Obese African American Women Research Articles

Preliminary efficacy of group medical nutrition therapy and motivational interviewing among obese African American women with type 2 diabetes: a pilot study.

Objective. To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). Research Design & Method. African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention. Results. Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes. Conclusion. The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.

Abstract 367: Insulin Resistance is Associated with Increased Sympathetic Activity and Decreased Baroreflex Function in Obese African American Women

Obesity has a greater detrimental impact on the health of African American (AA) women than any other racial or gender group. Nearly 80% of AA women are overweight or obese and have higher incidence of insulin resistance compared to Caucasian women. The sympathetic nervous system (SNS) is increased in obesity and previous studies have reported that it may contribute to insulin resistance. However, most of these studies were performed in Caucasians. Thus, the contribution of the SNS to insulin resistance in African Americans remains unknown.The aim of this study was to determine if sympathetic activity is increased in obese AA women with insulin resistance. A total of 35 obese AA women with metabolic syndrome were studied (age 43±9 years, body mass index 38.7±5.5 Kg/m 2 , percentage body fat 48±4). Insulin sensitivity (SI) was evaluated by frequently sampled intravenous tolerance test and analyzed with Bergman's minimal model (MINMOD). Measurement of sympathetic regulation of vasomotor tone and baroreflex gain were determined with baroreflex-cross spectral analysis. Our results showed that SI was directly associated with baroreflex sensitivity, Figure. Subjects with insulin resistance (SI<3) had lower baroreflex sensitivity compared with those with normal SI (6.2±2.8 vs 10.4±4.5 ms/mm Hg, P=0.009). Subjects with insulin resistance tended to have elevated sympathetic activity as measured by low frequency variability of systolic blood pressure (LF SBP ; 5.9±3.4 vs 3.7±2.0 mm Hg 2 , P=0.057). In conclusion, insulin resistance is associated with decreased baroreflex gain and increased sympathetic activity in obese AA women.

Abstract 226: Importance of Measuring the Time Course of Flow Mediated Dilation When Assessing Endothelial Function in Obese African Americans

Flow mediated dilation (FMD) is a noninvasive technique to assess endothelial function in humans. In most studies FMD is reported as the percent change in brachial artery diameter at 60 seconds after cuff deflation relative to baseline (%FMD at 60 seconds). Recently the availability of automated computer-based edge detection allows measurement of peak dilation during the entire time course of brachial dilation post-hyperemia. Considering that changes in arterial diameter in response to shear stress is a continuous process and that peak dilation may differ in pathological states and occur at any arbitrary time point, we examined the time course of brachial artery FMD after a 5-min period of ischemia in 38 obese African American women (42±9.3 years old, BMI 39±6, % body fat 48.2±4.3, SBP 131±13, DBP 83±8 mm Hg, HR 77±12 bpm). Results were analyzed using brachial analyzer software (Medical Imaging Applications LLC). Baseline brachial artery diameter was 3.95±0.55 mm, the time to peak was 48.93 ±13.82 seconds. The percent change in FMD (%FMD) obtained at peak diameter was greater (4.7±3.19 mm) than %FMD at 60 seconds (3.23±4.33 mm); mean difference = 1.4 (95% CI, 0.54-2.4, P=0.003). A large proportion (79%) of true peak diameters fell outside the 60 seconds time frame typically used to assess FMD, Figure. Our results suggest that the peak vasodilator effect occurs before 60±5 seconds in the majority of our population. Therefore, the evaluation of FMD as a continuous measurement has greater accuracy and less variability for the evaluation of FMD compared with an arbitrary time point.

Women weigh in: obese African American and White women's perspectives on physicians' roles in weight management.

