Accelerometer-Based Physical Activity, Sedentary Time, and BMI among Preschoolers in Puerto Rico.

OBJECTIVE: A minimum of 3-h/day of any intensity physical activity (PA) has been recommended for preschoolers. No previous study has documented accelerometer-based PA and sedentary time (ST) among Hispanic preschoolers in Puerto Rico, a population with high obesity and low PA prevalence. The purpose of this study was to describe and compare total, weekdays (during- and out-of-preschool) and weekend PA and ST, and test associations with body mass index (BMI). METHODS: A group of 3-5-year-old preschoolers (9 boys,13 girls) completed height and weight measurements, and wore an accelerometer during 7-days. Shapiro-Wilk, Mann-Whitney U test and Spearman correlations were used to test for normality, sex differences and associations, respectively. RESULTS: No sex differences were observed for BMI, weekdays and weekends PA and ST. Light to vigorous intensity PA (LVPA=3.2±0.6 h/day) and moderate to vigorous intensity PA (MVPA=80.4±21.7 min/day) were within guidelines only on weekdays. LVPA occupied 21.3% (15.4±3.7 min/h), MVPA 9.5% (6.6±2.3 min/h), and ST 65.3% (4.8±0.4 h/day) of preschool time. Boys had higher MVPA than girls only during-preschool time. BMI indicative of overweight-obesity was identified in 36.3%, and BMI directly correlated with total ST and inversely correlated with LVPA. CONCLUSION: Total and during-preschool LVPA and ST, and their association with BMI highlight the need for interventions to promote PA and reduce ST, particularly during-preschool time.

Development of the Anthropometric Grouping Index for the Eastern Caribbean Population Using the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study Data.

Improving public health initiative requires an accurate anthropometric index that is better suited to a specific community. In this study, the anthropometric grouping index is proposed as a more efficient and discriminatory alternative to the popular BMI for the Eastern Caribbean population. A completely distribution-free cluster analysis was performed to obtain the 11 categories, leading to AGI-11. Further, we studied these groups using novel non-parametric clustering summaries. Finally, two generalized linear mixed models were fitted to assess the association between elevated blood sugar, AGI-11 and BMI. Our results showed that AGI-11 tends to be more sensitive in predicting levels of elevated blood sugar compared to BMI. For instance, individuals identified as obese III according to BMI are (POR: 2.57; 95% CI: (1.68, 3.74)) more likely to have elevated blood sugar levels, while, according to AGI, individuals with similar characteristics are (POR: 3.73; 95% CI: (2.02, 6.86)) more likely to have elevated blood sugar levels. In conclusion, the findings of the current study suggest that AGI-11 could be used as a predictor of high blood sugar levels in this population group. Overall, higher values of anthropometric measures correlated with a higher likelihood of high blood sugar levels after adjusting by sex, age, and family history of diabetes.

Perinatal factors, female breast cancer, and associated risk factors in Puerto Rico: evidence from the Atabey epidemiology of breast cancer study.

PURPOSE: There is increasing evidence that exposures in utero and in infancy impact breast cancer risk. No previous studies have evaluated these associations among women in Puerto Rico. METHODS: In a population-based case-control study of breast cancer epidemiology in the San Juan metropolitan area in Puerto Rico, we examined the association of early life factors with breast cancer risk and breast cancer risk factors. Both cases (n = 315) and controls (n = 348) completed interviewer-administered questionnaires, including self-reported birth country, birthweight, and history of having been breastfed. Comparisons of characteristics of those with and without the early life factors were made with t-tests or chi-squared tests; associations between early life factors and breast cancer risk were estimated with unconditional logistic regression adjusting for age, education, body mass index (BMI), age at menarche, parity, and menopausal status. RESULTS: Women who had been breastfed tended to have higher adult body mass index (BMI), higher education, and lower parity (p < 0.05). Higher birthweight was associated with higher adult BMI and lower educational attainment (p < 0.05). Those born outside of Puerto Rico or the US were more likely to have higher educational attainment and earlier age at menarche than those born within Puerto Rico or the US (p < 0.05). We found no significant associations between any of the early life factors and breast cancer risk. CONCLUSION: We did not find evidence of an association of early life factors with breast cancer risk among women in Puerto Rico.

