The relationship between fat distribution and diabetes in US adults by race/ethnicity.

Introduction: This study examined the relationship between fat distribution and diabetes by sex-specific racial/ethnic groups. Methods: A secondary data analysis of National Health and Nutrition Examination Survey 2011-2018 data (n = 11,972) was completed. Key variables examined were visceral adipose tissue area (VATA), subcutaneous fat area (SFA), diabetes prevalence, and race/ethnicity. The association of VATA and SFA and diabetes prevalence was examined separately and simultaneously using multiple logistic regression. Bonferroni corrections were applied to all multiple comparisons between racial/ethnic groups. All analyses were adjusted for demographics and muscle mass. Results: VATA was positively associated with diabetes in both sexes (p < 0.001) and across all racial/ethnic groups (p < 0.05) except Black females. No statistically significant relationships were observed between SFA and diabetes while accounting for VATA with the exception of White females (p = 0.032). When comparing racial/ethnic groups, the relationship between VATA and diabetes was stronger in White and Hispanic females than in Black females (p < 0.005) while the relationship between SFA and diabetes did not differ between any racial/ethnic groups. Conclusion: This study found that VATA is associated with diabetes for both sexes across almost all racial/ethnic groups independent of SFA whereas the only significant relationship between SFA and diabetes, independent of VATA, was observed in White females. The findings indicated that visceral fat was more strongly associated with diabetes than subcutaneous. Additionally, there are health disparities in sex-specific racial/ethnic groups thus further study is warranted.

A cross-sectional study of the relationship between physical activity, diet quality, and high-sensitivity C-reactive protein in US adults.

BACKGROUND AND AIMS: High-sensitivity C-reactive protein (hs-CRP) is associated with many diseases, especially cardiovascular disease (CVD). Research into the independent and integrated relationships of physical activity and diet quality with hs-CRP across sex-specific cohorts is lacking. METHODS AND RESULTS: National Health and Nutrition Examination Survey data (2015-2018) was used to examine the relationship between physical activity and diet quality with hs-CRP and hs-CRP classified CVD risk using multiple multinormal logistic regression adjusted for covariates including demographics. Physical activity was measured using a self-reported survey and further categorized to those who met (MPAR) or did not meet (NPAR) national recommendations. Diet quality was measured using the Healthy Eating Index-2015, and further categorized to higher (HDQ) and lower (LDQ) diet quality. hs-CRP was also categorized as low, average, and high CVD risk using established cut-points. Physical activity was inversely related to hs-CRP in males (p < 0.001) whereas diet quality was inversely related to hs-CRP in females (p = 0.031). Compared to those with NPAR and LDQ, the hs-CRP for males with NPAR and HDQ and females with MPAR and HDQ was 1.18 mg/L and 0.75 mg/L lower respectively. Although, diet quality was inversely associated with high CVD risk in both sexes (p < 0.05), the lowest proportion of high and average CVD risk was observed in males and females with MPAR and HDQ. CONCLUSION: Physical activity and diet-quality lowered CVD risk regardless of sex. However, the independent effects of physical activity and diet quality on hs-CPR differs between sexes.

The Facilitators and Barriers to Digital Health for Managing Nutrition in People With Parkinson's Disease and Their Caregivers: A Formative, Qualitative Study.

OBJECTIVE: Identify techniques to assist in designing digital health platforms for nutrition services for people with Parkinson's disease and caregivers to improve their quality of life. DESIGN: Semistructured, dyadic interviews with 20 dyads (20 people with Parkinson's disease and 20 caregivers). SETTING: Home visits were conducted in the northeast US. PARTICIPANTS: People with Parkinson's disease and their caregivers were recruited via email, flyers, news articles and announcements at support groups. PHENOMENON OF INTEREST: Identification of facilitators and barriers to using digital health platforms to inform future digital nutrition services. ANALYSIS: Interviews were recorded, transcribed and double-coded using a framework analysis method. RESULTS: Reported digital health platforms utilization facilitators were: knowledge acquisition, convenience, intention to use, socializing, enjoyment, and forced adoption. Barriers included: negative feelings toward technology, lack of access or knowledge, disinterest, product design, frustration and functional reliability, and applying health information. CONCLUSIONS AND IMPLICATIONS: Although dyads often lack knowledge on both how to use technology and nutrition, they are willing to use digital health platforms to increase their nutrition knowledge if platforms are convenient. Based on the identified facilitators and barriers, the added benefits of access and training nutrition digital health platforms must be clearly communicated to end-users to improve their quality of life.