There is little qualitative research on the type of weight loss counseling patients prefer from their physicians and whether preferences differ by race. This qualitative study used semistructured, in-depth interviews of 33 moderately to severely obese white and African American women to elucidate and compare their perceptions regarding their primary care physician's approach to weight loss counseling. Data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. White and African American women seemed to internalize weight stigma differently. African American participants spoke about their pride and positive body image, whereas white women more frequently expressed self-deprecation and feelings of depression. Despite these differences, both groups of women desired similar physician interactions and weight management counseling, including (1) giving specific weight loss advice and individualized plans for weight management; (2) addressing weight in an empathetic, compassionate, nonjudgmental, and respectful manner; and (3) providing encouragement to foster self-motivation for weight loss. While both African American and white women desired specific strategies from physicians in weight management, some white women may first need assistance in overcoming their stigma, depression, and low self-esteem before attempting weight loss.

Racial disparities in pregnancy outcomes in obese women

Objective: To estimate the effect of race on perinatal outcomes in obese women.Methods: Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton infants ≥37 weeks gestation born to African-American or Caucasian Missouri residents from 2000 to 2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. Obesity was defined as pre-pregnancy body mass index ≥30 kg/m2.Results: There were 312 412 births meeting study criteria. 27.1% (11 776) of African-American mothers and 19.1% (49 415) of Caucasian mothers were obese. There were no differences in cesarean delivery or preeclampsia between obese African-American and obese Caucasian women. Infants of obese African-American women were significantly less likely to be macrosomic (0.9% vs. 2.2%, adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.4 0.6) and more likely to be low birth weight (3.4% vs. 1.8%, aOR 1.9, 95% CI 1.7, 2.2) compared to infants of obese Caucasian women. Compared to their normal weight peers, obese Caucasian women had a greater relative risk of developing preeclampsia (aOR 3.1, 95% CI 2.9, 3.2) than obese African-American women (aOR 2.1, 95% CI 1.9, 2.4).Conclusion: Racial disparities impact obesity-related maternal and neonatal complications of pregnancy.

Fatty acid and very low density lipoprotein metabolism in obese African American and Caucasian women with type 2 diabetes

Type 2 diabetes mellitus (T2DM) is associated with increased plasma triglyceride (TG) concentrations, but African Americans (AA) have lower plasma TG than Caucasians (CC). We evaluated the hypothesis that obese AA women have lower plasma TG than obese CC women do because of differences in lipid kinetics. Eleven AA and 11 CC obese women with T2DM, matched on body mass index (BMI) (AA = 37 ± 1, CC = 37 ± 1 kg/m(2)), age, duration of diabetes, percentage body fat, and insulin sensitivity (S(I), determined by an intravenous glucose tolerance test), were studied. Plasma TG concentration (AA = 1.14 ± 0.11, CC = 1.88 ± 0.18 mmol/l), FFA rate of appearance (R(a)) into plasma (AA = 419 ± 27, CC = 503 ± 31 µmol·min(-1)), and total VLDL-TG secretion rate (AA = 18 ± 2, CC = 29 ± 4 µmol·min(-1)) were lower in AA than CC women (all P < 0.05). In contrast, plasma total apolipoprotein (apo)B-100 concentration (AA = 1,542 ± 179, CC = 1,620 ± 118 nmol/l) and VLDL-apoB-100 secretion rate (AA = 1.3 ± 0.1, CC = 1.3 ± 0.1 nmol·min(-1)) were similar in both groups, so the molar ratio of VLDL-TG secretion rate to VLDL-apoB-100 secretion rate was lower in AA women than in CC women. VLDL-TG concentration was lower in AA women due to lower total VLDL-TG secretion rate. However, the VLDL-apoB-100 secretion rate was the same in both groups, demonstrating that AA women secrete smaller VLDL particles containing less TG than do CC women.

