UNIVERSIDADE TÉCNICA DE LISBOA FACULDADE DE MOTRICIDADE HUMANA Predictors and Methological Issues in Tracking Total Body Fat Mass, Trunk Fat, Mass and Abdominal Fat Mass Changes in a Weight Loss Intervention with Overweight and Obese Women Dissertação apresentada com vista à obtenção do grau de Doutor no Ramo de Motricidade Humana, Especialidade de Saúde e Condição Física Orientador: Doutor Luís Fernando Cordeiro Bettencourt Sardinha, Professor Catedrático da Faculdade de Motricidade Humana Júri: Presidente Reitor da Universidade Técnica de Lisboa Vogais Doutor José Alberto Ramos Duarte, Professor Catedrático da Faculdade de Desporto da Universidade do Porto Doutor Davide Maurício Costa Carvalho, Professor Associado da Faculdade de Medicina da Universidade do Porto Doutor José Henriques Fuentes Gomes Pereira, Professor Catedrático da Faculdade de Motricidade Humana da Universidade Técnica de Lisboa Doutor Luís Fernando Cordeiro Bettencourt Sardinha, Professor Catedrático da Faculdade de Motricidade Humana Doutora Maria Isabel Caldas Januário Fragoso, Professora Associada da Faculdade de Motricidade Humana da Universidade Técnica de Lisboa Teresa Cristina Lourenço Branco Março 2012 CONTENTS __________________________________________________ Abbreviations.......................................................................................................3 Chapter 1 – General Introduction....................................................................5 Introduction.....................................................................................................6 Human Adiposity Anatomy and typology of body fat..................................................................8 Human Body Fat and Health Total body fat and health...............................................................................15 Abdominal body fat and health......................................................................21 Physical Activity and Human Body Physical activity and total body fat................................................................31 Physical activity and abdominal body fat......................................................40 Human Body Composition Methodology......................................................44 Dual energy X-Ray absorptiometry...............................................................45 Accuracy of dual energy X-Ray absorptiometry............................................47 Reliability of dual energy X-Ray absorptiometry..........................................51 Regional estimations by dual energy X-Ray absorptiometry.........................52 Anthropometry..............................................................................................55 Accuracy of anthropometry...........................................................................64 Reliability of anthropometry..........................................................................65 Human Body Composition Methodology – Conclusion................................67 References..........................................................................................................69 Chapter 2 – Methods..........................................................................................91 Sample...............................................................................................................92 Intervention........................................................................................................93 Body Composition Measurements....................................................................94 Statistical Analysis............................................................................................97 References.........................................................................................................99 Chapter 3 – What baseline anthropometric measurements predict changes in total body, trunk, and abdominal fat mass with DXA and morphologic markers? .......................................................................................................100 Abstract ...........................................................................................................101 Introduction..................................................................................................... 102 Methods……………………….......................................................................103 Results.............................................................................................................107 Discussion........................................................................................................111 Conclusion.......................................................................................................115 References.......................................................................................................116 Chapter 4 – The association between type and intensity of physical activity and changes in total and abdominal fat mass during weight reduction in overweight and obese women…………………..…………………………......................119 Abstract…........................................................................................................120 Introduction………………………….............................................................121 Methods…………………...............................................................................122 Results………………………….....................................................................128 Discussion…………………............................................................................131 Conclusion……...............................................................................................135 References…………………………................................................................137 Chapter 5 – Usefulness of anthropometric measurements in predicting DXA- based measures of adiposity in a weight loss intervention.............................140 Abstract…........................................................................................................141 Introduction………………………….............................................................142 Methods…………………...............................................................................143 Results………………………….....................................................................148 Discussion…………………............................................................................151 Conclusion……...............................................................................................154 References…………………………...............................................................155 Chapter 6 – General Discussion .....................................................................157 References…...................................................................................................167 Chapter 7 – Summary .....................................................................................170 Acknowledgements................................................................................. ....177 ABBREVIATIONS ______________________________________________________ AC - Abdominal circumference ACC - Abdominal circumference change AF-ROI - Abdominal fat region of interest (region of interest between L2-L4, excluding lateral subcutaneous fat) AF-ROIC - Abdominal fat region of interest change AT - Adipose tissue BMC – Bone mineral content BMD – Bone mineral density BMI - Body mass index BW - Body weight BWC - Body weight change CHD – Cardiac heart disease CKD - Chronic kidney disease CT - Computed tomography CV - Coefficients of variation %CV - Coefficients of variations DLW - Doubly labeled water DXA - Dual energy x-ray absorptiometry EI - Energy intake FFAs – Free fatty acids FFM - Fat-free mass FM - Fat mass %FM – Percent fat mass HC - Hip circumference HCC - Hip circumference change ICC - Intraclass coefficient of correlation IDF - International Diabetes Federation IPAQ - International physical activity questionnaire LPL - Lipoprotein lipase LPTA - Leisure-time physical activity MPA - Moderate physical activity MPAC - Moderate physical activity change MRI - Magnetic resonance imaging PCOS - Polycystic ovary syndrome REE - Resting energy expenditure R - Reliability coefficients SEE – Standard error of measurement SD – Standard deviation SD - Sagital diameter SDC - Sagital diameter change SIT - Total minutes sit SITC - Total minutes sit change TBFM - Total body fat mass TF-ROI - Trunk fat region of interest TEM - Technical error of measurement TBFMC - Total body fat mass change TF-ROIC - Trunk fat region of interest change TPA - Total physical activity TKD -Total calories spent per day TKDC -Total calories spent per day change TPAC - Total physical activity change VPA - Vigorous physical activity VPAC - Vigorous physical activity change WAT - White adipose tissue WC - Waist circumference WCC - Waist circumference change WHR – Waist to hip ratio WK - Total minutes walking WKC - Total minutes walking change CHAPTER 1 ______________________________________________________ GENERAL INTRODUCTION General Introduction ______________________________________________________ Obesity is a major public health problem among developed and less developed countries. Obesity has been shown to be associated with chronic diseases and health conditions such as heart disease, diabetes, cancer, hypertension, and hiperlipidemia (1-3). The risk associated with obesity is becoming a global health hazard. Until 1999 it was estimated that approximately 64.5% of USA adults over the age of 18y have