Cedar City, GA, United States
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Cogswell M.E.,Physical Activity and Obesity | Wang C.-Y.,National Center for Health Statistics | Chen T.-C.,National Center for Health Statistics | Pfeiffer C.M.,National Center for Chronic Disease Prevention and Health Promotion | And 8 more authors.
American Journal of Clinical Nutrition | Year: 2013

Background: Collecting a 24-h urine sample is recommended for monitoring the mean population sodium intake, but implementation can be difficult. Objective: The objective was to assess the validity of published equations by using spot urinary sodium concentrations to predict 24-h sodium excretion. Design: This was a cross-sectional study, conducted from June to August 2011 in metropolitan Washington, DC, of 407 adults aged 18-39 y, 48% black, who collected each urine void in a separate container for 24 h. Four timed voids (morning, afternoon, evening, and overnight) were selected from each 24-h collection. Published equations were used to predict 24-h sodium excretion with spot urine by specimen timing and race-sex subgroups. We examined mean differences with measured 24-h sodium excretion (bias) and individual differences with the use of Bland-Altman plots. Results: Across equations and specimens, mean bias in predicting 24-h sodium excretion for all participants ranged from-267 to 1300mg (Kawasaki equation). Bias was least with International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) equations with morning (-165 mg; 95% CI: -295, 36 mg), afternoon (-90 mg; -208, 28 mg), and evening (-120 mg; -230, -11 mg) specimens. With overnight specimens, mean bias was least when the Tanaka (-23 mg; 95% CI: -141, 95 mg) or Mage (-145 mg; -314, 25 mg) equations were used but was statistically significant when using the Tanaka equations among females (216 to 243 mg) and the Mage equations among races other than black (-554 to -372 mg). Significant over- And underprediction occurred across individual sodium excretion concentrations. Conclusions: Using a single spot urine, INTERSALT equations may provide the least biased information about population mean sodium intakes among young US adults. None of the equations evaluated provided unbiased estimates of individual 24-h sodium excretion. This trial was registered at clinicaltrials.gov as NCT01631240. © 2013 American Society for Nutrition.

Park S.,Physical Activity and Obesity | Blanck H.M.,Physical Activity and Obesity | Sherry B.,Centers for Disease Control and Prevention | Brener N.,Centers for Disease Control and Prevention | O'Toole T.,Centers for Disease Control and Prevention
Journal of Nutrition | Year: 2012

This cross-sectional study examined associations of demographic characteristics, weight status, availability of school vending machines, and behavioral factors with sugar-sweetened beverage (SSB) intake, both overall and by type of SSB, among a nationally representative sample of high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,209 students (grades 9-12) were used. SSB intake was based on intake of 4 nondiet beverages [soda, other (i.e., fruit-flavored drinks, sweetened coffee/tea drinks, or flavored milk), sports drinks, and energy drinks]. Nationwide, 64.9% of high school students drank SSB≥1 time/d, 35.6% drank SSB≥2 times/d, and 22.2% drank SSB≥3 times/d. The most commonly consumed SSB was regular soda. Factors associated with a greater odds for high SSB intake (≥3 times/d) were male gender [OR = 1.66 (95% CI = 1.41,1.95); P < 0.05], being non-Hispanic black [OR = 1.87 (95% CI = 1.52, 2.29); P < 0.05], eating at fast-food restaurants 1-2 d/wk or eating there ≥3 d/wk [OR = 1.25 (95% CI = 1.05, 1.50); P, 0.05 and OR = 2.94 (95% CI = 2.31, 3.75); P < 0.05, respectively] and watching television > 2 h/d [OR = 1.70 (95% CI = 1.44, 2.01); P < 0.05]. Non-Hispanic other/multiracial [OR = 0.67 (95% CI = 0.47, 0.95); P < 0.05] and being physically active ≥ 60 min/d on < 5 d/wk were associated with a lower odds for high SSB intake [OR = 0.85 (95% CI = 0.76, 0.95); P < 0.05]. Weight status was not associated with SSB intake. Differences in predictors by type of SSB were small. Our findings of significant associations of high SSB intake with frequent fast-food restaurant use and sedentary behaviors may be used to tailor intervention efforts to reduce SSB intake among high-risk populations. © 2012 American Society for Nutrition.

