associations
and environmental
between
factors
Bette
J Caan,
fat
energy
tivity)
E Bud,
body
influencing
balance
were examined
in 5 1 1 5 young
adults.
Protein
was directly associated
with body mass index (BMI) in all race and sex
groups
alcohol
hydrate
=
(P < 0.01)
intake,
intake
0.02).
Total
inversely
ories)
from
was
inversely
associated
associated
with
percent
in whites,
of kilojoules
grams
in black
was
consistently
KEY
intake,
WORDS
physical
Am
and
with
associated
J Clin Nutr
Alcohol,
activity
total
with
fiber/4
184
activity (except
with cigarette
alcohol
intake
WHCR
in
in all race
l992;55:943-9.
fat, cigarette
body
(kilocal-
of crude
except
men,
with
measures
(P
ratio (WHCR)
(kilocalories)
in
smoking
sex groups.
smoking,
dietary
hip
may
circumference
factors
fat and
associated
its distribution.
study
Adults
only
ac-
energy-yielding
with
body
To examine
these
population
ofyoung
adult men
are participants
in the ongoing
on
Coronary
(CARDIA)
Artery
were
Risk
Devel-
used.
Methods
Data
for these
analyses
were
amination
1985 and
of the CARDIA
1986. The study
and
(48%)
white
amination
women;
than
individuals
MN;
obtained
and
from
Birmingham,
Oakland,
CA.
school
during
the
baseline
study,
which
was conducted
population
consisted
of black
education;
consisted
education
and
AL;
exduring
(52%)
Chicago,
At the baseline
ex-
of46%
men and
or less and 60%
54%
with
45%
aged
18-24
y and
be related
to the
risk
of developing
CVD
(3-6).
in Young
(physical
that
Physical
activity,
a key deterwas examined
as a factor
that
a biracial
18-30 y who
aged
expenditure
are not
its distribution.
expenditure,
collaborative
oprnent
more
The relation
between
total body fat and the development
of
cardiovascular
disease (CVD) as well as risk factors for developing
cardiovascular
diseases
is well established
(1, 2). Limited
data
suggest that the distribution
of fat at various
sites within the
also
national
energy
It is hypothesized
alcohol,
also with
of energy
IL; Minneapolis,
Introduction
body
including
fat but
minant
and women
activity
kcal)(except
in black men), and physical
women).
WHCR
was directly associated
and
nutrients,
and
examined.
physical
carbohydrates
Beer
(kilocalories)],
were
could impact
on body
hypotheses,
data from
Id (1000
in white
men.
[kilajoules
E Hilner,
Joan
ratio
contributing
Am J C/in Nuir
1992;55:943-9.
(WHCR),
to energy
Printed
with
cigarette
smoking
energy
and
balance,
total
intake
in USA.
1992 American
Society
C From
the
of Medicine,
Nutrition
and
Heart, Lung,
Applications,
nente Medical
Department
of Family and Preventive
Medicine,
School
University
of Utah, Salt Lake City; the Department
of
Medical Dietetics, University
ofillinois,
Chicago; National
and Blood Institute,
Division ofEpidemiology
and Clinical
Bethesda,
MD; the Division
of Research,
Kaiser Perma-
University
of Minnesota,
Health and Preventive
School, Chicago.
N0l-HC-48048,
N01-HCfrom the National
Heart,
Nutrition
943
ABSTRACf
Diane
SLATTERY
944
was
designed
so that
Study
design
detail elsewhere
methods,
results
adults
methods
however,
with
of data
collection
recruitment
and
were
methods
recruitment
methods
the
same
were
center-spe-
were
reported
range
ofyears
ofeducation
and
methods
used to obtain
the data presented
below.
The study was conducted
according
lines of the participating
study centers.
in duplicate
protrusion
in
income.
AL
measured
(13). Because
ofthe studys goals and recruitment
from this study pertain
to black and white young
a wide
ET
The
of the
of the
duplicate
WHCRs
used
as weight
size
Dietary-intake
data
questionnaire
ticipants
were
month
asked
obtained
from
a detailed
their
study
usual
of the
questionnaire
the
University
trient database
the diet-history
of Minnesota
tape 10(17).
questionnaire
Alcohol
and
used
consumed
in these
Physical
per
week.
tivities
were described
to nutrients
by
Center
nu-
were
over
the
past
example,
moderate
energy
jogging
and intense
expenditure
as intense
an activity
requiring
Physical-activity
the
of months
for
than
activity
(20).
1 h by the
Data
from
degree
a test
types of ac-
questionnaire
was
Activities
categories,
associated
expenditure.
number
various
This
a phys-
ofenergy
multiplying
more
by using
the
of performance.
was classified
year.
study
Activity
were
depending
on the
with them.
For
activity
a more
whereas
bowl-
moderate
degree
units
were calculated
by
the activity
was performed
of intensity
with
assigned
to the
a symptom-limited
exercise
treadmill
were used as an estimate
of physical
fitness.
Scores
for
total activity
and for the subset
of intense
activities
were significantly
test,
associated
with
as assessed
Body
brated
with
weight
ipant.
