Estimating the Burden and Distribution of Post-COVID-19 Condition in Washington State, March 2020-October 2023.

Introduction: After SARS-CoV-2 infection, some people will experience long-term sequelae known as post-COVID-19 condition (PCC). Although PCC is recognized as a public health problem, estimates of the prevalence of PCC are sparse. We described a framework for estimating the incidence and prevalence of PCC by population subgroups and geography over time in Washington State. Methods: We collected data on reported COVID-19 cases and hospitalizations and estimated SARS-CoV-2 infections in Washington State from March 2020 through October 2023. The reported case data were incorporated with parameter estimates from published articles and prevalence estimates from the Household Pulse Survey into a mathematical compartmental model of PCC progression. The model used differential equations to describe how the population of people with PCC moved through the model's various stages. This framework allowed us to integrate data on age group, sex, race and ethnicity, vaccination status, and county to estimate incidence and prevalence of PCC for each subgroup. Results: Our model indicated that 6.4% (95% CI, 5.9%-6.8%) of all adults in Washington State were experiencing PCC as of October 2023. In addition to temporal differences in PCC prevalence and incidence, we found substantial differences across age groups, race and ethnicity, and sex. Geographic heterogeneity was pronounced, with the highest rates of PCC in central and eastern Washington. Conclusion: Estimation of PCC prevalence is essential for addressing PCC as a public health problem. Responding to PCC will require continued surveillance, research, and dedicated financial and public health action. This analysis, accounting for heterogeneities, highlights disparities in the prevalence, incidence, and distribution of PCC in Washington State and can better guide awareness and response efforts.

Greater male variability in daily energy expenditure develops through puberty.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure.

Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

The relationship between total energy expenditure and physical activity level in women living in an impoverished Brazilian urban area.

OBJECTIVE: This study aimed to describe how strong is the relationship between TEE and PAL in women living in an impoverished Brazilian urban area. METHODS: Anthropometric, hormonal (insulin, TSH, FT4 , and FT3 ), body composition (deuterium), TEE (doubly labeled water) and PAL (metabolic equivalent task [MET]-7-day triaxial accelerometer, ActivPAL®) data were collected from 55 women (mean age: 31y, mean BMI: 27.4 kg/m2 ). Adjusted-TEE models were calculated incorporating the residuals of anthropometric, hormonal, and body composition variables in the TEE, to assess the relation between MET and adjusted-TEE, through three different analyzes: linear regression, nonlinear regression and change-point regression. RESULTS: Most participants (89.1%, n = 49) were classified as low-active. There was no association between crude TEE and MET.h/d (R2  = 0.05; p = 0.09). There was a positive, although weak, linear relationship between adjusted-TEE and MET.h/d (ß = 2705.26 kcal; 95% CI: 436.25; 4974.27; adj-R2  = 0.08). A change point of this relationship was identified in the MET.h/d value of 1.53 (SD = 0.02; adj-R2 = 0.13). The association between adjusted-TEE and MET.h/d before the change point (ß = 5101.46 kcal; 95%CI: 978.84; 9224.08; adj-R2  = 0.11) was stronger than the association in the full linear model, nevertheless, it was still weak. This association stop existing when it is assessed in individuals after the change point (ß = -6609.92 kcal; 95%CI: -16773.24; 3553.40; adj-R2  = 0.08). CONCLUSIONS: These results suggest that the relationship between TEE and PAL is weak and it is not completely linear in women living in an impoverished Brazilian urban area.

Strengthening Vegetable Production and Consumption in a Kenyan Informal Settlement: A Feasibility and Preliminary Impact Assessment of a Sack Garden Intervention.

