthropomorphic and demographic models.

Weight changes, sodium levels, and performance in the South African Ironman Triathlon.

ObjectiveTo establish relationships between body weight changes and serum sodium during and after an Ironman Triathlon, and postrace fluid status and rectal temperature, including the incidence of hyponatremia. DesignDescriptive research. SettingThe 2000 South African Ironman Triathlon, in which each athlete swam 3.8 km, cycled 180 km, and ran 42.2 km. ParticipantsAll entrants in the race were invited to participate in the study. MethodsAthletes were weighed at registration, immediately prerace, immediately postrace, and 12 hours later. Blood samples were drawn at registration and immediately postrace. Rectal temperatures were measured postrace. ResultsStarting body weight was significantly related to total finishing time (r = 0.27) and to cycling (r = 0.20) and running (r = 0.28) time. Body weight decreased significantly (p < 0.0001) during the race and had not returned to prerace values 12 hours later (p < 0.0001). Percentage change in body weight was unrelated to postrace rectal temperatures and inversely related to the postrace serum sodium concentrations (r = −0.45). Postrace serum sodium concentrations fell within a normal distribution (141.8 ± 3.1 mmol.L−1, mean ± SD) and were negatively correlated to overall triathlon time (r = −0.22). Three sodium values (0.6%) were below 135 mmol.L−1. Percentage change in body weight was unrelated to time in the marathon leg. ConclusionsPercentage change in body weight was linearly related to postrace serum sodium concentrations but unrelated to postrace rectal temperature or performance in the marathon. There was no evidence that in this study, more severe levels of weight loss or dehydration were related to either higher body temperatures or impaired performance.

The human visceral fat depot has a unique inflammatory profile.

Obesity can be considered as a low‐grade inflammatory condition, strongly linked to adverse metabolic outcomes. Obesity‐associated adipose tissue inflammation is characterized by infiltration of macrophages and increased cytokine and chemokine production. The distribution of adipose tissue impacts the outcomes of obesity, with the accumulation of fat in visceral adipose tissue (VAT) and deep subcutaneous adipose tissue (SAT), but not superficial SAT, being linked to insulin resistance. We hypothesized that the inflammatory gene expression in deep SAT and VAT is higher than in superficial SAT. A total of 17 apparently healthy women (BMI: 29.3±5.5 kg/m2) were included in the study. Body fat (dual‐energy X‐ray absorptiometry) and distribution (computed tomography) were measured, and insulin sensitivity, blood lipids, and blood pressure were determined. Inflammation‐related differences in gene expression (real‐time PCR) from VAT, superficial and deep SAT biopsies were analyzed using univariate and multivariate data analyses. Using multivariate discrimination analysis, VAT appeared as a distinct depot in adipose tissue inflammation, while the SAT depots had a similar pattern, with respect to gene expression. A significantly elevated (P < 0.01) expression of the CC chemokine receptor 2 (CCR2) and macrophage migration inhibitory factor (MIF) in VAT contributed strongly to the discrimination. In conclusion, the human adipose tissue depots have unique inflammatory patterns, with CCR2 and MIF distinguishing between VAT and the SAT depots.

BMI, fat and muscle differences in urban women of five ethnicities from two countries

Objective:To investigate body composition differences, especially the relationship between body mass index (BMI) and percent body fat (%BF), among five ethnic groups.Design:Cross-sectional.Subjects:Seven hundred and twenty-one apparently healthy women aged 18–60 years (BMI: 17.4–54.0 kg/m2) from South Africa (SA, 201 black, 94 European) and New Zealand (NZ, 173 European, 76 Maori, 84 Pacific, 93 Asian Indian).Measurements:Anthropometry, including waist circumference, and total, central and peripheral body fat, bone mineral content and total appendicular skeletal muscle mass (ASMM) derived from dual X-ray absorptiometry.Results:Regression analysis determined that at a BMI of 30 kg/m2, SA European women had a %BF of 39%, which corresponded to a BMI of 29 for SA black women. For a BMI of 30 kg/m2 in NZ Europeans, equivalent to 43% body fat, the corresponding BMIs for NZ Maori, Pacific and Asian Indian women were 34, 36 and 26 kg/m2, respectively. Central fat mass was lower in black SA than in European SA women (P<0.001). In NZ, Pacific women had the lowest central fat mass and highest ASMM, whereas Asian Indian women had the highest central fat mass, but lowest ASMM and bone mineral content.Conclusions:The relationship between %BF and BMI varies with ethnicity and may be due, in part, to differences in central fatness and muscularity. Use of universal BMI or waist cut-points may not be appropriate for comparison of obesity prevalence among differing ethnic groups, as they do not provide a consistent reflection of adiposity and fat distribution across ethnic groups.

