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Early-life intervention to reduce obesity and poor dental health through early-life nutrition will improve health outcomes in later life. This study examined the prevalence of overweight and obesity and visual dental decay in 4-year old children in New Zealand between 2013 and 2017, and the impact of a nutrition and physical activity intervention programme, Under-5-Energize (U5E), on prevalence of these conditions within ethnic groups and by deprivation. The data set included 277,963 4-year-old children, including 25,140 from the Waikato region children of whom 8067 attended one of the 121 early childhood centres (ECC) receiving the U5E programme from 2014. Purposively the U5E-ECC selected were attended by higher proportions of indigenous Māori children and children living in higher deprivation areas than non-U5E-ECC. From 2013 to 2017, the overall prevalence of obesity, as defined by World Health Organisation criteria, declined slightly but rates of dental decay did not change. In the Waikato region, the prevalence of obesity declined in non-Māori children from 2015 to 2017 and children attending U5E-ECC had lower rates of dental decay than non-U5E children. Binary logistic regression showed that between 2015 and 2017 visible dental decay was more likely in children who were Māori (3.06×3.17), living in high deprivation (1.54×1.66) and male (1.10) but less likely if attending an U5E-ECC (0.83×0.79). Early-life intervention had efficacy at reducing dental decay, and demonstrated that the origins of disparities in health such as ethnicity and deprivation need to be addressed further to break the intergenerational cycles of poor health.

Background and Objectives: Examine availability and price of healthier foods-vs-regular counterparts and their association with obesity., Methods and Study Design: A cross-sectional survey of weight and height among Māori in 2 urban and 96 rural areas in the Waikato/Lakes Districts-NZ (year 2004-06) was undertaken. Concurrently, availability of 11 'healthier' food in fast-food-outlets was examined by location (urban vs rural) and median income (high-low). In supermarkets, five-specific 'regular' foods were scored against 'healthier' counterparts (white-vs-wholemeal bread, with-skin-vs-skinless chicken, regular-vs-trim meat, standard-vs-trim milk, sugarsweetened- beverages vs-water) for in-store availability and price according to the Nutrition Environment Measures Survey., Results: Overall, 3,817 Māori (BMI: women: 32.9±7.8 kg/m2; men: 33.1±6.7 kg/m2) were included with 451 food-outlets in two urban-clusters and 698 food-outlets in 96 rural-clusters. Fast-foods: The availability of healthier food choices was higher for 8/11 items in rural and low-income areas than urban and high-income areas. Multivariate analysis considered location and income as cofactors. No association between number of fast-food-outlets/cluster and healthier foods/cluster with obesity prevalence (General/Māori BMI cutoffs) was observed. Supermarkets: Water was cheaper than sugar-sweetened-beverages and negatively associated with obesity prevalence (General r=-0.53, p=0.03; Māori r=-0.53, p=0.03); high availability scores for trim milk compared to standard milk correlated with higher obesity prevalence (General r=0.49, p=0.04; Māori r=0.57, p=0.01)., Conclusions: Bottled water vs sugar-sweetened-beverages prices were inversely associated with obesity. This supports the argument to regulate the availability and price of sugar-sweetened-beverages in NZ. The positive association of the availability of trim milk with the prevalence of obesity warrants investigation into individual's dietary and food-purchase behaviour.

To reduce weight gain and encourage healthy eating including reduced sugar intake, Under 5 Energize (U5E) was introduced to 121 early-childhood-centres in the Waikato region of New Zealand in July 2013. Using anonymized data collected from January 2013 to September 2016 through free physical assessments of all 4-year-olds provided by the NZ Ministry of Health, the prevalence of obesity and dental decay children measured in the Waikato region was examined. Data were divided into four periods representing pre-implementation and 3 years of gradual implementation. Obesity was defined according to International Obesity Task Force criteria. Of 18,774 Waikato children included in the analysis, 32% were indigenous Māori, and 32% attended an U5E centre. Pre-implementation prevalences of obesity (4%) and visible dental decay (11%) of children attending and not-attending U5E centres were not different. While obesity prevalence did not change significantly over time, prevalence of dental decay decreased among children at U5E (trend p = 0.003) but not non-U5E (trend p = 0.14) centres, such that prevalences were significantly different between children at U5E vs. non-U5E centres at Year 3 ( p = 0.02). The U5E intervention is a small but arguably effective part of the wider system approach that is required to improve children's future health.

