Publications by authors named "Kara M Whitaker"

37 Publications

Objectively Measured Sedentary Behavior and Physical Activity Across 3 Trimesters of Pregnancy: The Monitoring Movement and Health Study.

J Phys Act Health 2021 Jan 28:1-8. Epub 2021 Jan 28.

Background: Though moderate- to vigorous-intensity physical activity is recommended, limited research exists on sedentary behavior (SED) during pregnancy.

Methods: The authors conducted a prospective cohort study to describe objectively measured patterns of SED and activity during each trimester of pregnancy. Women wore thigh- (activPAL3) and waist-mounted (ActiGraph GT3X) activity monitors. SED and activity were compared across trimesters using likelihood ratio tests and described using group-based trajectories. Exploratory analyses associated SED and activity trajectories with adverse pregnancy outcomes and excessive gestational weight gain.

Results: Pregnant women (n = 105; mean [SD] age = 31 [5] y; prepregnancy body mass index = 26.2 [6.6] kg/m2) had mean SED of 9.7, 9.5, and 9.5 hours per day (P = .062) across trimesters, respectively. Some activities differed across trimesters: standing (increased, P = .01), stepping (highest in second trimester, P = .04), steps per day (highest in second trimester, P = .008), and moderate- to vigorous-intensity physical activity (decreased, P < .001). Prolonged SED (bouts ≥ 30 min) and bouted moderate- to vigorous-intensity physical activity (≥10 min) were stable (P > .05). In exploratory analyses, higher SED and lower standing, stepping, and steps per day trajectories were associated with increased odds of adverse pregnancy outcomes (P < .05). No trajectories were associated with excessive gestational weight gain.

Conclusions: Pregnant women exhibited stable SED of nearly 10 hours per day across pregnancy. Future research evaluating SED across pregnancy and adverse pregnancy outcome risk is warranted.
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http://dx.doi.org/10.1123/jpah.2020-0398DOI Listing
January 2021

Variations in health behaviors among pregnant women during the COVID-19 pandemic.

Midwifery 2021 Apr 22;95:102929. Epub 2021 Jan 22.

Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States. Electronic address:

Purpose: To examine changes in lifestyle behaviors early in the COVID-19 pandemic among pregnant women.

Materials And Methods: A cross-sectional internet-based survey was completed by 706 pregnant women (mean age 29.6 years ± 3.2) residing in the United States in May 2020 to assess self-reported changes in diet, physical activity, and sleep during the COVID-19 pandemic. Logistic regression analyses examined whether sociodemographic, clinical, and pandemic-related characteristics were associated with health behavior changes.

Results: Approximately 17% of women reported their diets worsened during the COVID-19 pandemic, 42% reported improvements, and 41% reported no change. For physical activity, 22% reported they stopped being active, 2% reported they became active, and 76% reported no change. Nearly one-third of participants reported getting less sleep. The factors consistently associated with adverse lifestyle changes (worse diet, stopped being active, and reduced sleep) were experiences of pregnancy complications, loss of income due to COVID-19, and changes in social connections due to COVID-19.

Conclusions: A substantial proportion of pregnant women reported adverse lifestyle changes during the COVID-19 pandemic. Interventions during the pandemic to optimize health behaviors in pregnant women, especially among those with pregnancy complications, should address economic disadvantages and social support.
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http://dx.doi.org/10.1016/j.midw.2021.102929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825911PMC
April 2021

Longitudinal Associations of Midlife Accelerometer Determined Sedentary Behavior and Physical Activity With Cognitive Function: The CARDIA Study.

J Am Heart Assoc 2021 Feb 20;10(3):e018350. Epub 2021 Jan 20.

University of California San Francisco CA.

Background To determine if accelerometer measured sedentary behavior (SED), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) in midlife is prospectively associated with cognitive function. Methods and Results Participants were 1970 adults enrolled in the CARDIA (Coronary Artery Risk Development in Young Adults) study who wore an accelerometer in 2005 to 2006 (ages 38-50 years) and had cognitive function assessments completed 5 and/or 10 years later. SED, LPA, and MVPA were measured by an ActiGraph 7164 accelerometer. Cognitive function tests included the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop Test. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA with repeated measures of the cognitive function standardized scores. In men, statistical reallocation of 30 minutes of LPA with 30 minutes of MVPA resulted in an estimated difference of SD 0.07 (95% CI, 0.01-0.14), SD 0.09 (95% CI, 0.02-0.17), and SD -0.11 (95% CI, -0.19 to -0.04) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating better performance. Associations were similar when reallocating time in SED with MVPA, but results were less robust. Reallocation of time in SED with LPA resulted in an estimated difference of SD -0.05 (95% CI, -0.06 to -0.03), SD -0.03 (95% CI, -0.05 to -0.01), and SD 0.05 (95% CI, 0.03- 0.07) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating worse performance. Associations were largely nonsignificant among women. Conclusions Our findings support the idea that for men, higher-intensity activities (MVPA) may be necessary in midlife to observe beneficial associations with cognition.
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http://dx.doi.org/10.1161/JAHA.120.018350DOI Listing
February 2021

Sedentary behaviour and physical activity across pregnancy and birth outcomes.

Paediatr Perinat Epidemiol 2020 Oct 30. Epub 2020 Oct 30.

Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA.

Background: Shorter gestation or smaller birth size are indicators of a suboptimal fetal environment and negatively impact short- and long-term offspring health. Understanding how modifiable maternal behaviours, such as moderate-to-vigorous intensity physical activity (MVPA) or sedentary behaviour (SED), improve fetal outcomes could inform strategies to improve health across the lifespan.

Objectives: The objective of this study was to examine the association of MVPA and SED across pregnancy trimesters on gestational age at delivery and newborn anthropometrics.

Methods: The MoM Health Study measured SED (thigh-mounted activPAL3 micro) and MVPA (waist-worn Actigraph GTX3) in each trimester of pregnancy. Birth outcomes (gestational age at delivery, birthweight, birth length, and head circumference) were abstracted from medical records and used to calculate ponderal index (grams*100/cm ) and size-for-gestational age percentiles. Associations of group-based trajectories and trimester-specific SED and MVPA with birth outcomes were analysed using regression models.

