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Kruger HS, Makore P, van Zyl T, Faber M, Ware LJ, Monyeki MA, Kruger R. Validation of a short food group questionnaire to determine intakes from healthy and unhealthy food groups in 5-9-year-old South African children. J Hum Nutr Diet 2024; 37:234-245. [PMID: 37798954 PMCID: PMC10953415 DOI: 10.1111/jhn.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Reliable dietary data for children are necessary to investigate associations with health outcomes. The present study aimed to develop and validate a questionnaire to determine the frequency of intakes of specific healthy and unhealthy food groups in young children. METHODS Participants were 5-9-year-old South African children (n = 920) from 10 urban schools. Their parents completed a demographic questionnaire and the food intake questionnaire with food pictures. Based on the literature, four healthy food groups (fruits, vegetables, milk, meat/fish/poultry/eggs) and six unhealthy food groups (hot and cold sugar-sweetened beverages, candy, salty snacks, cakes and fast foods) were included, with five different frequency responses. Six experienced nutritionists assessed the face validity and content validity. After pilot testing, construct validity and homogeneity were determined in the participants. Convergent validity was determined using urinary sodium and potassium concentrations as biological intake markers. RESULTS Nutritionists confirmed face and content validity. Caregivers confirmed understanding of the questionnaire. Three factors explained 50.2% of the variance, with most unhealthy food groups as factor 1, fruits and vegetables as factor 2, and animal source protein and milk groups clustered with sugar-sweetened beverages as factor 3. The frequency of milk group, fruits and vegetables intake correlated negatively, whereas the frequency of salty snacks and fast foods intakes correlated positively with the urinary sodium:potassium ratio. CONCLUSIONS The healthy and unhealthy food group questionnaire has advantages of low respondent burden, as well as acceptable content and convergent validity in South African children. The questionnaire may be used to investigate associations between food intakes and health outcomes.
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Affiliation(s)
- H Salome Kruger
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
- Medical Research Council Research Unit for Hypertension and Cardiovascular DiseaseNorth‐West UniversityPotchefstroomSouth Africa
| | - Persuade Makore
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Tertia van Zyl
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
- Medical Research Council Research Unit for Hypertension and Cardiovascular DiseaseNorth‐West UniversityPotchefstroomSouth Africa
| | - Mieke Faber
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
- Non‐Communicable Diseases Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Lisa J. Ware
- SA MRC‐Wits Developmental Pathways for Health Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Makama A. Monyeki
- Physical Activity, Sport and Recreation Research Focus AreaNorth‐West UniversityPotchefstroomSouth Africa
| | - Ruan Kruger
- Medical Research Council Research Unit for Hypertension and Cardiovascular DiseaseNorth‐West UniversityPotchefstroomSouth Africa
- Centre of Excellence: Hypertension in Africa Research TeamNorth‐West UniversityPotchefstroomSouth Africa
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Maugana VF, Kruger R, Kruger HS, Hanssen H, Smith W. Food intake in South African children and retinal microvascular health: The ExAMIN Youth SA study. Nutr Metab Cardiovasc Dis 2024; 34:188-197. [PMID: 37798229 DOI: 10.1016/j.numecd.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Retinal arteriolar narrowing and venular widening are associated with increased cardiovascular risk, even at young ages. Whether diet contributes to early microvascular changes in children is not widely explored. We explored the associations of frequency of healthy and unhealthy food group intake with retinal vessel calibers in black and white children. METHODS AND RESULTS This study included school-aged (5-9 years) black (N = 433, 7.46 ± 0.98 years), and white (N = 403, 7.43 ± 0.82 years) children. Anthropometric and blood pressure measurements were taken, along with retinal vessel calibers (central retinal arteriolar (CRAE) and venular (CRVE) equivalents). Frequencies of food group intake were assessed using a food-frequency questionnaire. A factor analysis was performed to describe food group patters. Independent associations between retinal vessel calibers and frequencies of food group intake and food group patters were explored. In black children, cookies, cakes, and biscuits were associated with narrower arterioles (p < 0.05). In white children, cold sweetened beverages were associated with narrower arterioles (p = 0.02), whereas salty snacks were associated with narrower arterioles (p = 0.01) and wider venules (p < 0.05). Fruits were positively associated with CRAE (p = 0.03) in white children only. CONCLUSION A higher frequency of unhealthy food group consumption was associated with retinal arteriolar narrowing and venular widening in both black and white children. However, fruit intake was shown beneficial for retinal microvascular health in white children only. Our findings may highlight the importance of promoting healthy eating patterns from early childhood which may reduce the risk of premature cardiovascular disease development.