The Sex and Race/Ethnicity-Specific Relationships of Abdominal Fat Distribution and Anthropometric Indices in US Adults.

The purpose of this study was to examine demographic-specific relationships between direct abdominal fat measures and anthropometric indices. A cross-sectional study was conducted utilizing abdominal fat measures (visceral fat area, VFA; visceral to subcutaneous adipose area ratio, VSR) and anthropometrics (body mass index, BMI; waist circumference, WC) data from the 2011-2018 National Health and Nutrition Examination Survey. Linear or polynomial linear regression models were used to examine the relationships of abdominal fat measures to anthropometrics with adjustment for demographics. The results revealed that while VFA was linearly related to BMI and WC across all demographics (p < 0.001), the relationships between VSR and both BMI and WC were concave in men and convex in women. The relationships between VFA, VSR, and BMI, WC varied by sex and race/ethnicity. In conclusion, increasing BMI and WC were linearly associated with increased VFA, but their relationships with VSR were nonlinear and differed by sex.

The Demographic Specific Abdominal Fat Composition and Distribution Trends in US Adults from 2011 to 2018.

Despite the rising awareness of abdominal adiposity associated health problems and demographic health disparities, research is lacking about abdominal fat trends using a national representative sample of US adults. Our purpose was to examine national demographic specific abdominal fat composition and distribution trends from 2011 to 2018. This trend analysis was using National Health and Nutrition Examination Survey data (n = 13,163). Visceral adipose percent (VAT%), visceral adipose tissue area (VAA) and visceral to subcutaneous adipose area ratio (VSR) were utilized in data analyses. Multiple polynomial linear regression was utilized with adjustment for confounding variables. Our findings revealed that VAT%, VAA and VSR trends were concave among all demographic groups. The VAT%, VAA and/or VSR changes were observed in most demographic groups (p < 0.05) except younger, White and Black respondents. The pattern was consistent with biennial increases up to 2014 or 2016 followed by decreases in 2017-2018. There were demographic disparities, with middle-aged respondents and Hispanics having the most evident VAT%, VSR and/or VAA changes biennially when compared to their counterparts (p < 0.05). In conclusion, abdominal fat composition and distribution increased before 2014 or 2016 but decreased afterwards with variations by age and/or race/ethnicity. Further research is needed to explore the possible causes of abdominal fat changes overtime.

Diet Quality and Nutrition Concerns of People with Parkinson's Disease and Their Informal Caregivers: A Mixed Methods Study.

Limited research exists regarding the diet quality and nutritional concerns of people with Parkinson's disease (PwPD) and their informal caregivers. The study's purpose was to assess diet quality via the Healthy Eating Index-2015 (HEI-2015) and self-reported nutrition concerns via semi-structured, dyadic interviews of 20 PwPD (69.7 ± 9.2 yrs) and their caregivers (66.7 ± 13.0 yrs). HEI-2015 scores were 58.3 ± 12.4 and 58.1 ± 10.6 for PwPD and caregivers, respectively. Reported dietary concerns related to PD included: change in appetite or amount eaten, gastrointestinal issues, food-medication management, chewing/swallowing issues, and change in taste/smell. The poor diet quality and nutrition concerns identified suggest nutrition professionals and caregivers are critical on the healthcare team to promote optimal health among PwPD. Future research should address overall and specific aspects of diet quality, and nutritional concerns identified by dyads in this study, such as gastrointestinal issues and food-medication management.

Acceptance and perception of digital health for managing nutrition in people with Parkinson's disease and their caregivers and their digital competence in the United States: A mixed-methods study.

