Moderate-intensity physical activity and fasting insulin levels in women: the Cross-Cultural Activity Participation Study.

OBJECTIVE: The purpose of this study was to determine the association between moderate-intensity physical activity (PA) and fasting insulin levels among African-American (n = 47), Native American (n = 46), and Caucasian women (n = 49), aged 40-83 years, enrolled in the Cross-Cultural Activity Participation Study. Associations by race/ethnicity, levels of central obesity, and cardiorespiratory fitness were also examined. RESEARCH DESIGN AND METHODS: Physical activity scores were obtained from detailed PA records that included all PA performed during two consecutive 4-day periods scheduled 1 month apart. Using MET intensity (the associated metabolic rate for a specific activity divided by a standard resting metabolic rate), PA was expressed as MET-min (the product of the minutes for each activity times the MET intensity level) per day of energy expended in moderate (3-6 METs) and moderate/vigorous (> or = 3 METs) PA. Fasting insulin levels were determined by radioimmunoassay. Data were analyzed by multiple linear regression analysis. RESULTS: After adjusting for race/ethnicity, age, educational attainment, and site, an increase of 30 min of moderate-intensity PA was associated with a 6.6% lower fasting insulin level (P < 0.05). The association was similar among races/ethnicities, centrally lean and centrally obese women, and women with low and high cardiorespiratory fitness levels. CONCLUSIONS: These findings lend support to the 1995 Centers for Disease Control and Prevention and American College of Sports Medicine recommendations for an accumulation of 30 min/day in moderate-intensity PA. They also contribute to the growing literature suggesting that moderate amounts of PA have a significant role in reducing the burden of hyperinsulinemia and diabetes among ethnic populations at highest risk for these conditions.

Predictive accuracy of bioelectrical impedance in estimating body composition of Native American women.

The predictive accuracy of race-specific and fatness-specific bioelectrical impedance analysis (BIA) equations for estimating criterion fat-free mass (FFM) derived from two-component (2C) and multicomponent (MC) models was examined. Body density (Db) of Native American women (n = 151) aged 18-60 y was measured by hydrostatic weighing at residual volume. Total body bone ash was obtained by dual-energy, x-ray absorptiometry. Cross-validation of the Rising (5), Segal (3), and Gray (4) equations against FFM2C yielded high correlation coefficients (0.86-0.95) and acceptable SEEs (1.47-2.72 kg). Cross-validation of these equations against criterion FFMMC, with Db adjusted for total body mineral, yielded similar correlation coefficients (0.82-0.94) and SEEs (1.69-2.80 kg). However, each BIA equation significantly overestimated FFMMC. A new race-specific BIA equation based on an MC model was developed: FFMMC = 0.001254(HT2)-0.04904(R) + 0.1555(WT) + 0.1417(Xc) - 0.0833(AGE) + 20.05 (R = 0.864, and SEE = 2.63 kg).

The fatness-specific bioelectrical impedance analysis equations of Segal et al: are they generalizable and practical?

The fatness-specific bioelectrical impedance analysis (BIA) equations of Segal et al (Am J Clin Ntr 1988;47: 7-14; Segal equations) have been shown to be generalizable across sex, ethnicity, age, and degrees of adiposity. However, these fatness-specific equations require an a priori determination of percentage body fat (%BF) by using a skinfold equation or densitometry to categorize subjects into obese or nonobese groups. These procedures negate the use of BIA as a fast and simple method. It was hypothesized that the average of the Segal nonobese and obese fatness-specific equations (BIA average method) could be used in lieu of the skinfold method for categorizing subjects who are not obviously lean or obese. In phase 1 these three methods were compared for a subsample of 59 women who were not obviously lean or obese. The %BF of 75% of these subjects was accurately estimated within 3.5%BF by using the BIA average method whereas only 71% and 46% were accurately estimated by fusing the densitometric and skinfold methods, respectively. In phase 2, the predictive accuracy of the Segal fatness-specific equations, used in combination with the BIA average method, was compared with other BIA equations published previously for 602 American Indian, Hispanic, and white women and men. The Segal fatness-specific equations yielded the smallest prediction error (SEE = 2.22 kg for women and 3.59 kg for men) and the %BF of 70% of the subjects was accurately estimated within 3.5%BF compared with 24-59% for other BIA equations. Therefore, we recommend using the Segal fatness-specific and average equations to assess body composition in heterogeneous populations.

