Associations

of body fat and its distribution with dietary

intake, physical activity, alcohol, and smoking
in blacks and whites13
Martha
L Slattery,
Arline McDonald,
David R Jacobs Jr, and Kiang Liu
Cross-sectional

and its distribution

associations

and environmental

between

factors

Bette

J Caan,

fat
energy

tivity)

E Bud,

body

influencing

balance
were examined
in 5 1 1 5 young
adults.
Protein
was directly associated
with body mass index (BMI) in all race and sex

groups
alcohol
hydrate
=

(P < 0.01)

intake,
intake

0.02).

Total

inversely

ories)

from

was

inversely

associated

associated

with

percent

in whites,

of kilojoules

grams

in black

was

consistently

KEY

intake,

WORDS
physical

Am

and

with

associated
J Clin Nutr

Alcohol,
activity

total
with

fiber/4

184

activity (except
with cigarette
alcohol

intake

WHCR

in

in all race

l992;55:943-9.

fat, cigarette

body

(kilocal-

of crude

except

men,

with

measures
(P
ratio (WHCR)
(kilocalories)
in

smoking

sex groups.

smoking,

dietary

hip

may

circumference

factors

fat and

associated

its distribution.

study
Adults

only

ac-

energy-yielding
with

body

To examine

these

population
ofyoung
adult men
are participants
in the ongoing

on

Coronary

(CARDIA)

Artery

were

Risk

Devel-

used.

Methods
Data

for these

analyses

were

amination
1985 and

of the CARDIA
1986. The study

and

(48%)

white

amination
women;
than

individuals

MN;

obtained

and

from

Birmingham,

Oakland,

CA.

the study population

40% with a high school
a high

school

during

the

baseline

study,
which
was conducted
population
consisted
of black

education;

consisted
education
and

AL;

exduring
(52%)

Chicago,

At the baseline

ex-

of46%
men and
or less and 60%

54%
with

45%

aged

18-24

y and

55% aged 25-30

y. At subsequent
examinations
it was discovered
that 62 people
were slightly
older
or younger
than
18-30
y at
baseline;
these people
are included
in these analyses.
The study

be related

to the

risk

of developing

CVD

(3-6).

Both genetic and environmental

factors contribute
to body size
and body-fat
distribution
(7, 8). Environmental
factors such as
energy intake and energy expenditure
are related to total body
size in older adults (9, 10), although
their role in body-fat
distribution
has not been thoroughly
examined.
Recent
studies
suggested
that smokers
have more abdominal
adiposity
than do
nonsmokers,
despite
smaller
body sizes (1 1, 12). This finding
supports
the possibility
that cigarette
smoking
influences
bodyfat distribution
as well as overall body size.
The primary
hypothesis
of this study was that when energy
balance is not maintained,
the distribution
ofbody
fat is affected
in addition
to overall
body size. Therefore,
the relationships
between body fat and its distribution,
as reflected
in the waist-towith

in Young

(physical

that

Physical
activity,
a key deterwas examined
as a factor
that

a biracial
18-30 y who

aged

expenditure

are not

its distribution.
expenditure,

collaborative

oprnent

more

The relation
between
total body fat and the development
of
cardiovascular
disease (CVD) as well as risk factors for developing
cardiovascular
diseases
is well established
(1, 2). Limited
data
suggest that the distribution
of fat at various
sites within the
also

national

energy

It is hypothesized
alcohol,

also with
of energy

IL; Minneapolis,

Introduction

body

including

fat but
minant

and women

activity

kcal)(except
in black men), and physical
women).
WHCR
was directly associated

and

nutrients,

and

examined.

physical

carbohydrates

Beer

(kilocalories)],
were

could impact
on body
hypotheses,
data from

Id (1000
in white
men.

[kilajoules

E Hilner,

after age, education,

cigarette-smoking
status,
and physical
activity were adjusted
for. Carbowas inversely
associated
with BMI in males (P

BMI in white women

and with skinfold-thickness
< 0.01) in all groups.
Waist-to-hip-circumference
was positively
associated
with total kilojoules
women,

Joan

ratio

contributing

Am J C/in Nuir

1992;55:943-9.

(WHCR),

to energy
Printed

with

cigarette

smoking

energy

and

balance,

total

intake

in USA.

1992 American

Society

C From
the
of Medicine,
Nutrition
and
Heart, Lung,
Applications,
nente Medical

Department
of Family and Preventive
Medicine,
School
University
of Utah, Salt Lake City; the Department
of
Medical Dietetics, University
ofillinois,
Chicago; National
and Blood Institute,
Division ofEpidemiology
and Clinical
Bethesda,
MD; the Division
of Research,
Kaiser Perma-

Care Program (Northern

California Region), Oakland,
CA; the CARDIA
Coordinating
Center, University
of Alabama
at
Birmingham;
the Division
of Epidemiology,
Minneapolis;
and the Department
ofCommunity
Medicine,
Northwestern
University
Medical
2 Supported
by contracts
N01-HC-48047,
48049, NOl-HC-48050,
and NOl-HC-95095

University
of Minnesota,
Health and Preventive
School, Chicago.
N0l-HC-48048,
N01-HCfrom the National
Heart,

Lung, and Blood Institute, National Institutes of Health, and a small

research award from the Department
ofFamily
and Preventive
Medicine
at the University
of Utah.
3 Address
reprint requests to ML Slattery, Department
ofFamily
and
Preventive
Medicine,
School ofMedicine,
University
ofUtah,
Salt Lake
City, UT 84132.
Received
August 8, 1991.
Accepted for publication October 16, 1991.
for Clinical

Nutrition

943

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

ABSTRACf

Diane

SLATTERY

944
was

designed

so that

for all centers;

cific.

Study

design

detail elsewhere
methods,
results
adults

methods

however,

with

of data

collection

recruitment

and

were

methods

recruitment

methods

the

same

were

center-spe-

were

reported

range

ofyears

ofeducation

and

methods
used to obtain
the data presented
below.
The study was conducted
according
lines of the participating
study centers.

in duplicate

protrusion
in

income.

