Post on 02-Jun-2018
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Nutrition and PhysicalActivity for Health
John M. Jakicic, PhD
Linking Nutrition and Physical Activity to Health Outcomes
Nutrition andPhysicalActivityforHealth
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Nutrition and Physical Activity for HealthNutrition andPhysicalActivityforHealth
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Fitness
Body Weightand Body
Composition
Theoretical Pathway for Lifestyle Factors toInfluence Health-Related Outcomes
TheoreticalPathwayforLifestyleFactors
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Fitness
Body Weightand Body
Composition
Is Physical Activity Linked to Improved Health
IsPhysicalActivityLinkedtoImprovedHealth
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The Foundation of this Relationship
C HD
Ra te ,p e
r1,0 0 0
Image Source Note 1
Transport workers
The Foundation ofthis Relationship
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The Foundation of this Relationship
C HD
Ra te ,p e
r1,0 0 0
Image Source Note 1
Postal workers
The Foundation ofthis Relationship
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Relative risk of death (from all causes)according to measures of physical activity.
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1.10
3500
Physical Activity Index (kcal per week)
Relativ
eRisk
Image Source Note 2
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Physical Activity and Risk of Type 2 Diabetes in Women
0.840.87
0.770.74
1.0
0.5
0.75
1
0-2.0 (0.8) 2.1-4.6 (3.3) 4.7-10.4 (7.7) 10.5-21.7 (15.7) >=21.8 (35.4)
Activity (MET-hrs per Week)
Image Source Note 3
R e
l a t i
v e R
i s k
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Physical Activity and Treatment ofDepression47%
30%29%
0
5
10
15
20
25
3035
40
45
50
Control Low Dose High Dose
Image Source Note 4
Re d u c tio ni n
Ha mi lto n
Ra t ing S c a le fo rDe p
re s s io n
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Fitness
Body Weightand Body
Composition
Diagram
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Association Between Cardiorespiratory Fitness andRisk of Cardiovascular Disease Mortality in Diabetics
RelativeRisk
Image Source Note 5
Fitness - METs
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Cardiovascular Disease Mortality byBody Fatness and Fitness
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Lean Normal Obese
RelativeRisk
Fit
Unfit
Adjusted for age (single year), examination year, smoking habit, alcohol intake, and parental history of ischemic heart disease
Image Source Note 6
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Fitness
Body Weightand Body
Composition
Is Diet and Nutrition Linked to Health Outcomes?Is DietandNutrition Linkedto Health Outcomes?
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Nutrition and Health Outcomes
Links have been shown with:
Cardiovascular disease
Diabetes
Cancer
Obesity
Others
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Nutrition and Health Outcomes
Dietary patterns can influence blood lipids
Transfats
Saturated Fat
Dash diet pattern
Encourage fruits and vegetables, whole grains, poultry/fish, legumes/nuts, low-fat dairy ,vegetable oils
Limit sweets, beverages containing sugar, red meat
Dietary patterns can influence blood pressure
Sodium intake
Dash diet pattern
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Fitness
Body Weightand Body
Composition
Is Diet and Nutrition Linked to Health Outcomes?IsDietandNutritionLinkedtoHealthOutcomes?
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Health Consequences of Obesity
Hypertension
Dyslipidemia
Type 2 Diabetes
Coronary Heart Disease
Stroke
Gallbladder Disease Osteoarthritis
Sleep Apnea and Respiratory disorders
Some forms of cancer
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Health Costs of Obesity
Estimated to be $147 billion in the United States in2008
Finkelstein et al. 2009
Estimated to account for 0.7% to 2.8% of total healthcare costs in a country worldwide
Withrow and Alter, 2011
Health costs are estimated to be 30% higher in obese
adults compared to normal weight adults
Withrow and Alter, 2011
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Nutrition and Physical Activity for HealthNutritionandPhysicalActivityforHealth
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Behavior
PhysicalActivity
Health-Related
Outcomes
Diet /Nutrition
Fitness
Body Weightand Body
Composition
Theoretical Pathway for Lifestyle Factors to
Influence Health-Related OutcomesTheoreticalPathwayforLifestyleFactorstoInfluenceHealth-RelatedOutcomes
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Summary
Physical activity is an important healthbehavior that can have an independent
effect on health
Eating behaviors that influence diet andnutrition are also important and can
have an independent effect on health
Physical Activity and Nutrition mayinteract to maximize the health benefits
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Image Source Notes1. Chart created by instructor based on data from: Morris, J. N., Heady, J. A., Raffle, P., Roberts, C. G., & Parks, J. W.
(1953). Coronary heart-disease and physical activity of work. The Lancet, 262(6795), 1053-1057. doi: 10.1016/S0140-6736(53)91495-0
2.