Results: Low, medium, and high trajectory groups were generated SED and MVPA in 103 and 99 pregnant women, respectively. High vs low SED trajectory was associated with earlier gestational age at delivery (β -1.03 weeks, 95% CI -2.01, -0.06), larger head circumference (β 0.83 cm, 95% CI 0.24, 1.63), longer birth length (β 1.37 cm, 95% CI 0.09, 2.64), and lower ponderal index (β -0.24 g*100/cm , 95% CI -0.42, -0.06), after adjustment for demographics, pre-pregnancy BMI, and (for newborn anthropometric outcomes) gestational age. The association of high SED with lower ponderal index was the most robust across progressively adjusted models (β -0.25 g*100/cm , 95% CI -0.44, -0.07). SED trajectory was not associated with birthweight or size-for-gestational age. High vs low MVPA trajectory was only associated with smaller head circumference (β -0.86 cm, 95% CI -1.70, -0.02).

Conclusions: Higher SED during pregnancy may result in shorter gestation and inhibited fetal growth. Further research evaluating the effect of reducing SED during pregnancy on birth outcomes is warranted.
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http://dx.doi.org/10.1111/ppe.12731DOI Listing
October 2020

Moderate-to-vigorous intensity physical activity trajectories during adolescence and young adulthood predict adiposity in young adulthood: The Iowa Bone Development Study.

J Behav Med 2020 Oct 17. Epub 2020 Oct 17.

Department of Epidemiology, University of Iowa, Iowa City, IA, USA.

This study examined the associations of moderate-to-vigorous intensity physical activity (MVPA) trajectories in adolescence through young adulthood with adiposity in young adults. Participants from The Iowa Bone Development Study cohort were longitudinally assessed (N = 297; 57% female). Accelerometry-measured MVPA (min/day) at ages 15 through 23 years, and fat mass and visceral adipose tissue mass indices (kg/m, g/m) derived from dual-energy X-ray absorptiometry scans at age 23 years were analyzed. Latent trajectory analyses classified MVPA into two patterns. Multivariable linear regression analyses showed that being in the high MVPA trajectory group was associated with lower fat mass index z-scores. Individuals who were consistently active with high MVPA (vs. moderately active with decreasing MVPA) during adolescence up until early young adulthood had less accumulation of total body adiposity in young adulthood. This study suggests that adopting a consistently active lifestyle throughout adolescence can result in healthier body composition in young adulthood.
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http://dx.doi.org/10.1007/s10865-020-00190-xDOI Listing
October 2020

Association of provider advice and gestational weight gain in twin pregnancies: a cross-sectional electronic survey.

BMC Pregnancy Childbirth 2020 Jul 23;20(1):417. Epub 2020 Jul 23.

Department of Exercise Science, University of South Carolina, Columbia, SC, USA.

Background: Little is known about patient-provider communication on gestational weight gain among women pregnant with twins, a growing population at high risk for adverse maternal and neonatal outcomes. We examined if women's report of provider advice on gestational weight gain was consistent with the Institute of Medicine (IOM) weight gain guidelines for twin pregnancies, and the association of provider advice on weight gain with women's weight gain during their twin pregnancy.

Methods: We conducted a cross-sectional survey of 276 women who delivered twins and received prenatal care in the United States. The 2009 IOM provisional weight gain guidelines for twin pregnancies defined whether provider advice on weight gain and women's weight gain were below, within, or above guidelines. Multinomial logistic regression examined associations between provider advice on weight gain with women's weight gain, after adjustment for maternal age, gestational age at delivery, education, parity, twin type, use of assisted reproductive technologies and pre-pregnancy BMI category.

Results: Approximately 30% of women described provider advice on weight gain below the IOM guidelines, 60% within, and 10% above guidelines. Compared to women who reported weight gain advice within guidelines, women who reported advice below guidelines or who reported no advice were 7.1 (95% CI: 3.2, 16.0) and 2.7 (95% CI: 1.3, 5.6) times more likely to gain less than recommended, respectively. Women who reported provider advice above guidelines were 4.6 (95% CI: 1.5, 14.2) times more likely to exceed guidelines.

Conclusions: Provider advice on gestational weight gain may be an important predictor of women's weight gain during twin pregnancies, highlighting the critical need for accurate provider counseling to optimize health outcomes.
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http://dx.doi.org/10.1186/s12884-020-03107-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376962PMC
July 2020

Racial residential segregation, racial discrimination, and diabetes: The Coronary Artery Risk Development in Young Adults study.

Health Place 2020 03 25;62:102286. Epub 2020 Jan 25.

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Although racial residential segregation and interpersonal racial discrimination are associated with cardiovascular disease, few studies have examined their link with diabetes risk or management. We used longitudinal data from 2,175 black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study to examine associations of racial residential segregation (G* statistic) and experiences of racial discrimination with diabetes incidence and management. Multivariable Cox models estimated associations for incident diabetes and GEE logistic regression estimated associations with diabetes management (meeting targets for HbA1c, systolic blood pressure, and LDL cholesterol). Neither segregation nor discrimination were associated with diabetes incidence or management.
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http://dx.doi.org/10.1016/j.healthplace.2020.102286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266830PMC
March 2020

Association between Objective Activity Intensity and Heart Rate Variability: Cardiovascular Disease Risk Factor Mediation (CARDIA).

Med Sci Sports Exerc 2020 06;52(6):1314-1321

Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN.

Purpose: We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease risk factors.

Methods: Data were from 1668 participants (X[Combining Overline]age = 45.9 ± 3.5 yr, 58.0% female, 39.9% black) who participated in year 20 (2005-2006) of the Coronary Artery Risk Development in Young Adults Fitness Study. The ActiGraph 7164 estimated participants' mean minutes per day of vigorous-intensity PA (VPA), moderate-intensity PA (MPA), and light-intensity PA (LPA) over 7 d. Three sequential 10-s 12-lead ECG strips were used to derive standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Mediators representing glycemic control indices included fasting glucose, fasting insulin, and 2-h oral glucose tolerance, with other mediators being traditional cardiovascular disease risk factors. Multiple linear regression assessed independent associations of PA intensity with HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV association attributable to physiological mediators.