Metabolic adaptations to a high-fat diet in endurance cyclists

We examined the time course of metabolic adaptations to 15 days of a high-fat diet (HFD). Sixteen endurance-trained cyclists were assigned randomly to a control (CON) group, who consumed their habitual diet (30% +/- 8% mJ fat), or a HFD group, who consumed a high-fat isocaloric diet (69% +/- 1% mJ fat). At 5-day intervals, the subjects underwent an oral glucose tolerance test (OGTT); on the next day, they performed a 2.5-hour constant-load ride at 70% peak oxygen consumption (VO2peak), followed by a simulated 40-km cycling time-trial while ingesting a 10% 14C-glucose + 3.44% medium-chain triglyceride (MCT) emulsion at a rate of 600 mL/h. In the OGTT, plasma glucose concentrations at 30 minutes increased significantly after 5 days of the HFD and remained elevated at days 10 and 15 versus the levels measured prior to the HFD (P < .05). The activity of carnitine acyltransferase (CAT) in biopsies of the vastus lateralis muscle also increased from 0.45 to 0.54 micromol/g/min over days 0 to 10 of the HFD (P < .01) without any change in citrate synthase (CS) or 3-hydroxyacyl-coenzyme A dehydrogenase (3-HAD) activities. Changes in glucose tolerance and CAT activity were associated with a shift from carbohydrate (CHO) to fat oxidation during exercise (P < .001), which occurred within 5 to 10 days of the HFD. During the constant-load ride, the calculated oxidation of muscle glycogen was reduced from 1.5 to 1.0 g/min (P < .001) after 15 days of the HFD. Ingestion of a HFD for as little as 5 to 10 days significantly altered substrate utilization during submaximal exercise but did not attenuate the 40-km time-trial performance.

Determinants of Insulin-resistant Phenotypes in Normal-weight and Obese Black African Women

Objective: Subsets of metabolically “healthy obese” and “at‐risk” normal‐weight individuals have been previously identified. The aim of this study was to explore the determinants of these phenotypes in black South African (SA) women.

Estimating the burden of disease attributable to excess body weight in South Africa in 2000

OBJECTIVE To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. DESIGN World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population-attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modeling techniques were used for the uncertainty analysis. SETTING South Africa. SUBJECTS Adults >or= 30 years of age. OUTCOME MEASURES Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. RESULTS Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI >or= 21 kg/m2. Excess body weight is estimated to have caused 36,504 deaths (95% uncertainty interval 31,018 - 38,637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462,338 DALYs (95% uncertainty interval 396,512 - 478,847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. CONCLUSIONS This study shows the importance of recognizing excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight.

Differential Effects of Abdominal Adipose Tissue Distribution on Insulin Sensitivity in Black and White South African Women

Black South African women are more insulin resistant than BMI‐matched white women. The objective of the study was to characterize the determinants of insulin sensitivity in black and white South African women matched for BMI. A total of 57 normal‐weight (BMI 18–25 kg/m2) and obese (BMI > 30 kg/m2) black and white premenopausal South African women underwent the following measurements: body composition (dual‐energy X‐ray absorptiometry), body fat distribution (computerized tomography (CT)), insulin sensitivity (SI, frequently sampled intravenous glucose tolerance test), dietary intake (food frequency questionnaire), physical activity (Global Physical Activity Questionnaire), and socioeconomic status (SES, demographic questionnaire). Black women were less insulin sensitive (4.4 ± 0.8 vs. 9.5 ± 0.8 and 3.0 ± 0.8 vs. 6.0 ± 0.8 × 10−5/min/(pmol/l), for normal‐weight and obese women, respectively, P < 0.001), but had less visceral adipose tissue (VAT) (P = 0.051), more abdominal superficial subcutaneous adipose tissue (SAT) (P = 0.003), lower SES (P < 0.001), and higher dietary fat intake (P = 0.001) than white women matched for BMI. SI correlated with deep and superficial SAT in both black (R = −0.594, P = 0.002 and R = 0.495, P = 0.012) and white women (R = −0.554, P = 0.005 and R = −0.546, P = 0.004), but with VAT in white women only (R = −0.534, P = 0.005). In conclusion, body fat distribution is differentially associated with insulin sensitivity in black and white women. Therefore, the different abdominal fat depots may have varying metabolic consequences in women of different ethnic origins.