Chart created by instructor based on data from: Paffenbarger, R. S., Hyde, R., Wing, A. L., & Hsieh, C. (1986).Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine, 314(10),
605-613. doi: 10.1056/NEJM198603063141003
3.
Chart created by instructor based on data from: Hu, F. B., Sigal, R. J., Rich-Edwards, J. W., Colditz, G. A., Solomon,C. G., Willett, W. C., ... Manson, J. E. (1999). Walking compared with vigorous physical activity and risk of type 2diabetes in women. The Journal of the American Medical Association, 282(15), 1433-1439. doi: 10.1001/jama.
282.15.1433
4.
Chart created by instructor based on data from: Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss,
H. O. (2005). Exercise treatment for depression: Efficacy and dose response.American Journal of PreventiveMedicine, 28(1), 1-8. doi: 10.1016/j.amepre.2004.09.003
5.
Chart created by instructor based on data from: Church, T. S., LaMonte, M. J., Barlow, C. E., & Blair, S. N. (2005).Cardiorespiratory fitness and body mass index as predictors of Cardiovascular disease mortality among men withdiabetes. JAMA Internal Medicine (formerlyArchives of Internal Medicine), 165(18), 2114-2120. doi: 10.1001/archinte.165.18.2114
6. Chart created by instructor based on data from: Lee, C. D., Blair, S. N., & Jackson, A. S. (1999). Cardiorespiratoryfitness, body composition, and all-cause and cardiovascular disease mortality in men. The American Journal of ClinicalNutrition, 69(3), 373-380.
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Nutrition and PhysicalActivity for Health
John M. Jakicic, PhD
Assessment of Nutrition, Physical Activity, and Body Composition
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Criteria to Evaluate Assessment Methods Valid
The assessment instrument must measure what it is intended tomeasure.
Reliable
The instrument must consistently give the same results under thesame circumstances.
If the instrument is reliable and valid, it is also accurate.
Practical
The instrument must have acceptable costs to the investigator.
The instrument must have acceptable costs to the participant.
Nonreactive
The instrument must not alter the population or the behavior it seeksto measure.
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Dietary and NutritionAssessment
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Dietary and Nutrition Assessment
Direct observation
Direct measurement
Self-Report
Global measures
Recall measures
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Dietary and Nutrition Assessment
Direct observation
Plate waste studies
Determination between what was served and
what was not eaten
Usually not performed in a natural
environment without the person knowing theyare being observed
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Dietary and Nutrition Assessment
Direct measurement
Energy Intake
Energy
Expenditure
Weight
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Dietary and Nutrition Assessment
Direct measurement
Assumes that a fluctuation in weight is thedifference between energy expenditure andenergy intake
Does not provide information about the
composition of the diet, just the calorieintake
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Dietary and Nutrition Assessment Self-Report
Global measures
Food frequency measure
Recall frequency and amount of foodconsumed over a specific period
Assumes that this is representative of thetypical eating patterns
Recall measures
Self-report of food consumed Can be performed on random days
Self-report measures typically result in under-reporting and recall bias
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Physical ActivityAssessment Methods
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Physical Activity Assessment Methods
Self-Reports (paper or online tools)
Wearable Devices/Motion Sensors/Portable Technology
Physiological and Biological Markers
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Self Report Administration
self-administrated vs. interviewer administered
single- item questions
lifetime physical activity
Time frame
Usual/typical
Short term (past week, past month) Long term (past 6 months, past year, lifetime)
Type of activity assessed
Leisure, occupational, household
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Self Reports Strengths
Extremely practicaland cost efficient
Tailored to the
characteristics of aspecific population
Information onspecific activities
Weaknesses
Recall bias
May not reflect usualactivity if short term
Difficult to get intensityinformation.
Cognition factors
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Physical Activity Assessment Methods
Wearable Devices/Motion Sensors/PortableTechnology
Pedometer Accelerometer
Multi-sensor technology-based systems
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Pedometers
Device that measures number of steps (count) ordistance traveled by individual.
Typically worn on the hip
Newer models are less location sensitive
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PedometersStrengths
Low-cost (money & time)
Objective (limits self-report bias)
Non-cumbersome and acceptableto subject.
Accurately measure # of steps andmost horizontal distances.
Works with a variety ofpopulations (children,adults)
Weaknesses
Pace of movement influencesaccuracy.
Values can vary between same
model of device.Insensitive to non-locomotor
activity (i.e. lifting) and otheractivities (i.e. cycling andstair climbing).
Cannot measure intensity,
frequency, or duration of themovement detected.
Non-specific for activities.
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Accelerometers (Actigraphy) Single Plane Accelerometers
Provides relatively accurate mean estimation of EE for groups of subjects
Worn on the waist or on the wrist
Activity counts are used to classify intensity of physical activity
Multi-Plane Accelerometers
Measures in mediolateral, anteroposterior, and vertical dimensions
Measures in 3 planes.
