Correlation of obesity with elevated blood pressure among racial/ethnic minority children in two Los Angeles middle schools.

INTRODUCTION: To identify anthropometric and fitness correlates of elevated blood pressure, serum cholesterol, and glycated hemoglobin, we examined anthropometric and physiologic biomarkers among racial/ethnic minority children aged 11 to 13 years in two urban Los Angeles middle schools. We explored the potential for using obesity or fitness level as screening variables for cardiovascular disease risk factors in these students. METHODS: During regularly scheduled physical education classes, we collected data on demographic characteristics, height, weight, blood pressure, nonfasting total serum cholesterol, glycated hemoglobin, time to run/walk 1 mile, and a range of self-reported behaviors. A total of 199 sixth-graders (121 Latinos, 78 African Americans) participated in the study. RESULTS: Bivariate analyses indicated that 48.6% of sixth-graders were of desirable weight, 17.5% were overweight, 29.9% were at risk for overweight, and 4.0% were underweight. Higher weight was associated with higher levels of serum cholesterol, systolic blood pressure, and diastolic blood pressure (P values for all associations <.02) but not with glycated hemoglobin. Multivariate analyses maintained the findings with regard to blood pressure but not serum cholesterol. CONCLUSION: Overweight status could be a screening variable for identifying youth at risk for high blood pressure. Obesity prevention and intervention programs and policies need to target low-income racial/ethnic minority children. Assessment of hypertension status also seems warranted in low-income racial/ethnic minority sixth-graders, as does early intervention for children at high risk.

Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention.

OBJECTIVE: This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition. METHODS: A randomized, attention-controlled, two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy, obese African American women. A free 1-year membership to the study site gym was provided to participants in both groups. Data were collected at baseline, 2, 6, and 12 months. RESULTS: Sample retention at 1 year was 71%. Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls (+0.05 kg/m(2), p = 0.75; +0.32 kg/m(2), p = 0.08, respectively), disappearing at 12 months (+1.37 kg/m(2), p = 0.0001; +1.02 kg/m(2), p = 0.001, respectively). Within-group analysis demonstrated that intervention and control participants' fitness (1-mile run-walk) improved by 1.9 minutes (p = 0.0001) and 2.3 minutes (p = 0.0001), respectively, at 12 months. Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness (p = 0.0185) and a marginally significant effect on body mass index (BMI) (p = 0.057), at 2 months, disappearing by 6 months. By 12 months, however, the controls exhibited a significant advantage in waist circumference stability compared with intervention participants (+1.1 cm, p = 0.2763; +2.1 cm, p = 0.0002, respectively). CONCLUSIONS: The intervention produced modest short-term improvements in body composition, but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested. However, longer-term fitness enhancement remains elusive and demands research and policy attention. These findings have policy implications in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change (e.g., physical or social/environmental) to foster sustainable fitness improvements.

Population-based interventions engaging communities of color in healthy eating and active living: a review.

INTRODUCTION: The U.S. obesity epidemic is escalating, particularly among communities of color. Obesity control efforts have shifted away from individual-level approaches toward population-based approaches that address socio-cultural, political, economic, and physical environmental factors. Few data exist for ethnic minority groups. This article reviews studies of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses. METHODS: Inclusion criteria were established, an electronic database search conducted, and non-electronically catalogued studies retrieved. Findings were aggregated for earlier (early 1970s to early 1990s) and later (mid-1990s to present) interventions. RESULTS: The search yielded 23 ethnically inclusive intervention studies published between January 1970 and May 2003. Several characteristics of inclusive interventions were consistent with characteristics of community-level interventions among predominantly white European-American samples: use of non-interpersonal channels for information dissemination directed at broad spheres of influence (e.g., mass media), promotion of physical activity, and incorporation of social marketing principles. Ethnically inclusive studies, however, also placed greater emphasis on involving communities and building coalitions from study inception; targeting captive audiences; mobilizing social networks; and tailoring culturally specific messages and messengers. Inclusive studies also focused more on community than individual norms. Later studies used "upstream" approaches more than earlier studies. Fewer than half of the inclusive studies presented outcome evaluation data. Statistically significant effects were few and modest, but several studies demonstrated better outcomes among ethnic minority than white participants sampled. CONCLUSION: The best data available speak more about how to engage and retain people of color in these interventions than about how to create and sustain weight loss, regular engagement in physical activity, or improved diet. Advocacy should be directed at increasing the visibility and budget priority of interventions, particularly at the state and local levels.

Malnutrition and dietary protein: evidence from China and from international comparisons.

