Evaluating Associations Between Energy Density, BMI, and Waist Circumference among Young Adults in Puerto Rico and Exploring Physical Activity as a Potential Moderator Open Access

Mazzitelli, Natalia (Spring 2024)

Permanent URL: https://etd.library.emory.edu/concern/etds/wh246t47k?locale=en
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Abstract

Background: Obesity is a public health problem that is particularly alarming for young adults in Puerto Rico (PR) given their high burden. Energy density (ED), characterized by the caloric content of foods relative to their weight, has been linked to weight gain. Although physical activity (PA) is a protective factor against obesity and ED, PA levels in PR are suboptimal. Little is known about ED among young adults in PR, its association with markers of obesity and the role of PA in this relationship. Thus, this study evaluated the relationship between ED, BMI, and WC among young adults in PR and explored the moderating role of PA.

Methods: This cross-sectional analysis used baseline data from the PR-OUTLOOK cohort study (n=1,829) aged 18-29y. ED was defined as the energy content (kJ/g) of all foods, excluding beverages, and was categorized according to sample-based tertiles. Adjusted linear regression models for ED tertiles and each outcome of interest, Body Mass Index and Waist Circumference (BMI and WC), were used. A series of models were conducted: Model 1 (unadjusted), Model 2 (adjusted for age, sex, alcohol intake, education, income, subjective socioeconomic status, food security, depressive symptoms), and Model 3 (Model 2 + PA). The moderating role of PA was assessed by including multiplicative interaction terms with ED in each model.

Results: In Models 1 and 2, mean WC differed significantly across tertiles of ED. Specifically, in Model 2, those in T3 had the highest mean WC (86.5cm, 95%CI: 84.7-88.4) compared to those in T1 (83.8cm, 95%CI: 82.1-85.5) and T2 (83.8cm, 95%CI: 82.5-85.2). There was no interaction between ED and PA on WC. After adjusting for PA (Model 3), those in T3 had a mean WC (86.8cm, 95%CI: 84.9-88.6) that was significantly higher than those in T2 (84.1cm, 95% CI:82.7-85.5; p=0.0173), but not in T1. No association was observed between ED and BMI in any of the models.

Conclusion: Consuming diets that are higher in ED was associated with higher WC. Future studies should evaluate the longitudinal effects of ED on weight change among Puerto Rican young adults.

Table of Contents

Table of Contents

 

LITERATURE REVIEW

Obesity Prevalence and Young Adults

Energy-Dense Diets and Obesity

Potential Mechanisms Linking Energy Density and Obesity

Physical Activity and Obesity Prevention

Gaps in the Literature

INTRODUCTION

MEASURES AND METHODS

Study design and participants

Measures

Exposure: Energy-dense diets

Outcome: Anthropometric measures

Moderator: Physical Activity

Assessment of covariates

Statistical Analysis

RESULTS

DISCUSSION

REFERENCES

TABLE 1. CHARACTERISTICS OF PR-OUTLOOK PARTICIPANTS IN THE TOTAL SAMPLE AND BY TERTILES OF ENERGY DENSITY.

TABLE 2. LEAST-SQUARES MEANS AND REGRESSION COEFFICIENTS FOR BMI AND WAIST CIRCUMFERENCE BY TERTILES OF ENERGY DENSITY WITH FOOD ONLY (KJ/G)

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