BACKGROUND: Type 2 diabetes and cardiovascular disease (CVD) are among the leading causes of death in the United States. The Metabolic Syndrome, which comprises a cluster of cardiometabolic risk factors, puts individuals at increased risk for these diseases. It is therefore important that people with Metabolic Syndrome, at high risk for CVD and type 2 diabetes, are identified and treated. Since it may not often be practical to obtain the laboratory measures necessary for diagnosing the Metabolic Syndrome, simple anthropometric measures are a useful way of quickly identifying individuals at increased risk for the Metabolic Syndrome. OBJECTIVE: The purpose of this thesis is to evaluate the utility of three of the most commonly used anthropometric measures – Body Mass Index (BMI), Waist Circumference (WC), and Waist-to-Height Ratio (WC) – for classifying individuals with and without the Metabolic Syndrome and its component risk factors in the United States. Using Receiver Operating Characteristic (ROC) curve analysis and Area Under the Curve (AUC) statistics, this thesis will assess the utility of each body measurement and compare it to BMI. METHODS: A large, multi-ethnic, nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 was used for this analysis. The study sample was restricted to adults aged 20-65 with complete information on height, weight, waist circumference, blood pressure, HDL cholesterol, fasting glucose, and triglycerides (n=3,769). In order to compare the utility of different anthropometric measures for classification, weighted ROC curves were constructed for each anthropometric measure-outcome combination and AUC statistics were compared. AUC statistics were calculated by approximating the definite integral of the ROC curves with the trapezoidal rule. Variances for AUC statistics and differences in AUC statistics were estimated with jackknife repeated replication. Analyses were completed for the entire sample and separately for non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. RESULTS: For the entire sample, WC (AUC=0.752) did a better job than BMI (AUC=0.728) at classifying individuals with and without the Metabolic Syndrome (p CONCLUSION: Waist circumference should be considered, especially over BMI, for risk stratification in clinical settings and research. Further research should attempt to identify optimum waist circumference cut points for use in the US population.

This research compared structured physical activity patterns to changes in body mass index (BMI) of Chinese university students. Chinese students attending Midwestern universities completed a 26-itemized, validated and reliable physical activity questionnaire. The questionnaire assessed demographics, time spent in various physical activities, BMI, and perceived barriers to exercise prior to and after residing in the U.S. for at least three months. Analysis of variance revealed that, after residing in the U.S., males had a greater increase in time spent in moderate-intensity physical activity compared to females (p < .01), while females had a greater increase in time spent in vigorous-intensity physical activity when compared to males (p < .01). Also, students 21 years of age or older were more likely to increase their time spent in moderate- and vigorous-intensity physical activities combined than those 20 years of age or younger. Lastly, change in BMI appeared to be affected by geographical region of origin (p < .05), where participants from the Eastern region of China had a greater increase in BMI than those from the Western, Northern, and Southern regions. Overall, educating Chinese university students on the importance of incorporating structured physical activities may help prevent future increases in BMI after immersion into the U.S lifestyle. / Department of Family and Consumer Sciences

The purpose of this study was to determine the relationship between oral health status and body mass index for residents in a Transitional Care Center. The population utilized in this study were 193 males and females between the ages of 16-98 years old who were admitted to the Transitional Care Center at Columbus Regional Hospital in Columbus, Indiana. The researcher obtained informed consent from each participant upon admission to the subacute unit. The information used for this study was obtained from the Minimum Data Set located in each resident's medical record. Subjects were divided in two groups according to age, less than 75 years old and > 75 years old to determine whether age had an effect on oral health status and body mass index.The conclusion was that there was a difference between males and females. Women had a higher BMI than males for both age groups. Participants less than 75 years old were more likely to have a higher body mass index compared with subjects > 75 years of age. Seventy-four percent of those aged > 75 years old wore dentures or a removable bridge compared with 56% of younger subjects (< 75 years old).Although no statistically significant relationship was found between oral health status and body mass index, a trend was noted. As the number of oral health problems increased for individuals, body mass index decreased. The types and prevalence of specific oral health problems were reported indicating a need for further research into relationship between obesity, oral health, lifestyle factors, availability of dental care, and nutrient intakes for the elderly population. / Department of Family and Consumer Sciences