Project Energize, a multicomponent through-school physical activity and nutrition programme, is delivered to all primary school children in the Waikato region. The programme aim is to improve the overall health and reduce the rate of weight gain of all Waikato primary school children. An existing economic model was used to extrapolate the programme effects, initial costs, lifetime health treatment cost structures, quality-adjusted-life-years gained and increased life expectancy to the general and Māori child population of New Zealand. In March 2011, a sample of 2474 younger (7.58 ± 0.57 years, mean ± SD) and 2330 older (10.30 ± 0.51 years) children (36% Māori) attending Energize schools had body mass index measured and compared using mixed effect modelling with unEnergized comparison children from 2004 and 2006 from the same region. In 2011 the median body mass index reduction compared with the comparison younger children was -0.504 (90% CI -0.435 to -0.663) kg/m(2) and in the older children -0.551 (-0.456 to -0.789) kg/m(2). In 2010 there were 42,067 children attending Energize schools and in the same year NZ$1,891,175 was spent to deliver the programme; a cost of $44.96/child/year. Compared to the comparison children the increment in cost/quality-adjusted-life-year gained was $30,438 for the younger and $24,690 for the older children, and lower for Māori (younger $28,241, older $22,151) and for the middle socioeconomic status schools ($23,211, $17,891). Project Energize would improve quality and length of life and when compared with other obesity prevention programmes previously assessed with this model, it would be relatively cost-effective from the health treatment payer's perspective.

There is strong evidence that increased physical activity is beneficial for blood glucose homeostasis and the prevention of obesity and type 2 diabetes mellitus. This chapter takes a life course approach with an emphasis on the intrauterine and childhood stages of life. Firstly, growth and development at critical periods with a focus on skeletal muscle and adipose tissue; then, obesity and type 2 diabetes mellitus are considered in relation to physical activity and sedentary behaviour. The importance of the development of fundamental movement skills in early childhood for both physical fitness and also growth and development is emphasised. Physical activity guidelines in westernised countries are examined for commonalities. Finally, the effective translation of the evidence base for the benefits of physical activity into randomised controlled trials and then into real-world public health services that are sustainable is addressed with a case study from New Zealand of Project Energize--a through-school physical activity and nutrition intervention. Physical activity, alongside a 'healthy diet' is arguably the best preventive measure and treatment for both obesity and type 2 diabetes. It is an essential and normal activity of daily life, and all aspects of the life course and the environment should support physical activity.