BACKGROUND AND AIMS: This mixed-methods study examined participants' acceptance and perception of using digital health for managing nutrition and participants' digital competence. The results will be formative for making digital nutrition education more effective and acceptable for people with Parkinson's disease (PwPD) and their informal caregivers. METHODS: Qualitative data were collected through in-person semi-structured, dyadic interviews, and questionnaires from 20 dyads (20 PwPD and their caregivers) in the Northeastern United States and analyzed throughout the 2018 to 2019 academic year. Interview transcripts were deductively coded using the framework analysis method. Phrases related to acceptance of digital health were sub-coded into accept, neutral, or reject and those related to perceptions of digital health were sub-coded into perceived usefulness, perceived ease of use, and awareness of digital health. Quantitative data were analyzed using independent samples t tests and Fisher's exact tests. Qualitative codes were transformed into variables and compared to digital competence scores to integrate the data. An average acceptance rate for digital health was calculated through examining the mean percent of phrases coded as accept from interview transcripts. RESULTS: Twenty-five of 40 (62.5%) participants used the internet for at least 5 health-related purposes and the average acceptance rate was 54.4%. Dyads rejected digital health devices if they did not see the added benefit. The majority of participants reported digital health to be useful, but hard to use, and about half felt they needed education about existing digital health platforms. There was no difference in digital competence scores between PwPD and their caregivers (28.6 ± 12.6). CONCLUSION: Findings suggest that dyads accept and use technology but not to its full potential as technology can be perceived as hard to use. This finding, combined with digital competence scores, revealed that education is warranted prior to providing a digital nutrition intervention.

Maternal Blood Pressure in Relation to Prenatal Lipid-Based Nutrient Supplementation and Adverse Birth Outcomes in a Ghanaian Cohort: A Randomized Controlled Trial and Cohort Analysis.

BACKGROUND: It is unknown whether prenatal lipid-based nutrient supplements (LNSs) affect blood pressure (BP). Associations between hypertension and birth outcomes using recently updated BP cutoffs are undetermined. OBJECTIVES: We aimed to assess the impact of LNSs on maternal hypertension and associations between hypertension and birth outcomes. METHODS: Pregnant Ghanaian women at ≤20 weeks of gestation (n = 1320) were randomly assigned to receive daily 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNSs until delivery. BP was measured at enrollment and 36 weeks of gestation. We analyzed the effect of LNSs on BP using ANOVA and associations between hypertension [systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) ≥80 mm Hg] and birth outcomes by linear and logistic regressions. RESULTS: Mean ± SD SBP and DBP were 110 ± 11 and 63 ± 8 mm Hg at 36 weeks of gestation and did not differ by supplementation group (SBP, P > 0.05; DBP, P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter gestation; women with high DBP had greater risk of low birth weight (LBW) [risk ratio (RR): 2.58; 95% CI: 1.09, 6.08] and preterm birth (PTB) (RR: 3.30; 95% CI: 1.47, 7.40). At 36 weeks of gestation, higher SBP was associated with lower birth weight, length, and head circumference and shorter gestation; higher DBP was associated with lower birth weight and length; and women with high DBP had greater risk of LBW (RR: 3.39; 95% CI: 1.32, 8.69). Neither high SBP nor hypertension were associated with birth outcomes at either time point. CONCLUSIONS: Daily provision of LNSs does not affect maternal hypertension, compared with IFA and MMN. Higher SBP and DBP are associated with a shorter gestation and smaller birth size; however, only high DBP is associated with LBW and PTB. The new BP cutoffs may help identify pregnancies at risk of adverse birth outcomes.This trial was registered at clinicaltrials.gov as NCT00970866.

The Relationships between Total Protein Intake, Protein Sources, Physical Activity, and Lean Mass in a Representative Sample of the US Adults.

BACKGROUND: Although dietary protein and physical activity play essential roles in developing and preserving lean mass, studies exploring these relationships are inconsistent, and large-scale studies on sources of protein and lean mass are lacking. Accordingly, the present study examined the relationship between total protein intake, protein sources, physical activity, and lean mass in a representative sample of US adults. METHODS: This cross-sectional study analyzed data from 2011-2016 US National Health and Nutrition Examination Survey and corresponding Food Patterns Equivalents Database (n = 7547). Multiple linear regression models were performed to examine the sex-specific associations between total protein intake, protein sources (Dairy, Total Protein Foods, Seafood, and Plant Proteins), physical activity, and lean mass adjusting for demographics, weight status, and total daily energy intake. RESULTS: Total protein intake was inversely related to lean mass in females only (Lean mass index: ß= -0.84, 95%CI: -1.06--0.62; Appendicular lean mass index: ß= -0.35, 95%CI: -0.48--0.22). However, protein sources and physical activity was positively associated with lean mass in males and/or females (p < 0.05). CONCLUSION: Study results suggest that consuming more protein daily had a detrimental influence on lean mass in females whereas eating high-quality sources of proteins and being physically active are important for lean mass for men and women. However, the importance of specific protein sources appears to differ by sex and warrants further investigation.