O'Sullivan E.J.,Cornell University | Perrine C.G.,Physical Activity and Obesity | Rasmussen K.M.,Cornell University
Journal of Nutrition | Year: 2015

Background: Compared with normal-weight women, women with obesity experience poorer breastfeeding outcomes. Successful breastfeeding among women with obesity is important for achieving national breastfeeding goals. Objectives: The objectives were to determine whether the negative association between obesity and any or exclusive breastfeeding at 1 and 2 mo postpartum is mediated through breastfeeding problems that occur in the first 2 wk postpartum and if this association differs by parity. Methods: Mothers (1151 normal-weight and 580 obese) in the Infant Feeding Practices Study II provided information on sociodemographic and psychosocial characteristics, body mass index, and breastfeeding outcomes. At 1 mo postpartum, participants reported the breastfeeding problems they experienced in the first 2 wk postpartum from a predefined list of 17 options. We used factor analysis to condense these problems into 4 explanatory variables; continuous factor scores were computed for use in further analyses. We used maximum likelihood logistic regression to assess mediation of the association between obesity and breastfeeding outcomes through early breastfeeding problems. Results: No significant effect of obesity was found on any breastfeeding at 1 or 2 mo. At 1 mo postpartum, for both primiparous and multiparous women, there was a significant direct effect of obesity on exclusive breastfeeding and a significant indirect effect of obesity through early breastfeeding problems related to the explanatory mediating variable "Insufficient Milk" (throughout the remainder of the Abstract, this factor will be denoted by upper case notation). At 2 mo postpartum both the direct effect of obesity and the indirect effect through Insufficient Milk were significant in primiparous women but only the indirect effect remained significant in multiparous women. Conclusions: Early problems related to Insufficient Milk may partially explain the association between obesity and poor exclusive breastfeeding outcomes. Women who are obese, particularly those reporting breastfeeding problems that grouped in the Insufficient Milk factor in the early postpartum period, may benefit from additional breastfeeding support. © 2015 American Society for Nutrition.

Freedman D.S.,Physical Activity and Obesity | Lawman H.G.,National Center for Health Statistics | Skinner A.C.,University of North Carolina at Chapel Hill | McGuire L.C.,Physical Activity and Obesity | And 2 more authors.
American Journal of Clinical Nutrition | Year: 2015

Background: The WHO cutoffs to classify biologically implausible values (BIVs) for weight, height, and weight-for-height in children and adolescents are widely used in data cleaning. Objectives: We assess 1) the prevalence of these BIVs, 2) whether they were consistent with information on waist circumference, arm circumference, and leg lengths, and 3) the effect of their exclusion on the estimated prevalence of obesity in 2- to 19-y-olds in the NHANES, which is a study in which extreme values were verified when recorded. Design: We conducted cross-sectional analyses in 26,480 children and adolescents in the NHANES from 1999-2000 through 2011-2012. Results: The overall prevalence for a BIV for any body-size measure was 0.9% (n = 277), and almost all BIVs were due to extremely high, rather than low, values. Of 186 subjects who had a high BIV for weight or body mass index (BMI), all but one subject had both arm and waist circumferences that were greater than the sex- and age-specific 95th percentiles; 75% of subjects had circumferences greater than the 99th percentile. Of 63 subjects with a high height BIV, 75% of them had a leg length that was greater than the 95th percentile. The exclusion of children and adolescents with a BIV reduced the overall prevalence of obesity by ∼0.5 percentage points and by 1.7% in non-Hispanic blacks. Conclusions: Most of the extremely high values of weight, height, and BMI flagged as BIVs in the NHANES are very likely correct. The increase of z score cutoffs or the use of an alternative method to detect possible errors could improve the balance between removing incorrect values and retaining extremely high, but accurate, values in other data sets. © 2015 American Society for Nutrition.

