Energy metabolism in African Americans: potential risk factors for obesity.

BACKGROUND: Recent reports have identified a lower resting metabolic rate in African Americans than in whites, but most studies included only females and used short-term measurements with ventilated-hood systems. OBJECTIVE: Our objective was to compare 24-h measurements of energy metabolism between African American and white women and men using a respiratory chamber. DESIGN: Thirty-eight African American (x +/- SD: 32 +/- 7 y of age, 24 +/- 10% body fat) and 288 white (31 +/- 7 y of age, 26 +/- 12% body fat) subjects spent 24 h in a respiratory chamber for measurement of 24-h energy expenditure (24EE), sleeping metabolic rate (SMR), 24-h respiratory quotient (24RQ), and substrate oxidation rates. RESULTS: After adjustment for sex, age, and body composition (by hydrodensitometry), African Americans had lower SMR (-301 +/- 105 kJ/d; P < 0.01) and higher 24RQ (0.014 +/- 0.004; P < 0.001) than whites, whereas 24EE was similar. A sex-specific analysis, using a subset of 38 whites with an equal sex distribution and similar age and body weight, revealed that African American women had lower SMR (-442 +/- 182 kJ/d; P < 0.05) and lower 24EE (-580 +/- 232 kJ/d; P < 0.05), but similar 24RQ values compared with white women. African American men tended to have lower SMRs than white men (-355 +/- 188 kJ/d; P = 0. 07), but had higher 24RQ values, accounting for a 992 +/- 327-kJ/d lower 24-h fat oxidation rate (P < 0.005). CONCLUSIONS: These data not only confirm the findings of a lower metabolic rate in African American than in white women, but also suggest that fat oxidation is lower in African American men than in white men.     

Associations of fat distribution and obesity with hypertension in a bi-ethnic population: the ARIC study. Atherosclerosis Risk in Communities Study

OBJECTIVE: To examine associations of hypertension with obesity and fat distribution among African American and white men and women. RESEARCH METHODS AND PROCEDURES: The analysis sample included 15,063 African American and white men and women between the ages of 45 and 64 years who were participants in the 1987 through 1989 examination of the Atherosclerosis Risk in Communities Study (ARIC). Odds ratios and adjusted prevalences of hypertension were calculated across sex-specific quintiles of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, and waist-to-height ratio (waist/ height) and adjusted for age, research center, smoking, education, physical activity, alcohol consumption, hormone replacement therapy, and menopausal status. RESULTS: The prevalence of hypertension was higher among African Americans than whites. In the lowest quintile of BMI, 41% of African American women and 43% of African American men had hypertension compared with 14% of white women and 19% of white men. Elevated BMI, WHR, waist circumference, and waist/height were associated with increased odds of hypertension in African American and white men and women. In women, but not in men, there were significant interactions between ethnicity and the anthropometric variables studied here. The direction of the interaction indicated larger odds ratios for hypertension with increasing levels of anthropometric indices in white compared with African American women. DISCUSSION: Obesity and abdominal fat preponderance were associated with increased prevalence of hypertension in African American and white men and women. Associations were similar among African American and white men, but obesity and fat patterning were less strongly associated with hypertension in African American than in white women.     

Comparison of regional fat distribution and health risk factors in middle-aged white and African American women: The Healthy Transitions Study

OBJECTIVE: Both ethnicity and menopause appear to influence intra-abdominal fat distribution. This study evaluated intra-abdominal fat distribution and obesity-related health risks in perimenopausal white and African American women. RESEARCH METHODS AND PROCEDURES: Baseline data from a longitudinal study of changes in body composition and energy balance during menopause are reported. Healthy women (55 African Americans and 103 whites) who were on no medication and had at least five menstrual cycles in the previous 6 months were recruited. Body composition was assessed by DXA, and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were assessed by computed tomography scan. SAT was divided into deep and superficial layers demarcated by the fascia superficialis. RESULTS: African American women were slightly younger (46.7 +/- 0.2 vs. 47.7 +/- 0.2 years, p = 0.002) and fatter (42.4% +/- 1.0% vs. 39.4% +/- 0.8% body fat, p = 0.02) than white women. In unadjusted data, African Americans had significantly more total abdominal fat and total, deep, and superficial SAT than whites. After adjustment for percent body fat and age, only total and superficial SAT remained significantly higher in African Americans. VAT, although slightly less in African American women, did not differ significantly by race. In multiple regression analysis, VAT was the strongest predictor of serum lipids, glucose, and insulin in women of both races, although superficial SAT was significantly associated with fasting glucose in whites. CONCLUSIONS: Middle-aged African American women have larger SAT depots, adjusted for total body fatness, but do not differ from white women with regard to VAT. The complexity of the relationship between abdominal fat and metabolic risk is increased by ethnic differences in such associations.     