AL

measured

(13). Because
ofthe studys goals and recruitment
from this study pertain
to black and white young

a wide

ET

The

here are described

to the ethical
guide-

of the

of the
duplicate

WHCRs

used

as weight

size

Dietary-intake

data

questionnaire
ticipants

were

month

asked

obtained

from

a detailed

for the CARDIA

to recall

their

study

usual

of the

questionnaire

the

University

trient database
the diet-history

of Minnesota

tape 10(17).
questionnaire

Alcohol
and

used

consumed

in these

Physical

per

week.

tivities

were described
to nutrients
by
Center

nu-

were

over

the

for the CARDIA

Time
Physical

past

example,

moderate
energy

jogging

and intense
expenditure

as intense

an activity

requiring

Physical-activity

the

of months

for

than

activity

(20).

1 h by the
Data

from

degree

a test

types of ac-

questionnaire

was

Activities

categories,
associated

expenditure.
number

various

This

a phys-

(18) and was patterned

after
Questionnaire
developed
by
type of activities
engaged
in

ofenergy
multiplying
more

by using

the
of performance.

was classified

ing was considered

year.

study
Activity

Taylor et al (19) to ascertain

and the degree
of intensity
grouped
into
predetermined

were

depending
on the
with them.
For

activity
a more

whereas

bowl-

moderate

degree

units

were calculated
by
the activity
was performed
of intensity

with

assigned

to the

a symptom-limited

exercise

treadmill
were used as an estimate
of physical
fitness.
Scores
for
total activity
and for the subset
of intense
activities
were significantly
test,

associated

with

as assessed

Body
brated

with

weight

ipant.

Fifty

the exercise

treadmill

on the treadmill

to the nearest
wore

light

0.5 cm with
shoes.
Triceps,
were

measured

Harpenden

twice

calipers.

at standard

millimeters

(20).

0.2 kg with

clothing;

was

height

a vertical
ruler
subscapular,
to the
Each

nearest

sites on the right

was

used

as the

measured
abdominal

in duplicate
girth.
Hip

a cali-

was

mea-

while subjects
and suprailiac

skinfold

millimeter
thickness

was

side of the partic-

value

skinfold
thickness
was too thick
to measure,
the maximum
that could
be measured
with
circumference
at the minimum

sites.

Each

separately.

skinfold

The

mea-

WHCR

was

for

well

waist

outside

and

hip

in recording

10 white

men;

the

overall

distribution

circumference

a WHCR
a WHCR

>

values
1.05

>

1.0 for

for

were

1 3 black

1 5 black

women

women).

Other variables
Demographic
variables
examined
were educational
level, race,
age, and sex. Smoking
status
was obtained
from a self-reported
smoking
history
and subjects
were classified
as having
never
smoked
or as exsmokers
or current
smokers.
ofcigarettes
smoked
per day was used in some
for smoking.
Because
cigarette
olism and thus influence
energy

smoking
balance

The usual number

analyses
to control

can alter basal metab(2 1 ), smoking

status
is

indicating

that

because
this was
the calipers.
Waist

to the

nearest

circumference

0.5

cm

also was

of analyses

Analyses

sex and

of the
race

selected

stratum

smoking

(22).

variables

of the

were used to determine

tribution
with dietary
Both

linear

and

of total

calories

from

amount

ofcrude

fiber

measures

to standardize

was examined

along

fiber

were

fat, protein,

associations

were

cx-

as a percentage

or carbohydrate

kJ (1000

each

fat and its disalcohol,

and

expressed
kcal).

for caloric

with

for

techniques

of body
activity,

quadratic

variables
per 4184

performed
Regression

the associations
factors,
physical

Dietary-intake

density

were

population.

amined.

and

We used

as the

nutrient-

consumption.

the energy-yielding

Crude

nutrients

be-

cause it could alter fat absorption.

Alcohol
was examined
as the
number
ofgrams
consumed
per day, grams consumed
per 4184
kJ (1000 kcal), and drinks consumed
per week. A 0.360-L
beer,
a 0. l2-L

glass

ofwine,

and

0.0045-L

ofliquor

were

defined

To determine

whether

fold-thickness
overall
body

measurements
size, BMI was

and WHCRs
were independent
of
controlled
in the analyses
of those

anthropometric

measures.

Total

smoking
status,
and total
same
model
to determine
variables

ponents

were

to determine
its distribution.

on
then

body

fat and

independent
Alcohol-intake

between

physical

caloric
intake
the independent

substituted

their

associations

each

as one drink.

these

subjects

thicknesses

calibrated

measured

sustained

was measured

while

to the nearest
not wearing

skinfold

during

measures

scale

sured
were

performance

by the duration

Anthropomeiric

the

errors

Methods

physical
activity
was ascertained
history
questionnaire
describing

developed
the Leisure

three

presented.

analyses.

performed

values

and

activity

Individual
ical-activity

ofthe

evaluated

body

(BMI), calculated
averages
for skin-

mass

were

of the

of alcohol

body

each
was

variable;

for 7 white

estimates

of body

of total

WHCR

intake
was estimated
from
was expressed
as grams
of

Both

of location

measures

for this

alcohol consumed
per day. A second estimate
of alcohol intake
was obtained
from a separate
questionnaire,
which defined
alcohol intake in terms of the number
of drinks of various types
of alcohol

two

their

men

Coding

fat and

The

past

and

Nutrition

for

par-

and

results

and

of central
adiposity.
Forty-five
individuals
the analyses
of central
adiposity
because

considered

the

averages

thicknesses

as an indicator
excluded
from

and methods
of prepmethods
concerning

study on comparative
validity
ofthe questionnaire
previously
(1 5, 16). Food items were converted
using

the

maximum

The

activity,
were

Dietary

for total

associations
variables

with
and

alcohol,

assessed
in the
effects
of each of

its distribution.

in the model

skin-

com-

caloric

intake

body

fat and

physical-activity

units
were transformed
by using
a log transformation
before
analyses
because
the distributions
ofthese
variables
were skewed.
When it was necessary
to categorize
data, the race- and sexspecific
proximate

distributions
quartiles.

for those

variables

were

divided

into

ap-

Results
The
given

mean
in Table

and the standard

error of the study variables
are
1 Black men had smaller
tricep
and suprailiac
.