The purpose of this study was to examine maternal and infant factors associated with body mass index (e.g., maternal weight gain, infant birth weight, infant feeding methods, and motor coordination) among obese pre-adolescents and adolescents aged 8-18 years enrolled in the Pediatric OverWeight Education and Research (POWER) program operated by Riley Hospital for Children in Indianapolis, IN, between October 2008 and September 2011. POWER, a three-phase, 12-month multi-disciplinary program to reduce childhood obesity funded by Indiana University Health, enrolls obese children (Body Mass Index [BMI] greater than the 95th percentile for age and gender) through referrals from pediatricians throughout Indiana. Prior to the child’s initial visit, each family completes a comprehensive background and family history profile, approved by the Indiana University-Purdue University (IUPUI) Institutional Review Board, that includes questions related to the obese child’s motor skill development, infant feeding methods, maternal prenatal weight gain, and infant birth weight. Data related to these four categories collected during Phase 1 (12 weeks) was examined using date from 253 pre-adolescents (8-12 years of age), and 285 adolescents (13-18 years of age), to determine their impact on the subjects’ BMI. No relationship between a mother’s prenatal weight gain and the child’s BMI was seen. There was a significant correlation between infant birth weight and BMI in the pre-adolescent group. Breastfed subjects entered the POWER program at a lower BMI than non-breast fed subjects and had consistently lower BMIs throughout the program compared to the non-breastfed subjects. Differences in physical activity were observed between adolescents and pre-adolescents. Paired analysis indicated the POWER program was associated with a significant reduction in BMI overall, and among both age groups throughout Phase 1 of the program. Adolescents were especially successful in reducing their BMI compared to preadolescents. Further research is needed to identify the association of maternal and infant factors and BMI among obese children. / Department of Family and Consumer Sciences

The purpose of this study was to investigate the effects of: 1) caffeine consumption; 2) Body Mass Index (BMI); and 3) frequency and intensity of physical activity on the frequency and severity of hot flashes, in pre-menopausal, peri-menopausal, menopausal and post-menopausal Hispanic women. Ordinary Least Squares regressions indicated there was a statistical significant correlation between daily total estimated caffeine intake with frequency (R2=0.078 (F(8, 207)=2.2, P=0.029) and severity of hot flashes (R2=0.086 (F(8, 208)=2.45, P=0.015). Analysis of variance revealed that and increase in frequency of 30 min strength physical activity reduced severity of hot flashes by 0.72 on a hedonic scale (p<0.05). Conversely, caffeine intake of 100 mg increased frequency and severity of hot flashes (p<0.001, p=0.004, respectively). / Department of Family and Consumer Sciences

Submitted in partial compliance with the requirements for the Master of Technology: Chiropractic, Durban University of Technology, 2014. / Background: Poor balance is a risk factor for injury in adolescent sport including soccer. Despite the rapid growth in female adolescent soccer especially in South Africa, the association between balance and injury in this population has not been fully explored. This study aimed to determine the relationship between injury and balance. Static and dynamic balance was monitored as sway index (SI) and limits of stability direction control (LOSDC). Objectives: The objectives of this study were to determine the body mass index of adolescent female soccer players; to determine the prevalence of injury in adolescent female soccer players; to determine static balance as revealed by the sway index (SI); to determine dynamic stability as revealed by limits of stability direction control (LOSDC) and to correlate body mass index (BMI) to sway index and limits of stability. Method: Eighty adolescent female soccer players, between the ages of fourteen and eighteen, were recruited through convenience sampling from schools in the eThekwini district of KwaZulu-Natal. After obtaining informed consent and assent, participants completed questionnaires and were scheduled for the balance and BMI assessments. The objective data for each participant consisted of height, weight, Sway Index (SI) and Limits of Stability Direction Control (LOSDC) readings, measured using a stadiometer, electronic scale and Biodex Biosway Balance System (Biodex Medical Systems Inc., Shirley, New York) respectively. The subjective and objective data were analyzed using SPSS version 21.0 (SPSS Inc. Chicago, Ill, USA). Statistical tests included descriptive statistics using frequency and cross-tabulation. Inferential statistics using t-tests and Pearson’s correlations at a significance level of 0.05 was also incorporated. The testing of hypotheses was performed using Fisher’s Exact tests for nominal data and ordinal data. A p value of < 0.05 was considered as statistically significant. The statistical analysis also included Odds Ratio calculations. Results: The mean body mass index of the injured participants was 23.54±3.56 kg/m2 and the mean body mass index of the uninjured participants was 23.00±4.63. Only 27.5% of the participants sustained an injury. Injured participants performed poorly on average in the SI assessment involving their eyes open when standing on a soft surface. The results were similar for the LOSDC in the overall, right, left, backward-right and backward-left directions. However, there were no significant correlations calculated. Significant relationships existed between BMI and the SI assessments in the injured participants which involved standing on a firm surface with their eyes open (p = 0.05), their eyes closed when also standing on a firm surface (p = 0.05), their eyes open when standing on a soft surface (p = 0.02), and their eyes closed when standing on a soft surface (p = 0.04). A significant relationship also existed between BMI and LOS right direction control (p = 0.02). Conclusion: This research paper revealed that the body mass index as investigated in this study is similar to other studies involving female adolescents; soccer injury as investigated in this study is similar to other studies involving female adolescents; poor static and dynamic balance is not associated with injury in adolescent female soccer players and lastly, body mass index is linked to the balance of an individual.

