OpenUCT :: Browsing by Author "Lambert, Estelle V"

Browsing by Author "Lambert, Estelle V"

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Open Access
A mixed ecologic-cohort comparison of physical activity & weight among young adults from five populations of African origin
(2014-04-24) Luke, Amy; Bovet, Pascal; Plange-Rhule, Jacob; Forrester, Terrence E; Lambert, Estelle V; Schoeller, Dale A; Dugas, Lara R; Durazo-Arvizu, Ramon A; Shoham, David A; Cao, Guichan; Brage, Soren; Ekelund, Ulf; Cooper, Richard S
Abstract Background Examination of patterns and intensity of physical activity (PA) across cultures where obesity prevalence varies widely provides insight into one aspect of the ongoing epidemiologic transition. The primary hypothesis being addressed is whether low levels of PA are associated with excess weight and adiposity. Methods We recruited young adults from five countries (500 per country, 2500 total, ages 25–45 years), spanning the range of obesity prevalence. Men and women were recruited from a suburb of Chicago, Illinois, USA; urban Jamaica; rural Ghana; peri-urban South Africa; and the Seychelles. PA was measured using accelerometry and expressed as minutes per day of moderate-to-vigorous activity or sedentary behavior. Results Obesity (BMI ≥ 30) prevalence ranged from 1.4% (Ghanaian men) to 63.8% (US women). South African men were the most active, followed by Ghanaian men. Relatively small differences were observed across sites among women; however, women in Ghana accumulated the most activity. Within site-gender sub-groups, the correlation of activity with BMI and other measures of adiposity was inconsistent; the combined correlation across sites was -0.17 for men and -0.11 for women. In the ecological analysis time spent in moderate-to-vigorous activity was inversely associated with BMI (r = -0.71). Conclusion These analyses suggest that persons with greater adiposity tend to engage in less PA, although the associations are weak and the direction of causality cannot be inferred because measurements are cross-sectional. Longitudinal data will be required to elucidate direction of association.
Open Access
A model for presenting accelerometer paradata in large studies: ISCOLE
(2015-04-20) Tudor-Locke, Catrine; Mire, Emily F; Dentro, Kara N; Barreira, Tiago V; Schuna, John M; Zhao, Pei; Tremblay, Mark S; Standage, Martyn; Sarmiento, Olga L; Onywera, Vincent; Olds, Tim; Matsudo, Victor; Maia, José; Maher, Carol; Lambert, Estelle V; Kurpad, Anura; Kuriyan, Rebecca; Hu, Gang; Fogelholm, Mikael; Chaput, Jean-Philippe; Church, Timothy S; Katzmarzyk, Peter T
Abstract Background We present a model for reporting accelerometer paradata (process-related data produced from survey administration) collected in the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE), a multi-national investigation of >7000 children (averaging 10.5 years of age) sampled from 12 different developed and developing countries and five continents. Methods ISCOLE employed a 24-hr waist worn 7-day protocol using the ActiGraph GT3X+. Checklists, flow charts, and systematic data queries documented accelerometer paradata from enrollment to data collection and treatment. Paradata included counts of consented and eligible participants, accelerometers distributed for initial and additional monitoring (site specific decisions in the face of initial monitoring failure), inadequate data (e.g., lost/malfunction, insufficient wear time), and averages for waking wear time, valid days of data, participants with valid data (≥4 valid days of data, including 1 weekend day), and minutes with implausibly high values (≥20,000 activity counts/min). Results Of 7806 consented participants, 7372 were deemed eligible to participate, 7314 accelerometers were distributed for initial monitoring and another 106 for additional monitoring. 414 accelerometer data files were inadequate (primarily due to insufficient wear time). Only 29 accelerometers were lost during the implementation of ISCOLE worldwide. The final locked data file consisted of 6553 participant files (90.0% relative to number of participants who completed monitoring) with valid waking wear time, averaging 6.5 valid days and 888.4 minutes/day (14.8 hours). We documented 4762 minutes with implausibly high activity count values from 695 unique participants (9.4% of eligible participants and <0.01% of all minutes). Conclusions Detailed accelerometer paradata is useful for standardizing communication, facilitating study management, improving the representative qualities of surveys, tracking study endpoint attainment, comparing studies, and ultimately anticipating and controlling costs. Trial registration ClinicalTrials.gov: NCT01722500
Open Access
Are point-of-decision prompts in a sports sciece and medicine centre effective in changing the prevalence of stair usage? A preliminary study
(2009) Pillay, Julian D; Kolbe-Alexander, Tracy; Achmat, Masturah; Carstene, Madelaine; Lambert, Estelle V
Objective. To determine the impact of a signed intervention on promoting stair versus lift usage in a health and fitness facility. Design. A 3-week observational study in which a simple timeseries design of collecting data before, during and after the introduction of an intervention was used. Setting. The Sports Science Institute of South Africa (SSISA): a 5-storey building with a centrally located lift lobby and internal stairwell. Method. Observers were placed unobtrusively on the ground floor, with good visibility of lift/stairwell, to observe ascending movement of students, staff, tenants, visitors and patients 4 hours/day (07h00 - 09h00, 16h00 - 18h00), 4 days/week for 3 weeks. During week 2, motivational signs were displayed on the wall next to the lift and stairs and on the floor leading to the stairwell. In week 3, signage was removed. Factors considered in predicting stair use were gender, phase of intervention, and whether persons were staff/students or visitors. Results. A total of 4 256 person-counts were recorded. Prevalence of stair use increased from 43% before the intervention to 53% during the intervention to 50% after the intervention. Odds of using the stairs during the intervention increased by 45% (odds ratio (OR) 1.45, 95% confidence interval (CI) 1.25 - 1.68) (p<0.00001), were 41% higher for staff/students compared with visitors (p<0.00001) and were 55% greater for women (p<0.00001). These effects did not change significantly after the intervention and stair use remained modestly higher than before the intervention. Conclusion. Signed intervention produced significant increases in stair usage during and after the intervention. These findings support the effectiveness of point-of-decision prompts for changing behaviour, and highlight potential factors influencing the impact of such messages.