Song M.,Epidemic Intelligence Service | Carroll D.D.,Physical Activity and Obesity | Carroll D.D.,Health-U | Fulton J.E.,Physical Activity and Obesity
American Journal of Preventive Medicine | Year: 2013

Background: Participation in physical activity brings health benefits for adolescents. However, limited data are available on the percentage of U.S. adolescents who engage in levels of aerobic and muscle-strengthening activities recommended in the 2008 Physical Activity Guidelines for Americans (2008 Guidelines). Purpose: To examine the prevalence at which U.S. adolescents aged 12-17 years meet the 2008 Guidelines, and whether demographic and BMI variables influence that prevalence. Methods: Using data from an interviewer-administered self-report questionnaire in the 1999-2006 National Health and Nutrition Examination Survey (analyzed in 2011), estimates were made of the percentage of adolescents who engaged in recommended levels of aerobic and muscle-strengthening activities (≥60 minutes of aerobic activity/day and participation in muscle-strengthening activities ≥3 days/week). Results: Among 6547 U.S. adolescents aged 12-17 years, 16.3% (95% CI=14.9%, 17.9%) met both aerobic and muscle-strengthening guidelines; 14.7% (13.3%, 16.2%) met the aerobic guideline only, 21.3% (19.4%, 23.3%) met the muscle-strengthening guideline only, and 47.8% (45.4%, 50.1%) met neither guideline. Adjusted for covariates, odds of meeting either the aerobic or muscle-strengthening guideline only or both guidelines versus meeting neither guideline were (p<0.05) higher among boys than girls. The odds of meeting the aerobic guideline only were higher among underweight/normal-weight adolescents than among obese adolescents. No clear pattern was observed by family groups according to poverty-to-income ratio. Conclusions: Less than 20% of adolescents reported engaging in recommended levels of both aerobic and muscle-strengthening activities.

Freedman D.S.,Physical Activity and Obesity | Ford E.S.,Adult and Community Health
American Journal of Clinical Nutrition | Year: 2015

Background: Several studies showed that the waist circumference of US adults has increased over the past 25 y. However, because of the high correlation between waist circumference and body mass index (BMI; in kg/m2) (r ∼ 0.9), it is uncertain if these trends in waist circumference exceed those expected on the basis of BMI changes over this time period. Objective: We assessed whether the recent trend in waist circumference was independent of changes in BMI, age, and race-ethnicity. Design: We analyzed data from the 1999-2000 through 2011-2012 cycles of the NHANES. Results: The mean waist circumference increased by ∼ 2 cm (inmen) and ∼4 cm (in women) in adults in the United States over this 12-y period. In men, this increase was very close to what would be expected because of the 0.7 increase in mean BMI over this period. However, in women, most of the secular increase in waist circumference appeared to be independent of changes in BMI (mean: 0.6), age, and raceethnicity over the 12-y period. We estimated that, independent of changes in these covariates, the mean waist circumference increased by 0.2 cm in men and 2.4 cm in women from 1999-2000 through 2011-2012; only the latter estimate was statistically significant. Conclusions: Our results indicate that, in women but not men, the recent secular trend in waist circumference is greater than what would be expected on the basis of changes in BMI. Possible reasons for this secular increase, along with sex differences, are uncertain. © 2015 American Society for Nutrition.

Blanck H.M.,Physical Activity and Obesity | Kim S.A.,Physical Activity and Obesity
American Journal of Preventive Medicine | Year: 2012

Childhood obesity is a major threat to individual health and society overall. Policies that support healthier food and beverage choices have been endorsed by many decision makers. These policies may reach a large proportion of the population or in some circumstances aim to reduce nutrition disparities to ensure health equity. The Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) evaluates policy as a tool to improve food and beverage environments where Americans live, work, play, and learn. The network aspires to address research and evaluation gaps related to relevant policies, create standardized research tools, and help build the evidence base of effective policy solutions for childhood obesity prevention with a focus on reach, equity, cost effectiveness, and sustainability. © 2012 American Journal of Preventive Medicine.