Malnutrition, as measured by anthropometric status, is a powerful risk factor for illness and elevated death rates throughout life. Understanding the relative importance of disease, dietary quantity, and dietary quality in causing malnutrition is therefore of major importance in the design of public policy. This paper contributes to the understanding of the relative importance of quantity and quality of diet by utilizing aggregate data to complement previously reported individual-level studies. Three compilations of anthropometric data--one involving subjects from 13 provinces in China, another involving subjects from 64 counties in China, and a third involving 41 populations in 40 countries--are used to examine the relative importance for human growth of inadequacies of dietary energy and protein. The analysis involves regressing average adult heights and weights against estimates of average energy and protein availability (by province, county, or country) and per capita incomes. We use protein availability in part as a marker for overall quality of the diet, while recognizing that protein is far from perfectly correlated with dietary fat or micronutrient availability. The paper discusses issues of both data quality and statistical methodology, and points to relevant resulting caveats to our conclusions. Subject to these limitations, all three analyses suggest that, at the levels of dietary intake in these populations, lower protein intake is related to growth failure whereas lower levels of energy availability are not. The protein effect appears stronger for males than for females.

Fighting cancer with fitness: dietary outcomes of a randomized, controlled lifestyle change intervention in healthy African-American women.

OBJECTIVES: This study tested the efficacy of an 8-week, culturally targeted community-based nutrition and physical activity promotion intervention, Fight Cancer with Fitness! (FCF). METHODS: A randomized, controlled trial was conducted in a black-owned commercial gym in a sample of 366 predominantly overweight or obese, healthy African-American women. RESULTS: Dietary quality as indexed by fruit and vegetable intake improved significantly in the intervention group compared to the control group at 12-month follow-up, and proportion of calories consumed as fat decreased in both groups. CONCLUSIONS: This individually targeted cancer prevention intervention produced beneficial effects on dietary quality that were sustained for at least 12 months.

Estudios prospectivos de los efectos de las enfermedades en una comunidad rural del nordeste del Brasil / Prospective studies of the illness burden in a rural community of northeast Brazil

Publicado en inglés: Bull. Pan. Am. Health Organ 19(2)

Estudios prospectivos de los efectos de las enfermedades en una comunidad rural del Nordeste del Brasil / Prospective studies of the effects of diseases in a rural community Northeast of Brazil

Se hizo un estudio longitudinal de 78 semanas de duración de los residentes de tres vecindarios diferentes de Pacatuba, pueblo situado al nordeste del Brasil, para tratar de conocer la frecuencia de las enfermedades febriles, respiratorias y diarreicas entre esta población. Un miembro del equipo que llevó a cabo el estudio compiló la información mediante visitas que hacía una vez por semana a cada vivienda; los datos se basaban en lo que recordaba un adulto respecto a los síntomas manifestados durante la semana anterior por los miembros de la unidad familiar. En total, se obtuvieron datos de 48 familias por un período de tiempo suficiente y con bastante regularidad como para incluirlos en el análisis subsiguiente. Este análisis reveló que se habían notificado síntomas de enfermedades febriles, respiratorias o diarreicas en aproximadamente la tercera parte de todas las semanas del estudio entre niños de uno a dos años de edad residentes en dos vecindarios pobres comprendidos en la encuesta. De ahí en adelante esta tasa disminuyó constantemente, a medida que los grupos de edad se hacían progresivamente mayores, hasta alcanzar los niveles de adultos. Los números promedio de episodios de enfermedades febriles, respiratorias y diarreicas notificados en los niños menores de cinco años en los dos vecindarios pobres (Matadouro y Säo Joäo) fueron 6, 8, 5 y 3, 4 episodios por año en Matadouro y 4, 2, 7, 8 y 5, 1 por año en Säo Joäo. En contraste, parece que los niños estudiados en el "Centro" de clase media de Pacatuba acusaban una morbilidad coherentemente más baja en todos los grupos de edad estudiados. En general, los patrones de morbilidad de este vecindario mostraron la tendencia a parecerse a los notificados en Cleveland, Ohio y Charlottesville, Virginia. No se ha aclarado si la notificación incompleta podría ser en parte responsable de estas tasas aparentemente bajas. Sin embargo, es probable que los datos de los dos vecindarios pobres reflejen los patrones de morbilidad generales prevalecientes entre las grandes poblaciones rurales empobrecidas del nordeste del Brasil, que tiene una población rural de más de un millón de habitantes, y en la que más del 90% de los niños pertenecen a familias con ingresos por persona inferiores a US$ 30 mensuales. De ahí que los datos notificados ofrezcan una base provisional para visualizar un lastre de enfermedades de impresionante magnitud que soporta esta población mucho más numerosa