Sun Exposure Is Associated with Reduced Breast Cancer Risk among Women Living in the Caribbean: The Atabey Study in Puerto Rico.

BACKGROUND: Though inconsistent, there is evidence that sun exposure is associated with reduced breast cancer risk. Previous studies have been conducted in geographical regions with seasonal variation in UV radiation, including periods of low to no exposure, and among participants mostly of European descent. Puerto Rico has no significant seasonal fluctuation, with continuous exposure to very high UV radiation. METHODS: We conducted a population-based case-control study of breast cancer among women in metropolitan San Juan, Puerto Rico, examining a cumulative sun exposure index (SEI) based on a comparison of reflectance of sun-exposed and non-exposed skin. A chromameter was used to measure skin reflectance and estimate the difference between constitutive (unexposed) and facultative (exposed) skin pigmentation in 307 cases and 328 controls. Breast cancer risk factors were ascertained with interviewer-administered questionnaires. OR and 95% confidence intervals (CI) were estimated with unconditional logistic regression. RESULTS: Adjusted breast cancer odds were lower for the highest tertile of the SEI (ORadj = 0.47; 95% CI, 0.29-0.74). Results were similar within strata of estrogen receptor status. In analyses stratified by constitutive skin pigmentation, among participants with darker skin color, breast cancer risk was lower with more sun exposure (ORadj = 0.33; 95% CI, 0.16-0.70). CONCLUSIONS: We found lower risk of breast cancer associated with greater sun exposure in a population living with high, continuous sun exposure. This beneficial finding should be placed in the context of other effects of sun exposure. IMPACT: Sun exposure is a modifiable factor that may contribute, directly or indirectly, to lower breast cancer risk.

Brief Report: Effects of Low-Volume High-Intensity Interval Training in Hispanic HIV+ Women: A Nonrandomized Study.

BACKGROUND: Low cardiorespiratory fitness (CRF) is usually observed in people living with HIV. The effect of a low-volume high-intensity interval training (LV-HIIT) on CRF in HIV+ and HIV- Hispanic women was evaluated in this study. SETTING: A nonrandomized clinical trial with pre-test and post-test using a LV-HIIT intervention was conducted in the AIDS Clinical Trials Unit and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico Medical Sciences Campus. METHODS: Twenty-nine HIV+ and 13 HIV- Hispanic women recruited from community-based programs and clinics, and able to engage in daily physical activities, volunteered to participate. Of these, 20 HIV+ (69%) and 11 HIV- (85%) completed the study and were included in the analyses. LV-HIIT consisted of 6-week, 3 d/wk, 8-10 high-intensity and low-intensity intervals on a cycle ergometer at 80%-90% of heart rate reserve. Main outcome measures were CRF (defined as VO2peak), peak workload, and time to peak exercise. RESULTS: Average peak workload and time to peak exercise increased after training (P < 0.05) in both groups. However, average CRF was significantly higher after training only in the HIV- group. Gains in CRF were observed in 100% of HIV- and 50% of HIV+ women. This was not influenced by exercise testing, habitual physical activity, or anthropometric variables. CONCLUSIONS: Given the lack of change in CRF observed in the HIV+ group after LV-HIIT intervention, it is important to focus on variations that may occur within groups.

Breast Cancer in a Caribbean Population in Transition: Design and Implementation of the Atabey Population-Based Case-Control Study of Women in the San Juan Metropolitan Area in Puerto Rico.

Global breast cancer incidence varies considerably, particularly in comparisons of low- and high-income countries; rates may vary even within regions. Breast cancer rates for Caribbean countries are generally lower than for North America and Europe. Rates in Puerto Rico are in the middle of the range between the highest and the lowest Caribbean countries. Populations in transition, with greater variability in risk factor exposures, provide an important opportunity to better understand breast cancer etiology and as potential sources of variation in rates. Understanding of exposures across the life span can potentially contribute to understanding regional differences in rates. We describe here the design and implementation of a population-based, case-control study in the San Juan Metropolitan Area (SJMA) of Puerto Rico, the Atabey Epidemiology of Breast Cancer Study. We describe steps taken to ensure that the study was culturally appropriate, leveraging the Atabey researchers' understanding of the culture, local health system, and other required resources to effectively recruit participants. A standardized, in-person interview was developed, with attention to life course events customized to the study population. In order to understand variation in global breast cancer rates, studies customized to the populations outside of North America and Europe are required.