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

administration

Study

during

at the

used
were

diet-history

(14).

intake

by reporting
amounts,
frequency,
of foods consumed.
Quality-control

aration
the

were

developed

cm

index
(m2), and the sum ofthe
were

from
also

body

analyses.

(kg)/height
site

0.5

of the buttocks.
for skinfold

of total
used

fold thicknesses

intake

level

in the analyses.

in these

fat or body

surement
Dietary

used

indicators

fat were

nearest

at the

measurements

were

Several

to the

hips

BODY
TABLE
1
Values for selected

variables,

FAT

AND

Black

men

White

24.6
10.8
13.8
16.3
40.4
0.817

(mm)

0.13

24.3
12.3
13.6
19.4
45.1
0.839

0.19
0.21
0.31
0.66
0.001

16 903 298
38.2 0.17
14.4 0.07
45.0 0.21
1.7 0.02
17.90.13
17.5 0.94

men

11Significantly

0.10
0.19
0.30f
0.59
0.OOlf

509.7
168.1
341.6

36.9 [423]
9.3 [106]
53.8 [616]

women

25.9
22.2
20.0
20.5
61.5

0.18f

White

0.17

23.1

0.12

0.27

20.2

0.22

0.29

15.2 0.23
17.8 0.27

0.82

52.7

0.002

2.0

8 937 l03
36.5 0.l8
15.4 0.08

0.20

46.8

0.02

2.6 0.04
18.30.14*

17.40.12
5.5

0.65
0.00l

0.726

10 837 149
37.7 0.16
14.2 0.07
47.7

women

(n= 1286-1306)

0.31

0.742

13 774 l75
37.3 0.l7t
15.3 0.07f
44.8 0.20
2.1 0.02f
l8.70.l5
16.8 0.70

534.9 10.1
158.1 3.6
376.7 7.7

skinfold
women

different

0.33

8.5

0.2011

0.32*

8.8

277.8

5.9

399.5

7.2*

3.2cc

108.0

2.4

143.9

2.7*

6.9t

169.9

4.4

255.7

5.7

26.5 [307]j
15.7 [l82]t
57.8 [67l]**

measures
had smaller
site

from

men:

0.001,

<

and WHCR
than
did
BMIs,
smaller
skinfold

measured,

and

Blacks consumed
and percentage

black

<

**

31.3 [461]
8.6 [127]
60.1 [885]

27.3 [355]**
20.1 [26lJt
52.7 [685]f

0.05.

from black women: P < 0.001, lIP < 0.01.

was reported
by 277 black men, 172 white

different
consumption

#{182}
No alcohol

smaller

white
men.
measurements

WHCRs

than

black

diets higher in total kilojoules

of kilojoules
(kilocalories)
from

White
for
women.

men,

525 black

upper
one

quartile

Americans.

alcohol,

bution

more

both

in volume

and

significant

group

The
within

had

the

greatest

mean

BMI,

race-

physical

WHCR,

and

alcohol

for blacks

intake

was inversely

blacks

and

0.001).

was

Reported

sum

of total

and

2 and

with

associated

energy

intake,

WHCR

activity

status

in Table 3. Energy
(P
0.03) among

BMI

with

physical

thicknesses

cigarette-smoking

for whites

and

in women

was negatively

(P

asso-

were

consumed

lower

did men
amounts

or one

who

to two drinks

did not consume

of alcohol

per

day

per day

alcohol

(P

had

larger

or who

< 0.0 1). The

that

than
than

Although

qua-

were

not

any
also

of energy

0.02).

Total

associated

ciated

WHCR

in all groups

with

with

ofthe

BMI

(kilocalin all race

carbohydrate

BMI

associated
significantly

ex-

analyses

of kilojoules

associated

intake
was inversely
crude
fiber intake
was

with

intensities

as a percentage

directly

inversely

its distri-

energy-yielding

multivariate-regression

P values

(all

fat and

activity,

different
in

Carbohydrate
whites
and

intake

among

men.

with WHCR
in
inversely
asso-

population

except

black

men (Table 4). No dietary

factors were consistently
associated
with the skinfold measurements
across race and sex groups (data
not shown).
Activities

when

g alcohol/d

less

WHCRs

these environmental
did not observe

of body

physical

and

intake,
was

sex groups

sumed

than

diet

4). Protein

significantly

13-26

smoked.

associations

and

examined

consumed,

ciated
with the sum of the skinfold
measurements
as well as
with each of the three individual
skinfold
measurements
in all
race and sex strata (P
0.002; data not shown). Men who con-

WHCRs

never

the associations
intake

of the

penditure

(Table

quadratic

dietary

was significantly

of skinfold

quartiles

associated
total

smokers.

intake,

in Table

directly

of current

and

sex-specific

activity,

are shown

number

population
blacks
as a

who

was

larger

were examined
between
body-size
variables,
we

explore

with

ories)

ofthe
study
cigarettes;

in women
had

linearly.

amount
(50-60%)

majority
smoked

intake
smokers

or individuals

To further
components

activity.
The
never having

women.

alcohol

Current

significant

as a percentage
ofcalories,
than did women.
Men reported
more
total physical
activity
as well as more
activities
of an intense
nature
than did women,
with black women
reporting
the smallest
ofphysical
reported

day.

dratic associations
variables
and the
statistically

consumed

and 231 white

of total

per

did exsmokers

(kilocalories)
fat and from

counterparts.
Women
conId (1000
kcal) than did men;
crude
fiber than did African

Men

women,

drink

carbohydrate
than
their white-sex
sumed
more crude
fiber per 4184
white individuals
consumed
more

<

Black

(n= 1393-1479)

(n= 1157-1171)

SE. n in brackets.