Aim: School-based interventions to tackle the rise in childhood overweight and obesity remain inconclusive and are often limited in their application to diverse populations. To inform and measure the effect of the implementation of a primary school-based longitudinal randomised controlled nutrition and activity intervention, Project Energize, baseline measures of body size and blood pressure were required., Methods: This cross-sectional study stratified by age, sex, ethnicity, rurality and school socio-economic-status (school-SES) measured body mass index (BMI), percentage body fat (%BF), waist and resting blood pressure from 2752 5- and 10-year-old children (62% European, 31% Māori) representative of the Waikato region of New Zealand., Result: Waikato children have a high prevalence of overweight and obesity that is linked with hypertension. Cardiovascular risk factors including raised blood pressure and hypertension, waist and arm circumference and percentage body fat (%BF) were more prevalent in 10-year-olds, lower school-SES and to some extent, urban living. In European children, BMI and waist circumference were similarly predictive of %BF, but for Māori children, waist circumference predicted %BF better than BMI., Conclusions: A variety of stratified, baseline measurements is important when designing school-based interventions. In particular, waist circumference measures may be a more accurate predictor of %BF than BMI when determining measurement protocols that consider different ethnic groups and environments among children. The effect of targeted improvements of the school physical activity and nutrition environment on the rate of increase of weight, fatness and blood pressure in children should be examined., (© 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Background/objectives: In 2002, the prevalence of overweight and obesity, defined by body mass index (BMI), was higher in New Zealand Māori (40%) and Pacific (60%) than in European (24%) children; however, this does not take into account interethnic differences in body composition. This study compared trajectories of anthropometric indices from 2004 to 2006 among 5- and 10-year-old Māori and European children., Subjects/methods: In 2004 and then in 2006, 1244 children (639 boys and 605 girls) aged 5 and 10 years had height, weight and fat-free mass (FFM) by bioimpedance measured to derive measures of fat mass (FM), percentage body fat (%BF), FM index (FMI, FM/height(2)), FFM index (FFMI, FFM/height(2)), and s.d. scores for BMI and %BF and BMI categories by International Obesity Task Force criteria., Results: Body composition and growth in Māori children is different from European children. Over 2 years, the BMI and %BF s.d. scores in both 5- and 10-year-old cohorts increased more in Māori children than in European children. The prevalence of overweight and obesity also increased within ethnicity and age group. The relative change of FMI and FFMI differed by age group, gender and ethnicity. In Māori girls, the magnitude of the changes between 10 and 12 years of age was most marked-the major contribution was from an increase in FMI. At 12 years, the mean %BF of Māori girls was 31.7% (95% confidence interval (CI): 30.1 and 33.3) compared with that of European girls (28.0%; 95% CI: 27.0 and 29.0)., Conclusions: FM and FFM measures provide a more appropriate understanding of growth and body composition change in children than BMI, and vary with gender and ethnicity. Thus, FMI and FFMI should be tracked and compared among populations.

Through-school nutrition and physical activity interventions are designed to help reduce excess weight gain and risk of chronic disease. From 2004 to 2006, Project Energize was delivered in the Waikato Region of New Zealand as a longitudinal randomised controlled study of 124 schools (year 1-6), stratified by rurality and social deprivation, and randomly assigned to intervention or control. Children (686 boys and 662 girls) aged 5 (1926) and 10 (1426) years (692 interventions and 660 controls) had height, weight, body fat (by bioimpedance) and resting blood pressure (BP) measured at baseline and 2 years later. Each intervention school was assigned an 'Energizer'; a trained physical activity and nutrition change agent, who worked with the school to achieve goals based on healthier eating and quality physical activity. After adjustment for baseline measures, rurality and social deprivation, the intervention was associated with a reduced accumulation of body fat in younger children and a reduced rate of rise in systolic BP in older children. There was some evidence that the pattern of change within an age group varied with rurality, ethnicity and sex. We conclude that the introduction of an 'Energizer led' through-school programme may be associated with health benefits over 2 years, but the trajectory of this change needs to be measured over a longer period. Attention should also be paid to the differing response by ethnicity, sex, age group and the effect of rurality and social deprivation.