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Affiliation(s)
- Vuledzani F Maugana
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Henner Hanssen
- Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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Kruger R, Monyeki MA, Schutte AE, Smith W, Mels CMC, Kruger HS, Pienaar AE, Gafane-Matemane LF, Breet Y, Lammertyn L, Mokwatsi GG, Kruger A, Deacon E, Hanssen H. The Exercise, Arterial Modulation and Nutrition in Youth South Africa Study (ExAMIN Youth SA). Front Pediatr 2020; 8:212. [PMID: 32411640 PMCID: PMC7201091 DOI: 10.3389/fped.2020.00212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/09/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children. Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ~1,000 primary school children (black and white boys and girls between ages 5-9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging. Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs. Trial registration: The study was retrospectively registered on ClinicalTrials.gov on 15 August 2019 (NCT04056377).
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Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Makama Andries Monyeki
- Physical Activity, Sport and Recreation Research Focus Area; North-West University, Potchefstroom, South Africa
| | - Aletta Elisabeth Schutte
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Public Health and Community Medicine, University of New South Wales and The George Institute for Global Health, Sydney, NSW, Australia
| | - Wayne Smith
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Catharina Martha Cornelia Mels
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Herculina Salomé Kruger
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Anita Elizabeth Pienaar
- Physical Activity, Sport and Recreation Research Focus Area; North-West University, Potchefstroom, South Africa
| | - Lebo Francina Gafane-Matemane
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Leandi Lammertyn
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Gontse Gratitude Mokwatsi
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ankebé Kruger
- Physical Activity, Sport and Recreation Research Focus Area; North-West University, Potchefstroom, South Africa
| | - Elmari Deacon
- Optentia Research Focus Area, North-West University, Potchefstroom, South Africa
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Wrottesley SV, Pedro TM, Fall CH, Norris SA. A review of adolescent nutrition in South Africa: transforming adolescent lives through nutrition initiative. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1607481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Titilola M Pedro
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline H Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
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5
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The contribution of processed pork meat products to total salt intake in the diet. Food Chem 2018; 238:139-145. [DOI: 10.1016/j.foodchem.2016.11.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/06/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
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Restricting the marketing of foods and non-alcoholic beverages to children in South Africa: are all nutrient profiling models the same? Br J Nutr 2017; 116:2150-2159. [DOI: 10.1017/s0007114516004244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe WHO has called for governments to improve children’s food environment by implementing restrictions on the marketing of ‘unhealthy’ foods to children. Nutrient profiling (NP) models are used to define ‘unhealthy’ foods and support child-directed food marketing regulations. The aim of the present study was to assess the suitability of the South African NP model (SANPM), developed and validated for health claim regulations, for child-directed food marketing regulations. The SANPM was compared with four NP models specifically developed for such regulations. A representative list of 197 foods was compiled by including all foods advertised on South African free-to-air television channels in 2014 and foods commonly consumed by South African children. The nutritional information of the foods was sourced from food packaging, company websites and a food composition table. Each individual food was classified by each of the five NP models. The percentage of foods that would be allowed according to the different NP models ranged from 6 to 45 %; the models also varied considerably with regard to the type of foods allowed for marketing to children. The majority of the pairwise comparisons between the NP models yieldedκstatistics >0·4, indicating a moderate agreement between the models. An almost perfect pairwise agreement (κ=0·948) existed between the SANPM and the UK Food Standards Agency model (United Kingdom Office of Communication nutrient profiling model), a model extensively tested and validated for such regulations. The SANPM is considered appropriate for child-directed food marketing regulations in South Africa.
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Van Heerden I, Schönfeldt H. The lack of food intake data and the consequences thereof. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2011.11734345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Draper CE, Micklesfield LK, Kahn K, Tollman SM, Pettifor JM, Dunger DB, Norris SA. Application of Intervention Mapping to develop a community-based health promotion pre-pregnancy intervention for adolescent girls in rural South Africa: Project Ntshembo (Hope). BMC Public Health 2014; 14 Suppl 2:S5. [PMID: 25080940 PMCID: PMC4120156 DOI: 10.1186/1471-2458-14-s2-s5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND South Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women. Adolescence is key to addressing trans-generational risk and a window of opportunity to intervene and positively impact on individuals' health trajectories into adulthood. Using Intervention Mapping (IM), this paper describes the development of the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the inter-generational transfer of risk of metabolic disease, in particular diabetes risk. METHODS This paper describes the application of the first four steps of IM. Evidence is provided to support the selection of four key behavioural objectives: viz. to eat a healthy, balanced diet, increase physical activity, reduce sedentary behaviour, and promote reproductive health. Appropriate behaviour change techniques are suggested and a theoretical framework outlining components of relevant behaviour change theories is presented. It is proposed that the Ntshembo intervention will be community-based, including specialist adolescent community health workers who will deliver a complex intervention comprising of individual, peer, family and community mobilisation components. CONCLUSIONS The Ntshembo intervention is novel, both in SA and globally, as it is: (1) based on strong evidence, extensive formative work and best practice from evaluated interventions; (2) combines theory with evidence to inform intervention components; (3) includes multiple domains of influence (community through to the individual); (4) focuses on an at-risk target group; and (5) embeds within existing and planned health service priorities in SA.