t In kg/m2.
tee Significantly

each

945

of both
associated

a moderate
with

and
BMI.

intense

Activity

degree
of a more

were

not

intense

nature was inversely

for white women.
duration

physical

activity

Activities

ofa

associated
with WHCR
in all groups except
Similar
patterns
of association
were noted
on the treadmill
was used as an indicator
of
rather

moderate

than
nature

reported
were

intense
not associated

physical
with

activity.
WHCR

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

Anthropometry
BMIt
Triceps (mm)
Subscapular
(mm)
Suprailiac
(mm)
Sum ofskinfold
thicknesses
Waist-to-hip
ratio
Dietary intake
Energy (kJ)
Fat (% Id)
Protein (% Id)
Carbohydrate
(% kJ)
Crude fiber (g/4l84
Id)
Starch(g/4l84kJ)
Alcohol (g)1J
Physical activity (PA units)
Total activity
Moderate
activity
Intense activity
Smoking
status
Current
smoker (%)
Exsmoker
(%)
Never smoked (%)

DISTRIBUTION

by race and sex*

(n= 1134-1157)

ITS

946

SLATTERY

TABLE

Values
intake,

ET

AL

TABLE

for anthropometric
physical activity,

variables
within the categories
energy
alcohol,
and smokingstatus
for blacks

Values
intake,

3
for anthropometric
physical activity,

variable within the categories

energy
alcohol, and smoking
status for whites*

Sum of
skinfold

Sum of
skinfold

BMI

thicknesses

WHCR

BMI

Men
41.0
40.2
40.2
40.6
0.77

0.818[286]
0.8l7[28l]
0.816 [282]
0.816 [278]
0.53

24.6
24.8
24.2
24.6
0.7 1

42.9
41.2
39.7
38.1
<0.001

0.817
0.817
0.817
0.816
0.77

[288]
[279)
[284]
[276]

24.7
24.8
24.0
24.7
0.62

41.7
40.1
39.9
40.4
0.28

0.813
0.815
0.815
0.823
0.01

[271]
[295]
[280]
[281]

24. 1
24.8
24.9
0.02

39.3
40.9
41.3
0.08

0.8 18 [409]
0.817 [104]
0.816 [604]
0.7 1

Current

9707
9708-12719
12 720-16 242
>

16 242

Linear trend P
Physical activity (PA units)
288
288.1-462.5
462.6-672.0
>672.0
Linear trend P
Alcohol intake (g/d)
None
0.1-10.17
10.18-23.0
>23.0
Linear trend P
Smoking
status
Current
smoker

26.3
26.4
25.9
24.9
0.003

62.6
61.3
59.9
62.4
0.61

0.733 [365]
0.741 [357]
0.744[362]
0.748 [363]
<0.001

units)

0.59

47.2
44.9
43.7
45.0
0.04

0.838 [291]
0.835

[284]

0.03
0.837

[170]

0.834

[408]

0.839
0.845
0.009

[288]
[283]

[304]

44.4

0.847

45.0

0.836 [180]

Never smoked
Overall P

24.5
0.09

45.2
0.64

0.835
<0.001

[663]

23.3
23.1
23.1
22.7

52.6
52.0
53.6
52.8

[323]
[323]
[324]
[314]

0.10

0.51

0.722
0.722
0.726
0.735
<0.001

23.6
22.9
23.1
22.7
0.02

54.7
53.9
52.1
50.2
<0.001

0.729
0.724
0.725
0.728
0.66

[325]
[319]
[322]
[318]

24.1
23.0
22.7
22.8
0.0004

53.3
52.4
52.1
53.6
0.87

0.729
0.726
0.725
0.727
0.54

[227]
[418]
[320]
[319]

23.4

50.7

0.732 [350]

23.2
22.9
0.24

53.9
53.4
0.004

0.725
0.723

6594
6595-8263
8264-10602
> 10 602
Linear trend

25.8
25.9
26.0
25.8
0.89

63.2
62.1
62.6
59.4
0.002

26.2
25.3
25.5
26.1
0.91

0.749
0.742
0.739
0.736
<0.001

[364]
[365]
[364]
[354]

62.7
61.3
61.0
60.6
0.07

0.742
0.740
0.740
0.742
0.95

[516]
[212]
[359]
[360]

0.747 [45 1]

Current

0.742
0.738
0.01

Exsmoker
Never smoked
Overall P

Adjusted

alcohol,

for age, education,

smoking,

energy intake,

[124]
[872]

and

lower

than

the n values

into approximate
of the study

given

quartiles

variable.

for WHCR).

on the basis of the

(PA

units)

208
208.1-351.0
351.1-543.0
>543.0
Linear trend P
Alcohol intake (g/d)
None
0.1-4.7
4.8-12.0
>12.0
Linear trend P
Smoking
status

59.8

physical activity; skinfold measurements

and waist-to-hip
ratio (WHCR)
are also adjusted for BMI by linear-regression
technique. n in brackets
(n values for BMI are slightly higher than and n values for sum of skinfold

activity

62.2
62.3
0.03

distribution

24.4
24.1
24.1
24.6

[286]
[286]

24.0

25.3
26. 1
0.24

sex-specific

0.838
0.843

24.0

25.6

divided

48.1
46.0
44.6
41.2
<0.001

0.51

Exsmoker

Physical

P
(g/d)

are slightly

24.3
24.1
24.0
24.6
0.43

0.840 [292]
0.835 [284]

Women
Energy intake (Id)

smoker

t Categories

0.837 [286]
0.838 [285]

0.27

45.0
45.7
44.6
44.6
0.49

24.3

Exsmoker
Never smoked
Overall P

thicknesses

24.5
24.3
23.9

smoker

for age, education,

Adjusted

alcohol,

smoking,

[259]
[675]

0.008
energy intake,

and

physical activity; skinfold measurements

and waist-to-hip
ratio (WHCR)
are also adjusted for BMI by linear-regression
techniques. n in brackets
(n values for BMI are slightly higher than and n values for sum of skinfold
thicknesses
are slightly lower than the n values given for WHCR).

