Inflammation and Healthy Lifestyle Choices Influence Cardiometabolic Risks in African American Women.

OBJECTIVES: Individuals of African origin in Europe and the Caribbean have a lower prevalence of coronary heart disease (CHD) than do Europeans and European Americans; however, African Americans, especially women, do not possess the same low CHD prevalence as Africans. As such, this study was designed to determine whether highly sensitive C-reactive protein (hsCRP) and fitness (V˙O2max) cluster with other cardiometabolic risks (CMRs) or whether their influence is independent of other CMRs in African American women. METHODS: Fifty African American women were compared on fasting glucose, triglyceride, high-density lipoprotein cholesterol, blood pressure, and adiposity-based hsCRP classifications (low <1, group 1; moderate >1, group 2). Participants were obese but metabolically healthy. RESULTS: Oxygen uptake (V˙O2max) was correlated with systolic blood pressure, and percentage of fat in group 1. V˙O2max was related to systolic blood pressure, diastolic blood pressure, low-density lipoprotein-cholesterol, and percentage of fat, and hsCRP was related to triglycerides, and percentage of fat was related to diastolic blood pressure in group 2. These data indicate that CMRs are inversely related to V˙O2max at moderate hsCRP values in African American women. Inflammation and obesity are relatively independent of other CMRs. CONCLUSIONS: Inflammation along with sedentary lifestyles may contribute to the disparity observed for CHD morbidity and mortality in African American women. Adding the CMR profile may improve the prediction of CHD in African American women.

Influence of obesity assessments on cardiometabolic risks in African and European American women.

OBJECTIVES: African American women (AAW) have increased odds of developing cardiometabolic (CME) risks and cardiovascular diseases (CVD) compared with European American women (EAW). The influence of obesity on other CME risks and the CVD disparity is unclear. The purpose of our study was to develop a CME index and evaluate the obesity and CME risk index relationships based on race. DESIGN: A comparative research design was employed in our study as 213 women (132 AAW; 81 EAW) from the Louisiana Delta were evaluated for CME risk clustering patterns by race, based on BMI, dual energy X-ray absorptiometry % body fat and waist conference. Fasting glucose, triglyceride (TC), high density lipoprotein cholesterol (HDL-C), systolic (SBP) and diastolic blood pressure (DBP) were the measured CME risks. FINDINGS: In summary, when the CME indexes were evaluated by obesity classification categories the ones that were CVD risk or near risk for the AAW were SBP and TG. The trend of CME index risk for the EAW was SBP and glucose. The stepwise regression equations indicate that HDL-C and SBP/DBP were the best indicators of the effects of obesity on CME risks in AAW and that SBP/DBP and glucose were the best indicators of CME risks in EAW. CONCLUSIONS: Our results indicate that CME risks as evaluated based on obesity categories are different for AAW than for EAW.

Influence of Obesity on the Relationship of Cardiometabolic Risks Factors With Cardiovascular Disease in Older African and European Americans.

PURPOSE: This study evaluated the impact of obesity on cardiometabolic risk factors (CRF) interrelationships and predictive efficiency of CVD development in older African (AA) and European Americans (EA). DESIGN: A comparative research design evaluated CRF risk profile differences between participant groups. SETTING: Seven neighborhoods in a southern US city. SUBJECTS: A sample of 179 older AA (n = 128) and EA (n = 51) adults. MEASURES: Non-fasting blood samples were evaluated for lipids and lipoproteins, glycosylated hemoglobin, systolic -(SBP) and diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF%) and physical function. ANALYSIS: Data were analysis with descriptive statistics, t-tests, and correlations. RESULTS: AA were heavier than EA although all had above average age-appropriate fitness. Means and relationships between CRF and other variables were different (P < .05) based on race. Both AA (41.3 + 5.8) and EA (38.6 + 6.4) BF% were CRF risks. Holding BMI constant, CRF were generally not related, and the relationships were different for AA and EA. AA had a range of 13.0 to 27.2% more favorable values for cholesterol, HDL-C, and triglyceride. EA had favorable A1c (EA 5.8 vs AA 6.2%) values. CONCLUSIONS: A limitation of this report is the small sample size. Although further research is warranted, these findings suggest population specific CRF selections would improve CVD prediction in AA.