Fifty
the exercise
treadmill
on the treadmill
to the nearest
wore
light
0.5 cm with
shoes.
Triceps,
were
measured
Harpenden
twice
calipers.
at standard
millimeters
(20).
0.2 kg with
clothing;
was
height
a vertical
ruler
subscapular,
to the
Each
nearest
used
as the
measured
abdominal
in duplicate
girth.
Hip
a cali-
was
mea-
while subjects
and suprailiac
skinfold
millimeter
thickness
was
value
skinfold
thickness
was too thick
to measure,
the maximum
that could
be measured
with
circumference
at the minimum
sites.
Each
separately.
skinfold
The
mea-
WHCR
was
for
well
waist
outside
and
hip
in recording
10 white
men;
the
overall
distribution
circumference
a WHCR
a WHCR
>
values
1.05
>
1.0 for
for
were
1 3 black
1 5 black
women
women).
Other variables
Demographic
variables
examined
were educational
level, race,
age, and sex. Smoking
status
was obtained
from a self-reported
smoking
history
and subjects
were classified
as having
never
smoked
or as exsmokers
or current
smokers.
ofcigarettes
smoked
per day was used in some
for smoking.
Because
cigarette
olism and thus influence
energy
smoking
balance
indicating
that
because
this was
the calipers.
Waist
to the
nearest
circumference
0.5
cm
also was
of analyses
Analyses
sex and
of the
race
selected
stratum
smoking
(22).
variables
of the
linear
and
of total
calories
from
amount
ofcrude
fiber
measures
to standardize
was examined
along
fiber
were
fat, protein,
associations
were
cx-
as a percentage
or carbohydrate
kJ (1000
each
expressed
kcal).
for caloric
with
for
techniques
of body
activity,
quadratic
variables
per 4184
performed
Regression
the associations
factors,
physical
Dietary-intake
density
were
population.
amined.
and
We used
as the
nutrient-
consumption.
the energy-yielding
Crude
nutrients
be-
glass
ofwine,
and
0.0045-L
ofliquor
were
defined
To determine
whether
fold-thickness
overall
body
measurements
size, BMI was
and WHCRs
were independent
of
controlled
in the analyses
of those
anthropometric
measures.
Total
smoking
status,
and total
same
model
to determine
variables
ponents
were
to determine
its distribution.
on
then
body
fat and
independent
Alcohol-intake
between
physical
caloric
intake
the independent
substituted
their
associations
each
as one drink.
these
subjects
thicknesses
calibrated
measured
sustained
was measured
while
to the nearest
not wearing
skinfold
during
measures
scale
sured
were
performance
by the duration
Anthropomeiric
the
errors
Methods
physical
activity
was ascertained
history
questionnaire
describing
developed
the Leisure
three
presented.
analyses.
performed
values
and
activity
Individual
ical-activity
ofthe
evaluated
body
(BMI), calculated
averages
for skin-
mass
were
of the
of alcohol
body
each
was
variable;
for 7 white
estimates
of body
of total
WHCR
intake
was estimated
from
was expressed
as grams
of
Both
of location
measures
for this
alcohol consumed
per day. A second estimate
of alcohol intake
was obtained
from a separate
questionnaire,
which defined
alcohol intake in terms of the number
of drinks of various types
of alcohol
two
their
men
Coding
fat and
The
past
and
Nutrition
for
par-
and
results
and
of central
adiposity.
Forty-five
individuals
the analyses
of central
adiposity
because
considered
the
averages
thicknesses
as an indicator
excluded
from
and methods
of prepmethods
concerning
study on comparative
validity
ofthe questionnaire
previously
(1 5, 16). Food items were converted
using
the
maximum
The
activity,
were
Dietary
for total
associations
variables
with
and
alcohol,
assessed
in the
effects
of each of
its distribution.
in the model
skin-
com-
caloric
intake
body
fat and
physical-activity
units
were transformed
by using
a log transformation
before
analyses
because
the distributions
ofthese
variables
were skewed.
When it was necessary
to categorize
data, the race- and sexspecific
proximate
distributions
quartiles.
for those
variables
were
divided
into
ap-
Results
The
given
mean
in Table
administration
Study
during
at the
used
were
diet-history
(14).
intake
by reporting
amounts,
frequency,
of foods consumed.
Quality-control
aration
the
were
developed
cm
index
(m2), and the sum ofthe
were
from
also
body
analyses.
