Relationships of physical activity with dietary behaviors among adults

Associations between self-reported weight management methods with diet quality as measured by the Healthy Eating Index-2005

OBJECTIVE

We examine the relationship between weight management practices and diet quality.

METHOD

Regressions were used to analyze the associations between self-reported weight management methods and diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of 1,933 respondents who tried to lose or not gain weight in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). The regressions controlled for sociodemographics, lifestyle behaviors, and other health-related behaviors and perceptions.

RESULTS

Including both switching to foods with lower calories and exercise in weight management was associated with better diet quality, i.e., a higher total HEI-2005 score and higher scores in eight of the twelve HEI-2005 components than including neither method. The eight components included six components on fruit, vegetables and grains, milk, and calories from solid fat, alcohol beverages, and added sugars. Similar but smaller associations were also found among those who reported including either switching to foods with lower calories or exercise.

CONCLUSIONS

Based on self-reported data, the findings suggest that including switching to lower calorie foods and exercise in weight management, as recommended by the Dietary Guidelines for Americans (DGA), is associated with diet quality that is more consistent with the key diet-related advice of the DGA.

Multiple behavior change among church members taking part in the faith, activity, and nutrition program

OBJECTIVE

To examine the extent to which participants in a combined physical activity (PA) and dietary intervention achieved changes in multiple health behaviors.

DESIGN

Group randomized trial; includes only participants assigned to the intervention group only.

SETTING

Thirty-six churches in South Carolina.

PARTICIPANTS

Three hundred sixty African American church members.

INTERVENTION

A 15-month PA and dietary intervention, guided by the structural ecological model, targeting environmental (i.e., social, cultural, physical) and organizational (ie, policies, practices) changes within the church.

MAIN OUTCOME MEASURES

Self-reported PA, fruit and vegetable consumption, fat-, and fiber-related behaviors.

ANALYSIS

Change in each behavior was defined as unadjusted pretest-posttest improvement ≥ 0.20 of the baseline standard deviation. The total number and each combination of behaviors changed were calculated.

RESULTS

Up to 19% changed no health behaviors as defined above, 31% changed 1 health behavior, 31% changed 2 health behaviors, 13% changed 3 health behaviors, and 5% changed all 4 of the targeted health behaviors. Combinations of multiple behavior change included PA and dietary behaviors, which suggests that both behaviors can be changed simultaneously.

CONCLUSIONS AND IMPLICATIONS

Nearly half of participants changed at least 2 health behaviors. Faith-based interventions targeting environmental and organizational change can successfully change multiple behaviors, potentially leading to greater improvements in public health.

Obesity and other modifiable factors for physical inactivity measured by accelerometer in adults with knee osteoarthritis

OBJECTIVE

To investigate the public health impact of obesity and other modifiable risk factors related to physical inactivity in adults with knee osteoarthritis (OA).

METHODS

The frequency of inactivity as defined by the US Department of Health and Human Services was assessed from objective accelerometer monitoring of 1,089 participants (ages 49-84 years) with radiographic knee OA during the Osteoarthritis Initiative 48-month visit (2008-2010). The relationship between modifiable factors (weight status, dietary fat, fiber, smoking, depressive symptoms, knee function, knee pain, and knee confidence) with inactivity was assessed using odds ratios (ORs) and attributable fractions (AFs), controlling for descriptive factors (age, sex, race, education, lives alone, employment, frequent knee symptoms, and comorbidity).

RESULTS

Almost half (48.9%) of participants with knee OA were inactive. Being overweight (OR 1.8, 95% confidence interval [95% CI] 1.2-2.5) or obese (OR 3.9, 95% CI 2.6-5.7), having inadequate dietary fiber intake (OR 1.6, 95% CI 1.2-2.2), severe knee dysfunction (OR 1.9, 95% CI 1.3-2.8), and severe pain (OR 1.7, 95% CI 1.1-2.5) were significantly related to inactivity, controlling for descriptive factors. Modifiable factors with significant average AFs were being overweight or obese (AF 23.8%, 95% CI 10.5-38.6%) and inadequate dietary fiber (AF 12.1%, 95% CI 0.1-24.5%), controlling for all factors.

CONCLUSION

Being obese or overweight, the quality of the diet, severe pain, and severe dysfunction are significantly associated with physical inactivity in adults with knee OA. All components should be considered in designing physical activity interventions that target arthritis populations with low activity levels.

Physical activity and fruit and vegetable intake: correlations between and within adults in a longitudinal multiethnic cohort

PURPOSE

To determine if changes in physical activity were associated with changes in fruit and vegetable intake.

DESIGN

Prospective cohort.

SETTING

Hawaii.

SUBJECTS

Seven hundred adults (18+ years) sampled from the general population.

MEASURES

Computer-assisted telephone interviews conducted at 0, 3, 6, 9, 12, 18, and 24 months; the International Physical Activity Questionnaire; the National Cancer Institute's Fruit and Vegetable Screener.

ANALYSIS

Between-individual correlations of each individual's mean physical activity and mean fruit and vegetable intake were estimated with Pearson correlations. Correlations of physical activity and fruit and vegetable intake within individuals over time were calculated from analysis of covariance models to factor out the variation between individuals.

RESULTS

Individuals with a higher mean physical activity duration tended to eat more fruits and vegetables (r = .30, p < .0001). Within individuals, no average correlation between physical activity and intake of fruit and vegetables was observed over time (r = .03). The variation was great in that some individuals, these behaviors changed simultaneously, but in others, they did not.

CONCLUSION

Although individuals who are more physically active tend to eat more fruits and vegetables (i.e., there is a weak correlation between individuals), on average, individuals do not simultaneously change these behaviors. Implications are that health behaviors may not covary, or that intervention is necessary to bring about covariation in health behaviors. The great variation from individual to individual in the extent to which these two behaviors covaried needs to be studied to determine if the individual tendency for behaviors to covary could be measured and used to individually tailor multiple behavior interventions.

Association between diet and physical activity and sedentary behaviours in 9-10-year-old British White children

OBJECTIVES

To examine the association between diet and physical activity and sedentary behaviours in 9-10-year-old children.

STUDY DESIGN

A cross-sectional study using data from the SPEEDY (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young People) study undertaken in Norfolk, UK.

METHODS

Data from 4-day food diaries and 7 days of accelerometery were matched on concurrent days. Time spent in moderate-to-vigorous physical activity (MVPA), time spent in sedentary behaviour and various measures of dietary intake were collected. Covariates included age, sex, weight status, family socio-economic status, and energy intake reporting quality. Multivariable regression models, adjusted for clustering of children by school and stratified by sex, were fitted to examine the associations between dietary measures and physical activity and sedentary outcomes.

RESULTS

In total, 1317 children (584 boys and 733 girls) provided concurrent data. Boys in the highest quartile of energy percentage from protein spent approximately 6 min [95% confidence interval (CI) 0-12] less in MVPA compared with boys in the lowest quartile. Those in the highest quartiles of fruit and vegetable intake and fruit juice intake had respective average activity counts per minute that were 56 above (95% CI 8-105) and 48 below (95% CI 2-95) those in the lowest quartiles, whilst those in the highest quartile of fizzy drink consumption spent approximately 7 min (95% CI 2-13) more in MVPA and approximately 14 min (95% CI 5-24 min) less in sedentary behaviour. Boys in the highest quartile of savoury snack consumption spent approximately 8 min (95% CI 2-13 min) more in MVPA per day, and approximately 12 min (95% CI 2-23) less in sedentary behaviour. No significant associations were apparent among girls.

CONCLUSIONS

Few associations were detected, and the directions of those that were apparent were mainly counterintuitive. The extent to which this reflects a true lack of association or is associated with the measurement methods used for diet and physical activity needs further investigation.