Cardiovascular disease is known as one of the leading causes of mortality worldwide, where low income countries or developing countries have the highest prevalence of cardiovascular disease. One of the main reasons for this statistics is acculturation that leads to changes in behavioral lifestyle and malnutrition within these countries. Low body mass index was found to be an independent risk factor for cardiovascular disease in several studies. From literature it is found that body mass index is lower than the ideal body mass index and is associated with cardiovascular disease. According to Higashi (2003) a body mass index of 22.2 kg/m2 is associated with the lowest morbidity. If body mass index decreases to lower values than the ideal body mass index, a J–curve will be evident suggesting higher prevalence of cardiovascular disease associated with low body mass index. These findings imply that not only high body mass index but also a low body mass index may be a risk factor for cardiovascular disease, morbidity and mortality. Whether low body mass index is associated with cardiovascular risk in an African population remains unclear. Objective: The aim of this study was to investigate the possible associations of low body mass index with variables of cardiovascular function in Africans, with a low socio–economic status. Methodology: This prospective cohort study (N= 2 010) is part of the Prospective Urban and Rural Epidemiology study (PURE) conducted in the North–West Province of South Africa in 2005, where the health transition in urban and rural subjects was investigated within an apparently low socio–economic status group. Our crosssectional PURE sub–study included 496 African people from rural and urban settings, (men, N= 252 and women, N= 244) aged between 35–65 years and body mass index lower than 25 kg/m2. Subjects were sub–divided into two groups. The first group consisted of Africans with a low body mass index smaller or equal to 20 kg/m2 (men; N= 152, women; N= 94) whilst the second group consisted of Africans with a normal body mass index larger than 20 kg/m2 and smaller or equal to 25 kg/m2 (men; N= 100, women; N= 150). Systolic blood pressure and diastolic blood pressure measurements were obtained with the validated OMRON HEM–757 device. The pulse wave velocity was measured using the Complior SP device. Blood was drawn by a registered nurse from the antebrachial vein using a sterile winged infusion set and syringes. Analyses for cholesterol, high density lipoprotein, triglycerides, gamma–glutamyl transferase and high sensitive C–reactive protein were completed utilizing the Konelab 20i. Data analyses were performed using the Statistica 10 program. Statistical analyses were executed to determine significant differences between age, body mass index and lifestyle factors as well as cardiovascular related variables in the different groups. T–tests were used to determine significant differences between independent groups. ANCOVA tests were used to determine BMI group differences independent of age, smoking and alcohol consumption. Partial correlations, which were adjusted for age, smoking and alcohol consumption, determined associations between the BMI groups and cardiovascular variables. Results: Our results indicated significantly higher mean values for the African men, with low body mass index, for cardiovascular variables (Diastolic blood pressure, 88.0 ± standard deviation (SD) 13.4 mmHg; mean arterial pressure, 103.8 ± SD 14.4 mmHg and carotid–radial pulse wave velocity, 12.6 ± SD 2.47 m/s) compared to the normal body mass index group (Diastolic blood pressure, 84.2 ± SD 12.2 mmHg; mean arterial pressure, 100.0 ± SD 13.2 mmHg and carotid–radial pulse wave velocity, 11.6 ± SD 2.00 m/s). The African women with low body mass index had a significant difference for carotid–radial pulse wave velocity (11.3 ± SD 2.43 m/s) compared to the normal body mass index group (10.6 ± SD 2.10 m/s). In African men, after the variables were adjusted for age, smoking and alcohol consumption, we revealed that diastolic blood pressure (88.0 with confidence interval (CI) [86.0– 90.0] mmHg) and carotid–radial pulse wave velocity (12.5 with CI [12.1–12.9] m/s) remained significant higher in the low body mass index group. Additionally, carotidradial pulse wave velocity was negatively associated with body mass index in African men. In the low body mass index group, Pearson and partial correlations of r= – 0.204; p= 0.012 and r= –0.200; p= 0.020 were found respectively in carotid–radial pulse wave velocity. Furthermore, in our unadjusted scatter plot with body mass index versus pulse wave velocity this negative trend of increasing carotid–radial pulse wave velocity with decreasing body mass index was noticeable in both African men and women. Even when carotid–radial pulse wave velocity was adjusted for age, smoking, alcohol consumption, mean arterial pressure and heart rate, a J–curve between carotid–radial pulse wave velocity and body mass index was still evident. Conclusion: A detrimental effect of low body mass index is evident on cardiovascular function in Africans. If body mass index decreases from the optimum value of 22.2 kg/m2 to lower values, a J–curve is evident between body mass index and cardiovascular variables suggesting higher prevalence of cardiovascular disease associated with low body mass index. In our sub–study the carotid–radial pulse wave velocity increases significantly in African men with low body mass index, thus supporting the theory that stiffening of the arteries is evident in Africans with a low body mass index. Low body mass index may contribute to the high prevalence of cardiovascular disease mortality within developing countries and therefore, increase the risk for cardiovascular disease. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2012.