Assessing body composition of adults with diabetes.

Overweight and obesity are associated with the development of type 2 diabetes. Thus, it is important for clinicians to accurately measure and monitor the body composition of at-risk individuals and patients with diabetes. This article reviews valid and reliable field methods and prediction equations for assessing the body composition of obese individuals, as well as persons with type 2 diabetes. We also reviewed research that assessed the validity of practical methods in estimating the body composition of individuals with either type 1 or type 2 diabetes.

Predictive accuracy of skinfold equations for estimating body density of African-American women.

PURPOSE: The purpose of this study was to compare the predictive accuracy of previously published skinfold (SKF) equations for estimating body density of 134 premenopausal African-American women (18 to 40 yr). METHODS: The equations cross-validated were: the sum of seven skinfolds equation (JPW7) and the sum of three skinfolds equation (JPW3), both of Jackson et al. (1980); the generalized equation (DWgen) and the age-specific equation (DWage) of Durnin and Womersley (1974); and the equation of Wang et al. (1994). Total body density was determined by hydrodensitometry (BDuww) at residual lung volume and converted to %BFuww using the Siri (1991) formula. The predictive accuracy of the SKF equations tested in this study was evaluated using the cross-validation procedures outlined by Lohman (1992). RESULTS: The validity coefficients (ry,y') ranged from 0.83 (DWgen) to 0.87 (JPW7). The SEEs ranged from 0.0076 g.cc-1 (DWage) to 0.0122 g.cc-1 (Wang), and the total errors ranged from 0.0103 g.cc-1 (JPW7) to 0.0478 g.cc-1 (Wang). The percentage of individual residual scores falling within +/- 3.5% BF for this sample ranged from 31% (DWage) to 58% for the JPW7 equation. Comparison of the predictive accuracy of the five equations indicated that the JPW7 equation was the most valid equation, explaining 75% of the variance in reference body density with no significant difference between average reference BDuww (1.03035 g.cc-1) and average predicted BDJPW7 (1.03152 g.cc-1). CONCLUSIONS: We recommend using the JPW7 equation to assess body composition and %BF of premenopausal African-American women.

Predictive accuracy of BIA equations for estimating fat-free mass of black men.

This study assessed the predictive accuracy of previously published bioelectrical impedence analysis (BIA) equations in estimating the fat-free mass (FFM) of black men, 19 to 50 years. The reference method was hydrostatic weighing (HW) at residual lung volume. Body density (Db) was converted to relative body fat (%BF) for calculation of FFMHW using the Schutte et al. equation. Resistance and reactance were measured with a Valhalla bioimpedance analyzer. Age-specific, generalized, and fatness-specific BIA equations were cross validated using regression analysis. The Segal fatness-specific equations were modified using a method recommended by Stolarczyk. All of the equations significantly (P < 0.05) underestimated the average reference measure of FFMHW. However, the underestimation of FFM for the modified Segal fatness-specific equation was relatively small (-1.8 kg) and not likely to have much clinical significance. Furthermore, this equation had a high correlation with reference FFMHW (ry,y' = 0.97), low prediction errors (SEE = 2.1 kg; E = 2.7 kg), and accurately estimated the FFM within +/- 3.5 kg for 78% of the individuals in the sample. Thus, we recommend using the modified fatness-specific BIA equation for estimating the FFM of black men.

Validation of near-infrared interactance and skinfold methods for estimating body composition of American Indian women.