Aim: Little is known about the perception of overweight, expressed as a level of concern, of Pacific parents and its relevance to children's weight. The aim of this study was to analyse data collected at birth and four and six years in the Pacific Island Families Study (PIFS) to investigate the relationship between parental perceptions of child weight status and actual weight status., Method: A total of 569 parent child dyads (299 boys (52.5%), 270 girls (47.5%); 47.1% Samoan, 20.9% Tongan, 18.6% Cook Island, 4.9% Niue, 8.4% other Pacific) were examined in this Parental Perception of Overweight Obesity Study (PPOS). At four and six years the question was asked of the parent "How concerned are you about your child becoming overweight?" A 5-point Likert scale was used, with possible answers ranging from "unconcerned" through increasing levels of concern to "very concerned". At four and six years weight and height were also measured and body mass index (BMI) derived and classified using international standards. Potential factors associated with parental perception were examined in a multivariate model using logistic regression., Results: The majority of parents were unconcerned at four and six years (62% and 69.1%) about the future overweight status of their child. Using the international BMI classifications, at four years 40.1% of the children were classified as normal weight, 34.1% as overweight, and 25.8% as obese. At six years the proportions were similar; i.e., normal 41.3%, overweight 31.1%, and obese 27.6%. At four and six years the proportion of parents who were concerned about their child's future weight status was related to the child weight status e.g., at 6 years 20% of parents of normal children, 28% percent of parents of overweight and 51% of parents of obese children were concerned (p trend < 0.0001). Ethnicity and parity were significantly related to parental perceptions (p < 0.0001); identification with Tongan ethnicity was related to a higher proportion of concerned parents and an increased number of children in the family were related to a smaller proportion of concerned parents., Discussion: While the level of concern was low and the prevalence of overweight and obesity high, the context of the socio economic and demographic environments must be taken into account in the formulation of interventions. Overweight and obese Pacific children may benefit from interventions that target the awareness of parents, making them more conscious of the relationship of obesity with food and activity patterns and give practical support to change the environment. These findings raise the concern that there is a normalisation of overweight and obesity in Pacific parents and/or children. Interventions firstly should address the socio economic demographic environment of a Pacific family making healthier choices the easier choices.

Objective: Pacific children living in New Zealand exhibit considerably higher rates of overweight and obesity than their non-Pacific peers. The study aim was to identify physical activity and sedentary behaviors related to increased body size in Pacific children, to inform future intervention development for improved activity profiles and body size outcomes in this population., Methods: Three hundred and ninety-three 6-year-old Pacific children and their mothers living in Auckland, New Zealand were invited to participate. Activity was assessed over 8 days using accelerometry and mothers reported on their child's sedentary behaviours. Children's height, weight, and body fatness was assessed and body mass index (BMI) and body fat z-scores calculated. Maternal height, weight, and waist circumference were assessed and BMI calculated. Associations between children's body fat z-scores and potential related factors were determined using regression analyses., Results: Of the 254 children who registered, 102 (27% overweight, 32% obese) were included in analyses. Almost all mothers were overweight or obese. On average, children's body fat z-scores were 1.75 standard deviations above the reference group (range -0.6, 3.14). After accounting for all other factors, watching television every day and having a mother with a high waist circumference were associated with increased body fat z-scores., Conclusions: Strategies for obesity reduction in Pacific children and their mothers living in New Zealand are urgently required. Multifaceted, family based interventions that include the promotion of healthy nutritional practices and television free days may be efficacious in improving activity profiles and body size outcomes for Pacific children.

Objective: Several limitations of published bioelectrical impedance analysis (BIA) equations have been reported. The aims were to develop in a multiethnic, elderly population a new prediction equation and cross-validate it along with some published BIA equations for estimating fat-free mass using deuterium oxide dilution as the reference method., Design and Setting: Cross-sectional study of elderly from five developing countries., Methods: Total body water (TBW) measured by deuterium dilution was used to determine fat-free mass (FFM) in 383 subjects. Anthropometric and BIA variables were also measured. Only 377 subjects were included for the analysis, randomly divided into development and cross-validation groups after stratified by gender. Stepwise model selection was used to generate the model and Bland Altman analysis was used to test agreement., Results: FFM = 2.95 - 3.89 (Gender) + 0.514 (Ht2/Z) + 0.090 (Waist) + 0.156 (Body weight). The model fit parameters were an R2, total F-Ratio, and the SEE of 0.88, 314.3, and 3.3, respectively. None of the published BIA equations met the criteria for agreement. The new BIA equation underestimated FFM by just 0.3 kg in the cross-validation sample. The mean of the difference between FFM by TBW and the new BIA equation were not significantly different; 95% of the differences were between the limits of agreement of -6.3 to 6.9 kg of FFM. There was no significant association between the mean of the differences and their averages (r= 0.008 and p= 0.2)., Conclusions: This new BIA equation offers a valid option compared with some of the current published BIA equations to estimate FFM in elderly subjects from five developing countries.