(kg)/height
site
0.5
of the buttocks.
for skinfold
of total
used
fold thicknesses
intake
level
in the analyses.
in these
fat or body
surement
Dietary
used
indicators
fat were
nearest
at the
measurements
were
Several
to the
hips
BODY
TABLE
1
Values for selected
variables,
FAT
AND
Black
men
White
24.6
10.8
13.8
16.3
40.4
0.817
(mm)
0.13
24.3
12.3
13.6
19.4
45.1
0.839
0.19
0.21
0.31
0.66
0.001
16 903 298
38.2 0.17
14.4 0.07
45.0 0.21
1.7 0.02
17.90.13
17.5 0.94
men
11Significantly
0.10
0.19
0.30f
0.59
0.OOlf
509.7
168.1
341.6
36.9 [423]
9.3 [106]
53.8 [616]
women
25.9
22.2
20.0
20.5
61.5
0.18f
White
0.17
23.1
0.12
0.27
20.2
0.22
0.29
15.2 0.23
17.8 0.27
0.82
52.7
0.002
2.0
8 937 l03
36.5 0.l8
15.4 0.08
0.20
46.8
0.02
2.6 0.04
18.30.14*
17.40.12
5.5
0.65
0.00l
0.726
10 837 149
37.7 0.16
14.2 0.07
47.7
women
(n= 1286-1306)
0.31
0.742
13 774 l75
37.3 0.l7t
15.3 0.07f
44.8 0.20
2.1 0.02f
l8.70.l5
16.8 0.70
534.9 10.1
158.1 3.6
376.7 7.7
skinfold
women
different
0.33
8.5
0.2011
0.32*
8.8
277.8
5.9
399.5
7.2*
3.2cc
108.0
2.4
143.9
2.7*
6.9t
169.9
4.4
255.7
5.7
26.5 [307]j
15.7 [l82]t
57.8 [67l]**
measures
had smaller
site
from
men:
0.001,
<
and WHCR
than
did
BMIs,
smaller
skinfold
measured,
and
Blacks consumed
and percentage
black
<
**
31.3 [461]
8.6 [127]
60.1 [885]
27.3 [355]**
20.1 [26lJt
52.7 [685]f
0.05.
different
consumption
#{182}
No alcohol
smaller
white
men.
measurements
WHCRs
than
black
White
for
women.
men,
525 black
upper
one
quartile
Americans.
alcohol,
bution
more
both
in volume
and
significant
group
The
within
had
the
greatest
mean
BMI,
race-
physical
WHCR,
and
alcohol
for blacks
intake
was inversely
blacks
and
0.001).
was
Reported
sum
of total
and
2 and
with
associated
energy
intake,
WHCR
activity
status
in Table 3. Energy
(P
0.03) among
BMI
with
physical
thicknesses
cigarette-smoking
for whites
and
in women
was negatively
(P
asso-
were
consumed
lower
did men
amounts
or one
who
to two drinks
of alcohol
per
day
per day
alcohol
(P
had
larger
or who
that
than
than
Although
qua-
were
not
any
also
of energy
0.02).
Total
associated
ciated
WHCR
in all groups
with
with
ofthe
BMI
carbohydrate
BMI
associated
significantly
ex-
analyses
of kilojoules
associated
intake
was inversely
crude
fiber intake
was
with
intensities
as a percentage
directly
inversely
its distri-
energy-yielding
multivariate-regression
P values
(all
fat and
activity,
different
in
Carbohydrate
whites
and
intake
among
men.
with WHCR
in
inversely
asso-
population
except
black
when
g alcohol/d
less
WHCRs
these environmental
did not observe
of body
physical
and
intake,
was
sex groups
sumed
than
diet
4). Protein
significantly
13-26
smoked.
associations
and
examined
consumed,
ciated
with the sum of the skinfold
measurements
as well as
with each of the three individual
skinfold
measurements
in all
race and sex strata (P
0.002; data not shown). Men who con-
WHCRs
never
the associations
intake
of the
penditure
(Table
quadratic
dietary
was significantly
of skinfold
quartiles
associated
total
smokers.
intake,
in Table
directly
of current
and
sex-specific
activity,
are shown
number
population
blacks
as a
who
was
larger
were examined
between
body-size
variables,
we
explore
with
ories)
ofthe
study
cigarettes;
in women
had
linearly.
amount
(50-60%)
majority
smoked
intake
smokers
or individuals
To further
components
activity.
The
never having
women.
alcohol
Current
significant
as a percentage
ofcalories,
than did women.
Men reported
more
total physical
activity
as well as more
activities
of an intense
nature
than did women,
with black women
reporting
the smallest
ofphysical
reported
day.
dratic associations
variables
and the
statistically
consumed
of total
per
did exsmokers
(kilocalories)
fat and from
counterparts.
Women
conId (1000
kcal) than did men;
crude
fiber than did African
Men
women,
drink
carbohydrate
than
their white-sex
sumed
more crude
fiber per 4184
white individuals
consumed
more
<
Black
(n= 1393-1479)
(n= 1157-1171)
SE. n in brackets.
t In kg/m2.
tee Significantly
each
945
of both
associated
a moderate
with
and
BMI.
intense
Activity
degree
of a more
were
not
intense
physical
activity
Activities
ofa
associated
with WHCR
in all groups except
Similar
patterns
of association
were noted
on the treadmill
was used as an indicator
of
rather
moderate
than
nature
reported
were
intense
not associated
physical
with
activity.