Open Access
Association between breakfast frequency and physical activity and sedentary time: a cross-sectional study in children from 12 countries
(BioMed Central, 2019-02-21) Zakrzewski-Fruer, Julia K; Gillison, Fiona B; Katzmarzyk, Peter T; Mire, Emily F; Broyles, Stephanie T; Champagne, Catherine M; Chaput, Jean-Philippe; Denstel, Kara D; Fogelholm, Mikael; Hu, Gang; Lambert, Estelle V; Maher, Carol; Maia, José; Olds, Tim; Onywera, Vincent; Sarmiento, Olga L; Tremblay, Mark S; Tudor-Locke, Catrine; Standage, Martyn
Background Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods This multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance. Trial registration The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).
Open Access
The association between daily steps and health, and the mediating role of body composition: a pedometer-based, cross-sectional study in an employed South African population
(BioMed Central, 2015-02-22) Pillay, Julian D; van der Ploeg, Hidde P; Kolbe-Alexander, Tracy L; Proper, Karin I; van Stralen, Maartje; Tomaz, Simone A; van Mechelen, Willem; Lambert, Estelle V
Background: Walking is recognized as an easily accessible mode of physical activity and is therefore supported as a strategy to promote health and well-being. To complement walking, pedometers have been identified as a useful tool for monitoring ambulatory physical activity, typically measuring total steps/day. There is, however, little information concerning dose-response for health outcomes in relation to intensity or duration of sustained steps. We aimed to examine this relationship, along with factors that mediate it, among employed adults. Methods: A convenience sample, recruited from work-site health risk screening (N = 312, 37 ± 9 yrs), wore a pedometer for at least three consecutive days. Steps were classified as “aerobic” (≥100 steps/minute and ≥10 consecutive minutes) or “non-aerobic” (<100 steps/minute and/or <10 consecutive minutes). The data were sub-grouped according to intensity-based categories i.e. “no aerobic activity”, “low aerobic activity” (1-20 minutes/day of aerobic activity) and “high aerobic activity” (≥21 minutes/day of aerobic activity), with the latter used as a proxy for current PA guidelines (150-minutes of moderate-intensity PA per week). Health outcomes included blood pressure, body mass index, percentage body fat, waist circumference, blood cholesterol and blood glucose. Analysis of covariance, adjusting for age, gender and total steps/day were used to compare groups according to volume and intensity-based steps categories. A further analysis compared the mediation effect of body fat estimates (percentage body fat, body mass index and waist circumference) on the association between steps and health outcomes, independently. Results: Average steps/day were 6,574 ± 3,541; total steps/day were inversely associated with most health outcomes in the expected direction (p < 0.05). The “no aerobic activity” group was significantly different from the “low aerobic activity” and “high aerobic activity” in percentage body fat and diastolic blood pressure only (P < 0.05). Percentage body fat emerged as the strongest mediator of the relationship between steps and outcomes, while body mass index showed the least mediation effect. Conclusion: The study provides a presentation of cross-sectional pedometer data that relate to a combination of intensity and volume-based steps/day and its relationship to current guidelines. The integration of volume, intensity and duration of ambulatory physical activity in pedometer-based messages is of emerging relevance.
Open Access
Association between perceived built environmental attributes and physical activity among adults in South Africa
(BioMed Central, 2017-02-20) Malambo, Pasmore; Kengne, Andre P; Lambert, Estelle V; De Villers, Anniza; Puoane, Thandi
Background: To investigate the association between perceived environmental attributes and leisure-time and transport-related physical activity. Methods: This was a cross-sectional survey involving 671 South Africans aged ≥35 years from urban and rural settings. International Physical Activity Questionnaire and Neighbourhood Walkability Scale were used to collect data. Multivariable logistic regressions were used to investigate the associations. Results: Significant urban vs. rural differences were apparent in the distribution of most attributes of neighborhood environment. After adjusting for gender, age, setting and relevant interaction terms, proximity to local stores was significantly associated with leisure-time physical activity (OR: 4.26; 95% CI, 1.00–18.08); while proximity to transit stops (2.44; 1.48–4.02), pleasant scenery (1.93; 1.07–3.46), sidewalks (2.36; 1.25–4.44), shade from trees (2.14; 1.19–3. 85), traffic (2.17; 91.21–3.91) and well-lit streets (2.01; 1.04–3.89) were significantly associated with walking for leisure. Four-way intersections (4.54; 1.54–13.43), pleasant scenery (3.84; 1.35–10.99), traffic (0.28; 0.09–0.89), sidewalks (3.75; 1.06-13.27) and crosswalks were associated with transport related physical activity. Proximity to transit stops (2.12; 1.17–3.84) and well maintained sidewalks (2.69; 2.20–10.02) were significantly associated with total physical activity. Significant interactions by setting were apparent in some of the associations. Conclusion: Some, but not all attributes of a neighborhood environment were significantly associated in expected directions with the three physical activity domains in this mixed urban and rural population. This study highlights the need for policy strategies aimed at improving or maintaining these perceived environmental attributes to promote physical activity.