Trends in the lung cancer incidence and mortality in the Slovak and Czech Republics in the contexts of an international comparison

INTRODUCTION

Lung cancer represents the most frequent cause of cancer-related deaths in the industrialized countries. The aim of this study was to analyze the lung cancer incidence and mortality and the possible reasons for any differences discovered in two neighboring Central European countries-the Slovak Republic.

METHODS

We used linear regression model when analyzing incidence and mortality; the trends are presented with corresponding 95% confidence intervals (CI) and p-value with null hypothesis being constant with time.

RESULTS

Statistically significant increase of age-standardized incidence (0.707/100,000/year, 95% CI 0.107-1.307, p = 0,025) and mortality (1.339/100,000/year, 95% CI 1.050-1.629, p < 0.0001) of the lung cancer was revealed in males in the Slovak Republic (1980-1991). On the contrary, values of both indicators were stabilized in the Czech Republic. Since year 1991-2005 a statistically highly significant decrease of both incidence and mortality values was observed in males, which was greater in the Slovak Republic. Peak of the curve was not reached in women population, while incidence and mortality values have significantly continuous growth in both countries.

CONCLUSIONS

According to the lung cancer incidence and mortality trends in both countries (in correlation with smoking prevalence) we consider the support of efforts to change the attitude towards smoking predominantly in women and younger generation to be the most accurate action to reduce these trends.

Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology

BACKGROUND

Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes.

METHODS

To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, high sedentary leisure time, and low physical activity to 1 of 4 treatments: increase fruit/vegetable intake and physical activity, decrease fat and sedentary leisure, decrease fat and increase physical activity, and increase fruit/vegetable intake and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up, incentives were contingent only on recording. The outcome was standardized, composite improvement on the 4 diet and activity behaviors at the end of treatment and at 5-month follow-up.

RESULTS

Of the 204 individuals randomized, 200 (98.0%) completed follow-up. The increase fruits/vegetables and decrease sedentary leisure treatments improved more than the other 3 treatments (P < .001). Specifically, daily fruit/vegetable intake increased from 1.2 servings to 5.5 servings, sedentary leisure decreased from 219.2 minutes to 89.3 minutes, and saturated fat decreased from 12.0% to 9.5% of calories consumed. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (P < .001).

CONCLUSIONS

Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes.

Improving the Accuracy of Self-Reports on Diet and Physical Exercise: The Co-Twin Control Method

The objective was to examine the association between several obesity-related nongenetic behaviors and body mass index (BMI) and waist circumference (WC) in young adult twins using reports from both twins on their similarities and differences. A total of 713 monozygotic (MZ) and 698 same-sex dizygotic (DZ) twin pairs aged 22–28 years filled in structured questionnaires to compare their eating, physical activity and dieting behavior with their co-twin's behavior, and to report their own eating and exercise habits. In both MZ and DZ pairs, the co-twins for whom both twin pair members concordantly answered that this twin eats more, snacks more, eats more fatty foods and sweet and fatty delicacies, chooses less healthy foods, eats faster and exercises less, had significantly higher BMIs (0.6–2.9 kg/m2) and WCs (1.5–7.5 cm). Multivariate regression analysis identified co-twin differences in the amount of food consumed as the strongest independent predictor of intrapair differences in BMI (β = 0.63 and 1.21, for MZ and DZ, respectively,p< .001) and WC (β = 1.52 and 3.53, for MZ and DZ, respectively,p< .001). Higher leisure-time physical activity and healthier dietary choices clustered in the same subjects. The measurement of habitual dietary intake and physical activity has previously relied on subjective self-reports that are prone to misreporting. By using comparative measures within twin pairs we found that the amount of food consumed is the major contributor to obesity independent of genetic predisposition.

Benefits of pedometer-measured habitual physical activity in healthy women

This cross-sectional study aimed at (i) characterizing pedometer-determined physical activity and (ii) examining its associations with dietary intake and anthropometric and metabolic profile in healthy women. Anthropometric and metabolic profile was evaluated in 68 healthy women of reproductive age. Habitual physical activity was assessed using a pedometer for 6 consecutive days, including weekends. Participants were stratified into active and inactive according to the mean steps·day–1(≥6000 and <6000, respectively). Food consumption was evaluated by 24-h recall in a subsample of 35 participants. Thirty-eight women were defined as active and had significantly lower body mass index (BMI), fat percentage, waist circumference, sum of skinfold thickness, insulin, and HOMA than the sedentary group. Mean BMI was 27 kg·m–2(overweight) in active participants and 31 kg·m–2(class I obesity) in inactive participants. Active women consumed more carbohydrates (55.5% ± 9.4% vs. 46.3% ± 7.6%) and calories (2138 ± 679 vs. 1664 ± 558 kcal), and less protein (15.4% ± 4.2% vs. 19.9% ± 5.8%) and lipids (29.0% ± 7.2% vs. 33.8% ± 6.2%) than inactive individuals (p < 0.05). Fiber, cholesterol, and fatty acid intake was similar in both groups. The number of steps was lower on Sunday than on weekdays for the overall group. Using a pedometer for 3 days was sufficient to determine habitual physical activity (sensitivity: 94%; specificity 91% vs. 6 days of pedometer use). In the present study, nonstructured physical activity was associated with more adequate dietary consumption and contributed toward a healthier anthropometric and metabolic profile in young women, despite the high prevalence of overweight.

Associations between dietary patterns, physical activity (leisure-time and occupational) and television viewing in middle-aged French adults

Diet and physical activity are considered to be major components of a healthy lifestyle. However, few studies have examined in detail the relationships between specific types of physical activity, sedentary behaviour and diet in adults. The objective of the present study was to assess differential relationships between dietary patterns, leisure-time and occupational physical activities and time spent watching television (TV), as an indicator of sedentary behaviour, in middle-aged French subjects. We performed a cross-sectional analysis using data from 1359 participants in the SUpplémentation en VItamines et Minéraux AntioXydants study, who completed a detailed physical activity questionnaire and at least six 24 h dietary records. Sex-specific dietary patterns were derived using factor analysis; their relationships with leisure-time and occupational physical activities and TV viewing were assessed using ANCOVA, after adjustment for age, educational level and smoking status. Three dietary patterns were identified in each sex. After adjustment for potential confounders, leisure-time physical activity was positively associated with a ‘healthy’ food pattern in both men (P for trend < 0·01) and women (P for trend < 0·03) and negatively associated with an ‘alcohol/meat’ pattern in men (P for trend < 0·01). TV viewing was positively associated with a ‘convenience’ pattern in men and with a ‘alcohol-appetiser’ pattern in women. In conclusion, identification of relationships between dietary patterns, physical activity and sedentary behaviour can enable identification of different types of lifestyle and should help to target at-risk groups in nutrition prevention programmes.

Maintaining exercise and healthful eating in older adults: the SENIOR project II: study design and methodology

The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) Project II is an intervention study to promote the maintenance of both exercise and healthful eating in older adults. It is the second phase of an earlier study, SENIOR Project I, that originally recruited 1277 community-dwelling older adults to participate in behavior-specific interventions designed to increase exercise and/or fruit and vegetable consumption. The general theoretical framework for this research is the Transtheoretical Model (TTM) of Health Behavior Change. The current intervention occurs over a 48-month period, using a manual, newsletters, and phone coaching calls. Annual assessments collect standardized data on behavioral outcomes (exercise and diet), TTM variables (stage of change and self-efficacy), psychosocial variables (social support, depression, resilience, and life satisfaction), physical activity and functioning (SF-36, Up and Go, Senior Fitness Test, and disability assessment), cognitive functioning (Trail Making Test and Forward and Backward Digit Span), physical measures (height, weight, and waist circumference), and demographics. The SENIOR Project II is designed to answer the following question as its primary objective: (1) Does an individualized active-maintenance intervention with older adults maintain greater levels of healthful exercise and dietary behaviors for 4years, compared to a control condition? In addition, there are two secondary objectives: (2) What are the psychosocial factors associated with the maintenance of health-promoting behaviors in the very old? (3) What are the effects of the maintenance of health-promoting behaviors on reported health outcomes, psychosocial measures, anthropometrics, and cognitive status?