60 % of Canadians have suboptimal vitamin D (<75 nmol/L) and 25% are obese. Obesity has been reported to be a risk factor for low vitamin D, but there is uncertainty about the magnitude of the association. Linear regression was performed using data from the nationally representative cross-sectional Canadian Health Measures Survey (2007-2009). Height, weight, waist circumference (WC), and vitamin D levels were directly measured. There were 5298 participants aged 6 to 79 years. Using a conservative p value of 0.001, body mass index (BMI) category obese / obese I was positively associated and WC was inversely associated with vitamin D level in crude analysis. WC was inversely associated with vitamin D level in multivariate analysis. The pattern of relationship is not the same as other studies, yet this was a large study with direct measurements. There may be issues with linearity of relationships or subgroups disturbing the relationship.

Cardiovascular disease is known as one of the leading causes of mortality worldwide, where low income countries or developing countries have the highest prevalence of cardiovascular disease. One of the main reasons for this statistics is acculturation that leads to changes in behavioral lifestyle and malnutrition within these countries. Low body mass index was found to be an independent risk factor for cardiovascular disease in several studies. From literature it is found that body mass index is lower than the ideal body mass index and is associated with cardiovascular disease. According to Higashi (2003) a body mass index of 22.2 kg/m2 is associated with the lowest morbidity. If body mass index decreases to lower values than the ideal body mass index, a J–curve will be evident suggesting higher prevalence of cardiovascular disease associated with low body mass index. These findings imply that not only high body mass index but also a low body mass index may be a risk factor for cardiovascular disease, morbidity and mortality. Whether low body mass index is associated with cardiovascular risk in an African population remains unclear. Objective: The aim of this study was to investigate the possible associations of low body mass index with variables of cardiovascular function in Africans, with a low socio–economic status. Methodology: This prospective cohort study (N= 2 010) is part of the Prospective Urban and Rural Epidemiology study (PURE) conducted in the North–West Province of South Africa in 2005, where the health transition in urban and rural subjects was investigated within an apparently low socio–economic status group. Our crosssectional PURE sub–study included 496 African people from rural and urban settings, (men, N= 252 and women, N= 244) aged between 35–65 years and body mass index lower than 25 kg/m2. Subjects were sub–divided into two groups. The first group consisted of Africans with a low body mass index smaller or equal to 20 kg/m2 (men; N= 152, women; N= 94) whilst the second group consisted of Africans with a normal body mass index larger than 20 kg/m2 and smaller or equal to 25 kg/m2 (men; N= 100, women; N= 150). Systolic blood pressure and diastolic blood pressure measurements were obtained with the validated OMRON HEM–757 device. The pulse wave velocity was measured using the Complior SP device. Blood was drawn by a registered nurse from the antebrachial vein using a sterile winged infusion set and syringes. Analyses for cholesterol, high density lipoprotein, triglycerides, gamma–glutamyl transferase and high sensitive C–reactive protein were completed utilizing the Konelab 20i. Data analyses were performed using the Statistica 10 program. Statistical analyses were executed to determine significant differences between age, body mass index and lifestyle factors as well as cardiovascular related variables in the different groups. T–tests were used to determine significant differences between independent groups. ANCOVA tests were used to determine BMI group differences independent of age, smoking and alcohol consumption. Partial correlations, which were adjusted for age, smoking and alcohol consumption, determined associations between the BMI groups and cardiovascular variables. Results: Our results indicated significantly higher mean values for the African men, with low body mass index, for cardiovascular variables (Diastolic blood pressure, 88.0 ± standard deviation (SD) 13.4 mmHg; mean arterial pressure, 103.8 ± SD 14.4 mmHg and carotid–radial pulse wave velocity, 12.6 ± SD 2.47 m/s) compared to the normal body mass index group (Diastolic blood pressure, 84.2 ± SD 12.2 mmHg; mean arterial pressure, 100.0 ± SD 13.2 mmHg and carotid–radial pulse wave velocity, 11.6 ± SD 2.00 m/s). The African women with low body mass index had a significant difference for carotid–radial pulse wave velocity (11.3 ± SD 2.43 m/s) compared to the normal body mass index group (10.6 ± SD 2.10 m/s). In African men, after the variables were adjusted for age, smoking and alcohol consumption, we revealed that diastolic blood pressure (88.0 with confidence interval (CI) [86.0– 90.0] mmHg) and carotid–radial pulse wave velocity (12.5 with CI [12.1–12.9] m/s) remained significant higher in the low body mass index group. Additionally, carotidradial pulse wave velocity was negatively associated with body mass index in African men. In the low body mass index group, Pearson and partial correlations of r= – 0.204; p= 0.012 and r= –0.200; p= 0.020 were found respectively in carotid–radial pulse wave velocity. Furthermore, in our unadjusted scatter plot with body mass index versus pulse wave velocity this negative trend of increasing carotid–radial pulse wave velocity with decreasing body mass index was noticeable in both African men and women. Even when carotid–radial pulse wave velocity was adjusted for age, smoking, alcohol consumption, mean arterial pressure and heart rate, a J–curve between carotid–radial pulse wave velocity and body mass index was still evident. Conclusion: A detrimental effect of low body mass index is evident on cardiovascular function in Africans. If body mass index decreases from the optimum value of 22.2 kg/m2 to lower values, a J–curve is evident between body mass index and cardiovascular variables suggesting higher prevalence of cardiovascular disease associated with low body mass index. In our sub–study the carotid–radial pulse wave velocity increases significantly in African men with low body mass index, thus supporting the theory that stiffening of the arteries is evident in Africans with a low body mass index. Low body mass index may contribute to the high prevalence of cardiovascular disease mortality within developing countries and therefore, increase the risk for cardiovascular disease. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2012.