The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: The Jackson Heart Study

It is often hypothesized that psychosocial stress may contribute to associations of socioeconomic position (SEP) with risk factors for cardiovascular disease (CVD). However, few studies have investigated this hypothesis among African Americans, who may be more frequently exposed to stressors due to social and economic circumstances. Cross-sectional data from the Jackson Heart Study (JHS), a large population-based cohort of African Americans, were used to examine the contributions of stressors to the association of SEP with selected cardiovascular (CVD) risk factors and subclinical atherosclerotic disease. Among women, higher income was associated with lower prevalence of hypertension, obesity, diabetes and carotid plaque and lower levels of stress. Higher stress levels were also weakly, albeit positively, associated with hypertension, diabetes, and obesity, but not with plaque. Adjustment for the stress measures reduced the associations of income with hypertension, diabetes and obesity by a small amount that was comparable to, or larger, than the reduction observed after adjustment for behavioral risk factors. In men, high income was associated with lower prevalence of diabetes and stressors were not consistently associated with any of the outcomes examined. Overall, modest mediation effects of stressors were observed for diabetes (15.9%), hypertension (9.7%), and obesity (5.1%) among women but only results for diabetes were statistically significant. No mediation effects of stressors were observed in men. Our results suggest that stressors may partially contribute to associations of SEP with diabetes and possibly hypertension and obesity in African American women. Further research with appropriate study designs and data is needed to understand the dynamic and interacting effects of stressors and behaviors on CVD outcomes as well as sex differences in these effects.

Early Alterations of the Immune Transcriptome in Cultured Progenitor Cells From Obese African‐American Women

Progenitor cells (PCs) are key components of vasculogenic remodeling and hematopoietic development. Decreases in the number and function of angiogenic progenitors have been observed in coronary artery disease, hypertension, and diabetic vasculopathy. Several recent studies have also demonstrated a close relationship between increased visceral fat and cardiovascular disease, implying an association between obesity and vascular dysfunction. However, very little is known about the role of PCs in obesity. We generated whole genome expression profiles of cultured PCs from 18 obese and 6 lean African-American women on Agilent microarrays and analyzed the data through bioinformatic pathway analysis using multiple databases and analytic tools. False-discovery rates (FDR) were calculated to assess statistical significance while controlling for multiple testing. We identified 1,145 upregulated and 2,257 downregulated genes associated with obesity (1.5-fold or greater absolute fold-change). Pathway analysis further identified a statistically significant downregulation of immune-response pathways in the obese subjects, including T-cell receptor signaling, natural killer cell signaling, and chemokine-signaling pathways (FDR <5%). Chemokine gene-expression patterns were consistent with an angiogenic-angiostatic imbalance and a downregulation of CXCR3 receptor-mediated signaling in the PCs from obese subjects. Overall, these findings reveal a novel transcriptional signature in cultured PCs from obese African-American women and further suggest that obesity-associated immune-compromise may originate much earlier in cellular development than currently appreciated. Clinically, this may translate into a lengthier period of immune dysregulation in obese subjects exposing them to greater risks of infection and other morbidities.

A Qualitative Study of Factors Affecting Pregnancy Weight Gain in African American Women

African Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG in this population; however, research on exercise and nutritional barriers during pregnancy in African American women is limited. The objective of this qualitative study is to better inform intervention messages by eliciting information on perceptions of appropriate weight gain, barriers to and enablers of exercise and healthy eating, and other influences on healthy weight gain during pregnancy in overweight or obese African American women. In-depth interviews were conducted with 33 overweight or obese African American women in Columbia, South Carolina. Women were recruited in early to mid-pregnancy (8-23 weeks gestation, n = 10), mid to late pregnancy (24-36 weeks, n = 15), and early postpartum (6-12 weeks postpartum, n = 8). Interview questions and data analysis were informed using a social ecological framework. Over 50 % of women thought they should gain weight in excess of the range recommended by the Institute of Medicine. Participants were motivated to exercise for personal health benefits; however they also cited many barriers to exercise, including safety concerns for the fetus. Awareness of the maternal and fetal benefits of healthy eating was high. Commonly cited barriers to healthy eating include cravings and availability of unhealthy foods. The majority of women were motivated to engage in healthy behaviors during pregnancy. However, the interviews also uncovered a number of misconceptions and barriers that can serve as future intervention messages and strategies.