Background/objectives: To investigate the relationships between body mass index (BMI), body fatness, ethnicity, age and blood lipids., Subjects/method: In a subsample (N=643) of the 2002 New Zealand Child Nutrition Survey (N=3275, age 5-14 years) consisting Māori (89 boys, 69 girls), Pacific (154 boys, 194 girls) and European (71 boys, 66 girls) ethnic groups, fat-free mass (FFM) was determined by bioimpedance analysis. FFM index (FFMI, FFM/height(2)), fat mass index (FMI, fat mass/height(2)) and percentage body fat (%BF) were derived. Plasma total cholesterol and high-density lipoprotein (HDL) cholesterol were measured in 515 (80%) of these children., Results: For the same BMI, %BF was lower in Pacific Island (P<0.0001) and Māori (P<0.0001) girls compared with European but for boys there were no ethnic differences. Cross-sectional analysis across ages using Hattori charts clearly showed sexual dimorphism with girls having a higher FMI, FFMI and BMI than boys by the age of 13 year. Both Pacific girls and boys showed upward trends in FFMI and FMI with age that were significantly higher than those of the other ethnicities. Adjusting for age, sex and ethnicity, %BF was a better predictor (R(2)=0.090, P=0.0002) of total cholesterol than BMI (R(2)=0.061, P=0.049) or waist (R(2)=0.075, P=0.013) while FFMI was the best predictor of HDL cholesterol (R(2)=0.15, P<0.0001) and waist was the best predictor of the total cholesterol/HDL cholesterol ratio (R(2)=0.17, P<0.0001)., Conclusions: Measurements of body fat and indices of body fatness additional to BMI in multiethnic paediatric populations allow changes in fat mass and FFM to be tracked and improve the ability to predict dyslipidaemia.

Background: Pacific adults and children have very high rates of obesity., Objective: Body size at birth, 2- and 4 years for the whole cohort, compliant (not smoking and breastfed) and non-compliant children was compared to the 2006 World Health Organization (WHO) growth standard using z-scores., Design: Longitudinal data (n=659) from the 2000 Pacific Island family birth cohort study of weight at birth and weight and height at 2- and 4 years was analysed., Results: At birth the average child was 3.673+/-0.501 kg; z-score 0.605 units higher (P<0.000001) than the WHO standard. At 2- and 4 years, average z-scores for weight and body mass index (BMI) were significantly different from 0 (mean z-scores for weight +1.062 and +1.688, for BMI +1.701 and +1.969 respectively, P<0.000001). Mean height was significantly lower (P<0.000001) z-score=-0.232 at 2 years but higher (P<0.000001) at 4 years, z-score=+0.626. Over 4 years, the daily weight gain was 11.2 g day(-1) compared with 8.9 g day(-1) for the WHO child. Compliant (n=287) compared to non-compliant (n=372) weighed less and were slightly shorter at 2- and 4 years measurement points. Non-compliant children categorized as non-smoking (n=229) weighed more than smoking mothers' (n=143) children at birth, 2- and 4 years., Conclusion: Pacific children are born heavy, over 4 years increase in weight is faster and between 2- and 4 years increase in height is faster than the reference breastfed child, independent of pre- and postnatal factors. Smoking decreases the rate of weight gain and children who are not breastfed gain weight faster. Interventions to limit weight gain need to start with the family before conception.

Objective: To investigate body composition differences, especially the relationship between body mass index (BMI) and percent body fat (%BF), among five ethnic groups., Design: Cross-sectional., Subjects: Seven hundred and twenty-one apparently healthy women aged 18-60 years (BMI: 17.4-54.0 kg/m(2)) from South Africa (SA, 201 black, 94 European) and New Zealand (NZ, 173 European, 76 Maori, 84 Pacific, 93 Asian Indian)., Measurements: Anthropometry, including waist circumference, and total, central and peripheral body fat, bone mineral content and total appendicular skeletal muscle mass (ASMM) derived from dual X-ray absorptiometry., Results: Regression analysis determined that at a BMI of 30 kg/m(2), SA European women had a %BF of 39%, which corresponded to a BMI of 29 for SA black women. For a BMI of 30 kg/m(2) in NZ Europeans, equivalent to 43% body fat, the corresponding BMIs for NZ Maori, Pacific and Asian Indian women were 34, 36 and 26 kg/m(2), respectively. Central fat mass was lower in black SA than in European SA women (P<0.001). In NZ, Pacific women had the lowest central fat mass and highest ASMM, whereas Asian Indian women had the highest central fat mass, but lowest ASMM and bone mineral content., Conclusions: The relationship between %BF and BMI varies with ethnicity and may be due, in part, to differences in central fatness and muscularity. Use of universal BMI or waist cut-points may not be appropriate for comparison of obesity prevalence among differing ethnic groups, as they do not provide a consistent reflection of adiposity and fat distribution across ethnic groups.