t Categories
sex-specific

divided

distribution

into approximate
ofthe

study

quartiles
variable.

on the basis of the

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

25.1
24.5
24.4
24.3
0.03

Women
Energy intake (Id)

(PA

WHCR

Men
Energy intake (kJ)t

Energy intake (kJ)t

107l9
10720-14489
14 490-20 079
>20 079
Linear trend P
Physical activity (PA units)
270.5
270.6-471.0
471.1-723.0
>723.0
Linear trend P
Alcohol intake (g/d)
None
0.1-6.26
6.27-21.1
>21.1
Linear trend P
Smoking
status
Current
smoker
Exsmoker
Never smoked
Overall P

6807
6808-9410
9411-13443
> 13 443
Linear trend
Physical activity
103.0
103.1-228.0
228.1-396.0
>396.0
Linear trend
Alcohol intake
None
0.1-1.39
1.40-5.58
>5.58
Linear trend
Smoking
status

thicknesses

BODY
except

among

of physical

black

men.

activity

the sum

ofthe

were

Both

moderate

consistently

skinfold-thickness

with

a larger

sociated

with

consumption
women
and
women

When

(kilocalories)
week when

white

wine

not

significantly

alcohol

was

a slightly

positively

black

per week;

Wine

used

with

as a percent

wine

WHCR

of total

conin this

kilojoules

Because

the degree
ofenergy

degree

and

for

for wine

beer

consumption

consumption

among

0.07).

between
WHCR
were examined

association

0.07)

per
ex-

of physical

expenditure

activity

and

thus

is an important
body

size,

and dietary
intake,
alcohol
separately
for individuals
of physical

activity

deter-

the associations

intake,
and smoking
above
and below
the

for their

respective

race

and

sex group. BMI contributed

to the majority
ofthe variability
in
WHCR,
thus these associations
were assessed
with and without
BMI in the model. Although
the patterns ofobserved
associations
were similar
to those
variability
in WHCR
trients,

alcohol,

reported

activity,

physical
blacks,

WHCR

was accounted
than

TABLE

in whom

if they

in WHCR

smoking

(Table
twice
more

varied

6).
as

for by these

were

accounted

(Tables
2-4),
the amount
by these
energy-yielding

and

activity

among
active

presented
explained

active.

for by alcohol

This

was

much
The

if people

amount

also

2.47
9.88
3.73

0.003
0.002
0.006

0.002
0.001
0.002

0.15
0.03
0.0001

0.90
5.24
1.39

2.29
8.12
3.63

0.004
0.003
0.004

0.002
0.001
0.002

0.03
0.009
0.01

0.56
0.98
0.53

1.59
3.20
1.98

-0.007
0.006
+0.003

0.003
0.002
0.003

0.008
0.007
0.93

1.23
1.56
0.84

2.41
3.68
2.68

-0.002
0.004
0.005

0.002
0.002
0.002

0.20
0.004
0.02

adjusted

for age, education,

of cigarettes

smoked
by using

BMI, caloric

per day; wine,

beer,

intake,

and liquor

a log transformation

before

and number

consumption

was

analyses.

white
men,
by alcohol

2.2%
intake

of the
if their

variability
physical

in WHCR
activity
was

physical

activity,

was exof a high

Discussion

were less

ofdietary-intake

and physical-activity

components

In this
by

cigarette

study,
smoking

dietary

intake,

were

significantly

associated

alcohol,
with

both

and
total

on BMI and WHCR

Black men
(n = 1 127)

SE

W hite women

Bla ck women
(n = 1447)

White men
(n = 1 147)

SE

SE

( n = 1284)

fi

SE

intake/d

Fat (% Id)
Protein

(% LI)

Carbohydrate
Crude fiber
Physical

0.74
5.1 1
1.39

Regression

BMI
Dietary

in

varied

SE

degree.

true

of variability

alone

/3

transformed

among
plained

of

variability

SD

degree
of physical
activity.
Among
black
men whose
reported
degree
of physical
activity
was above
the median,
3.7% of the
variability
in WHCR
was contributed
by alcohol
intake
whereas

of
nu-

degree

especially

of the

variables
intake

by the

Model

on WHCR*

Mean
servings/wk
Black men
Wine
Beer
Liquor
White men
Wine
Beer
Liquor
Black women
Wine
Beer
Liquor
White women
Wine
Beer
Liquor

as-

women.

however,

associated

weaker

(P

men

(P

men

median

relations

consumed
rather
than as the number
ofdrinks
assessing
associations,
there were similar
results

black

minant

but

of type of alcohol

(% Id)
(g/4184

activity

Id)

0.02

0.02

0.39

0.03

0.02

0.1

0.12
-0.04

0.05
0.02

0.01
0.02

0.22
-0.08

0.04
0.02

<0.01
<0.01

-0.12

0.17

0.47

-0.30

0.13

0.01

-0.09

-0.03

0.03

0.25

-0.04

0.02

0.03

0.15
0.0004

0.06
0.02

0.02
1.00

0.17
-0.02

0.04
0.02

<0.01
0.23

0. 17

0. 19

0.39

-0.02

0. 10

0.86

0.10

0.93

-0.20

0.09

0.03

0. 12

0. 1 1

-0.20

+0. 12

0.09

(PA units)tt

Intense

Moderate

0.12

0.44

-0.02

0.10

0.81

0.03

0.1 1

0.76

-0.08

0. 1 1

0.47

-0.008

-0.0003
0.00006
0.00008

0.0002
0.0004
0.0002

0.00001

0.0002

0.96

0.0003

0.0002

0.09

0.89
0.61

0.0008
-0.0005

0.0005
0.0002

0.1 1
<0.01

-0.001
0.00007

0.0005
0.0002

0.02
0.69

-0.00007
-0.0003

0.0004
0.0002

0.86
0.05

-0.001

0.002

0.51

-0.004

0.001

<0.01

-0.005

0.002

<0.01

-0.002

0.001

0.05

-0.002
0.0007

0.001
0.0009

0.03
0.47

-0.004

0.001
0.001

<0.01

-0.003

0.0008

<0.01

-0.00004

0.0009

0.97

-0.001

-0.003

0.0009

<0.01

0.001

0.85

0. 18

WHCR
intake/d
Fat (% kJ)
Protein (% U)
Carbohydrate
(% Id)
Crude fiber (g/4184 Id)
Physical activity (PA units)ff
Intense
Moderate
Dietary

Adjusted

for age, education,

t Activity

units transformed
for age, education,

Adjusted

BMI,

total

activity,

0.09

alcohol

intake,

0.0003

and smoking

by using the natural log of the variables.