Abstract 785: Leptin-Notch-Wnt axis affects drug resistance in breast cancer

Abstract Introduction: Triple negative breast cancer (TNBC) is a particularly aggressive form of the disease whose incidence is disproportionate in obese African American and Latina women. TNBC is commonly associated with acute early onset, poor survival and acquired drug-resistance. Obesity, characterized by high levels of leptin, is frequently found among these ethnic groups. We hypothesize that intact leptin-Notch-Wnt signaling crosstalk affects the development of drug-resistance in TNBC. Objective: To determine whether leptin signaling induces Notch/Wnt pathway crosstalk, decreasing the effectiveness of cisplatin in TNBC cells. Materials &amp; Methods: TNBC cells (MDA MB 231 and HCC1806) and ER+ MCF-7 (as control) were treated with pharmacological doses of leptin and agonists of the Notch and Wnt pathways JAG1-17 mer peptide and Wnt-1, respectively. In addition, the cells were challenged with the leptin receptor, Notch pathway, and Wnt pathway antagonists LPrA2, DAPT, and Wnt-1 respectively. The impact of these molecules on cisplatin anti-cancer effects was also determined. Activation of Wnt (total/pβ-catenin), expression of Notch (Notch 1-4 and JAG1/Dll-4 and targets: survivin/Hey2), cell proliferation and apoptosis were determined by Western blot and flow cytometry. β-catenin levels were also investigated by immunofluorescence. We also determined the impact of the inhibition of leptin signaling (via LPrA2) on the expression of Wnt and Notch in DMBA-induced breast cancer from DIO (diet-induced obese) mice. Results: We found that leptin increased the levels of β-catenin mainly in TNBC cells. Similarly, inhibition of leptin signaling decreased Wnt/Notch expression in DMBA/DIO-breast cancer. Interestingly, leptin increased expression of Notch and attenuated the detrimental effects of cisplatin on breast cancer cells. Wnt-1 affected Notch levels but its effects were less pronounced. Conclusions: Leptin is able to induce the Notch and Wnt signaling pathways in breast cancer. Cisplatin effects were attenuated by leptin in TNBC probably through its crosstalk with Wnt and Notch signaling pathways. These results are particularly relevant for TNBC and obese patients, and suggest that leptin inhibition could be useful in increasing the chemotherapeutic effectiveness in TBNC by disrupting leptin-Wnt-Notch crosstalk. [This work was supported in part by NIH/NCI1SC1CA138658-02; NIH/ARRA/3SC1CA138658-02S1 and the Georgia Cancer Coalition Distinguished Cancer Scholar Award (to RRGP); CREDO (MSCR) 2R25RR017694-06A1 (to L.S.C); NIH/NIGMS R25 GM058268 and NCRR 5P20RR11104 (to T.Z.M); and facilities and support services at MSM (NIH RR03034 and 1C06 RR18386)]. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 785. doi:1538-7445.AM2012-785

Evidence for the Association between Abdominal Fat and Cardiovascular Risk Factors in Overweight and Obese African American Women

Objective: To determine the association between total body fat and abdominal region fat derived from dual-energy x-ray absorptiometry (DXA) scans and cardiovascular disease (CVD) risk factors in middle- to older-aged African American (AA) women. We also compared tape-measured waist and hip circumference and their ratio (WHR) with DXA measurements in the context of CVD risk factor predictability.Methods: Participants included 59 overweight or obese African American women (age, 48.7 ± 5.6 years). Anthropometries, including waist and hip circumferences, were measured, and DXA scans were used to derive fat mass from the total body and abdominal region. Blood analyses included glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol/HDL and LDL/HDL ratios, C-reactive protein (CRP), and fibrinogen. Multiple linear regression models were used to investigate the association among DXA-derived fat mass measures, waist circumference, WHR, and cardiovascular risk factors.Results: Among DXA-derived fat mass measures, DXA-derived abdominal fat mass showed the best prediction for glucose and triglycerides, although waist circumference and DXA-derived abdominal fat mass had equivalent capacity for predicting the total cholesterol/HDL ratio. Furthermore, waist circumference showed the best prediction for LDL/HDL ratio and CRP.Conclusions: Both DXA-derived abdominal fat mass and waist circumference had comparable capacity for predicting blood lipid profiles and CRP. Therefore, if waist circumference is measured correctly, it could be used as the simplest means of predicting CVD risk factors in overweight/obese AA women when DXA is not available.