Effects of familial predisposition to obesity on energy expenditure in multiethnic prepubertal girls

BACKGROUND: The prevalence of childhood obesity is increasing and the causes of this are unknown. OBJECTIVE: The objective of this study was to determine whether energy expenditure (EE), measured by 24-h calorimetry and doubly labeled water, differed in normal-weight-for-height, multiethnic prepubertal girls with or without a familial predisposition to obesity. DESIGN: Normal-weight, prepubertal white (n = 52), African American (n = 30), and Hispanic (n = 19) girls with a mean (+/-SD) age of 8.5 +/- 0.4 y were studied according to parental leanness and overweight or obesity. The girls were grouped according to whether they had 2 lean parents (n = 30), 2 obese parents (n = 27), or 1 lean and 1 obese parent (n = 44). Basal metabolic rate (BMR), sleeping metabolic rate (SMR), 24-h EE, respiratory quotient, heart rate, and activity were measured by 24-h room calorimetry; free-living total EE (TEE), activity-related EE (AEE), and physical activity level were measured by doubly labeled water. EE was standardized by fat-free mass (FFM). RESULTS: There were no significant differences among familial groups in weight, height, fat mass, FFM, or percentage body fat. African American girls had a higher FFM than did white or Hispanic girls (P < 0.05). BMR, SMR, 24-h EE, respiratory quotient, heart rate, and activity levels were not significantly different among familial groups. Additionally, there were no significant familial group differences in TEE, AEE, or physical activity level. However, BMR, SMR, and TEE were lower in African American girls than in white girls (P < 0.05). CONCLUSION: There was no significant difference in EE between normal-weight, multiethnic prepubertal girls predisposed to obesity and those not predisposed to obesity.     

Plasma carotenoid and vitamins a and e concentrations in older African American women after wheat bran supplementation: effects of age, body mass and smoking history

OBJECTIVE: This study investigated the relationships of plasma vitamins A, E, and carotenoids with age, BMI and former/non-smoking history after adjusting for wheat bran supplementation. METHODS: All 39 African American women in the church-based, volunteer sample, 40-70 years old, supplemented their daily diets for 5-6 wks. with 1/2 cup of a riboflavin-spiked wheat bran cereal. RESULTS: Urinary riboflavin concentrations increased from 0.8 +/- 0.1 mg/day at baseline to 7.5 +/- 0.5 mg/day after supplementation, confirming the 99.2 +/- 10.5% self-reported adherence. Plasma nutrient concentrations did not change significantly with supplementation nor was never/former smoking history related to diet. Plasma retinol and serum cholesterol were significantly higher (p < 0.0002) in persons older than 55 years compared to younger adults. Plasma retinol (microg/dL) but not serum cholesterol was associated significantly with menopausal status and hormone replacement therapy (HRT; p = 0.05); progressive increases in retinol concentrations were found in the women after adjusting for pre/post supplementation: lowest in pre-menopause (47.7 +/- 4.8); intermediate concentrations in post-menopause on HRT (54.6 +/- 3.0); highest level in post-menopause without HRT (61.1 +/- 3.0). Similarly, a progressive increase was found in lipid-unadjusted alpha-tocopherol concentrations and menopausal status with or without HRT. Vitamin A and cholesterol intakes were not significantly different by age group. Plasma carotenoids were not significantly different by age or fiber supplementation, but alpha- and beta-carotene and beta-cryptoxanthin were significantly lower with BMI > or = 30. In contrast to carotenoids, both plasma levels of gamma-tocopherol and lipid-adjusted gamma-tocopherol were significantly higher with obesity compared to those with BMI < 30. CONCLUSION: Plasma alpha- and beta-carotene and beta-cryptoxanthin were negatively associated with obesity, whereas gamma-tocopherol measures were consistently elevated with high BMI. The increase in age-associated plasma retinol in postmenopausal women was likely related to decreased estrogen concentrations in the African American women. Smoking history was not influential in this study.     