Results: Participants averaged 2.7 ± 6.2 min·d, 33.0 ± 22.0 min·d, and 360.2 ± 83.8 min·d of VPA, MPA, and LPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. After adjustment for demographic and lifestyle behaviors, VPA was associated with both HRV metrics (SDNN: std beta = 0.06 [0.03, 0.10]; rMSSD: std beta = 0.08 [0.05, 0.12]) and LPA with rMSSD only (std beta = 0.05 [0.01, 0.08]). Fasting insulin and glucose mediated 11.6% to 20.7% of the association of VPA and LPA with HRV, with triglycerides also potentially mediating these associations (range, 9.6%-13.4%).

Conclusions: Accelerometer-estimated VPA was associated with higher (i.e., improved) HRV. Light-intensity PA also demonstrated a positive association. Mediation analyses suggested these associations may be most attributable to glucose-insulin dynamics.
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http://dx.doi.org/10.1249/MSS.0000000000002259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275933PMC
June 2020

Women's Report of Health Care Provider Advice and Gestational Weight Gain: A Systematic Review.

J Womens Health (Larchmt) 2021 Jan 27;30(1):73-89. Epub 2020 Apr 27.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.

Inadequate and excessive gestational weight gain (GWG) is associated with adverse health outcomes for mother and child. Health care providers are well positioned to help women achieve appropriate GWG. This systematic review examined associations between women's report of provider advice on GWG and women's compliance with the Institute of Medicine (IOM) GWG guidelines. In March 2019, PubMed, EMBASE, and Cochrane CENTRAL databases were searched. Observational studies were eligible if published from 1990 to 2019, described provider advice on GWG, and determined whether women's target or actual GWG was consistent with the 1990 or 2009 IOM guidelines. Heterogeneity across studies precluded the use of meta-analytic methods. Seventeen cross-sectional and cohort studies of poor to good quality, representing 20,717 women were included. Approximately 69% of women reported provider advice on GWG during pregnancy; however, only 50% reported provider advice consistent with IOM guidelines. Eleven studies found that provider advice on GWG was significantly associated with women's compliance with IOM guidelines, and six studies found no association. While a high percentage of women report provider advice on GWG, accuracy of reported advice is less than optimal. The evidence examining associations of provider advice and women's compliance with guidelines is mixed and limited by methodological concerns. Future studies using more robust methods in diverse populations are needed to confirm the role of provider advice in optimizing GWG. Intervention studies are also necessary to increase the proportion of providers who accurately counsel their patients on appropriate GWG to improve health outcomes.
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http://dx.doi.org/10.1089/jwh.2019.8223DOI Listing
January 2021

Validity of self-reported and objectively measured sedentary behavior in pregnancy.

BMC Pregnancy Childbirth 2020 Feb 11;20(1):99. Epub 2020 Feb 11.

Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, USA.

Background: Sedentary behavior (SED) is a potential risk factor for poor pregnancy outcomes. We evaluated the validity of several common and one new method to assess SED across three trimesters of pregnancy.

Methods: This cohort study of pregnant women measured objective and self-reported SED each trimester via thigh-worn activPAL3 micro (criterion), waist-worn Actigraph GT3X, and self-report from the Pregnancy Physical Activity Questionnaire (PPAQ) and the de novo Sedentary Behavior Two Domain Questionnaire (SB2D). SED (hours per day) and percent time in SED (SED%) from activPAL were compared to GT3X, SB2D, and PPAQ using Pearson's r, ICC, Bland-Altman analysis, and comparison of criterion SED and SED% across tertiles of alternative methods.

Results: Fifty-eight women (mean age 31.5 ± 4.8 years; pre-pregnancy BMI 25.1 ± 5.6 kg/m; 76% white) provided three trimesters of valid activPAL data. Compared to activPAL, GT3X had agreement ranging from r = 0.54-0.66 and ICC = 0.52-0.65. Bland-Altman plots revealed small mean differences and unpatterned errors, but wide limits of agreement (greater than ±2 h and ± 15%). The SB2D and PPAQ had r < 0.5 and ICC < 0.3 vs. activPAL SED, with lower agreement during the 2nd and 3rd trimesters, and performed poorly in Bland-Altman analyses. SED% from the modified SB2D performed best of the self-reported instruments with modest mean differences, r ranging from 0.55 to 0.60, and ICCs from 0.31-0.33; though, limits of agreement were greater than ±35%. Significant trends in activPAL SED were observed across increasing tertiles of SB2D SED in the 1st and 3rd trimesters (both p ≤ 0.001), but not the 2nd trimester (p = 0.425); and for PPAQ SED in the 1st and 2nd trimesters (both p < 0.05), but not the 3rd trimester (p = 0.158). AcitvPAL SED and SED% increased significantly across tertiles of GT3X SED and SED% as well as SB2D SED% (all p-for-trend ≤ 0.001).

Conclusions: Compared to activPAL, waist-worn GT3X produced moderate agreement, though similar mean estimates of SED across pregnancy. Self-report questionnaires had large absolute error and wide limits of agreement for SED hr./day; SB2D measurement of SED% was the best self-report method. These data suggest activPAL be used to measure SED when possible, followed by GT3X, and - when necessary - SB2D assessing SED% in pregnancy.

Trial Registration: www.clinicaltrials.gov NCT03084302 on 3/20/2017.
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http://dx.doi.org/10.1186/s12884-020-2771-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014698PMC
February 2020

Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey.

BMC Pregnancy Childbirth 2019 Nov 14;19(1):418. Epub 2019 Nov 14.

Department of Exercise Science, University of South Carolina, Columbia, SC, USA.

Background: Health care providers should counsel pregnant patients on physical activity and nutrition to improve pregnancy outcomes. However, little is known about provider advice on these lifestyle behaviors among women pregnant with twins, a growing population at high risk for pregnancy complications. We examined the prevalence and content of provider advice on physical activity and nutrition among women pregnant with twins.

