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Briggs Early K, Valencia SI, Stendell-Hollis N, Klyve D, Gee DL. Hypertension Prevalence and Related Risk Factors Among Mexican American Adults Are Increasing: National Health and Nutrition Examination Survey 1999 to 2018. J Am Heart Assoc 2024; 13:e030126. [PMID: 38818945 DOI: 10.1161/jaha.123.030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/15/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Acculturation affects hypertension prevalence among Hispanic people, but there have been no recent analyses specifically focused on Mexican American (MA) people. We sought to determine age-adjusted hypertension prevalence, abdominal obesity, and acculturation trends among MA adults and non-Hispanic White adults. METHODS AND RESULTS Data from the NHANES (National Health and Nutrition Examination Survey) were analyzed in 2-year increments to observe trends in hypertension and risk factors (age, sex, body mass index, smoking status, abdominal obesity, waist-to-height ratio (WHtR), education, and income). Acculturation was based on three commonly used measures. The sample included 30 920 adults. Age-adjusted hypertension prevalence is higher in MA adults (52.7%) than White adults (48.3%). Hypertension risk factors-age, obesity prevalence, WHtR, acculturation-all significantly increased among MA adults, while smoking declined. Higher acculturation scores increased hypertension likelihood (odds ratio [OR], 1.44 [95% CI, 0.91-1.97]) for MA adults compared with those with lower acculturation scores. White adults with elevated WHtR >0.5 had a 40% higher risk of hypertension than those with WHtR <0.5, but among MA adults, elevated WHtR did not increase risk for hypertension. There was a significant increase in hypertension prevalence among MA adults from 2003 to 2018 at an average biennial rate of 2.23%. There was no change in hypertension prevalence among White adults from 1999 to 2018. CONCLUSIONS Over 20 years of NHANES, more highly acculturated MA adults were at greater risk for hypertension, despite declines in smoking and controlling for age, sex, obesity status, education, and income. Finding ways to promote more traditional lifestyle and eating habits for MA adults could be a beneficial approach to reducing hypertension risk factors in this population.
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Affiliation(s)
- Kathaleen Briggs Early
- Department of Biomedical Sciences Pacific Northwest University of Health Sciences Yakima WA USA
| | - Sandra I Valencia
- Department of Health Sciences Central Washington University Ellensburg WA USA
| | | | - Dominic Klyve
- Department of Mathematics Central Washington University Ellensburg WA USA
| | - David L Gee
- Department of Health Sciences Central Washington University Ellensburg WA USA
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2
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Chen Z, Qiu X, Wang Q, Wu J, Li M, Niu W. Serum vitamin D and obesity among US adolescents, NHANES 2011-2018. Front Pediatr 2024; 12:1334139. [PMID: 38836246 PMCID: PMC11148364 DOI: 10.3389/fped.2024.1334139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
Background and objectives Childhood obesity is highly prevalent worldwide. We aimed to assess whether serum 25-hydroxyvitamin D was associated with general/central obesity among US adolescents, and further to explore the mediatory impact of homeostasis model assessment of insulin resistance (HOMA-IR) on this association. Methods This study is cross-sectional in design. Study adolescents were enrolled from the National Health and Nutrition Examination Survey (NHANES), 2011-2018. Serum 25-hydroxyvitamin D categories associated with general (indexed by body mass index) and central (indexed by waist circumference to height ratio) obesity were regressed. The possible mediatory effect of HOMA-IR on this association was explored. The nonlinear and dose-response association was examined by restricted cubic spline (RCS) test. Results Total 2,696 adolescents were eligible for inclusion, and the mean age of all adolescents was 15.4 years. Overall, the percentage of general and central obesity was 38.0% and 38.6%, respectively. Compared with adolescents with sufficient vitamin D, adolescent with deficient and insufficient vitamin D intake were associated with general obesity and central obesity; fully-adjusted OR for general obesity was 1.602 (95% CI: 1.161-2.211) and 1.659 (1.385-1.986), and fully-adjusted OR for central obesity was 2.025 (1.445-2.837) and 1.557 (1.287-1.884), respectively, while there was no observable significance in adolescents with possibly harmful vitamin D. The proportion mediated by HOMA-IR was estimated to be 31.7% for global obesity and 50.3% for central obesity (both P < 0.05). More stratified analyses were presented, and identified that the association with general obesity was particularly present among Mexican American, while with central obesity among Non-Hispanic Black adolescents. Conclusions Our findings indicate that deficient or insufficient 25-hydroxyvitamin D concentrations were associated with the significant risk of general and central obesity among US adolescents, and approximately 30% and 50%, respectively, of these associations were mediated by HOMA-IR.
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Affiliation(s)
- Zisu Chen
- Department of Pediatrics, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiaojin Qiu
- Department of Pediatrics, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Qiong Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Min Li
- Department of Pediatrics, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
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3
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Salerno PRVO, Qian A, Dong W, Deo S, Nasir K, Rajagopalan S, Al-Kindi S. County-level socio-environmental factors and obesity prevalence in the United States. Diabetes Obes Metab 2024; 26:1766-1774. [PMID: 38356053 DOI: 10.1111/dom.15488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
AIMS To investigate high-risk sociodemographic and environmental determinants of health (SEDH) potentially associated with adult obesity in counties in the United States using machine-learning techniques. MATERIALS AND METHODS We performed a cross-sectional analysis of county-level adult obesity prevalence (body mass index ≥30 kg/m2) in the United States using data from the Diabetes Surveillance System 2017. We harvested 49 county-level SEDH factors that were used in a classification and regression trees (CART) model to identify county-level clusters. The CART model was validated using a 'hold-out' set of counties and variable importance was evaluated using Random Forest. RESULTS Overall, we analysed 2752 counties in the United States, identifying a national median (interquartile range) obesity prevalence of 34.1% (30.2%, 37.7%). The CART method identified 11 clusters with a 60.8% relative increase in prevalence across the spectrum. Additionally, seven key SEDH variables were identified by CART to guide the categorization of clusters, including Physically Inactive (%), Diabetes (%), Severe Housing Problems (%), Food Insecurity (%), Uninsured (%), Population over 65 years (%) and Non-Hispanic Black (%). CONCLUSION There is significant county-level geographical variation in obesity prevalence in the United States, which can in part be explained by complex SEDH factors. The use of machine-learning techniques to analyse these factors can provide valuable insights into the importance of these upstream determinants of obesity and, therefore, aid in the development of geo-specific strategic interventions and optimize resource allocation to help battle the obesity pandemic.
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Affiliation(s)
- Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center & Case Western Reserve University, Cleveland, Ohio, USA
| | - Alice Qian
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Weichuan Dong
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Salil Deo
- Surgical Services, Louis Stokes VA Medical Center, and Case Western Reserve University, Cleveland, Ohio, USA
| | - Khurram Nasir
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center & Case Western Reserve University, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Kopinska J, Atella V, Bhattacharya J, Miller G. The changing relationship between bodyweight and longevity in high- and low-income countries. ECONOMICS AND HUMAN BIOLOGY 2024; 54:101392. [PMID: 38703461 DOI: 10.1016/j.ehb.2024.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
Standard measures of bodyweight (overweight and obese, for example) fail to reflect differences across populations and technological progress over time. This paper builds on the pioneering work of Hans Waaler (1984) and Robert Fogel (1994) to empirically estimate how the relationship between body mass index (BMI) and longevity varies across high-, middle-, and low-income countries. Importantly, we show that these differences are so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined)-and in fact, relative to current standards, a larger share of low-income countries' populations can be unhealthily heavy.
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Affiliation(s)
| | - Vincenzo Atella
- Department of Economics and Finance, University of Rome Tor Vergata, Italy.
| | - Jay Bhattacharya
- School of Medicine - Stanford University, Stanford, United States of America; NBER, United States of America
| | - Grant Miller
- School of Medicine - Stanford University, Stanford, United States of America; NBER, United States of America
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Kebeh M, Dlott CC, Kurek D, Morris JC, Wiznia DH. Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization: Obesity and Malnutrition-Part Four of the Movement Is Life Special ONJ Series. Orthop Nurs 2024; 43:75-83. [PMID: 38546679 PMCID: PMC10987043 DOI: 10.1097/nor.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Obesity and malnutrition affect many patients with osteoarthritis and can predispose patients to worse outcomes after total joint arthroplasty (TJA). However, these modifiable risk factors can be addressed in preoperative optimization programs driven by nurse navigators. Our aim is to provide resources and recommendations for nurse navigators when addressing obesity and malnutrition among TJA patients. In addition to discussions with nurse navigators regarding obesity and malnutrition, a literature review was conducted to assess the current practice standards for management. Nurse navigators often had difficulty implementing long-term interventions, but interventions in the literature included medical and bariatric treatments for obesity and more targeted assessment of nutrition status. These findings are incorporated into our recommendations for nurse navigators. Addressing obesity and malnutrition in preoperative optimization can contribute to improved outcomes, as has been demonstrated in current practice and in the literature.