Comparison of health perceptions and health status in African Americans and Caucasians.

PURPOSE: This study was designed to compare the health perceptions of adults based on race (African American and Caucasian) and gender in the southern United States to determine if health perception contributed to health disparity between African Americans and Caucasians. METHODS: A between-groups design was used in this study where African Americans and Caucasians completed an extensive health questionnaire and were compared for health perceptions and self-reported health status differences. RESULTS: Fewer African Americans (p < .05; males, 55.8%; females, 68%) perceived their health to be good to excellent compared with Caucasians (males, 76.6%; females, 77.1%) and more had been diagnosed with 1 or more chronic diseases. Yet, more than three-quarters of all groups thought that their health care provider shared with them good to excellent information about their health, and 75.0% of the African American males and 71.5% of the Caucasian males and more than 62.0% of the African American and Caucasian females stated that medication cost was not a reason they did not take prescribed medications. CONCLUSIONS: Health perceptions of African Americans are often not consistent with their actual health, and this is especially true for African American males. Their perceptions appear to influence the value they place on health behaviors which may result in a reduced health status.

Do the Same Central Anthropometric Variables that Best Predict Blood Pressure in European Americans also Best Predict Blood Pressure in African Americans?

Objective: The purpose of this study was to determine if central anthropometric variables that best estimate blood pressure risks in European Americans also best estimate blood pressure risks in African Americans. Design: The participants were 357 normotensive African and European American volunteers with a mean age of 32.6 ± 12.4 years. Participants were evaluated for central adiposity with dual energy X-ray absorptiometry, abdomen and thigh skinfolds, waist and hip circumferences, waist/hip ratio, waist/height ratio, body mass index, and systolic and diastolic blood pressures. Descriptive statistics, partial correlations, ANOVA and stepwise regressions were used to analyze the data. Results: Central adiposity anthropometric indices made different contributions to blood pressure in African and European American men and women. When weight was held constant, waist circumference shared stronger partial relationships with blood pressure in African Americans (r = .30 to .47) than in European Americans (r = .11 to .32). Waist circumference in combination with other indices was a predictor of systolic and diastolic blood pressures in European American men (P<.05) but only a predictor for diastolic blood pressure in African American men and women (P<.01). Hip circumference was the only predictor for systolic blood pressure (P<.01) in African American men and women. Conclusions: Further research on the relative contributions of central anthropometric indices to blood pressure in African and European Americans is warranted. A better understanding of this relationship may help reduce hypertensive morbidity and mortality disparities between African and European Americans.

Walking, body composition, and blood pressure dose-response in African American and white women.

PURPOSE: The purpose of this study was to evaluate body composition and blood pressure (BP) responses to a 16-week dose of brisk walking in sedentary and obese African American (AA) and White women. METHODS: Seventy-five sedentary women (45 AA and 30 White) between the ages of 18 and 50 years and body fat > or =27% signed institutional approved informed consent forms and volunteered to participate in this study. The participants were divided into four groups (AA exercisers [AAE], AA control [AAC], White exercisers [WE], White controls [WC]). The exercisers walked three miles a day, three days a week. Body composition and BP were measured before and after the training intervention. Food records were collected before, during, and after the intervention. RESULTS: Following training, only the WE experienced a reduction in body weight and body fat (P<.05). However, the energy intake of the AAE increased 4.7% during and 16% at the conclusion of the intervention and contributed to them neither losing nor gaining weight or fat. Both exercise groups experienced reductions (P<.05) in systolic (AAE 5.7 mm Hg, WE 11.3 mm Hg) and diastolic BPs (AAE 3.0 mm Hg, WE 3.6 mm Hg) following training, but the reductions for the WE were greater (P<.05) than for the AAE. There were no changes in body composition or BP for either AAC or WC. CONCLUSIONS: These results indicate that a 16-week walking intervention provides body composition and BP benefits for both AA and White women, but the benefits are greater for White women.

The thermic effect of food and obesity: discrepant results and methodological variations.