PURPOSE: This study tested the predictive accuracy of the Jackson et al. skinfold (SKF) equations (sigma7SKF and sigma3SKF), a multi-site near-infrared interactance (NIR) prediction equation, and the Futrex-5000 NMR equation in estimating body composition of American Indian women (N = 151, aged 18-60 yr). METHODS: Criterion body density (Db) was obtained from hydrodensitometry at residual lung volume. RESULTS: Sigma7SKF significantly underestimated Db (P < 0.05). Sigma3SKF and Heyward's NIR equations significantly overestimated Db (P < 0.05). The Futrex-5000 NIR equation significantly underestimated percent of body fat (%BF) (P < 0.05). Prediction errors for SKF and multi-site NIR exceeded 0.0080 g x cc(-1). The SEE for Futrex-5000 was 5.5%BF. Thus, ethnic-specific SKF and NIR equations were developed. For the SKF model, the sigma3SKF (triceps, axilla, and suprailium) and age explained 67.3% of the variance in Db:Db = 1.06198316 -0.00038496(sigma3SKF) -0.00020362(age). Cross-validation analysis yielded r = 0.88, SEE = 0.0068 g x cc(-1), E = 0.0070 g x cc(-1), and no significant difference between predicted and criterion Db. For the NIR model, the hip circumference, sigma2AdeltaOD2 (biceps and chest), FIT index, age, and height explained 73.9% of the variance in Db:Db = 1.0707606 -0.0009865(hip circumference) -0.0369861(sigma2deltaOD2) + 0.0004167(height) + 0.0000866(FIT index) -0.0001894(age). Cross-validation yielded r = 0.85, SEE = 0.0076 g x cc(-1), E = 0.0079 g x cc(-1), and a small, but significant, difference between predicted and criterion Db. CONCLUSIONS: We recommend using the ethnic-specific SKF and NIR equations developed in this study to estimate Db of American Indian women.

Predictive accuracy of bioimpedance equations in estimating fat-free mass of Hispanic women.

This study assessed the predictive accuracy of previously published bioelectrical impedance analysis equations for estimating fat-free mass of young (20-39 yr) Hispanic women (N = 29). The reference method was hydrostatic weighing at residual lung volume. Body density was converted to percent body fat using the Siri equation. Resistance and reactance were measured with a Valhalla bioimpedance analyzer. The bioelectrical impedance analysis equations of Lohman, Rising, Stolarczyk, Segal, Gray, and Van Loan were cross-validated. There were significant correlations between criterion and predicted fat-free mass (r = 0.86-0.95) for all equations. The standard error of estimate for each equation was acceptable; however, the total error for the Stolarczyk (3.2 kg) and the Van Loan (4.6 kg) equations exceeded the recommended value (2.8 kg). For all equations, the difference between average criterion and predicted fat-free mass was significant (P < 0.05). However, the mean differences for the Lohman (0.8 kg), Segal (0.8 kg), and Gray (0.9 kg) equations were small. In conclusion, the Segal, Lohman, and Gray equations may have potential for assessing the body composition of healthy, acculturated, Hispanic women.

Predictive accuracy of bioimpedance in estimating fat-free mass of African-American women.

The purpose of this study was to identify the BIA (bioimpedance analysis) equation that yields the best estimate of body composition for 122 premenopausal African-American women (18-40 yr). Total body density (Db) was determined by hydrodensitometry at residual lung volume and converted to %BFHD using the Siri (31) formula, %BFHD was used to calculate reference fat-free mass (FFM). Resistance and reactance were measured using a Valhalla bioimpedance analyzer. The predictive accuracy of generalized, age-gender, race-specific, fatness-specific, and the Valhalla manufacturer's BIA equations was compared. There were significant correlations between FFMHD and FFMBIA for all BIA equations (r = 0.85 to 0.92). Except for the modified Segal fatness-specific equations, the prediction errors (SEE and E) exceeded 2.8 kg. For individuals, the %BF derived from FFMBIA predicted by the modified Segal equations was within +/- 3.5% BF for 69% of the subjects. This percentage was less (34-53%) for other equations. These results suggest that the predictive accuracy of BIA for estimating body composition of African-American women is improved when fatness-specific equations are used. We recommend using the modified Segal fatness-specific equations to assess FFM and %BF of premenopausal African-American women.

Knowledge, attitudes and behaviors related to physical activity among Native Americans with diabetes.

