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Biomedical subjects

Shiriki Kumanyika

Publications and source records attributed to Shiriki Kumanyika.

17 recordsLinked to original sources
PubMed2006

The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it.

The Look AHEAD (Action for Health in Diabetes) study is a multicenter, randomized controlled trial designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes. The study began in 2001 and is scheduled to conclude in 2012. A total of 5145 participants have been randomly assigned to a lifestyle intervention or to an enhanced usual care condition (i.e., diabetes support and education). This article describes the lifestyle intervention and the empirical evidence to support it. The two principal intervention goals are to induce a mean loss >or = 7% of initial weight and to increase participants' moderately intense physical activity to > or =175 min/wk. For the first 6 months, participants attend one individual and three group sessions per month and are encouraged to replace two meals and one snack a day with liquid shakes and meal bars. From months 7 to 12, they attend one individual and two group meetings per month and continue to replace one meal per day (which is recommended for the study's duration). Starting at month 7, more intensive behavioral interventions and weight loss medication are available from a toolbox, designed to help participants with limited weight loss. In Years 2 to 4, treatment is provided mainly on an individual basis and includes at least one on-site visit per month and a second contact by telephone, mail, or e-mail. After Year 4, participants are offered monthly individual visits. The intervention is delivered by a multidisciplinary team that includes medical staff who monitor participants at risk of hypoglycemic episodes.

Cardiovascular Diseases↗
PubMed2006

Nutrition and chronic disease prevention: priorities for US minority groups.

Persistent disparities affecting US racial/ethnic minorities present a continuing challenge within the larger picture of chronic disease prevention, in part because of the socio-political disadvantages that affect minority populations. Many of these disparities are nutrition related. Complementary approaches to identifying priorities for nutrition assessment and intervention in minority populations include: 1) a dietary perspective that considers eating patterns in relation to current dietary guidelines, and 2) a chronic disease perspective that considers dietary implications of population risk profiles. Integrating these perspectives requires additional considerations of feasibility and relative priority for the population in question.

Chronic Disease↗
PubMed2006

Targeting interventions for ethnic minority and low-income populations.

Although rates of childhood obesity among the general population are alarmingly high, they are higher still in ethnic minority and low-income communities. The disparities pose a major challenge for policymakers and practitioners planning strategies for obesity prevention. In this article Shiriki Kumanyika and Sonya Grier summarize differences in childhood obesity prevalence by race and ethnicity and by socioeconomic status. They show how various environmental factors can have larger effects on disadvantaged and minority children than on their advantaged white peers-and thus contribute to disparities in obesity rates. The authors show, for example, that low-income and minority children watch more television than white, non-poor children and are potentially exposed to more commercials advertising high-calorie, low-nutrient food during an average hour of TV programming. They note that neighborhoods where low-income and minority children live typically have more fast-food restaurants and fewer vendors of healthful foods than do wealthier or predominantly white neighborhoods. They cite such obstacles to physical activity as unsafe streets, dilapidated parks, and lack of facilities. In the schools that low-income and minority children attend, however, they see opportunities to lead the way to effective obesity prevention. Finally, the authors examine several aspects of the home environment-breast-feeding, television viewing, and parental behaviors-that may contribute to childhood obesity but be amenable to change through targeted intervention. Kumanyika and Grier point out that policymakers aiming to prevent obesity can use many existing policy levers to reach ethnic minority and low-income children and families: Medicaid, the State Child Health Insurance Program, and federal nutrition "safety net" programs. Ultimately, winning the fight against childhood obesity in minority and low-income communities will depend on the nation's will to change the social and physical environments in which these communities exist.

Adolescent↗
PubMed2005

Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment.

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.

Adolescent↗
PubMed2004

Analysis of data with multiple sources of correlation in the framework of generalized estimating equations.

This paper is motivated by a study of physical activity participation habits in African American women with three potential sources of correlation among study outcomes, according to method of assessment, timing of measurement, and intensity of physical activity. To adjust for the multiple sources of correlation in this study, we implement an approach based on generalized estimating equations that models association via a patterned correlation matrix. We present a general algorithm that is relatively straightforward to program, an analysis of our physical activity study, and some asymptotic relative efficiency comparisons between correctly specifying the correlation structure vs ignoring two sources of correlation in the analysis of data from this study. The efficiency comparisons demonstrate that correctly modeling the correlation structure can prevent substantial losses in efficiency in estimation of the regression parameter.

Algorithms↗
PubMed2004

Confronting the epidemic: the need for global solutions.

The growth in the global epidemic of obesity is fundamentally linked to economic factors. The rising prevalence of overweight and obesity has occurred during a period when the real cost of the main components of many processed foods has declined significantly,partly due to state subsidies in the protected markets of Western economies. It is suggested that the vigorous promotion of foods high in fats and sugars, and intensive marketing to children, have aggravated the problems of obesity. The metabolic syndrome, a recent feature of the epidemic, now is a marker for the health impact of obesity both in the US and other countries. The IOTF suggests that global populations will continue to become progressively heavier if present consumption forecasts are sustained, with obesity imposing a burden of social and economic costs that no country, least of all developing countries with limited resources, can afford. Commitments to deliver effective action are needed from non-health sectors such as culture and education, commerce and trade, development,planning, and transport. Only a comprehensive and integrated international approach, based on an effective implementation of the WHO global strategy on diet, physical activity and health, offers any real hope of arresting the public health catastrophe unfolding throughout the world.

Adult↗
PubMed2003

Amount and bouts of physical activity in a sample of African-American women.