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Affiliation(s)
- Martha Kebeh
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Chloe C. Dlott
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Donna Kurek
- National Association of Orthopaedic Nurses and Movement is Life, Chicago, IL, USA
- OrthoVirginia, Chesterfield, VA, USA
| | - Jensa C. Morris
- Hospital Medicine Service, Yale New Haven Hospital, New Haven, CT, USA
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Daniel H. Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Blasingame M, Samuels LR, Heerman WJ. The Combined Effects of Social Determinants of Health on Childhood Overweight and Obesity. Child Obes 2024; 20:107-118. [PMID: 36989504 DOI: 10.1089/chi.2022.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Background: To characterize the association between multiple social determinants of health (SDOH) and overweight and obesity among US children. Methods: We conducted a cross-sectional analysis using the 2016-2020 National Survey of Children's Health. SDOH domains consisted of Economic Stability, Social and Community Context, Neighborhood and Built Environment, and Health Care Access and Quality. We used ordinal logistic regression to model associations between SDOH and weight status and calculate predicted probabilities of having overweight or obesity for various SDOH profiles. Results: Data from 81,716 children represented a weighted sample of 29,415,016 children ages 10-17 years in the United States. Of these, 17% had overweight and 17% had obesity. Compared with children with the theoretically lowest-risk SDOH profile, children with the highest-risk SDOH profiles in all four domains had an odds ratio of having a higher BMI category of 4.38 (95% confidence interval 1.67-7.09). For the lowest risk profile, the predicted probability of obesity varied from 8% to 11%, depending on race. For the highest risk profile, the predicted probability of obesity varied from 26% to 34%, depending on race. Conclusions: While high-risk values in each SDOH domain were associated with higher predicted probability of overweight and obesity, it was the combination of highest risk values in all the SDOH domains that led to greatest increases. This suggests a complex and multilayered relationship between the SDOH and childhood obesity, necessitating a comprehensive approach to addressing health equity to reduce childhood obesity.
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Affiliation(s)
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Wang S, Shi S, Huang Y, Huang H, Zhong VW. Severity of abdominal obesity and cardiometabolic diseases in US adults. Public Health 2024; 227:154-162. [PMID: 38232563 DOI: 10.1016/j.puhe.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To determine the prevalence of cardiometabolic diseases (CMDs) among adults with abdominal obesity and to evaluate the necessity of differentiating severity of abdominal obesity. STUDY DESIGN Cross-sectional study and prospective cohort study. METHODS National Health and Nutrition Examination Survey (NHANES) data between 2011 and 2020 were included for cross-sectional analyses. Class I, II and III abdominal obesity were created by dividing waist circumference within sex-specific abdominal obesity range into tertiles. Age-standardized prevalence of CMDs was estimated and differences by severity of abdominal obesity were compared using Poisson regressions. Prospective analyses were performed using NHANES data between 1988 and 2018 with linked mortality data. Cox proportional hazards models were used to assess the association between severity of abdominal obesity and mortality. RESULTS Among 23,168 adults included (mean age: 47.8 years, 49.3% men), 13,307 (57.4%) had abdominal obesity. Among adults with abdominal obesity, the estimated prevalence of diabetes was 17.3% (95% confidence interval: 16.3%, 18.2%), hypertension 39.3% (38.2%, 40.3%), dyslipidemia 59.5% (58.0%, 61.1%), cardiovascular disease 9.0% (8.3%, 9.8%), chronic kidney disease 16.8% (15.9%, 17.7%) and non-alcoholic fatty liver disease 39.9% (38.4%, 41.4%). The estimated prevalence was 55.5% (53.8%, 57.2%) for having ≥2 CMDs. Compared with class I abdominal obesity, class III abdominal obesity was related to a 43%-184% higher prevalence of CMDs and a 44% higher risk of all-cause mortality. CONCLUSIONS The prevalence of CMDs was high and multimorbidity of CMDs was common among US adults with abdominal obesity. The prevalence of CMDs and risk of mortality differed significantly by severity of abdominal obesity.
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Affiliation(s)
- S Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - H Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - V W Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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8
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Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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Affiliation(s)
- Stephanie W. Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado School of Medicine, Nutrition Obesity Research Center at the University of Colorado, Aurora, CO, USA
| | - Daisy Wang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
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9
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Zhao Y, Araki T. Diet quality and its associated factors among adults with overweight and obesity: findings from the 2015-2018 National Health and Nutrition Examination Survey. Br J Nutr 2024; 131:134-142. [PMID: 37462503 DOI: 10.1017/s0007114523001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
The rate of adult severe obesity has been continually rising in the USA. While improving diet quality has been shown to reduce the risk of obesity, few studies have explored the differences in diet quality among adults with overweight and obesity by different weight statuses along with socio-demographic factors and physical activity using data from a nationally representative survey in the USA. The main goal of the study is to assess the diet quality of adults with overweight and obesity by examining differences in the Healthy Eating Index-2015 (HEI-2015) scores, using data from the 2015-2018 National Health and Nutrition Survey. Among 6746 adults with overweight and obesity (aged ≥ 20 years), severe obesity was prevalent (27 %), particularly among females, non-Hispanic Blacks and those with lower education and income. Compared to adults with overweight, adults with severe obesity had lower HEI-2015 total scores as well as component scores for total fruits, whole fruits, greens and beans, refined grains, sodium and saturated fats. Among adults with overweight and obesity, non-Hispanic Blacks had lower diet quality than non-Hispanic Asians; females had better diet quality than males; older adults had better diet quality than younger adults; adults with a college degree and above had better diet quality than those with less than a high school degree. Socio-demographic differences in diet quality and weight status should be considered in future obesity interventions to reduce adult severe obesity in the USA.
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Affiliation(s)
- Yajie Zhao
- International Agro-Informatics Laboratory, Department of Global Agricultural Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Japan
| | - Tetsuya Araki
- International Agro-Informatics Laboratory, Department of Global Agricultural Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Japan
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Banas J, McDowell Cook A, Raygoza-Cortez K, Davila D, Irwin ML, Ferrucci LM, Humphries DL. United States Long-Term Trends in Adult BMI (1959-2018): Unraveling the Roots of the Obesity Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:73. [PMID: 38248537 PMCID: PMC10815706 DOI: 10.3390/ijerph21010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
The escalating rates of obesity since the 1950s poses a critical public health challenge across all age groups in the United States. While numerous studies have examined cross-sectional disparities across racial, ethnic, and socioeconomic groups, there has been limited research on long-term trends. To address this gap, we analyzed average adult body mass index (BMI) trends from 1959 to 2018, using data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Examination Survey (NHES). Employing time series analysis, we evaluated BMI trends across income, education, and race/ethnicity. The results revealed a consistent upward trajectory in average BMI across all groups over the six-decade period, with no significant differences by income or education levels among high school graduates. However, individuals with less than a high school education displayed a more gradual increase in BMI. Racial disparities were also evident, with Black adults showing higher BMI growth rates compared to White adults, while Hispanic and other racial groups experienced slower increases. These findings underscore the need for systemic interventions to address the ongoing obesity epidemic, emphasizing the importance of research to identify trends over time and a system-thinking approach to inform effective population-level interventions and policy decisions.
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Affiliation(s)
- Julia Banas
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
| | | | | | - Daniel Davila
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
| | - Melinda L Irwin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
- Yale Cancer Center, New Haven, CT 06510, USA
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Dharod JM, Frazier CM, Labban J, Black MM. Breastfeeding duration and associations with prevention of accelerated growth among infants from low-income, racially and ethnically diverse backgrounds. Public Health Nutr 2023; 27:e6. [PMID: 38047374 PMCID: PMC10830380 DOI: 10.1017/s1368980023002689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/30/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To describe breastfeeding rates from early to late infancy and to examine associations between breastfeeding duration and infant growth, including rapid weight gain (RWG, > 0·67 SD increase in weight-for-age Z-score), among infants from low-income, racially and ethnically diverse backgrounds. DESIGN A short, prospective cohort study was conducted assessing breastfeeding status at infant ages 2, 4, 6, 9 and 12 months. Infant length and weight measurements were retrieved from electronic health records to calculate weight-for-length Z-scores and the rate of weight gain. SETTING Pediatric clinic in the Southeastern USA. PARTICIPANTS Mother-infant dyads (n = 256). RESULTS Most participants were African American (48 %) or Latina (34 %). Eighty-one per cent were participating in the Special Supplemental Nutrition Program for Women, Infants and Children. Infants were breastfed for a median duration of 4·75 months, with partial more common than exclusive breastfeeding. At 12 months, 28 % of the participants were breastfeeding. Infants breastfed beyond 6 months had significantly lower growth trajectories than infants breastfed for 0-2 months (β = 0·045, se = 0·013, P = 0·001) or 3-6 months (β = 0·054, se = 0·016, P = 0·001). Thirty-six per cent of the infants experienced RWG. RWG was more common among infants who were breastfed for 2 months or less than 6+ month breastfed group (relative risk = 1·68, CI95 (1·03, 2·74), P = 0·03). CONCLUSIONS Breastfeeding beyond 6 months is associated with the prevention of accelerated growth among infants from low-income, racially and ethnically diverse backgrounds, suggesting progress toward health equity.