Background: Over 85% of Kibera's population, an informal settlement in Nairobi, Kenya, is food insecure. Nutrition-sensitive agriculture interventions, such as sack gardens, have the potential to diversify diets-in turn, improving household food security and diet quality. Furthermore, the sale of extra vegetables may provide an income for program participants. Objectives: The aim of this paper was to conduct a feasibility assessment and preliminary impact assessment of a nutrition-sensitive urban agriculture intervention that used sack gardens for women in Kibera. Methods: Women, from a women's empowerment program, in Kibera (n = 36; n = 21 full program participants, n = 11 withdrawn, n = 4 new members) were engaged in a sack garden intervention in June 2018. A mixed-method approach was used to assess the feasibility and preliminary impact of the program. Qualitative semi-structured interviews (n = 25; n = 18 full program participants, n = 5 withdrawn, n = 2 new members), administered at the end of the pilot phase (March 2019), identified barriers and facilitators (e.g., preferences, inputs, group dynamics) to the production, consumption, and sale of self-produced vegetables. Quantitative surveys (n = 21 full program participants), administered in June 2018 and March 2019, were conducted to evaluate preliminary intervention impact on food security and diet quality through analysis of the Household Hunger Scale (HHS) and Minimum Dietary Diversity for Women (MDD-W). Results: Key barriers included insufficient inputs and group work difficulties, particularly around communication. Facilitators included positive intervention feedback, social bonds and teamwork, participants' self-sufficiency, and preference for sack garden vegetables over market vegetables. Post-intervention, participants reported reduced household food insecurity. Recommendations for program scale-up include investment in additional inputs, a water-collection/irrigation system, additional training, and placing sack gardens closer to women's homes to reduce time constraints. Conclusions: This study suggests that sack gardens may provide partial solutions to improve diet quality; however, further research is needed to assess any impact on household income.

Breakfast Consumption, Family Breakfast, and Adiposity Trajectory in Adolescence-The Adolescent Nutritional Assessment Longitudinal Cohort Study.

BACKGROUND: The relationship between breakfast and family breakfast and adiposity gain during adolescence remains inconclusive. OBJECTIVE: This study aimed to investigate the relationship between breakfast and family breakfast frequency and adiposity trajectory in adolescence. DESIGN: Prospective cohort study with middle school students aged 10 to 16 years enrolled in 2010 (baseline) and followed for 3 years. PARTICIPANTS/SETTING: A total of 945 students from two public and four private schools in the metropolitan area of Rio de Janeiro were included. Among 945 students, 809 participated in the study at baseline. Pregnant or lactating students and those with physical or mental disabilities were excluded. MAIN OUTCOME MEASURES: Body mass index (BMI) was assessed by measuring the participants' weight and height, and percent body fat (%BF) was assessed by performing bioelectrical impedance analysis. STATISTICAL ANALYSES PERFORMED: Linear mixed-effect models were used to examine the relationship between baseline and persistence of breakfast consumption and family breakfast over a 3-year period and change in BMI and %BF. Breakfast and family breakfast were assessed by questions on frequency of consumption. Both variables were classified as regular, intermediate, and no consumption at baseline. Persistence was divided into persistently regular, persistently irregular, changing from regular to irregular, and contrariwise. RESULTS: Overall, frequent breakfast consumption and family breakfast did not have protective effects against adiposity. At baseline, these behaviors were associated with low BMI and %BF among girls. During follow-up, these behaviors and persistence of regular breakfast consumption were associated with an increase in %BF (P<0.05). In boys, those who increased or decreased family breakfast frequency had greater decrease in %BF compared with those persistently regular at both time points. CONCLUSION: Breakfast had no consistent relationship with adolescence adiposity trajectory, which is in line with the results of experimental studies and in contrast with those of many cross-sectional studies.

Effect of Radiation on Male Stress Urinary Incontinence and the Role of Urodynamic Assessment.

OBJECTIVE: To evaluate the effect of radiation on male stress urinary incontinence (SUI) and to assess the relative value of preoperative urodynamic (UDS) testing in radiated vs nonradiated men with SUI. METHODS: A retrospective chart review of all male patients with SUI who underwent UDS testing from 2010 to 2016 was performed. The impact of UDS findings on treatment decision making was assessed. UDS parameters and treatment patterns of radiated vs nonradiated patients were compared as well as the fates of storage symptoms in each group. RESULTS: Two hundred seven men were identified that underwent UDS with a clinical diagnosis of SUI. Sixty-five out of 207 (31.4%) were exposed to radiation as a treatment modality for prostate cancer. All patients that underwent UDS testing moved on to surgical correction of SUI, and the UDS findings did not alter plan to treat SUI in any patients. Men who were radiated prior to surgical correction of SUI were more likely to have detrusor overactivity (70% vs 38%, P <.0001) and had lower maximum cystometric capacity (255 vs 307.4 mL, P = .01) when compared to nonradiated on UDS. After artificial urinary sphincter or sling implantation, the proportion of patients requiring overactive bladder medications was higher in radiated vs nonradiated men (44.3% vs 25.3%; P = .01). CONCLUSION: Radiation therapy appears to increase the likelihood of bladder dysfunction in male patients with SUI. The UDS findings did not alter the plan to treat SUI in any patients in our series, and its role before SUI surgery in male patients, including those receiving radiation, may be limited.