Sweating and core temperature in athletes training in continuous and intermittent sports in tropical climate / Sudoración y temperatura interna en atletas durante entrenamiento para deportes continuos e intermitentes en clima tropical

Higher sweat rate values have been reported during intermittent compared to continuous type exercise in hot conditions in the laboratory. Studies in the training field are scarce. Objective: Document sweat rate, rehydration and core temperature (Tc) during training in long duration-continuous (CON) and intermittent (INT ) type sports, and determine the presence of a mutation in the CFTR gene in athletes with high sodium concentration ([Na+]) in sweat.Methods: Athletes (CON =50 and INT=123) were tested during training in tropical climate. Sweat rate, sweat [Na+], Tc, de-hydration level, and presence of ∆ F508 gene mutation in the CFTR gene in athletes with high sweat [Na+] were evaluated. Results: Sweat rate was higher in CON (1.5 ± 0.4 L/h) compared to INT (1.2 ± 0.5 L/h) and CON athletes finished training with higher dehydration (2.1 ± 0.8 vs 1.2 ± 0.7%) P < 0.05. Sweat [Na+] was higher in INT (62.0 ± 21.1 mmol/L) compared to CON (53.9 ± 18.1 mmol/L), P < 0.05. A tennis player with high [Na+] was heterozygous for the ΔF508 mutation. Average and highest Tc was similar for CON (38.4 ± 0.3 and 38.8 ± 0.4 oC) and INT (38.3 ± 0.3 and 38.7 ± 0.4 oC), P > 0.05. Conclusion: During training in a tropical climate, sweat loss and dehydration level are lower, and fluid intake is higher in intermittent compared to continuous type sports. Core temperature may rise to a similar level in intermittent type sports due to the repeated high intensity bouts and/or the effects of clothing worn while training in hot venues. Healthy athletes with high [Na+] in sweat who are heterozygous carriers of CFTR mutations may be at increased risk for hyponatremic dehydration and whole-body muscle cramps

Se reportan tasas de sudoración más altas durante ejercicio intermitente comparado con continuo en condiciones de calor en el laboratorio. Estudios en el campo de entrenamiento son escasos. Objetivo: Documentar la tasa de sudoración, rehidratación y temperatura central (Tc) durante entrenamiento para deportes de tipo continuo (CON) e intermitente (INT ), y determinar presencia de mutación genética en el gen CFTR en atletas con alta concentración de sodio ([Na+]) en sudor.Metodología: Se evaluó la tasa de sudoración, la [Na+] en sudor, la Tc, y el nivel de deshidratación en atletas (CON = 50; INT =123) durante entrenamiento en clima tropical, y la presencia de la mutación genética ∆F508 en el gen CFTR en aquellos con alta [Na+] en sudor.Resultados: La tasa de sudoración fue mayor en CON (1,5 ± 0,4 L/h) comparado con INT (1,2 ± 0,5 L/h) y los atletas en CON terminaron el entrenamiento con mayor deshidratación (2,1 ± 0,8 vs 1,2 ± 0,7%) P < 0,05. La [Na+] en sudor fue más alta en INT (62,0 ± 21,1 mmol/L) comparado con CON (53,9 ± 18,1 mmol/L), P < 0,05. Un tenista con alta [Na+] era heterocigoto para la mutación ΔF508. La Tc promedio y más alta fueron similares para CON (38,4 ± 0,3 y 38,8 ± 0,4 oC) e INT (38,3 ± 0,3 y 38,7 ± 0,4 oC), P > 0,05. Conclusión: Durante el entrenamiento en clima tropical, la pérdida de sudor y el nivel de deshidratación son más bajos, y la ingesta de líquido es más alta en deportes intermitentes que en deportes continuos. La temperatura interna puede aumentar a nivel similar en deportes intermitentes debido a periodos repetidos de alta intensidad y/o la vestimenta usada durante el entrenamiento. Atletas saludables con alta [Na+] en sudor que son heterocigóticos para mutaciones de CFTR pueden estar en mayor riesgo de deshidratación hiponatrémica y calambres musculares

Foods Contributing to Macronutrient Intake of Women Living in Puerto Rico Reflect Both Traditional Puerto Rican and Western-Type Diets.