Methods: A cross-sectional electronic survey was administered to 276 women who delivered twins in the past 3 years and received prenatal care in the United States. The proportion of women reporting provider advice on physical activity and nutrition during prenatal visits (yes/no) was assessed and open-ended questions examined the content of provider advice. Bivariate differences in participant characteristics, stratified by provider advice on physical activity and nutrition (yes/no), were assessed. Responses from open-ended questions were examined using a content analysis approach to identify commonly reported advice on physical activity and nutrition.

Results: Approximately 75 and 63% of women reported provider advice on physical activity and nutrition, respectively, during their twin pregnancy. Women who recalled advice on physical activity most commonly reported recommendations to walk at a light to moderate intensity level. However, few women reported physical activity recommendations consistent with current guidelines, and approximately 55% of women reported provider advice to limit or restrict activity during their pregnancy, including bedrest. Nutrition advice was focused on eating a healthy, balanced diet and increasing protein intake. More women reported self-initiating the conversation on physical activity with their provider (40%) compared to nutrition (21%). Despite limited advice, 70% of women reported being satisfied or very satisfied with the information they received from their provider on physical activity or nutrition.

Conclusions: The majority of women reported provider advice on physical activity and nutrition during their twin pregnancies. However, advice was limited in detail, and physical activity levels were commonly restricted, despite the lack of evidence that activity restriction is beneficial during pregnancy. More research is needed to determine the optimal physical activity and dietary patterns in twin pregnancies to facilitate clear and consistent provider counseling on these lifestyle behaviors.
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http://dx.doi.org/10.1186/s12884-019-2574-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854797PMC
November 2019

Sedentary Time and Physical Activity Across Occupational Classifications.

Am J Health Promot 2020 03 14;34(3):247-256. Epub 2019 Nov 14.

Department of Health and Physical Activity, University of Pittsburgh, PA, USA.

Purpose: To examine differences in activity patterns across employment and occupational classifications.

Design: Cross-sectional.

Setting: A 2005-2006 Coronary Artery Risk Development in Young Adults (CARDIA) study.

Sample: Participants with valid accelerometry data (n = 2068).

Measures: Uniaxial accelerometry data (ActiGraph 7164), accumulated during waking hours, were summarized as mean activity counts (counts/min) and time spent (min/d) in long-bout sedentary (≥30 minutes, SED), short-bout sedentary (<30 minutes, SED), light physical activity (LPA), short-bout moderate-to-vigorous physical activity (<10 minutes, MVPA), and long-bout MVPA (≥10 minutes, MVPA) using Freedson cut-points. Employment status was self-reported as full time, part time, unemployed, keeping house, or raising children. Self-reported job duties were categorized into 23 major groups using the 2010 Standard Occupational Classification.

Analysis: Omnibus differences were analyzed using adjusted analysis of covariance and repeated after stratification by race (black/white) and sex (female/male).

Results: SED, SED, LPA, and MVPA differed significantly by employment and occupational categories ( ≤ .05), while MVPA did not ( ≥ .50). SED, SED, and LPA differed by occupational classification in men, women, blacks, and whites ( < .05). Mean activity counts, MVPA, and MVPA were significantly different across occupational classifications in whites ( ≤ .05), but not in blacks ( > .05). Significant differences in mean activity counts and MVPA across occupational classifications were found in males ( ≤ .001), but not in females ( > .05).

Conclusion: Time within activity intensity categories differs across employment and occupational classifications and by race and sex.
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http://dx.doi.org/10.1177/0890117119885518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355336PMC
March 2020

Risk Estimates for Diabetes and Hypertension with Different Physical Activity Methods.

Med Sci Sports Exerc 2019 12;51(12):2498-2505

Division of Research, Kaiser Permanente, Oakland, CA.

Purpose: To estimate risks of incident type 2 diabetes (T2D) and stage 2 and greater hypertension associated with self-reported and accelerometer-determined moderate-vigorous physical activity (MVPA) separately and adjusted for each other.

Methods: The sample included 2291 black and white men and women, ages 38-50 yr, in the Coronary Artery Risk Development in Young Adults (CARDIA) fitness study, conducted during the year 20 core CARDIA examination. Accelerometer-determined (Actigraph, LLC. model 7164) MVPA (MVPA-Acc), assessed at year 20, was defined as minutes per day of counts ≥2020 min. Self-reported MVPA (MVPA-SR) was assessed at year 20 using the CARDIA Physical Activity History. Incident T2D was ascertained at years 25 and 30 from fasting glucose, 2 h glucose tolerance test, HbA1c, or diabetes medication; incident hypertension was ascertained at those same times from measured blood pressure or use of antihypertensive medications. Modified Poisson regression models estimated relative risk (RR) of incident (years 25 and 30) T2D or hypertension, associated with middle and high tertiles of year 20 MVPA-Acc alone, year 20 MVPA-SR alone, and both, adjusted for each other, relative to bottom tertile.

Results: In men, MVPA-Acc, but not MVPA-SR, was associated with a 37% to 67% decreased risk of incident T2D in a dose-response relation that persisted with adjustment for BMI, Similar associations were observed in women, although the risk reduction was similar in the second and third tertiles, relative to the bottom tertile. In both men and women, MVPA-Acc was marginally associated with reduced risk of incident stage 2 and greater hypertension, but only after adjustment for BMI, whereas MVPA-SR was not associated in either sex.

Conclusions: Accelerometer-determined MVPA may provide more consistent risk estimates for incident diabetes than self-reported MVPA.
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http://dx.doi.org/10.1249/MSS.0000000000002083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138450PMC
December 2019

Association of Full Breastfeeding Duration with Postpartum Weight Retention in a Cohort of Predominantly Breastfeeding Women.

Nutrients 2019 Apr 25;11(4). Epub 2019 Apr 25.

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.

Full breastfeeding (FBF) is promoted as effective for losing pregnancy weight during the postpartum period. This study evaluated whether longer FBF is associated with lower maternal postpartum weight retention (PPWR) as compared to a shorter FBF duration. The MILK (Mothers and Infants Linked for Healthy Growth) study is an ongoing prospective cohort of 370 mother-infant dyads, all of whom fully breastfed their infants for at least 1 month. Breastfeeding status was subsequently self-reported by mothers at 3 and 6 months postpartum. Maternal PPWR was calculated as maternal weight measured at 1, 3, and 6 months postpartum minus maternal prepregnancy weight. Using linear mixed effects models, by 6 months postpartum, adjusted means ± standard errors for weight retention among mothers who fully breastfed for 1-3 (3.40 ± 1.16 kg), 3-6 (1.41 ± 0.69 kg), and ≥6 months (0.97 ± 0.32 kg) were estimated. Compared to mothers who reported FBF for 1-3 months, those who reported FBF for 3-6 months and ≥6 months both had lower PPWR over the period from 1 to 6 months postpartum ( = 0.04 and < 0.01, respectively). However, PPWR from 3 to 6 months was not significantly different among those who reported FBF for 3-6 versus ≥6 months ( > 0.05). Interventions to promote FBF past 3 months may increase the likelihood of postpartum return to prepregnancy weight.
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http://dx.doi.org/10.3390/nu11040938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520964PMC
April 2019

Perceived and objective characteristics of the neighborhood environment are associated with accelerometer-measured sedentary time and physical activity, the CARDIA Study.

Prev Med 2019 06 30;123:242-249. Epub 2019 Mar 30.

Preventive Medicine, Northwestern University, Chicago, IL, United States of America.

We investigated cross-sectional and longitudinal associations of neighborhood environment characteristics with accelerometer-measured sedentary time (SED), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA). Participants were 2120 men and women in the year 20 (2005-2006) and year 30 CARDIA exams (2015-2016). Year 20 neighborhood characteristics included neighborhood cohesion, resources for physical activity, poverty, and racial residential segregation. Physical activity was measured by accelerometer at years 20 and 30. Multivariable linear regression models examined associations of standardized neighborhood measures at year 20 with SED, LPA, and MVPA assessed that year, and with 10-year changes in SED, LPA, and MVPA. Cross-sectionally, a one standard deviation (SD) increase in cohesion was associated with 4.06 less SED min/day (95% CI: -7.98, -0.15), and 4.46 more LPA min/day (95% CI: 0.88, 8.03). Each one SD increase in resources was associated with 1.19 more MVPA min/day (95% CI: 0.06, 2.31). A one SD increase in poverty was associated with 11.18 less SED min/day (95% CI: -21.16, -1.18) and 10.60 more LPA min/day (95% CI: 1.79, 19.41) among black men. No neighborhood characteristic was associated with 10-year changes in physical activity in the full sample; however, a one SD increase in cohesion was associated with a 10-year decrease of 25.44 SED min/day (95% CI: -46.73, -4.14) and an increase of 19.0 LPA min/day (95% CI, 1.89, 36.10) in black men. Characteristics of the neighborhood environment are associated with accelerometer-measured physical activity. Differences were observed by race and sex, with more robust findings observed in black men.
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http://dx.doi.org/10.1016/j.ypmed.2019.03.039DOI Listing
June 2019

Relationship of Maternal Weight Status Before, During, and After Pregnancy with Breast Milk Hormone Concentrations.

Obesity (Silver Spring) 2019 04;27(4):621-628

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.

Objective: The aim of this study was to test associations of prepregnancy BMI, gestational weight gain, oral glucose challenge test results, and postpartum weight loss as predictors of breast milk leptin, insulin, and adiponectin concentrations and whether these relationships vary over time.

Methods: Milk was collected at 1 and 3 months from 135 exclusively breastfeeding women from the longitudinal Mothers and Infants Linked for Healthy Growth (MILk) study. Hormones were assayed in skimmed samples using ELISA. Mixed-effects linear regression models were employed to assess main effects and effect-by-time interactions on hormone concentrations.

Results: In adjusted models, BMI was positively associated with milk leptin (P < 0.001) and insulin (P = 0.03) and negatively associated with milk adiponectin (P = 0.02); however, the association was stronger with insulin and weaker with adiponectin at 3 months than at 1 month (time interaction P = 0.017 for insulin and P = 0.045 for adiponectin). Gestational weight gain was positively associated and postpartum weight loss was negatively associated with milk leptin (both P < 0.001), independent of BMI. Oral glucose challenge test results were not associated with these milk hormone concentrations.

Conclusions: Maternal weight status before, during, and after pregnancy contributes to interindividual variation in human milk composition. Continuing work will assess the role of these and other milk bioactive factors in altering infant metabolic outcomes.
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http://dx.doi.org/10.1002/oby.22409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432940PMC
April 2019

Higher Maternal Diet Quality during Pregnancy and Lactation Is Associated with Lower Infant Weight-For-Length, Body Fat Percent, and Fat Mass in Early Postnatal Life.

Nutrients 2019 Mar 15;11(3). Epub 2019 Mar 15.

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.

Maternal pregnancy nutrition influences fetal growth. Evidence is limited, however, on the relationship of maternal diet during pregnancy and lactation on infant postnatal growth and adiposity. Our purpose was to examine associations between maternal diet quality during pregnancy and lactation with offspring growth and body composition from birth to six months. Maternal diet quality was serially assessed in pregnancy and at one and three months postpartum, using the Healthy Eating Index⁻2015 in a cohort of 354 fully breastfeeding mother⁻infant dyads. Infant length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores were assessed at birth, one, three, and six months. Infant body fat percent (BF%), fat mass (FM), and fat-free mass (FFM) were measured at six months using dual-energy X-ray absorptiometry. Higher maternal diet quality from pregnancy through three months postpartum was associated with lower infant WLZ from birth to six months ( = 0.02) and BF% at six months ( ≤ 0.05). Higher maternal diet quality at one and three months postpartum was also associated with lower infant FM at six months ( < 0.01). In summary, maternal diet quality during pregnancy and lactation was inversely associated with infant relative weight and adiposity in early postnatal life. Additional research is needed to explore whether associations persist across the life course.
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http://dx.doi.org/10.3390/nu11030632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471184PMC
March 2019

Associations of Accelerometer-Measured Sedentary Time and Physical Activity With Prospectively Assessed Cardiometabolic Risk Factors: The CARDIA Study.