Background: Factors that contribute to body fat and adiposity include energy consumption, macronutrient intake, and physical activity. Alcohol not only contributes to total energy consumed but also influences metabolic pathways that may alter fat oxidation and storage. Alcohol provides 7.1 kilocalories per gram (kcal/g) and makes up 6-10% of the daily caloric intake of adults in the United States. Cross-sectional studies have shown that increased alcohol intake is associated with higher body mass index (BMI), especially in men. Other studies suggest that there is a “U” shaped association whereby non-drinkers and heavy drinkers have a higher BMI and waist-to-hip ratio (WHR) then low to moderate drinkers. While many previous studies evaluate alcohol based on the average consumption (g/day), there is increasing evidence that it is the pattern of alcohol consumption (ie. frequency) that influences body composition. The purpose of this study is to evaluate the effect of the frequency of wine, beer, and liquor consumption on body fat percent (BF%) and WHR in a population of university faculty and staff. Methods: The Center for Health Discovery and Well Being (CHDWB) cohort trial is being conducted at Emory University in Atlanta, GA. Recruitment of faculty and staff for the study began in 2007. Demographic, reported dietary intake including wine, beer, and liquor consumption, and anthropometric data including weight, height, BF%, and waist circumference are collected at baseline and annually thereafter. We used linear regression models to determine the effect of frequency and quantity of wine, beer, and liquor consumption on BF% while controlling for age and the effects of the other types of alcohol. We applied the Kruskal-Wallis test to determine if the median BF% and waist-hip ratio (WHR) was significantly different for those that reported at different five different frequencies (several times a year to 5-7 days a week). Results: Baseline visits have been conducted on 700 participants. Their median age was 51 years (66% female). Median weight was 76.9 kg (range, 65.3 - 90.5 kg) and mean BMI was 27.9 + 6.4 kg/m2. A significant negative relationship was observed between frequency of beer consumption and BF% in women (p Conclusions: The frequency of wine intake consumed by university employees and staff independently predicted BF% and BMI. Greater frequency of wine consumption was associated with lower BF%.