Effects of Resistance Training and Walking on Cardiovascular Disease Risk in African-American Women

The study's purpose was to evaluate the effects of walking (W) and walking plus resistance training (WRT) on cardiovascular disease risk factors in inactive middle-aged (49.0 ± 5.5 yr) African-American women (body mass index = 34.7 ± 6.4 kg·m(-2)). Body composition, blood pressure, HDL cholesterol, triglycerides, glycosylated hemoglobin (HbA1c), C-reactive protein, and fibrinogen were measured before and after a 12-wk exercise intervention. Subjects were randomly assigned to one of two training groups. The W group (n = 25) was instructed to increase daily pedometer-measured walking to ≥10,000 steps per day, whereas the WRT group (n = 19) was given the same walking prescription plus supervised resistance training 2 d·wk(-1). A two-way repeated-measures ANOVA with an intention-to-treat analysis was performed to examine changes between groups. Significance was accepted at P ≤ 0.05. Both groups significantly (P < 0.001) increased walking (W = 5453 ± 2119 to 6845 ± 2279 steps per day, WRT = 4823 ± 1758 to 6859 ± 2012 steps per day). WRT significantly (P < 0.001) increased both upper (100 ± 15 to 113 ± 18 kg) and lower (102 ± 20 to 116 ± 25 kg) body strength compared with W. WRT significantly decreased waist circumference (94.8 ± 12.3 to 92.9 ± 12.0 cm, P = 0.021) and total fat mass (42.6 ± 11.1 to 41.8 ± 10.8 kg, P = 0.036) compared with W. WRT also significantly decreased pre- to postintervention body fat (45.8% ± 6.2% to 45.3% ± 6.2%, P = 0.018), HbA1c (5.9% ± 1.2% to 5.6% ± 1.0%, P = 0.028), and mean glucose calculated from HbA1c (122 ± 39 to 114 ± 32 mg·dL(-1), P = 0.028), whereas W showed no changes. Blood pressure, HDL cholesterol, triglycerides, and C-reactive protein were not affected by either intervention. Although both interventions increased steps per day, WRT was more effective in improving several body composition measures and glucose control in 12 wk. WRT may be an important addition to a lifestyle intervention aiming to facilitate reductions in cardiovascular disease risk factors in overweight and obese African-American women.

A Single A1C ≥ 6.5% Accurately Identifies Type 2 Diabetes/Impaired Glucose Tolerance in African Americans

In 2010, the American Diabetes Association revised its criteria for the diagnosis of diabetes to include A1C ≥ 6.5%; however, this has remained controversial, particularly for African Americans. The objective of this pilot study was to examine the usefulness of a single A1C determination in comparison with a same day 2-hour oral glucose tolerance test to diagnose type 2 diabetes in African Americans. In sum, 195 oral glucose tolerance tests and A1Cs were obtained on the same day from 77 overweight and obese African American women and 6 men over a period of 15 months. A1C ≥ 6.5% was present in 31 of 195 patients, with 15 of these having type 2 diabetes by oral glucose tolerance test, another 12 having impaired glucose tolerance, and 4 having normal glucose tolerance. This gives a sensitivity of 50% and a specificity of 90%, with a positive predictive value of 48% and a negative predictive value of 91%. A1C ≤ 5.6%, proposed by the American Diabetes Association to indicate normal glucose tolerance, was present in only 28 patients, 10 (35.7%) of whom had normal glucose tolerance, whereas 18 (64.3%) had either impaired glucose tolerance (15 patients) or type 2 diabetes (3 patients). Fasting plasma glucose ≥ 126 mg/dL was present in 5 of 29 patients with type 2 diabetes (sensitivity, 17.2%; specificity, 100%). First, A1C ≥ 6.5% was a good "rule in" value to identify impaired glucose tolerance and type 2 diabetes (ie, patients at high risk for micro- and macrovascular complications). Second, A1C ≤ 5.6% did not rule out impaired glucose tolerance or type 2 diabetes. Last, fasting plasma glucose ≥ 126 mg/dL detected less than 1 in 5 cases with type 2 diabetes.