WHCR
Anthropometry
BMIt
Triceps (mm)
Subscapular
(mm)
Suprailiac
(mm)
Sum ofskinfold
thicknesses
Waist-to-hip
ratio
Dietary intake
Energy (kJ)
Fat (% Id)
Protein (% Id)
Carbohydrate
(% kJ)
Crude fiber (g/4l84
Id)
Starch(g/4l84kJ)
Alcohol (g)1J
Physical activity (PA units)
Total activity
Moderate
activity
Intense activity
Smoking
status
Current
smoker (%)
Exsmoker
(%)
Never smoked (%)
DISTRIBUTION
(n= 1134-1157)
ITS
946
SLATTERY
TABLE
Values
intake,
ET
AL
TABLE
for anthropometric
physical activity,
variables
within the categories
energy
alcohol,
and smokingstatus
for blacks
Values
intake,
3
for anthropometric
physical activity,
Sum of
skinfold
Sum of
skinfold
BMI
thicknesses
WHCR
BMI
Men
41.0
40.2
40.2
40.6
0.77
0.818[286]
0.8l7[28l]
0.816 [282]
0.816 [278]
0.53
24.6
24.8
24.2
24.6
0.7 1
42.9
41.2
39.7
38.1
<0.001
0.817
0.817
0.817
0.816
0.77
[288]
[279)
[284]
[276]
24.7
24.8
24.0
24.7
0.62
41.7
40.1
39.9
40.4
0.28
0.813
0.815
0.815
0.823
0.01
[271]
[295]
[280]
[281]
24. 1
24.8
24.9
0.02
39.3
40.9
41.3
0.08
0.8 18 [409]
0.817 [104]
0.816 [604]
0.7 1
Current
9707
9708-12719
12 720-16 242
>
16 242
Linear trend P
Physical activity (PA units)
288
288.1-462.5
462.6-672.0
>672.0
Linear trend P
Alcohol intake (g/d)
None
0.1-10.17
10.18-23.0
>23.0
Linear trend P
Smoking
status
Current
smoker
26.3
26.4
25.9
24.9
0.003
62.6
61.3
59.9
62.4
0.61
0.733 [365]
0.741 [357]
0.744[362]
0.748 [363]
<0.001
units)
0.59
47.2
44.9
43.7
45.0
0.04
0.838 [291]
0.835
[284]
0.03
0.837
[170]
0.834
[408]
0.839
0.845
0.009
[288]
[283]
[304]
44.4
0.847
45.0
0.836 [180]
Never smoked
Overall P
24.5
0.09
45.2
0.64
0.835
<0.001
[663]
23.3
23.1
23.1
22.7
52.6
52.0
53.6
52.8
[323]
[323]
[324]
[314]
0.10
0.51
0.722
0.722
0.726
0.735
<0.001
23.6
22.9
23.1
22.7
0.02
54.7
53.9
52.1
50.2
<0.001
0.729
0.724
0.725
0.728
0.66
[325]
[319]
[322]
[318]
24.1
23.0
22.7
22.8
0.0004
53.3
52.4
52.1
53.6
0.87
0.729
0.726
0.725
0.727
0.54
[227]
[418]
[320]
[319]
23.4
50.7
0.732 [350]
23.2
22.9
0.24
53.9
53.4
0.004
0.725
0.723
6594
6595-8263
8264-10602
> 10 602
Linear trend
25.8
25.9
26.0
25.8
0.89
63.2
62.1
62.6
59.4
0.002
26.2
25.3
25.5
26.1
0.91
0.749
0.742
0.739
0.736
<0.001
[364]
[365]
[364]
[354]
62.7
61.3
61.0
60.6
0.07
0.742
0.740
0.740
0.742
0.95
[516]
[212]
[359]
[360]
0.747 [45 1]
Current
0.742
0.738
0.01
Exsmoker
Never smoked
Overall P
Adjusted
alcohol,
smoking,
energy intake,
[124]
[872]
and
lower
than
the n values
into approximate
of the study
given
quartiles
variable.
for WHCR).
(PA
units)
208
208.1-351.0
351.1-543.0
>543.0
Linear trend P
Alcohol intake (g/d)
None
0.1-4.7
4.8-12.0
>12.0
Linear trend P
Smoking
status
59.8
activity
62.2
62.3
0.03
distribution
24.4
24.1
24.1
24.6
[286]
[286]
24.0
25.3
26. 1
0.24
sex-specific
0.838
0.843
24.0
25.6
divided
48.1
46.0
44.6
41.2
<0.001
0.51
Exsmoker
Physical
P
(g/d)
are slightly
24.3
24.1
24.0
24.6
0.43
0.840 [292]
0.835 [284]
Women
Energy intake (Id)
smoker
t Categories
0.837 [286]
0.838 [285]
0.27
45.0
45.7
44.6
44.6
0.49
24.3
Exsmoker
Never smoked
Overall P
thicknesses
24.5
24.3
23.9
smoker
Adjusted
alcohol,
smoking,
[259]
[675]
0.008
energy intake,
and
t Categories
sex-specific
divided
distribution
into approximate
ofthe
study
quartiles
variable.
