Dietary factors associated with obesity indicators and level of sports participation in Flemish adults : a cross-sectional study

BACKGROUND: Obesity develops when energy intake continuously exceeds energy expenditure, causing a fundamental chronic energy imbalance. Societal and behavioural changes over the last decades are held responsible for the considerable increase in sedentary lifestyles and inappropriate dietary patterns. The role of dietary fat and other dietary factors in the aetiology and maintenance of excess weight is controversial. The purposes of the present study were to investigate the dietary factors associated with body mass index (BMI) and waist circumference (WC), and to analyse whether dietary intake varies between subjects with different levels of sports participation. METHODS: Data for this cross-sectional study, including anthropometric measurements, 3-day diet diary and physical activity questionnaire, were collected by the Flemish Policy Research Centre Sport, Physical Activity and Health (SPAH) between October 2002 and April 2004. Results of 485 adult men and 362 women with plausible dietary records were analysed. Analyses of covariance were performed to determine the differences in dietary intake between normal weight, overweight and obese subjects, and between subjects with different levels of sports participation. RESULTS: Total energy intake, protein and fat intake (kcal/day) were significantly higher in obese subjects compared to their lean counterparts in both genders. Percentage of energy intake from fat was significantly higher in obese men compared to men with normal weight or WC. Energy percentages from carbohydrates and fibres were negatively related to BMI and WC in men, whereas in women a higher carbohydrate and fibre intake was positively associated with obesity. Alcohol intake was positively associated with WC in men. Subjects participating in health related sports reported higher intake of carbohydrates, but lower intake of fat compared to subjects not participating in sports. CONCLUSION: This study supports the evidence that carbohydrate, fat, protein and fibre intake are closely related to BMI and WC. The sex differences for dietary intake between obese men and women might reflect the generally higher health consciousness of women. Alcohol intake was only associated with WC, emphasizing the importance of WC as an additional indicator in epidemiological studies. Besides enhancing sports and physical activity, it is necessary to improve the knowledge about nutrition and to promote the well-balanced consumption of wholesome food

Secular trend, tracking and familial resemblance in physical activity and physical fitness : The Leuven Longitudinal Study on Lifestyle, Fitness and Health 1969-2004

The importance of regular physical activity and of physical fitness for health has been widely accepted and extensively documented. However, before developing and implementing strategies to encourage physical activity and improve physical fitness, it is important to 1) be able to accurately assess physical activity and physical fitness, 2) be well informed about the status and (generation- or age-related) change of physical activity and physical fitness and 3) have clear insight into the causes underlying the phenotypic variation in physical activity and physical fitness. The purpose of this thesis was to document each of these aspects in the Flemish population using data from the Leuven Longitudinal Study on Lifestyle, Fitness and Health (LLSLFH) 1969-2004. Therefore this thesis was divided into a methodological, a longitudinal epidemiological and a genetic epidemiological part each consisting of two chapters addressing one specific research question. In the first chapter of the methodological part, three difficulties associated with longitudinal research, i.e. the “imperfect” design, the evolution of data collection methods and the representativeness of the ongoing study sample, were documented by means of findings from the LLSLFH. The LLSLFH provides unique research opportunities, especially in studying longitudinal and genetic epidemiological aspects of physical activity and physical fitness, but is also faced with several limitations. However, when aware of these possible “pitfalls” several measures (e.g., thorough planning, appropriate sampling procedures, reimbursement of travel expenses, personal results, newsletters, telephone interviews with dropouts) should be taken to prevent or limit them as much as possible and to interpret the results in the right perspective. In the second chapter two-week test-retest reliability and concurrent validity of the Flemish Physical Activity Computerized Questionnaire (FPACQ) developed for employed/unemployed and retired people was investigated. The FPACQ was used in the most recent phase of the LLSLFH. The RT3 Tri-axial Research Tracker, in combination with a written seven-day activity record was used as objective criterion measure. Particularly in employed/unemployed people and slightly less in retired people, the FPACQ was a reliable and reasonably valid questionnaire for the assessment of different dimensions of physical activity and sedentary behaviour. In the first chapter of the longitudinal epidemiological part the secular trend in physical activity and physical fitness was investigated in adolescents from 1969 to 2005. Several anthropometric characteristics in both sexes and skeletal age in boys demonstrated a positive secular trend, while a negative secular trend was observed for most physical fitness tests. No secular trend was apparent for sports participation. In the second chapter tracking of physical activity and physical fitness was studied from adolescence to middle adulthood in females. Most anthropometric and physical fitness characteristics were relatively stable from adolescence to adulthood. On the other hand, sports participation was not a stable characteristic. In the first chapter of the genetic epidemiological part the familial aggregation in physical activity and physical fitness was studied and the proportion of the variability attributable to genetic, common and unique environmental factors was quantified. The observed familial aggregation was explained by genetic factors for body mass index, sum of five skinfolds, trunk-extremity skinfold index, flexibility and muscular endurance and by common environmental factors for balance and sports participation, while both factors were important for waist circumference and explosive strength. However, for all variables at least about half of the variance was explained by unique environmental factors. In the second chapter parent-offspring resemblance in physical activity and physical fitness was compared between adolescent chronological age-matched parent-offspring pairs and date-of-exam-matched (adult parent-adolescent offspring) parent-offspring pairs. Only for height, weight, trunk-extremity skinfold index and vertical jump in males, the stated hypothesis of higher adolescent chronological age-matched parent-offspring correlations could be confirmed. The findings of this thesis have important implications with regard to the necessity and the efficacy of strategies to improve physical activity and physical fitness. From the longitudinal epidemiological studies it can be concluded that 1) during adolescence measures are necessary to encourage physical activity and improve physical fitness and 2) during adulthood constant efforts should be made to keep people active and to reactivate those who have shifted from an active to a more sedentary lifestyle. Moreover, the identification of environmental factors, viewed against the background of genetic susceptibility, as major causes of the phenotypic variance in physical activity and physical fitness in the genetic epidemiological studies emphasizes the potential efficacy of such strategies.Table of contents iii Acknowledgements/Dankwoord v Professional career ix Publications xi Abbreviations xiii English summary xv Dutch Summary/Samenvatting xvii Section 1. General introduction and outline 19 Section 2. Research articles 45 Part 1. Methodological issues 47 Chapter 1. Methodological issues associated with longitudinal research: Findings from the Leuven Longitudinal Study on Lifestyle, Fitness and Health (1969-2004) Journal of Sports Sciences, accepted for publication 49 Chapter 2. Reliability and validity of the Flemish Physical Activity Computerized Questionnaire (FPACQ) in adults Research Quarterly for Exercise and Sport, accepted for publication 75 Part 2. Longitudinal epidemiological studies 103 Chapter 1. Secular trends in anthropometric characteristics, physical fitness, physical activity, and biological maturation in Flemish adolescents between 1969 and 2005 American Journal of Human Biology, accepted for publication 105 Chapter 2. Tracking of physical fitness and physical activity from youth to adulthood in females Medicine and Science in Sports and Exercise 38 (6): 1114-1120, 2006 129 Part 3. Genetic epidemiological studies 145 Chapter 1. Aggregation of anthropometric characteristics, physical fitness and physical activity in Flemish nuclear families Twin Research and Human Genetics, in revision 147 Chapter 2. Parent-offspring resemblance in physical fitness and physical activity: date-of-exam-matched versus adolescent age-matched analysis American Journal of Epidemiology, submitted 169 Section 3. Summary and general discussion 189nrpages: 215status: publishe

