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BACKGROUND. Recent studies have shown considerable variation in body fatness among children and adolescents defined as obese by a percentile rank for skinfold thickness. METHODS. We examined the relationship between percent body fat and risk for elevated blood pressure, serum total cholesterol, and serum lipoprotein ratios in a biracial sample of 3320 children and adolescents aged 5 to 18 years. Equations developed specifically for children using the sum of subscapular (S) and triceps (T) skinfolds were used to estimate percent fat. The S/T ratio provided an index of trunkal fat patterning. RESULTS. Significant overrepresentation (greater than 20%) of the uppermost quintile (UQ) for cardiovascular disease (CVD) risk factors was evident at or above 25% fat in males (32.2% to 37.3% in UQ) and at or above 30% fat in females (26.6% to 45.4% in UQ), even after adjusting for age, race, fasting status, and trunkal fat patterning. CONCLUSIONS. These data support the concept of body fatness standards in White and Black children and adolescents as significant predictors of CVD risk factors. Potential applications of these obesity standards include epidemiologic surveys, pediatric health screenings, and youth fitness tests.

(2006). Agreement in Body Fat Estimates Between a Hand-Held Bioelectrical Impedance Analyzer and Skinfold Thicknesses in African American and Caucasian Adolescents. Research Quarterly for Exercise and Sport: Vol. 77, No. 4, pp. 519-526.

Purpose: To develop an historical bone loading questionnaire that assesses loads applied to the skeleton using bone loading units and to determine its reproducibility. Additional purposes were to correlate bone loading units with areal bone mineral density (aBMD) and to determine whether low levels of bone loading increase the odds for low aBMD in healthy premenopausal women. Methods: Premenopausal women (N = 80; age: 31 +/- 7.7 yr) completed the newly developed bone loading history questionnaire (BLHQ) twice within 4-6 wk to establish reproducibility. aBMD (g[middle dot]cm-2) of the whole body, lumbar spine (L2-4), and right hip (proximal femur) were assessed with dual energy x-ray absorptiometry (DXA) in the women. Results: The questionnaire demonstrated good test-retest reliability in premenopausal women using intraclass correlation coefficients (spine r = 0.89, P < 0.001; hip r = 0.92, P < 0.001). Total spine bone loading exposure (r = 0.338; P = 0.002) and hip bone loading exposure (r = 0.317; P = 0.004) were significantly and independently correlated with femoral neck aBMD, after adjusting for BMI. Logistic regression analyses revealed increased odds for low femoral neck aBMD among those in the lowest tertile for recent hip bone loading exposure after adjusting for older ages, oral contraceptive use, low calcium intake, and an overweight BMI (OR = 3.62; CI = 1.09-11.94; P = 0.035). Conclusion: Historical bone loading activity can be reliably assessed and is moderately associated with femoral neck aBMD. This questionnaire could help to identify women with low femoral neck aBMD prior to menopause.

To determine the relations among peak aerobic capacity, physical activity, functional ability, components of the metabolic syndrome (high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], glucose, insulin, abdominal obesity, high blood pressure), and inflammatory factors (interleukin-6 [IL-6], C-reactive protein [CRP]) in men with paraplegia.Cross-sectional exploratory design.University research laboratory.Twenty-two men (age, 39+/-9y; duration of injury, 17+/-9y; level of injury, T2-L2) with functionally complete paraplegia volunteered to participate.Not applicable.Peak aerobic capacity was measured using a graded peak exercise test with an arm ergometer, and physical activity was assessed by the Physical Activity and Disability Scale. Functional ability was assessed by the Self-Report Functional Measure. Circulating glucose, insulin, HDL-C, TG, total cholesterol, IL-6, and CRP levels were determined by specific enzyme or immunologic assays. Body fat was determined by dual-energy x-ray absorptiometry, and central obesity was estimated from abdominal sagittal diameters.Lower peak aerobic capacities were associated with lower HDL-C and lower physical activity levels ( P.014). Lower physical activity levels were associated with higher fasting glucose, lower HDL-C level, and larger abdominal sagittal diameters ( P.036). Larger abdominal sagittal diameters were associated with higher fasting glucose, higher fasting and postload insulin, lower HDL-C, higher TG, and higher CRP levels ( P.05).Diet and exercise trials are needed to determine the efficacy and effectiveness of lifestyle interventions aimed at slowing the progression of the metabolic syndrome in people with spinal cord injury.

