Correlates of Physical Activity Engagement among Pregnant Women with Overweight and Obesity

BackgroundExcess weight during pregnancy increases risk for adverse obstetrical outcomes. Physical activity (PA) may buffer these effects, although it is unclear what factors are associated with PA in women who begin pregnancy with overweight/obesity. The present study sought to characterize the demographic and psychological correlates of PA among women with prepregnancy overweight/obesity.MethodsPregnant women (N = 249; mean age, 28.48 ± 5.48 years; mean body mass index, 34.13 ± 7.07 kg/m²) at 12–20 weeks of gestation (mean, 15.68 ± 2.44 weeks of gestation) completed ratings of perceived stress and depressive symptoms and were interviewed using the pregnancy version of the Eating Disorders Examination. The Paffenbarger Physical Activity Survey was administered via interview to estimate energy expenditure. Continuous outcomes were evaluated via linear regression, while logistic regression was conducted to assess likelihood of meeting PA guidelines.ResultsMean weekly duration of moderate to vigorous PA was 109.50 ± 248.17 minutes, with 21% of women meeting federal PA guidelines of 150 minutes or more. Higher perceived stress (β = –0.217; p = .02) and eating psychopathology (β = –0.213; p < .01) were associated with lower total energy expenditure. Black women reported lower expenditure specifically from walking compared with White women (β = –0.180; p = .03). Depressive symptoms were not associated with PA. No estimate of PA predicted body mass index.ConclusionsPregnant women with overweight/obesity engage in modest amounts of PA early in pregnancy, although few meet PA guidelines. Greater perceived stress and eating psychopathology were associated with lower PA engagement. These factors should be monitored by obstetrics providers to identify women who may particularly benefit from counseling about PA during pregnancy.     

Body composition influences blood pressure during submaximal graded test in women

This study aimed to determine whether body composition affected cardiovascular responses of normal, overweight and obese women by comparing heart rate (HR) and blood pressure (BP) during a graded submaximal treadmill exercise. Thirty five healthy non-smoking, premenopausal women (age 30.8 ± 9.5 yr; height 1.66 ± 0.05 m; weight 73.8 ± 18.9 kg; body fat 36.2 ± 9.5%; maximum oxygen uptake 33.5 ± 8.1 mL·min·kg⁻¹) volunteered for this study, and were classified into three groups based on BMI: normal weight (NOR; ≤24.9 kg·m²), overweight (OVW; 25−29.9 kg·m²) and obese (OBE; ≥30 kg·m²). Participants performed a submaximal graded test at 30%, 40%, 50% and 60% of maximal oxygen uptake, during which HR, systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were measured. At rest, participants of OBE group had higher BP than NOR and OVW. During the submaximal graded test, HR, SBP and MAP increased as a function of intensity. There were no group differences in HR, but greater SBP, DBP and MAP in OBE compared to NOR and OBW at all intensities except 60%. Overall, our study further contributes to underscore the importance of stress testing specifically to evaluate the increased risks apparently healthy obese women are placed at to developing diseases from the chronic exposure to raised BP, despite normal resting BP and HR responses during exercise.     

Marginal vitamin C status is associated with reduced fat oxidation during submaximal exercise in young adults

Background

We examined aerobic and anaerobic exercise energy expenditure and excess post-exercise oxygen consumption (EPOC) between a 250 Watt, 1-minute bout of cycling and uphill treadmill running.

Methods

Fourteen active to well-trained subjects volunteered for the investigation (VO₂ max: 57.0 ± 12.9 ml·kg·min^-1 cycle; 59.3 ± 13.7 ml·kg·min^-1 run; p = 0.44). Anaerobic energy expenditure was estimated from △blood lactate. Statistical analysis was completed using a paired t-test (mean ± SD).