Relationships of Physical Activity and Diet Quality with Body Composition and Fat Distribution in US Adults.

OBJECTIVE: This study aimed to investigate the relationships among physical activity (PA), diet quality, body composition, and fat distribution in a representative sample of US adults. METHODS: A cross-sectional analysis was conducted using publicly accessible data from the 2011 to 2016 National Health and Nutrition Examination Survey and the Food Patterns Equivalents Database (n = 7,423). Variables from the data sets were analyzed for this study, including PA, two 24-hour dietary recalls, and dual-energy x-ray absorptiometry outputs. RESULTS: For men, PA and diet quality were inversely associated with the percentage of body fat (ß = -0.0042, 95% CI: -0.0084 to -0.0001; ß = -0.28, 95% CI: -0.42 to -0.14) and fat mass index (ß = -0.0125, 95% CI: -0.0209 to -0.0041; ß = -0.56, 95% CI: -0.81 to -0.32); meeting the PA recommendation and having good diet quality provided an additive effect on body fat. A similar pattern was observed in women. Additionally, diet quality was inversely associated with all fat distribution measures in both sexes, whereas PA was positively associated with lean mass measures in men only. CONCLUSIONS: Increased PA and/or better diet quality were associated with reduced body fat, a healthier fat distribution, and increased lean mass. Further research examining how changes in PA or diet quality influence body composition and fat distribution in adults is warranted.

Temporal Association between Abdominal Weight Status and Healthy Aging: Findings from the 2011-2018 National Health and Aging Trends Study.

BACKGROUND/OBJECTIVES: The longitudinal effect of abdominal weight status (AWS) defined by waist circumference (WC) on healthy aging has not yet been comprehensively examined. Therefore, the purpose of the present study was to examine the temporal association between WC-defined AWS and a comprehensive assessment for healthy aging. SUBJECTS/METHODS: This study utilized data from 5211 respondents aged 65+ who participated in the National Health and Aging Trends Study from 2011 to 2018. Mixed effects regression models were used to examine the association between baseline AWS and the annual change rate in healthy aging score (HAS) via interaction terms (AWS*round) adjusting for confounding effects. Further multiple mixed models examined the relationship of AWS and HAS over an 8-year period. RESULTS: There were no annual change rate differences in HAS by baseline AWS, regardless of sex. However, males with abdominal obesity were more likely to have a lower HAS than males with normal AWS (ß = -0.20, 95% CI: -0.30, -0.10, p < 0.001) but no difference in HAS was observed between males with overweight and normal AWS. A similar pattern was observed among females. CONCLUSIONS: Study results indicate that AWS was associated with HAS but it did not modify annual HAS change rate over time.

Exploring the Provider-Level Socio-Demographic Determinants of Diet Quality of Preschool-Aged Children Attending Family Childcare Homes.

Since food preferences develop during early childhood and contribute to dietary patterns that can track into adulthood, it is critical to support healthy food environments in places where children spend significant amounts of time in, such as childcare. It is important to understand what factors influence the diet quality of children cared for in family childcare homes (FCCH). METHODS: This study used baseline data from a cluster-randomized trial in FCCH, Healthy Start/Comienzos Sanos. Surveys capturing providers' socio-demographic characteristics were completed. Food and beverage consumptions were estimated using the Dietary Observation in Childcare protocol, and diet quality was calculated using the Healthy Eating Index (HEI)-2015. Comparison of mean HEI scores by provider socio-demographic variables were completed using ANOVAs, followed by multiple linear regression models for significant variables. Post-hoc ANOVA models compared mean HEI-2015 sub-components by income and ethnicity. RESULTS: Significant differences in mean HEI-2015 scores were found for provider income level (less than $25,000, HEI: 64.8 vs. $25,001-$50,000: 62.9 vs. $75,001 or more: 56.2; p = 0.03), ethnicity (Non-Latinx: 56.6 vs. Latinx: 64.4; p = 0.002), language spoken outside of childcare (English: 58.6 vs. Spanish: 64.3, p = 0.005), and language spoken in childcare (English: 59.6 vs. Spanish: 64.4; p = 0.02). In linear regression models, a higher provider income ($75,001 or more) was negatively and significantly associated with the total HEI-2015 scores (ß = -9.8, SE = 3.7; p = 0.009) vs. lower income (less than $25,000). When entering provider income and ethnicity to the same model, adjusting for Child and Adult Food Program (CACFP), only ethnicity was significant, with Latinx being positively associated with total HEI-2015 scores vs. non-Latinx (ß = 6.5, SE = 2.4; p = 0.007). Statistically significant differences were found by ethnicity and language for greens/beans, total protein, and seafood and plant protein HEI-2015 component scores. DISCUSSION: Lower income, and Latinx providers cared-for children had higher diet quality in FCCH compared to the other providers. Future studies should better understand what specific foods contribute to each of the HEI-2015 components in order to better tailor trainings and interventions.

