Linda A. Vaughan

Physical Activity Is Associated with Risk Factors for Chronic Disease across Adult Women's Life Cycle

OBJECTIVE The purpose of this study was to examine the association of age (young, midlife, and older) and activity level (active and sedentary), determined by a pedometer, with risk factors of chronic disease, including body composition, dietary intake, serum lipids, insulin, leptin, C-reactive protein (CRP), plasma glucose, and resting metabolic rate (RMR) in women across the adult life cycle. METHODS Young (aged 20 to 30 years) (n=49), midlife (aged 40 to 50 years) (n=62), and older (aged 60 years and older) (n=47) women were recruited for this cross-sectional study. For 7 days, participants completed weighed food records and wore a pedometer. Based on the average number of steps per day, the women were further classified as active (>/=7,500 steps per day) or sedentary (<7,500 steps per day). Height, weight, and waist circumference were determined for each participant. Fasting blood samples were taken to assess serum lipid, CRP, insulin, leptin, thyroid stimulating hormone, and plasma glucose levels. RMR and body composition (via dual-energy x-ray absorptiometry) were assessed. RESULTS Young and midlife women had lower concentrations compared to older women for serum cholesterol (P<0.01), low-density lipoprotein cholesterol (P<0.01), triglycerides (P<0.01), leptin (P<0.01), and plasma glucose (P<0.01); midlife women had lower serum insulin concentrations vs young and older groups (P=0.01); young women had smaller waist circumference compared to midlife and older groups (P<0.01); percent body fat (P<0.01) and percent fat-free mass (P<0.01) differed between all ages. Lower values were found in active vs sedentary women for serum insulin (P=0.02), serum leptin (P<0.01), waist circumference (P<0.01) and percent body fat (P<0.01). A higher percent fat-free mass (P<0.01) was also found in active compared to sedentary women. No differences were found between activity groups for serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, CRP, plasma glucose levels, or RMR. RMR was higher in young and midlife vs the older women (P<0.01). Significant inverse correlations were found between activity (steps per day) and body mass index, insulin level, CRP concentration, leptin level, waist circumference, and body fat. Significant positive correlations were found between age and body mass index, total serum cholesterol level, low-density lipoprotein cholesterol level, serum triglyceride level, leptin level, plasma glucose level, CRP concentration, waist circumference, and body fat. Young and midlife women reported consuming more relative energy (kilocalories per kilogram body weight) and protein (grams per kilogram body weight) than older women (P<0.01). The midlife women reported consuming more dietary cholesterol compared to the young and older women (P<0.01). Active women reported a higher relative energy (kilocalories per kilogram body weight) and protein (grams per kilogram body weight) intake vs the sedentary women (P<0.01). Active women also reported a higher intake of dietary carbohydrates (grams per day, P<0.01; percent of energy, P=0.04). CONCLUSIONS Overall, these results indicate that younger age and greater physical activity, despite age, are associated with fewer risk factors for chronic disease, such as cardiovascular disease, type 2 diabetes, and obesity.

Using Visual Methods to Uncover Context

The accurate assessment of physical activity and dietary intake is essential for assessing the relationships between physical activity, dietary intake, and health outcomes. However, the measurement of physical activity and dietary intake among women, particularly minority women, poses unique challenges related to gender, ethnicity, and social context. Measures that are not culturally relevant or sensitive to the experiences, traditions, or beliefs of ethnically diverse women might result in data that are unreliable, or which cannot be interpreted. Visual methods show promise for elucidating concepts that are important to refine established measures for assessing dietary intake and physical activity in diverse ethnic groups. Hispanic women, a largely understudied subgroup that experiences long-term health risks associated with dietary and physical activity behaviors, serves as the focal group for this discussion of the potential for visual methods to develop culturally and contextually relevant and valid approaches to outcome assessment.

A systematic review of the evidence: the effects of portion size manipulation with children and portion education/training interventions on dietary intake with adults.