Results

Perceived exertion did not differ between exercise bouts (14.0 ± 2.3 cycle; 13.2 ± 2.1 run; p = 0.29). Exercise oxygen uptake was significantly greater for running (41.4 ± 6.9 kJ) compared to cycling (31.7 ± 7.7 kJ) (p = 0.0001). EPOC was not different between cycling and running (p = 0.21) so that exercise oxygen uptake + EPOC was greater for running (103.0 ± 13.5 kJ) as compared to cycling (85.4 ± 20.2 kJ; p = 0.008). Anaerobic energy expenditure was significantly greater for cycling (32.7 ± 8.9 kJ) versus running (22.5 ± 11.1 kJ) (p = 0.009). Aerobic + anaerobic exercise energy expenditure (cycle 64.3 ± 12.2 kJ; run 63.9 ± 10.1 kJ) (p = 0.90) and total energy expenditure (including EPOC; cycle 118.0 ± 21.8 kJ; run 125.4 ± 19.1 kJ; p = 0.36) were similar for cycling and running.

Conclusion

Oxygen-only measures reveal discrepancy in energy expenditure between cycling and uphill running. Measurements of exercise oxygen uptake, △blood lactate and a modified EPOC promote the hypothesis of a similarity in exercise and total energy expenditure between 1-minute work-equivalent bouts of cycling and uphill running.     

Quantitation of alpha-linolenic acid elongation to eicosapentaenoic and docosahexaenoic acid as affected by the ratio of n6/n3 fatty acids

Background

Resting and postprandial oxidative stress is elevated in those with metabolic disorders such as diabetes. Antioxidant supplementation may attenuate the rise in oxidative stress following feeding. Therefore we sought to determine the effects of acetyl L-carnitine arginate (ALCA) on resting and postprandial biomarkers of glucose and lipid metabolism, as well as oxidative stress.

Methods

Twenty-nine pre-diabetic men and women were randomly assigned to either 3 g·day^-1 of ALCA (n = 14; 31 ± 3 yrs) or placebo (n = 15; 35 ± 3 yrs) in a double-blind design, to consume for eight weeks. Fasting blood samples were taken from subjects both pre and post intervention. After each fasting sample was obtained, subjects consumed a high fat, high carbohydrate meal and additional blood samples were taken at 1, 2, 4, and 6 hours post meal. Samples were analyzed for a variety of metabolic variables (e.g., glucose, HbA1c, lipid panel, C-reactive protein, nitrate/nitrite, and several markers of oxidative stress). Area under the curve (AUC) was calculated for each variable measured post meal, both pre and post intervention.

Results

ALCA, but not placebo, resulted in an increase in nitrate/nitrite (25.4 ± 1.9 to 30.1 ± 2.8 μmol·L^-1) from pre to post intervention, with post intervention values greater compared to placebo (p = 0.01). No other changes of statistical significance were noted (p > 0.05), although ALCA resulted in slight improvements in glucose (109 ± 5 to 103 ± 5 mg·dL^-1), HbA1c (6.6 ± 1.1 to 6.2 ± 1.2%), and HOMA-IR (3.3 ± 1.3 to 2.9 ± 1.2). AUC postprandial data were not statistically different between ALCA and placebo for any variable (p > 0.05). However, nitrate/nitrite demonstrated a moderate effect size (r = 0.35) for increase from pre (139.50 ± 18.35 μmol·L^-1·6 hr^-1) to post (172.40 ± 21.75 μmol·L^-1·6 hr^-1) intervention with ALCA, and the magnitude of decrease following feeding was not as pronounced as with placebo.

Conclusion

Supplementation with ALCA results in an increase in resting nitrate/nitrite in pre-diabetics, without any statistically significant change in other metabolic or oxidative stress variables measured at rest or post meal.     