Communication With Family Child Care Providers and Feeding Preschool-Aged Children: Parental Perspectives.

OBJECTIVE: To describe parent communication about child nutrition-related topics with family child care providers (FCCPs). DESIGN: Five focus groups conducted from December, 2016 to July, 2017. PARTICIPANTS: Parents (n = 25) of 2- to 5-year-old children attending family child care homes in Rhode Island. PHENOMENON OF INTEREST: How and what parents communicate about with FCCPs related to feeding young children. ANALYSIS: Recordings were transcribed verbatim. Two independent coders employed content analysis to analyze transcripts. Reflections, emerging themes, and final themes were discussed. RESULTS: Participants were recruited through FCCPs and were mostly Hispanic and female. Parents mainly communicated with FCCPs in person. Communication with FCCPs related to how and what children were fed did not occur frequently, and parents usually inquired about how much children ate. CONCLUSIONS AND IMPLICATIONS: Parents did not engage in frequent child nutrition-related communication with their FCCP. However, parents trusted FCCPs to provide healthy and sufficient food to children. More research is needed to identify effective strategies that facilitate child nutrition communication between parents and FCCPs.

Micronutrient Adequacy in Preschool Children Attending Family Child Care Homes.

Limited data is available on the micronutrient intake and adequacy in preschool children enrolled in family child care homes (FCCH). The goal of this paper is to describe the micronutrient adequacy relative to age-specific recommendations of preschool-aged children (aged 2-5 years) attending FCCH in Rhode Island (RI). Dietary data among younger preschoolers (aged 2-3 years), n = 245) and older preschoolers (aged 4-5 years), n = 121) in 118 RI FCCH (N = 366 children) were analyzed. Nutrient adequacy was assessed as the amount of nutrient per 1000 kcal of the diet that would meet the Institute of Medicine nutrient requirements (critical nutrient density), and it was compared to the observed nutrient densities of the children. The sodium:potassium ratio was also calculated. For most micronutrients, the observed density met or exceeded the recommendation, meaning the children's intake was adequate. However, a high proportion of children had nutrient densities under the recommendation for vitamins D, E, K, and potassium (86.1%, 89.1%, 70.8%, and 99.2% of children, respectively). The mean vitamin B12, potassium, and zinc densities were statistically higher in younger vs. older preschoolers (p < 0.05 for all). Low densities in calcium and vitamins K and B5 were more frequent in older children vs. younger children (p < 0.05). In addition, older preschoolers had a higher sodium:potassium ratio than younger children (p < 0.05). The micronutrient intake density was adequate for most nutrients. However, intake of some nutrients was of concern. Further attention to training and compliance in FCCH may improve the diet quality of those cared for in these settings.