We tested the hypothesis that exercise training (Ex) attenuates the effects of hyperlipidemia on endothelial function by enhancing NO-mediated vasorelaxation in porcine brachial (Br) arteries. Adult female pigs were fed a normal-fat (NF) or high-fat (HF) diet for 20 wk. Four weeks after initiation of the diet, pigs underwent Ex or remained sedentary (Sed) for 16 wk. Relaxation to ACh was impaired by HF ( P = 0.03). The combination of HF and Sed impaired ACh-induced relaxation more than HF or Sed alone ( P = 0.0002). Relaxation to high doses of bradykinin (BK) was impaired by HF ( P = 0.0002). Ex significantly improved ACh-induced relaxation ( P = 0.01) and tended to improve relaxation to BK ( P = 0.38). To determine the mechanism(s) by which HF and Ex affected relaxation to ACh and BK, relaxation was assessed in the presence of N G-nitro-l-arginine methyl ester (l-NAME; to inhibit NO synthase), indomethacin (Indo; to inhibit cyclooxygenase), or l-NAME + Indo. In the presence of l-NAME, Indo, or l-NAME + Indo, ACh-induced relaxation was no longer different between HF and NF arteries; however, relaxation remained greater in Ex than in Sed arteries. In the presence of l-NAME or Indo, BK-induced relaxation was no longer altered by HF but was enhanced by Ex. In the presence of l-NAME + Indo, BK-induced relaxation was enhanced by HF and Ex. These data indicate that hyperlipidemia impairs ACh- and BK-induced relaxation by impairing NO- and PGI2-mediated relaxation. Ex attenuates the effects of HF by enhancing a vasodilator mechanism independent of NO and PGI2.

Little information has been reported on the leisure time physical activity (LTPA) habits of adults with mental retardation. Prevalence of physical inactivity and recommended LTPA of adults with mild to moderate mental retardation who live in community settings was described. Adults with mental retardation (76 men, 74 women) reported their physical activity habits. Overall, men and women who resided in community settings were similarly inactive, with 47% to 51% of individuals participating in little to no LTPA. Forty-two to 47% of them reported participation in moderate to vigorous LTPA five or more times per week. Limitations to quantifying physical activity through questionnaire process is discussed and development and implementation of programs designed to increase physical activity levels recommended.

The association between physical activity, dietary behaviors, and elevated cardiovascular disease risk factor components of the insulin resistance syndrome in adults with mental retardation was identified. Established clinical cutoff points were used to identify 145 participants with mild mental retardation and hyperinsulinemia, borderline high triglycerides, low high-density lipoprotein cholesterol, hypertension, and abdominal obesity. Odds ratios were calculated from logistic regression analysis. Those who participated in more frequent bouts of physical activity or who consumed lower dietary fat intakes were approximately one third as likely to have hyperinsulinemia and abdominal obesity compared to those who participated in less frequent physical activity or who consumed higher fat intakes, suggesting that these behaviors are protective against elevated components of the insulin resistance syndrome.

A reduced expression of the insulin resistance syndrome, a common neuroendocrine disorder underlying atherosclerosis, may play a role in reduced atherosclerosis in adults with Down syndrome. We compared selected components of the insulin resistance syndrome between 75 adults with Down syndrome and 70 with mental retardation due to other causes. After adjusting for age differences, residence, cigarette smoking, and medication use, women with Down syndrome had lower fasting plasma glucose and lower systolic blood pressure than comparison women. Men with Down syndrome had lower systolic and diastolic blood pressure than comparison men. Results suggest that women with Down syndrome may be less likely to express the insulin resistance syndrome, and men and women with Down syndrome may possess fewer atherosclerotic risk factors than the comparison groups.

Background and Objectives The pain following total knee arthroplasty can be associated with significant morbidity, especially in the elderly. Regional anesthetic techniques attenuate or eliminate postoperative pain, which may reduce this morbidity. Methods A 74-year-old patient with history of an epidural abscess underwent elective bilateral total knee arthroplasty for degenerative joint disease. Bilateral lumbar plexus catheters were placed via the fascia iliaca compartments. Lidocaine was infused postoperative through both catheters, and serum lidocaine levels were followed. Results The patient received significant postoperative pain relief based on physical and subjective examination. There were no complications or untoward effects related to the technique. Conclusion Lumbar plexus blockade with continuous local anesthetic infusion via the fascia iliaca compartment is an effective means of providing postoperative analgesia after total knee arthroplasty when epidural analgesia is contraindicated.