Higher amounts of body fat are associated with inadequate intakes of calcium and vitamin D in African American women

Calcium and vitamin D are associated with obesity. We hypothesized that African American women with higher calcium and vitamin D intakes would have lower body fat compared with women with lower calcium and vitamin D intakes. This cross-sectional study included 100 premenopausal African American women aged 18 to 40 years with a spectrum of body mass indices (17.3-46.7 kg/m²). Dietary information was obtained using 24-h recalls. Total body fat was determined by dual-energy x-ray absorptiometry and reported as percentage body fat (%BF). Subjects' data were divided into 2 groups (n = 50 per group) based on the median quartile of %BF, and differences were determined using independent t tests. Women with at least 37.9%BF had mean calcium (mg per day ± SD) and vitamin D intakes (µg per day ± SD) of 528.6 ± 146.0 and 3.8 ± .9, respectively. In comparison, women with lower %BF (<37.9%) had higher (P < .001) calcium and vitamin D intakes of 911.5 ± 208.3 and 5.0 ± 0.8, respectively. Partial correlation coefficients (controlling for the confounding variables of fat, carbohydrate, and protein intakes) indicated significant (P < 0.001) inverse associations between calcium intake and %BF (r = −.666), and vitamin D and %BF (r = −.460) in the 100 women. In conclusion, women with lower intakes of calcium and vitamin D were more likely to exhibit excessive adiposity compared with women with higher intakes.     

Energy restriction results in a mass-adjusted decrease in energy expenditure in cats that is maintained after weight regain

Dietary energy restriction (ER) is used to treat obesity in cats but it is often unsuccessful. The purpose of this study was to determine whether ER results in a sustained decrease in mass-adjusted energy expenditure (EE) that may oppose weight loss and promote weight regain. EE and body composition were measured in 10 adult neutered cats at 3 time points: baseline (obese cats), during weight loss (40% ER), and following weight regain. The cats started with a body weight (BW) of 6.1 +/- 0.30 kg, body condition score (BCS) of 7.6 +/- 0.14 (on a 9-point scale), and fat body mass (FM) of 38 +/- 1.0% of BW. After weight loss, BW was 5.0 +/- 0.19 kg, BCS was 5.5 +/- 0.07 kg, and FM was 31 +/- 1.6% (P < 0.01). After weight regain, BW was 6.2 +/- 0.30 kg, BCS was 7.7 +/- 0.16, and FM was 42 +/- 1.8% (P < 0.01). Total EE decreased from 1258 +/- 33.7 kJ/d to 1025 +/- 39.6 kJ/d during weight loss (P < 0.001). After weight regain, EE was still lower than baseline (1103 +/- 41.5 kJ/d, P < 0.001). Energy intake (EI) at baseline (1337 +/- 50.6 kJ/d) was higher than EI after weight loss and regain (1217 +/- 61.2 kJ/d), resulting in no differences in energy balance (78 +/- 30.4 and 104 +/- 35.4 kJ/d, respectively, P = 0.581). These results support the hypothesis that ER results in a mass-adjusted decrease in EE in cats that is maintained after weight regain.     