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Affiliation(s)
- Jigna M Dharod
- Department of Nutrition, School of Health and Human Sciences, 319 College Avenue, University of North Carolina at Greensboro, Greensboro, NC27412, USA
| | - Christina M Frazier
- Office of Research, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Maureen M Black
- Department of Pediatrics, University of Maryland, School of Medicine, Baltimore, MD, USA
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Zare H, Aazami A, Shalby N, Gilmore DR, Thorpe RJ. Measuring Racial Differences in Obesity Risk Factors in Non-Hispanic Black and White Men Aged 20 Years or Older. Am J Mens Health 2023; 17:15579883231205845. [PMID: 37978812 PMCID: PMC10657537 DOI: 10.1177/15579883231205845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023] Open
Abstract
Obesity prevalence in the United States has increased drastically in the last two decades. Racial differences in obesity have emerged with the increase in obesity, with temporal trends because of individual, socioeconomic, and environmental factors, eating behaviors, lack of exercise, etc., raising questions about understanding the mechanisms driving these racial differences in the prevalence of obesity among non-Hispanic Black (NHB) and non-Hispanic White (NHW) men. Although many studies have measured obesity using body mass index (BMI), little is known about waist circumference (WC). This study examines variations in obesity among NHW and NHB using BMI and WC. We used National Health and Nutrition Examination Surveys (1999-2016) with a sample of 9,000 NHW and 3,913 NHB men aged 20 years or older. To estimate the association between the prevalence of obesity (BMI ≥30) and race, we applied modified Poisson regression; to explore and decompose racial differences, we used Oaxaca-Blinder decomposition (OBD). We found that NHW had higher abdominal obesity (WC ≥102) than NHB, but NHB were more likely to be obese (BMI ≥30) during most years, with some fluctuations. Modified Poisson regression showed that NHB had a higher prevalence of obesity (prevalence ratio [PR]: 1.11, 95% confidence interval [CI] = [1.04, 1.18]) but lower abdominal obesity (PR: 0.845; 95% CI = [0.801, 0.892]) than NHW. OBD showed that age, access to health care, smoking, and drinking contributed to the differences in abdominal obesity. The study identifies a significant increase in obesity among men over the last two decades; generalized obesity (based on BMI) was more problematic for NHB men, but abdominal obesity was more problematic for NHW men.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, USA
| | - Aida Aazami
- The University of Texas at Dallas, Dallas, TX, USA
| | - Noran Shalby
- Public Health Studies in the Johns Hopkins Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle R. Gilmore
- Trachtenberg School of Public Policy & Administration, George Washington University, Washington, DC, USA
- Department of Health, Behavior, and Society Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ortiz-Hernandez L, Miranda-Quezada IP. Differences in Body Weight According to Skin Color and Sex in Mexican Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01829-6. [PMID: 37855997 DOI: 10.1007/s40615-023-01829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES 1) To analyze the differences in body weight according to skin color in Mexican adults. 2) Identify mediator variables that could explain possible differences in body weight according to skin color. METHODS A nationally representative survey of Mexican adults was analyzed (n = 12,021). People with obesity were identified (body mass index, BMI > 30) based on self-reported weight and height. Skin color was measured by self-report using a chromatic scale. The mediator variables were socioeconomic level, height, neighborhood public services, public safety, and discrimination based on skin color. RESULTS Compared to white-skinned women, brown-skinned women had higher BMI and a higher probability of being obese. These differences in weight by skin color are related to the lower level of education and more discrimination experiences of brown-skinned women. In men, there were no differences in weight according to skin color. CONCLUSIONS In Mexican women (but not in men), darker skin color was associated with a higher probability of being obese, and the examined social factors partially explained this disparity.
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Cohen SA, Brown MJ, Xu F, Nash CC, Greaney ML. Geographic differences in the magnitude of black-white disparities in having obesity. Obes Sci Pract 2023; 9:516-528. [PMID: 37810524 PMCID: PMC10551120 DOI: 10.1002/osp4.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background Obesity disparities in the United States are well documented, but the limited body of research suggests that geographic factors may alter the magnitude of these disparities. A growing body of evidence has identified a "rural mortality penalty" where morbidity and mortality rates are higher in rural than urban areas, even after controlling for other factors. Black-White differences in health and mortality are more pronounced in rural areas than in urban areas. Objective Therefore, the purpose of this study was to explore how rural-urban status and region moderate Black-White health disparities in obesity. Methods Data were abstracted from the 2012 Behavioral Risk Factor Surveillance System, with the sample being restricted to Black and White respondents (n = 403,231). Respondents' county of residence was linked to US Census information to obtain the county-level Index of Relative Rurality (IRR) and Census division. Crude and adjusted logistic regression models were utilized to assess the magnitude of Black-White disparities in having obesity (yes/no) by IRR quartile and by Census division. Results Overall, Black-White differences in obesity were wider in rural than in urban counties, with a significant linear trend (p < 0.001). Furthermore, when stratified by US Census division, results revealed that disparities were significantly wider in rural than urban areas for respondents living in the Middle Atlantic and South Atlantic divisions. In contrast, the association was reversed for the remaining divisions (New England, East North Central, West North Central, Mountain, and Pacific), where the magnitude of the Black-White difference was the largest in urban areas. Conclusion Findings highlight the need to understand and account for critical place-based factors that exacerbate racial obesity disparities to develop and maximize the effectiveness of policies and programs designed to reduce racial inequalities and improve population health.
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Affiliation(s)
- Steven A. Cohen
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Monique J. Brown
- Department of Epidemiology and BiostatisticsArnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Furong Xu
- School of EducationAlan Shawn Feinstein College of Education and Professional StudiesUniversity of Rhode IslandChafee Social Science CenterKingstonRhode IslandUSA
| | - Caitlin C. Nash
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Mary L. Greaney
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
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Stern M, Rancourt D, Soca Lozano S, Buro AW, Gray HL, Rodriguez C, Bailey R, Redwine L. Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness. J Pediatr Psychol 2023; 48:666-675. [PMID: 37541829 PMCID: PMC10468101 DOI: 10.1093/jpepsy/jsad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities. METHODS In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated. RESULTS Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up. CONCLUSION Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial. CLINICAL TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov under identifier NCT04800432.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, USA
| | | | - Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, USA
| | | | | | - Laura Redwine
- Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, USA
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16
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Aguayo L, Chang C, McCormack LR, Shalowitz MU. Parental determinants associated with early growth after the first year of life by race and ethnicity. Front Pediatr 2023; 11:1213534. [PMID: 37565242 PMCID: PMC10411553 DOI: 10.3389/fped.2023.1213534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023] Open
Abstract
Objective To investigate maternal and parental factors associated with changes in children's body mass index percentile (BMI-P) from 12 to 24 months. Methods Data from a prospective cohort of racially and ethnically diverse mothers, fathers, and children (n = 245) were used. Changes in BMI-P from 12 to 24 months of age were examined using height and weight measurements collected at both times. Separate longitudinal mixed-effects models with maximum likelihood were introduced to examine the determinants introduced by mothers and determinants from both parents among all children, and by race and ethnicity. Results Models that examine maternal and parental factors showed that children's overall BMI-P decreased from 12 to 24 months [β = -4.85, 95% confidence interval (CI), -7.47 to -2.23]. Stratified tests showed that White children whose parents graduated high school or completed a 4-year college degree or higher had greater decreases in BMI-P than White children born to parents with less than high school education (β = -60.39, 95% CI, -115.05 to -5.72; β = -61.49, 95% CI, -122.44 to -0.53). Among Hispanic/Latinx children, mean BMI-P significantly decreased from 12 to 24 months (β = -7.12, 95% CI, -11.59 to -2.64). Mother's older age (β = 1.83, 95% CI, 0.29-3.36) and child female sex (β = 11.21, 95% CI, 1.61-20.82) were associated with gains in children's BMI-P, while father's older age was associated with decreases (β = -1.19, 95% CI, -2.30 to -0.08). Conclusions Parental determinants associated with children's early growth varied by children's sex and racial and ethnic background. Results highlight the importance of understanding racial and ethnicity-specific obesity risks and including fathers in research.
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Affiliation(s)
- Liliana Aguayo
- Hubert School of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Cecilia Chang
- Research Institute, NorthShore University HealthSystem, Evanston, IL, United States
| | - Luke R. McCormack
- Rush Medical College of Rush University Medical Center, Chicago, IL, United States
| | - Madeleine U. Shalowitz
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Hayes JF, LaRose JG, Hutchinson K, Sutherland M, Wing RR. Health, health behaviors, and medical care utilization among college students with obesity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-7. [PMID: 37437179 PMCID: PMC10784414 DOI: 10.1080/07448481.2023.2225629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/27/2023] [Accepted: 06/01/2023] [Indexed: 07/14/2023]
Abstract
Objective: The study assessed perceived health, health behaviors and conditions, and medical care utilization among students of different weight categories. Participants: Participants were college students (n = 37,583) from 58 institutions who responded to a national survey of student health behaviors. Methods: Chi-squared and mixed model analyses were completed. Results: Compared to healthy weight students, those with obesity were less likely to report excellent health and meet dietary and physical activity recommendations, and more likely to have obesity-related chronic conditions and to have attended a medical appointment in the prior 12 months. Students with obesity (84%) and overweight (70%) were more likely to be attempting weight loss compared to students of healthy weight (35%). Conclusions: Students with obesity have poorer health and health behaviors relative to students of healthy weight; students with overweight were in between. Adapting and implementing evidence-based weight management programs within colleges/universities may be beneficial for student health.
