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Non-communicable diseases (NCDs), also known as chronic diseases of lifestyle, cause the greatest burden of disease globally. The major risk factors for NCDs are hypertension, hyperglycaemia, high cholesterol, tobacco smoking, alcohol abuse, overweight/obesity and physical inactivity. NCDs in South Africa are increasing in black South Africans with the transition from rural to urban areas. The transitions have resulted in a change in lifestyle. Regular moderate intensity physical activity (PA) has many health benefits and decreases the risk for NCDs. PA is often determined by means of questionnaires, motion sensors (pedometers and accelerometers), heart rate and accelerometry combined. Within the South African context PA has traditionally been determined with internationally composed questionnaires adapted for South Africa. In South Africa the relationship between PA and risk factors for NCDs has not been investigated in populations in transition, and limited information on the relationship between change in PA and the change in risk factors in a South African population is available. The objectives of this study was to determine the correlation between the adapted Baecke physical activity questionnaire and the International Physical Activity Questionnaire (short version) (IPAQ-S), the changes in PA and how the changes relate to changes in BMI, and finally the relationship between the changes in PA and the changes in the risk factors for NCDs of black South Africans. The study forms part of the baseline and five year follow-up of the South African leg of the Prospective Urban and Rural Epidemiological (PURE) study. This study is a longitudinal study of which the baseline data was allocated in 2005 and the five year follow-up allocated in 2010. 2 000 participants aged 30 years and older were recruited for the initial study – 1 000 urbanised (from Ikageng), and 1 000 rural black adults (from Ganyesa, Moswana and Tlakgameng). Data, including the PA questionnaires (Baecke & IPAQ-S) were collected by a specialised multidisciplinary team. After signing an informed consent form, questionnaires were completed during individual interviews and conducted by extensively trained fieldworkers in the language of the participants’ choice. The variables used in this study were anthropometric measurements, blood pressure, serum lipids and fasting blood glucose. BMI was calculated from the body weight divided by the height squared. Statistical analysis was performed using SPSS for windows (Version 21.0). Descriptive statistics were performed to determine the characteristics of the participants. The relationship between Baecke and IPAQ-S was determined by means of a partial correlation adjusting for age and BMI. Linear regression analyses were used to determine the relationship between the changes in PA (dependent variable) and BMI (predictor variable) and then adjusted for gender and age. Where a significant relationship was observed (in the case of setting, urban versus rural) separate analyses were performed for the rural and urban participants; likewise the relationship between the changes in PAI (dependant variable) and the change in the risk factors for NCDs (predictor variable) was determined by means of linear regression analysis, and also adjusted for gender, change in age and setting (urban/rural). The results from this study indicated that a weak but significant relationship was found between the Baecke and IPAQ-S (Spearman r = 0.243; p = 0.00) when adjusted for age and BMI. Significant differences were found between rural and urban participants for age and BMI in 2005, where the urban participants where older and reported a higher BMI compared to the rural participants. Rural women gained significantly more weight than the urban women. The PAI in the urban participants increased from 2005 (6.40 ± 1.84) to 2010 (7.50 ± 1.40), but decreased in rural participants from 2005 (8.21 ± 1.48) to 2010 (5.10 ± 1.54). Change in BMI was significantly inverse associated with change in PA for the urban population after adjusting for gender, setting (rural/urban) and change in age (β = -0.10; p = 0.004). Significant differences were found for resting systolic blood pressure (SBP) for the rural (129.72 ± 23.30) and urban (137.33 ± 25.14) participants as well as the diastolic blood pressure (DBP) of rural (86.16 ± 14.48) and urban (89.28 ± 14.46), fasting glucose of rural (4.88 ± 1.23) and urban (5.10 ± 1.86), triglycerides of rural (1.21 ± 0.64) and urban (1.38 ± 0.92) and physical activity index (PAI) of rural (8.21 ± 1.48) and urban (6.40 ± 1.84) in 2005. There were significant changes in the high density lipoprotein cholesterol (HDL-C) and in the low density lipoprotein