Racial differences in the relation between uncoupling protein genes and resting energy expenditure

BACKGROUND: Lower resting energy expenditure (REE) in African American women may contribute to their obesity. The identification of uncoupling protein (UCP) genes has fueled a search for genes involved in energy metabolism in humans. OBJECTIVE: We examined variation in REE in relation to variation in UCP1, UCP2, and UCP3 in 141 women aged 18-21 y. DESIGN: Standard methods were used for REE measurements and genetic analysis. Body composition was determined with the use of dual-energy X-ray absorptiometry. Multivariate analysis was used to examine the effect of genotypes on REE and on fat mass in relation to other potentially confounding variables. RESULTS: REE was 295 kJ/d lower in African American women than in white women. No significant variation in REE was seen for UCP1, UCP2, and UCP3 (p-55; exon 3a; and exon 3b) variants after adjustment for other variables including smoking status. For the UCP3 exon 5 variant, REE was significantly (P = 0.019) lower in African American women with the CC genotype than in those with the TT genotype. In African American women, there was a significant trend (P = 0.012) toward lower REE and a weak but nonsignificant trend (P = 0.1) toward greater fat mass across the 3 genotypes (TT, CT, and CC). CONCLUSIONS: The significant and dose-dependent relation between lower REE and the C allele suggests that it may be a thrifty allele. The presence of this parsimonious energy metabolism in African American women, possibly linked to UCP3, may be implicated in their susceptibility to obesity. The absence of a UCP3 effect in white women is intriguing and needs to be explored to further understand possible interactions between UCP3 and other genes.     

Energy expenditure in African American and white boys and girls in a 2-y follow-up of the Baton Rouge Children's Study

BACKGROUND: Previously reported race and sex differences in energy expenditure (EE) may play a role in body fat gain. OBJECTIVE: The purpose of the study was to determine the relations between race, sex, Tanner stage, and EE. DESIGN: We conducted a 2-y follow-up study of EE in 114 African American (AA) and white girls and boys aged 12.7 +/- 0.1 y ( +/- SE), who were stratified as obese or lean and were part of the Baton Rouge Children's Study. Total daily EE (TDEE) was measured by using doubly labeled water. Resting metabolic rate (RMR) and thermic effect of food were measured by using indirect calorimetry. RESULTS: White children had significantly higher TDEE and RMR than did AA children when fat-free mass was considered. Boys had significantly higher TDEE and RMR than did girls, even after adjustment for differences in size. TDEE and RMR were significantly higher in obese children, as a result of their greater fat-free mass and body fat, than in lean children. Activity-related EE did not differ significantly between obese and lean children. There was a strong relation between initial and 2-y TDEE and RMR. There was a significant decrease in activity-related EE in both racial groups. AA children had significantly more lean limb mass than did white children. CONCLUSIONS: Average TDEE did not change over 2 y, but RMR increased significantly, and activity-related EE decreased significantly. Differences in trunk and limb lean mass of white and AA children may explain some of the ethnic differences in EE. The decrease in physical activity over 2 y may contribute to the risk of obesity.     

Racial differences in energy expenditure and aerobic fitness in premenopausal women

BACKGROUND: Aerobic fitness, or maximal oxygen uptake (f1.gif" BORDER="0">O(2)max), and energy expenditure (EE) may be lower in African Americans than in whites. OBJECTIVE: The objective of this study was to compare sleeping EE (SEE), resting EE (REE), free-living total EE (TEE), and f1.gif" BORDER="0">O(2)max in African American and white women after adjustment for body composition and free-living activity-related energy expenditure (AEE). DESIGN: Eighteen African American and 17 white premenopausal women were matched for weight, percentage body fat, and age. SEE and REE were measured in a room calorimeter and f1.gif" BORDER="0">O(2)max was measured on a treadmill. Fat-free mass (FFM) and fat mass (FM) (4-compartment model), AEE (doubly labeled water and SEE), and regional lean tissue (dual-energy X-ray absorptiometry) were used as adjustment variables in SEE, REE, TEE, and f1.gif" BORDER="0">O(2)max comparisons. RESULTS: The African American women had significantly more limb lean tissue and significantly less trunk lean tissue than did the white women. The African American women also had significantly lower SEE (6.9%), REE (7.5%), TEE (9.6%), and f1.gif" BORDER="0">O(2)max (13.4%) than did the white women. Racial differences persisted after adjustment for f1.gif" BORDER="0">O(2)max, AEE, FFM, and limb lean tissue but disappeared after adjustment for trunk lean tissue. The f1.gif" BORDER="0">O(2)max difference was independent of all body-composition variables and of AEE. CONCLUSIONS: African American women had lower aerobic fitness than did white women, independent of differences in lean tissue or AEE. Diminished racial differences in SEE, REE, and TEE after adjustment for trunk lean tissue suggest that low EE in African American women is mediated by low volumes of metabolically active organ mass.     