Influence of Physical Activity Participation on the Associations between Eating Behaviour Traits and Body Mass Index in Healthy Postmenopausal Women

Available data reveals inconsistent relationships between eating behaviour traits and markers of adiposity level. It is thus relevant to investigate whether other factors also need to be considered when interpreting the relationship between eating behaviour traits and adiposity. The objective of this cross-sectional study was thus to examine whether the associations between variables of the Three-Factor Eating Questionnaire (TFEQ) and adiposity are influenced by the level of physical activity participation. Information from the TFEQ and physical activity was obtained from 113 postmenopausal women (56.7 ± 4.2 years; 28.5 ± 5.9 kg/m(2)). BMI was compared between four groups formed on the basis of the physical activity participation and eating behaviour traits medians. In groups of women with higher physical activity participation, BMI was significantly lower in women who presented higher dietary restraint when compared to women who had lower dietary restraint (25.5 ± 0.5 versus 30.3 ± 1.7 kg/m(2), P < .05). In addition, among women with lower physical activity participation, BMI was significantly lower in women presenting a lower external hunger than in those with a higher external hunger (27.5 ± 0.8 versus 32.4 ± 1.1 kg/m(2), P < .001). Our results suggest that physical activity participation should also be taken into account when interpreting the relationship between adiposity and eating behaviour traits.

Nutritional issues of Korean Americans

This cross-sectional, descriptive study examined factors influencing healthy eating of Korean Americans in a convenience sample of 517 Korean adults in a Midwestern city. Participants completed a self-administered survey written in either English or Korean as their preferences, which measured health, acculturation, healthy eating benefits, barriers, and self-efficacy as well as healthy eating practice. Descriptive statistics, cluster analysis, and structural equation modeling were used for analysis. Participants reported retaining elements of the traditional Korean diet regardless of acculturation. The worst eating habits were seen in participants who were younger (t = 4.57), currently not married (t = 3.10), less educated (F = 5.03), and acculturated to American society (F = 5.93) at the p < .05. Clinicians should provide culturally sensitive interventions targeting Korean Americans with poor dietary habits by providing population-specific, tailored interventions about the benefits of healthy eating and modeling healthier recipes for traditional Korean dishes.

Socio-economic, demographic, lifestyle and health characteristics associated with consumption of fatty-sweetened and fatty-salted foods in middle-aged French adults

Few studies have specifically focused on characteristics associated with consumption of combined fatty-salted and fatty-sweetened foods, whereas their identification could be useful for defining effective public health measures. The aim of the present study was to investigate the association between demographic, socio-economic, lifestyle and health characteristics and consumption of these types of food in a general sample of French adults. Dietary intake was assessed using a minimum of six 24 h dietary records collected over a 2-year period in 6240 subjects aged 35-60 years who participated in the Supplémentation en VItamines Minéraux et AntioXydants cohort study. Associations of individual characteristics with high and intermediate consumption of fatty-sweetened and fatty-salted foods were assessed using multivariate polytomic logistic regression models. Risk of moderate or high consumption of fatty-salted foods decreased with increasing age. Current smokers, drinkers, individuals with overweight and with hypertension were more likely to consume moderate or high amounts of such foods. Risk of moderate or high consumption of fatty-sweetened foods decreased with increasing age. Women, individuals living as a couple, moderate drinkers and persons with low or medium physical activity level were more likely to consume moderate or high amounts of such foods. Lower educated subjects, current smokers, heavy drinkers and individuals with severe hypertriacylglycerolaemia were less likely to have moderate or high consumption. Consumption of fatty-sweetened and fatty-salted foods varied according to demographic, lifestyle and health characteristics. Common unhealthy behaviours such as smoking, low physical activity and alcohol drinking, associated with high consumption of these food groups, may help to effectively target public health efforts.

Make Better Choices (MBC): study design of a randomized controlled trial testing optimal technology-supported change in multiple diet and physical activity risk behaviors

Background

Suboptimal diet and physical inactivity are prevalent, co-occurring chronic disease risk factors, yet little is known about how to maximize multiple risk behavior change. Make Better Choices, a randomized controlled trial, tests competing hypotheses about the optimal way to promote healthy change in four bundled risk behaviors: high saturated fat intake, low fruit and vegetable intake, low physical activity, and high sedentary leisure screen time. The study aim is to determine which combination of two behavior change goals - one dietary, one activity - yields greatest overall healthy lifestyle change.

Methods/Design

Adults (n = 200) with poor quality diet and sedentary lifestyle will be recruited and screened for study eligibility. Participants will be trained to record their diet and activities onto a personal data assistant, and use it to complete two weeks of baseline. Those who continue to show all four risk behaviors after baseline recording will be randomized to one of four behavior change prescriptions: 1) increase fruits and vegetables and increase physical activity, 2) decrease saturated fat and increase physical activity, 3) increase fruits and vegetable and decrease saturated fat, or 4) decrease saturated fat and decrease sedentary activity. They will use decision support feedback on the personal digital assistant and receive counseling from a coach to alter their diet and activity during a 3-week prescription period when payment is contingent upon meeting behavior change goals. They will continue recording on an intermittent schedule during a 4.5-month maintenance period when payment is not contingent upon goal attainment. The primary outcome is overall healthy lifestyle change, aggregated across all four risk behaviors.

Discussion

The Make Better Choices trial tests a disseminable lifestyle intervention supported by handheld technology. Findings will fill a gap in knowledge about optimal goal prescription to facilitate simultaneous diet and activity change. Results will shed light on which goal prescription maximizes healthful lifestyle change.

Trial Registration

Clinical Trials Gov. Identifier NCT00113672

Leisure-time physical activity and diet quality are not associated in people with chronic spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To determine the association between leisure-time physical activity (LTPA) and adherence to Eating Well with Canada's Food Guide (CFG) in community-dwelling adults with chronic Spinal Cord Injury (SCI).

SETTING

Ontario, Canada.

METHODS

Participants were recruited as part of the Study of Health and Activity in People with SCI (SHAPE-SCI). Dietary data were collected using 24-h recalls and analysed for adherence to CFG recommendations by age group and gender. LTPA was assessed using the Physical Activity Recall Assessment for Persons with SCI. Statistical analysis comprised correlations, multiple regression and χ(2).

RESULTS

We studied 75 adults (n=61 M; 42.4±11.8 years; 25.5±5.2 kg m(-2)) with chronic (≥1-year post-injury) SCI. Of these, 37% of participants were inactive, 29% were low-active and 33% were high-active. Fewer than 5% of participants were 100% adherent with CFG; 85% were adherent to ≤50%. Activity level and overall adherence to CFG were not correlated (r=-0.052, P=0.666). Although there were no associations between LTPA and vegetables and fruit, grain products, milk and alternatives, or other foods (all P>0.05), high activity was associated with consuming less than the minimum number of recommended servings of meat and alternatives (φ=-0.258, P=0.026).

CONCLUSION

Clinicians need to be aware of the poor diet quality, and low levels of physical activity, of people with chronic SCI. They should not assume that those who are more active consume better quality diets than those who are low active or inactive.

SPONSORSHIP

Canadian Institutes of Health Research.

