Nutrition and Physical Activity for

Health

Nutrition and Physical

Activity for Health
John M. Jakicic, PhD

Linking Nutrition and Physical Activity to Health Outcomes

Nutrition and Physical Activity for Health

Nutrition and Physical Activity for Health

Physical
Activity

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Theoretical Pathway for Lifestyle Factors to

Influence Health-Related Outcomes
Physical
Activity

Fitness

HealthRelated
Outcomes

Theoretical Pathway for Lifestyle Factors

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

Is Physical Activity Linked to Improved Health

Physical
Activity

Fitness

HealthRelated
Outcomes

Is Physical Activity Linked to Improved Health

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

The Foundation of this Relationship

The Foundation of this Relationship

CHD Rate, per 1,000

Transport workers

Image Source Note 1

The Foundation of this Relationship

The Foundation of this Relationship

CHD Rate, per 1,000

Postal workers

Image Source Note 1

1.10

Relative risk of death (from all causes)

according to measures of physical activity.

Relative Risk

1.00
0.90
0.80
0.70
0.60
0.50
0.40
<500

500-999 10001499

15001999

20002499

25002999

30003499

>3500

Physical Activity Index (kcal per week)

Image Source Note 2

Physical Activity and Risk of Type 2 Diabetes in Women

1.0

Relative Risk

0.84

0.87
0.77

0.75

0.5

0-2.0 (0.8)

2.1-4.6 (3.3)

0.74

4.7-10.4 (7.7) 10.5-21.7 (15.7) >=21.8 (35.4)

Activity (MET-hrs per Week)

Image Source Note 3

Reduction in Hamilton
Rating Scale for Depression

Physical Activity and Treatment of

Depression
50
45
40
35
30
25
20
15
10
5
0

47%

29%

30%

Control

Low Dose

High Dose
Image Source Note 4

Diagram
Physical
Activity

Fitness

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

Relative Risk

Association Between Cardiorespiratory Fitness and

Risk of Cardiovascular Disease Mortality in Diabetics

Fitness - METs
Image Source Note 5

Diagram

Physical
Activity

Fitness

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

Cardiovascular Disease Mortality by

Body Fatness and Fitness
4.5
4
Relative Risk

3.5
3
2.5

Fit

Unfit

1.5
1
0.5
0
Lean

Normal

Obese

Adjusted for age (single year), examination year, smoking habit, alcohol intake, and parental history of ischemic heart disease
Image Source Note 6

Is Diet and Nutrition Linked to Health Outcomes?

Is Diet and Nutrition Linked to Health Outcomes?

Physical
Activity

Fitness

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

Nutrition and Health Outcomes

; Links have been shown with:
Cardiovascular disease
Diabetes
Cancer
Obesity
Others

Nutrition and Health Outcomes

; Dietary patterns can influence blood lipids
Transfats
Saturated Fat
Dash diet pattern
; Encourage fruits and vegetables, whole grains, poultry/fish, legumes/nuts, low-fat dairy ,
vegetable oils
; Limit sweets, beverages containing sugar, red meat

; Dietary patterns can influence blood pressure

Sodium intake
Dash diet pattern

Is Diet and Nutrition Linked to Health Outcomes?

Is Diet and Nutrition Linked to Health Outcomes?

Physical
Activity

Fitness

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

Health Consequences of Obesity

; Hypertension
; Dyslipidemia
; Type 2 Diabetes
; Coronary Heart Disease
; Stroke
; Gallbladder Disease
; Osteoarthritis
; Sleep Apnea and Respiratory disorders
; Some forms of cancer

Health Costs of Obesity

; Estimated to be $147 billion in the United States in
2008
Finkelstein et al. 2009

; Estimated to account for 0.7% to 2.8% of total health

care costs in a country worldwide
Withrow and Alter, 2011

; Health costs are estimated to be 30% higher in obese

adults compared to normal weight adults
Withrow and Alter, 2011

Nutrition and Physical Activity for Health

Nutrition and
Physical
Activity for
Health

Physical
Activity

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Theoretical Pathway for Lifestyle Factors to