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Affiliation(s)
- Jacqueline F. Hayes
- Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond, Richmond, Virginia
| | | | - Melissa Sutherland
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| | - Rena R. Wing
- Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island
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Taren D, Alaofè H, Yamanaka AB, Coleman P, Fleming T, Aflague T, Shallcross L, Wilkens L, Novotny R. Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region. Nutrients 2023; 15:2718. [PMID: 37375623 DOI: 10.3390/nu15122718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. METHODS Two 24 h dietary records were collected for 558 children, 2-8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children's Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. RESULTS AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. CONCLUSIONS Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence.
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Affiliation(s)
- Douglas Taren
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Halimatou Alaofè
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Ashley B Yamanaka
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA
| | - Patricia Coleman
- Cooperative Research, Extension, and Education Service, Northern Marianas College, Saipan, MP 96950, USA
| | - Travis Fleming
- Agriculture, Community and Natural Resources Division, Samoa Community College, Pago Pago, AS 96799, USA
| | - Tanisha Aflague
- Cooperative Extension and Outreach, College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96913, USA
| | - Leslie Shallcross
- Health, Home and Family Development, UAF Institute of Agriculture, Natural Resources and Extension, University of Alaska Fairbanks, Fairbanks, AK 99775, USA
| | - Lynne Wilkens
- Biostatistics Shared Resource, University of Hawai'i Cancer Center, University of Hawai'i at Mānoa, Honolulu, HI 96813, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA
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Ward K, Herekar A, Wang P, Lindsay KL. Feasibility and Acceptability of a Mindfulness-Based Smartphone App among Pregnant Women with Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5421. [PMID: 37048035 PMCID: PMC10094241 DOI: 10.3390/ijerph20075421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/19/2023]
Abstract
Maternal obesity is associated with an increased risk for prenatal depressive symptoms. Mindfulness-based interventions (MBIs) have been shown to reduce the risk of prenatal depression. This pilot study assesses the feasibility and acceptability of a smartphone-based MBI among pregnant women with obesity, and its potential for improving maternal mental and behavioral health outcomes. Five second-trimester pregnant women with a prepregnancy body mass index > 30 kg/m2 participated in a 30-day audio-guided mindfulness practice using the Headspace app. All participants engaged in the pregnancy module, while three concurrently engaged in the mindful eating module. Daily engagement with the app was tracked and a post-trial survey assessed maternal acceptability. Validated pre- and post-trial questionnaires explored changes in perceived stress, anxiety, depression, and eating habits. All participants completed the study with varying levels of adherence to the prescribed daily practice; the average number of days of engagement was 23/30 (77%) for the pregnancy module and 20/30 (67%) for the mindful eating module. All subjects reported some degree of perceived benefit, and none reported negative experiences. Trends were observed for improvements in maternal mental wellbeing and eating behaviors. This pilot study shows that a smartphone-based MBI is feasible, acceptable, and perceived to provide benefit among pregnant women with obesity.
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Affiliation(s)
- Kerrie Ward
- School of Medicine, University of California, Irvine, 1001 Health Sciences Road, Irvine, CA 92617, USA
| | - Anjali Herekar
- School of Medicine, University of California, Irvine, 1001 Health Sciences Road, Irvine, CA 92617, USA
| | - Peiyi Wang
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92617, USA
| | - Karen L. Lindsay
- Department of Pediatrics, School of Medicine, University of California, Irvine, 3800 Chapman Ave. Suite 2200, Orange, CA 92868, USA
- UCI Susan Samueli Integrative Health Institute, College of Health Sciences, 856 Health Sciences Road, Suite 4600, Irvine, CA 92617, USA
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20
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Marquez B, Lebensohn-Chialvo F, Huang X, Zhang X, Allison M. Improving Relational Functioning in Mother-Daughter Dyads With Obesity. FAMILY & COMMUNITY HEALTH 2023; 46:103-111. [PMID: 36799943 PMCID: PMC10959269 DOI: 10.1097/fch.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Family-level interventions have the potential to address intergenerational obesity among Mexican American women. Given that poor family functioning is associated with worse weight loss outcomes, this study tested a weight management program aimed at improving relational functioning in mothers and daughters with obesity. Mexican American mothers and their adult daughters were randomly assigned to participate in a 16-week group-based standard behavioral (SB) weight loss program without or with relationship skills training (SRT). Relational functioning was assessed via observational behavioral coding using the Global Structural Family Rating Scale. General relational functioning and specifically positive alliance patterns and conflict avoidance improved significantly more in the SRT group than in the SB group. Average weight changes included percent weight loss of -5.6% in the SRT group versus -3.9% in the SB group and body mass index reduction of -2.2 kg/m2 in the SRT group versus -1.2 kg/m2 in the SB group. More participants in the SRT group (75%) than in the SB group (40%) tended to achieve at least 3% weight loss. Greater changes in positive alliance patterns increased the likelihood of losing 3% of body weight. Improving relational functioning in mother-daughter dyads may promote favorable outcomes in a behavioral weight loss intervention.
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Affiliation(s)
- Becky Marquez
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Florencia Lebensohn-Chialvo
- Department of Counseling & Marital and Family Therapy Program, University of San Diego, San Diego, United States of America
| | - Xinyi Huang
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Xinlian Zhang
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Matthew Allison
- Department of Family Medicine, University of California San Diego, La Jolla, California, United States of America
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Wang JS, Xia PF, Ma MN, Li Y, Geng TT, Zhang YB, Tu ZZ, Jiang L, Zhou LR, Zhang BF, Tong WW, Shan Z, Liu G, Yang K, Pan A. Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018. JAMA Netw Open 2023; 6:e232145. [PMID: 36892842 PMCID: PMC9999245 DOI: 10.1001/jamanetworkopen.2023.2145] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
IMPORTANCE Improved understanding of trends in the proportion of individuals with metabolically healthy obesity (MHO) may facilitate stratification and management of obesity and inform policy efforts. OBJECTIVES To characterize trends in the prevalence of MHO among US adults with obesity, overall and by sociodemographic subgroups. DESIGN, SETTING, AND PARTICIPANTS This survey study included 20 430 adult participants from 10 National Health and Nutrition Examination Survey (NHANES) cycles between 1999-2000 and 2017-2018. The NHANES is a series of cross-sectional and nationally representative surveys of the US population conducted continuously in 2-year cycles. Data were analyzed from November 2021 to August 2022. EXPOSURES National Health and Nutrition Examination Survey cycles from 1999-2000 to 2017-2018. MAIN OUTCOMES AND MEASURES Metabolically healthy obesity was defined as a body mass index of 30.0 (calculated as weight in kilograms divided by height in meters squared) without any metabolic disorders in blood pressure, fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), or triglycerides based on established cutoffs. Trends in the age-standardized prevalence of MHO were estimated using logistic regression analysis. RESULTS This study included 20 430 participants. Their weighted mean (SE) age was 47.1 (0.2) years; 50.8% were women, and 68.8% self-reported their race and ethnicity as non-Hispanic White. The age-standardized prevalence (95% CI) of MHO increased from 3.2% (2.6%-3.8%) in the 1999-2002 cycles to 6.6% (5.3%-7.9%) in the 2015-2018 cycles (P < .001 for trend). There were 7386 adults with obesity. Their weighted mean (SE) age was 48.0 (0.3) years, and 53.5% were women. The age-standardized proportion (95% CI) of MHO among these 7386 adults increased from 10.6% (8.8%-12.5%) in the 1999-2002 cycles to 15.0% (12.4%-17.6%) in the 2015-2018 cycles (P = .02 for trend). Substantial increases in the proportion of MHO were observed for adults aged 60 years or older, men, non-Hispanic White individuals, and those with higher income, private insurance, or class I obesity. In addition, there were significant decreases in the age-standardized prevalence (95% CI) of elevated triglycerides (from 44.9% [40.9%-48.9%] to 29.0% [25.7%-32.4%]; P < .001 for trend) and reduced HDL-C (from 51.1% [47.6%-54.6%] to 39.6% [36.3%-43.0%]; P = .006 for trend). There was also a significant increase in elevated FPG (from 49.7% [95% CI, 46.3%-53.0%] to 58.0% [54.8%-61.3%]; P < .001 for trend) but no significant change in elevated blood pressure (from 57.3% [53.9%-60.7%] to 54.0% [50.9%-57.1%]; P = .28 for trend). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that the age-standardized proportion of MHO increased among US adults from 1999 to 2018, but differences in trends existed across sociodemographic subgroups. Effective strategies are needed to improve metabolic health status and prevent obesity-related complications in adults with obesity.