Bone Mineral Density as a Predictor of Atherosclerosis and Arterial Wall Stiffness in Obese African-American Women

Bone demineralization is associated with higher cardiovascular event rates, possibly due to vascular calcification and accelerated atherosclerosis. African-Americans have less bone loss and less calcium content within atherosclerotic plaques. However, whether loss of bone mass is related to atherosclerosis has not been examined in African-Americans. The objective of this study was to evaluate possible associations between bone mineral density (BMD), carotid intimal-medial thickness (CIMT), and arterial stiffness. We studied 100 obese African-American women (BMI: 26.6 ± 6.2; age: 63 ± 14 years) referred for BMD estimation by dual-energy X-ray absorptiometry scan. BMD (g/cm²) was obtained at the lumbar spine (L1–L4), femoral neck, and total hip. Arterial stiffness was evaluated by the heart rate-corrected augmentation index (AI@75) and pulse wave velocity (PWV) using applanation tonometry. CIMT was measured by vascular ultrasound. Mean CIMT, AI@75, and PWV were 0.72 ± 0.14 mm, 28.8 ± 9.0%, and 8.9 ± 1.6 m/s, respectively. Mean BMD values at the lumbar spine, femoral neck, and hip were 0.96 ± 0.19, 0.80 ± 0.16, and 0.91 ± 0.17 g/cm². Older subjects had higher CIMT (r = 0.61, p < 0.001) and AI@75 (r = 0.42, p < 0.001). There was a significant correlation between AI@75 and CIMT (r = 0.45, p < 0.001). BMD was negatively correlated with AI@75 (lumbar: r = –0.22, p = 0.03; femoral neck: r = –0.24, p = 0.01; hip: r = –0.21, p = 0.03). BMD was unrelated to CIMT (lumbar: r = –0.09, p = 0.42; femoral neck: r = –0.15, p = 0.17; hip: r = –0.13, p = 0.23). On multivariate analysis, age (p < 0.001), hypertension (p = 0.02), and lumbar BMD (p = 0.01, R² = 0.30) were independent predictors of increased AI@75 after adjusting for age, height, and cardiovascular risk factors. These findings were unchanged upon substitution of femoral neck BMD (p = 0.05, R² = 0.28) into the model. There was a trend with hip BMD (p = 0.06, R² = 0.28) in the regression model. Age-matched comparison between normal BMD (n = 25) and osteoporotic patients (n = 34) demonstrated a significant difference in AI@75 (26.6 ± 8.9 vs. 31.6 ± 9.1%, p = 0.04). In summary, women with lower BMD had increased arterial stiffness. There was no relationship between BMD and atherosclerosis. In conclusion, age, hypertension, and BMD are independent predictors of higher arterial stiffness. Vascular changes are related to bone mineral loss, suggesting lower BMD may increase cardiovascular risk in African-Americans.

Ethnic disparity in spontaneous preterm birth and maternal pre-pregnancy body mass index

