Physical Activity as a Mediator Between Race/Ethnicity and Changes in Multimorbidity

Plant-Based Diets and Risk of Multimorbidity: The Health and Retirement Study

BACKGROUND

Plant-based diets have gained attention due to their beneficial effects against major chronic diseases, although their association with multimorbidity is mostly unknown.

OBJECTIVES

We examined the association between the healthful (hPDI) and unhealthful plant-based diet indices (uPDI) with multimorbidity among middle-aged and older adults from the United States.

METHODS

Data on 4262 adults aged >50 y was obtained from the 2012-2020 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Food consumption was collected at baseline with a food frequency questionnaire and 2 PDIs were derived: the hPDI, with positive scores for healthy plant foods and reverse scores for less healthy plant foods and animal foods; and the uPDI, with only positive scoring for less healthy plant foods. Complex multimorbidity, defined as ≥3 coexistent conditions, was ascertained from 8 self-reported conditions: hypertension, diabetes, cancer, chronic lung disease, heart disease, stroke, arthritis, and depression. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

After a median follow-up of 7.8 y, we documented 1202 incident cases of multimorbidity. Compared with the lowest quartile, higher adherence to the hPDI was inversely associated with multimorbidity (HR for quartile 3: 0.77; 95% CI: 0.62, 0.96 and HR for quartile 4: 0.79; 95% CI, 0.63, 0.98; P-trend = 0.02). In addition, a 10-point increment in the hPDI was associated with a 11% lower incidence of multimorbidity (95% CI: 1, 20%). No significant associations were found for the uPDI after adjusting for sociodemographic and lifestyle factors.

CONCLUSIONS

Higher adherence to the hPDI was inversely associated with multimorbidity among middle-aged and older adults. Plant-based diets that emphasize consumption of high-quality plant foods may help prevent the development of complex multimorbidity.

Racial health disparities: a population-based analysis of physical activity and diabetes-related complications in Brazil

OBJECTIVES

Racial disparity in physical activity in people with diabetes in Brazil remains scarcely investigated. We examined the association between physical activity and diabetes-related complications according to race in the Brazilian population.

STUDY DESIGN

Cross-sectional.

METHODS

We analyzed data from the 2019 National Health Survey, a population-based survey of Brazilian adults. We used a self-reported questionnaire to assess physical activity during commuting, leisure-time, domestic, and occupational activities. Diabetes-related complications included vision, kidney, and circulatory impairment, foot ulcers, diabetic coma, and all-cause complications. We used robust Poisson regression models with restricted cubic splines to examine the association between physical activity and diabetes-related complications.

RESULTS

We included 2529 adults with diabetes (48.9% women; mean age: 53.5 ± 11.9 years). One-third experienced diabetes-related complications. Black adults performed less leisure-time and more occupational and commuting physical activity than White participants. Black participants showed a higher probability of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) compared to White participants independent of physical activity status. Only leisure-time physical activity was associated with a reduced probability of all-cause complications (PR: 0.78; 0.71, 0.86) whereas commuting and occupational physical activity were not associated with any diabetes-related complications. Physically inactive, Brown adults showed a higher probability of kidney, circulatory, vision, and all-cause complications than active, White adults. However, physical activity attenuated the probability of these complications in Brown participants.

CONCLUSION

The association between physical activity and diabetes-related complications is domain-specific. We revealed a racial disparity in physical activity in people with diabetes in Brazil.

Trunk Muscle Function and Core Stability in Women Who Had Muscle-Sparing Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction

OBJECTIVE

The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer.

METHODS

Forty women (mean age = 42.6 years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6 months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2 years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sørensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit.

RESULTS

Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups.

CONCLUSIONS

Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10 months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis.

IMPACT

Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation.

Race and ethnic differences in physical activity, osteopenia, and osteoporosis: results from NHANES 2009-2010, 2013-2014, 2017-2018

This study aimed to determine current physical activity trends association with bone density in a racial and ethnically diverse sample of older adults. We found that those engaged in no and some physical activity had lower femoral BMD when compared to those that met the physical activity recommendation.

PURPOSE

Most older adults do not engage in the recommended levels of physical activity to improve health, and there are racial and ethnic differences in physical activity participation. This study aims to evaluate whether meeting the physical activity recommendation is related to osteopenia and osteoporosis in a racially and ethnically diverse sample of older adults.

METHODS

Femoral neck bone mineral density (BMD) data from the National Health and Nutrition Examination Survey (NHANES 2009-2010, 2013-2014, 2017-2018) was obtained from 5252adults 60-80 years old. Self-reported physical activity was categorized into met recommendation, some physical activity, and no physical activity. We used linear regression models to examine the association between physical activity and BMD for each race and ethnic group adjusting for sociodemographics and other selected variables.

RESULTS

Non-Latino Blacks (NLB) and Latinos reported the lowest prevalence of meeting the physical activity recommendation, compared with Non-Latino Whites (NLW) (40.0%, 44.0%, and 51.4%, respectively; p < 0.0001). Further, NLB and Latinos had a lower prevalence of osteoporosis when compared to NLW (5.4%, 7.3%, and 9.1% respectively; p < 0.0001). There was a 0.03 g/cm2 difference in BMD between those who met the physical activity recommendation when compared to the no physical activity group; however, this decreased after adjusting for selected covariates.

CONCLUSION

Considering the prevalence and burden of osteopenia and osteoporosis, and projected increases in the racial and ethnic diversity of the older population, more research is needed to further understand the association between meeting the physical activity recommendation and bone health among racial and ethnic diverse older adults.

A prospective cohort study of physical activity in relation to lung cancer incidence among Black women

BACKGROUND

Black women have higher lung cancer incidence and mortality rates despite a lower smoking prevalence than White women. Physical activity may reduce lung cancer risk through several pathways, including the immune and inflammatory systems, as well as those with effects on sex hormones and metabolism.

METHODS

We examined vigorous physical activity, walking for exercise, sitting watching television, and metabolic equivalents (METs) in relation to lung cancer risk among 38,432 participants in a prospective cohort of Black women. We used Cox proportional hazards models adjusted for covariates to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

In 1995-2017, 475 incident lung cancer cases accrued. Participants who engaged in ≥ 1 h/week of vigorous physical activity or expended the highest tertile of METs experienced a decreased risk of lung cancer (HR: 0.85, 95% CI: 0.65-1.10; 0.89, 0.68-1.18; respectively). An increased risk was observed for sitting watching television (≥1 h/week: 1.27, 0.72-2.21). In stratified models, an inverse association between walking for exercise and lung cancer risk was only present among former smokers (≥1 h/week: 0.71, 0.52-0.98), while inverse associations between vigorous physical activity (≥1 h/week: 0.45, 0.28-0.73) and METs (tertile 3: 0.54, 0.34-0.85) and lung cancer risk were present among smokers with ≥ 20 pack-years.

CONCLUSION

Physical activity may play a role in reducing lung cancer risk among Black women, particularly among smokers. Future studies should explore biologic mechanisms whereby physical activity may influence carcinogenesis and investigate the role of exercise interventions in reducing lung cancer risk among smokers.