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Affiliation(s)
- Jiang-Shui Wang
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Peng-Fei Xia
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Meng-Nan Ma
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yue Li
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ting-Ting Geng
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yan-Bo Zhang
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhou-Zheng Tu
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Limiao Jiang
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Li-Rong Zhou
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Bing-Fei Zhang
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Wen-Wei Tong
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Zhilei Shan
- Hubei Key Laboratory of Food Nutrition and Safety, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Gang Liu
- Hubei Key Laboratory of Food Nutrition and Safety, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Kun Yang
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - An Pan
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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22
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Wang ML, Narcisse MR, McElfish PA. Higher walkability associated with increased physical activity and reduced obesity among United States adults. Obesity (Silver Spring) 2023; 31:553-564. [PMID: 36504362 PMCID: PMC9877111 DOI: 10.1002/oby.23634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined associations among perceived neighborhood walkability, physical activity (PA), and obesity among United States adults. METHODS Data from the 2020 National Health Interview Survey were analyzed. Walkability was assessed using a summative scale and was categorized as low, medium, or high. PA was categorized as insufficient (0-149 min/wk) or sufficient (150+ min/wk). Multivariable regressions estimated an association between obesity and BMI and PA/walkability. Mediation analysis was used to partition contribution of PA as a mediator. Effect modification by race and ethnicity in the association between walkability and BMI was explored. RESULTS The sample included N = 31,568 adults. Compared with those in low-walkability neighborhoods, participants in high-walkability neighborhoods had increased odds of sufficient PA (odds ratio [OR] = 1.48; 95% CI: 1.30-1.69) and decreased obesity odds (OR = 0.76; 95% CI: 0.66-0.87). PA partially mediated the association between walkability and BMI (23.4%; 95% CI: 14.6%-62.7%). The association between walkability and BMI was modified by race and ethnicity (F[5,567] = 2.75; p = 0.018). Among White, Black, Hispanic, and Asian adults, BMI decreased with increasing walkability; among American Indian/Alaska Native and multiracial/other adults, BMI increased with increasing walkability. CONCLUSIONS The findings highlight the importance of investing in the built environment to improve perceptions of walkability and promote PA and healthy weight, as well as developing interventions to target racial and ethnic disparities in these outcomes.
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Affiliation(s)
- Monica L. Wang
- Boston University School of Public Health, Department of Community Health Sciences, 715 Albany St., Boston, MA 02118, USA
- Boston University Center for Antiracist Research, 1 Silber Way, Boston, MA 02215, USA
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Ave., Boston, MA 02115, USA
| | - Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48 St., Springdale, AR 72762, USA
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Molitor F, Kehl S. Disparities in Perceived Availability of Healthful Foods, Dietary Behaviors, Diet Quality, and Obesity Among Mothers from Low-Income Households: Additional Evidence in the Call for Broader Approaches to Obesity Prevention. Health Equity 2023; 7:235-242. [PMID: 37096054 PMCID: PMC10122250 DOI: 10.1089/heq.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
Purpose To examine racial/ethnic differences in dietary behaviors, diet quality, body mass, and the perceived availability of healthful foods in one's neighborhood among mothers from low-income California households. Methods Cross-sectional telephone surveys of mothers from randomly sampled households with incomes ≤185% federal poverty level in 2018 and 2019 using a validated 24-h dietary recall assessment. Dietary outcomes were cups of fruits and vegetables, ounces of sugar-sweetened beverages, teaspoons of added sugars, and kilocalories consumed the previous day. Diet quality was assessed by calculating Health Eating Index-2015 scores. Supplemental survey items assessed mothers' weight and height. Body mass index (BMI) was calculated with a BMI of 30 or higher considered obese. Perceived availability of fresh fruits and vegetables and healthy foods in general within one's neighborhood was recorded. Results The analytic sample of 9200 mothers was 66.3% Latina, 17.3% white, 12.6% African American, and 3.8% Asian American, Native Hawaiian, or Pacific Islander (AANHPI). African American mothers consumed the fewest cups of fruits and vegetables and the most teaspoons of added sugars, reported poor diet quality, and had the highest obesity rate, 54.7% versus 46.9% for Latinas, 39.9% for whites, and 23.5% for AANHPIs. Accordingly, a greater proportion of African Americans reported limited availability of fresh fruits and vegetables and healthy foods in general in their neighborhood. Conclusion Findings are interpreted in light of recent calls for broader approaches to address health disparities, including strategies that focus on inequalities in racial/ethnic socioeconomic status and systemic racism.
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Affiliation(s)
- Fred Molitor
- Department of Communication Studies, California State University Sacramento, Sacramento, California, USA
- Address correspondence to: Fred Molitor, PhD, Department of Communication Studies, California State University Sacramento, 6000 J Street, Sacramento, CA 95819-6088, USA.
| | - Sarah Kehl
- CalFresh Healthy Living Program, California Department of Social Services, Sacramento, California, USA
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Yang B, Yang J, Wong MMH, Rana J, Yang Q, Chan V, Khan MS, Yang A, Lo K. Trends in elevated waist-to-height ratio and waist circumference in U.S. adults and their associations with cardiometabolic diseases and cancer, 1999-2018. Front Nutr 2023; 10:1124468. [PMID: 37113294 PMCID: PMC10126508 DOI: 10.3389/fnut.2023.1124468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Although waist-to-height ratio (WHtR) has established association with cardiometabolic disease, the trend of changes in elevated WHtR among general population have not been examined adequately. Methods This study examined the prevalence of elevated WHtR and waist circumference (WC) and their trends over time using Joinpoint regression models among adults who participated in the United States National Health and Nutrition Examination Survey (U.S. NHANES) 1999-2018. We performed weighted logistic regression to identify the association between central obesity subtypes and the prevalence of comorbidities, including diabetes, chronic kidney disease, hypertension, cardiovascular disease, and cancer. Results The prevalence of elevated WHtR has increased from 74.8% in 1999-2000 to 82.7% in 2017-2018 while elevated WC also increased from 46.9% in 1999-2000 to 60.3% in 2017-2018. Men, older adults, former smokers, and people with lower education levels were more likely to have elevated WHtR. A total of 25.5% of American adults had normal WC but elevated WHtR, and they had a significantly higher chance of suffering from diabetes (odds ratio [OR] = 2.06 [1.66, 2.55]), hypertension (OR = 1.75 [1.58, 1.93]) and CVD (OR = 1.32 [1.11, 1.57]). Discussion In conclusion, the burden of elevated WHtR and WC have been increasing among U.S. adults throughout the years, and the changes have been more significant across most subgroups. It is also notable that approximately a quarter of the population had normal WC but elevated WHtR, which had increased likelihood of having cardiometabolic diseases, especially diabetes. Future clinical practices should pay more attention to this subgroup of the population with overlooked health risks.
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Affiliation(s)
- Bo Yang
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, United States
| | - Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, China
| | - Martin Ming-him Wong
- School of Professional and Continuing Education, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Juwel Rana
- Department of Epidemiology, Biostatistics and Occupational Health, School of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | - Qinghua Yang
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Vicky Chan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Moyukh Shabon Khan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Aimin Yang,
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Kenneth Lo,
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Kracht CL, Katzmarzyk PT, Champagne CM, Broyles ST, Hsia DS, Newton RL, Staiano AE. Association between Sleep, Sedentary Time, Physical Activity, and Adiposity in Adolescents: A Prospective Observational Study. Med Sci Sports Exerc 2023; 55:110-118. [PMID: 35977103 PMCID: PMC9771953 DOI: 10.1249/mss.0000000000003018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to examine the effects of substituting sedentary time with sleep or physical activity on adiposity in a longitudinal sample of adolescents. METHODS Adolescents (10-16 yr) were recruited for a prospective observational cohort. Parents and adolescents reported demographic characteristics and pubertal development. Accelerometry was used to measure sleep, physical activity, and sedentary time. Adiposity was quantified with imaging techniques. Isotemporal substitution modeling was conducted to examine the effect of substituting 10 min of sedentary time with sleep or differing intensities of physical activity. Results were stratified by sex and race and adjusted for covariates. RESULTS A total of 217 adolescents provided complete measures at both baseline and 2 yr later (58.1% White, 51.8% girls; 12.9 ± 1.9 yr at baseline). Sleep was negatively related to adiposity 2 yr later when considering other movement behaviors, but substituting baseline sedentary time with sleep was not related to future adiposity ( P > 0.05). In boys and non-White adolescents, substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity 2 yr later ( P < 0.05). Substituting sedentary time for moderate- to vigorous-intensity physical activity was not associated with future adiposity. CONCLUSIONS Substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity in later adolescence in certain groups. Opportunities to promote an adequate balance of sleep, sedentary time, and physical activity in all adolescents are encouraged for optimal development.
