Nutrition Physical Activity Health

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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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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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Direct measurement

Energy Intake

Energy

Expenditure

Weight


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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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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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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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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

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BMI(kg/m

2)

Percent Fat (DXA)


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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

Nutrition Physical Activity Health

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