Dietary intake based on physical activity level in Korean elementary school students

Prevalence of childhood obesity is increasing significantly worldwide due to energy imbalance perhaps stemming from undesirable dietary behavior and physical activity level. The objective of the study was to examine the effects of physical activity level on nutritional status in elementary school students. The subjects were comprised of 287 elementary school students between 4th and 6th grades in Seoul, Korea. The level of physical activity was scored with a modified Godin leisure-time exercise questionnaire and was categorized as active, moderately active, and sedentary. Dietary intakes were obtained using a 24-hour food recall method. An analysis of variance (ANOVA) was conducted to test for global significant differences of nutrient intakes by physical activity level. Boys were more active than girls. Daily intakes of energy in moderately active boys were significantly higher than in the sedentary group, but intakes of calcium and iron in moderately active boys were lower than active boys. For girls, physical activity level did not affect nutrient density at all. Intakes of calcium, vitamin C, and folate for both boys and girls were below 50% of recommended intake. Physical activity did not affect nutrient density and our participants were exposed to nutritional imbalance. Therefore, the results suggest that nutrition education regarding balanced diet and optimum physical activity is required for children's health and growth.

Leisure-time physical activity and nutrition: a twin study

Objective

To determine the association between long-term leisure-time physical activity/inactivity and eating behaviours in twin pairs discordant for physical activity for 30 years.

Design

Co-twin control design with cross-sectional data collection using questionnaire on eating habits and 5 d food diary. Differences in eating behaviours between physically active and inactive co-twins were analysed with pairwise tests.

Setting

Finland.

Subjects

Sixteen same-sex twin pairs (seven monozygotic and nine dizygotic, mean age 60 years) discordant for physical activity, selected from the Finnish Twin Cohort on the basis of physical activity discordance for 30 years, blinded to their possible differences in eating behaviours.

Results

The eating habits questionnaire revealed that physically active co-twins more frequently reported that it is easy to eat according to need, whereas overeating and/or restrictive eating was more common among the inactive co-twins (P = 0·035). Avoiding calories was more common among the active than inactive co-twins (P = 0·034). Based on food diaries the physically active co-twins had daily energy intake on average 15·5 kJ/kg higher than their inactive co-twins (P = 0·030). The active co-twins also had a higher intake of vitamin C (P = 0·004), total water (P = 0·044), legumes and nuts (P = 0·015) and sweets (P = 0·036), as well as a lower energy-adjusted intake of meat (P = 0·013).

Conclusions

The physically active persons seem to eat more but not necessarily healthier food. However, habitual physical activity may help in eating according to need and in reaching and maintaining a healthy body composition. Therefore, it is necessary to incorporate both dietary and physical activity advice into health counselling.

Improving physical activity and dietary behaviours with single or multiple health behaviour interventions? A synthesis of meta-analyses and reviews

Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic.

Food patterns according to sociodemographics, physical activity, sleeping and obesity in Portuguese children

Our study aimed to describe the association between food patterns and gender, parental education, physical activity, sleeping and obesity in 1976 children aged 5−10 years old. Dietary intake was measured by a semi quantitative food frequency questionnaire; body mass index was calculated and categorized according to the IOTF classification. Factor analysis and generalized linear models were applied to identify food patterns and their associations. TV viewing and male gender were significant positive predictors for fast-food, sugar sweetened beverages and pastry pattern, while a higher level of maternal education and longer sleeping duration were positively associated with a dietary patterns that included fruit and vegetables.

Obesogenic diet and physical activity: independent or associated behaviours in adolescents?

OBJECTIVE

Associations between diet and physical activity may identify behaviours that could be changed together to prevent childhood obesity. The present study examines associations between physical activity and obesogenic dietary behaviours in a large UK adolescent cohort.

DESIGN

Cross-sectional analysis of a UK cohort. Adolescents aged 10-11 years completed three 1 d diet diaries. Average daily energy consumption, percentage energy from fat and carbohydrate, energy density and grams of fruit and vegetables were estimated. To assess physical activity participants wore an accelerometer for three or more days. Regression models were run by sex to examine the extent to which dietary variables predicted physical activity before and after controlling for pubertal status, maternal education and adiposity.

SETTING

The Avon Longitudinal Study of Parents and Children (ALSPAC), south-west England.

SUBJECTS

Adolescents who provided diet data at age 10 years and physical activity data at age 11 years.

RESULTS

Among boys, percentage energy from fat was consistently negatively associated with accelerometer-determined indicators of physical activity (standardized beta (beta) = -0.055 to -0.101, P < 0.05) while total energy (beta = 0.066 to 0.091, P < 0.05) and percentage energy from carbohydrate (beta = 0.054 to 0.106, P < 0.05) were positively associated before and after adjustment for confounders. For girls fruit and vegetable intake was consistently positively associated with physical activity (beta = 0.056 to 0.074, P < 0.005). However all associations were weak. Associations were broadly comparable when participants with non-plausible dietary reports were included or excluded from the analyses.

CONCLUSIONS

Obesogenic diet and physical activity behaviours were weakly associated, suggesting that interventions should focus on implementing strategies that are independently successful at changing diet or physical activity behaviours either separately or in combination.

Inatividade física no lazer de adultos e fatores associados

OBJETIVO: Analisar a associação entre inatividade física no lazer de adultos com fatores sociodemográficos e indicadores de risco e proteção para doenças crônicas. MÉTODOS: Estudo transversal com indivíduos com idade de 18 anos e superior (n=1996). Foram utilizados dados obtidos do Sistema Municipal de Monitoramento de Fatores de Risco para Doenças Crônicas Não Transmissíveis, por meio de entrevistas telefônicas, em Florianópolis, SC, 2005. Analisaram-se fatores sociodemográficos e comportamentais de proteção e de risco. Os resultados das análises de regressão múltipla para associação entre inatividade física no lazer e variáveis independentes foram expressos por razões de prevalência. RESULTADOS: A prevalência da inatividade física no lazer foi de 54,6% (47,3% homens, 61,4% mulheres). Após análise ajustada, entre os homens, maior probabilidade de inatividade física no lazer foi associada ao aumento da faixa etária, à diminuição do nível de escolaridade e ao fato de trabalharem; menor probabilidade de inatividade física no lazer foi associada ao consumo abusivo de bebida alcoólica, independentemente da faixa etária, nível de escolaridade e trabalho. Entre as mulheres, maior probabilidade de inatividade foi observada entre as que relataram nível de escolaridade inferior a 12 anos de estudo e que trabalhavam. Análises ajustadas pelo nível de escolaridade e trabalho mostraram maior probabilidade de inatividade física no lazer para mulheres que relataram consumo de frutas e hortaliças com freqüência inferior a cinco vezes por dia e consumo de leite integral. CONCLUSÕES: Os fatores associados à inatividade física no lazer apresentaram perfil diferente entre homens e mulheres. Para mulheres, a inatividade física se associou a comportamentos de risco para doenças crônicas, em especial aos hábitos alimentares, e para os homens, se associaram a fatores sociodemográficos.

Can individuals meet multiple physical activity and dietary behavior goals?

OBJECTIVES

To examine whether participants with the most behavioral goals to achieve were more likely to meet more goals than those given fewer goals.

METHODS

Eight hundred ten participants were randomly assigned to advice-only, established guidelines for blood pressure control (reduced sodium, increased physical activity), or established guidelines plus the DASH diet (increased fruits, vegetables, low-fat dairy, reduced fat).

RESULTS

At 6 months, 11.7% of Advice-Only, 19.3% of Established, and 44.6% of Established plus DASH met at least 3 goals (P<0.0001). At 18 months, 33.5% of Established plus DASH met at least 3 goals.

CONCLUSIONS

Those with the most goals to achieve reached the most goals.

Dietary patterns and the risk of mortality: impact of cardiorespiratory fitness

BACKGROUND

While dietary patterns that are both predictive of chronic disease and mortality have been identified, the confounding effects of cardiorespiratory fitness have not been properly addressed. The primary objective was to assess the relation between dietary patterns with all-cause mortality, while controlling for the potentially confounding effects of fitness.