25.1
24.5
24.4
24.3
0.03
Women
Energy intake (Id)
(PA
WHCR
Men
Energy intake (kJ)t
6807
6808-9410
9411-13443
> 13 443
Linear trend
Physical activity
103.0
103.1-228.0
228.1-396.0
>396.0
Linear trend
Alcohol intake
None
0.1-1.39
1.40-5.58
>5.58
Linear trend
Smoking
status
thicknesses
BODY
except
among
of physical
black
men.
activity
the sum
ofthe
were
Both
moderate
consistently
skinfold-thickness
with
a larger
sociated
with
consumption
women
and
women
When
(kilocalories)
week when
white
wine
not
significantly
alcohol
was
a slightly
positively
black
per week;
Wine
used
with
as a percent
wine
WHCR
of total
conin this
kilojoules
Because
the degree
ofenergy
degree
and
for
for wine
beer
consumption
consumption
among
0.07).
between
WHCR
were examined
association
0.07)
per
ex-
of physical
expenditure
activity
and
thus
is an important
body
size,
and dietary
intake,
alcohol
separately
for individuals
of physical
activity
deter-
the associations
intake,
and smoking
above
and below
the
for their
respective
race
and
alcohol,
reported
activity,
physical
blacks,
WHCR
was accounted
than
TABLE
in whom
if they
in WHCR
smoking
(Table
twice
more
varied
6).
as
for by these
were
accounted
(Tables
2-4),
the amount
by these
energy-yielding
and
activity
among
active
presented
explained
active.
for by alcohol
This
was
much
The
if people
amount
also
2.47
9.88
3.73
0.003
0.002
0.006
0.002
0.001
0.002
0.15
0.03
0.0001
0.90
5.24
1.39
2.29
8.12
3.63
0.004
0.003
0.004
0.002
0.001
0.002
0.03
0.009
0.01
0.56
0.98
0.53
1.59
3.20
1.98
-0.007
0.006
+0.003
0.003
0.002
0.003
0.008
0.007
0.93
1.23
1.56
0.84
2.41
3.68
2.68
-0.002
0.004
0.005
0.002
0.002
0.002
0.20
0.004
0.02
adjusted
of cigarettes
smoked
by using
BMI, caloric
beer,
intake,
and liquor
a log transformation
before
and number
consumption
was
analyses.
white
men,
by alcohol
2.2%
intake
of the
if their
variability
physical
in WHCR
activity
was
physical
activity,
Discussion
were less
ofdietary-intake
and physical-activity
components
In this
by
cigarette
study,
smoking
dietary
intake,
were
significantly
associated
alcohol,
with
both
and
total
Black men
(n = 1 127)
SE
W hite women
Bla ck women
(n = 1447)
White men
(n = 1 147)
SE
SE
( n = 1284)
fi
SE
intake/d
Fat (% Id)
Protein
(% LI)
Carbohydrate
Crude fiber
Physical
0.74
5.1 1
1.39
Regression
BMI
Dietary
in
varied
SE
degree.
true
of variability
alone
/3
transformed
among
plained
of
variability
SD
degree
of physical
activity.
Among
black
men whose
reported
degree
of physical
activity
was above
the median,
3.7% of the
variability
in WHCR
was contributed
by alcohol
intake
whereas
of
nu-
degree
especially
of the
variables
intake
by the
Model
on WHCR*
Mean
servings/wk
Black men
Wine
Beer
Liquor
White men
Wine
Beer
Liquor
Black women
Wine
Beer
Liquor
White women
Wine
Beer
Liquor
as-
women.
however,
associated
weaker
(P
men
(P
men
median
relations
consumed
rather
than as the number
ofdrinks
assessing
associations,
there were similar
results
black
minant
but
of type of alcohol
(% Id)
(g/4184
activity
Id)
0.02
0.02
0.39
0.03
0.02
0.1
0.12
-0.04
0.05
0.02
0.01
0.02
0.22
-0.08
0.04
0.02
<0.01
<0.01
-0.12
0.17
0.47
-0.30
0.13
0.01
-0.09
-0.03
0.03
0.25
-0.04
0.02
0.03
0.15
0.0004
0.06
0.02
0.02
1.00
0.17
-0.02
0.04
0.02
<0.01
0.23
0. 17
0. 19
0.39
-0.02
0. 10
0.86
0.10
0.93
-0.20
0.09
0.03
0. 12
0. 1 1
-0.20
+0. 12
0.09
(PA units)tt
Intense
Moderate
0.12
0.44
-0.02
0.10
0.81
0.03
0.1 1
0.76
-0.08
0. 1 1
0.47
-0.008
-0.0003
0.00006
0.00008
0.0002
0.0004
0.0002
0.00001
0.0002
0.96
0.0003
0.0002
0.09
0.89
0.61
0.0008
-0.0005
0.0005
0.0002
0.1 1
<0.01
-0.001
0.00007
0.0005
0.0002
0.02
0.69
-0.00007
-0.0003
0.0004
0.0002
0.86
0.05
-0.001
0.002
0.51
-0.004
0.001
<0.01
-0.005
0.002
<0.01
-0.002
0.001
0.05
-0.002
0.0007
0.001
0.0009
0.03
0.47
-0.004
0.001
0.001
<0.01
-0.003
0.0008
<0.01
-0.00004
0.0009
0.97
-0.001
-0.003
0.0009
<0.01
0.001
0.85
0. 18
WHCR
intake/d
Fat (% kJ)
Protein (% U)
Carbohydrate
(% Id)
Crude fiber (g/4184 Id)
Physical activity (PA units)ff
Intense
Moderate
Dietary
Adjusted
t Activity
units transformed
for age, education,
Adjusted
BMI,
total
activity,
0.09
alcohol
intake,
0.0003
and smoking
0.0002
status.
status.