Open Access
Association of car ownership and physical activity across the spectrum of human development: Modeling the Epidemiologic Transition Study (METS)
(BioMed Central, 2015-02-21) Shoham, David A; Dugas, Lara R; Bovet, Pascal; Forrester, Terrence E; Lambert, Estelle V; Plange-Rhule, Jacob; Schoeller, Dale A; Brage, Soren; Ekelund, Ulf; Durazo-Arvizu, Ramon A; Cooper, Richard S; Luke, Amy
Background: Variations in physical activity (PA) across nations may be driven by socioeconomic position. As national incomes increase, car ownership becomes within reach of more individuals. This report characterizes associations between car ownership and PA in African-origin populations across 5 sites at different levels of economic development and with different transportation infrastructures: US, Seychelles, Jamaica, South Africa, and Ghana. Methods: Twenty-five hundred adults, ages 25–45, were enrolled in the study. A total of 2,101 subjects had valid accelerometer-based PA measures (reported as average daily duration of moderate to vigorous PA, MVPA) and complete socioeconomic information. Our primary exposure of interest was whether the household owned a car. We adjusted for socioeconomic position using household income and ownership of common goods. Results: Overall, PA levels did not vary largely between sites, with highest levels in South Africa, lowest in the US. Across all sites, greater PA was consistently associated with male gender, fewer years of education, manual occupations, lower income, and owning fewer material goods. We found heterogeneity across sites in car ownership: after adjustment for confounders, car owners in the US had 24.3 fewer minutes of MVPA compared to non-car owners in the US (20.7 vs. 45.1 minutes/day of MVPA); in the non-US sites, car-owners had an average of 9.7 fewer minutes of MVPA than non-car owners (24.9 vs. 34.6 minutes/day of MVPA). Conclusions: PA levels are similar across all study sites except Jamaica, despite very different levels of socioeconomic development. Not owning a car in the US is associated with especially high levels of MVPA. As car ownership becomes prevalent in the developing world, strategies to promote alternative forms of active transit may become important.
Open Access
Cardiovascular risk status of Afro-origin populations across the spectrum of economic development: findings from the Modeling the Epidemiologic Transition Study
(BioMed Central, 2017-05-12) Dugas, Lara R; Forrester, Terrence E; Plange-Rhule, Jacob; Bovet, Pascal; Lambert, Estelle V; Durazo-Arvizu, Ramon A; Cao, Guichan; Cooper, Richard S; Khatib, Rasha; Tonino, Laura; Riesen, Walter; Korte, Wolfgang; Kliethermes, Stephanie; Luke, Amy
Background: Cardiovascular risk factors are increasing in most developing countries. To date, however, very little standardized data has been collected on the primary risk factors across the spectrum of economic development. Data are particularly sparse from Africa. Methods: In the Modeling the Epidemiologic Transition Study (METS) we examined population-based samples of men and women, ages 25–45 of African ancestry in metropolitan Chicago, Kingston, Jamaica, rural Ghana, Cape Town, South Africa, and the Seychelles. Key measures of cardiovascular disease risk are described. Results: The risk factor profile varied widely in both total summary estimates of cardiovascular risk and in the magnitude of component factors. Hypertension ranged from 7% in women from Ghana to 35% in US men. Total cholesterol was well under 200 mg/dl for all groups, with a mean of 155 mg/dl among men in Ghana, South Africa and Jamaica. Among women total cholesterol values varied relatively little by country, following between 160 and 178 mg/dl for all 5 groups. Levels of HDL-C were virtually identical in men and women from all study sites. Obesity ranged from 64% among women in the US to 2% among Ghanaian men, with a roughly corresponding trend in diabetes. Based on the Framingham risk score a clear trend toward higher total risk in association with socioeconomic development was observed among men, while among women there was considerable overlap, with the US participants having only a modestly higher risk score. Conclusions: These data provide a comprehensive estimate of cardiovascular risk across a range of countries at differing stages of social and economic development and demonstrate the heterogeneity in the character and degree of emerging cardiovascular risk. Severe hypercholesterolemia, as characteristic in the US and much of Western Europe at the onset of the coronary epidemic, is unlikely to be a feature of the cardiovascular risk profile in these countries in the foreseeable future, suggesting that stroke may remain the dominant cardiovascular event.