cholesterol (LDL-C). Although the overall PAI decreased from 2005 (7.30 ± 1.90) to 2010 (6.46 ± 1.85), it increased in urban participants (6.40 ± 1.84 – 7.50 ± 1.40) and decreased in rural participants (8.21 ± 1.48 – 5.10 ± 1.54). A significant negative relationship between changes in PAI and changes in blood pressure (systolic and diastolic), total cholesterol and LDL-cholesterol was found when adjusted for gender. When changes in PA and changes in risk factors were separated according to gender, a significant negative relationship was found between PA and diastolic blood pressure (β -0.63; p 0.02) in the male population, and a significant negative relationship for females between PA and systolic blood pressure (β -1.05; p 0.002), diastolic blood pressure (β -0.59; p 0.003), total cholesterol (β -0.05; p 0.01) and LDL-cholesterol (β -0.07; p 0.00). In conclusion, the study found that the low but significant correlation between PAI assessed with the Baeck questionnaire and IPAQ-S makes both questionnaires applicable for the South African context, however the Baecke questionnaire is based on various domains for PA, while the IPAQ-S report on time spent in physical activity. Over the 5-year period PA decreased in this black South African population with a concomitant increase in BMI. Biological risk factors for NCDs increased from 2005 to 2010. The change in PA was inversely related to changes in total blood pressure. Future in PA interventions would be beneficial in the management of hypertension in the at risk South African black population. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

Non-communicable diseases (NCDs), also known as chronic diseases of lifestyle, cause the greatest burden of disease globally. The major risk factors for NCDs are hypertension, hyperglycaemia, high cholesterol, tobacco smoking, alcohol abuse, overweight/obesity and physical inactivity. NCDs in South Africa are increasing in black South Africans with the transition from rural to urban areas. The transitions have resulted in a change in lifestyle. Regular moderate intensity physical activity (PA) has many health benefits and decreases the risk for NCDs. PA is often determined by means of questionnaires, motion sensors (pedometers and accelerometers), heart rate and accelerometry combined. Within the South African context PA has traditionally been determined with internationally composed questionnaires adapted for South Africa. In South Africa the relationship between PA and risk factors for NCDs has not been investigated in populations in transition, and limited information on the relationship between change in PA and the change in risk factors in a South African population is available. The objectives of this study was to determine the correlation between the adapted Baecke physical activity questionnaire and the International Physical Activity Questionnaire (short version) (IPAQ-S), the changes in PA and how the changes relate to changes in BMI, and finally the relationship between the changes in PA and the changes in the risk factors for NCDs of black South Africans. The study forms part of the baseline and five year follow-up of the South African leg of the Prospective Urban and Rural Epidemiological (PURE) study. This study is a longitudinal study of which the baseline data was allocated in 2005 and the five year follow-up allocated in 2010. 2 000 participants aged 30 years and older were recruited for the initial study – 1 000 urbanised (from Ikageng), and 1 000 rural black adults (from Ganyesa, Moswana and Tlakgameng). Data, including the PA questionnaires (Baecke & IPAQ-S) were collected by a specialised multidisciplinary team. After signing an informed consent form, questionnaires were completed during individual interviews and conducted by extensively trained fieldworkers in the language of the participants’ choice. The variables used in this study were anthropometric measurements, blood pressure, serum lipids and fasting blood glucose. BMI was calculated from the body weight divided by the height squared. Statistical analysis was performed using SPSS for windows (Version 21.0). Descriptive statistics were performed to determine the characteristics of the participants. The relationship between Baecke and IPAQ-S was determined by means of a partial correlation adjusting for age and BMI. Linear regression analyses were used to determine the relationship between the changes in PA (dependent variable) and BMI (predictor variable) and then adjusted for gender and age. Where a significant relationship was observed (in the case of setting, urban versus rural) separate analyses were performed for the rural and urban participants; likewise the relationship between the changes in PAI (dependant variable) and the