BMI, total energy intake, alcohol,
and smoking

0.0002

status.
status.

0.1 1

0.23

0.0002

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

for

among

group

was

947

and

associated
with WHCR
in black
with WHCR
in white men. White

the most

was

group.

cept

inversely
associated

consumed

sumption

with

on the observed

DISTRIBUTION
TABLE 5
Linear regression

degrees

for all race

consumption

in every

was
directly

ITS

was evaluated
(Table
5). In all four
beer consumption
was associated

Liquor

WHCR

AND

associated

measurements

WHCR
higher

WHCR.

intense

inversely

sex groups (data not shown).

The effect of the source of alcohol
between
alcohol
and
race and sex groups,

and

FAT

SLATTERY

948
TABLE

Variability

(R2) in WHCR
activity (PA)*

of physical

Model

accounted

Model

Model

Model 1
(high PA)

(low PA)

If

for by study variables,

by degree

Model 2
(low PA)

Model 2
(high PA)

Black men
White

27.4

men

35.7

18.2

11.7

14.1

9.9

35.3

37.0

34.0

9.0

13.2

6.4

Black

women

25.0

30.4

19.1

7.7

9.3

5.3

White

women

25.7

27.3

24.2

8.2

8.2

8.3

S R2 obtained
t Includes age.
arette-smoking

from

linear-regression

status,

and

for low and high degrees

alcohol

intake

of physical

intake,

in the

activity

are

total physical

regression

on

median

and

<

WI-ICR.

AL

intake,

alcohol

consumption,

activity
among

among
individuals

individuals
with low degrees
of activity
than
who reported
high degrees
ofphysical
activity.

We are not sure

possible
physical

from

chance.

study
found

activity,
cigAnalyses

median.

shown

its distribution.

adults,

black men)
was directly

In this cross-sectional

carbohydrates

(in whites)

fiber

(except

in

were inversely
associated
with WHCR,
and protein
associated
with BMI in all race and sex groups
after

the degree
of physical
activity
was adjusted
for. As a percentage
of kilojoules
(kilocalories),
fat was not associated
with body fat
or its distribution.
Physical
activity,
especially
intense
activity,

was

inversely

women)

associated

and

with

skinfold

it was not associated

was positively
associated
the

amount

with

for men,

(except

measurements

consumption

which

may

among

have

groups

associated
had larger

than

did

In addition
amined
suprailiac
(23),

although

was

associations
associated
consumption

with

or exsmokers.

to WHCR,

the distribution

of body

fat was

different

when

examining

physical
been

associations

activity

estimated

between

and cigarette
that

heredity

with skinfold

body-fat

distribution

women

(26,
fat

without

this

fat pattern

27).

accounts

for

20-3

1% of

the variability

in WHCRs
(7, 25). In the present
study
2628% of the variability
in WHCR
was explained
by age, educational
status,
BMI, total activity,
carbohydrate
intake,
smoking
status,
men,

and alcohol
intake
in all race-sex
groups
except
white
for whom
36% of the variability
was explained
by these

variables.
contributed
by BMI.

WHCR,

The

largest

proportion

of the

variability

in WHCR

by the variables
examined
in this study was explained
Thus,
although
protein
intake
was not associated
with
it was consistently
associated
with
BMI and could

therefore
tivity did

influence
WHCR.
Although
not change
the significance

the degree

between
percentage

environmental
variables
and
ofthe
variability
in WHCR

ofassociations

of physical
that

ac-

existed

WHCR,
a much
larger
was explained
by dietary

may

and sex
may be

be explained

exists.

A previous

data were used,

of trunk
fat relative
to

respond

tend

(26).

that

to

body fat
also have

differences

the

here,

the influence

between

lowest
white

women

WHCR
The

were

also

an

well

fat

with

more

do

those

than

with

fat (as

abdominal-

as reduce

blood

that intense
physical
activity
in white women,
the group

WHCR.

ofphysical

no differences

people

differently

body

men

abdominal

and increase
lean body
mass with
individuals
without
this fat pattern
effects with an exercise
training
pro-

pressure)
whereas
the same

mean

that

Individuals

gram.
Results
of this study reveal
was not associated
with the WHCR
with

and

more

shown

exercise

pattern.

Women

having

have

to decrease

lipids and blood

exercise
(27, 28),
do not experience

but

suggested

been

men

Studies

body-fat

In other
activity

above

analyses,

on WHCR

and

in associations

below

the

between

not

shown

was compared
median

physical

WHCR,
activity

and

observed.

associations

of body-fat

indicators

with

dietary

intake

also differed
between
race and sex groups.
Although
the examination
of dietary
intake
in this study
was more
detailed
than
what has generally
been reported,
the data presented
can only
crudely
describe
individual
dietary
intake.
Because
individuals
eat foods and not nutrients
in isolation,
a composite
value for
intake
of fat or for any nutrient
may be the same for individuals
(in grams consumed),
but may be obtained
from entirely
different

take

and

food

its associations
endpoints

can

patterns
expressed
In this population

smoking.

they

sex groups

factors

with

disease

than

skinfold

to these

also found

with WHCR

triceps

exposures

nutrients,
which
on the endpoint.

associations

to the

that

and

It has

in fat distribution,

Different

stronger

subscapular

to the
fat index

race

(26).

ofother
nutrient

It has

of the

to exist

sources.

