Kara M. Whitaker

Depressive symptoms are associated with dietary intake but not physical activity among overweight and obese women from disadvantaged neighborhoods

Evidence suggests that depressive symptoms are associated with poorer dietary intake and inadequate physical activity; however, this association has not been examined in lower-income overweight and obese African American women. The objective of this cross-sectional study was to examine the associations between depressive symptoms and diet and physical activity in 196 women (87% African American; age, 25-51 years). Higher depressive symptoms were hypothesized to predict poorer diet quality, greater emotional eating, lower physical activity levels, and greater sedentary time. Depressive symptoms were measured using the validated short form of the Center for Epidemiological Studies Depression Scale. Dietary intake and quality were assessed using three 24-hour dietary recalls. Emotional eating was evaluated using 4 items from the emotional eating subscale of the Eating Behavior Patterns Questionnaire. Physical activity and sedentary time were objectively measured using the ActiGraph accelerometer. Linear regression models tested the associations between depressive symptoms and each dietary and physical activity outcome variable. Symptoms of depression were positively associated with total daily caloric intake from saturated fat and total sugars, as well as emotional eating scores (P < .05). Although not statistically significant, depressive symptoms were positively associated with sweetened beverage consumption (P = .06) and added sugars (P = .07). Depressive symptoms were not associated with total fat, sodium, fruit and vegetables, fast food consumption, the Alternate Healthy Eating Index score, moderate-to-vigorous physical activity, or sedentary time. Future studies should explore the mechanisms linking the identified associations between depressive symptoms and dietary intake, such as the role of emotional eating.

Associations between human breast milk hormones and adipocytokines and infant growth and body composition in the first 6 months of life

Much is to be learnt about human breast milk (HBM).

Patient and Provider Perceptions of Weight Gain, Physical Activity, and Nutrition Counseling during Pregnancy: A Qualitative Study.

OBJECTIVE This study investigated patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. METHODS Individual qualitative interviews were conducted with 30 pregnant women between 20 and 30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. RESULTS The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. CONCLUSIONS Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy.

African American and White women׳s perceptions of weight gain, physical activity, and nutrition during pregnancy

OBJECTIVE To describe African American and White womens perceptions of weight gain, physical activity, and nutrition during pregnancy and to explore differences in perceptions by race. DESIGN Qualitative interview study. SETTING Two Ob/Gyn clinics in South Carolina, USA. PARTICIPANTS Thirty pregnant women (15 African American, 15 White) between 20 and 30 weeks gestation, equally represented across pre-pregnancy BMI categories (10 normal weight, 10 overweight, and 10 obese). FINDINGS White women more frequently described intentions to meet weight gain, physical activity, and dietary guidelines in pregnancy than African American women. African American women were more concerned with inadequate weight gain while White women more commonly expressed concerns about excessive weight gain. More White women discussed the importance of physical activity for weight management. Regardless of race, few women described risks of excessive weight gain or benefits of physical activity as it relates to the babys health. The primary cited barrier of healthy eating was the high cost of fresh produce. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Several knowledge gaps as well as race differences were identified in womens perceptions and intentions toward weight gain, physical activity, and nutrition during pregnancy. Future interventions should seek to educate women about common misperceptions. It may be necessary to culturally tailor gestational weight gain interventions to optimise health outcomes.

Sedentary Behaviors and Cardiometabolic Risk: An Isotemporal Substitution Analysis

Evidence suggests that time spent engaging in sedentary behaviors is associated with a greater risk of adverse cardiometabolic outcomes. We investigated the cross-sectional associations of 6 unique sedentary tasks (watching television, using the computer, completing paperwork, reading, talking on the telephone, and sitting in a car) with cardiometabolic risk factors, and also examined the effect of replacing one type of sedentary behavior with another on the level of cardiometabolic risk. Participants consisted of 3,211 individuals from the Coronary Artery Risk Development in Young Adults Study who visited the clinic between 2010 and 2011. Linear regression models examined the independent and joint associations of sedentary tasks with a composite cardiometabolic risk score, as well as with individual cardiometabolic risk factors (waist circumference, blood pressure, fasting glucose, insulin, triglycerides, and high density lipoprotein cholesterol) after adjusting for physical activity and other covariates. Replacing 2 hours of television viewing with 2 hours spent performing any other sedentary activity was associated with a lower cardiometabolic risk score of 0.06-0.09 standard deviations (all 95% confidence intervals: -0.13, -0.02). No other replacements of one type of sedentary task for another were significant. Study findings indicate that television viewing has a more adverse association with cardiometabolic risk factors than other sedentary behaviors.

Dietary intake, Behaviors anD Psychosocial Factors among Women From FooD-secure anD FooD-insecure householDs in the uniteD states

OBJECTIVE Determine whether macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake, and psychosocial and behavioral factors are associated with household food security. DESIGN Baseline data from in-person interviews and telephone-based, 24-hour dietary recall from women recruited to a diet and physical activity controlled trial. SETTING Neighborhoods encompassing 18 urban census tracts in South Carolina. PARTICIPANTS Participants (n=202) were predominantly African American (87%), overweight or obese women aged 25 to 51 years with mean body mass index of 40.6±8.7. MAIN OUTCOME MEASURES Macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake (via multi-pass, 24-h recall); diet-related self-efficacy and social support, healthy/lowfat and emotional eating behaviors, and depressive symptoms. RESULTS Women in food-secure (FS) and food insecure (FI) households were not different on health and sociodemographic characteristics. Women in FI households had lower self-efficacy and healthy/low-fat eating behaviors, and higher emotional eating and depressive symptoms compared with women in FS households. The groups did not differ on social support. Significant dietary differences were few (FS>FI on protein and lean meat; FS<FI on carbohydrate intake). For 29 of 35 (74%) dietary intake recommendations, less than 75% of women in both groups met each recommendation. CONCLUSIONS While food security status was associated with diet-related psychosocial and behavioral factors, it was associated with few aspects of dietary intake. Dietary intake overall was poor. Participants were not meeting guidelines for a diet supportive of general health or weight loss and management, regardless of food security status.