METHODS

This was a prospective cohort study. Participants consisted of 13 621 men and women from the Aerobics Center Longitudinal Study (ACLS). Participants completed a clinical exam and 3-day diet record between 1987 and 1999. Participants were followed for mortality until 2003. Reduced rank regression (RRR) was used to identify dietary patterns that predicted unfavourable total and high-density lipoprotein-cholesterol, triglyceride, glucose, blood pressure, uric acid, white blood cell and body mass index values.

RESULTS

One primary dietary pattern emerged and was labelled the Unhealthy Eating Index. This pattern was characterized by elevated consumption of processed and red meat, white potato products, non-whole grains, added fat and reduced consumption of non-citrus fruits. The hazard ratio for all-cause mortality in the fifth vs the first quintile of the Unhealthy Eating Index was 1.40 (1.02-1.91). This risk estimate was reduced by 13.5 and 55.0% after controlling for self-reported physical activity and fitness, respectively.

CONCLUSION

In this study the association between diet and overall mortality was, in large part, confounded by fitness.

Dietary intake and different types of physical activity: full-day energy expenditure, occupational and leisure-time

Objective

To describe the relationship between dietary intake and different levels and types of physical activity (PA).

Design

Cross-sectional evaluation of the EPIPorto study. Energy expenditure (metabolic energy equivalent tasks) and dietary intake during the past year were assessed using a PA questionnaire and a semi-quantitative food-frequency questionnaire, respectively.

Setting

Representative sample of adults in Porto, Portugal.

Subjects

Data were analysed for 2404 Portuguese Caucasian adults, aged between 18 and 92 years.

Results

For total PA, males who were active had significantly higher mean intake of energy (10·76 (2570·7) vs. 9·78 (2336·9) MJ/d (kcal/d), P < 0·001) and lower level of protein consumption (16·9 vs. 17·6 % of energy, P < 0·001) compared with sedentary males. In males, the association between total PA and energy intake remained after adjustment for age, education and body mass index. Similar results were observed when occupational activity was analysed. Concerning the energy expended in leisure time, in both genders, after adjustment for the previously described variables, a significant positive association was found between PA and intake of vitamin C (g/d): β = 0·12, 99 % confidence interval (CI) 0·02, 0·21 for females and β = 0·13, 99 % CI 0·03, 0·22 for males. Leisure-time activity in females was also positively associated with intakes of fibre, vitamin E, folate, calcium and magnesium, and negatively associated with saturated fat.

Conclusions

Higher levels of PA in leisure time were associated with higher intakes of micronutrients and lower intakes of saturated fat, particularly in females. For total and occupational PA, similar nutrient intake was observed between active and sedentary individuals.

Effects of tailored feedback on multiple health behaviors

BACKGROUND

The effects of tailored intervention on multiple behaviors and possible moderators of tailoring effects have not yet been sufficiently demonstrated.

PURPOSE

The purpose of this study was to examine the effectiveness of a computer-tailored intervention on smoking; physical activity; and fruit, vegetable, and fat intake; and to test potential moderators of the effectiveness (BMI, age, SES, gender, motivation, and the number of behaviors for which respondents met the recommendations from national guidelines).

METHODS

Respondents were randomly assigned to a tailored intervention group, receiving one tailored letter on all of these behaviors, or a control intervention group, receiving one general information letter on all behaviors.

RESULTS

Three months after the baseline assessment, the tailored intervention group showed significantly better effects than the control group for all behaviors studied, except for smoking. Notably, the intervention did not enhance the health behaviors, but rather reduced a decline in these behaviors during the 3-month study interval. Effect sizes were small. No moderating factors were found, except for the number of behaviors for which recommendations were met in the tailoring intervention group on fruit consumption. The largest effects of the tailored intervention were found for fruit in respondents who did not meet the recommendations for any behavior (Cohen's d = 0.3).

CONCLUSIONS

A tailored intervention on multiple behaviors had significant, but limited effects when compared to generic information. The number of bad habits influenced the effects of the tailored intervention on fruit consumption.

Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial

BACKGROUND

Although experts claim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change, few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet.

PURPOSE

To evaluate the short-term (1 month) efficacy of an Internet-delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity (PA), and smoking cessation, and to evaluate exposure to the intervention.

METHODS

A pretest-posttest randomized controlled trial with an intervention group and a no intervention waiting list control group was conducted. Self-reported behavior and determinants were assessed at baseline and 1 month follow-up. Exposure to the intervention was monitored through server registrations. The data were analyzed using multiple linear and logistic regression analysis.

RESULTS

The intervention resulted in a significantly lower self-reported saturated fat intake (b = -0.76, p < 0.01) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline (OR = 1.34, 95%CI = 1.001-1.80). No significant intervention effects were found for self-reported smoking status. Of the participants, 81% actually visited the website.

CONCLUSIONS

The Internet-delivered, computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study.

Predictors of changes in physical activity in a prospective cohort study of the Danish adult population

AIM

To investigate predictors of changes in physical activity, in a prospective population-based study.

METHODS

Data were from the Danish Health Interview Surveys in 1994 and 2000, and included persons between 16 and 64 years of age who answered the questions on physical activity and various covariates in 1994, and who were re-interviewed in 2000. In total 2,957 subjects participated (62% of the original sample). Data were analysed using logistic regression.

RESULTS

Predictors of physical inactivity were, for men and women respectively, heavy smoking (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.24-3.48, and OR 2.23, 95% CI 1.34-3.71), poor self-rated health (OR 2.11, 95% CI 1.25-3.58, and OR 1.75, 95% CI 1.10-2.80), and believing that one's own effort has no effect on health (OR 1.86, 95% CI 1.20-2.88, and OR 1.63, 95% CI 1.00-2.65). For men, further predictors for physical inactivity were obesity as compared to normal weight (OR 2.10, 95% CI 1.11-3.98), and being unmarried as compared to being married (OR 2.22, 95% CI 1.40-3.51). The only predictor for becoming physically active among initially sedentary respondents was meeting often with family (p=0.011).

CONCLUSIONS

Our results show a number of strong predictors for physical inactivity. Variables of an unhealthy lifestyle tend to cluster in some individuals, and physical inactivity interventions may therefore be more successful if they also address smoking, self-belief, and obesity. Interventions tailored to raise inactive people's level of activity should focus on social support from the family.

Patterns and correlates of multiple risk behaviors in overweight women

BACKGROUND

Knowledge about the prevalence, co-occurrence, and correlates of lifestyle related behaviors of overweight women is needed to inform the design of health promotion interventions for weight loss.

METHODS

Cross-sectional study involves 394 overweight and obese women, aged 18 to 55 (mean age=41.26), 39% from minority backgrounds, recruited through primary care clinics for a weight loss trial. Dependent variables were the proportion meeting recommended levels of physical activity (measured with an Actigraph), percent calories from fat, and servings of fruits and vegetables (assessed with a Food Frequency Questionnaire, FFQ) and accumulating less than 8 h/day of sedentary time for sedentary behavior (Actigraph). Covariates included socio-demographics, psychosocial variables, diet behaviors, and depression.

RESULTS

Seventy-five percent of the sample did not engage in at least 30 min/day of physical activity, and 56% spent less than 8 h/day in sedentary activities. About 76% and 79% of the sample did not meet the dietary fat, and fruits and vegetable consumption guidelines, respectively. Two-thirds of the sample had three or more risk factors. Being employed full-time, lower education level, less use of physical activity change strategies, and low levels of social support were associated with higher likelihood of having a greater total number of health risk behaviors.

CONCLUSION

Nearly 80% of the sample had multiple lifestyle risk behaviors. Poor dietary behaviors were present in all of the most prevalent risk behavior combinations. Lower socioeconomic and educational status and family and employment obligations characterize overweight and obese women with unhealthy activity and dietary behaviors in need of health promotion interventions.