May allow for more accurate assessment of activity
Worn on the waist or on the wrist
Activity counts are used to classify intensity of physical activity
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Accelerometers (Actigraphy)
Strengths
Objective (limits self-report bias)
Most accurate for activities thatinvolve level walking
Some systems provide accurateinformation on sleep
Works with a variety of
populations (children,adults)
Weaknesses
Data can vary between samemodel of device.
Less sensitive to non-locomotoractivity (i.e. , sitting, lifting)and other activities (i.e.cycling).
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Additional Wearable Devices and Technologies
Multi-Sensor Technology
Input from multiple channels
Accelerometry, Heat Flux, etc.
May increase accuracy compared to otherportable technologies
May allow for detection of posture changes
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Physical Activity Assessment Methods
Biological Markers
Doubly labeled water
Direct and indirect calorimetry
Heart rate monitoring
Physiological surrogates
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TOTAL DAILY
ENERGY
EXPENDITURE
RESTING
ENERGYEXPENDITURE
THERMIC EFFECT OFFOOD
PHYSICALACTIVITY
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Doubly Labeled Water Technique
Dose of a radio-labeled isotope (2H2180) administered orally.
Collection of urine samples.
Over 5 to 14 days, 2H is eliminated as water and 180 eliminated as water and CO2.
Difference between two (2H and 180) at end of observation is proportional toCO2production or total energy expenditure.
Provides a measure of the average daily total energy expenditure
Need to subtract out the resting energy expenditure and the thermic effect offood to determine energy expenditure in physical activity
Unable to determine what type of activity was performed to result in this amount of energyexpenditure
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Doubly Labeled Water
Strengths
Can be used on all agegroups
Does not influence behavior
Accurate
Representative of energyexpenditure integrated overmany days
Weaknesses
High cost of isotopes anduse of mass spectrometrylimits use to relatively
small samples Technically challenging
Time-consuming analysis
Provides no detailedinformation on theseparate components ofenergy expenditure.
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Indirect Calorimetry Involves the assessment of:
Oxygen consumed
Carbon Dioxide produced
Use of Respiratory Quotient (RQ) to convertto calories
1 liter of oxygen consumed = approximately 5kcal
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Indirect CalorimetryStrengths
Provides an accuratemeasurement of energyexpenditure of specificactivities
Considered the goldstandard
Weaknesses
Usually limited tolaboratory environment
Requires expensiveequipment
Requires trained staff
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Heart Rate Monitoring
Continuously measure heart rate over anacute or prolonged period of days.
Portable heart rate monitors
Assumes a linear relationship betweenheart rate and oxygen consumption or
energy expenditure
Must be established for each individual.
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HR and O2 Relationship
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Heart Rate MonitoringStrengths Can assess spontaneous bouts
of physical activity
Can be used in free-livingindividuals
Simple, relatively inexpensive(depending on type)
Can be used in all age groups
Weaknesses
Need to assess individual HR-VO2 relations for each subject
HR influenced by factors suchas age, body size, mode ofexercise and physical fitness
HR is highly sensitive toemotional stressors, posture,positions, and ambient airtemp. humidity, and even suchthings as smoking
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Physical Activity Assessment Methods
Self-Reports (paper or online tools)
Diaries
Global Reports
Recall Questionnaires
Quantitative History Questionnaires Motion Sensors/Portable Technology
Pedometer
Accelerometer
Multi-sensor technology-based systems
Biological Markers Direct and indirect calorimetry
Doubly labeled water
Heart rate monitoring
Physiological surrogates
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Assessing Body Weight andBody Composition
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Assessing Body Weight and Body Composition
Body Mass Index (BMI)
Computed as weight, measured in kilograms,divided by height squared, measured in meters
kg/m2
Online tools are available to provide thismeasurement of BMI
Waist Circumference
Provides a measure of abdominal adiposity
Measured using a tape measure Measured horizontally at the level of the iliac crest
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For Whom is Weight Loss Recommended?
BMI
(kg/m2)
Obesity
Class
Underweight 40 III
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For Whom is Weight Loss Recommended?
BMI
(kg/m2)
Obesity
Class
Men < 40 in.Women < 35 in.
Men > 40 in.Women > 35 in.
Underweight 40 III Extremely High Extremely High
Risk of Disease
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0
5
10
15
20
25
30
35
40
45
0 10 20 30 40 50 60
BMI(kg/m
2)
Percent Fat (DXA)
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0
10
20
30
40
50
60
0 5 10 15 20 25 30 35 40 45
BMI (kg/m2)
PercentFat
(BIA)
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Summary
There are a variety of techniques toassess nutrition, physical activity, and
body composition.
Need to base the selection of thetechnique on:
What information do you want to know?
Strengths and Weakness of the measures