Open Access
“Choice Set” for health behavior in choice-constrained settings to frame research and inform policy: examples of food consumption, obesity and food security
(BioMed Central, 2016) Dover, Robert V H; Lambert, Estelle V
Objectives: Using the nexus between food consumption, food security and obesity, this paper addresses the complexity of health behavior decision-making moments that reflect relational social dynamics in context-specific dialogues, often in choice-constrained conditions. Methods: A pragmatic review of literature regarding social determinants of health in relation to food consumption, food security and obesity was used to advance this theoretical model. Results and discussion: We suggest that health choice, such as food consumption, is based on more than the capacity and volition of individuals to make “healthy” choices, but is dialogic and adaptive. In terms of food consumption, there will always be choice-constrained conditions, along a continuum representing factors over which the individual has little or no control, to those for which they have greater agency. These range from food store geographies and inventories and food availability, logistical considerations such as transportation, food distribution, the structure of equity in food systems, state and non-government food and nutrition programs, to factors where the individual exercises a greater degree of autonomy, such as sociocultural foodways, family and neighborhood shopping strategies, and personal and family food preferences. At any given food decision-making moment, many factors of the continuum are present consciously or unconsciously when the individual makes a decision. These health behavior decision-making moments are mutable, whether from an individual perspective, or within a broader social or policy context. We review the construct of “choice set”, the confluence of factors that are temporally weighted by the differentiated and relationally-contextualized importance of certain factors over others in that moment. The choice transition represents an essential shift of the choice set based on the conscious and unconscious weighting of accumulated evidence, such that people can project certain outcomes. Policies and interventions should avoid dichotomies of “good and bad” food choices or health behaviors, but focus on those issues that contribute to the weightedness of factors influencing food choice behavior at a given decision-making moment and within a given choice set.
Open Access
Community-Based Approaches to Reducing Health Inequities and Fostering Environmental Justice through Global Youth-Engaged Citizen Science
(2021-01-21) King, Abby C; Odunitan-Wayas, Feyisayo A; Chaudhury, Moushumi; Rubio, Maria Alejandra; Baiocchi, Michael; Kolbe-Alexander, Tracy; Montes, Felipe; Banchoff, Ann; Sarmiento, Olga Lucia; Bälter, Katarina; Hinckson, Erica; Chastin, Sebastien; Lambert, Estelle V; González, Silvia A; Guerra, Ana María; Gelius, Peter; Zha, Caroline; Sarabu, Chethan; Kakar, Pooja A; Fernes, Praveena; Rosas, Lisa G; Winter, Sandra J; McClain, Elizabeth; Gardiner, Paul A; on behalf of the Our Voice Global Citizen Science Research Network
Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.
Open Access
Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol
(2021-02-26) Okop, Kufre J; Murphy, Kathy; Lambert, Estelle V; Kedir, Kiya; Getachew, Hailemichael; Howe, Rawleigh; Niyibizi, Jean B; Ntawuyirushintege, Selemani; Bavuma, Charlotte; Rulisa, Stephen; Kasenda, Stephen; Chipeta, Effie; Bunn, Christopher; Crampin, Amelia C; Chapotera, Gertrude; King, Abby C; Banchoff, Ann; Winter, Sandra J; Levitt, Naomi S
Background In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk. Methods This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy. Discussion Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.
Open Access
Comparisons of intensity-duration patterns of physical activity in the US, Jamaica and 3 African countries
(BioMed Central, 2014-08-27) Dugas, Lara R; Bovet, Pascal; Forrester, Terrence E; Lambert, Estelle V; Plange-Rhule, Jacob; Durazo-Arvizu, Ramon A; Shoham, David; Kroff, Jacolene; Cao, Guichan; Cooper, Richard S; Brage, Soren; Ekelund, Ulf; Luke, Amy
Background: This difference in how populations living in low-, middle or upper-income countries accumulate daily PA, i.e. patterns and intensity, is an important part in addressing the global PA movement. We sought to characterize objective PA in 2,500 participants spanning the epidemiologic transition. The Modeling the Epidemiologic Transition Study (METS) is a longitudinal study, in 5 countries. METS seeks to define the association between physical activity (PA), obesity and CVD risk in populations of African origin: Ghana (GH), South Africa (SA), Seychelles (SEY), Jamaica (JA) and the US (suburban Chicago). Methods: Baseline measurements of objective PA, SES, anthropometrics and body composition, were completed on 2,500 men and women, aged 25–45 years. Moderate and vigorous PA (MVPA, min/d) on week and weekend days was explored ecologically, by adiposity status and manual labor. Results: Among the men, obesity prevalence reflected the level of economic transition and was lowest in GH (1.7%) and SA (4.8%) and highest in the US (41%). SA (55%) and US (65%) women had the highest levels of obesity, compared to only 16% in GH. More men and women in developing countries engaged in manual labor and this was reflected by an almost doubling of measured MPVA among the men in GH (45 min/d) and SA (47 min/d) compared to only 28 min/d in the US. Women in GH (25 min/d), SA (21 min/d), JA (20 min/d) and SEY (20 min/d) accumulated significantly more MPVA than women in the US (14 min/d), yet this difference was not reflected by differences in BMI between SA, JA, SEY and US. Moderate PA constituted the bulk of the PA, with no study populations except SA men accumulating > 5 min/d of vigorous PA. Among the women, no sites accumulated >2 min/d of vigorous PA. Overweight/obese men were 22% less likely to engage in manual occupations. Conclusion: While there is some association for PA with obesity, this relationship is inconsistent across the epidemiologic transition and suggests that PA policy recommendations should be tailored for each environment.