change in the risk factors for NCDs (predictor variable) was determined by means of linear regression analysis, and also adjusted for gender, change in age and setting (urban/rural). The results from this study indicated that a weak but significant relationship was found between the Baecke and IPAQ-S (Spearman r = 0.243; p = 0.00) when adjusted for age and BMI. Significant differences were found between rural and urban participants for age and BMI in 2005, where the urban participants where older and reported a higher BMI compared to the rural participants. Rural women gained significantly more weight than the urban women. The PAI in the urban participants increased from 2005 (6.40 ± 1.84) to 2010 (7.50 ± 1.40), but decreased in rural participants from 2005 (8.21 ± 1.48) to 2010 (5.10 ± 1.54). Change in BMI was significantly inverse associated with change in PA for the urban population after adjusting for gender, setting (rural/urban) and change in age (β = -0.10; p = 0.004). Significant differences were found for resting systolic blood pressure (SBP) for the rural (129.72 ± 23.30) and urban (137.33 ± 25.14) participants as well as the diastolic blood pressure (DBP) of rural (86.16 ± 14.48) and urban (89.28 ± 14.46), fasting glucose of rural (4.88 ± 1.23) and urban (5.10 ± 1.86), triglycerides of rural (1.21 ± 0.64) and urban (1.38 ± 0.92) and physical activity index (PAI) of rural (8.21 ± 1.48) and urban (6.40 ± 1.84) in 2005. There were significant changes in the high density lipoprotein cholesterol (HDL-C) and in the low density lipoprotein cholesterol (LDL-C). Although the overall PAI decreased from 2005 (7.30 ± 1.90) to 2010 (6.46 ± 1.85), it increased in urban participants (6.40 ± 1.84 – 7.50 ± 1.40) and decreased in rural participants (8.21 ± 1.48 – 5.10 ± 1.54). A significant negative relationship between changes in PAI and changes in blood pressure (systolic and diastolic), total cholesterol and LDL-cholesterol was found when adjusted for gender. When changes in PA and changes in risk factors were separated according to gender, a significant negative relationship was found between PA and diastolic blood pressure (β -0.63; p 0.02) in the male population, and a significant negative relationship for females between PA and systolic blood pressure (β -1.05; p 0.002), diastolic blood pressure (β -0.59; p 0.003), total cholesterol (β -0.05; p 0.01) and LDL-cholesterol (β -0.07; p 0.00). In conclusion, the study found that the low but significant correlation between PAI assessed with the Baeck questionnaire and IPAQ-S makes both questionnaires applicable for the South African context, however the Baecke questionnaire is based on various domains for PA, while the IPAQ-S report on time spent in physical activity. Over the 5-year period PA decreased in this black South African population with a concomitant increase in BMI. Biological risk factors for NCDs increased from 2005 to 2010. The change in PA was inversely related to changes in total blood pressure. Future in PA interventions would be beneficial in the management of hypertension in the at risk South African black population. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

African American (AA) women have the highest prevalence of obesity than other groups in the US making them disproportionately at high risk for chronic diseases associated with obesity such type 2 diabetes mellitus. Research has shown that stress may be a risk factor for obesity and that it may be more prevalent within AA women. The aim of this study was to identify if there is an association between psychological stress in AA women in the US and abdominal obesity (AO). A cross sectional study design was employed using secondary data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). There were 655 AA female participants included in the study sample. The exposure variable was psychological stress assessed by select questions from the NHANES survey. The outcome variable was AO measured by waist circumference. Logistic regression was used to examine the relationship between psychological stress and AO among AA women. The results of this study were that psychological stress was correlated with increased odds of AO upon adjusting for age, BMI, educational level and marital status (OR=1.192 95% CI 0.305 – 4.655). However, the association was not statistically significant. When examining the relationship between other covariates and AO, having a formal education and being a married woman were each found to be associated with decreased odds of AO. The results were not generalizable, but they suggest areas of promise in better understanding the impact of AO among AA women which could lead to targeted interventions to reduce this outcome in the population as well as others.