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Barré T, Carrat F, Ramier C, Fontaine H, Di Beo V, Bureau M, Dorival C, Larrey D, Delarocque-Astagneau E, Mathurin P, Marcellin F, Petrov-Sanchez V, Cagnot C, Carrieri P, Pol S, Protopopescu C, Alric L, Pomes C, Zoulim F, Maynard M, Bai R, Hucault L, Bailly F, Raffi F, Billaud E, Boutoille D, Lefebvre M, André-Garnier E, Cales P, Hubert I, Lannes A, Lunel F, Boursier J, Asselah T, Boyer N, Giuily N, Castelnau C, Scoazec G, Pol S, Fontaine H, Rousseaud E, Vallet-Pichard A, Sogni P, de Ledinghen V, Foucher J, Hiriart JB, M’Bouyou J, Irlès-Depé M, Bourlière M, Ahmed SNS, Oules V, Tran A, Anty R, Gelsi E, Truchi R, Thabut D, Hammeche S, Moussali J, Causse X, De Dieuleveult B, Ouarani B, Labarrière D, Ganne N, Grando-Lemaire V, Nahon P, Brulé S, Ulker B, Guyader D, Jezequel C, Brener A, Laligant A, Rabot A, Renard I, Habersetzer F, Baumert TF, Doffoel M, Mutter C, Simo-Noumbissie P, Razi E, Bronowicki JP, Barraud H, Bensenane M, Nani A, Hassani-Nani S, Bernard MA, Pageaux GP, Larrey D, Meszaros M, Metivier S, Bureau C, Morales T, Peron JM, Robic MA, Decaens T, Faure M, Froissart B, Hilleret MN, Zarski JP, Riachi G, Goria O, Paris F, Montialoux H, Leroy V, Amaddeo G, Varaut A, Simoes M, Amzal R, Chazouillières O, Andreani T, Angoulevant B, Chevance A, Serfaty L, Samuel D, Antonini T, Coilly A, Duclos-Vallée JC, Tateo M, Abergel A, Reymond M, Brigitte C, Benjamin B, Muti L, Geist C, Conroy G, Riffault R, Rosa I, Barrault C, Costes L, Hagège H, Loustaud-Ratti V, Carrier P, Debette-Gratien M, Mathurin P, Lassailly G, Lemaitre E, Canva V, Dharancy S, Louvet A, Minello A, Latournerie M, Bardou M, Mouillot T, D’Alteroche L, Barbereau D, Nicolas C, Elkrief L, Jaillais A, Gournay J, Chevalier C, Archambeaud I, Habes S, Portal I, Gelu-Simeon M, Saillard E, Lafrance MJ, Catherine L, Carrat F, Chau F, Dorival C, Goderel I, Lusivika-Nzinga C, Bellance MA, Bellet J, Monfalet P, Chane-Teng J, Bijaoui S, Pannetier G, Téoulé F, Nicol J, Sebal F, Bekhti R, Cagnot C, Boston A, Nailler L, Le Meut G, Diallo A, Petrov-Sanchez V, Bourlière M, Boursier J, Carrat F, Carrieri P, Delarocque-Astagneau E, De Ledinghen V, Dorival C, Fontaine H, Fourati S, Housset C, Larrey D, Nahon P, Pageaux GP, Petrov-Sanchez V, Pol S, Bruyand M, Wittkop L, Zoulim F, Zucman-Rossi J, L’hennaff M, Sizorn M, Cagnot C. Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: results from the ANRS CO22 Hepather cohort. J Cannabis Res 2022; 4:31. [PMID: 35690798 PMCID: PMC9188079 DOI: 10.1186/s42238-022-00138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patients with chronic hepatitis C virus (HCV) infection are at greater risk of developing metabolic disorders. Obesity is a major risk factor for these disorders, and therefore, managing body weight is crucial. Cannabis use, which is common in these patients, has been associated with lower corpulence in various populations. However, this relationship has not yet been studied in persons with chronic HCV infection. Methods Using baseline data from the French ANRS CO22 Hepather cohort, we used binary logistic and multinomial logistic regression models to test for an inverse relationship between cannabis use (former/current) and (i) central obesity (i.e., large waist circumference) and (ii) overweight and obesity (i.e., elevated body mass index (BMI)) in patients from the cohort who had chronic HCV infection. We also tested for relationships between cannabis use and both waist circumference and BMI as continuous variables, using linear regression models. Results Among the 6348 participants in the study population, 55% had central obesity, 13.7% had obesity according to their BMI, and 12.4% were current cannabis users. After multivariable adjustment, current cannabis use was associated with lower risk of central obesity (adjusted odds ratio, aOR [95% confidence interval, CI]: 0.45 [0.37–0.55]), BMI-based obesity (adjusted relative risk ratio (aRRR) [95% CI]: 0.27 [0.19–0.39]), and overweight (aRRR [95% CI]: 0.47 [0.38–0.59]). This was also true for former use, but to a lesser extent. Former and current cannabis use were inversely associated with waist circumference and BMI. Conclusions We found that former and, to a greater extent, current cannabis use were consistently associated with smaller waist circumference, lower BMI, and lower risks of overweight, obesity, and central obesity in patients with chronic HCV infection. Longitudinal studies are needed to confirm these relationships and to assess the effect of cannabis use on corpulence and liver outcomes after HCV cure. Trial registration ClinicalTrials.gov identifier: NCT01953458.
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Sanchez-Johnsen L, Dykema-Engblade A, Rosas CE, Calderon L, Rademaker A, Nava M, Hassan C. Mexican and Puerto Rican Men's Preferences Regarding a Healthy Eating, Physical Activity and Body Image Intervention. Nutrients 2022; 14:4634. [PMID: 36364897 PMCID: PMC9654900 DOI: 10.3390/nu14214634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 01/28/2024] Open
Abstract
This study examined the logistical, practical, and cultural preferences of Latinos regarding the design of a healthy eating, physical activity, and body image intervention. Puerto Rican and Mexican men (n = 203) completed an interview as part of an NIH-funded study. Overall, 66.5% preferred the intervention to be in Spanish only or both Spanish and English; 88.67% said it was moderately, very or extremely important for the intervention leader to be bilingual; and 66.01% considered it moderately to extremely important for the leader to be Hispanic or Latino. Most participants (83.74%) reported they would be willing to attend an intervention that met twice per week and 74.38% said they would be willing to attend an intervention that met for 1.5 to 2 h, twice weekly. Overall, the majority said they would be moderately to extremely interested in attending an exercise program if it consisted of aerobics with Latin or salsa movements (74.88%) and if it consisted of aerobics with Latin or salsa music (70.44%). Some participants were moderately to extremely interested in attending an intervention if it included dichos (Latino sayings) (65.02%) and cuentos (folktales or stories) (69.46%). The findings have implications for lifestyle and body image interventions aimed at preventing cardiometabolic diseases.
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Affiliation(s)
- Lisa Sanchez-Johnsen
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 West Jackson Blvd, Suite 302, Chicago, IL 60612, USA
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St., Chicago, IL 60607, USA
| | - Amanda Dykema-Engblade
- Department of Psychology, Northeastern Illinois University, 5500 North St. Louis Ave, Chicago, IL 60625, USA
| | - Carlos E. Rosas
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 West Jackson Blvd, Suite 302, Chicago, IL 60612, USA
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St., Chicago, IL 60607, USA
| | - Leonilda Calderon
- Puerto Rican Cultural Center, 2628 W. Division St., Chicago, IL 60612, USA
| | - Alfred Rademaker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite #1400, Chicago, IL 60611, USA
| | - Magdalena Nava
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Suite #1100, Chicago, IL 60601, USA
| | - Chandra Hassan
- Department of Surgery, University of Illinois at Chicago, 840 South Wood Street (MC 958), Chicago, IL 60612, USA
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Gonzalez-Nahm S, Marchesoni J, Maity A, Maguire RL, House JS, Tucker R, Atkinson T, Murphy SK, Hoyo C. Maternal Mediterranean Diet Adherence and Its Associations with Maternal Prenatal Stressors and Child Growth. Curr Dev Nutr 2022; 6:nzac146. [PMID: 36406812 PMCID: PMC9665863 DOI: 10.1093/cdn/nzac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background Psychosocial and physiologic stressors, such as depression and obesity, during pregnancy can have negative consequences, such as increased systemic inflammation, contributing to chronic disease for both mothers and their unborn children. These conditions disproportionately affect racial/ethnic minorities. The effects of recommended dietary patterns in mitigating the effects of these stressors remain understudied. Objectives We aimed to evaluate the relations between maternal Mediterranean diet adherence (MDA) and maternal and offspring outcomes during the first decade of life in African Americans, Hispanics, and Whites. Methods This study included 929 mother-child dyads from the NEST (Newborn Epigenetics STudy), a prospective cohort study. FFQs were used to estimate MDA in pregnant women. Weight and height were measured in children between birth and age 8 y. Multivariable linear regression models were used to examine associations between maternal MDA, inflammatory cytokines, and pregnancy and postnatal outcomes. Results More than 55% of White women reported high MDA during the periconceptional period compared with 22% of Hispanic and 18% of African American women (P < 0.05). Higher MDA was associated with lower likelihood of depressive mood (β = -0.45; 95% CI: -0.90, -0.18; P = 0.02) and prepregnancy obesity (β = -0.29; 95% CI: -0.57, -0.0002; P = 0.05). Higher MDA was also associated with lower body size at birth, which was maintained to ages 3-5 and 6-8 y-this association was most apparent in White children (3-5 y: β = -2.9, P = 0.02; 6-8 y: β = -3.99, P = 0.01). Conclusions If replicated in larger studies, our data suggest that MDA provides a potent avenue by which effects of prenatal stressors on maternal and fetal outcomes can be mitigated to reduce ethnic disparities in childhood obesity.