A randomized trial of sequential and simultaneous multiple behavior change interventions for physical activity and fat intake

BACKGROUND

Major questions remain unanswered about how best to accomplish multiple behavior change. The purpose of this study was to evaluate whether there are differences in successfully changing multiple behaviors in computer-tailored sequential and simultaneous interventions for physical activity (PA) promotion and fat intake (FI) reduction.

METHODS

Participants (N=567) were randomly assigned to receive an intervention for PA and FI simultaneously; PA at baseline and FI at 3 months; or FI at baseline and PA at 3 months. Successful behavior change at 6 months was defined as: >60 min PA increase and/or 5% FI reduction. Using multinomial logistic regression the odds ratios of successful behaviors change (none, PA only, FI only, or both) were determined for intervention mode, gender, age, BMI and education.

RESULTS

Overall drop-out was 26%. There was no behavior change for 20.2% of participants; 30.5% successfully decreased FI; 15.8% successfully increased PA; 33.5% successfully changed both behaviors. Intervention mode, gender and age were not associated with successful behavior change. Compared to those that did not change any behaviors: participants that successfully changed FI were more likely to be overweight/obese (OR=1.85); and participants that successfully changed both behaviors were more likely to be overweight/obese (OR=2.13) and have lower education (OR=2.46).

CONCLUSIONS

Success in changing multiple behaviors was not associated with intervention mode; both simultaneous and sequential interventions can be applied. Being overweight might be an extra motivator to change health behaviors.

Dietary and physical activity patterns in French children are related to overweight and socioeconomic status

Sedentary behavior (SED) has already been identified as a risk factor of childhood overweight (OW) but less is known about the dietary patterns related to adiposity. Our objective was to investigate if lifestyle patterns combining overall diet and physical activity were associated with childhood OW and if they were involved in the reverse association between socioeconomic status (SES) and OW. Dietary intake was assessed using a 7-d food record in 748 French children aged 3-11 y from the 1998-1999 cross-sectional French Enquête Individuelle et Nationale sur les Consommations Alimentaires national food consumption survey. Weight and height, leisure time physical activity, SED (television viewing), and SES were reported by parents or children by answering questionnaires. Scores for lifestyle patterns were assessed with factor analysis and their relationship with OW was explored by logistic regression analysis. Two similar lifestyle patterns were identified in children aged 3-6 y and 7-11 y: "snacking and sedentary" and "varied food and physically active." The snacking and sedentary pattern was positively associated with OW in the youngest children (P-trend = 0.0161) and partly mediated the negative association of SES to OW. The varied food and physically active pattern was inversely correlated with OW in the eldest children only (P-trend = 0.0401). A third pattern called "big eaters at main meals" was derived in children aged 7-11 y and was positively correlated with OW (P-trend = 0.0165). From a public health perspective, the combinations of identifiable dietary and physical activity behaviors may be useful as a basis for recommendations on preventing OW.

Covariation of adolescent physical activity and dietary behaviors over 12 months

PURPOSE

This study examined covariation among changes in dietary, physical activity, and sedentary behaviors over 12 months among adolescents participating in a health behavior intervention. Evidence of covariation among behaviors would suggest multi-behavior interventions could have synergistic effects.

METHODS

Prospective analyses were conducted with baseline and 12-month assessments from a randomized controlled trial to promote improved diet, physical activity, and sedentary behaviors (experimental condition) or SUN protection behaviors (comparison condition). Participants were adolescent girls and boys (N = 878) aged 11-15 years on entry. The main outcomes were: diet, based on multiple 24-hour recalls (total fat, grams of fiber, servings of fruit and vegetables, total calories); average daily energy expenditure (kcals/kg) based on 7-day physical activity recall interviews; daily minutes of moderate-vigorous physical activity minutes from accelerometery; and self-reported daily hours of sedentary behavior.

RESULTS

Covariation was found between fat and calories (r = .16), fiber and calories (r = .53), fiber and fruit/vegetables (r = .53), calories and fruit/vegetables (r = .34), and fruit and vegetables and sedentary behavior (r = -.12) for the total sample (all p values < .01). The pattern of findings was similar for most subgroups defined by gender and study condition.

CONCLUSIONS

The strongest covariation was observed for diet variables that are inherently related (calories and fat, fiber, and fruit/vegetables). Little covariation was detected within or between other diet, physical activity and sedentary behavior domains suggesting that interventions to improve these behaviors in adolescents need to include specific program components for each target behavior of interest.

Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study

OBJECTIVE

To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children.

METHODS

A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires.

FINDINGS

Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins (R(2) = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R(2) = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups.

CONCLUSION

Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered.

Effects of an exercise intervention on other health behaviors in overweight/obese post-menopausal women

BACKGROUND

Little is known about whether initiating physical activity induces change in other health-related behaviors. If other behaviors do change with increasing physical activity, this would complicate interpretation of differences in study outcomes in exercise intervention trials.

DESIGN

Randomized controlled trial.

SETTING/PARTICIPANTS

173 sedentary, overweight (body mass index between 24.0 and 25.0 kg/m2 with body fat>33% or BMI>or=25.0 kg/m2), postmenopausal women, ages 50 to 75 years, not using hormone therapy, and living in the Seattle, WA area.

INTERVENTION

Participants were randomly assigned to an exercise intervention (n=87) or a stretching-control group (n=86). The exercise intervention included facility and home-based moderate-intensity exercise.

MAIN OUTCOME MEASURES

Changes in dietary intake, alcohol consumption, and medication and supplement use were compared from baseline to 3- and 12-month follow-up between exercise and control groups, and by tertiles of exercise adherence. Data were collected between January 1998 and July 2001.

RESULTS

In general, changes in dietary intake between the exercise and control group were not statistically different. The exercise group had a greater increase in the proportion of participants who used multivitamins (+5%) compared to the control group (-10%) at 3 months (p-interaction=0.04), but not at 12 months (p-interaction=0.58). Furthermore, there were few differences when comparing changes in health behaviors across exercise adherence tertiles.

CONCLUSIONS

Our results suggest that participation in a year-long exercise intervention trial among post-menopausal women has little effect on other health behaviors. These findings suggest that additional behavior changes in exercise trials are minimal and unlikely to bias primary study results.

Leisure-time and occupational physical activity in relation to cardiovascular risk factors and eating habits in French adults

Objective

To investigate the relationships of two main physical activity domains (during leisure and at work) with cardiovascular risk factors and eating habits.

Design

Cross-sectional study.

Setting

Preventive medicine centre.

Subjects

In 5478 adults (32% women, aged 20–80 years) who consecutively underwent a standardised health examination, leisure-time physical activity (LTPA; i.e. non-sport leisure and sport activities), occupational physical activity (OPA) and eating habits were assessed by self-administered questionnaires. We analysed sex-specific relationships of LTPA and OPA (in quartiles) with (1) various cardiovascular risk factors and (2) eating habits using analysis of variance and logistic regression, respectively.

Results

In both genders, with and without adjustment for education in addition to age, LTPA was associated negatively with body mass index, body fat, waist circumference, resting heart rate, diastolic blood pressure and triglycerides, and positively associated with high-density lipoprotein cholesterol (all P ≤ 0.005). OPA adjusted for age only was positively associated with most cardiovascular risk factors but these associations were not significant after further adjustment on education (except for waist circumference in women). Age- and education-adjusted LTPA was associated with increased frequency of consumption of fruits (odds ratio (OR) = 2.05, 95% confidence interval (CI) 1.68–2.52 in men; OR = 1.90, 95% CI 1.41–2.05 in women) and vegetables (OR = 1.81, 95% CI 1.48–2.21 in men; OR = 2.22, 95% CI 1.66–2.97 in women).

Conclusions

The data emphasise the favourable associations of LTPA, a modifiable behaviour, with various cardiovascular risk factors and healthy eating habits. The results also suggest that the relationships of OPA with cardiovascular risk factors depend, at least in part, on socio-economic status as reflected by educational level.