Dietary factors associated with obesity indicators and level of sports participation in Flemish adults: a cross-sectional study

Abstract Background Obesity develops when energy intake continuously exceeds energy expenditure, causing a fundamental chronic energy imbalance. Societal and behavioural changes over the last decades are held responsible for the considerable increase in sedentary lifestyles and inappropriate dietary patterns. The role of dietary fat and other dietary factors in the aetiology and maintenance of excess weight is controversial. The purposes of the present study were to investigate the dietary factors associated with body mass index (BMI) and waist circumference (WC), and to analyse whether dietary intake varies between subjects with different levels of sports participation. Methods Data for this cross-sectional study, including anthropometric measurements, 3-day diet diary and physical activity questionnaire, were collected by the Flemish Policy Research Centre Sport, Physical Activity and Health (SPAH) between October 2002 and April 2004. Results of 485 adult men and 362 women with plausible dietary records were analysed. Analyses of covariance were performed to determine the differences in dietary intake between normal weight, overweight and obese subjects, and between subjects with different levels of sports participation. Results Total energy intake, protein and fat intake (kcal/day) were significantly higher in obese subjects compared to their lean counterparts in both genders. Percentage of energy intake from fat was significantly higher in obese men compared to men with normal weight or WC. Energy percentages from carbohydrates and fibres were negatively related to BMI and WC in men, whereas in women a higher carbohydrate and fibre intake was positively associated with obesity. Alcohol intake was positively associated with WC in men. Subjects participating in health related sports reported higher intake of carbohydrates, but lower intake of fat compared to subjects not participating in sports. Conclusion This study supports the evidence that carbohydrate, fat, protein and fibre intake are closely related to BMI and WC. The sex differences for dietary intake between obese men and women might reflect the generally higher health consciousness of women. Alcohol intake was only associated with WC, emphasizing the importance of WC as an additional indicator in epidemiological studies. Besides enhancing sports and physical activity, it is necessary to improve the knowledge about nutrition and to promote the well-balanced consumption of wholesome food.</p

Association between leisure time physical activity and stress, social support and coping: a cluster-analytic approach