0.1 1
0.23
0.0002
for
among
group
was
947
and
associated
with WHCR
in black
with WHCR
in white men. White
the most
was
group.
cept
inversely
associated
consumed
sumption
with
on the observed
DISTRIBUTION
TABLE 5
Linear regression
degrees
consumption
in every
was
directly
ITS
was evaluated
(Table
5). In all four
beer consumption
was associated
Liquor
WHCR
AND
associated
measurements
WHCR
higher
WHCR.
intense
inversely
and
FAT
SLATTERY
948
TABLE
Variability
(R2) in WHCR
activity (PA)*
of physical
Model
accounted
Model
Model
Model 1
(high PA)
(low PA)
If
by degree
Model 2
(low PA)
Model 2
(high PA)
Black men
White
27.4
men
35.7
18.2
11.7
14.1
9.9
35.3
37.0
34.0
9.0
13.2
6.4
Black
women
25.0
30.4
19.1
7.7
9.3
5.3
White
women
25.7
27.3
24.2
8.2
8.2
8.3
S R2 obtained
t Includes age.
arette-smoking
from
linear-regression
status,
and
alcohol
intake
of physical
intake,
in the
activity
are
total physical
regression
on
median
and
<
WI-ICR.
AL
intake,
alcohol
consumption,
activity
among
among
individuals
individuals
with low degrees
of activity
than
who reported
high degrees
ofphysical
activity.
from
chance.
study
found
activity,
cigAnalyses
median.
shown
its distribution.
adults,
black men)
was directly
In this cross-sectional
carbohydrates
(in whites)
fiber
(except
in
were inversely
associated
with WHCR,
and protein
associated
with BMI in all race and sex groups
after
the degree
of physical
activity
was adjusted
for. As a percentage
of kilojoules
(kilocalories),
fat was not associated
with body fat
or its distribution.
Physical
activity,
especially
intense
activity,
was
inversely
women)
associated
and
with
skinfold
amount
with
for men,
(except
measurements
consumption
which
may
among
have
groups
associated
had larger
than
did
In addition
amined
suprailiac
(23),
although
was
associations
associated
consumption
with
or exsmokers.
to WHCR,
the distribution
of body
fat was
different
when
examining
physical
been
associations
activity
estimated
between
and cigarette
that
heredity
with skinfold
body-fat
distribution
women
(26,
fat
without
this
fat pattern
27).
accounts
for
20-3
1% of
the variability
in WHCRs
(7, 25). In the present
study
2628% of the variability
in WHCR
was explained
by age, educational
status,
BMI, total activity,
carbohydrate
intake,
smoking
status,
men,
and alcohol
intake
in all race-sex
groups
except
white
for whom
36% of the variability
was explained
by these
variables.
contributed
by BMI.
WHCR,
The
largest
proportion
of the
variability
in WHCR
by the variables
examined
in this study was explained
Thus,
although
protein
intake
was not associated
with
it was consistently
associated
with
BMI and could
therefore
tivity did
influence
WHCR.
Although
not change
the significance
the degree
between
percentage
environmental
variables
and
ofthe
variability
in WHCR
ofassociations
of physical
that
ac-
existed
WHCR,
a much
larger
was explained
by dietary
may
and sex
may be
be explained
exists.
A previous
respond
tend
(26).
that
to
body fat
also have
differences
the
here,
the influence
between
lowest
white
women
WHCR
The
were
also
an
well
fat
with
more
do
those
than
with
fat (as
abdominal-
as reduce
blood
that intense
physical
activity
in white women,
the group
WHCR.
ofphysical
no differences
people
differently
body
men
abdominal
and increase
lean body
mass with
individuals
without
this fat pattern
effects with an exercise
training
pro-
pressure)
whereas
the same
mean
that
Individuals
gram.
Results
of this study reveal
was not associated
with the WHCR
with
and
more
shown
exercise
pattern.
Women
having
have
to decrease
but
suggested
been
men
Studies
body-fat
In other
activity
above
analyses,
on WHCR
and
in associations
below
the
between
not
shown
was compared
median
physical
WHCR,
activity
and
observed.
associations
of body-fat
indicators
with
dietary
intake
also differed
between
race and sex groups.
Although
the examination
of dietary
intake
in this study
was more
detailed
than
what has generally
been reported,
the data presented
can only
crudely
describe
individual
dietary
intake.