The consumption of energy drinks containing sucrose and caffeine is increasing worldwide. Ten healthy women aged 18 to 22 years and fasted overnight were randomly allocated to a standardised dose of sucrose either as an "energy" drink (containing sucrose and caffeine) or lemonade on the first day and then crossed over to the alternative drink on a second day. For thirty minutes before and thirty minutes after drinking oxygen consumption and carbon dioxide production were measured in the resting subject breath-by-breath by indirect calorimetry and the rates of carbohydrate and fat oxidation calculated. Energy drink consumption apparently caused increased carbohydrate oxidation (P = 0.004) and reduced lipid oxidation (P = 0.004) compared to lemonade. The longer term effects of combined caffeine and sucrose intake, particularly in sedentary individuals, on metabolism and body fatness needs further examination.

In light of alarming rises in the prevalence of obesity worldwide, tackling the obesity 'epidemic' is now a national health priority in many countries. Increasingly, population measures that provide accurate estimates of body fatness are required to assist public health organisations in identifying at-risk groups and developing appropriate preventative strategies. Body mass index (BMI) remains the most cost-effective and practical tool in this regard. The World Health Organization (WHO) has issued universal BMI standards for defining 'overweight' and 'obesity' in adults (BMI > or =25 kg x m(-2), and > or =30 kg x m(-2), respectively) based on the risk of obesity-related disease in Europeans. Although widely used, there is mounting evidence suggesting that these standards are not appropriate for all populations. Research indicates that the associations between BMI, percent body fat (%BF), and health risks can vary across different ethnicities. Accordingly, ethnic-specific and country-specific BMI cut-offs for overweight and obesity may be necessary to attain valid prevalence estimates. In New Zealand, this area is largely unexplored in both young people and Asian populations. There is a need for large-scale longitudinal studies investigating the relationships between excessive body fatness and related health outcomes across all major ethnic groups in New Zealand.

Economic development in developing societies characterized by industrialization, urbanization, and globalization has seen the emergence of an epidemic of diet- and life-style-related chronic degenerative diseases. A research project was initiated under the aegis of the International Atomic Energy Agency (IAEA), Vienna, Austria under its Coordinated Research Programme (CRP) to promote the use of stable isotopic techniques to document the extent of the problem and to understand the determinants of this epidemic. The principal objectives of this CRP involving countries both in the North and the South are to define the magnitude of the problem of obesity and non-insulin dependent diabetes mellitus (NIDDM) in developing countries, to identify the vulnerable groups at increased risk, and to attempt to describe the metabolic and physiological mechanisms underlying this phenomenon. These comparative international studies of obesity and NIDDM are looking at the effects of childhood malnutrition (Brazil) and socioeconomic differentials (Mexico) on adult risk factors; the composition of the daily diet on obesity (Chile); levels of patterns of physical activity of older adults (China) as well as their influence on weight gain and obesity (Cuba, Nigeria); the impact of body composition and energy expenditure on the evolution frank diabetes from impaired glucose tolerance (Jamaica), and of body compositional changes and the role of inflammatory cytokines on impaired glucose tolerance (India). The last study conducted in New Zealand was aimed at comparing the energy expenditures of Maori (Pacific Island) with New Zealanders of European descent.