4～6月龄婴儿能量需要量研究

用双标记水法对广东２３名４月龄和２１名６月龄健康婴儿的总能量消耗进行为期８天的测量，用称重法测定婴儿２４小时母乳和食物摄入量，计算婴儿的能量摄入量，通过测定婴儿的体重变化估计生长的能量贮留，以了解婴儿的能量摄入是否满足其基础代谢、活动和生长等的需要。结果：母乳组和人工喂养组４月龄婴儿的能量摄入分别为３３０±６０和４０２±４６ｋＪ／（ｋｇ·ｄ），能量贮留分别为４９±１９和４９±１９ｋＪ／（ｋｇ·ｄ），能量消耗分别为２６８±７９和３２６±７９ｋＪ／（ｋｇ·ｄ）。母乳组和人工喂养组６月龄婴儿的能量摄入分别为３４７±７１和３８９±８８ｋＪ／（ｋｇ·ｄ），能量贮留分别为１８±１１和２９±１１ｋＪ／（ｋｇ·ｄ），能量消耗分别为３２２±９６和３４３±１２１ｋＪ／（ｋｇ·ｄ）。４～６月龄婴儿的能量需要量估计为３７３ｋＪ／（ｋｇ·ｄ）。     

Role of an electronic armband in motor function monitoring in patients with Parkinson's disease

ObjectiveLevodopa replacement still is the gold standard for the management of Parkinson's disease (PD). Long-term treatment with levodopa is frequently associated with motor fluctuations. A low-protein (LP) dietary regimen has proved to be effective in reducing this adverse effect, but has been associated with weight loss, probably due to increased energy expenditure. A new wearable device (SenseWear Armband [SWA]) has recently been introduced into clinical practice. It is designed to monitor physical activity continuously and provide estimates of energy consumption. We assessed its role in measuring the effects of dietary regimens on motor function in PD.MethodsSix patients with levodopa-treated PD and motor fluctuations were asked to follow a balanced diet (protein 1 g · kg^?1 · d^?1) for 7 d and then to cross over to a isocaloric LP (protein 0.7 g · kg^?1 · d^?1) dietary regimen. Total daily energy expenditures, physical activity, number of steps, and metabolic rate were assessed continuously (14 d) by the SWA. Motor control was evaluated by daily diaries.ResultsThe SWA proved that, during the LP diet, mean total daily energy expenditure was higher (P < 0.05) and so were physical activity (P = 0.05) and average metabolic rate (P = 0.01), despite no change in the number of steps. The duration of periods with dyskinesias was also increased (P < 0.05). These data support the role of upper-extremity involuntary movements in increasing total daily energy expenditure during an LP diet.ConclusionThe SWA may help in monitoring patients with PD because it can assist in evaluating motor response to treatment and changes in physical activity and daily calorie needs.     

Effects of insulin and amino acids on leucine metabolism in young and middle-aged humans

Summary Background Aging is characterized by loss of muscle mass. In healthy subjects this process is associated with hormone and nutritional changes which take place over many decades. Aim of the study To investigate the effects of insulin and amino acids on amino acid metabolism in middle-aged humans. Methods We evaluated leucine kinetics by means of the intravenous infusion of [1-¹⁴C]leucine, in 8 young (age 24±2 yr, BMI 21±2 kg/m²) and in 6 middle-aged (age 53±4 yr, BMI 26±1 kg/m²) healthy subjects. Studies were performed under fasting conditions (basal), and after 180 min of euglycemic hyperinsulinemic clamp (study I), or 180 min of euglycemic hyperinsulinemia in combination with an intravenous amino acid infusion (study II). Results In the basal state endogenous leucine flux (ELF, an index of proteolysis), normalized for IBW, averaged 1.71±0.12 and 1.66±0.14 μmol/kg·min in young and middle-aged subjects, respectively. Basal leucine oxidation (0.22±0.03 vs 0.28±0.03 μmol/kg·min, p < 0.05) was lower in middle-aged with respect to young subjects. Non-oxidative leucine disposal (NOLD, an index of protein synthesis: 1.44±0.11 vs 1.43±0.11 μmol/kg·min) was similar in young and middle-aged subjects, respectively. In response to insulin (study I) the absolute and percent decline of ELF and LOX were similar in young and middle-aged subjects: ELF declined to 1.05±0.06 μmol/kg·<,min (−M39±5 %) and 1.07±0.14 μmol/kg·min (−36±4 %), in young and middle-aged, respectively (both p < 0.01 vs basal); LOX declined to 0.21±0.02 μmol/kg·min (−35±3 %), and 0.18±0.05 μmol/kg·min (−28±3 %, p < 0.05 vs basal) in young and middle-aged individuals respectively (both p < 0.01 vs basal). In contrast, insulin-mediated whole-body glucose uptake was lower in middle-aged subjects (6.6±1.4 mg/kg·min) with respect to young individuals (8.1±1.7 mg/kg·min, p < 0.05). During study II (insulin plus AA) a significant rise in NOLD was obtained in both young (1.72±0.10 μmol/kg·min, p < 0.01 vs basal) and middle-aged subjects (1.76±0.25 μmol/kg·min, p < 0.01 vs basal). Similarly, net leucine balance rose significantly in both young (+0.62±0.13 vs −0.25±0.02 μmol/kg·min, p < 0.01 vs basal) and middle-aged subjects (+0.37±0.08 vs −0.22±0.03 μmol/kg·min, p < 0.01 vs basal) suggesting that the anabolic response to amino acids is preserved in middle-aged subjects. Conclusions In middle-aged subjects we observed 1) a moderate decline in basal leucine oxidation; 2) a normal antiproteolytic response to insulin and a reduction in glucose uptake; and 3) a normal anabolic response to AA plus insulin. In conclusion, the data provide evidence for a normal regulation of protein anabolism and an early dissociation between the metabolic effects of insulin on glucose uptake and proteolysis in middle-aged subjects. Received: 6 September 2000, Accepted: 10 July 2001     