Because
individuals
eat foods and not nutrients
in isolation,
a composite
value for
intake
of fat or for any nutrient
may be the same for individuals
(in grams consumed),
but may be obtained
from entirely
different
take
and
food
its associations
endpoints
can
patterns
expressed
In this population
smoking.
they
sex groups
factors
with
disease
than
skinfold
to these
also found
with WHCR
triceps
exposures
nutrients,
which
on the endpoint.
associations
to the
that
and
It has
in fat distribution,
Different
stronger
subscapular
to the
fat index
race
(26).
ofother
nutrient
It has
of the
to exist
sources.
and both
ratio
ex-
the possibility
it is
active,
in findings
across
all race
that statistical
associations
between
thicknesses
(24). None ofthe
associations
between
these skinfold
ratios and dietary
intake,
physical
activity,
alcohol,
or smoking
were consistent
across
the race and sex groups.
Selby et al (7)
ratios
the
WHCR
were not
Current
cigrace and sex
and
much
difficult
with WHCR
as was beer.
WHCRs
in most of the
nonsmokers
white
consumed
also
in men although
women
made
to identify.
Beer was the source ofalcohol
in all race-sex
groups.
Wine and liquor
as consistently
arette
smokers
among
in all groups
of alcohol
less than
WHCR
although
physically
on WHCR.
abdominal
examination
and
occurred,
become
more
less of an impact
physical
sources
to differences
contribute
may modify
the effects
A better
understanding
with
only
anthropometric,
be made
physiological,
by a description
as combinations
of foods
of young
adults,
both
physical
activity
were
that the
physical
energy-yielding
activity
differ
related
to body
components
in their effects
in intake
ofthe
primary
of dietary
in-
size,
and
of dietary
consumed.
energy
intake
although
and
it appears
bution.
Several
studies
suggested
that dietary
composition
may
affect adiposity
independent
ofcalories(29,
30). In healthy
adult
men it has been shown
that individuals
who consume
a highfat diet have
who consume
a higher
percentage
ofbody
isocaloric
diets containing
few population-based
studies
position
and
activity
Findings
by Laws
physical
Bernardo,
the percentage
versely
associated
with
have
examined
together
both
in relation
those
white
dietary
com-
to body
size.
recently
reported
adults
in Rancho
of calories
from carbohydrate
WHCR
among
men. In addition,
was ingrams
in body
explained
than
fat and
differences
and
extremity
fat than whites,
but whites
had more
total
than did blacks
(26). Sex differences
in fat distribution
differ
of young
However,
smoking,
ofblacks,
in which
skinfold-measurement
them to have a higher
proportion
been
age, education,
total energy intake. total physical activity, cigarettesmoking
status, and alcohol intake in the regression
on WHCR.
Analyses for low
and high degrees
of physical activity are < median
and
median degree
of PA.
BMI is not included as a covariate
in model 2.
these
lack of consistency
raises the possibility
by real differences
t Includes
body
why
cigarette
that as individuals
activity
itself had
The
groups
models.
education,
ET
BODY
ofalcohol
per day
consumed
per week and number
were significantly
associated
with
women.
Exercising
less than
three
FAT
AND
ofcigarettes
smoked
WHCR
in men and
times
a week
was
The
finding
that
do nonsmokers
is consistent
current
was
studies
have
of
the
studies
examined
study ofSwedish
relations
with
was
larger
14.
source
idemiol
for black
men)
16. Hilner
dietary
and
ofalcohol
consumed.
with
WHCR
composition,
may
the
findings
alcohol,
be associated
the distribution
needed
to verify
from
physical
with
a better
differences
volved.
observed
the
and
in white
physiological
basis
that
smoking
body
body.
Additional
identified
in this
of the
of the
suggest
of total
understanding
and
study
activity,
the amount
of fat within
the associations
to provide
this
dietary
for race
and
mechanisms
tivity.
Am
J Epidemiol
20.
sex
in-
21.
1984;
120:900-
H, Muller
DC,
Reubin
distribution
L, Slattery
and
implementation.
ML, Jacobs
validity
Jacobs
ofthe
McDonald
DR
Jr.
CARDIA
A, Van
Hahn
ofa
dietary
Horn
L, Haskell
short
Heart
physical
Health
Am
J Ep-
control
for
history.
L, et al. Quality
WL,
Pirie
activity
Program.
activities.
S. Validity and
P. Sidney
history:
CARDIA
and
J Cardiopulmonary
the
Rehab
Mm-
l989;9:
Schucker
JB, Knudsen
J, Leon AS,
for the assessment
of leisure time
J Chronic
Dis
I 978;3
1:741-55.
Comparison
of two
methods
ofassessing
physical activity in the CARDIA
Study. Am J
Epidemiol 1991;133:l231-45.
Hofstetter A, Schutz Y, Jequier E, Wahren J. Increased 24-hour energy
Sidney
5, Jacobs
DR
Jr.
in cigarette
tribution.
Haskell
WL,
smokers.
Ct al.
N EngI
J Med
Acts
Med
The
Suppl
l986;3l:79-82.
27.
in the regulation
with
1989:49:958-61.
exercise.
changes
l988;723:l35-4l.
28.
WH.
Scand
Mueller
Am
J Clin
Krotkiewski
M, Bjorntorp
distribution
of adipose
1986;
10:33
with
Nutr
age
of the
P. Muscle
tissue
anatomical
tissue
effect
distribution
of energy
in obesity
of physical
balance
with
training.
different
Int
J Obes
1-4 1.
fat content
32.
and
Clin
Nutr
Laws
A, Terry
to-hip
fat
oxidation
on
energy
intake
in humans.