Influence Health-Related Outcomes
Theoretical Pathway for Lifestyle Factors to Influence Health-Related Outcomes

Physical
Activity

Fitness

HealthRelated
Outcomes

Behavior

Diet /
Nutrition

Body Weight
and Body
Composition

Summary
; Physical activity is an important health
behavior that can have an independent
effect on health
; Eating behaviors that influence diet and
nutrition are also important and can
have an independent effect on health
; Physical Activity and Nutrition may
interact to maximize the health benefits

Image Source Notes

1. Chart created by instructor based on data from: Morris, J. N., Heady, J. A., Raffle, P., Roberts, C. G., & Parks, J. W.
(1953). Coronary heart-disease and physical activity of work. The Lancet, 262(6795), 1053-1057. doi: 10.1016/
S0140-6736(53)91495-0
2. Chart created by instructor based on data from: Paffenbarger, R. S., Hyde, R., Wing, A. L., & Hsieh, C. (1986).
Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine, 314(10),
605-613. doi: 10.1056/NEJM198603063141003
3. Chart created by instructor based on data from: Hu, F. B., Sigal, R. J., Rich-Edwards, J. W., Colditz, G. A., Solomon,
C. G., Willett, W. C., ... Manson, J. E. (1999). Walking compared with vigorous physical activity and risk of type 2
diabetes in women. The Journal of the American Medical Association, 282(15), 1433-1439. doi: 10.1001/jama.
282.15.1433
4. Chart created by instructor based on data from: Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss,
H. O. (2005). Exercise treatment for depression: Efficacy and dose response. American Journal of Preventive
Medicine, 28(1), 1-8. doi: 10.1016/j.amepre.2004.09.003
5. Chart created by instructor based on data from: Church, T. S., LaMonte, M. J., Barlow, C. E., & Blair, S. N. (2005).
Cardiorespiratory fitness and body mass index as predictors of Cardiovascular disease mortality among men with
diabetes. JAMA Internal Medicine (formerly Archives of Internal Medicine), 165(18), 2114-2120. doi: 10.1001/archinte.
165.18.2114
6. Chart created by instructor based on data from: Lee, C. D., Blair, S. N., & Jackson, A. S. (1999). Cardiorespiratory
fitness, body composition, and all-cause and cardiovascular disease mortality in men. The American Journal of Clinical
Nutrition, 69(3), 373-380.

Nutrition and Physical

Activity for Health
John M. Jakicic, PhD

Assessment of Nutrition, Physical Activity, and Body Composition

Criteria to Evaluate Assessment Methods

F Valid
The assessment instrument must measure what it is intended to
measure.
F Reliable
The instrument must consistently give the same results under the
same circumstances.
If the instrument is reliable and valid, it is also accurate.
F Practical
The instrument must have acceptable costs to the investigator.
The instrument must have acceptable costs to the participant.
F Nonreactive
The instrument must not alter the population or the behavior it seeks
to measure.

Dietary and Nutrition

Assessment

Dietary and Nutrition Assessment

F Direct observation
F Direct measurement
F Self-Report
Global measures
Recall measures

Dietary and Nutrition Assessment

F Direct observation
Plate waste studies
F Determination between what was served and
what was not eaten
F Usually not performed in a natural
environment without the person knowing they
are being observed

Dietary and Nutrition Assessment

F Direct measurement
Weight

Energy Intake

Energy
Expenditure

Dietary and Nutrition Assessment

F Direct measurement
Assumes that a fluctuation in weight is the
difference between energy expenditure and
energy intake
Does not provide information about the
composition of the diet, just the calorie
intake

Dietary and Nutrition Assessment

F Self-Report
Global measures
F Food frequency measure
Recall frequency and amount of food
consumed over a specific period
Assumes that this is representative of the
typical eating patterns
Recall measures
F Self-report of food consumed
F Can be performed on random days
F Self-report measures typically result in underreporting and recall bias