Energy expenditure and estimated caloric intake in asthmatic adolescents with excess body weight

ObjectiveTo measure resting energy expenditure (REE) and to estimate caloric intake of asthmatic adolescents with excess body weight and compare results with those groups of eutrophic asthmatic adolescents and non-asthmatic adolescents with excess body weight.MethodsThis cross-sectional study categorized 69 adolescents aged 10 to 18 y into three matched groups. Nutritional status was assessed using anthropometric and body composition measurements. Indirect calorimetry was used to measure energy expenditure, and caloric intake was estimated from dietary recalls.ResultsIn each group, there were 23 adolescents (10 girls) aged 12.39 ± 2.40 y. Results for each group were as follows. For asthmatic adolescents with excess body weight, body mass index (BMI) was 24.83 ± 2.73 kg/m², REEs were 1550.24 ± 547.23 kcal/d and 27.69 ± 11.33 kcal · kg^?1 · d^?1, and estimated caloric intake was 2068.75 ± 516.66 kcal/d; for eutrophic asthmatic adolescents, BMI was 19.01 ± 2.10 kg/m², REEs were 1540.82 ± 544.22 kcal/d and 36.65 ± 15.04 kcal · kg^?1 · d^?1, and estimated caloric intake was 2174.05 ± 500.55 kcal/d; and for non-asthmatic adolescents with excess body weight, BMI was 25.35 ± 3.66 kg/m², REEs were 1697.24 ± 379.84 kcal/d and 28.18 ± 6.70 kcal · kg^?1 · d^?1, and estimated caloric intake was 1673.17 ± 530.68 kcal/d. Absolute REE values between groups were not statistically different, even after correction for lean mass and fat mass (F = 0.186, P = 0.831). REE (kilocalories per kilogram per day) was significantly higher in the group of eutrophic asthmatic adolescents (P = 0.016). Estimated caloric intake was greater than REE only in the group of adolescents with asthma.ConclusionThe REE was not significantly different among groups, and REE (kilocalories per kilogram per day) was higher in the group of eutrophic asthmatic adolescents. Estimated caloric intake was greater than REE in the group of adolescents with asthma.     

The Influence of Habitual Protein Intake on Body Composition and Muscular Strength in Career Firefighters

Objective: The aim of this research was to determine the relationship among protein (PRO) intake, body composition, and muscle strength in overweight and obese firefighters. A secondary objective was to evaluate differences in body composition and muscle strength among overweight and obese firefighters with low (L; < 0.8 g·kg^?1), moderate (M; 0.8–1.0 g·kg^?1), and high (H; > 1.0 g·kg^?1) PRO intake.