To investigate differences in pre-pregnancy BMI status in patients with spontaneous preterm birth (PTB) compared with term birth and assess the role of ethnicity as a risk modifier in BMI-associated PTB. A case-control study involving self-reported African American and Caucasian women delivering singletons in Nashville, TN, USA, 2003-2009. Maternal pre-pregnancy BMI was recorded in 447 PTB-cases (African American = 145, Caucasian = 302) and 1315 term-birth controls (African American = 522; Caucasian = 793). Crude and adjusted odds ratio (OR and AOR) for PTB were calculated using normal BMI (18.5-24.9 kg/m(2)) as reference. Age, education, marital status, income, smoking, parity, previous PTB and pregnancy weight gain were included as covariates in logistic regression. No significant differences were noted in the OR for PTB among different BMI categories when women of different ethnicity were combined. Odds of PTB were greater in obese than in normal weight Caucasian women, even after adjusting for confounders (AOR = 1.84, 95%CI [1.15, 2.95]). Obese African American women had a decreased crude OR for PTB, although this was not significant after adjusting for confounders (AOR = 0.72, 95%CI [0.38, 1.40]). The odds for early PTB (<32 weeks) were decreased in obese compared with normal weight African American women (OR = 0.23, 95%CI [0.08, 0.70]), whereas they were increased in obese compared with normal weight Caucasian women (OR = 2.30, 95%CI [1.32, 4.00]). The risk for PTB in women with different pre-pregnancy BMI categories differs according to ethnicity.

Coping With Perceived Racism: A Significant Factor in the Development of Obesity in African American Women?

African American women have the highest rates of obesity in the United States. The prevalence of obesity in this group calls for the identification of psychosocial factors that increase risk. Psychological stress has been associated with obesity in women; however, there is scant literature that has explored the impact of racism on body mass index (BMI) in African American women. The current study aimed to determine whether emotional responses and behavioral coping responses to perceived racism were associated with BMI in African American women. A sample of 110 African American women participated in a community-based study. Height and weight measurements were taken to calculate BMI and participants completed the Perceived Racism Scale and the Perceived Stress Scale. Hierarchical regression analyses demonstrated a significant relationship between BMI and behavioral coping responses to perceived racism. Findings for emotional responses to perceived racism and appraisal of one's daily life as stressful were nonsignificant. Mean comparisons of BMI groups showed that obese African American women used more behavioral coping responses to perceived racism as compared to normal-weight and overweight women in the sample. Findings suggest that behavioral coping responses better explained increased risk for obesity in African American women. A biobehavioral pathway may explain this finding with a stress-response process that includes cortisol reactivity. Maladaptive behavioral coping responses may also provide insight into obesity risk. Future research is needed to determine which behavioral coping responses place African American women at greater risk for obesity.

Plasma Estradiol Concentrations at Rest and Exercise in Obese and Lean Women

Plasma estradiol concentrations are typically elevated in obese African American women with upper body adiposity. Exercise may alleviate higher than normal estradiol concentrations. However, direct evaluations of plasma estradiol with ethnicity and adipose phenotype at rest and exercise in obese women are limited. PURPOSE: There were two purposes for the study: 1) to determine if a relationship exists between mean immediate-post exercise plasma estradiol concentrations and two predictor variables: ethnicity (African American and Caucasian) and adipose phenotype (lean, upper body adiposity, lower body adiposity), and 2) to determine if a relationship exists between mean resting plasma estradiol concentrations and two predictor variables: ethnicity and adipose phenotype. METHODS: Seventy-two women completed the study. We evaluated anthropometrics and estimated VO2max utilizing a treadmill and modified Balke protocol. Adipose phenotype was determined by the waist hip ratio and body mass index, while body fat percentage was determined via DXA on day 1. Plasma estradiol was measured at rest and immediate-post 30-minutes of walking at a moderate intensity (40-60% heart rate reserve) on day 2. RESULTS: Forward multiple linear regression indicated that ethnicity (E) and adipose phenotype (AP) did not predict immediate-post exercise (E, r = -.158; AP, r =.002) or resting (E, r = -.203; AP, r =.018) follicular-phase plasma estradiol concentrations. Further, ANCOVA analysis revealed no significant difference in immediate-post exercise or resting estradiol concentrations by ethnicity or adipose phenotype while controlling for resting plasma estradiol concentrations. CONCLUSION: A novel finding of this research revealed that immediate-post plasma estradiol concentrations were similar across the groups after moderate intensity exercise. Also, resting plasma estradiol concentrations were similar across the groups. Further research should examine the physiological response of plasma estradiol following moderate intensity endurance exercise in women who have been identified as possessing higher than normal plasma estradiol concentrations.