Open Access
Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?
(2015-09-23) Steyn, Nelia P; de Villiers, Anniza; Gwebushe, Nomonde; Draper, Catherine E; Hill, Jillian; de Waal, Marina; Dalais, Lucinda; Abrahams, Zulfa; Lombard, Carl; Lambert, Estelle V
Background: Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods: Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results: The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion: The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty.Conclusions: The HK intervention did not significantly improve quality of diet of children.
Open Access
Distribution of metals exposure and associations with cardiometabolic risk factors in the “Modeling the Epidemiologic Transition Study”
(2014-11-05) Ettinger, Adrienne S; Bovet, Pascal; Plange-Rhule, Jacob; Forrester, Terrence E; Lambert, Estelle V; Lupoli, Nicola; Shine, James; Dugas, Lara R; Shoham, David; Durazo-Arvizu, Ramon A; Cooper, Richard S; Luke, Amy
Abstract Background Metals are known endocrine disruptors and have been linked to cardiometabolic diseases via multiple potential mechanisms, yet few human studies have both the exposure variability and biologically-relevant phenotype data available. We sought to examine the distribution of metals exposure and potential associations with cardiometabolic risk factors in the “Modeling the Epidemiologic Transition Study” (METS), a prospective cohort study designed to assess energy balance and change in body weight, diabetes and cardiovascular disease risk in five countries at different stages of social and economic development. Methods Young adults (25–45 years) of African descent were enrolled (N = 500 from each site) in: Ghana, South Africa, Seychelles, Jamaica and the U.S.A. We randomly selected 150 blood samples (N = 30 from each site) to determine concentrations of selected metals (arsenic, cadmium, lead, mercury) in a subset of participants at baseline and to examine associations with cardiometabolic risk factors. Results Median (interquartile range) metal concentrations (μg/L) were: arsenic 8.5 (7.7); cadmium 0.01 (0.8); lead 16.6 (16.1); and mercury 1.5 (5.0). There were significant differences in metals concentrations by: site location, paid employment status, education, marital status, smoking, alcohol use, and fish intake. After adjusting for these covariates plus age and sex, arsenic (OR 4.1, 95% C.I. 1.2, 14.6) and lead (OR 4.0, 95% C.I. 1.6, 9.6) above the median values were significantly associated with elevated fasting glucose. These associations increased when models were further adjusted for percent body fat: arsenic (OR 5.6, 95% C.I. 1.5, 21.2) and lead (OR 5.0, 95% C.I. 2.0, 12.7). Cadmium and mercury were also related with increased odds of elevated fasting glucose, but the associations were not statistically significant. Arsenic was significantly associated with increased odds of low HDL cholesterol both with (OR 8.0, 95% C.I. 1.8, 35.0) and without (OR 5.9, 95% C.I. 1.5, 23.1) adjustment for percent body fat. Conclusions While not consistent for all cardiometabolic disease markers, these results are suggestive of potentially important associations between metals exposure and cardiometabolic risk. Future studies will examine these associations in the larger cohort over time.
Open Access
Effect of body mass and physical activity volume and intensity on pedometry-measured activity energy expenditure in rural black South Africans in the Limpopo Province
(2010) Cook, Ian; Alberts, Marianne; Lambert, Estelle V
Objectives. We developed a novel approach to investigate patterns of pedometry-measured total weekly activity energy expenditure (EEAct) in rural black South Africans in the Limpopo Province. Design. We analysed 7-day pedometry data in 775 subjects (female: N=508; male: N=267). Variance components models for EEAct were used to estimate the variance explained by body mass (BM), total weekly steps (volume) and estimated intensity (kcal. kg-1.step-1). Univariate General Linear Models, adjusting for age, BM and physical activity (PA) volume, were used to determine if EEAct was primarily affected by volume or intensity. Results. BM (13.1%), PA intensity (24.4%) and PA volume (56.9%) explained 94.4% of the variance in EEAct. Adjusted EEAct did not differ between sexes (78 kcal.week-1, p =0.2552). There were no significant differences across activity categories (sedentary to very active) for adjusted EEAct (62 - 287 kcal.week-1, p>0.1). Adjusted EEAct for 6 - 7 days of compliance (≥10 000 steps.day-1) differed significantly from 1 - 2 days of compliance (266 - 419 kcal.week-1, p<0.04). Obese (body mass index ≥30 kg.m-2) and normal weight (body mass index 18.5 - 24.9 kg.m-2) women did not differ significantly across activity categories for EEAct (200 - 592 kcal.week-1, p>0.30). Conclusions. We have highlighted an intensity effect for days of compliance and at very active ambulatory levels (≥12 500 steps. day-1). A volume effect appeared to dominate between sexes, across activity categories and weight-by-activity categories. It is important that post hoc statistical adjustments be made for body mass and PA volume when comparing EEAct across groups.