Studies have yielded discrepant results concerning whether the thermic effect of food (TEF) is reduced in obesity. Methodological variations among published studies make understanding the discrepant results very difficult. Although methodological differences are often noted as contributing to the discrepant results, little work has been done to address these differences and standardize experimental protocols. This paper reviews 50 studies that have investigated TEF in obesity and focuses on factors related to experimental protocol and subject control that reportedly affect measurements of resting energy expenditure, postprandial energy expenditure, and the calculation of TEF.

Effects of long-term resistive training on mobility and strength in older adults with diabetes.

BACKGROUND: Strength training has been shown to be beneficial in older adults. However, very little data exist on the effects of strength training in older diabetics. METHODS: 31 community-dwelling older adults with diabetes (mean age = 66.1 years) were randomly assigned to either an exercise (EX) or control (CO) group. The EX group trained the plantar flexors, knee extensors, knee flexors, hip extensors, and hip flexors muscle groups at 50%, 60%, and 70% of 1-repetition maximum, 2.6 days a week, for 24 months. Mobility tests included the timed up and go, 50-foot walk, and walking up and down 8 stairs. Strength and mobility for both groups were evaluated at 6-month intervals. RESULTS: There was a group and time effect as the EX group increased 31.4% (p <.001) in strength for all muscle groups after the first 6 months of training, and the strength gains were retained for the duration of the training intervention. There was also a group and time effect for mobility as performance increased 8.6% and 9.8% (p =.032 and p = 0.031) for the first 6 and 12 months, respectively, but decreased to 4.6% above baseline at the end of the intervention. There were essentially no changes from baseline strength or mobility values for the CO group. CONCLUSION: In conclusion, these data suggest that a moderate-intensity resistive-training program can improve mobility and strength for the duration of a 24-month intervention in older adults with diabetes, thus potentially reducing the rate of mobility loss during aging.

Comparison of obesity assessment procedures in obese African-American and white women.

The purpose of this study was to compare the accuracy of dual energy X-ray absorptiometry (DEXA) to field-based procedures for the estimation of obesity in 27 sedentary and obese African-American (AA) (34.8, +/- 7.7 yr) and 25 sedentary and obese White women (41.1, +/- 8.3 yr). Body fat was estimated by DEXA and skinfolds equations. Obesity was also estimated from BMI and percent of ideal body weight (greater than 120% of ideal body weight based on height and weight tables). All of the procedures classified the subjects as obese. Results from each procedure were compared with minimal obesity standards to determine the percentage by which each mean exceeded the minimal standard (percent difference). The percent difference was smaller for BMI and percent ideal body weight than for the 2 body fat assessment procedures. Although DEXA percent body fat did not differ by race, BMI and percent ideal body weight tended to be greater in AA women compared to White women, and more AA women were classified as obese. Therefore, field-based procedures that do not include percent body fat assessments are not as accurate for AA women. This finding suggests that obesity can be more effectively assessed in AA women if the standards for classifications are population-specific.

Personal characteristics that influence exercise behavior of older adults.

Long-term exercise participation among older adults will result in healthier lifestyles and reduced need for health care. A better understanding, therefore, of what influences older individuals to start and maintain exercise plans would be beneficial. The twofold purpose of this study was (1) to create a knowledge base of determinants that influence exercise behavior in older adults and (2) to have health professionals prioritize determinants that affect exercise initiation and adherence in older adults. The expert panel examined nine determinants within the category of personal characteristics: age, gender, ethnicity, occupation, educational level, socioeconomic status, biomedical status, smoking status, and past exercise participation. The experts rated the determinants on importance for influencing exercise behavior of older adults. This expert panel concluded that older adults who are in good health and have a history of exercise activity might be more likely to participate in long-term exercise programs.

Skeletal muscle lipid peroxidation and insulin resistance in humans.

OBJECTIVE: The relationships among skeletal muscle lipid peroxidation, intramyocellular lipid content (IMCL), and insulin sensitivity were evaluated in nine insulin-sensitive (IS), 13 insulin-resistant (IR), and 10 adults with type 2 diabetes (T2DM). DESIGN: Insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamp [glucose disposal rate (GDR)]. Lipid peroxidation was assessed by 4-hydroxynonenal (HNE)-protein adducts and general oxidative stress by protein carbonyl content. All patients were sedentary. RESULTS: Protein-HNE adducts were elevated 1.6-fold in T2DM compared with IS adults, whereas IR showed intermediate levels of HNE-modified proteins. Protein-HNE adducts correlated with GDR, waist circumference, and body mass index. IMCL was increased by 4.0- and 1.9-fold in T2DM and IR patients, respectively, compared with IS, and was correlated with GDR and waist circumference but not BMI. Protein carbonyls were not different among groups and did not correlate with any of the measured variables. Correlations were detected between IMCL and protein-HNE. CONCLUSION: Our data show for the first time that skeletal muscle protein-HNE adducts are related to the severity of insulin resistance in sedentary adults. These results suggest that muscle lipid peroxidation could be involved in the development of insulin resistance.