Lack of variability in dietary intake within a population makes identification of relationships between diet and disease difficult. Studies in populations with greater interindividual variation can provide important insights. The Puerto Rican diet is in transition from a traditional to a more Western-type diet, resulting in greater interindividual variability. We identified foods contributing to absolute intake and variability in the intake of macronutrients among Puerto Rican women. One hundred women, aged 30⁻79, residents of San Juan, Puerto Rico, completed three, interviewer-administered, 24-h dietary recalls from which foods contributing to absolute intake and intake variability in intake of energy, fat, protein, carbohydrate and dietary fiber were determined. The overall prevalence of intake of foods was also calculated. Traditional Puerto Rican foods such as legumes, rice, and plantains were important contributors to the intake of calories and macronutrients as were foods more typical of Western diets including white bread and sweetened carbonated beverages. Identification of food sources of nutrients for this population with a diet in transition can contribute to the development of instruments to measure dietary intake and to understand the contribution of diet to the etiology of chronic disease among Puerto Rican women.

Self-reported and objective physical activity in postgastric bypass surgery, obese and lean adults: association with body composition and cardiorespiratory fitness.

BACKGROUND: This study aimed to 1) describe physical activity (PA) in 15 post gastric bypass surgery (GB), 16 obese (Ob), and 14 lean (L) participants (mean ± se: age = 37.1 ± 1.6, 30.8 ± 1.9, 32.7 ± 2.3 yrs.; BMI = 29.7 ± 1.2, 38.2 ± 0.8, 22.9 ± 0.5 kg/m2, respectively); and 2) test associations between PA, body composition, and cardiorespiratory fitness (VO2max). METHODS: Participants completed a PA questionnaire after wearing accelerometers from 5-7 days. Body composition was determined with DEXA and CT scans, and VO2max with open circuit spirometry. ANOVA was used to detect differences between groups, and linear regressions to evaluate associations between PA (self-reported, accelerometer), body composition, and VO2max. RESULTS: Self-reported moderate to vigorous PA (MVPA) in GB, Ob, and L participants was 497.7 ± 215.9, 988.6 ± 230.8, and 770.7 ± 249.3 min/week, respectively (P = .51); accelerometer MVPA was 185.9 ± 41.7, 132.3 ± 51.1, and 322.2 ± 51.1 min/week, respectively (P = .03); and steps/day were 6647 ± 141, 6603 ± 377, and 9591 ± 377, respectively (P = .03). Ob showed a marginally higher difference between self-report and accelerometer MVPA (P = .06). Accelerometer-MVPA and steps/day were inversely associated with percent fat (r = -0.53, -0.46), and abdominal fat (r = -0.36, -0.40), and directly associated with VO2max (r = .36). CONCLUSIONS: PA was similar between GB and Ob participants, and both were less active than L. Higher MVPA was associated with higher VO2max and lower body fat.

Assessing arsenic exposure from consumption of seafood from Vieques-Puerto Rico: a pilot biomonitoring study using different biomarkers.