Diagnostic accuracy of a rapid telemedicine encounter in the Emergency Department.

OBJECTIVES: Emergency Department crowding is an increasing problem, leading to treatment delays and higher risk of mortality. Our institution recently implemented a telemedicine physician intake ("tele-intake") process as a mitigating front-end strategy. Previous studies have focused on ED throughput metrics such as door to disposition; our work aimed to specifically assess the tele-intake model for clinical accuracy. METHODS: We retrospectively reviewed ED visits at a high acuity, tertiary care academic hospital before and after tele-intake implementation. We defined the primary outcome as the degree of additional laboratory, imaging, and medication orders placed by the subsequent ED provider. Our secondary outcomes were the cancellation rate of intake orders and the percentage of encounters where no additional second provider orders were necessary. RESULTS: For in-person and tele-intake physician encounters between September 2015 and February 2017, most labs and diagnostic radiology studies, and approximately half of CT, ultrasound, and pharmacy orders were initiated by the intake physician. We found no significant difference for our primary outcome (p = 0.2449). For both tele-intake and in-person encounters, <1% of orders were cancelled by the second provider. Additionally, 30.8% of in-person and 31.5% of telemedicine patient encounters required no additional orders to make a disposition decision. DISCUSSION: This novel analysis of an innovative patient care model suggests that the benefits of tele-intake as a replacement for in-person physician directed intake are not at the cost of over or under utilization of diagnostic testing or interventions.

Effect of Exercise Intensity on Spontaneous Physical Activity Energy Expenditure in Overweight Boys: A Crossover Study.

OBJECTIVE: Evaluate the effect of different exercise intensities on spontaneous physical activity energy expenditure in overweight adolescents. METHODS: A crossover study was developed with a control session, followed by moderate and vigorous exercise sessions, with six days of monitoring each. Twenty-four adolescents, 11-13 years old, male and overweight were selected. Spontaneous physical activity energy expenditure was assessed by accelerometers. Linear mixed effects models were used to evaluate the differences per session across time. RESULTS: Energy expenditure during the 1st hour was different between all three sessions, with averages of 82, 286 and 343 kcal to the control, moderate and vigorous sessions, respectively (p <0.001). The same pattern of difference in energy expenditure between the sessions remained after 24 hours (704 vs 970 vs 1056 kcal, p <0.001). However, energy expenditure during the six days indicates compensation from second to the sixth day, although small differences remained at the end of the 6-day period (5102 vs 5193 vs 5271 kcal, p <0.001). CONCLUSIONS: A single aerobic session seems to modify the spontaneous physical activities in overweight adolescents but still keeping the vigorous session with higher total energy expenditure during the follow-up period. Despite the observed compensatory effect, the greater energy expenditure observed in both moderate and vigorous exercise sessions indicates that physical activity should be recommended to promote an increased energy expenditure in adolescents. TRIAL REGISTRATION: ClinicalTrials.gov NCT 02272088.

Association between Adult Stature and Energy Expenditure in Low-Income Women from Northeastern Brazil.