Correlates of diet quality in the Quebec population

Objective:

To determine the correlates of a high-fat diet in urban, suburban and rural areas of Quebec, Canada.

Design:

A secondary analysis of data collected as part of a 5-year multi-factorial, multi-setting, community-intervention project.

Setting:

Urban, suburban and rural settings of the province of Quebec, 1997.

Subjects:

Data were analysed from a sample of 5214 participants (2227 males, 2987 females). A food-frequency questionnaire was completed and a global index of food quality was calculated. Logistic regression was used to identify correlates of a diet high in total fats, saturated fat and cholesterol.

Results:

In both genders, lower level of education, smoking status, French and English languages compared with other languages spoken at home, and a rural environment were associated with poor diet quality. Having no intention to eat low-fat dairy products more often was associated with a high-fat diet. In men, obesity (body mass index >30 kg m−2) and absence of reported health problems were correlates of a high-fat diet, while, in women, lower physical activity was a correlate.

Conclusions:

Future health interventions in Quebec should target people with low education, smokers and those living in a rural environment. Obese men and sedentary women should have access to specific dietetic resources.

The stability of soft drinks intake from adolescence to adult age and the association between long-term consumption of soft drinks and lifestyle factors and body weight

Objectives

To investigate the tracking of sugar-sweetened, carbonated soft drinks intake from age 15 to 33 years and the association between this intake and lifestyle factors and body weight.

Design

A longitudinal study with 18–20 years of follow-up. Data about diet, physical activity, smoking and dieting were collected in 1981/1979, 1991 and 1999. Body weight and height were measured in 1981/1979 and self-reported in 1999.

Setting

Oslo, Norway.

Subjects

Four hundred and twenty-two men and women.

Results

Tracking of soft drinks intake from adolescence into early adulthood (age 25 years) and from early adulthood into later adulthood (33 years) was moderate to high, while tracking from adolescence into later adulthood was low. Comparing those reporting a high intake of soft drinks in both 1991 and 1999 with those reporting a low intake at both times, male long-term high consumers were more likely to smoke (48 vs. 21%, P = 0.002) and reported higher intakes of energy (12.2 vs. 10.2 MJ day−1, P = 0.005) and sugar (142 vs. 50 g day−1, P < 0.001) in 1999 than did long-term low consumers. Women high consumers were less likely to be physically active (14 vs. 42%, P = 0.03) and had higher sugar intake (87 vs. 41 g day−1, P < 0.001) in 1999 than did women low consumers. There were no differences in body mass index, overweight or obesity in 1999 between long-term high and low consumers.

Conclusion

In this study, stability of soft drinks intake from age 15 to 25 years and from age 25 to 33 years was moderate to high, while from age 15 to 33 years it was low. Soft drinks intake from age 25 to 33 years was associated with smoking and physical inactivity, but not with body weight.

Conceptualization and Development of a Theory-Based Healthful Eating and Physical Activity Intervention for Postpartum Women Who Are Low Income

Eating and physical activity behaviors that confer risk for chronic disease are prominent among women from varying ethnic and racial groups who are low income. Conceptualization and development of a theory-based behavioral intervention to address their unique needs during the first year following childbirth comprised four steps: (a) translating public health guidelines and emerging epidemiologic data into specific intervention messages; (b) developing practical strategies to operationalize theoretical constructs, in the context of a social ecological framework; (c) stating achievementbased objectives and writing scripts for five home visits; and (d) conducting formative research. Focus group participants expressed a desire for a “health mentor,” not somebody who “nags” or “stresses you out.” Paraprofessionals from the Expanded Food and Nutrition Education Program (EFNEP) were directly involved in pretesting the intervention and remain involved as health mentors. This intervention can serve as a basis for future organizational partnerships to benefit the health of populations who are low income.

Physical activity and lung cancer risk in the European Prospective Investigation into Cancer and Nutrition Cohort

Research conducted predominantly in male populations on physical activity and lung cancer has yielded inconsistent results. We examined this relationship among 416,277 men and women from the European Prospective Investigation into Cancer and Nutrition (EPIC). Detailed information on recent recreational, household and occupational physical activity, smoking habits and diet was assessed at baseline between 1992 and 2000. Relative risks (RR) were estimated using Cox regression. During 6.3 years of follow-up we identified 607 men and 476 women with incident lung cancer. We did not observe an inverse association between recent occupational, recreational or household physical activity and lung cancer risk in either males or females. However, we found some reduction in lung cancer risk associated with sports in males (adjusted RR = 0.71; 95% confidence interval 0.50-0.98; highest tertile vs. inactive group), cycling (RR = 0.73; 0.54-0.99) in females and non-occupational vigorous physical activity. For occupational physical activity, lung cancer risk was increased for unemployed men (adjusted RR = 1.57; 1.20-2.05) and men with standing occupations (RR = 1.35; 1.02-1.79) compared with sitting professions. There was no evidence of heterogeneity of physical activity associations across countries, or across any of the considered cofactors. For some histologic subtypes suggestive sex-specific reductions, limited by subgroup sizes, were observed, especially with vigorous physical activity. In total, our study shows no consistent protective associations of physical activity with lung cancer risk. It can be assumed that the elevated risks found for occupational physical activity are not produced mechanistically by physical activity itself but rather reflect exposure to occupation-related lung cancer risk factors.

Intake of sugar-sweetened beverages and weight gain: a systematic review

Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages' high added sugar content, low satiety, and incomplete compensation for total energy. Whether an association exists between SSB intake and weight gain is unclear. We searched English-language MEDLINE publications from 1966 through May 2005 for cross-sectional, prospective cohort, and experimental studies of the relation between SSBs and the risk of weight gain (ie, overweight, obesity, or both). Thirty publications (15 cross-sectional, 10 prospective, and 5 experimental) were selected on the basis of relevance and quality of design and methods. Findings from large cross-sectional studies, in conjunction with those from well-powered prospective cohort studies with long periods of follow-up, show a positive association between greater intakes of SSBs and weight gain and obesity in both children and adults. Findings from short-term feeding trials in adults also support an induction of positive energy balance and weight gain by intake of sugar-sweetened sodas, but these trials are few. A school-based intervention found significantly less soft-drink consumption and prevalence of obese and overweight children in the intervention group than in control subjects after 12 mo, and a recent 25-week randomized controlled trial in adolescents found further evidence linking SSB intake to body weight. The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.

Nutrition Information Sources Vary with Education Level in a Population of Older Adults

Education level, more than any other socioeconomic factor, can predict disease risk, health behavior patterns, and diet quality. It has been suggested that one reason higher education promotes more healthful diets is that better-educated people may get better nutrition information. We present data from a survey examining specific sources of nutrition information among an older adult population (age >50 years, n=176), and compare the difference in sources associated with extent of education. Reliance on doctors, television, and neighbors was significantly higher among those with less education (P<0.05). Our results also show that less-educated older adults rely more upon different specific sources for their nutrition information than those who have attained a higher level of education. Strategies to improve and/or ensure the quality of the specific nutrition information sources this vulnerable group relies on may be needed.

CDE and non-CDE dietitians' knowledge of exercise and content of exercise programs for older adults with type 2 diabetes

OBJECTIVE

To study differences between non-certified diabetes educator registered dietitians (non-CDE-RDs) and certified diabetes educator registered dietitians (CDE-RDs) in the design and content of programs to promote physical activity in older adults with type 2 diabetes.

DESIGN

The Exercise Teaching Questionnaire was used to assess knowledge of and promotion of physical activity.

SETTING AND PARTICIPANTS

Surveys were sent to CDE-RDs and non-CDE-RDs in Florida, California, and Texas. Ninety-four CDE-RDs and 73 non-CDE-RDs completed the study.

MAIN OUTCOME MEASURES

The independent variable was CDE status. The dependent variables were knowledge, design, content, and total exercise scores.