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Affiliation(s)
- Catherine E Draper
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Sports Science Institute of South Africa, Boundary Road, Newlands, Cape Town, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - John M Pettifor
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David B Dunger
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Micklesfield LK, Lambert EV, Hume DJ, Chantler S, Pienaar PR, Dickie K, Puoane T, Goedecke JH. Socio-cultural, environmental and behavioural determinants of obesity in black South African women. Cardiovasc J Afr 2013; 24:369-75. [PMID: 24051701 PMCID: PMC3896104 DOI: 10.5830/cvja-2013-069] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/12/2013] [Indexed: 11/06/2022] Open
Abstract
South Africa (SA) is undergoing a rapid epidemiological transition and has the highest prevalence of obesity in sub-Saharan Africa (SSA), with black women being the most affected (obesity prevalence 31.8%). Although genetic factors are important, socio-cultural, environmental and behavioural factors, as well as the influence of socio-economic status, more likely explain the high prevalence of obesity in black SA women. This review examines these determinants in black SA women, and compares them to their white counterparts, black SA men, and where appropriate, to women from SSA. Specifically this review focuses on environmental factors influencing obesity, the influence of urbanisation, as well as the interaction with socio-cultural and socio-economic factors. In addition, the role of maternal and early life factors and cultural aspects relating to body image are discussed. This information can be used to guide public health interventions aimed at reducing obesity in black SA women.
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Affiliation(s)
- Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Campbell A, Rudan I. Systematic review of birth cohort studies in Africa. J Glob Health 2011; 1. [PMID: 23198102 PMCID: PMC3484737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AIM In sub-Saharan Africa, unacceptably high rates of mortality amongst women and children continue to persist. The emergence of research employing new genomic technologies is advancing knowledge on cause of disease. This review aims to identify birth cohort studies conducted in sub-Saharan Africa and to consider their suitability as a platform to support genetic epidemiological studies. METHODS A systematic literature review was conducted to identify birth cohort studies in sub-Saharan Africa across the following databases: MEDLINE, EMBASE, AFRO and OpenSIGLE. A total of 8110 papers were retrieved. Application of inclusion/exclusion criteria retained only 189 papers, of which 71 met minimum quality criteria and were retained for full text analysis. RESULTS The search revealed 28 birth cohorts: 14 of which collected biological data, 10 collected blood samples and only one study collected DNA for storage. These studies face many methodological challenges: notably, high rates of attrition and lack of funding for several rounds of study follow up. Population-based 'biobanks' have emerged as a major approach to harness genomic technologies in health research and yet the sub-Saharan African region still awaits large scale birth cohort biobanks collecting DNA and associated health and lifestyle data. CONCLUSION Investment in this field, together with related endeavours to foster and develop research capacity for these studies, may lead to an improved understanding of the determinants of intrauterine growth and development, birth outcomes such as prematurity and low birth weight, the links between maternal and infant health, survival of infectious diseases in the first years of life, and response to vaccines and antibiotic treatment.
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Affiliation(s)
- Alasdair Campbell
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh, Scotland, UK,Croatian Centre for Global Health, University of Split School of Medicine, Split, Croatia
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Levine JA, McCrady SK, Boyne S, Smith J, Cargill K, Forrester T. Non-exercise physical activity in agricultural and urban people. URBAN STUDIES (EDINBURGH, SCOTLAND) 2011; 48:2417-2427. [PMID: 22073428 DOI: 10.1177/0042098010379273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With evidence that urbanisation is associated with obesity, diabetes, hypertension and cardiovascular disease, this article compares daily physical activity between rural and urban dwellers. Specifically, it examines habitual daily activity levels, non-exercise activity thermogenesis (NEAT) and energy expenditure in agricultural and urban Jamaicans and urban North Americans. Ambulation was 60 per cent greater in rural Jamaicans than in the urban dwellers (4675 ± 2261 versus 2940 ± 1120 ambulation-attributed arbitrary units (AU)/day; P = 0.001). Levels of ambulation in lean urban Jamaicans were similar to those in lean urban North Americans, whereas obese urban dwellers walked less than their lean urban counterparts (2198 ± 516 versus 2793 ± 774 AU/day; P = 0.01). The data with respect to daily sitting mirrored the walking data; obese Americans sat for almost four hours more each day than rural Jamaicans (562 ± 78 versus 336 ± 68 minutes/day; P < 0.001). Urbanisation is associated with low levels of daily activity and NEAT.
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In this issue. Public Health Nutr 2008; 11:548-9. [DOI: 10.1017/s136898000800236x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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