BACKGROUND: Perinatal undernutrition may lead to important metabolic adaptations in adult life, short stature being the most visible. The present study aimed to evaluate the association between stature and total energy expenditure of low-income women. METHOD: Women aged 19-45 years from low-income communities in Maceió-AL were recruited. A sample of 67 volunteers was selected and divided into either short stature (≤ 152.4 cm; n = 34) or non-short stature (≥ 158.7 cm; n = 33) group. Data on socioeconomic status, anthropometric variables, and hormonal profiles was collected. Total energy expenditure and body composition were assessed by the doubly labeled water technique with multiple points over 14 days. In addition, physical activity levels were measured with triaxial accelerometers and dietary intake data were collected using three 24-hour food records. RESULTS: The mean subject age was 30.94 years. Women of short stature had lower body weight and lean body mass compared to non-short women, but there were no differences in thyroid hormone concentrations or daily energy intake between the two groups. Short-stature women showed lower total energy expenditure (P = 0.01) and a significantly higher physical activity level (P = 0.01) compared to non-short women. However, the difference in total energy expenditure was no longer significant after statistical adjustment for age, lean body mass, and triiodothyronine concentrations. CONCLUSION: Women with short stature present the same energy intake, but lower total energy expenditure than non-short women, even with a higher physical activity level, which suggests that they are more prone to weight gain.

Changes in nutritional status among displaced North Korean children living in South Korea.

BACKGROUND: As many nations experience the nutrition transition, changes in the nutritional status of children moving from food insecure to food affluent societies has become an important, but infrequently studied, public health issue. AIM: To determine changes in the nutritional status of North Korean children after relocating to food-affluent South Korea (SK) from food-deficient North Korea (NK) and relationships of current nutritional status with food environment at birth and exposure to food affluent environments. SUBJECTS AND METHODS: Socioeconomic status, relocation history and anthropometric information were obtained from 70 NK children (6-15 years) living in SK, through questionnaires, interviews and direct measurements. RESULTS: Following the first 2 years in SK, the height and weight of NK children significantly (p = 0.000) improved, yet they were still shorter (p = 0.000) than SK peers, while the prevalence of obesity was similar to those of SK children. The likelihood of remaining stunted was significantly associated with older age and shorter residency in SK (p < 0.05), but there was no significant association with food security situation at birth. CONCLUSION: Even a short exposure to food affluent environments improved the nutritional status among children, but linear growth deficits are slow to recover as overall nutritional status remains poor compared to peers without exposures to food insecurity.

Fat free mass explains the relationship between stunting and energy expenditure in urban Mexican Maya children.

BACKGROUND: Childhood stunting has been associated with an increased risk of obesity in adulthood, but the causes are unclear. This study hypothesizes that stunting significantly reduces both resting and activity energy expenditure. AIM: To assess and describe energy expenditure of low socio-economic Maya children and to determine whether stunting is independently related to energy expenditure after controlling for lean mass. SUBJECTS AND METHODS: Thirty-three urban Maya children, 17 boys, aged 7-9 years, living in Merida, Mexico, were measured for height, weight and bioelectrical impedance analysis (BIA). Body composition was estimated from BIA. Energy expenditure was measured for one week using the Actiheart (combined heart rate and accelerometer). RESULTS: Stunting (height-for-age below the 5(th) percentile of NHANES III based references) affected 35% of these physically active children. Using multiple linear regression analysis, greater lean body mass predicted higher resting and activity energy expenditure. Stature was not a significant predictor of resting energy expenditure. A lower height-for-age z-score, but not stunting as a categorical variable, significantly predicted lower activity energy expenditure. CONCLUSION: The hypothesis that stunting reduces total energy expenditure (resting + active) in children is not supported. Rather, children with shorter stature and less lean body mass have lower total energy expenditure. Complex interactions between body size, body composition, and metabolic activity appear to elevate the risk for later life obesity in these Maya children.

Growth in transitional countries: the long-term impact of under-nutrition on health.

CONTEXT: Despite significant economic development in many parts of the world, upwards of 150 million children are short for their age. Epidemiologic and clinical data suggest that stunting increases the risk for nutrition-related chronic diseases (NRCD), a particular problem for transitional countries as dietary and environmental shifts that accompany development are also reported to increase the risk for NRCD. OBJECTIVE AND METHODS: This paper reviews studies on the causes and long-term effects of poor nutrition as well as data from clinical studies of growth retardation and metabolism and body composition that may explain the link between poor growth and later risk for NRCD. RESULTS: Growth retardation is the physical outcome of a complex interaction of socio- economic factors during key periods of development. Growth-retarded children may present with metabolic or body fat distribution profiles that predispose them to NRCD, a risk factor that may be compounded by consuming a diet consistent with the 'nutrition transition'. CONCLUSION: It is important to continue studying the long-term physiological changes following recovery from under-nutrition, especially in countries undergoing a 'nutrition transition'. Estimates suggest that, within 20-30 years, ∼ 2/3 of the world population will reside in urban areas. The potential economic fallout of continued poor nutrition, poor growth and changing diets and activity patterns will be great given the healthcare costs and social problems associated with NRCD.