PURPOSE: To describe physical activity (PA) patterns in a sample of African-American women in comparison with the national recommendation for moderate PA. METHODS: Volunteers (N=55; ages 25-55 yr (mean +/- SD 39.6 +/- 8.7); body mass index [BMI] 17.9-56.4 kg.m(-2) (31.3 +/- 7.9 kg.m(-2))) were recruited by word of mouth. PA was measured using accelerometers, pedometers, and PA records for two 4-d periods. RESULTS: Participants accumulated 31.9 +/- 18.0 min.d(-1) in moderate-to-vigorous PA (MVPA), primarily through short bouts lasting 1-4 (median 11.9 bouts.d(-1)) and 5-7 min (median 0.6 bouts.d(-1)) but only on 3.1 +/- 2.4 d.wk(-1). Women with BMI<25.0 kg.m(-2) accumulated more daily PA than those with BMI 25.0-29.9 kg.m(-2) or > or =30 kg.m(-2) (50.3, 32.0, and 25.3 min.d(-1), respectively; P<0.001) and on more days per week (5.8, 3.0, 2.3 d, respectively; P<0.001). Of 42 women who completed both PA data collection periods, 17 achieved > or =30 min of MVPA on > or =5 of 8 d; however, only two achieved the PA in the recommended pattern (one 30-min bout or several 8-10 min bouts). CONCLUSION: The current study showed that, although this sample was not sedentary, few participants met the activity level recommended for health benefits because activity was performed on too few days per week, particularly among overweight and obese participants. In addition, the bout pattern for most participants was not at the recommended length of at least 8-10 min. This suggests that additional emphasis on the recommended days per week and bout length may be necessary when counseling individuals about physical activity.

Adult↗
PubMed2002

Electrolyte intake and nonpharmacologic blood pressure control.

PURPOSE: To characterize relationships between sodium and potassium intakes and blood pressure control. METHODS: We analyzed repeated 24-hour diet recalls and 24-hour urine assays from 873 elderly participants with established hypertension in a 3-year clinical trial of lifestyle interventions. Pooled estimates of electrolyte intakes were developed using hierarchical measurement error models and related to nonpharmacologic blood pressure control. RESULTS: Relative decreases in sodium and increases in potassium intakes each had graded relationships with better blood pressure control. After adjustment for measurement error, a 100 mmol/24-hour decrease in sodium intake was associated with an odds ratio of 2.93 [95% confidence interval: 1.83, 4.64] for maintaining nonpharmacologic blood pressure control throughout follow-up. A 50 mmol/24-hour increase in potassium intake was associated with an odds ratio of 2.00 [1.12, 3.55]. These relationships were independent of each other and of baseline levels of intakes. Blood pressure control was most strongly associated with sodium intake for participants with lower systolic blood pressures and longer duration of hypertension, and with potassium for those with elevated diastolic blood pressures. CONCLUSIONS: Sodium and potassium intakes exert independent graded influences on nonpharmacologic blood pressure control. Correlated measurement error may spuriously introduce a dependency among these relationships.

Aged↗
PubMed2002

Infant weight gain and childhood overweight status in a multicenter, cohort study.

OBJECTIVE: To determine whether a rapid rate of weight gain in early infancy is associated with overweight status in childhood. DESIGN: Prospective, cohort study from birth to age 7 years. SETTING: Twelve sites across the United States. PARTICIPANTS: Twenty-seven thousand, eight hundred ninety-nine (27 899) eligible participants born at full term between 1959 and 1965. MAIN OUTCOME MEASURE: Overweight status at age 7 years, defined by a body mass index above the 95th percentile of the Centers for Disease Control and Prevention reference data. RESULTS: In the 19 397 participants with complete data (69.6%), the prevalence of overweight status at age 7 years was 5.4%. The rate of weight gain during the first 4 months of life (as 100 g/month) was associated with being overweight at age 7 years, after adjustment for several confounding factors: odds ratio: 1.38; 95% confidence interval: 1.32-1.44. This association was present in each birth weight quintile, and remained significant after adjustment for the weight attained at age 1 year (odds ratio: 1.17; 95% confidence interval: 1.11-1.24). CONCLUSIONS: A pattern of rapid weight gain during the first 4 months of life was associated with an increased risk of overweight status at age 7 years, independent of birth weight and weight attained at age 1 year. These findings may lead to new hypotheses regarding the cause of childhood obesity, which may contribute to our understanding of this increasing public health problem in the United States.

Adult↗
PubMed1995

Truth and confidentiality without harm.

Case vignette: sharing unanticipated genetic information. The Questor family has experienced an unusual number of malignancies in the past two generations and has been advised by an oncologist that the p53 oncogene known as Li-Fraumeni Syndrome may be present in the family genome. The option of predictive genetic testing has been raised and several branches of the family have chosen to undergo screening to determine whether they are at risk for cancer because of the gene. Roger and Liz Questor have arranged for screening of themselves and their three children, ages 12, 10, and 7. The couple has, by all appearances, been happily married for 14 years. None of the family members are found to carry the oncogene; however, the geneticist conducting the analyses has made an interesting incidental discovery. The 10-year-old child is not the biological progeny of Roger Questor. Although the 12- and 7-year-olds are clearly the biological children of the couple, it is evident that the 10-year-old born to Liz Questor was fathered by a person other than Roger. What are the ethical obligations of the geneticist with respect to any sharing or disclosure of the information that has been discovered incidentally? What course of action, if any, do you recommend?

Confidentiality↗