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Affiliation(s)
- Sarah Gonzalez-Nahm
- Department of Nutrition, University of Massachusetts Amherst, Amherst, MA, USA
| | - Joddy Marchesoni
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Arnab Maity
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Rachel L Maguire
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - John S House
- National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Rachel Tucker
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Tamara Atkinson
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
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Cuda S, Censani M, Kharofa R, Williams DR, O'Hara V, Karjoo S, Paisley J, Browne NT. Social consequences and genetics for the child with overweight and obesity: An obesity medicine association (OMA) clinical practice statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100032. [PMID: 37990726 PMCID: PMC10662046 DOI: 10.1016/j.obpill.2022.100032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) clinical practice statement (CPS) covers two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA clinical practice statement details two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. Conclusions This OMA clinical practice statement on genetics and social consequences for the child with overweight and obesity is an overview of current literature. The literature provides a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145 San Antonio, TX, 78218, USA
| | - Marisa Censani
- Associate Professor of Clinical Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of MedicineCenter for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F Columbus, OH, 43215, USA
| | - Valerie O'Hara
- Medical Director, WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology, 501 6th Ave S, St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
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Raufi А, Konstantinova MK. Prevalence of Overweight and Obesity in Children: Variation in Different Ethnicities, Age, and Sex in North Macedonia. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:23-31. [PMID: 35843913 DOI: 10.2478/prilozi-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Childhood obesity is assuredly one of the most important health challenges of the 21st century, particularly regarding long-term metabolic complications. In the last four decades, there has been a tenfold increase in childhood and adolescence obesity. This cross-sectional study aimed to show the prevalence of overweight and obesity compared by age, sex, and ethnicity in n=1034 healthy male and female children, aged 6-13 years in North Macedonia. Out of the total 1034 children included in the study, 589 (57.0%) were observed with normal weight, 202 (19.5%) children were obese, 140 (13.5%) children were overweight and, 103 (10.0%) children underweight. The study presents an insight that 33% of primary school children are at >85th percentile overweight; or at ≥95th percentile with increased weight due to obesity. The data show that boys have a higher prevalence of obesity and overweight with 37.1%, compared to girls with 29.1%. Also, all age groups demonstrate an exponential increase of the prevalence of overweight: in 6-7 years (5.8%); 8-9 years (12%); 10-11 years (15%); and, 12-13 years old with 19.5%. A jump of prevalence of overweight and obesity between the age groups of 6-7 years, and 8-9 years was observed (17.9% to 25.4% obese and 5.8% to 12.0% overweight). The onset of puberty may be the possible cause. According to the Global Atlas of Childhood Obesity, North Macedonia is graded with a risk index of 7/11; i.e. it is expected that in the next decade until 2030 the obesity rate will rise to 52.5% for children aged 5-19 years old. It is with utmost importance to emphasize that continuous monitoring of children's nutritional status and their risk of obesity is essential, as to further prevent obesity and overweight in the pediatric population.
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Affiliation(s)
- Аrjeta Raufi
- Children's Department, Clinical Hospital in Tetovo, RN Macedonia
| | - Marina Krstevska Konstantinova
- Department of Endocrinology and Genetics, University Children's Hospital, Faculty of Medicine, St's. Cyril and Methodius University in Skopje, RN Macedonia
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Multimorbidity patterns across race/ethnicity as stratified by age and obesity. Sci Rep 2022; 12:9716. [PMID: 35690677 PMCID: PMC9188579 DOI: 10.1038/s41598-022-13733-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of our study is to assess differences in prevalence of multimorbidity by race/ethnicity. We applied the FP-growth algorithm on middle-aged and elderly cohorts stratified by race/ethnicity, age, and obesity level. We used 2016–2017 data from the Cerner HealthFacts electronic health record data warehouse. We identified disease combinations that are shared by all races/ethnicities, those shared by some, and those that are unique to one group for each age/obesity level. Our findings demonstrate that even after stratifying by age and obesity, there are differences in multimorbidity prevalence across races/ethnicities. There are multimorbidity combinations distinct to some racial groups—many of which are understudied. Some multimorbidities are shared by some but not all races/ethnicities. African Americans presented with the most distinct multimorbidities at an earlier age. The identification of prevalent multimorbidity combinations amongst subpopulations provides information specific to their unique clinical needs.
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Oh M, Jacobs DR, Gabriel KP, Bao W, Pierce GL, Carr LJ, Ding J, Whitaker KM. Cross-Sectional and Longitudinal Associations of Lifestyle Behaviors with Pericardial Adipose Tissue: The MESA Study. Med Sci Sports Exerc 2022; 54:984-993. [PMID: 35576135 PMCID: PMC9139422 DOI: 10.1249/mss.0000000000002866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE We examined associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) with pericardial adipose tissue (PAT). METHODS Adults from the Multi-Ethnic Study of Atherosclerosis were included from exam years 1 (2000-2002; N = 6057; mean age, 62.2 yr; 52.9% female, 38.0% White; 12.8% Chinese American, 26.7% African American, 22.5% Hispanic American), 2 (2002-2004), and 3 (2004-2005). Weekly volume of SB, LPA, and MVPA (in MET-hours per week) was reported using a questionnaire. PAT volume (in cubic centimeters) was quantified using computed tomography, analysis of covariance, and repeated-measures linear mixed models with adjustment for covariates (sociodemographics, cardiovascular disease risk factors, inflammation, waist circumference) tested cross-sectional and longitudinal associations, respectively. RESULTS In cross-sectional analysis, the highest tertile of SB (β = 2.71; 95% confidence interval (CI), 0.69 to 4.73; P < 0.01) and the middle tertile of MVPA (β = -1.97; 95% CI, -3.92 to -0.02; P < 0.05) were associated with PAT, whereas no association was observed for LPA in fully adjusted models. In longitudinal models, SB, LPA, and MVPA were not associated with PAT in the full study sample; however, LPA was inversely associated with PAT among Whites in stratified analysis (β = -0.54; 95% CI, -0.95 to -0.13; P < 0.05). CONCLUSIONS Lower SB and higher LPA (among Whites only) and MVPA may be associated with lower PAT, but additional longitudinal research is needed.
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Affiliation(s)
- Minsuk Oh
- Department of Public Health, Baylor University, Waco,
TX
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University
of Minnesota, Minneapolis, MN
| | | | - Wei Bao
- Department of Epidemiology, University of Iowa, Iowa City,
IA
| | - Gary L. Pierce
- Department of Health and Human Physiology, University of
Iowa, Iowa City, IA
| | - Lucas J. Carr
- Department of Health and Human Physiology, University of
Iowa, Iowa City, IA
| | - Jingzhong Ding
- Gerontology and Geriatric Medicine, Wake Forest School of
Medicine, Winston-Salem, NC
| | - Kara M. Whitaker
- Department of Epidemiology, University of Iowa, Iowa City,
IA
- Department of Health and Human Physiology, University of
Iowa, Iowa City, IA
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Moreno JP, Musaad S, Dadabhoy H, Baranowski T, Crowley SJ, Thompson D, Chen TA, Johnston CA. Seasonality of Children’s Height and Weight and Their Contribution to Accelerated Summer Weight Gain. Front Physiol 2022; 13:793999. [PMID: 35665226 PMCID: PMC9159375 DOI: 10.3389/fphys.2022.793999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: While children have been shown to have increased BMI during the summer compared to the school year, it is not known if this may be due to seasonal variations in height or weight separately. Methods: Trained nurses measured heights (cm) and weights (kg) in a cohort of Kindergarteners (n = 7648) twice per year from the beginning of kindergarten through 5th grade. Variation in height and weight by season (school year vs. summer) was examined using separate mixed-effects models. Season, sex, and BMI trajectory group were tested as fixed effects. Random effects included repeated measurements of time, students nested within a school, intercept, and slope for growth over time. Similar models using BMIz as the outcome examined the interaction of height or weight with season. Results: The rate of height gain was greater during the school year (∼Sept to April) compared to summer (∼April to Sept) (β = -0.05, SE = 0.013, p < 0.0001). The rate of weight gain did not differ seasonally. Height gain was more strongly associated with increased BMIz during summer compared to the school year (β =.02, SE = 0.005, p <0 .0001), mainly among children who remained healthy weight throughout elementary school (β = 0.014, SE = 0.003, p < 0.0001) and those who transitioned to a healthier weight status (β = 0.026, SE = 0.008, p = 0.004). We found a similar seasonal effect for the association between weight with BMIz among children who maintained a healthy weight status (β = 0.014, SE = 0.014, p < 0.0001). Conclusion: This study indicates seasonality in children’s height gain, gaining height at a faster rate during the school year compared to the summer, while weight gain remained relatively more consistent throughout the year. Seasonality in height and weight gain had the greatest impact on BMIz among children with a healthy weight status. Future research with more frequent measurements is needed to better understand the seasonal regulation of children’s growth and weight gain.