Methods: Relative PRO intake [r_PRO] was evaluated from 3-day dietary logs, self-reported by 43 overweight and obese male career firefighters (mean ± standard deviation; age = 37.3 ± 7.2 years; body mass index = 33.2 ± 5.0 kg·m^?2; percent body fat [%BF] = 28.9 ± 4.0%). Body composition (fat mass [FM], %BF, lean mass [LM], percent LM [%LM]) and muscle strength (peak torque [PT], relative peak torque [r_PT] of the leg extensors) were measured using dual-energy x-ray absorptiometry and isokinetic dynamometry, respectively.

Results: Greater r_PRO was associated with less FM, %BF, LM (r = ?0.498 to ?0.363) and greater %LM (r = 0.363), but not muscle strength (p > 0.05). Fat mass (r = ?0.373) and %BF (r = ?0.369) were associated with lower r_PT; %LM was associated with greater r_PT (r = 0.373). Individuals with L r_PRO had greater FM (mean difference ± standard error: L–H = 10.08 ± 3.18 kg), %BF (L–H = 3.8% ± 1.4%) and lower %LM (L–H = ?3.7% ± 1.3%) than those with H r_PRO (p < 0.05) but no significant differences in muscle strength (p > 0.05).

Conclusions: Protein intake > 0.8 g·kg^?1 was associated with more favorable body composition in male career firefighters.     

High-protein diet promotes a moderate postpartum weight loss in a prospective cohort of Brazilian women

ObjectiveWhether a high-protein (HP) diet promotes body weight loss (BWL) when compared with a low-protein (LP) diet is still unclear. Therefore, we evaluated the effects of an HP diet on BWL during postpartum.MethodsA food-frequency questionnaire with 81 items was applied at 6 mo after delivery to evaluate the diet of 430 postpartum women aged 18–45 y. Body weight was measured approximately at 0.5, 2, 6, and 9 mo after delivery. Body weight loss was modeled by comparing an HP diet (≥1.2 g · kg^?1 · d^?1) with an LP diet (<1.2 g · kg^?1 · d^?1) using mixed-effects linear regression models adjusted for energy intake, percentage of body fat at baseline, stature, age, race, smoking, and schooling.ResultsUsual energy intake was higher in the HP than in the LP diet group (2623 versus 1791 kcal, P < 0.0001). Daily mean protein intakes were 1.54 ± 0.32 g · kg^?1 · d^?1 for the HP group and 0.83 ± 0.20 g · kg^?1 · d^?1 for the LP group. A multivariate model showed that women in the HP group lost 316 ± 0.062 g of body weight more per month (P < 0.01) when compared with the LP group.ConclusionA reported higher protein intake may improve moderate postpartum body weight loss. Further studies should evaluate the long-term consequences of an HP diet postpartum.     

A Comparison of Meal Replacements and Medication in Weight Maintenance after Weight Loss

Objective: To compare the use of meal replacements or medication during weight maintenance subsequent to weight loss using a very low-energy diet (VLED) in overweight or obese adults.

Design: Participants followed a liquid VLED of 2177 kJ for 12 weeks followed by 4 weeks of re-orientation to solid foods. Participants were randomized at week 16 to receive either meal replacements or Orlistat both combined with a structured meal plan containing an energy value calculated to maintain weight loss.

Subjects: Sixty-four women (age = 49.9 ± 10 y, weight = 101.6 ± 17.1 kg, height = 164.9 ± 6.0 cm, BMI = 36.7 ± 5.4 kg/m²) and 28 men (age = 53.7 ± 9.6 y, weight = 121.8 ± 16.0 kg, height = 178.7 ± 5.6 cm, BMI = 37.8 ± 4.9 kg/m²) completed a 1 year weight management program. Behavioral weight management clinics included topics on lifestyle, physical activity (PA), and nutrition. Participants met for 90 min weekly for 26 weeks, and then biweekly for the remaining 26 weeks.

Outcomes: Minutes of PA, fruits and vegetables (FV), and pedometer steps were recorded on a daily basis and reported at each group meeting. Body weight was obtained at each group meeting.