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Effects of elevated plasma adrenaline levels on substrate metabolism, effort perception and muscle activation during low-to-moderate intensity exercise
(2005) West, Sacha J; Goedecke, Julia H; Van Niekerk, Lizl; Collins, Malcolm; St Clair Gibson, Alan; MacDonald, Ian A; Noakes, Timothy D; Lambert, Estelle V
The aim of this study was to differentiate the role of raised plasma adrenaline (Adr) concentrations from sympathoadrenal activation associated with moderate-intensity exercise, on muscle activation, cardiopulmonary responses, fuel metabolism, and ratings of perceived exertion (RPE) during low-intensity exercise. Two groups of subjects (MOD, n=6; LOW, n=7) cycled on two occasions for 90 min. MOD cycled at 68% VO2max with saline infusion, and at 34% VO2max with Adr infusion. LOW cycled twice at 34% VO2max, with either Adr or saline infusion. Infusions (0.015 g Adr/kg/min) started at 15 min and increased plasma [Adr] somewhat higher than during exercise at 68% VO2max (~1.9 vs. 1.4 nM, at 75 min). Mean plasma glucose and lactate concentrations during LOW were significantly higher with Adr than saline infusion (5.1±0.6 vs. 4.4±0.3 mmol/l, P<0.01 and 2.1±0.8 vs. 1.3±0.5 mmol/l, P<0.01, respectively). Elevated [Adr], without increased exercise intensity, did not alter glycogenolysis. There were also no effects of Adr infusion at 34% VO2max on heart rate, oxygen consumption, [FFA], respiratory exchange ratio, intramuscular triglyceride utilization, muscle activation or RPE. In conclusion, elevated [Adr] similar to those found during moderate-intensity exercise increased plasma glucose and lactate availability, but did not alter intramuscular fuel utilization, effort perception or muscle activation.
Open Access
Evaluation of a nutrition and health education program on components of metabolic health on women from under-resourced South African communities
(2022) Guillén, Pujol-Busquets Georgina; Lambert, Estelle V; Larmuth, Kate; Smith, James; Faig, Anna Bach
Background: Diet-related non-communicable diseases (NCDs) pose a substantial burden in terms of financial cost, morbidity, and mortality. In South Africa there is currently a double burden of infectious diseases and NCDs. Overconsumption of sugar, refined carbohydrates, and poor-quality fats, increases the risk for developing chronic diseases. Families from poor communities are often forced to eat these harmful foods due to a lack of nutrition education, or because they cannot afford or don't know how to access healthy foods. While poverty is an important barrier to health and education for both men and women, it tends to yield a higher burden in women. There is evidence that low-carbohydrate high-fat (LCHF) diets can improve metabolic health in well-controlled clinical trials where quality food is either provided or where participants have the financial and logistical means to access the foods promoted by this diet. However, one cannot assume that the same nutritional advice will translate to residents of underserved communities, who may not understand the advice nor be able to afford or access the foods promoted by this diet. Women from these communities are often the gatekeepers to healthy food choices for their families, but they are at a particular disadvantage. Eat Better South Africa (EBSA) runs nutrition education programs to teach – predominately women – how to choose affordable healthier foods that are lower in refined carbohydrates and higher in healthy fats to prevent or manage metabolic conditions. Aims: This research aims to optimise the EBSA program for women from underresourced communities and to evaluate its effectiveness for changing dietary behaviour and improving metabolic health. The objectives were: 1) to explore women's perceptions of the EBSA program and the barriers and facilitators that they faced to change their dietary habits and adhere to the EBSA recommended diet; 2) to conduct community assessments in the under-resourced communities that EBSA planned to run programs, better address women's needs and explore their willingness to participate in a nutrition and health education program; 3) to assess the effects of the EBSA program on women's metabolic health and wellbeing through mixed-methods and to explore EBSA's team perceptions of the program, and 4) to explore health practitioners' perceptions of the health and nutritional advice recommended by EBSA. Methods: The first part of this project consisted of a qualitative study through focus group discussions (FGDs) with women from previous EBSA programs (n=18) and naïve EBSA participants (n=60). The second part of the project consisted of a mixed-method evaluation (n=32) of a pilot study on an EBSA intervention to assess health status changes. These methods included qualitative methods (in-depth individual (IDIs) interviews with both EBSA participants and EBSA team members and FGDs with the EBSA participants), and quantitative methods (diet assessment, metabolic health markers and physical activity behaviour) to assess changes before and after the pilot intervention program. The last part of this project consisted of a qualitative IDI study on health practitioners' perceptions and understanding of a LCHF diet (n=16). Thematic analysis of the qualitative data was conducted using NVivo 12 software. Descriptive and statistical analysis of the quantitative data was done using Stata 16 and Jamovi. Results: The first formative study indicated that the EBSA participants' greatest facilitators and barriers revolved around understanding the educational content and on how to implement the dietary advice. The mixed methods results of the second study, the pilot, indicated that, overall, the women experienced improvements in dietary behaviours and biomarkers related to inflammation, lipids, and glycaemic profiles. Furthermore, the participants waist circumference, weight, blood pressure, triglycerides and HbA1c were significantly reduced, and those changes were sustained six months after the EBSA intervention. Women's carbohydrate intake was significantly reduced, and their health markers improved despite a slight increase in sedentary behaviour. The qualitative results found that the major reason women enrolled in the program was because they suffered from NCDs. Most women found that the EBSA diet made them feel less hungry, more energetic and they felt that their health had improved. Most women spoke of socioeconomic challenges which made it difficult for them to follow EBSA's recommendations, such as employment status, safety issues in the community, and lack of support from relatives. Women felt that some health practitioners were not supportive of the diet, but that they became more positive after observing the related health outcomes. Quantitative results converged with qualitative results except for physical activity behaviour. EBSA's team perceptions of the program and participants' challenges matched participants' experiences. The final qualitative study indicated that health practitioners' approaches to LCHF diets seemed to be supportive but not advocating. Conclusion: Although, currently, some international food guidelines endorse LCHF diets, there is still a considerable amount of confusion and lack of knowledge regarding this diet. This study provided data on the dietary intake and health risk status of women from under-resourced South African communities, and the facilitators and challenges of a LCHF education program to change their dietary behaviour. Results suggested that most participants followed EBSA's dietary recommendations and experienced health improvements as a result. Follow up data at six months suggested that those changes could be sustainable. For people with diet-related chronic diseases, LCHF diets should be supported by experienced health care professionals who can facilitate optimal nutritional intake. This is the same for any other diet; the evidence for long-term compliance and the sustainability of carbohydrate restriction is currently not yet established. In the absence of this evidence, existing data suggest that it is a legitimate and potentially effective treatment to adopt a LCHF diet as an option for patients to manage and prevent NCDs in under-resourced communities.