J Am Heart Assoc 2019 01;8(1):e010212

11 Division of Research Kaiser Permanente Northern California Oakland CA.

Background Isotemporal substitution examines the effect on health outcomes of replacing sedentary time with light-intensity physical activity or moderate-to-vigorous intensity physical activity; however, existing studies are limited by cross-sectional study designs. Methods and Results Participants were 1922 adults from the CARDIA (Coronary Artery Risk Development in Young Adults) study. Linear regression examined the associations of sedentary, light-intensity physical activity, and moderate-to-vigorous intensity physical activity at year 20 (2005-2006) with waist circumference, blood pressure, glucose, insulin, triglycerides, high-density lipoprotein cholesterol, and a composite risk score at year 30 (2015-2016). Models then examined change in activity with change in cardiometabolic risk over the same 10-year period. Replacing 30 min/day of sedentary time with 30 min/day of light-intensity physical activity at year 20 was associated with a lower composite risk score (-0.01 SD [95% CI, -0.02, -0.00]) at year 30, characterized by lower waist circumference (0.15 cm [95% CI, -0.27, 0.02]), insulin (0.20 μU/mL [95% CI, -0.35, -0.04]), and higher high-density lipoprotein cholesterol (0.20 mg/dL [95% CI, 0.00, 0.40]; all P<0.05). An increase of 30 min/day in MVPA from year 20 to year 30, when replacing an equivalent increase in sedentary time, was associated with a decrease in the composite risk score (-0.08 [95% CI, -0.13, -0.04]) over the same 10 years, characterized by a decrease in waist circumference (1.52 cm [95% CI, -2.21, -0.84]), insulin (-1.13 μU/mL [95% CI, -1.95, -0.31]), triglycerides (-6.92 mg/dL [95% CI, -11.69, -2.15]), and an increase in high-density lipoprotein cholesterol (1.59 mg/dL [95% CI, 0.45, 2.73]; all P<0.05). Conclusions Replacement of sedentary time with light-intensity physical activity or moderate-to-vigorous intensity physical activity is associated with improved cardiometabolic health 10 years later.
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http://dx.doi.org/10.1161/JAHA.118.010212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405708PMC
January 2019

Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis.

Sleep 2018 11;41(11)

Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Study Objectives: To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes.

Methods: Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity.

Results: Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity.

Conclusions: Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c.
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http://dx.doi.org/10.1093/sleep/zsy172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231520PMC
November 2018

Ten-Year Changes in Accelerometer-Based Physical Activity and Sedentary Time During Midlife: The CARDIA Study.

Am J Epidemiol 2018 10;187(10):2145-2150

Division of Research, Kaiser Permanente Northern California, Oakland, California.

We describe 10-year changes in accelerometer-determined physical activity (PA) and sedentary time in a midlife cohort of the Coronary Artery Risk Development in Young Adults Study, within and by race and sex groups. Participants (n = 962) wore the accelerometer with valid wear (≥4 of 7 days, ≥10 hours per day) at baseline (2005-2006; ages 38-50 years) and 10-year follow-up (2015-2016; ages 48-60 years). Data were calibrated to account for accelerometer model differences. Participants (mean age = 45.0 (standard deviation, 3.5) years at baseline) had reduced accelerometer counts overall (mean = -65.5 (standard error (SE), 10.2) counts per minute/day), and within race and sex groups (all P < 0.001). Sedentary time increased overall (mean = 37.9 (SE, 3.7) minutes/day) and within race and sex groups, whereas light-intensity PA (mean = -30.6 (SE, 2.7) minutes/day) and moderate- to vigorous-intensity PA (mean = -7.5 (SE, 0.8) minutes/day) declined overall and within race and sex groups (all P < 0.001). Significant differences in 10-year change estimates were noted by race and sex groups for accelerometer counts, sedentary time, and moderate- to vigorous-intensity PA bouts; black men had the greatest reductions in PA compared with other groups. PA declines during midlife were characterized by reductions in light-intensity PA with increases in sedentary time, which may have important health consequences. Targeted efforts are needed to preserve PA, regardless of intensity level, across midlife.
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http://dx.doi.org/10.1093/aje/kwy117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166210PMC
October 2018

Racial Disparities in Cardiovascular Health Behaviors: The Coronary Artery Risk Development in Young Adults Study.

Am J Prev Med 2018 07 18;55(1):63-71. Epub 2018 Jun 18.

Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.

Introduction: There are known racial differences in cardiovascular health behaviors, including smoking, physical activity, and diet quality. A better understanding of these differences may help identify intervention targets for reducing cardiovascular disease disparities. This study examined whether socioeconomic, psychosocial, and neighborhood environmental factors, in isolation or together, mediate racial differences in health behaviors.

Methods: Participants were 3,081 men and women from the Coronary Artery Risk Development in Young Adults study who were enrolled in 1985-1986 (Year 0) and completed a follow-up examination in 2015-2016 (Year 30). A health behavior score was created at Years 0, 7, 20, and 30 using smoking, physical activity, and diet assessed that year. The race difference in health behavior score was estimated using linear regression in serial cross-sectional analyses. Mediation analyses computed the proportion of the race and health behavior score association attributable to socioeconomic, psychosocial, and neighborhood factors.

Results: Data analysis conducted in 2016-2017 found that blacks had significantly lower health behavior scores than whites across 30 years of follow-up. Individual socioeconomic factors mediated 48.9%-70.1% of the association between race and health behavior score, psychosocial factors 20.3%-30.0%, and neighborhood factors 22.1%-41.4% (p<0.01 for all).

Conclusions: Racial differences in health behavior scores appear to be mediated predominately by correspondingly large differences in socioeconomic factors. This study highlights the profound impact of socioeconomic factors, which are mostly not under an individual's control, on health behaviors. Policy action targeting socioeconomic factors may help reduce disparities in health behaviors.
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http://dx.doi.org/10.1016/j.amepre.2018.03.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014889PMC
July 2018

Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis.

Med Sci Sports Exerc 2018 08;50(8):1613-1619

Division of Research, Kaiser Permanente Northern California, Oakland, CA.

Purpose: This study aimed to assess the associations of prepregnancy cardiorespiratory fitness, moderate- to vigorous-intensity physical activity (MVPA), and time spent watching television with subsequent development of gestational diabetes mellitus (GDM).