Aging is associated with increased insulin resistance, a condition in which the tissue response to insulin-stimulated glucose uptake is reduced. Insulin resistance is a strong predictor of disease and mortality. Aging is also associated with a decline in physical activity, lower cardiorespiratory fitness (ability to deliver oxygen to active muscles during exercise), and increase in abdominal fat. Both low cardiorespiratory fitness (CRF) and excess abdominal fat are associated with reduced insulin sensitivity in older adults. Improvements in CRF and abdominal obesity through exercise training may be responsible for improvement in insulin sensitivity. Several investigations have reported that changes in CRF and abdominal obesity through exercise are associated with changes in insulin sensitivity. To our knowledge, no prior study has assessed whether change in CRF or abdominal fat alone explains the association between exercise and improvement in insulin sensitivity in older adults. Our findings suggest that improvement in CRF may not explain the exercise-induced change in insulin sensitivity. The improvement in insulin sensitivity from exercise is explained through a decrease abdominal fat that also occurs with exercise. Additionally, improvements in waist circumference, a surrogate measure for abdominal obesity, and body mass index together explained a large portion of exercise-induced change in insulin sensitivity compared to either variable alone. Our findings suggest that exercise combined with a healthy diet will improve insulin resistance, a risk factor for development of type 2 diabetes and cardiovascular disease in older adults. Our findings suggest that the reduction in abdominal obesity is the conduit by which exercise improves insulin sensitivity in older adults. Although CRF is not related to exercise-induced change in insulin sensitivity, change in CRF from exercise has been reported to decrease risk for other health conditions, such as hypertension and all-cause mortality. Our findings suggest that clinicians should measure both waist circumference and body mass index when evaluating the effectiveness of a lifestyle-based treatment strategy for improving insulin resistance and its associated health outcomes in older adults. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2013-09-27 14:53:00.796

Ce travail de thèse avait pour objectif d'évaluer l'intérêt des peptides collagéniques sanguins dans différentes populations à haut risque de développer une insuffisance cardiaque (patients présentant une obésité abdominale ou en post-infarctus du myocarde) ou déjà symptomatiques (post-infarctus du myocarde). En effet la fibrose myocardique est un élément essentiel de l'évolution péjorative de l'insuffisance cardiaque.Ces travaux ont permis de montrer la pertinence clinique des dosages sanguins des peptides collagéniques tout au long du processus de l'insuffisance cardiaque : du stade asymptomatique aux stades symptomatiques. Nous avons mis en évidence, à travers l'expression des peptides collagéniques que : 1/ des patients asymptomatiques ayant une obésité abdominale présentent un remodelage cardiaque précoce tant structurel que fonctionnel (augmentation de la masse ventriculaire gauche, dysfonction diastolique associée au PIIINP) : R2C2 Study. 2/ le ratio PIIINP/ICTP ≤ 1, mesuré 1 mois après un infarctus, est indépendamment associé à la survenue d'un remodelage ventriculaire gauche à un an et améliore la prédiction de survenue d'évènements cardiovasculaires (décès cardiovasculaires et hospitalisation pour décompensation cardiaque) à 3 ans : REVE-2 study. 3/ les antagonistes des récepteurs aux minéralocorticoïdes (éplérénone), traitement anti-fibrotique par excellence, sont efficaces et sûrs (hyperkaliémie et insuffisance rénale) chez des patients à haut risque de remodelage et de complications: EMPHASIS-HF study. Ce travail doit conduire à la validation dans d'autres populations du rôle prépondérant de la fibrose mais surtout au bénéfice thérapeutique des classes anti-fibrotiques dans l'insuffisance cardiaque. / No abstract available