The various toxic effects associated with inorganic arsenic (iAs) warrants that exposure sources be identified. This pilot study evaluated if greater seafood consumption from Vieques-Puerto Rico is associated with increased exposure to iAs. Nail, hair, and urine samples were used as biomarkers of iAs exposure in adult women and men from Vieques classified as high (n = 31) and low (n = 21) seafood consumers, who reported eating fish and/or shellfish ≥1 time per week and once per month or less, respectively. The sum of urinary iAs (As III + As V), monomethylarsonic acid (MA[V]), and dimethylarsinic acid (DMA[V]), denoted as SumAs, fluctuated from 3.3 µg/g Cr (1.2 µg/L) to 42.7 µg/g Cr (42 µg/L) (n = 52). Levels of As in nail samples (n = 49) varied from 0.04 to 0.82 µg/g dry weight (dw), whereas in hair (n = 49) As was only detected in 49 % of the samples with a maximum value of 0.95 µg/g dw. None of the biomarkers of exposure to As exceeded exposure reference values for urine (50 µg/g Cr or 50 µg/L), nails (1 µg/g), or hair (1 µg/g). However, median (10.0 µg/g Cr; 10.6 µg/L) and 95th percentile (31.9 µg/g Cr; 40.4 µg/L) of urinary SumAs were higher in Vieques samples than in the those from the general population of other countries. Among the three biomarkers of exposure, nail samples reflected better the exposure to iAs from seafood consumption with significantly higher average As concentrations in high (0.24 µg/g) than low (0.12 µg/g) seafood consumers. Multivariate results for As in nail samples (R(2) = 0.55, p < 0.0001) showed a positive association with fish consumption, particularly for men, with levels increasing with years of residency in Vieques.

Metabolic syndrome in relation to cardiorespiratory fitness, active and sedentary behavior in HIV+ Hispanics with and without lipodystrophy.

OBJECTIVE: Hispanics in Puerto Rico (PR) have a high prevalence of metabolic syndrome (met-syn), partially explained by low physical activity (PA) and possibly low cardiorespiratory fitness (VO2peak). Met-syn is also associated with lipodystrophy in HIV infected (HIV+) adults taking antiretroviral therapies. However, associations between met-syn, VO2peak, PA, sedentary behavior and lipodystrophy among HIV+ Hispanics have not been adequately reported. We tested the following hypotheses: 1) HIV+ Hispanics with lipodystrophy (HIV-Lipo) would have a higher prevalence of met-syn, lower VO2peak and PA, and higher sedentary behavior compared with those without lipodystrophy (HIV-no-Lipo) and without HIV infection (Non-HIV); and 2) met-syn would be inversely associated with VO2peak and PA, and directly associated with sedentary behavior. METHODS: Ninety Hispanic adults (32 HIV-Lipo, 28 HIV-no-Lipo, 30 Non-HIV) completed measurements of VO2,peak, anthropometry, PA and sedentary behavior with accelerometry, blood pressure, fasting glucose, insulin, and lipids. ANOVA and chi-square tests were used to detect differences between groups, and regression analyses to test associations between variables. RESULTS: More HIV-Lipo (69%) had met-syn compared with HIV-no-Lipo (39%) and Non-HIV (37%) (P = 0.002). Sedentary behavior and PA were not different, but VO2peak differed between all groups: lowest in HIV-Lipo and highest in non-HIV. PA and sedentary behavior were not associated with met-syn, but PA was directly associated with VO2peak (R2 = 0.26, p < 0.01). Also, a lower odds ratio for met-syn was observed with higher VO2peak (0.87; 95% CI: 0.83-0.95). CONCLUSION: Met-syn is related to lipodystrophy in HIV+ Hispanics in PR, and high VO2peak may protect against met-syn in this population.

Predicted vs. Actual Resting Energy Expenditure and Activity Coefficients: Post-Gastric Bypass, Lean and Obese Women.