Open Access
Evaluation of a school-based physical activity intervention in Alexandra Township
(2010) Draper, Catherine E; de Kock, Lauren; Grimsrud, Anna T; Rudolph, Michael; Nemutandani, Simon; Kolbe-Alexander, Tracy; Lambert, Estelle V
Objectives. Non-communicable diseases and limited participation in school physical education have become increasing concerns in South Africa. In response to these concerns, a schoolbased physical activity intervention, Healthnutz, was implemented in three primary schools in Alexandra Township, Johannesburg. Evaluation of Healthnutz included assessing its feasibility and acceptability, and short-term changes in learners’ physical fitness, knowledge and attitudes. Methods. To assess feasibility and acceptability, a situational analysis and focus groups with teachers and programme monitors were conducted. Pre-post fitness testing (3-month interval) was conducted with learners, and a questionnaire assessed changes in learners’ knowledge, attitudes, self-efficacy, and perceived barriers to physical activity, in control and intervention schools. Results. At implementation, teachers identified the need for more physical activity in the school environment and were positive about Healthnutz. Follow-up focus group discussions suggested that it was positively impacting teachers, learners and the school in general. Scores for sit and reach (p<0.001), sit ups (p<0.02) and shuttle run (p<0.0001) improved significantly in intervention but not control schools. A significant decrease was observed in learners’ perceived external barriers to physical activity (p<0.0001) along with a positive change in learners’ self-efficacy for physical activity (p<0.05). Conclusions. Healthnutz raised awareness of the importance of physical activity in intervention schools. Findings indicate that even limited exposure to a physical activity intervention can lead to a significant improvement in aspects of learners’ fitness, knowledge, attitudes and perceptions regarding physical activity. Furthermore, training and support of teachers needs to be nonjudgemental and empowering.
Open Access
A formative assessment of nurses' lifestyle behaviours and health status
(2015) Phiri, Lindokuhle P; Kolbe-Alexander, Tracy; Lambert, Estelle V
Background: Previous research has identified health care workers (HCWs) and shift workers as having an increased risk for non-communicable diseases (NCDs). Nurses in particular have a high prevalence of obesity, poor eating habits and insufficient physical activity and are at an increased risk for NCDs. Nurses are required to work non-traditional hours, outside the parameters of traditional day shift. Furthermore, shift work is associated with obesity and lower levels of physical activity. Even though nurses' occupations require them to be active in doing ward rounds and other duties, it is possible for these professionals to be physically active, yet highly sedentary. Sedentary behaviours such as occupational sitting, leisure-time sitting and television (TV) viewing may be associated with overweight and obesity independent of physical activity. Aim: The primary aim of this mini-dissertation was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. The mini-dissertation included two different research methods. Study 1: The main purpose of this qualitative descriptive study was to describe health concerns, health priorities and determinants of healthy lifestyle behaviours among nurses. The objectively measured and self-reported physical activity and sedentary behaviour in day and night shift nurses were compared in Study 2. Combined, the results of these studies may be used to inform the development of worksite-related interventions for South African nurses. Methods: Participants for the first study were purposively sampled from public hospitals based in Cape Town, South Africa. The participants included 103 nurses, of whom 57 worked night shift and 36 worked day-shift. Twelve focus group discussion (FGD's) were conducted with nursing staff to obtain insight into their health concerns, lifestyle behaviours and the nature of and access to worksite health promotion programmes (Whip's). Nine hospital management personnel participated in key informant interviews (KII) to gain their perspective on health promotion in the worksite. The FGDs and interviews were conducted by a trained facilitator using guided questions. These included questions such as: 'What are your main personal health concerns?' and 'How does your work affect your lifestyle behaviours and health?' Thematic analysis was used 12 to analyse the qualitative data with the assistance of (Atlas.ti Qualitative Data Analysis Software (Scientific Software Development GmbH, Berlin, Germany). In a sub-study, 64 nurses (day shift n=30 and night shift n=34) working at two of the five public hospitals volunteered to complete a socio-demographic questionnaire and wear the ActiGraph GT3x accelerometer for 7 consecutive days to measure physical activity levels. Valid data was defined as ≥ 600 minutes wear time per day, minimum of 4 days (2 shift days and 2 non-shift days). In addition, self-reported physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). Statistical analyses included a T-test to determine differences in PA and SB between day and night shift nurses. If data were normally distributed, ANOVA (analyses of variance) was performed to determine the significant differences in continuous outcome variables between day and night shift nurses. If data were not normally distributed, such as the GPAQ data, a non-parametric comparison Mann Whitney U test was applied. Results: Study 1: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. The hospital environment was perceived to have a negative influence on the nurses' lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling and advisory services, an online employee wellness programme. The Western Cape Department of Health also offered wellness days in which clinical outcomes, such as blood glucose were measured. Most nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Both nurses and management personnel frequently mentioned lack of time to prepare healthy meals and/or participate in physical activity due to being overtired from the long working hours. Furthermore, both management and nurses reported a stressful working environment. The fact that the nurses were most concerned with the problems of overweight, obesity and living with NCDs such as diabetes and hypertension indicate that there is a need and desire for WHPP's aimed at addressing these concerns. Study 2: Based on the objectively-measured results from accelerometry, all the nurses in the sub-study met the physical activity recommendations of 150 minutes or more of moderate to vigorous intensity physical activity per w eek. The day shift nurses reported more leisure-time moderate and vigorous intensity physical activity than the night shift nurses (p=0.028). Objectively-measured physical activity also showed that night shift nurses accumulated significantly more moderate intensity physical activity than the day shift nurses ( 16.6 ± 5.6 hrs/week versus 12.1 ± 13 4.5 hrs/week, respectively, p=0.001). In addition, night shift nurses accumulated more steps per day than day shift nurses (10324 ± 3414 versus 8022 ± 3245, p=0.013). Self-reported sedentary behaviour was similar for the two shifts, 3.0 ± 1.8 hours versus 4.0 ± 2.6 hours a day, for day and night shift, respectively. Objectively-measured sedentary behaviour (SB) was significantly lower (as a % of wake time) in night shift compared to day shift workers, 66% and 69%, respectively, p= 0.047. These differences between groups remained significant, even after adjusting for differences in body size and age. Furthermore, results from the Bland – Altman plots indicate that the nurses significantly underreported their sedentary time. Summary: The nurses in this study were concerned about NCDs and being overweight. They expressed an interest and willingness to participate in future hospital-based intervention programmes. The most frequently identified preference for WHPPs was access to fitness facilities or support groups. Despite the fact that all the nurses met the current public health recommendations for physical activity, objectively-measured SB was substantial, with both day and night shift nurses spending an average of 13 hours a day in SB. Findings from this study highlight the need for WHPPs that minimize sedentary behaviour and create a more supportive environment for physical activity.
Open Access
Gut microbiota, short chain fatty acids, and obesity across the epidemiologic transition: the METS-Microbiome study protocol
(BioMed Central, 2018-08-06) Dugas, Lara R; Lie, Louise; Plange-Rhule, Jacob; Bedu-Addo, Kweku; Bovet, Pascal; Lambert, Estelle V; Forrester, Terrence E; Luke, Amy; Gilbert, Jack A; Layden, Brian T
Background While some of the variance observed in adiposity and weight change within populations can be accounted for by traditional risk factors, a new factor, the gut microbiota, has recently been associated with obesity. However, the causal mechanisms through which the gut microbiota and its metabolites, short chain fatty acids (SCFAs) influence obesity are unknown, as are the individual obesogenic effects of the individual SCFAs (butyrate, acetate and propionate). This study, METS-Microbiome, proposes to examine the influence of novel risk factors, the gut microbiota and SCFAs, on obesity, adiposity and weight change in an international established cohort spanning the epidemiologic transition. Methods The parent study; Modeling the Epidemiologic Transition Study (METS) is a well-established and ongoing prospective cohort study designed to assess the association between body composition, physical activity, and relative weight, weight gain and cardiometabolic disease risk in five diverse population-based samples in 2500 people of African descent. The cohort has been prospectively followed since 2009. Annual measures of obesity risk factors, including body composition, objectively measured physical activity and dietary intake, components which vary across the spectrum of social and economic development. In our new study; METS-Microbiome, in addition to continuing yearly measures of obesity risk, we will also measure gut microbiota and stool SCFAs in all contactable participants, and follow participants for a further 3 years, thus providing one of the largest gut microbiota population-based studies to date. Discussion This new study capitalizes upon an existing, extensively well described cohort of adults of African-origin, with significant variability as a result of the widespread geographic distributions, and therefore variation in the environmental covariate exposures. The METS-Microbiome study will substantially advance the understanding of the role gut microbiota and SCFAs play in the development of obesity and provide novel obesity therapeutic targets targeting SCFAs producing features of the gut microbiota. Trial registration Registered NCT03378765 Date first posted: December 20, 2017.