OBJECTIVE: Native Americans (NA) have higher diabetes morbidity and mortality compared to other ethnic groups. Although exercise plays an important role in diabetes management, little is known about exercise among Native Americans with diabetes. Our goal was to describe knowledge, attitudes and behaviors related to exercise in Native American participants in New Mexico. DESIGN: Bilingual community members administered a questionnaire to assess knowledge, stage of change (a measure of exercise readiness), and physical activity behavior. Hemoglobin A1c (HbA1c) was measured by DCA 2000 analyzer. Height and weight were measured to calculate body mass index (BMI). Average random blood glucose (RBS) levels and diabetes duration were assessed through chart audit. SETTING: Questionnaires were completed in offices in or near the communities. PARTICIPANTS: 514 Native Americans with diabetes were identified as potential participants, 40% (142 women, 64 men) participated. RESULTS: 37% of participants knew exercise lowers blood sugar. 82% reported they were in the preparation, action, or maintenance stage of change for exercise behavior. Seventy seven percent of this population did not meet the Surgeon General's recommendation for accumulating 30 minutes of leisure time endurance exercise on most days of the week. However, 67% of participants fell within the "high activity" category for all moderate and vigorous activities. Average age, BMI and HbA1c were 58.5 yrs., 30.5 kg/m2, 8.6%, respectively. CONCLUSIONS: Interventions to increase physical activity awareness and participation could improve diabetes management and overall health for Native Americans. When evaluating physical activity, researchers need to consider usual activities of daily living and leisure time activities specific to that population. Failure to do so would be ethnocentric and could lead to inappropriate conclusions.

Body composition of Native-American women estimated by dual-energy X-ray absorptiometry and hydrodensitometry.

In the present sample, the Native-American women varied in age (18-60 y) and fatness (23.0-57.4% BF). The cross-validation analysis for %BF estimated by DXA for this sample yielded a high validity coefficient (r = 0.89), and the average %BFDXA (37.3%) and %BFHW (37.6%) did not differ significantly. The prediction error (3.28% BF) was less than the theoretical expected value, given the wide range in age and fatness in this sample. Thus, it appears that DXA may be a viable alternative method for estimating the %BF of a diverse group of Native-American women. The DXA method is more practical than hydrostatic weighing, especially for subjects who are uncomfortable in the water. Also, DXA estimates of bone mineral may lead to improved estimates of FFB density for different ethnic populations.

Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study.

Using data from 12 days of detailed physical activity records (PA records), we analyzed the physical activity patterns of 141 African American and Native American women, ages 40 and older, enrolled in the Cross-Cultural Activity Participation Study. PA records were completed every other month for three consecutive 4-day periods. The proportion of women who met the 1993 Centers for Disease Control and Prevention and the American College of Sports Medicine recommendation to accumulate at least 30 minutes of moderate intensity activity during most days of the week (at least 3 days of the 4-day periods) ranged from 63% to 70%. Nearly one third of women met the recommendation for more than one 4-day period. On days when subjects accumulated at least 30 minutes of moderate activity, time spent in moderate activity was 112 minutes/day. Most women performed household chores (95%, median = 24 minutes/day), walking for exercise (87%, median = 30 minutes/day), occupational (65%, median = 37 minutes/day), child care (53%, median = 32 minutes/day), and lawn and garden activities (51%, median = 43 minutes/day). Fewer than 25% reported conditioning and sports activities. In general, more Native Americans than African Americans were active in moderate activities. In conclusion, definitions used to characterize regular physical activity should be consistent among studies, and physical activity surveys among women should include occupation-related and home-related activities.

Cross-validation of modified fatness-specific bioelectrical impedance equations.

The Segal fatness-specific bioelectrical impedance (BIA) equations are useful for predicting fat-free mass (FFM). Stolarczyk et al. Proposed a modified method of averaging the two equations for individuals who are neither lean nor obese, thus eliminating the need to know % BF a priori. To cross-validate this modification, we compared FFM determined using the averaging method versus hydrostatic weighing for 76 adults. Per the averaging method, accuracy for males was excellent (r =.91, SEE = 2.7 kg, E = 2.7 kg), with 78% of individuals within +/- .5% BF predicted by hydrostatic weighing. Accuracy for females was lower (r =.88, SEE = 3.0 kg, E = 3.1 kg), with % BF of 51% within +/- 3.5% of the reference method. The relative ease and practicality of the averaging method and the results of this study indicate this method may be useful with a diverse group.