Methods: Participants were 1333 women enrolled in the Coronary Artery Risk Development in Young Adults study who did not have diabetes either at baseline (1985-86) or before births occurring after baseline. Baseline fitness was estimated using a graded symptom-limited maximal exercise treadmill test and expressed in MET units. Baseline MVPA (exercise units per day) was measured using the Coronary Artery Risk Development in Young Adults physical activity history questionnaire, and television viewing (h·d) was assessed by self-report in 1990-1991. Logistic regression analysis was used to derive odds ratios and 95% confidence intervals, adjusting for time from baseline to delivery and baseline study center, age, race, education, parity, family history of diabetes, smoking, alcohol, saturated fat intake, waist circumference, homeostasis model assessment of insulin resistance, and HDL cholesterol.

Results: Over 25 yr of follow-up, 164 women developed GDM. The odds of developing GDM were 21% lower for each 1 SD increment in baseline level of fitness (2.3 METs, odds ratio = 0.79, 95% confidence interval = 0.65-0.96). Prepregnancy MVPA and television viewing were not statistically associated with the development of GDM.

Conclusion: Study findings indicate that objectively assessed prepregnancy fitness, but not self-reported MVPA or television time, is associated with GDM. Clinicians should counsel women on the benefits of improving fitness in the preconception period, particularly among women at greater risk for GDM.
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http://dx.doi.org/10.1249/MSS.0000000000001600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047908PMC
August 2018

Comparison of Two Generations of ActiGraph Accelerometers: The CARDIA Study.

Med Sci Sports Exerc 2018 06;50(6):1333-1340

Division of Research, Kaiser Permanente, Oakland, CA.

Purpose: This study aimed to examine the comparability of the ActiGraph 7164 and wGT3X-BT wear time, count-based estimates, and average time per day in physical activity of different intensities.

Methods: We studied 87 Coronary Artery Risk Development in Young Adults (CARDIA) participants 48-60 yr of age who simultaneously wore the 7164 and wGT3X-BT accelerometers at the waist in 2015-2016, with wear time of ≥4 of 7 d, ≥10 h·d for both monitors. Freedson cutpoints (counts per minute) were used to define sedentary (<100), light (100-1951), moderate (1952-5724), and vigorous activity (≥5725). Agreement was evaluated using paired-difference tests, intraclass correlation coefficients, and Bland-Altman plots. Given systematic differences in count-based estimates between monitors, a calibration formula applied to the wGT3X-BT values was obtained by linear regression.

Results: Total detected wear time minutes per day was nearly identical between the 7164 and the wGT3X-BT (881.5 ± 70.9 vs 880.3 ± 78.1, P = 0.72). The wGT3X-BT values were calibrated to the 7164 values by dividing counts by 1.088. After calibration, no differences were observed between the 7164 and the wGT3X-BT in total counts per day (310,184 ± 129,189 vs 307,085 ± 135,362, P = 0.48), average counts per min per day (349.5 ± 139.5 vs 346.5 ± 147.2, P = 0.54), sedentary (513.2 ± 93.6 vs 509.6 ± 98.6, P = 0.23), light (335.3 ± 81.5 vs 338.7 ± 81.1, P = 0.22), moderate (31.0 ± 21.9 vs 30.3 ± 23.4, P = 0.31), or moderate-to-vigorous minutes per day (33.1 ± 24.6 vs 32.0 ± 26.0, P = 0.13). A significant difference was observed for vigorous minutes per day (0.2 ± 1.0 vs 0.0 ± 0.3, P < 0.01); however, the absolute difference was marginal. Intraclass correlation coefficients showed excellent agreement for all measures (0.95-0.99).

Conclusions: After applying a calibration formula, the 7164 and wGT3X-BT were comparable for total wear time, count-based estimates, and average minutes per day in sedentary, light, moderate, and moderate-to-vigorous activity. Findings illustrate a novel methodological approach to facilitate accelerometer data harmonization.
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http://dx.doi.org/10.1249/MSS.0000000000001568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953790PMC
June 2018

A randomized controlled trial to prevent excessive gestational weight gain and promote postpartum weight loss in overweight and obese women: Health In Pregnancy and Postpartum (HIPP).

Contemp Clin Trials 2018 03 31;66:51-63. Epub 2018 Jan 31.

Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.

Background: Interventions to prevent excessive gestational weight gain and promote postpartum weight loss have yielded modest results, particularly in overweight and obese women.

Objectives: To examine the impact of a theory-based lifestyle intervention on gestational weight gain, postpartum weight loss, and related maternal and child outcomes and to examine race differences in these outcomes.

Design: A randomized controlled trial (target N=400; 200 intervention, 200 standard care; 200 African American, 200 white).

Methods: Overweight and obese African American and white women ≤16weeks gestation are recruited from obstetrics and gynecology clinics in South Carolina. Intervention participants receive two in-depth counseling sessions (early pregnancy and postpartum), telephone counseling, behavioral podcasts, and social media support that target weight self-monitoring and increasing physical activity and healthy dietary behavior practices, guided by Social Cognitive Theory. Standard care participants receive monthly mailings and a matched number of podcasts on non-weight related topics. All intervention activities last from ≤18weeks gestation to 6months after delivery. Gestational weight gain is the primary outcome. Secondary outcomes are meeting gestational weight gain guidelines (inadequate, adequate, excessive), weekly rate of gestational weight gain, postpartum weight retention, physical activity and dietary behaviors, health-related quality of life, and offspring adiposity. Participants are assessed at baseline (≤16weeks gestation), 32weeks gestation, and 6 and 12months postpartum, and offspring are assessed at 6 and 12months.

Summary: HIPP is an innovative study that addresses significant gaps in the literature. Primary outcome results are expected in 2019.
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http://dx.doi.org/10.1016/j.cct.2018.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841597PMC
March 2018

Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study.

Prev Med 2018 01 2;106:137-144. Epub 2017 Nov 2.

University of Minnesota School of Public Health, Division of Epidemiology & Community Health, Minneapolis, MN 55454, USA.