Introdução: A obesidade abdominal associa-se ao risco para diabetes mellitus tipo 2 (DM) e doença cardiovascular (DCV). Entre os fatores associados à obesidade abdominal, destaca-se o importante papel da dieta. Objetivo: O presente estudo investigou a associação entre fatores dietéticos e adiposidade em nipo-brasileiros de Bauru, Estado de São Paulo. Métodos: Para o presente estudo, 772 participantes (329 homens e 443 mulheres) com idade entre 30-92 anos foram analisados em inquérito transversal de base populacional. Um questionário quantitativo de freqüência alimentar validado para essa população foi empregado para avaliar a dieta habitual. Índice de massa corporal (IMC, em kg/m2) e circunferência de cintura (CC, em cm) foram classificados de acordo com critérios da Organização Mundial de Saúde para a população asiática (obesidade geral IMC >= 25kg/m2; obesidade abdominal CC >= 90 cm para homens e >= 80 cm para mulheres). Modelos de regressão logística múltiplos foram utilizados na comparação entre o menor e o maior tercil de consumo alimentar em relação ao risco associado para obesidade abdominal, obesidade geral ou obesidade geral com obesidade abdominal, após ajuste para co-variáveis sócio-demográficas, de estilo de vida e bioquímicas. As análises foram estratificadas por gênero. Resultados: Em toda a população, maior consumo de embutidos foi associado à obesidade abdominal [Odds Ratio (OR) =2,09; IC95%: 1,05-4,18; Pde tendência = 0,009] e geral com abdominal (OR=2,41; IC95%: 1,40-4,15; Pde tendência = 0,006). Em homens, a ingestão de fibra de leguminosas (OR =0,27; IC95%: 0,08-0,84; Pde tendência = 0,015) foi inversamente associada à obesidade abdominal. Houve associação entre maior consumo de colesterol e de alimentos embutidos e obesidade geral com obesidade abdominal (OR=3,03, IC95%: 1,21-7,60, Pde tendência = 0,050 e OR=2,41, IC95%: 1,40-4,15, Pde tendência = 0,188, respectivamente). Entre as mulheres, o maior consumo de carnes vermelhas (OR=0,50; IC95%: 0,26; 0,98; Pde tendência = 0,121) foi inversamente associado à obesidade geral com abdominal, provavelmente devido ao baixo consumo geral. Conclusão: O consumo de alimentos embutidos foi associado à obesidade geral, abdominal e geral na presença de abdominal. Diferentes associações entre fatores dietéticos e medidas de adiposidade foram observadas segundo gênero. / Introduction. Abdominal obesity has been associated with type 2 diabetes mellitus (DM) and cardiovascular disease. Among the risk factors for abdominal obesity, diet has been considered one of the most important. Aims/hypothesis. This study investigated which dietary factors are associated with the distribution of body adiposity in Japanese-Brazilians from Bauru-Sao Paulo. Methods. Analysis using a population-based cross-sectional study can out in 772 subjects (329 men and 443 women) aged 30-92 years from Bauru, Brazil. Dietary intakes were assessed using a validated food-frequency questionnaire. Measurements of weight, height, and waist circumference (WC, in cm) were taken using the following WHO cut-offs for Asians: overall obesity, Body Mass Index (BMI) >= 25kg/m2; abdominal obesity, WC >= 90 for men and >= 80 for women. Multiple logistic regression models were used for comparison between the lowest with the highest tertile of intakes stratified by gender, after adjusting for socio-demographic, lifestyle, biochemical and nutritional confounders. Results. In overall population, higher intakes of processed meats were associated with abdominal obesity [Odds Ratio (OR) =2.09; IC95%: 1.05-4.18; Pfor trend = 0.009] and with overall with abdominal obesity (OR=2.41; IC95%: 1.40-4.15; Pfor trend = 0.006). In stratified analysis by gender, among men, bean fiber was inversely associated with abdominal obesity (OR=0.27; 95%CI: 0.08; 0.84; Pfor trend = 0.015), when compared participants in the highest to the lowest tertile of intakes. Higher intakes of cholesterol and processed meats were associated with overall with abdominal obesity (OR=3.03, 95%CI: 1.21-7.60, Pfor trend = 0.050 and OR=2.41, IC95%: 1.40-4.15, Pfor trend = 0.188, respectively). Among women, higher intakes of red meats were inversely associated to overall with abdominal obesity (OR=0.50; IC95%: 0.26; 0.98; Pfor trend = 0.121) probably related to low intake levels. Conclusions. Processed meats were associated with overall, abdominal and overall with abdominal obesity. Diferent associations were observed in dietary factors in relation to overall, abdominal as well as overall with abdominal obesity according to gender.