Barrier Removal in Increasing Physical Activity Levels in Obese African American Women with Disabilities

This pilot study examined the effectiveness of a telephone-based intervention to increase physical activity in obese African American women with mobility disabilities by targeting the removal of barriers to participation. Severely obese (mean body mass index [BMI] = 49.1 kg.m²) African American women (n = 33) with mobility disabilities completed a 6-month telephone-based physical activity coaching intervention. The major environmental/facility barriers at preintervention were cost of the program (66.7%), lack of transportation (48.5%), not aware of fitness center in the area (45.5%), and lack of accessible facilities (45.5%). The major personal barriers were pain (63.6%), don't know how to exercise (45.5%), health concerns (39.4%), don't know where to exercise (39.4%), and lack of energy (36.4%). Despite only two personal barriers being significantly lower at posttest (don't know where to exercise and don't know how to exercise) (p < 0.01), total exercise time increased from < 6 minutes/day to 27 minutes/day at posttest (p < 0.001), and total physical activity time (structured exercise, leisure, indoor and outdoor household activity) increased from 26 minutes/day to 89 minutes/day at posttest (p < 0.001). Interventions aimed at increasing physical activity participation among obese African American women with mobility disabilities should start with increasing their awareness/knowledge on where and how to exercise. Other reported barriers (e.g., cost, transportation, finding an accessible facility, health concerns, pain) may not be as critical to alter/remove as identifying where participants can exercise (i.e., home, outdoors, gym) and providing them with a variety of routines that can be performed safely in their desired setting.

Neighborhood Socioeconomic Status in Relation to 10‐Year Weight Gain in the Black Women's Health Study

We prospectively assessed the association of neighborhood socioeconomic status (SES) with 10-year weight change and with incident obesity among 48,359 women in the Black Women's Health Study (BWHS). Lower neighborhood SES was significantly associated with 10-year weight gain after adjustment for individual SES and behavioral variables, such as physical activity and caloric intake. Low neighborhood SES was also associated with increased incidence of obesity during 10 years of follow-up among women of normal weight at baseline (BMI <25kg/m(2)). The associations were most evident among BWHS participants who had graduated from college. These prospective data suggest that lower neighborhood SES contributes to overweight and obesity in African-American women.

Impact of Obesity on Metabolic Syndrome CVD Risks in African American Woman

PURPOSE: The purpose of this study was to determine if cardiovascular diseases (CVD) metabolic syndrome risk factors (blood pressure (BP), total cholesterol (TC), high density lipoprotein, low density lipoprotein, triglyceride, and glucose) for normal weight (NW) African American women (AAW) would be different than for obese (OB) AAW and if values for either group would be different than healthy values published in the literature. METHODS: Fifty-two AAW (31.0 ± 10.5 years of age) were evaluated for body composition with DXA and BIA percent body fat (%fat), abdomen skinfolds (Abd-sf), waist circumference (waist C), waist C to hip C ratio, along with blood parameters and BP variables. The participants were divided into NW those < 30 %fat (N =21- DXA %fat 22.2 ± 4.6%) and OB those ≥ 30 %fat (N=31- DXA %fat 39.7 ±4.9%). Blood parameters and BP of the two groups were evaluated for differences and relationships. RESULTS: The OB group had larger values for waist C, Abd-sf, DXA and BIA %fat (p < 0.05). There were no differences for any of the blood parameters or BP variables between the two groups. All blood parameters and BP values were within acceptable healthy ranges for both groups. There were no relationships (p > 0.05) between body composition and any of the blood parameters or BP variables, except glucose was related to waist C (r = 0.49; p<0.05) in the NW women and TC was related to DXA %fat (r = 0.41; p <0.05) in the OB women. CONCLUSIONS: These data suggest that the influence of obesity on CVD in AAW occurs via a pathway different than typically reported in the literature for other populations. Thus, the health hazards of obesity in AAW may be more or less severe than typically reported.