Physical Activity
Assessment Methods

Physical Activity Assessment Methods

F Self-Reports (paper or online tools)

F Wearable Devices/Motion Sensors/Portable Technology

F Physiological and Biological Markers

Self Report
F Administration
self-administrated vs. interviewer administered
single- item questions
lifetime physical activity

F Time frame
Usual/typical
Short term (past week, past month)
Long term (past 6 months, past year, lifetime)

F Type of activity assessed

Leisure, occupational, household

Self Reports
F Strengths
Extremely practical
and cost efficient
Tailored to the
characteristics of a
specific population
Information on
specific activities

F Weaknesses
Recall bias
May not reflect usual
activity if short term
Difficult to get intensity
information.
Cognition factors

Physical Activity Assessment Methods

F Wearable Devices/Motion Sensors/Portable
Technology
Pedometer
Accelerometer
Multi-sensor technology-based systems

Pedometers
F Device that measures number of steps (count) or
distance traveled by individual.
F Typically worn on the hip
F Newer models are less location sensitive

Pedometers

Strengths

Weaknesses

Low-cost (money & time)

Objective (limits self-report bias)
Non-cumbersome and acceptable
to subject.
Accurately measure # of steps and
most horizontal distances.
Works with a variety of
populations (children,
adults)

Pace of movement influences

accuracy.
Values can vary between same
model of device.
Insensitive to non-locomotor
activity (i.e. lifting) and other
activities (i.e. cycling and
stair climbing).
Cannot measure intensity,
frequency, or duration of the
movement detected.
Non-specific for activities.

Accelerometers (Actigraphy)
F Single Plane Accelerometers
Provides relatively accurate mean estimation of EE for groups of subjects
Worn on the waist or on the wrist
Activity counts are used to classify intensity of physical activity

F Multi-Plane Accelerometers
Measures in mediolateral, anteroposterior, and vertical dimensions
F Measures in 3 planes.
F May allow for more accurate assessment of activity

Worn on the waist or on the wrist

Activity counts are used to classify intensity of physical activity

Accelerometers (Actigraphy)
Strengths
Objective (limits self-report bias)
Most accurate for activities that
involve level walking
Some systems provide accurate
information on sleep
Works with a variety of
populations (children,
adults)

Weaknesses
Data can vary between same
model of device.
Less sensitive to non-locomotor
activity (i.e. , sitting, lifting)
and other activities (i.e.
cycling).

Additional Wearable Devices and Technologies

F Multi-Sensor Technology
Input from multiple channels
F Accelerometry, Heat Flux, etc.
F May increase accuracy compared to other
portable technologies
May allow for detection of posture changes

Physical Activity Assessment Methods

F Biological Markers
Doubly labeled water
Direct and indirect calorimetry
Heart rate monitoring
Physiological surrogates

PHYSICAL
ACTIVITY

TOTAL DAILY
ENERGY
EXPENDITURE

THERMIC EFFECT OF
FOOD

RESTING
ENERGY
EXPENDITURE

Doubly Labeled Water

F Technique
Dose of a radio-labeled isotope (2H2180) administered orally.
Collection of urine samples.
F Over 5 to 14 days, 2H is eliminated as water and 180 eliminated as water and CO2.

Difference between two (2H and 180) at end of observation is proportional to

CO2 production or total energy expenditure.

F Provides a measure of the average daily total energy expenditure

Need to subtract out the resting energy expenditure and the thermic effect of
food to determine energy expenditure in physical activity
F Unable to determine what type of activity was performed to result in this amount of energy
expenditure

Doubly Labeled Water

Strengths
F Can be used on all age
groups
F Does not influence behavior
F Accurate
F Representative of energy
expenditure integrated over
many days

Weaknesses

F High cost of isotopes and

use of mass spectrometry
limits use to relatively
small samples
F Technically challenging
F Time-consuming analysis
F Provides no detailed
information on the
separate components of
energy expenditure.