Background: Reduced energy expenditure and excessive energy intake have been hypothesized to cause obesity. New Zealanders of Polynesian origin have a higher prevalence of obesity than do those of European origin., Objective: We investigated relations between components of energy expenditure and body composition., Design: We measured total energy expenditure (TEE) and resting metabolic rate (RMR) in 80 young women [40 New Zealand (NZ) Polynesian and 40 NZ European] aged 18-27 y by the doubly labeled water method and indirect calorimetry, respectively. Each group was partitioned into nonobese and obese on the basis of percentage body fat., Results: TEE and body weight were highly correlated in nonobese NZ Europeans (n = 23, r = 0.76, P < 0.001), obese NZ Europeans (r = 0.58, P = 0.016), and nonobese NZ Polynesians (n = 25, r = 0.59, P = 0.002) but not in obese NZ Polynesians (r = 0.11, P = 0.70). Activity energy expenditure (AEE = TEE - RMR) was similar in obese Polynesians and Europeans (mean+/-SD: 5.5+/-2.2 and 5.2+/-1.9 MJ/d, respectively), but significantly higher in nonobese Polynesians (5.7+/-2.5 MJ/d) than in their European counterparts (3.8+/-1.9 MJ/d, P = 0.005). Similar trends were seen when AEE adjusted for body weight and TEE/RMR were compared among the subgroups. Body weight and RMR together accounted for 66% of the variation in TEE for the European group but only 17% for the Polynesian group., Conclusion: Care should be taken in applying "Caucasian norms" relating to energy expenditure to NZ Polynesian people.

Aims: Programmes to prevent or delay chronic disease incorporate promotion of physical activity, particularly walking. The objective of this study was to test the associations of the ability to walk quickly with measures of adiposity and metabolic risk including dysglycaemia. Subjects and methods: Participants (3209), without known diabetes, in a lifestyle trial undertook a 4-minute walk test (4MWT) following measurements of fasting lipids, 75 g oral glucose tolerance test, anthropometry and blood pressure. Lower socio-economic status was defined by possession of a ‘community services card’ (CSC). Dysglycaemia (diabetes, impaired glucose tolerance and impaired fasting glucose) and metabolic syndrome (MS) were defined by WHO and ATPIII criteria, respectively. Results: Controlling for age, length of the walk-course and height, distance walked during the 4MWT decreased linearly ( p < 0.001) with increasing waist, body mass index, %fat mass and MS risk. On average those with dysglycaemia walked 15.2 (95% CI 9.3, 20.8) m less than ‘normal’ participants independent of gender. In the best-fit regression model, distance walked was associated with reduced distances walked 1.3 (1.2, 1.5) m/year of age, 0.9 (0.8, 1.1) m/kg fat, 15.7 (11.2, 19.5) m with a CSC and 8.0 (5.8,10.2) m if currently smoking. Each additional MS factor was associated with a reduction of the distance walked by 6.6 (4.6, 8.6) m. Conclusion: Increasing numbers of MS components are associated with slower walking. The 4MWT is an easy assessment of functional limitation, which may have use in guiding intervention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate whether resting metabolic rate (RMR) differs between Caucasian and Polynesian women. DESIGN: Cross-sectional comparison. SUBJECTS: Eighty-two (42 Caucasian, 40 Polynesian) healthy women aged between 18 and 27 y. MEASUREMENTS: RMR (indirect calorimetry) and body composition (fat-free mass and fat mass derived from oxygen-18 dilution measurement of total body water). RESULTS: RMR was similar in the Caucasian (6956±1291 (s.d.) kJ/d) and Polynesian (7125±1290 kJ/d) groups while fat-free mass was significantly lower in the Caucasian group (45.3±6.8 vs 51.0±6.4 kg, P<0.002). After adjustment for fat-free mass and fat mass, RMR was lower in the Polynesian than the Caucasian groups (6783±904 vs 7281±901 kJ/d, P=0.023). CONCLUSION: The significantly lower relative RMR observed in Polynesian compared to Caucasian women may predispose Polynesian women to eventual onset of obesity. [ABSTRACT FROM AUTHOR]