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Affiliation(s)
- Jennette P. Moreno
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Pediatrics-Nutrition, Houston, TX, United States
- *Correspondence: Jennette P. Moreno,
| | - Salma Musaad
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Pediatrics-Nutrition, Houston, TX, United States
| | - Hafza Dadabhoy
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Pediatrics-Nutrition, Houston, TX, United States
| | - Tom Baranowski
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Pediatrics-Nutrition, Houston, TX, United States
| | - Stephanie J. Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Pediatrics-Nutrition, Houston, TX, United States
| | - Tzuan A. Chen
- HEALTH Research Institute, University of Houston, Houston, TX, United States
- Department of Psychological, Health, and Learning Science, University of Houston, Houston, TX, United States
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
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Dhillon J, Jacobs AG, Ortiz S, Diaz Rios LK. A Systematic Review of Literature on the Representation of Racial and Ethnic Minority Groups in Clinical Nutrition Interventions. Adv Nutr 2022; 13:1505-1528. [PMID: 35108358 PMCID: PMC9526835 DOI: 10.1093/advances/nmac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The racial and ethnic disparities in diet-related chronic diseases are major concerns. This systematic review examines the extent to which diet-induced changes in health outcomes, such as cardiometabolic, inflammation, cancer, bone health, and kidney function outcomes, etc., have been reported and discussed by race or ethnicity in randomized trials with 2 or more diet arms that recruited both minority and non-Hispanic White groups. Databases (i.e., PubMed, Cochrane Library, and Web of Science) were searched up to August 2021. Thirty-four studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group compared with non-Hispanic Whites were included in the systematic review (PROSPERO registration number: CRD42021229256). Acute trials and those with 1 diet arm that accounted for race or ethnicity in their analyses and studies that focused on a single racial or ethnic group were discussed separately. Most studies were conducted in Black compared with White adults testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black adults compared with Whites particularly with DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability. Overall risk of bias was low. With emerging precision nutrition initiatives that aim to optimize metabolic responses in population subgroups through tailored approaches, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing health disparities. Factors that help explain variability in responses such as socioecological context should be included and adequately powered. Given the racial and ethnic disparities in chronic diseases, studying the adoption, maintenance, and effectiveness of dietary interventions on health outcomes among different groups is critical for developing approaches that can mitigate diet-related health disparities.
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Affiliation(s)
| | | | - Sigry Ortiz
- Department of Molecular & Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, USA
| | - L Karina Diaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA, USA
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Ramírez AS, Wilson MD, Miller LMS. Segmented assimilation as a mechanism to explain the dietary acculturation paradox. Appetite 2022; 169:105820. [PMID: 34843752 PMCID: PMC8944242 DOI: 10.1016/j.appet.2021.105820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 02/03/2023]
Abstract
Latinos have disproportionately high rates of diet-related diseases which are associated with acculturation to the U.S. This negative shift in dietary quality is paradoxical in light of gains in income and education that would be expected to lead to better diet. We examined the extent to which the dietary acculturation paradox among Mexican Americans can be explained by segmented assimilation, a theory that considers how immigrants' and their descendants' trajectories of integration are influenced by a complex interplay of individual, social, and structural factors. First, we performed confirmatory cluster analysis to identify three assimilation segments (classic, underclass, and selective) based on education, income, and an acculturation proxy derived from language, nativity, and time in the U.S. among Mexican-origin participants (N = 4475) of the 2007-2016 National Health and Nutrition Examination Survey (NHANES). These segments were then used as independent variables in linear regression models to estimate the relationship between cluster and dietary quality (assessed by the Health Eating Index (HEI)) and the interaction between cluster and gender, controlling for marital status. There were strong effects of cluster on dietary quality, consistent with hypotheses per segmented assimilation theory. The classic assimilation segment had the poorest diet, despite having higher income and education than the underclass segment. The selective segment had higher or similar dietary quality to the underclass segment. Consistent with expectations, this difference was driven by the relatively higher consumption of greens and beans and whole grains of those in the selective and underclass segments. Overall, women had better diets than men; however, the strongest gender contrast was in the underclass segment. This study advances understanding of dietary acculturation and potential disparities in diet-related health outcomes.
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Affiliation(s)
- A. Susana Ramírez
- Department of Public Health, University of California, 5200 North Lake Road, Merced, CA, 95340, USA.,Corresponding author:
| | - Machelle D. Wilson
- Department of Public Health Sciences, University of California, One Shields Avenue, Davis, CA, 95616, USA
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Nyrop KA, O'Hare EA, Teal R, Stein K, Muss HB, Charlot M. Person-centered communication about weight and weight management: Focus group discussions in a diverse sample of women with nonmetastatic breast cancer and obesity. Cancer 2021; 127:4266-4276. [PMID: 34374079 PMCID: PMC9907558 DOI: 10.1002/cncr.33843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women with obesity are at higher risk for high-grade and/or advanced-stage breast cancer in comparison with women without obesity. Many women with a high body mass index (BMI) at breast cancer diagnosis experience further weight gain during and after treatment. This study investigated Black and White patient perspectives on conversations with their oncologists about weight and weight management. METHODS Focus groups using a virtual platform (Zoom) were conducted with women after primary treatment for stage I to III breast cancer who were 21 years or older and had a BMI ≥ 30 kg/m2 : 2 with Black women (n = 12) and 2 with White women (n = 14). RESULTS Participants asked that their oncologists be "transparent" about weight gain as a potential side effect of their cancer treatment and how excess weight might affect their prognosis and survival. They asked to be "seen as an individual" to facilitate both person-centered and culturally appropriate conversations about behavioral changes needed for weight management. Participants urged clinicians to take the lead in initiating conversations about weight to underscore its importance in cancer care and survivorship. They welcomed actionable recommendations about nutrition and exercise from either the oncology clinician or a specialist. Participants offered specific suggestions on how clinicians could initiate weight-related conversations, beginning with questions eliciting patients' perspectives on their weight and lifestyle. CONCLUSIONS Many women with early-stage breast cancer and obesity have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management. LAY SUMMARY Focus group discussions with Black and White women with early-stage breast cancer and obesity have elicited patient perspectives on conversations with their oncologists about weight and weight management. Many patients have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin A O'Hare
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Stein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marjory Charlot
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Manjunath C, Jenkins SM, Phelan S, Breitkopf CR, Hayes SN, Cooper LA, Patten CA, Brewer LC. Association of body image dissatisfaction, behavioral responses for healthy eating, and cardiovascular health in African-American women with overweight or obesity: A preliminary study. Am J Prev Cardiol 2021; 8:100254. [PMID: 34632436 PMCID: PMC8487888 DOI: 10.1016/j.ajpc.2021.100254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African-American (AA) women have the lowest prevalence of ideal categorizations of diet and body mass index (BMI), as defined by the American Heart Association (AHA) Life's Simple 7 (LS7) cardiovascular health (CVH) components compared to other racial/ethnic groups, regardless of sex/gender. There is limited research exploring the interplay of unique psychosocial influences on CVH such as body image dissatisfaction (BID) and behavioral responses for healthy eating among AA women with overweight or obesity. OBJECTIVE This study aimed to assess the association of BID with behavioral responses for healthy eating and LS7 components. METHODS A cross-sectional analysis of baseline data was conducted among 32 AA women with overweight or obesity from a larger, community-based participatory research study. Self-reported measures were used to assess BID and behavioral responses to healthy eating (diet self-regulation to reduce fat or caloric intake and motivation for healthy eating [intrinsic motivation and integrated regulation]) using previously validated instruments. The LS7 components (e.g., BMI, diet, etc.) and composite score were evaluated using the AHA LS7 metrics rubric. RESULTS Women with no or lower BID had greater diet self-regulation to reduce fat or caloric intake (mean, 3.5 vs 3.0; P=.05), intrinsic motivation for healthy eating (mean, 5.3 vs 4.2; P=.01), and integrated regulation for healthy eating (mean, 5.3 vs 3.7; P=.002) than those with higher BID. These significant differences remained after adjustment for BMI. Women with higher BID had a higher proportion of BMI within the obesity range compared with those with no or lower BID (94.4% vs 57.1%, P=.03). BID was not significantly associated with other LS7 components or composite score. CONCLUSION BID and other psychosocial influences for healthy eating are potential targets for culturally tailored lifestyle interventions among AA women.
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Key Words
- AA, African-American
- AHA, American Heart Association
- African-American women
- BID, body image dissatisfaction;, BMI, body mass index
- Body image dissatisfaction
- CVD, cardiovascular disease
- CVH, cardiovascular health;, FAITH!, Fostering African-American Improvement in Total Health
- Cardiovascular health
- Healthy eating
- LS7, Life's simple 7
- Obesity
- SCT, Social Cognitive Theory
- SDT, Self-Determination Theory
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Affiliation(s)
- Chandrika Manjunath
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sarah M. Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Sean Phelan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | | | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Lisa A. Cooper
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States,Corresponding author at: Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
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