Due to age-related decreases in bone minera11,2 and total body protein3 coupled with a possible increase in the hydration of the fat-free mass (1,1-M)4, it is likely that, on average, the density of the FFM is lower in older relative to younger adults. Other investigators have speculated that the density of the FFM may become more variable with advancing age5,6. In either case, erroneous estimates of body fat percentage (%Fat) will result when traditional two-component (2C: fat and fat-free) models7 are used in older adults. More complex four component (4C: fat, water, mineral and fat-free residual) models3,5,8 may provide more valid substitutes for the 2C model7 in older adults.

The relationship of skinfold thicknesses and body density to body fatness was assessed, and skinfold prediction equations were developed for the estimation of body fatness determined from measures of body density, total body water, and bone mineral in a sample of 91 males and 116 females aged 34-84 years. For a given skinfold thickness, adjustment for individual deviations in the water and bone mineral fractions of the fat-free body assumed constant by traditional body composition models resulted in absolute reductions in overstimates of body fatness from 4.5 to 1.9% in females and from 2.8 to 1.7% in males for every 15 year increase in age. Percentage fat from density, water, and bone was estimated from skinfold thicknesses with SEEs of 2.9% in males and 3.8% in females. When compared to percentage fat from our multicomponent-derived criterion, percentage fat from body density and a two-component model resulted in individual errors ranging from underestimates of 5.6% fat to overestimates of 14.0% fat. The multicomponent prediction equations presented herein should produce more valid estimates of body composition in middle-aged and older men and women than equations based on two-component models. © 1992 Wiley-Liss, Inc.

The dietary intake of adults with mental retardation among three different community residential settings was described and compared. Two dietary screeners were administered to 325 adults. The women's Fruit and Vegetable Screener scores from group homes were significantly higher than scores from those with family members and in semi-independent settings. No significant differences were found in dietary intake across residences for men. Overall, 0% to 6% of the participants consumed the recommended 5 or more fruits and vegetables per day, and 15% to 30% consumed the recommendedor=30% or less of calories from fat. Results suggest that regardless of residential setting, men and women do not consume enough fruits and vegetables and consume too much dietary fat.

A reduced expression of the insulin resistance syndrome, a common neuroendocrine disorder underlying atherosclerosis, may play a role in reduced atherosclerosis in adults with Down syndrome. We compared selected components of the insulin resistance syndrome between 75 adults with Down syndrome and 70 with mental retardation due to other causes. After adjusting for age differences, residence, cigarette smoking, and medication use, women with Down syndrome had lower fasting plasma glucose and lower systolic blood pressure than comparison women. Men with Down syndrome had lower systolic and diastolic blood pressure than comparison men. Results suggest that women with Down syndrome may be less likely to express the insulin resistance syndrome, and men and women with Down syndrome may possess fewer atherosclerotic risk factors than the comparison groups.

The purpose of this study was to compare the relationships of anthropometric, bioelectrical impedance analysis (BIA), and near infrared interactance (NIR) measurements with a multiple-component (MC) criterion estimate of body composition derived from body density (D), body water (W), and bone mineral (B) in 48 white adults aged 49-80 yr. Relative errors of predicting the MC criterion from the practical measurements were determined by simple regressions within gender and calculated as the SEE divided by the criterion mean and expressed as a percentage. Relative errors were lowest for the BIA variable, height2/resistance (4.8-5.0%), higher for body mass index and the sum of 10 skinfold thicknesses (7.0-14.5%), and highest for NIR-derived optical density readings at the biceps and the sum of 10 sites (10.8-15.8%). Due to the low relative prediction error for height2/resistance, sex-specific BIA formulas for estimating fat-free mass from D, W, and B (FFM-DWB) were developed. The SEEs for predicting FFM-DWB from BIA, weight, and age were both 1.5 kg in women and men. Because BIA is not limited to ambulatory subjects, it is concluded that BIA may be a particularly useful, practical technique for estimating body composition in older adults.

The ability ofdual-energy x-ray absorptiometry (DEXA) to detect small changes in body composition was studied in I 7 men and women during a dehydration-rehydration pro- tocol. Scale weight (BW) and total mass (TM) from DEXA were highly related (r > 0.99) as were estimates of fat-free mass (r = 0.99) and percent fat (r = 0.97) from DEXA and densitometry. Changes in BW of � 1.5 kg due to fluid loss and gain were highly correlated (r = 0.90) with both changes in TM and soft-tissue mass (STM) by DEXA but less so (r = 0.67) with changes in lean-tissue mass (LTM). Mean changes in TM. STM. and LTM were not different (P > 0.05) from changes in BW. Estimates of bone mass and fat were unaffected by changes in hydration. We conclude that DEXA is able to detect small individual changes in TM and STM and is also useful for detecting group changes in LTM. .�1m J ('/in Nutr 1993:57:845-50.