Benefits of yoga for African American heart failure patients.

BACKGROUND: The number of African American (AA) patients living with heart failure (HF) has been increasing, especially among the economically disadvantaged. Yoga therapy has been found to improve physical and psychological parameters among healthy individuals, but its effect in patients with HF remains unknown. The purpose of this study was to examine the effects of yoga therapy on cardiovascular endurance (VO2peak), flexibility, quality of life (QoL), and inflammatory markers on medically stable HF patients. METHODS: Forty patients (38 AA, 1 Asian, and 1 Caucasian) with systolic or diastolic HF were randomized to the yoga group (YG, n = 21) or the control group (CG, n = 19). All patients were asked to follow a home walk program. Premeasurement and postmeasurement included a treadmill stress test to peak exertion, flexibility, interleukin-6 (IL-6), C-reactive protein (CRP), and extracellular superoxide dismutase (EC-SOD). QoL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ). RESULTS: The statistical analyses (assessed by ANOVA and t-tests) were significant for favorable changes in the YG, compared with those in the CG, for flexibility (P = 0.012), treadmill time (P = 0.002), VO2peak (P = 0.003), and the biomarkers (IL-6, P = 0.004; CRP, P = 0.016; and EC-SOD, P = 0.012). Within the YG, pretest to posttest scores for the total (P = 0.02) and physical subscales (P < 0.001) of the MLwHFQ were improved. CONCLUSIONS: Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers, and flexibility.

Relationships and CHD risks of BMI, lipoproteins, lipids, and blood pressure in African-American men and women.

BACKGROUND: Body mass index (BMI) is believed to be associated with coronary heart disease (CHD) risks. A major question is whether each BMI category provides independent risk information and whether the BMI categories provide similar results for African-American (AA) men and women relative to lipid, lipoproteins, and blood pressure. METHODS: A descriptive research design was used to evaluate the effects of BMI categories on lipoproteins, lipids, and blood pressure, and to determine if similar CHD risks related to these variables were observed in AA men and women. The 358 (108 men and 250 women; 40-70 year of age) participants were recruited from churches in a southeastern metropolitan area. RESULTS: The results indicate that BMI is positively associated with lipoproteins, lipids, and blood pressure in both AA men and women. Relative risks for CHD were higher for obese (BMI > 30 kg/m(2)) men and women, but the overweight (OW) category provided the same information as the normal weight (NW) category for men, but not for women. CONCLUSIONS: This suggests that the same BMI standards provide different CHD risk information for AA men than for AA women and that gender-specific BMI standards may be warranted for more effective CHD risk stratification in AA adults.

Predicting oxygen uptake in older adults using lower-limb accelerometer measures.

Assessing physical activity in older adults has proven to be difficult but important, because regular participation has a protective and rehabilitative effect against disability and morbidity. Commercially available physical activity monitors measure waist movements and have not been validated for older adults. This study developed a model for establishing prediction equations to estimate older adults physical activity levels based on lower-limb accelerometer measures. Oxygen uptake and lower-limb accelerometer data were simultaneously recorded from treadmill and stair-climbing exercises. The best stepwise regression equations were obtained when accelerometer and weight measures were regressed on oxygen uptake when subjects walked 1, 2, and 3 miles per hour (R = 0.69 with accelerometer on back of the heel) and for accelerometer measures and gender when subjects climbed stairs (R = 0.77 with accelerometer on mid-ankle). These findings illustrate that physical activity can be effectively predicted in older adults from lower-limb accelerometer measurements.

Resistive training and long-term function in older adults.

The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers- 25 women and 5 men; 25 comparisons- 16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.