Results: During VLED, the MR group decreased body weight by 22.8 ± 6.1 kg and the Orlistat group decreased body weight by 22.3 ± 6.1 kg. During weight maintenance, there was no significant group by time interaction for body weight, PA, FV consumption, or pedometer steps. At week 16, the meal replacement group had a body weight of 85.4 ± 14.3 kg that increased to 88.1 ± 16.5 kg at 52 weeks (p < 0.05). At week 16, the Orlistat group had a body weight of 85.7 ± 17.9 kg that increased to 88.5 ± 20.3 kg at 52 weeks (p < 0.05).

Conclusions: Subsequent to weight loss from a VLED, meal replacements and Orlistat treatments were both effective in maintaining weight significantly below baseline levels over a 52 week period of time. Meal replacements may be a viable alternative strategy to medications for weight maintenance.     

Diet quality is lower among adults with a BMI ≥40 kg m−2 or a history of weight loss surgery

BackgroundPoor diet is a major public health issue requiring strategies to support improvements. Nutrition knowledge influences eating behaviours, yet few studies have examined relationships with diet quality. The current study aimed to explore relationships between demographic characteristics, nutrition knowledge, and diet quality using the Australian Recommended Food Score (measuring diet variety).MethodsAdults 18–60 years completed a 210-item survey including questions on demographics, health, nutrition knowledge, and diet. Statistical analysis used chi-square tests, linear and multiple regression, adjusted for covariates.Results480 respondents with a mean (SD) age 39.1 ± 11.6 years (18% male) completed all questions. Overall diet quality scores were high (ARFS 39.5 ± 9 points). Nutrition knowledge (p < 0.001) and BMI (p < 0.001) were positively associated with ARFS. ARFS scores were higher for those with higher nutrition knowledge scores (ARFS 42 ± 8 points) and of lower BMI (ARFS 40 ± 8 points) compared to those with lower knowledge (ARFS 37 ± 11) and higher BMI (ARFS 35 ± 10 points). Those with BMI ≥ 40 kg·m⁻² and weight loss surgery reported the lowest diet quality (ARFS 31 ± 10 points).ConclusionDiet quality was highest among those with high nutrition knowledge and lower BMI. Those with a BMI ≥ 40 kg·m⁻², particularly those with past weight loss surgery reported the lowest diet quality, despite comparable levels of nutrition knowledge. It remains unclear which factors explain the variation in diet quality in the weight loss surgery group and this deserves further attention given the growing popularity of weight loss surgery.     

A meal replacement regimen improves blood glucose levels in prediabetic healthy individuals with impaired fasting glucose

ObjectiveThe aim of this study was to investigate the effect of a 6-wk intervention with either lifestyle intervention (increased physical activity and a low-calorie diet) or a meal replacement regimen on glycemic control in patients who are prediabetic and have impaired fasting glucose.MethodsForty-two overweight or obese men and women (age 54 ± 8 y; weight 95.1 ± 11.9 kg; body mass index [BMI] 32.8 ± 2.89 kg/m²) were included in this randomized controlled clinical trial. Patients in the lifestyle group (LS; n = 14) received dietary counseling sessions (fat-restricted low-calorie diet) and instructions on how to increase physical activity. Patients in the meal replacement group (MR; n = 28) were instructed to replace two daily meals with a low-calorie, high soy-protein drink with a low glycemic index.ResultsBoth interventions resulted in a significant decrease in body weight and BMI, although the reduction was more pronounced (P < 0.05) in the MR group. In both groups, glucose concentrations decreased significantly (LS: −12 mg/dL, P < 0.01; MR: −11 mg/dL, P < 0.01), and mean glucose levels returned to the normal range. Insulin (LS: −1 μU/mg [not significant]; MR: −6.3 μU/mg, P < 0.01) and homeostasis model assessment of insulin resistance (HOMA-IR; LS −0.92, P < 0.01; MR: −2.1, P < 0.01) were also significantly lower following both interventions; again improvements were more pronounced in the MR group (insulin: P < 0.05; HOMA P < 0.01)ConclusionIt can be concluded that meal replacement is an effective intervention for rapid improvement of elevated fasting glucose and increased insulin concentrations, these being important biomarkers of the prediabetic state. The 6-wk intervention has shown that the effect of meal replacement on fasting blood glucose was comparable to the effect of lifestyle intervention. The alterations in BMI, insulin, and HOMA-IR were significantly more pronounced following the meal replacement regimen.     