While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year 7 (ages 25-37years) and/or 20 exams (ages 38-50years), respectively, which included a GXT. Cox proportional hazard models were used to examine the effect of GXT disposition (at Year 7 and 20, separately) on risk of non-fatal and fatal cardiovascular events and all-cause mortality obtained through 28years of follow-up. A GXT was not conducted or completed according to protocol in 12.9% and 19.1% of participants attending the Year 7 and 20 exams, respectively. After adjustment, participants who missed the Year 20 GXT for medical reasons had a higher risk of cardiovascular events [HR: 4.06 (95% CI: 1.43, 11.5)] and all-cause mortality [HR: 3.07 (95% CI: 1.11, 12.3)] compared to GXT completers; participants who missed at Year 20 for non-medical reasons also had higher risk of all-cause mortality [HR: 2.53 (95% CI: 1.61, 3.99)]. Findings suggest that non-participation in a GXT, regardless of medical or non-medical reason, to be an important predictor of excess risk of adverse health outcomes and premature mortality. Additional patient follow-up, including identification of potential targets for intervention (e.g., weight management and smoking cessation programs), should be conducted at the point of a missed GXT.
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http://dx.doi.org/10.1016/j.ypmed.2017.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400469PMC
January 2018

Associations of Maternal Weight Status Before, During, and After Pregnancy with Inflammatory Markers in Breast Milk.

Obesity (Silver Spring) 2017 12 6;25(12):2092-2099. Epub 2017 Oct 6.

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.

Objective: The goal of this study was to examine the associations of maternal weight status before, during, and after pregnancy with breast milk C-reactive protein (CRP) and interleukin 6 (IL-6), two bioactive markers of inflammation, measured at 1 and 3 months post partum.

Methods: Participants were 134 exclusively breastfeeding mother-infant dyads taking part in the Mothers and Infants Linked for Health (MILK) study, who provided breast milk samples. Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) were assessed by chart abstraction; postpartum weight loss was measured at the 1- and 3-month study visits. Linear regression was used to examine the associations of maternal weight status with repeated measures of breast milk CRP and IL-6 at 1 and 3 months, after adjustment for potential confounders.

Results: Pre-pregnancy BMI and excessive GWG, but not total GWG or postpartum weight loss, were independently associated with breast milk CRP after adjustment (β = 0.49, P < 0.001 and β = 0.51, P = 0.011, respectively). No associations were observed for IL-6.

Conclusions: High pre-pregnancy BMI and excessive GWG are associated with elevated levels of breast milk CRP. The consequences of infants receiving varying concentrations of breast milk inflammatory markers are unknown; however, it is speculated that there are implications for the intergenerational transmission of disease risk.
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http://dx.doi.org/10.1002/oby.22025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705414PMC
December 2017

Sedentary Behaviors and Cardiometabolic Risk: An Isotemporal Substitution Analysis.

Am J Epidemiol 2018 02;187(2):181-189

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.

Evidence suggests that time spent engaging in sedentary behaviors is associated with a greater risk of adverse cardiometabolic outcomes. We investigated the cross-sectional associations of 6 unique sedentary tasks (watching television, using the computer, completing paperwork, reading, talking on the telephone, and sitting in a car) with cardiometabolic risk factors, and also examined the effect of replacing one type of sedentary behavior with another on the level of cardiometabolic risk. Participants consisted of 3,211 individuals from the Coronary Artery Risk Development in Young Adults Study who visited the clinic between 2010 and 2011. Linear regression models examined the independent and joint associations of sedentary tasks with a composite cardiometabolic risk score, as well as with individual cardiometabolic risk factors (waist circumference, blood pressure, fasting glucose, insulin, triglycerides, and high density lipoprotein cholesterol) after adjusting for physical activity and other covariates. Replacing 2 hours of television viewing with 2 hours spent performing any other sedentary activity was associated with a lower cardiometabolic risk score of 0.06-0.09 standard deviations (all 95% confidence intervals: -0.13, -0.02). No other replacements of one type of sedentary task for another were significant. Study findings indicate that television viewing has a more adverse association with cardiometabolic risk factors than other sedentary behaviors.
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http://dx.doi.org/10.1093/aje/kwx209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860012PMC
February 2018

Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA).

Am J Epidemiol 2017 Aug;186(4):445-455

Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discrimination-diabetes relationship.
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http://dx.doi.org/10.1093/aje/kwx047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860562PMC
August 2017

Sedentary Behavior, Physical Activity, and Abdominal Adipose Tissue Deposition.

Med Sci Sports Exerc 2017 03;49(3):450-458

1Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; 2Division of Research, Kaiser Permanente Northern California, Oakland, CA; and 3Department of Epidemiology, School of Medicine, University of California, Irvine, CA.

Purpose: We examined whether sedentary lifestyle habits and physical activity level are associated with abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and liver attenuation, independently of one another and potential confounders.

Methods: This study analyzed 3010 African American and Caucasian men and women, 42-59 yr old, from the Coronary Artery Risk Development in Young Adults (CARDIA) study, who completed multiple-slice abdominal computed tomography in 2010-2011. Participants reported average hours per day sitting (television, computing, paperwork, music, telephone, and car). Physical activity was assessed with the CARDIA physical activity history. VAT, SAT, IMAT, and liver attenuation were estimated from computed tomography. Multivariable general linear regression models regressed means of fat depots on total sedentary time, task-specific sedentary time, and total physical activity.

Results: Television viewing was positively, and physical activity inversely, associated with fat depots. For each 1 SD increment in television viewing (1.5 h·d), VAT, SAT, and IMAT were greater by 3.5, 3.4, and 3.9 cm, respectively (P < 0.03 for all). For each 1 SD increment in physical activity (275 exercise units), VAT, SAT, and IMAT were lower by 7.6, 6.7, and 8.1 cm, respectively, and liver attenuation was greater (indicating more liver fat) by 0.5 Hounsfield units (P < 0.01 for all). Total sedentary time was associated with VAT, IMAT, and liver attenuation in White men only after controlling for physical activity, SAT, and other potential confounders (P ≤ 0.01 for all). No other task-specific sedentary behaviors were associated with fat depots.

Conclusions: Sedentary behaviors, particularly television viewing, and physical activity levels have distinct, independent associations with fat deposition.
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http://dx.doi.org/10.1249/MSS.0000000000001112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315590PMC
March 2017