Food intake measured by an automated food-selection system: relationship to energy expenditure.

Measuring food intake in a laboratory usually involves limited food choices. An automated food-selection system with two vending machines containing a large variety of foods was used to measure food intake in 10 male volunteers (31 +/- 6 y, 69.2 +/- 7.1 kg, 18 +/- 7% fat, mean +/- SD) on a metabolic ward. The effect of carbohydrate, fat, and protein intakes on 24-h energy expenditure (24EE) and substrate oxidations was measured in a respiratory chamber during day 4 of weight maintenance and day 7 of ad libitum intake. Ad libitum intake resulted in a 7-d overfeeding of 6468 +/- 3824 kJ/d above weight-maintenance requirements, leading to a 2.3 +/- 1.2-kg gain. The 10,975 +/- 3774 kJ excess energy intake on day 7 of ad libitum intake caused a 1205 +/- 920 kJ/d increase in 24EE (delta 24EE = 0.17 x delta intake - 695; r = 0.71, P less than 0.02). Of the excess carbohydrate intake, 74% was oxidized (r = 0.86, P less than 0.001), whereas excess fat intake was not. Carbohydrate and protein stores are regulated whereas excess fat intake is channeled to fat stores.     

Relation between mothers' child-feeding practices and children's adiposity

BACKGROUND: The prevalence of obesity in American children is currently estimated to be 25%. Poor nutritional habits during childhood have been directly related to pediatric obesity. OBJECTIVE: Our objective was to evaluate the relation between mothers' child-feeding practices and children's adiposity in a sample of boys and girls from 2 ethnic groups. DESIGN: A total of 74 white (25 boys and 49 girls) and 46 African American (22 boys and 24 girls) children ( plus minus SD age: 11 plus minus 1.7 y) and their mothers participated in this study. The children's body composition was assessed by dual-energy X-ray absorptiometry. The mothers' child-feeding practices were assessed with the Child Feeding Questionnaire. Dietary intake data were based on three 24-h dietary recalls conducted by use of the multiple-pass technique. RESULTS: Two subscales of the Child Feeding Questionnaire, pressure to eat and concern for child's weight, explained 15% of the variance in total fat mass in both African American and white boys and girls (P < 0.001) after correction for total lean mass and energy intake (which explained 5% of the variance in total fat mass). Ethnicity, sex, and socioeconomic status did not contribute significantly to variance in total fat mass. CONCLUSIONS: Child-feeding practices are key behavioral variables that explain more of the variance in total fat mass than does energy intake in a biethnic population of boys and girls. These findings have important implications for the prevention of obesity in children because they suggest that prevention programs need to focus on the feeding behaviors of parents in addition to the macronutrient and energy intakes of children.     

Patterns of food use and nutrient intake of obese and non-obese Hualapai Indian women of Arizona

To document patterns of food use and nutrient intake associated with obesity in Native American women, a sample of 14 obese and 14 non-obese free-living Hualapai Indian women living in northwest Arizona was studied. Patterns of food use were determined through long-term observation, dietary histories, and 24-hour dietary recalls. Dietary intake was determined through 24-hour dietary recalls over 7 consecutive days. Patterns of food acquisition, selection, and preparation were similar for obese and non-obese Hualapai women. The diets of both groups were dominated by nonalcoholic beverages, potatoes, beans, white wheat flour, and canned goods. Wild and locally cultivated foods were not eaten on a regular basis. The diets of both the obese and non-obese women were high in energy (pooled mean +/- standard deviation [SD] = 2,602 +/- 766 kcal/day) and carbohydrates (pooled mean +/- SD = 333.4 +/- 95.6 gm/day), moderate in protein (pooled mean +/- SD = 77.8 +/- 20.9 gm/day) and fat (pooled mean +/- SD = 101.1 +/- 25.4 gm/day), and low in crude fiber (pooled mean +/- SD = 4.7 +/- 2.0 gm/day). The study indicates that significantly (p less than .001) higher energy intakes of the obese women can be attributed to their greater consumption of nonalcoholic and alcoholic beverages.     