Relationships of self-reported physical activity domains with accelerometry recordings in French adults

The objective was to examine the relationships of self-reported physical activity (PA) by domain (leisure, occupational, other) with PA and sedentary time as measured objectively by accelerometry. Subjects were adults with low habitual PA levels from a community in northern France. Among subjects in the lowest tertile of a PA score from a screening questionnaire, 160 (37% males, age: 41.0 ± 10.8 years, BMI: 25.1 ± 4.1 kg/m², mean ± SD) completed a detailed instrument (Modifiable Activity Questionnaire), and wore an accelerometer (Actigraph) for seven consecutive days. Relationships between questionnaire domains (occupational, leisure, and “non-occupational non-leisure”) and accelerometry measures (total activity and sedentary time) were assessed using Spearman correlation coefficients. In this population, the highest contributor to total reported PA (h/week) was occupational PA. Time spent in non-occupational non-leisure PA ranked second in women and third in men. The most frequent non-occupational non-leisure PA were shopping and household chores. In women, non-occupational non-leisure PA contributed more than occupational or leisure-time PA to total PA energy expenditure (median: 18.0, 9.1, and 4.9 MET-h/week, respectively). Total PA by accelerometry (count/day) was correlated to leisure-time PA in women (r = 0.22, P < 0.05) and to occupational (r = 0.43, P < 0.01) and total reported PA (r = 0.39, P < 0.01) in men (all in MET-h/week). There was an inverse relationship between accelerometry sedentary time (h/day) and non-occupational non-leisure PA (MET-h/week, r = −0.30, P < 0.001). These findings indicate the importance of assessing non-occupational non-leisure PA for a better understanding of how individuals partition their time between active or sedentary occupations.     

Sex difference in the immunogenicity of the quadrivalent Human Papilloma Virus vaccine: Systematic review and meta-analysis

BackgroundImmunological differences between males and females in response to viral vaccines are well known. This the first review to examine them for the Human Papilloma Virus.MethodsWe conducted a systematic review and meta-analysis of the immunogenicity of the Quadrivalent Human Papilloma Virus Vaccine qHPVV. We searched Medline, Embase, and CENTRAL for trials published until September 17, 2019. Inclusion criteria were 3-doses and reporting geometric mean titers (GMTs). We performed random-effects meta-analyses and meta-regression separated by age group and sex.ResultsOur search yielded 1809 unique studies. 334 full texts were screened and data from 18 studies were extracted. Females had higher pooled geometric mean titers than males in all age groups. Log transformed GMTs in male children (<16) years were: against HPV6: 6·62 (95% CI 6·29–6·94; I² = 86·0%), against HPV11: 7·07 (95% CI 6·90–7·23; I² = 63.1%), against HPV16: 8·53 (95% CI 8·28–8·78; I² = 73·0%), and against HPV18 7·21 (95% CI 7·08–7·34; I² = 26·4%). In females: against HPV6 7·10 (95% CI 6·79–7·41; I² = 96·6%), HPV11: 7·32 (95% CI 7·15–7·50; I² = 90·6%), HPV16: 8·71 (95% CI 8·52–8·91; I² = 90·2%), and HPV18 7·35 (95% CI 7·11–7·58; I² = 92·7%). In the meta-regression, the sexual difference was significant for HPV6 (p = 0·022) with a similar tendency for HPV11 (p = 0·066) and HPV18 (p = 0·079). Immunogenicity was significantly higher in children (<16) than in adults (p < 0·001).ConclusionFemales have higher antibody titers against HPV after receiving the qHPVV than do males. The difference is bigger in low-risk HPV strains. Adjusting the doses and schedules for each sex should be explored further.     

