The Developmental Origins of Health and Disease in Women from the Michigan Bone Health and Metabolism Study: An Examination with Longitudinal and Intergenerational Data.

Fetal and early life experiences may be associated with development of adult chronic disease and effects may extend across generations. Epidemiologists have adapted these concepts to identify risk factors for chronic disease, but studies with longitudinal or intergenerational data are limited. Using data from a cohort study of Caucasian women, aged 24-50 years in 1992 and followed annually for over 15 years, we evaluated whether low and high birth weight women had different adult body composition, carbohydrate metabolism, or lipid trajectories compared to normal birth weight women. We assessed whether longitudinal risk profiles for diabetes or metabolic clustering differed by birth weight. To better understand intergenerational continuity of risk, we evaluated whether pregnancy characteristics across two generations influenced the birth weight of these women’s offspring. High birth weight women had higher adult body composition measures compared to normal birth weight women; however, slopes did not differ, suggesting the higher body composition measures observed among high birth weight women were constant over time. High birth weight women had steeper rates of change in glucose levels, but no differences were observed in lipid, insulin, or insulin resistance levels or in their trajectories over time compared to normal birth weight women. Body composition, carbohydrate metabolism, and lipid trajectories did not differ between low and normal birth weight women and the risk for developing type-2 diabetes or metabolic clustering did not differ by birth weight groups. When we examined the intergenerational effects, we found that women with in utero cigarette smoking exposure had offspring who were an average of 136 grams heavier than women without in utero smoking exposure (p=0.02). Similarly, women born to older mothers had heavier offspring than women born to younger mothers. This dissertation expands our understanding of the relationship between birth weight and trajectories in adult body composition, carbohydrate metabolism, and lipids – known risk factors for many chronic diseases - and provides further support of an intergenerational effect on birth weight. Understanding these relationships contributes to knowledge about chronic disease etiology and can motivate research and interventions aimed at improving reproductive and women’s health and preventing chronic disease.Ph.D.Epidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/77888/1/erillama_1.pd

Development and application of an automated algorithm to identify a window of consecutive days of accelerometer wear for large-scale studies

Abstract Background Some accelerometer studies ask participants to document in a daily log when the device was worn. These logs are used to inform the window of consecutive days to extract from the accelerometer for analysis. Logs can be missing or inaccurate, which can introduce bias in the data. To mitigate this bias, we developed a simple computer algorithm that used data within the accelerometer to identify the window of consecutive wear days. To evaluate the algorithm’s performance, we compared how well it agreed to the window of days identified by visual inspection and participant logs. Findings Participants were older women (mean age 79 years) in a cohort study that aimed to examine the relationship of objective physical activity on cardiovascular health. The study protocol requested that participants wear an accelerometer 24 h per day over nine calendar days (to capture seven consecutive wear days) and to complete daily logs. A stratified sample with (n = 75) and without (n = 100) participant logs were selected. The Objective Physical Activity and Cardiovascular Health (OPACH) algorithm was applied to the accelerometer data to identify a window of up to seven consecutive wear days. Participant logs documented dates the device was first put on, worn, and removed. Using pre-established guidelines, two independent raters visually reviewed the accelerometer data and characterized the dates representing up to seven consecutive days of 24-h wear. Average agreement level between the two raters was 90%. The percent agreement was compared between the three methods. The OPACH algorithm and visual inspection had 83% agreement in identifying a window with the same total number of days, if one or more shifts in calendar dates were allowed. For visual inspection vs. logs and algorithm vs. logs, this agreement was 81 and 74%, respectively. Conclusion The OPACH algorithm can be efficiently and readily applied in large-scale accelerometer studies for the identification of a window of consecutive days of accelerometer wear. This algorithm was comparable to visual inspection and participant logs and might provide a quicker and more cost-effective alternative to selecting which data to extract from the accelerometer for analysis. Trial Registration: clinicaltrials.gov identifier: NCT0000061

Can Community Gardens with Workshops Increase Gardening Behavior? A Navajo Wellness Collaboration