Cognitive status and cardio-metabolic risk of patients with acquired brain injury and Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) and acquired brain injury (ABI) share common symptoms. People with PD and ABI risk nutritional decline at diagnosis, but little is known about their long-term health a year or more after diagnosis. OBJECTIVE: This cross-sectional study describes cognitive and dietary characteristics of people living with PD or ABI 12 months or more post diagnosis to identify cardio-metabolic risk factors. METHODS: Twelve community-dwelling participants (8 PD, 4 ABI) received interdisciplinary evaluations. Cognitive-linguistic status was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Nutritional and cardio-metabolic statuses were measured using the dietary screening tool (DST), anthropometrics, biochemical, and clinical measures. Descriptive statistics, independent t-tests and correlations were used to analyze the data. RESULTS: Mean BMI (n = 12) was 26.8 ± 3.0 kg/m(2) and the majority of participants were overweight. Participants with PD had significantly higher total RBANS scores than participants with ABI (87.1 ± 14.6 vs. 66.0 ± 12.6, p = 0.034, d = 2.455). DST scores indicated 58% (N = 7) at possible nutrition risk and 25% (N = 3) were at nutrition risk. A positive correlation was found between general activity level and DST scores (r = 0.697, p = 0.012). Multiple risk factors for development of cardiovascular disease (CVD) were present in all participants. CONCLUSION: These findings confirmed the presence of cognitive and dietary deficits in our participant group and support the need for an interdisciplinary team approach to improve health and prevent the development of symptoms for these populations a year or more after diagnosis.

The Green Eating Project: web-based intervention to promote environmentally conscious eating behaviours in US university students.

OBJECTIVE: To investigate the effectiveness of an online, interactive intervention, referred to as the Green Eating (GE) Project, to motivate university students to adopt GE behaviours. DESIGN: The study was quasi-experimental and integrated into courses for credit/extra credit. Courses were randomly stratified into experimental or non-treatment control. The 5-week intervention consisted of four modules based on different GE topics. Participants completed the GE survey at baseline (experimental, n 241; control, n 367) and post (experimental, n 187; control, n 304). The GE survey has been previously validated and consists of Transtheoretical Model constructs including stage of change (SOC), decisional balance (DB: Pros and Cons) and self-efficacy (SE: School and Home) as well as behaviours for GE. Modules contained basic information regarding each topic and knowledge items to assess content learning. SETTING: The GE Project took place at a public university in the north-eastern USA. SUBJECTS: Participants were full-time students between the ages of 18 and 24 years. RESULTS: The GE Project was effective in significantly increasing GE behaviours, DB Pros, SE School and knowledge in experimental compared with control, but did not reduce DB Cons or increase SE Home. Experimental participants were also more likely to be in later SOC for GE at post testing. CONCLUSIONS: The GE Project was effective in increasing GE behaviours in university students. Motivating consumers towards adopting GE could assist in potentially mitigating negative consequences of the food system on the environment. Future research could tailor the intervention to participant SOC to further increase the effects or design the modules for other participants.

Impact of a program of Tai Chi plus behaviorally based dietary weight loss on physical functioning and coronary heart disease risk factors: a community-based study in obese older women.

This study employed a quasi-experimental design in a community-based study translating the results of our recent findings on the combined effects of Tai Chi and weight loss on physical function and coronary heart disease (CHD) risk factors. A 16-week intervention was conducted to assess the impact of Tai Chi plus a behavioral weight loss program (TCWL, n = 29) on obese (body mass index [BMI] = 35.4 ± 0.8 kg/m²) older (68.2 ± 1.5 yr.) women compared to a control group (CON, n = 9, BMI = 38.0 ± 1.5 kg/m², 65.6 ± 2.7 yr.), which was asked to maintain their normal lifestyle. The TCWL group lost weight (1.6 ± 2.9 kg, P = 0.006) while the CON group did not (1.2 ± 1.9 kg, P = 0.106). Physical functioning as measured by the short physical performance battery improved in TCWL when compared to the CON group (ß = 1.94, 95% Confidence Interval [CI]: 1.12, 2.76, P < 0.001). TCWL also improved in sit-and-reach flexibility (ß = -2.27, 95% CI: -4.09, -0.46, P = 0.016), body fat mass (BMI, ß = -0.65, 95% CI: -1.03, -0.26, P = 0.002), waist circumference (ß = -1.78, 95% CI: -2.83, -0.72, P = 0.002), systolic blood pressure (ß = -16.41, 95% CI: -21.35, -11.48, P < 0.001), and diastolic blood pressure (ß = -9.52, 95% CI: -12.65, -6.39, P < 0.001). Thus, TCWL intervention may represent an effective strategy to improve physical function and ameliorate CHD risk in the older adult population.

Coronary heart disease risk factors in college students.