ANALYSIS

Two-way ANOVA's tested for Knowledge, Design, and Content scores by RD status and one of the following: years practicing in diabetes education, state, and practice setting.

RESULTS

The exercise Knowledge, Design and Content scores were significantly (P < .001) higher in the CDE-RDs compared to those of the non-CDE-RDs.

CONCLUSIONS AND IMPLICATIONS

The results of this study indicate that education and experience play a key role in the design and content of programs to promote physical activity in older adults. Therefore, the results raise the question of the role the dietitian and nutrition educator should play in the promotion of physical activity in older adults.

Cardiovascular Risk in Hispanic and Non-Hispanic Preschoolers

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in the United States for both men and women among all racial and ethnic groups. Identifying risk factors early in life can facilitate use of preventive strategies to reduce risk and improve health status across the life span.

OBJECTIVE

The aim of this study was to identify modifiable (tobacco smoke exposure, physical inactivity, dietary fat intake, overweight, and high blood pressure [BP]) and nonmodifiable (family history, gender, and age) cardiovascular risk factors in low-income preschool children.

METHODS

Low-income preschool children (N = 205) 3-5 years old were recruited to participate. Parents completed a multigenerational cardiovascular health history form and a 24-hour dietary recall for themselves and their child. The children's height, weight, and BP were obtained.

RESULTS

Of the 205 children, 61% reported ethnicity as Latino or Hispanic, 31.7% non-Hispanic White, 1% non-Hispanic Black, 3.9% Asian, and 2.4% mixed race. The number of males (50.7%) and females (49.3%) was similar. Only 22 (10.7%) children had no identified cardiovascular risk factors. At least one modifiable risk factor was present in 179 (87.3%) children. Fifty-two (25.5%) children had a body mass index (BMI) > or = 85th percentile for gender and age; 44 (22.3%) had a systolic or diastolic BP over the 90th percentile for gender, age, and height; 128 (66.3%) had a dietary fat intake of > 30%; 77 (37.6%) watched TV or played video games more than 2 hr/day; and 48 (23.4%) were exposed to passive tobacco smoke.

DISCUSSION

The identification of cardiovascular risk factors in almost 90% of presumably healthy preschoolers provides evidence to support testing of interventions that can improve health behaviors and reduce risks.

Longitudinal Physical Activity and Diet Patterns in the 1958 British Birth Cohort

PURPOSE

This study was conducted to investigate, in the 1958 British birth cohort, physical activity and diet frequency indicators in persons between the ages of 33 and 42 yr. We also assessed whether activity level in adulthood was influenced by activity or television viewing in adolescence or early adulthood and to examine change in diet quality and whether any change was related to change in activity level.

METHODS

Main outcome measures were frequency of leisure physical activity and consumption frequencies of fruit, salad or raw vegetables, fried food, chips, sweets, and biscuits, at 33 and 42 yr of age. A total of 9769 participants contributed data at both time points. Activity and television viewing frequency were measured in persons at 11, 16, and 23 yr of age.

RESULTS

Between the ages of 33 and 42 yr, tracking (Spearman correlation) coefficients for food items were similar for men and women and varied from 0.23 for fried food to 0.49 for fruit and, for physical activity, were 0.31 in men and 0.23 in women. From 11 to 42 yr, activity tracking was low; the longitudinal correlation coefficient was 0.09 for males, and 0.07 for females. Correlations between activity in adolescence and adulthood (33 or 42 yr) were generally low (0.002-0.20); those for television viewing in adolescence and activity in adulthood even lower (-0.08 to 0.02). Overall improvement in diet quality was very small, but those who increased their physical activity frequency showed greater improvements in diet quality than those who decreased their activity frequency.

CONCLUSIONS

Tracking of physical activity and diet in midadulthood is low to moderate, which may partly be caused by measurement methods. Television viewing has no influence on subsequent physical activity frequency. Improvements in physical activity and dietary habits appear to be related.

The comparative and cumulative effects of a dietary restriction and exercise on weight loss

OBJECTIVE

To assess the independence of changes made in diet and physical activity for weight loss; and, to examine the comparative and cumulative effects of these behavioral changes on weight loss outcomes.

DESIGN

The observational study is based on longitudinal data collected from 674 women and 288 men enrolled in a 2-year weight loss program introduced into a managed care setting.

MEASUREMENTS

The outcome variable was body mass index (BMI) change from baseline to 2-year follow-up. Primary independent variables were changes in physical activity and dietary fat intake, assessed as continuous measures using the Paffenbarger Physical Activity Questionnaire and Block Fat Screener Questionnaire, respectively. Two-way ANCOVA was used to assess the relative effect on BMI of behavioral changes.

RESULTS

Study results showed no preference for diet or physical activity change as a weight loss strategy. For both genders, the relationship between the two behaviors was synergistic rather than compensatory. Examination of the comparative benefits of behavioral changes indicated that, for women and men, restricting fat intake was more effective than increasing exercise for weight loss. While fat restrictions alone contributed to weight loss in both genders, exercise alone provided weight loss benefits to men, only. The cumulative effect of weight loss behaviors varied by gender. In women, an interaction was observed. The response of weight to fat restriction was greater among those who increased their exercise moderately or substantially. In men, there was no interaction; exercise increases helped to offset weight gain or provided small weight loss benefits at all levels of dietary fat change.

CONCLUSION

Dietary changes appeared to be more effective than increased physical activity for weight loss. For women, the cumulative effect of concomitant changes in diet and exercise on weight loss was more than additive.

Efficacy of an E-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context

PURPOSE

The purpose of this study was to evaluate a 12-week workplace e-mail intervention designed to promote physical activity and nutrition behavior.

DESIGN

A pre- and post-test design was conducted to compare the effects of e-mail messages between intervention and control groups.

SETTING

Five large workplaces in Alberta, Canada.

SUBJECTS

Employees with access to a personal e-mail address (N = 2121) were randomly assigned to an intervention (n = 1566) or a control group (n = 555).

INTERVENTION

Physical activity and nutrition messages were based on social-cognitive theories. The intervention group received one physical activity and one parallel nutrition message per week for 12 weeks. The control group received no weekly messages.

MEASURES

Each participant completed self-report measures of physical activity and nutrition related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week after (time 2) the intervention.

RESULTS

The intervention group was more efficacious at time 2 on measures of self-efficacy, pros, cons, intentions, and behavior related to physical activity. This group also reported more favorable changes in practicing healthy eating, balancing food intake with activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat foods. Effect sizes for all significant differences were small.

CONCLUSION

E-mail is a promising mode of delivery for promoting physical activity and nutrition in the workplace. Further theoretically driven studies are needed.

Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake

BACKGROUND

Little evidence exists about the effectiveness of "interactive" computer-tailored interventions and about the combined effectiveness of tailored interventions on physical activity and diet. Furthermore, it is unknown whether they should be executed sequentially or simultaneously.

PURPOSE

The purpose of this study was to examine (a) the effectiveness of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake and (b) which intervening mode, sequential or simultaneous, is most effective in behavior change.

METHODS

Participants (N = 771) were randomly assigned to receive (a) the physical activity and fat intake interventions simultaneously at baseline, (b) the physical activity intervention at baseline and the fat intake intervention 3 months later, (c) the fat intake intervention at baseline and the physical activity intervention 3 months later, or (d) a place in the control group.

RESULTS

Six months postbaseline, the results showed that the tailored interventions produced significantly higher physical activity scores, F(2, 573) = 11.4, p < .001, and lower fat intake scores, F(2, 565) = 31.4, p < .001, in the experimental groups when compared to the control group.

CONCLUSIONS

For both behaviors, the sequential and simultaneous intervening modes showed to be effective; however, for the fat intake intervention and for the participants who did not meet the recommendation in the physical activity intervention, the simultaneous mode appeared to work better than the sequential mode.