Background Anthropometric measurements are useful in clinical practice since they are non-invasive and cheap. Previous studies suggest that sagittal abdominal diameter (SAD) may be a better measure of visceral fat depots. The aim of this study was to prospectively explore and compare how laboratory and anthropometric risk markers predicted subclinical organ damage in 255 patients, with type 2 diabetes, after four years. Methods Baseline investigations were performed in 2006 and were repeated at follow-up in 2010. Carotid intima-media thickness (IMT) was evaluated by ultrasonography and aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries at baseline and at follow-up in a cohort of subjects with type 2 diabetes aged 55–65 years old. Results There were significant correlations between apolipoprotein B (apoB) (r = 0.144, p = 0.03), C - reactive protein (CRP) (r = 0.172, p = 0.009) at baseline and IMT measured at follow-up. After adjustment for sex, age, treatment with statins and Hba1c, the associations remained statistically significant. HbA1c, total cholesterol or LDL-cholesterol did not correlate to IMT at follow-up. Baseline body mass index (BMI) (r = 0.130, p = 0.049), waist circumference (WC) (r = 0.147, p = 0.027) and sagittal Abdominal Diameter (SAD) (r = 0.184, p = 0.007) correlated to PWV at follow-up. Challenged with sex, SBP and HbA1c, the association between SAD, not WC nor BMI, and PWV remained statistically significant (p = 0.036). In a stepwise linear regression, entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV. Conclusions We conclude that apoB and CRP, but not LDL-cholesterol predicted subclinical atherosclerosis. Furthermore, SAD was more independent in predicting arterial stiffness over time, compared with WC, in middle-aged men and women with type 2 diabetes. / <p>Funding Agencies|Medical Research Council of Southeast Sweden||Center for Medical Image Science and Visualization (CMIV)||Linkoping University||Futurum||King Gustaf V and Queen Victoria Freemason Foundation||GE Healthcare||Swedish Heart-Lung Foundation||Swedish Research Council Grant|12661|</p>

Accumulating evidence suggests that measures of abdominal obesity outperform BMI in predicting diabetes and cardiovascular risk. However, it is debated which measure of obesity should be used. Currently, waist circumference (WC) is most commonly used and codefines the metabolic syndrome.

The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions of cardiovascular risk among emerging adult men in college; 2) compare differences in unhealthy behaviors and obesity between emerging adults in college living in rural, Appalachian Kentucky and urban Fayette County, Kentucky; and 3) compare measures of general and abdominal obesity in predicting blood pressure among emerging adults in college. Specific Aim One was addressed by a qualitative study of perceptions of cardiovascular risk in 10 emerging adult males in college. Specific Aims Two and Three were addressed by a study of emerging adult college students living in rural, Appalachian and urban Fayette County, Kentucky. We hypothesized that students in rural, Appalachian Kentucky would engage in more unhealthy behaviors and be obese due to living in an austere environment with barriers to healthy behaviors. Although obesity and hypertension are known to be related, researchers have not determined whether body fat distribution, general vs. abdominal, is predictive of blood pressure in emerging adults. Knowing which body fat distribution is the strongest predictor of blood pressure may help in evaluating cardiovascular risk in emerging adults. Emerging adult men emphasized difficulty engaging in CVD health behaviors while attending college and choose to ignore long-term CVD risk. Overcoming college-specific and developmental barriers to engaging in healthy behaviors is critical to reducing cardiovascular risk in this population. Students living in rural, Appalachian Kentucky had more CVD risk behaviors and more were obese compared to those in urban Fayette County, Kentucky. Reducing CVD risk behaviors and obesity among students in rural Appalachian Kentucky may help decrease the high burden of CVD in this region. Findings suggest that waist circumference was the best predictor of systolic blood pressure among emerging adults in college.