Total Energy Expenditure (TEE) and energy requirements are commonly estimated from equations predicting Resting Energy Expenditure (REE) multiplied by a Physical Activity (PA) coefficient that accounts for both PA energy expenditure and the thermogenic effect of food. PA coefficients based on PA self-reports are a potential source of error that has not been evaluated. Therefore, in this study we compared: 1) the Harris-Benedict (HB), Mifflin-St. Jeor (MSJ), and the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) REE equations with REE measured (REE-m) with indirect calorimetry; 2) PA coefficients determined with PA self-reports vs. objectively assessed PA; and 3) TEE estimates in post-Gastric Bypass (GB = 13), lean (LE = 7), and obese (OB = 12) women. REE was measured in the morning after an overnight fast with participants resting supine for 30 min. Self-reported PA was evaluated with a questionnaire and objectively measured with accelerometers worn for 5-7 days. Nutritional intake was evaluated with a food frequency questionnaire. Anthropometry included DEXA, and abdominal CT scans. Eligible GB had surgery ≥ 12 months before the study, and had ≥ 10 kg of body weight loss. All participants were 18-45 years of age, able to engage in ambulatory activities, and not taking part in exercise training programs. One-way ANOVA was used to detect differences in REE and TEE. Accuracy of REE prediction equations were determined by cases within 10% of REE-m, and agreement analyses. REE predictions were not different than REE-m, but agreements were better with HB and MSJ, particularly in the GB and LE groups. Discrepancies in the PA coefficients determined with self-report vs. objectively assessed PA resulted in TEE overestimates (approximately 200-300 Kcal/day) using HB and MSJ equations. FAO/WHO/UNU overestimated TEE in all groups regardless of the PA assessment method (approximately 300-900 kcal/day). These results suggest that: 1) HB and MSJ equations are good predictors of REE among GB and LE, but not among OB women, 2) PA coefficients used to estimate TEE must be determined with objective PA assessment, and 3) TEE estimates using PA coefficients with the FAO/WHO/UNU equation must be used with caution.

Transport and health: a look at three Latin American cities.

Transport is associated with environmental problems, economic losses, health and social inequalities. A number of European and US cities have implemented initiatives to promote multimodal modes of transport. In Latin America changes are occurring in public transport systems and a number of projects aimed at stimulating non-motorized modes of transport (walking and cycling) have already been implemented. Based on articles from peer-reviewed academic journals, this paper examines experiences in Bogotá (Colombia), Curitiba (Brazil), and Santiago (Chile), and identifies how changes to the transport system contribute to encourage active transportation. Bus rapid transit, ciclovias, bike paths/lanes, and car use restriction are initiatives that contribute to promoting active transportation in these cities. Few studies have been carried out on the relationship between transport and physical activity. Car ownership continues to increase. The public health sector needs to be a stronger activist in the transport policy decision-making process to incorporate health issues into the transport agenda in Latin America.

Transport and health: a look at three Latin American cities / Transporte y salud: una mirada a tres ciudades latinoamericanas / Transporte e saúde: um olhar sobre três cidades latino-americanas

Transport is associated with environmental problems, economic losses, health and social inequalities. A number of European and US cities have implemented initiatives to promote multimodal modes of transport. In Latin America changes are occurring in public transport systems and a number of projects aimed at stimulating non-motorized modes of transport (walking and cycling) have already been implemented. Based on articles from peer-reviewed academic journals, this paper examines experiences in Bogotá (Colombia), Curitiba (Brazil), and Santiago (Chile), and identifies how changes to the transport system contribute to encourage active transportation. Bus rapid transit, ciclovias, bike paths/lanes, and car use restriction are initiatives that contribute to promoting active transportation in these cities. Few studies have been carried out on the relationship between transport and physical activity. Car ownership continues to increase. The public health sector needs to be a stronger activist in the transport policy decision-making process to incorporate health issues into the transport agenda in Latin America.

El transporte está asociado con problemas ambientales, pérdidas económicas, salud poblacional e inequidades sociales. En ciudades de Europa y Estados Unidos hay iniciativas para promover el transporte multimodal. En Latinoamérica hay proyectos en curso para cambiar los sistemas de transporte y estimular el transporte no motorizado (caminar y montar bicicleta). Basada en una revisión de artículos publicados en revistas académicas, se identifica de qué forma los cambios en el transporte en Bogotá (Colombia), Curitiba (Brasil) y Santiago (Chile) han contribuido a promover el transporte activo. A pesar que en estas tres ciudades se están implementando iniciativas para promover el transporte activo (sistema de autobuses articulados, ciclovías, ciclorutas, y restricciones para el uso del coche particular), pocos estudios han sido desarrollados sobre la relación entre el transporte y la actividad física utilitaria. La tenencia del coche particular continúa incrementándose. El sector de salud necesita ser un agente fuerte para incorporar la salud pública en la agenda de transporte en América Latina.