More than one-half of young adults aged 18-24 y have at least 1 coronary heart disease (CHD) risk factor and nearly one-quarter have advanced atherosclerotic lesions. The extent of atherosclerosis is directly correlated with the number of risk factors. Unhealthy dietary choices made by this age group contribute to weight gain and dyslipidemia. Risk factor profiles in young adulthood strongly predict long-term CHD risk. Early detection is critical to identify individuals at risk and to promote lifestyle changes before disease progression occurs. Despite the presence of risk factors and pathological changes, risk assessment and disease prevention efforts are lacking in this age group. Most young adults are not screened and are unaware of their risk. This review provides pathological evidence along with current risk factor prevalence data to demonstrate the need for early detection. Eighty percent of heart disease is preventable through diet and lifestyle, and young adults are ideal targets for prevention efforts because they are in the process of establishing lifestyle habits, which track forward into adulthood. This review aims to establish the need for increased screening, risk assessment, education, and management in young adults. These essential screening efforts should include the assessment of all CHD risk factors and lifestyle habits (diet, exercise, and smoking), blood pressure, glucose, and body mass index in addition to the traditional lipid panel for effective long-term risk reduction.

Dietary factors are associated with coronary heart disease risk factors in college students.

It is hypothesized that healthy dietary and physical activity choices will be inversely associated with coronary heart disease (CHD) risk factors. Results from a cross-sectional study of 294 first-year University of Rhode Island students were used for the analyses. The presence of CHD risk factors was defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines. Diet was assessed by three 24-hour food recalls, and physical activity was assessed by the International Physical Activity Questionnaire. Logistic regression models adjusted for sex estimated the odds of having CHD risk factors. A higher percent of kilocalories from alcohol was associated with a 9.9% increased risk for elevated triacylglycerol (odds ratio [OR], 1.099; 95% confidence interval [CI], 1.000-1.207). Sugar intake (OR, 1.015; 95% CI, 1.004-1.026), saccharin intake (OR, 1.047; 95% CI, 1.015-1.080), and body mass index (BMI; OR, 1.139; 95% CI, 1.037-1.252) were associated with an increased risk of low high-density lipoprotein cholesterol; dietary fiber intake (OR, 0.934; 95% CI, 0.873-1.000) was associated with a decreased risk of low high-density lipoprotein cholesterol. Participants with a higher BMI were 9.4% more likely to have elevated fasting glucose (OR, 1.094; 95% CI, 1.004-1.192) and 193.6% more likely to have a larger waist circumference (OR, 2.936; 95% CI, 1.543-5.586). Dietary factors and BMI are better indicators of CHD risk than physical activity is in this population.

Effects of the addition of t'ai chi to a dietary weight loss program on lipoprotein atherogenicity in obese older women.

OBJECTIVE: To examine the additive effect of t'ai chi (TC) to diet education on the traditional coronary heart disease (CHD) risk factor low-density lipoprotein cholesterol (LDL-C) and on emerging CHD risk factors (apolipoprotein B and LDL particle size) in older obese women. DESIGN: Ancillary study of a randomized clinical trial. SETTING: University of Rhode Island. PARTICIPANTS: 26 obese women (mean age±standard deviation, 61.5±6.0 years; mean body mass index, 34.3±4.0 kg/m(2)) were enrolled and randomly assigned to the diet education group (n=13) or the diet education plus TC group (n=13). INTERVENTION: All participants received 45 minutes of diet education per week. The diet education plus TC group also received 45 minutes of TC three times per week for 16 weeks. OUTCOME MEASURES: Anthropometrics (height, weight, BMI, waist circumference, and hip circumference), clinical variables (blood pressure), and biochemical variables (standard lipid profile, apolipoprotein B, LDL particle size) were measured. The primary outcome was LDL-C, and the secondary outcomes were apolipoprotein B and LDL particle size. RESULTS: Neither LDL-C nor apolipoprotein B improved in either group. Percentage of large LDL particles after the intervention was increased in the diet education plus TC group compared with the diet education group. Weight, waist circumference, and high-density lipoprotein cholesterol decreased in both groups from baseline to post-intervention. Triacylglycerol and dietary screening tool scores increased in both groups. Additional improvements were seen in the diet education plus TC group, including a significant increase in Dietary Approaches to Stop Hypertension score from baseline to post-intervention. CONCLUSION: The addition of TC to diet education is more effective than diet education alone at improving diet quality and emerging CHD risk factors, such as LDL particle size, in obese older women.