and both

ratio

ex-

the possibility

it is
active,

in findings
across
all race
that statistical
associations

between

thicknesses
(24). None ofthe
associations
between
these skinfold
ratios and dietary
intake,
physical
activity,
alcohol,
or smoking
were consistent
across
the race and sex groups.
Selby et al (7)
ratios

the

WHCR
were not

Current
cigrace and sex

by using the ratio of the triceps

plus subscapular
skinfold
thicknesses,
a measure
of relative

and

much
difficult

with WHCR
as was beer.
WHCRs
in most of the

nonsmokers

white

consumed
also
in men although
women

made

to identify.
Beer was the source ofalcohol
in all race-sex
groups.
Wine and liquor
as consistently
arette
smokers

among

in all groups

with BMI. Total

alcohol
with WHCR,
primarily

of alcohol

less than

WHCR

although

physically
on WHCR.

fat and its distribution

in race and sex groups
may be
by interactions
between
environmental
factors
or by

abdominal

examination

and

occurred,

become
more
less of an impact

physical

sources

to differences

contribute

may modify
the effects
A better
understanding
with
only

anthropometric,
be made

physiological,

by a description

as combinations
of foods
of young
adults,
both

physical

activity

were

that the
physical

energy-yielding
activity
differ

related

to body

components
in their effects

in intake

ofthe
primary
of dietary
in-

size,

and

of dietary

consumed.
energy
intake
although

and

it appears

of diet and the degree

of
on body fat and its distri-

bution.
Several
studies
suggested
that dietary
composition
may
affect adiposity
independent
ofcalories(29,
30). In healthy
adult
men it has been shown
that individuals
who consume
a highfat diet have
who consume

a higher
percentage
ofbody
isocaloric
diets containing

few population-based

studies

position

and

activity

Findings
by Laws

in this study are consistent

with
et al (32). In their study ofolder

physical

Bernardo,
the percentage
versely
associated
with

have

fat than do individuals

less fat (3 1 ). However,

examined

together

both

in relation
those
white

dietary

com-

to body

size.

recently
reported
adults
in Rancho

of calories
from carbohydrate
WHCR
among
men. In addition,

was ingrams

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

in body
explained

than
fat and

differences

and

extremity
fat than whites,
but whites
had more
total
than did blacks
(26). Sex differences
in fat distribution

differ

of young

However,

smoking,

ofblacks,
in which
skinfold-measurement
them to have a higher
proportion

been

age, education,
total energy intake. total physical activity, cigarettesmoking
status, and alcohol intake in the regression
on WHCR.
Analyses for low
and high degrees
of physical activity are < median
and
median degree
of PA.
BMI is not included as a covariate
in model 2.

these

lack of consistency
raises the possibility

by real differences

t Includes

body

why

cigarette

that as individuals
activity
itself had

The
groups

models.

BMI, total energy

education,

ET

BODY
ofalcohol
per day

consumed
per week and number
were significantly
associated
with

women.

Exercising

less than

three

FAT

AND

ofcigarettes
smoked
WHCR
in men and

times

a week

was

The

finding

that

do nonsmokers
is consistent

current

was

studies

have

of

the

studies
examined
study ofSwedish

relations

with

was

larger

14.

source

idemiol

for black

men)

16. Hilner
dietary

and

Not all of these

ofalcohol

consumed.

with

WHCR

composition,

may

the

findings

alcohol,

be associated

the distribution
needed
to verify

from

physical

with

a better

differences
volved.

observed

the

and

in white

physiological

basis

that

smoking
body

body.
Additional
identified
in this
of the

of the

suggest

of total

understanding
and

study

activity,

the amount

of fat within
the associations

to provide

this

dietary

for race

and

mechanisms

tivity.

Am

J Epidemiol

20.

sex
in-

21.

1984;

120:900-

H, Muller

DC,

Reubin

distribution

L, Slattery

and

implementation.

ML, Jacobs
validity

Jacobs

DR Jr, et al. A study of the reliability

ofthe

McDonald

DR

Jr.

CARDIA

A, Van

Hahn

ofa

dietary

Horn

L, Haskell

short

Heart

physical

Health

Am

J Ep-

control

for

history.

L, et al. Quality

WL,

Pirie

activity

Program.

activities.

S. Validity and

P. Sidney

history:

CARDIA

and

J Cardiopulmonary

the

Rehab

Mm-

l989;9:

Schucker
JB, Knudsen
J, Leon AS,
for the assessment
of leisure time

J Chronic

Dis

I 978;3

1:741-55.

Comparison
of two
methods
ofassessing
physical activity in the CARDIA
Study. Am J
Epidemiol 1991;133:l231-45.
Hofstetter A, Schutz Y, Jequier E, Wahren J. Increased 24-hour energy

Sidney

5, Jacobs

DR

Jr.

in cigarette

tribution.

Haskell

WL,

smokers.

Ct al.

N EngI

J Med

Acts

Med
The

Suppl

l986;3l:79-82.

27.

in the regulation

with

1989:49:958-61.

exercise.

changes

l988;723:l35-4l.

offat. Soc Sci Med l982;16:l91-6.

Bjorntorp
PA. Sex differences

28.

WH.

Scand

Mueller

Am

J Clin

Krotkiewski

M, Bjorntorp

distribution

of adipose

1986;

10:33

with

Nutr

age

of the

P. Muscle
tissue

anatomical

tissue

effect

distribution

of energy

in obesity

of physical

balance

with

training.

different
Int

J Obes

1-4 1.

Flatt JP. Dietary fat, carbohydrate

balance,
and weight
maintenance:
effects ofexercise.
Am J Clin Nutr 1987;45:296-306.
30. Flatt JP. The difference
in the storage capacities
for carbohydrate
and for fat, and its implications
in the regulation
of body weight.
Ann NY Acad Sci 1987;499:l04-23.
3 1 . Tremblay
A, Plourde G, Despres J-P, Couchard
C. Impact of dietary
29.

fat content
32.

and

Clin

Nutr

Laws

A, Terry

to-hip

fat

oxidation

on

energy

intake

in humans.