Racial differences in insulin resistance and mid-thigh fat deposition in postmenopausal women

OBJECTIVE: To determine whether racial differences in insulin resistance between African American (AA) and white women exist in postmenopausal women and whether they are related to physical fitness and/or obesity. RESEARCH METHODS AND PROCEDURES: We studied 35 obese AA (n = 9) and white (n = 26) women of comparable maximal oxygen consumption, obesity, and age. Total body fat was measured by DXA. Abdominal and mid-thigh low-density lean tissue (a marker of intramuscular fat) were determined with computed tomography. Glucose utilization (M) was measured during the last 30 minutes of a 3-hour hyperinsulinemic-euglycemic clamp. Insulin sensitivity was estimated from the relationship of M to the concentration of insulin during the last 30 minutes of the clamp. RESULTS: The percentage of fat and total body fat mass were similar between AA and white women, whereas fat-free mass was higher in African American women. Visceral adipose tissue was not different between groups, but subcutaneous abdominal fat was 17% higher in the AA than in the white women. AA women had an 18% greater mid-thigh muscle area (p < 0.01) and a 34% greater mid-thigh low-density lean tissue area than the white women. Fasting glucose concentrations were not different, but fasting insulin concentrations were 29% higher in AA women. Glucose utilization was 60% lower in the AA women because of a lower non-oxidative glucose disposal. Insulin sensitivity was 46% lower in the AA women. DISCUSSION: AA postmenopausal women have more mid-thigh intramuscular fat, lower glucose utilization, and are less insulin sensitive than white women despite comparable fitness and relative body fat levels.     

Changes of body fat mass determined by be-electrical impedance and by anthropometry: BMI method and skinfolds method in overweight and obese women after implementation of low energy diet

OBJECTIVE: To estimate the effect of a low energy diet on body fat mass measured by bioelectrical impedance (BIA) in overweight (BMI > or = 25 < 30) and obese women (BMI > or = 30). DESIGN: Randomised six weeks trial. METHODS: The studied group consisted of 86 women aged 20-67 attended the Outpatients Clinic of Metabolic Disorders. Dietary assessments were performed by 24-hour dietary recall. Body fat mass was measured by bioelectrical impedance method and by skinfolds thickness method. Percent body fat and fat free mass was estimated from equations based on BMI and skinfolds thickness. RESULTS: In overweight women after 6 weeks of dietary treatment mean intake of energy decreased from 10071 +/- 2678 kJ to 4560.6 +/- 1405.8 kJ, total fat intake from 88.7 +/- 33.9 g/d (33.4% of energy) to 38.8 +/- 19.9 g/d (31.1% of energy), protein intake from 89.5 +/- 36.5 g/d (14.8% of energy) to 50.7 +/- 16.9 g/d (19.0% of energy), carbohydrates intake from 312.7 +/- 106.6 g/d (51.8% of energy) to 134.5 +/- 53.7 g/d (50% of energy). In obese women mean intake of energy decreased from 10,376.3 +/- 2953.9 kJ to 4665.2 +/- 1380.7 kJ. The value of total energy, total fat and saturated fatty acids intake correlated with body weight, BMI and body fat. After dietary treatment the body weight decreased by 2.4 kg (3.3%) in overweight women and by 3.9 kg (4.1%) in obese women and percent of body fat decreased by 1.6% and 2.3%, respectively. Body fat mass determined by BIA method significantly correlated with skinfolds method by Siri, Schutte, Rathbun, Brozek, Keys-Brozek, and BMI method by Webster, Deurenberg. CONCLUSION: BIA method may be a helpful tool for the analysis of changes in total body composition occurring under obesity treatment.     