Maternal behavior and infant weight gain in the first year.

OBJECTIVE: To examine the relative contributions of maternal characteristics and behaviors in predicting infant weight gain over the first year of postpartum life. DESIGN: Longitudinal study of maternal feeding style throughout infancy. SETTING: A Special Supplemental Nutrition Program for Women, Infants, and Children center. PARTICIPANTS: Ninety-six low-income, minority mother-infant dyads. MAIN OUTCOME MEASURES: Infant weight gain at 3, 6, and 12 months. ANALYSIS: Multiple linear and backward regressions. RESULTS: None of the mother-infant perinatal measures predicted infant weight gain from birth to 3 months, nor did measures from birth to 3 months predict weight gain from 3 to 6 months. However, the number of feedings and lessened maternal sensitivity to infant cues predicted weight gain from 6 to 12 months. CONCLUSIONS AND IMPLICATIONS: These results suggest that feeding plays an important role in promoting rapid weight gain in infants, since the maternal reports of feeding frequency, as well as their lessened sensitivity to the infants' cues, indicate that the infants in this study may have been regularly overfed. Nutrition educators who work with low-income populations should provide guidance to mothers in feeding their infants by helping them to recognize hunger signals and respond to satiety cues.

Validity of resting energy expenditure estimated by an activity monitor compared to indirect calorimetry.

The use of activity monitors (triaxial accelerometers) to estimate total energy expenditure in kilocalories is dependent on the estimation of resting energy expenditure (REE). However, the REE estimated by activity monitors has not been validated against more precise techniques, such as indirect calorimetry (IC). Therefore, the objective of the present study was to compare REE estimated by the Actical activity monitor (ActMon) to that measured by IC and standard prediction equations of REE. Fifty healthy adults between 18 and 43 years of age were measured for weight and percentage of body fat using a digital scale and bioelectrical impedance. The REE estimated by the ActMon was only 129 kJ/d higher, but not statistically different (P>0.05), than the REE measured with IC. Using multiple linear regression, there was a positive relationship for men, but not for women, between fat mass (kg) and percentage of body fat and the difference in REE estimated by the ActMon compared to IC (P < 0.001). Therefore, in the cohort studied, the use of an activity monitor to estimate REE is valid when compared to IC, but not to a standard prediction equation of REE.

Economic transition and household food consumption: a study of Bulgaria from 1985 to 2002.

Major economic transitions typically entail changes in the availability of and purchasing power for different types of foods leading to long-term changes in the composition of the diet. Bulgaria, a former Eastern Bloc country, underwent a difficult and protracted transition from a centralized to market economy with acute economic crises and a much slower recovery of income levels than in Poland, the Czech Republic, and Hungary. Using annual data from the Bulgarian National Household Survey, we study changes in the reported consumption of major foods (excluding alcoholic drinks) and their constituent macronutrients from 1985 to 2002, examining also the differences in dietary patterns between the period prior to and following the transition. The consumption of most major food items decreased, resulting in a fall in per capita energy consumption of 429 kcal/day (1.80 MJ/d), following the economic transition of 1991. As expected, the consumption of foods that were more expensive per unit of energy decreased greater than cheaper foods, -34% for animal products and -19% for visible fats, but only -10% for carbohydrates. These changes are related to the changes in income and market prices as well as the general negative trend in economic growth and hyperinflation in the mid-1990s. Thus, Bulgaria experienced a decrease in food consumption without significant changes in the dietary pattern following the economic transition of 1991. The fact that part of this decline may be attributed to continued economic challenges suggests that future transitions in the diet may be expected as economic development proceeds.