Objectives: Identifying risk clusters of stress, anxiety and depression, taking into consideration social support and coping, two important factors through which leisure time physical activity may have stress-reducing effects, may lead to more effective exercise treatment strategies for stress. The aim of this study was to investigate whether stress, social support and coping cluster in meaningful ways in the general adult population, and whether individuals of these clusters also differ in anxiety, depression and different types of leisure time physical activity. Design: Cross-sectional study in a randomly chosen community based sample of adults in the Flemish region of Belgium. Method: A sample of 2616 Flemish adults, aged 18-75, completed two self-report computerized questionnaires on mental health, physical activity and demographic characteristics in the presence of a scientific staff member. Results: Three reliable clusters were identified in both males and females. The first cluster showed high levels of stress and ineffective coping and low levels of social support. The second one showed the opposite, and the third one an intermediate profile. Anxiety and depression were highest in persons of the stressed cluster and diminished gradually over the intermediate and the nonstressed ones. Sports participation and not other types of leisure time physical activity was significantly lower in the stressed cluster. Conclusions: By means of cluster analysis, risk groups of stress, anxiety and depression in adult males and females can be identified. Sports participation may have a beneficial effect in these at-risk groups. © 2006 Elsevier Ltd. All rights reserved.status: publishe

Reliability, equivalence and respondent preference of computerized versus paper-and-pencil mental health questionnaires

The purpose of this study was to examine the reliability, equivalence and respondent preference of a computerized version of the General Health Questionnaire (GHQ-12), Symptom Checklist (SCL-90-R), Medical Outcomes Study Social Support Survey (MOSSSS), Perceived Stress Scale (PSS) and Utrecht Coping List (UCL) in comparison with the original version in a general adult population. Internal consistency, equivalence and preference between both administration modes was assessed in a group of participants (n = 130) who first completed the computerized questionnaire, followed by the traditional questionnaire and a post-assessment evaluation measure. Test-retest reliability was measured in a second group of participants (n = 115), who completed the computerized questionnaire twice. In both groups, the interval between first and second administration was set at one week. Reliability of the PC versions was acceptable to excellent; internal consistency ranged from α = 0.52-0.98, ICC&apos;s for test-retest reliability ranged from 0.58-0.92. Equivalence was fair to excellent with ICC&apos;s ranging from 0.54-0.91. Interestingly, more subjects preferred the computerized instead of the traditional questionnaires (computerized: 39.2%, traditional: 21.6%, no preference: 39.2%). These results support the use of computerized assessment for these five instruments in a general population of adults. © 2006 Elsevier Ltd. All rights reserved.status: publishe

Sedentary behaviour, physical activity and a continuous metabolic syndrome risk score in adults

OBJECTIVE: The association of sedentary behaviour and leisure time physical activity with a validated continuous metabolic syndrome risk score was investigated in adults. SUBJECTS/METHODS: A number of 992 adults (559 men) without cardiovascular disease or diabetes. Subjects reported time spent in leisure time physical activity and television watching/computer activities. A validated metabolic syndrome risk score, based on waist circumference, triglycerides, blood pressure, fasting plasma glucose and high-density lipoprotein cholesterol, was used. The metabolic syndrome risk score and time spent in sedentary behaviour and physical activity were analysed as continuous variables using multiple linear regression. RESULTS: Metabolic syndrome risk was positively associated with time spent watching television/computer activities, irrespective of physical activity level, and after adjustment for age, education level, smoking status and dietary intake in women aged > or =45 years (beta=0.184, P or =45 years: beta=-0.192, P or =45 years (beta=-0.203, P or =45 years, besides promotion of moderate to vigorous physical activity, since both behavioural changes might show additional effects.status: publishe

Secular trends in anthropometric characteristics, physical fitness, physical activity, and biological maturation in Flemish adolescents between 1969 and 2005

In this study, secular trends in anthropometric characteristics, physical fitness, physical activity and biological maturity over the past 25 to 35 years in Flemish adolescents were investigated. Representative cross-sectional samples of 12-18-year-old secondary school children (11899 assessments in boys in 1969-1974, 4899 girls in 1979-1980, 1429 boys and 1772 girls in 2005) and parent-offspring pairs tested at approximately the same age during adolescence (55 father-son pairs, mean age fathers=15.47y, mean age sons=15.38y; 62 mother-daughter pairs, mean age mothers=16.63y, mean age daughters=15.01y) were used. The cross-sectional data were analysed in six yearly age-categories using Wilcoxon rank sum tests. For the parent-offspring data paired t-tests, simple linear regressions to adjust for parent-offspring differences in chronological age and multiple linear regressions to adjust for parent-offspring differences in chronological and skeletal age were conducted. The cross-sectional study generally revealed an increase in weight, stature, BMI, skinfolds and trunk-extremity index and a decrease in the performance on several physical fitness tests. In the parent-offspring study, only sons were maturationally advanced compared to fathers. Even after adjustment for parent-offspring differences in chronological age and in chronological and skeletal age, results for stature, trunk-extremity index and physical fitness were generally similar to the cross-sectional study. No secular trend was observed for sports participation. The fact that the positive secular trends in weight, BMI and skinfolds of the cross-sectional study were not entirely confirmed in the parent-offspring study is probably due to higher similarity in genetic and familial background, higher socio-economic status and more health-consciousness of the latter.status: publishe