Diet, smoking and anthropometric indices and postmenopausal bone fractures: a prospective study

OBJECTIVE: Bone fractures are an important cause of morbidity and mortality among the elderly in the US. The present study assesses the possible role of a number of risk factors for postmenopausal bone fractures. METHODS: We analysed the relationships of anthropometric, demographic and lifestyle factors with the risk of bone fracture among 6250 postmenopausal women in a prospective cohort study, the New York University Women's Health Study. RESULTS: After an average of 7.6 years of follow-up, 1025 new incident bone fractures were reported, including 34 hip and 159 wrist fractures (incidence rates; 71.6 and 334.7 per 105 woman-years, respectively). The risk of fracture increased with increasing age, body height and total fat intake, while it was significantly lower among obese and African American women. The relative risk among African Americans was 0.45 (95% CI: 0.32-0.63) compared with non-African Americans. Women taller than 170 cm had a 64% increase in risk of fractures, as compared with those under 155 cm. These associations were generally more pronounced when fractures were limited to those at the hip and wrist. CONCLUSIONS: The present study provides an indication for a potential role of dietary fat in the development of postmenopausal fractures and further evidence to support protective effects of obesity, short stature and African American ethnicity.     

Racial differences in prevalence of cobalamin and folate deficiencies in disabled elderly women.

BACKGROUND: Many previous investigations of cobalamin and folate status were performed in white populations. OBJECTIVE: Our objective was to determine whether there are racial differences in the prevalence of cobalamin and folate deficiency. DESIGN: The study was a cross-sectional comparison of baseline serum cobalamin, folate, methylmalonic acid (MMA), total homocysteine (tHcy), and creatinine concentrations, complete blood count, and vitamin supplementation in 550 white and 212 African American subjects from a cohort of physically disabled older women. RESULTS: The mean (+/-SD) serum MMA concentration was significantly higher in whites than in African Americans: 284 +/- 229 compared with 218 +/- 158 nmol/L (P = 0.0001). tHcy concentration was higher in African Americans than in whites: 12.4 +/- 7.0 compared with 10.9 +/- 4.6 micromol/L (P = 0.001). Serum cobalamin was lower in whites (P = 0.0002). Cobalamin deficiency (serum cobalamin <258 pmol/L and MMA >271 nmol/L) was more frequent in the white women (19% compared with 8%; P < 0.0003). Folate deficiency (serum folate <11.4 nmol/L, tHcy >13.9 micromol/L, and MMA <271 nmol/L) was more prevalent in African Americans than in whites (5% compared with 2%; P = 0.01). Multivitamin use was associated with lower tHcy but not with MMA concentrations. Regression models showed that age >85 y, African American race, serum creatinine >90 micromol/L, and high MMA concentration were all significantly correlated with higher tHcy. Creatinine > 90 micromol/L, white race, and folate concentration were positively associated with MMA concentration. CONCLUSIONS: Cobalamin deficiency with elevated serum MMA concentration is more prevalent in elderly white than in African American women and elevated serum tHcy and folate deficiency are more prevalent in elderly African American than in white women.     

Natural history of menopause symptoms in primary care patients: a MetroNet study

BACKGROUND: The association between changes in menopausal status and menopause-related symptom reporting over the course of the menopause transition is not well understood, especially whether there are any racial differences in this association. OBJECTIVE: To determine (1) the prevalence and the natural history of menopause symptoms among primary care patients approaching, or at menopause; (2) the relationship between self-reported symptoms and menopausal status; and (3) whether this relationship varies in African American and white women. STUDY DESIGN: Cross-sectional self-report survey of 342 women aged 40 to 55 years (31.6% African American) were recruited from 8 family practice centers in 2000 and 2001. RESULTS: Among 251 women without surgical menopause, 133 (53.0%) were premenopausal, 72 (28.7%) were peri-menopausal, and 46 (18.3%) were postmenopausal. The most commonly reported symptoms were joint/muscle pain and headache, which did not vary by menopausal status. As many as 28.6% of the women with regular menstruation reported hot flashes, and 18.8% had night sweats; although both symptoms were strongly associated with changes in menopausal status (P < .01). During the natural menopausal transition, white women had increasing trends of nervousness, memory loss, vaginal dryness, loss of sexual interest, hot flashes, and night sweats while African American women only had increasing trend of painful sex and hot flashes. In multivariate analyses, loss of sexual interest was associated with postmenopause status in white but not in African American women. CONCLUSIONS: Symptoms are not uncommon among premenopausal women and become more prevalent as the transition through menopause occurs. The prevalence of vasomotor symptoms in premenopausal women may be an under-recognized aspect of the natural history of the menopause transition. African American and white women may present different symptoms through menopause transition.     