This paper seeks to evaluate the potential efficacy of a community gardening intervention on the Navajo Nation to increase gardening and healthy eating behaviors, which are potentially important in preventing obesity and related health conditions. Rates of obesity are high among American Indians, including those living on Navajo Nation land. Eating fresh fruits and vegetables is part of healthy eating. However, availability and access to fresh fruits and vegetables are severely limited on the Navajo Nation, due to distance and cost. One way to increase both availability and consumption of fresh fruits and vegetables is through community gardening, yet many on the Navajo Nation have limited knowledge and capacity to garden. Methods: We used a quasi-experimental pre-post study design to estimate the effect of a community gardening intervention. Primary outcomes of interest were gardening frequency and fruit and vegetable consumption. Community gardens were constructed and planted in two communities on the Navajo Nation. In addition, a series of gardening workshops were held in each community. Community members were recruited to complete surveys at time points before and after the workshops. The time between baseline and follow-up was approximately one year. Results: We surveyed 169 participants at one time point at least, across both communities, and 25 of these participated in the gardening workshops. Within the 169, there was a cohort of 32 participants completing both baseline and follow-up surveys. For this cohort, interest in gardening increased from 78% to 97% (p=0.014), but none of the changes in gardening self-efficacy, knowledge or gardening frequency reached statistical significance. There were no measurable changes in reported fruit and vegetable consumption, self-efficacy or knowledge. Overall, the reported financial barriers to gardening increased from baseline to follow-up from 4.6 to 5.5 (p=0.035). Altogether 52 participants completed follow-up. In this group, those who attended at least one workshop gardened more frequently at follow-up than those who did not attend any workshops (21 times per month compared to 10 times per month (p=0.07). Conclusion: Despite enthusiasm for the community garden in both the communities studied and the increased interest in gardening, workshop attendance and participant retention in the study were low. These factors limited our ability to evaluate the potential efficacy of the intervention on gardening and healthy eating behaviors. Nonetheless, we found some evidence that participating in gardening workshops may lead to increased gardening frequency. Future studies should augment the intervention to include explicit efforts to reduce barriers to long term engagement and extend intervention reach

Association of Light Physical Activity Measured by Accelerometry and Incidence of Coronary Heart Disease and Cardiovascular Disease in Older Women

IMPORTANCE To our knowledge, no studies have examined light physical activity (PA) measured by accelerometry and heart disease in older women. OBJECTIVE To investigate whether higher levels of light PA were associated with reduced risks of coronary heart disease (CHD) or cardiovascular disease (CVD) in older women. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of older women from baseline (March 2012 to April 2014) through February 28, 2017, for up to 4.91 years. The setting was community-dwelling participants from the Women's Health Initiative. Participants were ambulatory women with no history of myocardial infarction or stroke. EXPOSURES Data from accelerometers worn for a requested 7 days were used to measure light PA. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% CIs for physician-adjudicated CHD and CVD events across light PA quartiles adjusting for possible confounders. Light PA was also analyzed as a continuous variable with and without adjustment for moderate to vigorous PA (MVPA). RESULTS Among 5861 women (mean [SD] age, 78.5 [6.7] years), 143 CHD events and 570 CVD events were observed. The HRs for CHD in the highest vs lowest quartiles of light PA were 0.42 (95% CI, 0.25-0.70; P for trend <. 001) adjusted for age and race/ethnicity and 0.58 (95% CI, 0.34-0.99; P for trend = .004) after additional adjustment for education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health. Corresponding HRs for CVD in the highest vs lowest quartiles of light PA were 0.63 (95% CI, 0.49-0.81; P for trend <. 001) and 0.78 (95% CI, 0.60-1.00; P for trend = .004). The HRs for a 1-hour/day increment in light PA after additional adjustment for MVPA were 0.86 (95% CI, 0.73-1.00; P for trend = .05) for CHD and 0.92 (95% CI, 0.85-0.99; P for trend = .03) for CVD. CONCLUSIONS AND RELEVANCE The present findings support the conclusion that all movement counts for the prevention of CHD and CVD in older women. Large, pragmatic randomized trials are needed to test whether increasing light PA among older women reduces cardiovascular risk.National Heart, Lung, and Blood Institute (NHLBI) [R01 HL105065]; NHLBI [T32HL079891-11]; National Institutes of Health; US Department of Health and Human Services [HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, HHSN268201600004C]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Comparison of Questionnaire and Device Measures of Physical Activity and Sedentary Behavior in a Multi-Ethnic Cohort of Older Women

Background: Limited data are available regarding the correlation between questionnaire and device-measured physical activity (PA) and sedentary behavior (SB) in older women. Methods:We evaluated these correlations in 5,992 women, aged 63 and older, who completed the Women’s Health Initiative (WHI) and Community Healthy Activities Model Program for Seniors (CHAMPS) PA questionnaires and the CARDIA SB questionnaire prior to wearing a hip-worn accelerometer for 7 consecutive days. Accelerometer-measured total, light, and moderate-to-vigorous PA (MVPA), and total SB time were defined according to cutpoints established in a calibration study. Spearman coefficients were used to evaluate correlations between questionnaire and device-measures. Results: Mean time spent in PA and SB was lower for questionnaire than accelerometer measures, with variation in means according to age, race/ethnicity, bodymass index, and functional status. Overall, correlations between questionnaires and accelerometer measures were moderate for total PA, MVPA, and SB (r ≈ 0.20–0.40). Light intensity PA correlated weakly for WHI (r ≈ 0.01–0.06) and was variable for CHAMPS (r ≈ 0.07–0.22). Conclusion: Questionnaire and accelerometer estimates of total PA, MVPA, and SB have at best moderate correlations in older women and should not be assumed to be measuring the same behaviors or quantity of behavior. Light intensity PA is poorly measured by questionnaire. Because light intensity activities account for the largest proportion of daily activity time in older adults, and likely contribute to its health benefits, further research should investigate how to improve measurement of light intensity PA by questionnaires