Am
l989;49:799-805.
ratio
RB,
Barrett-Connor
E. Behavioral
Bernardo.
in Rancho
of waistl990;80:l358-
covariates
Am J Public
Health
62.
33.
Seidell
JC,
Cigolini
M,
Deslypere
Study.
Am
JP, Charzewska
J, Ellsinger
in relation
to physical
activity
European
J Epidemiol
study
men:
BM,
and
the European
Fat
199 1 ;l33:257-66.
Ri,
Potter
with
JD, Gapstur
lifestyle
ofpostmenopausal
and
SM.
The
reproductive
Int J Obes
women.
1990; 14:583-91.
35.
of
collection
in a large epidemiologic
study. Controlled
Clin Trials
(in press).
Schakel SF, Sievert YA, Buzzard IM. Sources ofdata for developing
and maintaining
a nutrient
database.
J Am Diet Assoc
1988;88:
factors
in the
Horn
26.
1 1.
A. Studies
sub-
Kleinbaum
DO, Kupper
LL. Applied regression analysis and other
multivariable
methods.
North Scituate,
MA: Duxbury
Press, 1978.
23.
Hasstedt SJ, Ramirez
ME, Kuida
H, Williams
RR. Recessive
inheritance ofa relative fat pattern. Am J Hum Genet l989;45:9l7-25.
24.
Garn SM, Ryan AS, Robson iRK. Fatness-dependence
and utility of
the subscapular/triceps
ratio. Biology
Food Nutr 1982;12:
173-7.
25. Bouchard
C. Genetic factors in the regulation
ofadipose
tissue dis-
51.
Shimokata
study
examined
data
expenditure
ac-
of the
22.
34.
of physical
JE,
nesota
et al. CARDIA:
(in press).
reliability
are
and
1 . Donahue
RP, Abbott RD, Bloom E, Reed DM, Yano K. Central obesity
and coronary
heart disease in men. Lancet
1987;2:
821-4.
2. Ohlson
LO, Larsson
B, Svardsudd
K, Welin L, Eriksson
H, Wilhelmsen
L, Bjorntorp
P, Tibblin G. The influence
of body fat distribution
on the incidence
ofdiabetes
mellitus:
13.5 years of followup of the participants
in the study of men born in 1913. Diabetes
1985;34: 1055-8.
3. Blair D, Habicht
JP, Sims EA, Sylvester
D, Abraham
S. Evidence
for an increased
risk for hypertension
with centrally
located body
fat and the effect of race and sex on this risk. Am J Epidemiol
1984;l 19:526-40.
4. Selby JV, Friedman
GD, Quesenberry
CP. Precursors
of essential
hypertension:
the role of body fat distribution
pattern.
Am J Epidemiol
1989;129:45-53.
5. Andres
R. Effect of obesity
on total mortality.
Int J Obes 1980;4:
38 1-6.
6. Folsom AR, Burke GL, Ballew C, et al. Relation
of body fatness
and its distribution
to cardiovascular
risk factors in young blacks
and whites. The role of insulin. Am J Epidemiol
1989;l30:9l
1-24.
7. Selby JV, Newman
B, Quesenberry
CP Jr, et al. Genetic and behavioral
influences
on body fat distribution.
Int J Obes 1990;l4:
593-602.
8. Slattery ML, Bishop DT, French TK, Hunt SC, Meikle AW, Williams
HL. Dietary
A, Van
development
physical
References
Epidemiol
I988;5:277-87.
9. Sopko G, Jacobs DR. Taylor
RP,
characteristics
1268-71.
18.
behavior
fat as well as
studies
research
Donahue
some
448-59.
19. Taylor
HL, Jacobs DR Jr,
DeBacker
G. A questionnaire
13
17.
associated
GR,
and
comparative
than
alcohol
Cutter
1 104-12.
15. Liu K, Slattery
WHCRs
women.
In summary,
McDonald
history:
WHCRs
between
(27, 34-36).
GD,
recruitment,
Haffner
SM,
MP,
and
Non-Hispanic
Whites:
behavioral
36.
Stern
R. Upper body
Lapidus
and
Hazuda
distribution
study
in Gothenburg,
and
health
J, Patterson
in Mexican
to body
variables.
C, Hallstrom
Sweden.
Pugh
adiposity
relationship
demographic
L, Bengtsson
tissue
HP,
centralized
mass
lnt J Obes
T, Bjorntorp
in women-results
Appetite
JK,
Mailna
Americans
index
and
and
other
l986;10:493-502.
P. Obesity, adipose
from
1989:12:25-35.
a population
also
Friedman
design,
(1 1, 12, 34-36).
association
findings
with
(except
observations
inconsistent
13.
and
smokers
previous
yielded
liquor
associated
Previous
WHCR
during
sports
men.
949
DISTRIBUTION
positively
associated
with WHCRs
in men in the Rancho
Bernardo
study
(32). A recent study by Seidell et al (33) also showed
that physical
activity
performed
in 38-y-old
European
ITS