Pan L.,Physical Activity and Obesity
American Journal of Preventive Medicine | Year: 2015

Introduction Racial/ethnic differences in recent obesity trends have not been reported among young low-income children. The purpose of this study is to examine trends in obesity prevalence from 1998 through 2011 by race/ethnicity among low-income children aged 2-4 years. Methods The study was based on measured weight and height records of 29,040,851 participants of federally funded health and nutrition programs from 30 states and the District of Columbia, which provided data each year from 1998 through 2011. More than 80% of data were collected through the Special Supplemental Nutrition Program for Women, Infants, and Children, and about 50% of eligible children were included. In 2014, joinpoint regression was used to identify the inflection years when significant changes in obesity trends occurred and piecewise logistic regression was used to examine annual changes in obesity prevalence before and after the inflection years controlling for age, sex, and race/ethnicity. Results The overall obesity prevalence increased from 13.05% in 1998 to 15.21% in 2003, and decreased slightly to 14.74% in 2011. The increasing trends among non-Hispanic white, non-Hispanic black, and Hispanic children began decreasing in 2003. Asian/Pacific Islander was the only racial/ethnic group with a continual decreasing trend in obesity prevalence from 1998 (14.34%) through 2011 (11.66%). Among American Indian/Alaska Native children, obesity prevalence consistently increased from 16.32% in 1998 to 21.11% in 2011, although the annual increases slowed since 2001. Conclusions The study findings indicate modest recent declines in obesity prevalence for most racial/ethnic groups of low-income children aged 2-4 years. However, obesity prevalence remains high.

Freedman D.S.,Physical Activity and Obesity | Horlick M.,U.S. National Institutes of Health | Berenson G.S.,Tulane University
American Journal of Clinical Nutrition | Year: 2013

Background: Although estimation of percentage body fat with the Slaughter skinfold-thickness equations (PBFSlaughter) is widely used, the accuracy of this method has not been well studied. Objective: The objective was to determine the accuracy of the Slaughter skinfold-thickness equations. Design: We compared agreement between PBFSlaughter and estimations derived from dual-energy X-ray absorptiometry (PBFDXA) in 1169 children in the Pediatric Rosetta Body Composition Project and the relation to cardiovascular disease risk factors, as compared with body mass index (BMI), in 6725 children in the Bogalusa Heart Study. Results: PBFSlaughter was highly correlated (r = 0.90) with PBFDXA, but it markedly overestimated levels of PBFDXA in children with large skinfold thicknesses. In the 65 boys with a sum of skinfold thicknesses (subscapular- plus triceps-skinfold thicknesses) ≥50 mm, PBF Slaughter overestimated PBFDXA by 12 percentage points. The comparable overestimation in girls with a high skinfold sum was 6 percentage points.We also found that, after adjustment for sex and age, BMI showed slightly stronger associations with lipid, lipoprotein, insulin, and blood pressure values than did PBFSlaughter. Conclusions: These results indicate that PBFSlaughter, which was developed among a group of much thinner children and adolescents, is fairly accurate among nonobese children, but markedly overestimates the body fatness of children who have thick skinfold thicknesses. Furthermore, PBFSlaughter has no advantage over sex- And age-adjusted BMIs at identifying children who are at increased risk of cardiovascular disease based on lipid, lipoprotein, insulin, and blood pressure values. © 2013 American Society for Nutrition.

Brown D.R.,Physical Activity and Obesity
American Journal of Preventive Medicine | Year: 2012

The Community Preventive Services Task Force concludes there is insufficient evidence to determine the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. Additional research is needed to determine effectiveness.

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