Am

l989;49:799-805.

ratio

RB,

Barrett-Connor

E. Behavioral

Bernardo.

in Rancho

of waistl990;80:l358-

covariates

Am J Public

Health

62.
33.

Seidell

JC,

Cigolini

M,

Deslypere

Cruz A. Body fat distribution

smoking
habits in 38-year-old
Distribution

Study.

Am

JP, Charzewska
J, Ellsinger
in relation
to physical
activity

European

J Epidemiol

Kaye SA, Folsom

AR, Prineas
association
of body fat distribution
in a population

study

men:

BM,
and

the European

Fat

199 1 ;l33:257-66.

Ri,

Potter
with

JD, Gapstur
lifestyle

ofpostmenopausal

and

SM.

The

reproductive
Int J Obes

women.

1990; 14:583-91.
35.

of

body fat. III Effects of cigarette

smoking.
JAMA
1989;26 1:116973.
12. Barrett-Connor
E, Khaw K-T. Cigarette smoking and increased central adiposity.
Ann Intern Med l989;l 11:783-7.

ML, et al. The CARDIA dietary

J Am Diet Assoc l99l;91:

collection
in a large epidemiologic
study. Controlled
Clin Trials
(in press).
Schakel SF, Sievert YA, Buzzard IM. Sources ofdata for developing
and maintaining
a nutrient
database.
J Am Diet Assoc
1988;88:

factors

in the

Horn

26.

1 1.

A. Studies

sub-

Kleinbaum
DO, Kupper
LL. Applied regression analysis and other
multivariable
methods.
North Scituate,
MA: Duxbury
Press, 1978.
23.
Hasstedt SJ, Ramirez
ME, Kuida
H, Williams
RR. Recessive
inheritance ofa relative fat pattern. Am J Hum Genet l989;45:9l7-25.
24.
Garn SM, Ryan AS, Robson iRK. Fatness-dependence
and utility of
the subscapular/triceps
ratio. Biology
Food Nutr 1982;12:
173-7.
25. Bouchard
C. Genetic factors in the regulation
ofadipose
tissue dis-

51.
Shimokata

study

examined

data

expenditure

ac-

10. Slattery ML, Jacobs DR Jr, Nichaman MZ. An assessment of caloric

intake as an indicator
of physical activity.
Prey Med 1989;18:4441 1.

of the

22.

34.
of physical

JE,

nesota

in male twins in Utah. Genetic

measures

et al. CARDIA:

(in press).

reliability

are
and

1 . Donahue
RP, Abbott RD, Bloom E, Reed DM, Yano K. Central obesity
and coronary
heart disease in men. Lancet
1987;2:
821-4.
2. Ohlson
LO, Larsson
B, Svardsudd
K, Welin L, Eriksson
H, Wilhelmsen
L, Bjorntorp
P, Tibblin G. The influence
of body fat distribution
on the incidence
ofdiabetes
mellitus:
13.5 years of followup of the participants
in the study of men born in 1913. Diabetes
1985;34: 1055-8.
3. Blair D, Habicht
JP, Sims EA, Sylvester
D, Abraham
S. Evidence
for an increased
risk for hypertension
with centrally
located body
fat and the effect of race and sex on this risk. Am J Epidemiol
1984;l 19:526-40.
4. Selby JV, Friedman
GD, Quesenberry
CP. Precursors
of essential
hypertension:
the role of body fat distribution
pattern.
Am J Epidemiol
1989;129:45-53.
5. Andres
R. Effect of obesity
on total mortality.
Int J Obes 1980;4:
38 1-6.
6. Folsom AR, Burke GL, Ballew C, et al. Relation
of body fatness
and its distribution
to cardiovascular
risk factors in young blacks
and whites. The role of insulin. Am J Epidemiol
1989;l30:9l
1-24.
7. Selby JV, Newman
B, Quesenberry
CP Jr, et al. Genetic and behavioral
influences
on body fat distribution.
Int J Obes 1990;l4:
593-602.
8. Slattery ML, Bishop DT, French TK, Hunt SC, Meikle AW, Williams

HL. Dietary

A, Van
development

physical

References

Epidemiol
I988;5:277-87.
9. Sopko G, Jacobs DR. Taylor

RP,

characteristics

1268-71.
18.

behavior

fat as well as
studies
research

Donahue

some

448-59.
19. Taylor
HL, Jacobs DR Jr,
DeBacker
G. A questionnaire

13

RR. Lifestyle and blood pressurelevels

17.

did assess source of alcohol,

were not associated
with
was. In the present study,

associated

GR,
and

comparative

than

alcohol

Cutter

1 104-12.
15. Liu K, Slattery

WHCRs

women.
In summary,

McDonald
history:

WHCRs

between

(27, 34-36).

GD,
recruitment,

Haffner

SM,

MP,

and

Non-Hispanic

Whites:

behavioral

36.

Stern

R. Upper body

Lapidus

and

Hazuda

distribution

study

in Gothenburg,

and

health

J, Patterson

in Mexican

to body

variables.

C, Hallstrom
Sweden.

Pugh

adiposity

relationship

demographic

L, Bengtsson

tissue

HP,

centralized

mass

lnt J Obes

T, Bjorntorp

in women-results
Appetite

JK,

Mailna

Americans

index

and

and

other

l986;10:493-502.

P. Obesity, adipose
from

1989:12:25-35.

a population

Downloaded from ajcn.nutrition.org at Mongolia: ASNA Sponsored on October 21, 2015

also

Friedman
design,

jects.J Clin Epidemiol 1988:41:1 105-16.

(1 1, 12, 34-36).

association

findings

women (36), which

found that beer and wine consumption
WHCR
whereas liquor consumption
consumption

with

(except

observations

inconsistent

13.

and

smokers

previous

yielded

liquor

associated

in all race and sex groups

with

Previous

WHCR

during
sports
men.

949

DISTRIBUTION

positively

associated
with WHCRs
in men in the Rancho
Bernardo
study
(32). A recent study by Seidell et al (33) also showed
that physical
activity
performed
in 38-y-old
European

ITS