Indirect Calorimetry
F Involves the assessment of:
Oxygen consumed
Carbon Dioxide produced
Use of Respiratory Quotient (RQ) to convert
to calories
F 1 liter of oxygen consumed = approximately 5
kcal

Indirect Calorimetry
Strengths
F Provides an accurate
measurement of energy
expenditure of specific
activities
F Considered the gold
standard

Weaknesses
F Usually limited to
laboratory environment
F Requires expensive
equipment
F Requires trained staff

Heart Rate Monitoring

F Continuously measure heart rate over an
acute or prolonged period of days.
Portable heart rate monitors

F Assumes a linear relationship between

heart rate and oxygen consumption or
energy expenditure
Must be established for each individual.

HR and O2 Relationship

Heart Rate Monitoring

Strengths
F Can assess spontaneous bouts
of physical activity
F Can be used in free-living
individuals
F Simple, relatively inexpensive
(depending on type)
F Can be used in all age groups

Weaknesses
F Need to assess individual HRVO2 relations for each subject
F HR influenced by factors such
as age, body size, mode of
exercise and physical fitness
F HR is highly sensitive to
emotional stressors, posture,
positions, and ambient air
temp. humidity, and even such
things as smoking

Physical Activity Assessment Methods

F Self-Reports (paper or online tools)
Diaries
Global Reports
Recall Questionnaires
Quantitative History Questionnaires
F Motion Sensors/Portable Technology
Pedometer
Accelerometer
Multi-sensor technology-based systems
F Biological Markers
Direct and indirect calorimetry
Doubly labeled water
Heart rate monitoring
Physiological surrogates

Assessing Body Weight and

Body Composition

Assessing Body Weight and Body Composition

F Body Mass Index (BMI)
Computed as weight, measured in kilograms,
divided by height squared, measured in meters
F kg/m2
F Online tools are available to provide this
measurement of BMI
F Waist Circumference
Provides a measure of abdominal adiposity
Measured using a tape measure
F Measured horizontally at the level of the iliac crest

For Whom is Weight Loss Recommended?

Underweight

BMI
(kg/m2)
<18.5

Obesity
Class

Normal

18.5-24.9

Overweight

25.0-29.9

Obesity

30.0-34.9

35.0-39.9

II

>40

III

Extreme
Obesity

For Whom is Weight Loss Recommended?

Risk of Disease

Underweight

BMI
(kg/m2)
<18.5

Obesity
Class

Men < 40 in.

Women < 35 in.

Men > 40 in.

Women > 35 in.

----

----

Normal

18.5-24.9

----

----

Overweight

25.0-29.9

Increased

High

Obesity

30.0-34.9

High

Very High

35.0-39.9

II

Very High

Very High

>40

III

Extreme
Obesity

Extremely High Extremely High

Additional Measures of Body Composition

F Skinfolds
Measures fat depots at various anatomic sites
Assumes that these are representative of total body
fatness
F Bioelectrical Impedance Analysis (BIA)
Measures resistance to an electrical current
Water and lean tissue provide low resistance
Allows for computation of body fatness

F Hydrostatic Weighing (Underwater Weighing)

Based on the premise that buoyancy force is used to determine the

weight of water displaced
Fat is more buoyant than lean tissue

F Dual Energy X-Ray Absorptiometry (DXA)

Low level x-ray is used to determine density and thickness of tissue

Provides a measure of fat, lean, and bone mass

Body Mass Index

versus
Body Composition

45

40

BMI (kg/m2)

35

30

25

20

15

10

10

20

30

40

Percent Fat (DXA)

50

60

60

Percent Fat (BIA)

50

40

30

20

10

10

15

20

25

30

BMI (kg/m2)

35

40

45

Summary
F There are a variety of techniques to
assess nutrition, physical activity, and
body composition.
F Need to base the selection of the
technique on:
What information do you want to know?
Strengths and Weakness of the measures