BACKGROUND Evidence shows that 3-5-year-old children undergo important physical and behavioral changes that include being affected by the amount of food they are served, with larger portions of food served resulting in greater dietary intake. This may be a key finding as researchers continue to identify effective treatments for the growing number of preschool children who are overweight or obese. Knowledge of the effects of varying portion sizes on young childrens dietary intake is important; however, because parents of young children control the manner in which children are fed, educating parents regarding the estimation of portion sizes is an approach worth exploring as a way to affect the trajectory of their young childs weight gain. AIMS The purposes of this systematic review were to determine (1) findings regarding the effect of varying portion sizes with young children and (2) the evidence regarding the effects of educating adults to estimate portion sizes. Evidence from this review may guide clinical practice and future research efforts. METHODS A comprehensive literature search was conducted with multiple databases using MeSH Headings and keywords. This search strategy was supplemented by ancestry searches of all relevant articles. Two independent, trained pediatric practitioners determined quality of the studies using established criteria. RESULTS Nine studies met the inclusion criteria as portion-manipulation interventions or portion-education/training interventions and were appraised. Evidence showed the positive effect of portion sizes on the energy intake of children. In addition, the ability of adults to accurately estimate portion size improved following education/training. CONCLUSIONS Although many studies have focused on a variety of portion-related interventions, the influence of portion education with parents of young children has not been well researched. More research is needed to understand the effect of parent-focused, portion-education interventions that encourage appropriate energy intake and healthy weight attainment in young children.

The preliminary effects of a primary care-based randomized treatment trial with overweight and obese young children and their parents

INTRODUCTION Twenty-three percent of preschoolers are overweight/obese, which puts these children at risk for the development of chronic health comorbidities. The purpose of this randomized control pilot study was to determine the feasibility and preliminary effects of a theoretically based, primary care intervention on the physical outcomes of 60 overweight/obese preschool/early school-aged 4- to 8-year-old children. METHODS After recruitment and baseline assessment, parent-child dyads were randomly assigned to either the treatment or the control condition. Four intervention sessions were conducted with the parents in their childs primary health care office. The impact of the intervention was evaluated by assessing child anthropometric measures (e.g., waist, waist-by-height ratio, and body mass index [BMI]) immediately, 3 months, and 6 months after the intervention period. RESULTS Analysis of variance models suggested that children in the experimental group were found to have reduced waist circumference and waist-by-height ratio immediately after the intervention that persisted for 3 and 6 months (f = 0.33, 0.35, respectively). BMI and BMI percentile were not differentially affected. DISCUSSION These promising findings suggest that a primary care-based, parent-focused overweight/obesity treatment program is feasible and demonstrated positive preliminary effects, improving the childrens overall health trajectory.

Patient Nutrition Acuity as a Predictor of the Time Required to Perform Medical Nutrition Therapy

OBJECTIVE To determine if patient nutrition acuity accurately predicts the time required to perform medical nutrition therapy (MNT). DESIGN Data detailing demographic characteristics, patient nutrition acuity, and time spent performing MNT were collected for 12 consecutive days. Random systematic sampling was used to select 25%, or a minimum of 20 patients, from daily admissions to the hospital. Nutrition acuity was categorized using a 27-item patient acuity tool. SUBJECTS/SETTING Analysis included data from 92 acute-care hospitals nationwide; the median census was 271 patients. Of the 7,289 patients in the survey, 3,321 were included in this data analysis. All subjects were assigned an acuity rating and received MNT. Mean age (+/- standard deviation [SD]), was 55 +/- 24 years, and the sample was 48% male and 52% female. Time spent delivering MNT ranged from 5 to 285 minutes (mean +/- SD = 43.3 +/- 34.2 minutes). STATISTICAL ANALYSES PERFORMED Stepwise multiple regression analysis (P < .05), with independent variables of age, gender, and 27 acuity descriptors, determined time required to perform MNT. RESULTS The number of acuity descriptors assigned to patients ranged from zero (53 patients) to 20 (1 patient); the mean (+/- SD) for all patients was 5.6 +/- 3.1. Gender and 21 of the 27 acuity descriptors were statistically significant in predicting the time required to perform MNT. APPLICATIONS/CONCLUSIONS A formula was developed to determine medical nutrition therapy time (MNTT) as minutes per patient sampled. When extrapolated to a facilitys patient census, MNTT is the basis for predicting staffing requirements. The MNTT formula is crucial in the present environment of managed care where fiscal accountability challenges staffing rationales.