Sedentary Behavior, Physical Activity, and Abdominal Adipose Tissue Deposition

Purpose We examined whether sedentary lifestyle habits and physical activity level are associated with abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and liver attenuation, independently of one another and potential confounders. Methods This study analyzed 3010 African American and Caucasian men and women, 42–59 yr old, from the Coronary Artery Risk Development in Young Adults (CARDIA) study, who completed multiple-slice abdominal computed tomography in 2010–2011. Participants reported average hours per day sitting (television, computing, paperwork, music, telephone, and car). Physical activity was assessed with the CARDIA physical activity history. VAT, SAT, IMAT, and liver attenuation were estimated from computed tomography. Multivariable general linear regression models regressed means of fat depots on total sedentary time, task-specific sedentary time, and total physical activity. Results Television viewing was positively, and physical activity inversely, associated with fat depots. For each 1 SD increment in television viewing (1.5 h·d−1), VAT, SAT, and IMAT were greater by 3.5, 3.4, and 3.9 cm3, respectively (P < 0.03 for all). For each 1 SD increment in physical activity (275 exercise units), VAT, SAT, and IMAT were lower by 7.6, 6.7, and 8.1 cm3, respectively, and liver attenuation was greater (indicating more liver fat) by 0.5 Hounsfield units (P < 0.01 for all). Total sedentary time was associated with VAT, IMAT, and liver attenuation in White men only after controlling for physical activity, SAT, and other potential confounders (P ⩽ 0.01 for all). No other task-specific sedentary behaviors were associated with fat depots. Conclusions Sedentary behaviors, particularly television viewing, and physical activity levels have distinct, independent associations with fat deposition.

Sex differences in the rate of abdominal adipose accrual during adulthood: the Fels Longitudinal Study

Objectives:The purpose of this analysis was to evaluate sex differences in the rate of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) accrual in adults. Secondary analyses examined differences in the rate of VAT and SAT accrual in premenopausal, perimenopausal and postmenopausal women.Subjects/Methods:Participants were 472 (60% female) non-Hispanic whites and aged 18–84 years at baseline in whom abdominal VAT and SAT were assessed using multiple-image magnetic resonance imaging at two time points, with an average follow-up of 7.3±2.6 years. Linear regression models were used to examine the effects of sex, baseline age and their interaction on rate of change per year in body composition measures (ΔBMI, ΔVAT and ΔVAT/SAT ratio (ΔVSR)) independent of baseline body composition measures, visit year, income, marital status, physical activity, smoking and alcohol intake. Secondary analyses examined differences in the rate of fat change by menopausal status (premenopausal, perimenopausal, postmenopausal).Results:Levels of body mass index (BMI), VAT and VSR all increased over the 7-year period on average (P<0.001); however, the change in BMI (mean ΔBMI=+0.5%) was far smaller than for VAT (mean ΔVAT=+6.8%), SAT (mean ΔSAT=+2.4%) and VSR (mean ΔVSR=+3.6%). ΔBMI, ΔVAT and ΔSAT decreased linearly with age in both sexes (P<0.01), such that older individuals had lower rates of BMI, VAT and SAT gain, and this deceleration in BMI, VAT and SAT accrual was greater in men than women (P for interaction <0.05). ΔVSR did not vary with age in either sex but remained higher in men than women throughout adulthood. There were no differences in rate of weight or fat gain by menopausal status after adjustment for age.Conclusions:Men and women continue to accrue abdominal adiposity with age, but the rate of weight and fat gain decreases over time, particularly in men.

Associations of Maternal Weight Status Before, During, and After Pregnancy with Inflammatory Markers in Breast Milk

The goal of this study was to examine the associations of maternal weight status before, during, and after pregnancy with breast milk C‐reactive protein (CRP) and interleukin 6 (IL‐6), two bioactive markers of inflammation, measured at 1 and 3 months post partum.

Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study

While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year 7 (ages 25-37years) and/or 20 exams (ages 38-50years), respectively, which included a GXT. Cox proportional hazard models were used to examine the effect of GXT disposition (at Year 7 and 20, separately) on risk of non-fatal and fatal cardiovascular events and all-cause mortality obtained through 28years of follow-up. A GXT was not conducted or completed according to protocol in 12.9% and 19.1% of participants attending the Year 7 and 20 exams, respectively. After adjustment, participants who missed the Year 20 GXT for medical reasons had a higher risk of cardiovascular events [HR: 4.06 (95% CI: 1.43, 11.5)] and all-cause mortality [HR: 3.07 (95% CI: 1.11, 12.3)] compared to GXT completers; participants who missed at Year 20 for non-medical reasons also had higher risk of all-cause mortality [HR: 2.53 (95% CI: 1.61, 3.99)]. Findings suggest that non-participation in a GXT, regardless of medical or non-medical reason, to be an important predictor of excess risk of adverse health outcomes and premature mortality. Additional patient follow-up, including identification of potential targets for intervention (e.g., weight management and smoking cessation programs), should be conducted at the point of a missed GXT.