Effects of a group physical activity program on physical fitness and quality of life in individuals with schizophrenia

PurposeThe purpose of this study was to evaluate the effects of a 16-week group physical activity (PA) program on physical fitness and quality of life in outpatients with schizophrenia.MethodsNineteen outpatients with schizophrenia were divided into experimental (EG) (n = 8; mean age 39 ± 7 years) and control (CG) (n = 11; mean age 40 ± 6 years) groups. The EG underwent twice a week sessions of a group PA program for a period of 16-week. The participants completed a battery of tests at baseline and after 16-week, which included the assessment of body composition (dual-energy X-ray absorptiometry), functional exercise capacity (6MWT), physical activity levels (accelerometers), quality of life (WHOQOL-Brief), and anthropometric measures. During the program different strategies were implemented to ensure the participants' adherence.ResultsThe attendance to the program was 79.7%. In the EG a significant decrease was observed in hip circumference (p = 0.02); a significant increase occurred in moderate to vigorous physical activity (p = 0.05) and in the environment domain (WHOQOL-Brief) (p = 0.02). The improvement in environment domain scores was also associated with a decrease in sedentary behavior (r = −0.82, p = 0.01) in the EG.ConclusionsThe strategies used during the program promoted a high rate of attendance. PA may have a positive impact on the participants' ability to perform activities of daily living. This study showed that a group PA program can be successfully implemented for outpatients with schizophrenia and can influence their quality of life and PA levels.     

Results of High-Protein,High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational,Multicenter, Prospective,Pragmatic Study (PROT-e-GER)

ObjectivesTo assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting.DesignObservational, multicenter, prospective, pragmatic study.Setting and ParticipantsThis study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions.InterventionThe participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months.MeasuresPrimary outcomes were changes in nutritional status [body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF)]; secondary outcomes were functional changes [Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery (SPPB)], as well as safety and adherence after 12 weeks of follow-up.ResultsA total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m², interquartile range 18.3–21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 ± 3.1 kg, 5.2 ± 5.9%), BMI (1.0 ± 1.2 kg/m²) and MNA-SF (4.0 ± 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found.Conclusions and ImplicationsImprovements in nutritional and functional status can be found when using a high-protein, high-calorie ONS in older undernourished people living in nursing homes.     

Vitamin D status and its association with adiposity and oxidative stress in schoolchildren

ObjectiveThe aim of this study was to evaluate serum 25-hydroxyvitamin D [25(OH)D] level and its association with adiposity, inflammation, and oxidative stress in schoolchildren.MethodsA total of 1488 schoolchildren ages 7 to 11 y were recruited in Harbin, China (latitude: 44°04′N–46°40′N) in May. Serum 25(OH)D, which is an indicator of vitamin D status, was determined. Anthropometric data were collected following general physical examinations. Serum lipids, glucose metabolism indices, inflammatory molecules, and oxidative stress markers were determined. Dietary intake and physical activity also were assessed.ResultsThe median serum 25(OH)D concentration was 18.4 ng/mL. Of the 1488 schoolchildren included, 839 (56.4%) had vitamin D deficiency [25(OH)D < 20 ng/mL]. Children in the vitamin D deficiency group had significantly higher body weight (34.1 ± 3.8 versus 31.5 ± 3.3 kg; P < 0.001), body mass index (18.4 ± 2.2 versus 16.8 ± 1.7 kg/m²; P < 0.001), waist circumference (60.1 ± 8.5 versus 57.2 ± 7.7 cm; P < 0.001), percentage of body fat (20.2% ± 2.6% versus 19.1% ± 2.4%; P < 0.001), and significantly lower concentrations of serum superoxide dismutase (95.38 ± 12.22 versus 127.62 ± 15.98 U/mL; P < 0.001) compared with those in the vitamin D sufficiency group. After adjusting for sex, age, body mass index, and percentage of body fat, a positive association between serum 25(OH)D and superoxide dismutase was found (β = 0.230; P < 0.001).ConclusionsVitamin D deficiency is common in Harbin schoolchildren. Serum 25(OH)D is closely associated with adiposity and superoxide dismutase in schoolchildren, suggesting that vitamin D deficiency potentially increases the risk for diseases caused by higher adiposity and oxidative stress.