Blood pressure responses of mild hypertensive caucasian males to a metabolic diet with moderate sodium and two levels of dietary calcium

Abstract This study compared blood pressure (BP) responses of hypertensive males to two moderate (3300mg/d) sodium (Na) metabolic diets differing in calcium (Ca). Ten mild hypertensive Caucasian males were fed a 6-week high Ca diet (1400mg/d Ca) and 5 hypertensive males were fed a low Ca diet (400mg/d Ca). BP was measured twice/week and serum and urine were analyzed for Ca, Na, magnesium (Mg), potassium (K), parathyroid hormone (PTH), 1,25(OH) 2 vitamin D, red cell Mg, and plasma renin activity (PRA). Systolic and diastolic BP decreased (9% and 8%, respectively) in the high Ca group (p

Serum iron, zinc, folacin and vitamin B-12 in pregnant and non-pregnant adolescents

Abstract Iron status, blood folacin, vitamin B-12 and zinc were compared for 32 pregnant adolescents and 19 agematched non-pregnant controls. Blood samples were collected during the second and third trimesters (approximately 22 and 34 weeks gestation) and 6 to 8 weeks post-partum from the pregnant subjects and once from the controls. Second trimester pregnant subjects had significantly lower erythrocyte counts (p

A Comparison of Skinfold Measures Versus Infrared Interactance as Measures of Body Composition in Hemodialysis Patients

Objective: Compare the use of skinfold measures (SFM) and infrared interactance (IRI) measurements to determine percent body fat (% BF) in a stable adult hemodialysis (HD) population. Determine if IRI was statistically comparable to the widely accepted anthropometric measurer (SFM) of body composition. Design: Nonrandomized screening by established criteria; voluntary participation. Setting: Six free-standing, outpatient dialysis clinics. Patients: One hundred nineteen stable adult HD patients (64 men and 55 women age 18 to 86 years) including 8 blacks, 21 Native Americans, 10 Hispanics, and 80 Caucasians. Intervention: Each subject was measured once for % BF by SFM and IRI after a regularly scheduled HD treatment per established protocol. Main outcome measures: Comparison of SFM as criterion standard with IRI. Results: Correlation of r = 0.734 ( P Conclusions: Because the validity of IRI in the healthy population is still under investigation, further research is indicated before IRI is considered to be a useful tool for HD patients.

Bone Mineral Density (BMD) of Sedentary and Active Older Women With and Without Rheumatoid Arthritis (RA)

Abstract RA is a chronic, inflammatory disorder occurring more commonly in women. Women with RA may have increased risk of bone loss due to the hypermetabolic nature of the disease and steroid drug use. The purpose of this study was to determine the effect of RA and programmed physical activity (PPA) on BMD in sedentary and active women (56-77y, mean BMI=24.3kg/m 2 , mean body fat=40.9%). Subjects were classified into one of four groups: active RA (n=10; 25y with RA), sedentary RA (n=13; 24y with RA), active healthy control (HC) (n=10), sedentary HC (n=12). Active subjects engaged in PPA for 4-6h/wk for ⩾5y. Supplemental Ca intake was reported to be 564, 1368, 273, and 419mg/d for the RA Active, RA Sedentary, HC Active, and HC Sedentary groups, respectively. BMD (hip and spine) was measured by DXA. ANOVA indicated no difference between groups for the variables measured. Engaging in PPA did not prevent BMD loss in active subjects.L2-L4, BMD (g/cm 2 )Femur Neck, BMD (g/cm 2 )Wards Triangle, BMD (g/cm 2 )RA Active0.971±0.1370.649±0.1170.508±0.154RA Sedentary0.974±0.1460.649±0.0700.492±0.120HC Active0.894±0.1680.654±0.0970.506±0.132HC Sedentary0.956±0.1720.677±0.1200.531±0.158Using Wards Triangle BMD, a clinical diagnosis of osteoporosis was observed in 30% of the subjects overall and 40%, 27%, 10%, and 25% of subjects in the RA Active, RA Sedentary, HC Active, and HC Sedentary groups, respectively. These data indicate the importance of monitoring bone health in all older women regardless of health, activity level, and supplemental calcium intake.