O transporte está associado a problemas ambientais, perdas econômicas, de saúde da população e as desigualdades sociais. Em cidades da Europa e da América existem esforços para promover o transporte multimodal. Na América Latina, há projetos em andamento para mudar os sistemas de transporte e incentivar o transporte não motorizado (caminhar e andar de bicicleta). Com base em uma revisão de artigos publicados em revistas acadêmicas identificou-se como as mudanças no transporte contribuíram para promover o transporte ativo em Bogotá (Colômbia), Curitiba (Brasil) e Santiago (Chile). Apesar de que nestas três cidades se estejam implementando iniciativas para promover o transporte ativo (sistema de ônibus articulado, ciclovias, pistas de ciclismo e restrições ao uso do automóvel particular), poucos estudos têm sido desenvolvidos sobre a relação entre transporte e atividade física utilitária. O uso de carro particular continua aumentando. O setor da saúde tem de ser um ativista forte para incorporar a saúde pública na agenda de transportes na América Latina.

How many steps/day are enough? For older adults and special populations.

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

Predicting resting energy expenditure in healthy Puerto Rican adults.

Equations to predict resting energy expenditure (REE) can be influenced by cultural and climatic factors. The purpose of this cross-sectional study was to evaluate the validity of the Harris-Benedict and Mifflin-St Jeor equations to predict REE in 48 healthy Puerto Rican adults (23 men, 25 women; aged 21 to 60 years, tested between January and March 2007) using indirect calorimetry as the criterion method for comparison. Weight, height, and skinfold thickness were measured. One-way analysis of variance was used to determine differences between the REE measured and predicted with the two equations, and independent t tests were used to detect differences between men and women. Linear and multiple regressions were conducted to determine relationships between the measured and predicted REE and to evaluate factors influencing REE. The REE predicted with Harris-Benedict and Mifflin-St Jeor were not statistically different from the REE measured with indirect calorimetry (mean±standard deviation: 1,555±268, 1,500±285, and 1,633±299 kcal/day, respectively; P=0.08). There was a strong correlation between the REE measured and predicted with Harris-Benedict and Mifflin-St Jeor (r=0.83, 0.87, respectively; P=0.0001). Mean REE was higher in men compared to women, and fat-free mass was the most influencing factor on REE. The Harris-Benedict and Mifflin-St Jeor are both valid equations for the prediction of REE in healthy Puerto Rican adults living in a tropical climate such as Puerto Rico. Both equations are appropriate for dietetics practitioners to use in assessing energy requirements in this population.

Risk of cancer among Hispanics with AIDS compared with the general population in Puerto Rico: 1987-2003.

BACKGROUND: The risk of cancer among Hispanics with Acquired Immune Deficiency Syndrome (AIDS) in the United States and Puerto Rico (PR) has not been well described. The purpose of this study was to determine the risk of AIDS related and non-AIDS related cancers among Hispanics with AIDS in PR. METHODS: A probabilistic record linkage of the PR AIDS Surveillance Program and PR Central Cancer Registry databases was conducted. AIDS cases were grouped according to year of AIDS onset and antiretroviral therapy availability: 1987-1989 (limited availability), 1990-1995 (mono and dual therapy), and 1996-2003 (highly active antiretroviral therapy: HAART). Cancer risk was described using the standardized incidence ratios (SIR). RESULTS: A total of 612 cancers were identified after 3 months of AIDS diagnosis: 409 (66.7%) AIDS related and 203 (33.1%) non-AIDS related. Although a decreasing trend in the risk of AIDS and non-AIDS related cancers was observed, the risk for both remained higher in the AIDS group compared to the general population in PR. Non-AIDS related cancers with higher risk during the HAART availability were: oropharyngeal, anal, liver, larynx, eye and orbit, Hodgkin lymphoma, and vaginal. CONCLUSION: Hispanics with AIDS in PR consistently showed a greater risk of AIDS and non-AIDS related cancers compared to the general population in PR and that has not changed over time.

Prevalence of cardiometabolic risk factors in Hispanics living with HIV.