Diet quality varies by race/ethnicity of Head Start mothers

BACKGROUND: Despite the key role that women from limited income families play as family food providers and their high risk for diet-related chronic diseases, there is a paucity of data about their diet quality and how it might vary by race/ethnicity. OBJECTIVE: To compare nutrient and food intakes of multiethnic mothers with children in Head Start from Texas and Alabama. DESIGN: Cross-sectional, secondary data analysis. METHODS: The sample was 603 mothers, 33% Hispanic American from Texas; 19% African American from Texas; 24% African American from Alabama; and 24% white from Alabama who were interviewed from fall 2004 to spring 2005. Diet quality was evaluated by averaging 24-hour dietary recalls from 3 nonconsecutive days and calculating the percent meeting the Estimated Average Requirement, the Dietary Guidelines for fat and added sugar, and the mean adequacy ratio for eight nutrients. For multiple comparisons, the least square means statement was used for general linear model procedures, adjusted for age, body mass index, and energy intake. RESULTS: The average mean adequacy ratio scores for diet quality were low overall, but 44% of Hispanic Americans had mean adequacy ratio scores <85, whereas 96% to 97% of other groups did. Most mothers exceeded 35% of energy from fat, with Hispanic Americans having the lowest percentage. Overall, 15% of mothers exceeded 25% of energy from added sugars, with Hispanic Americans having 5% with excess intakes. Energy intakes were highest for Hispanic Americans (2,017 kcal) and lowest for African Americans (1,340 kcal). The Hispanic Americans surveyed averaged 4.6 c fruit and vegetables per day compared to 3.2, 2.3, and 2.9 c/day among African Americans from Texas, African Americans from Alabama, and whites from Alabama, respectively. CONCLUSIONS: Despite limited food resources, Hispanic-American mothers consumed adequate amounts of fruit and vegetables. There was considerable variation in diet quality among race/ethnic groups on a low income budget.     

The Cardiovascular Health of Urban African Americans: Diet-Related Results from the Genes,Nutrition, Exercise,Wellness, and Spiritual Growth (GoodNEWS) Trial

African Americans have a higher incidence of cardiovascular disease (CVD) than Americans in general and are thus prime targets for efforts to reduce CVD risk. Dietary intake data were obtained from African Americans participating in the Genes, Nutrition, Exercise, Wellness, and Spiritual Growth (GoodNEWS) Trial. The 286 women and 75 men who participated had a mean age of 49 years; 53% had hypertension, 65% had dyslipidemia, and 51% met criteria for metabolic syndrome. Their dietary intakes were compared with American Heart Association and National Heart, Lung, and Blood Institute nutrition parameters to identify areas for improvement to reduce CVD risk in this group of urban church members in Dallas, TX. Results from administration of the Dietary History Questionnaire indicated median daily intakes of 33.6% of energy from total fat, 10.3% of energy from saturated fat, 171 mg cholesterol, 16.3 g dietary fiber, and 2,453 mg sodium. A beneficial median intake of 2.9 cups fruits and vegetables per day was coupled with only 2.7 oz fish/week and an excessive intake of 13 tsp added sugar/day. These data indicate several changes needed to bring the diets of these individuals—and likely many other urban African Americans—in line with national recommendations, including reduction of saturated fat, sodium, and sugar intake, in addition to increased intake of fatty fish and whole grains. The frequent inclusion of vegetables should be encouraged in ways that promote achievement of recommended intakes of energy, fat, fiber, and sodium.