OBJECTIVE: Human immunodeficiency virus (HIV) infection and antiretroviral treatment are associated with metabolic and cardiovascular complications that resemble metabolic syndrome (MetS) and potentially increase the risk of diabetes and cardiovascular disease in this population. The purpose of this study was to determine the prevalence of MetS and its individual components among Hispanics living with HIV in Puerto Rico. METHODS: Data from 909 clinical records were extracted and the prevalence of MetS determined using the NCEP-ATPIII criteria. Fisher's exact test was used to detect sex differences, and logistic regression to examine the effect of age, sex, smoking, years of HIV infection, antiretroviral therapy, and Hepatitis C coinfection. RESULTS: The prevalence of MetS in our study group (35.4%) was higher than previously reported in the United States, but not higher than in the general population in Puerto Rico. Females had a higher prevalence of MetS (44.2%) than males (30.5%); mostly explained by high body mass index and waist circumference. Age and sex were associated with the presence of MetS. CONCLUSION: Understanding ethnic and sex differences in the prevalence of metabolic risk factors is essential for the implementation of specific targeted interventions to prevent subsequent vascular morbidity and mortality in this population.

Cardiovascular dynamics in healthy subjects with differing heart rate responses to tilt.

Orthostatic stress such as head-up tilt (HUT) elicits a wide range of heart rate (HR) and arterial pressure (AP) responses among healthy individuals. In this study, we evaluated cardiovascular dynamics in healthy subjects with different HR responses to HUT, but without autonomic dysfunction. We measured AP (brachial artery) and HR (ECG) during 5 min of 60 degrees HUT in 76 healthy normotensive individuals. We then chose individuals on the basis of the extremes of HR responses to HUT (high = DeltaHR > or = 20 beats/min, and low = DeltaHR < or = 10 beats/min; n = 15 per group). Peak HR during HUT was 87 +/- 10 beats/min in the high and 69 +/- 14 beats/min in the low group (P < 0.05). High HR responders had lower systolic pressure at baseline (121 +/- 9 vs. 129 +/- 11 mmHg, P < 0.05) and during HUT (120 +/- 10 vs. 131 +/- 13 mmHg, P < 0.05), and higher plasma norepinephrine (NE) response to HUT (DeltaNE: 156.9 +/- 17.8 vs. 89.0 +/- 17.2 pg/ml; P < 0.05). DeltaNE during HUT was also significantly correlated with DeltaHR when all 76 subjects were included in a regression analysis (r = 0.39; P < 0.001). Pulse pressure was lower during HUT in high HR responders compared with low HR responders (45 +/- 1 vs. 55 +/- 2 mmHg, P < 0.05). High HR responders also had larger fluctuations in systolic and pulse pressure during HUT (coefficient of variation = 10.7 +/- 0.7 vs. 5.7 +/- 0.3%; 7.9 +/- 0.5 vs. 4.1 +/- 0.4%, respectively, P < 0.05). Sex distribution was different between groups (high: 5 women, 10 men; low: 10 women, 5 men). Higher HR with lower AP during HUT is consistent with normal baroreflex mechanisms of integration. Although interindividual variability appears to be a fundamental part of cardiovascular regulation, the mechanisms of these differences and the sex discrepancy requires further investigation.

Self-reported physical activity in Hispanic adults living with HIV: comparison with accelerometer and pedometer.

Limited information is available regarding physical activity (PA) and its assessment in Hispanics living with HIV. This study compared self-reported PA using the International Physical Activity Questionnaire (IPAQ) with objectively measured PA using the ActiGraph accelerometer and DigiWalker pedometer in 58 Hispanic adults with HIV. IPAQ was administered before and after a 7-day period in which subjects wore the ActiGraph and DigiWalker. PA classification was based on > or = 150 min/wk (IPAQ, ActiGraph) and > or = 10,000 steps/day (DigiWalker). IPAQ-PA was higher than ActiGraph-PA (423 +/- 298 vs. 165 +/- 134 min/wk, respectively) (p < .01). There was a mismatch in PA classification with the IPAQ, ActiGraph, and DigiWalker (active = 81%, 54%, and 17%, respectively). Hispanics with HIV highly overestimated self-reported PA. Nurse scientists and other investigators must consider accelerometers or pedometers to assess PA in this population.