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Abstract
This study was conducted to evaluate the effects of an abdominal obesity management program on dietary intake, stress index, and waist to hip ratio (WHR) in abdominally obese women. The subjects were 195 adult abdominally obese women (WHR ≥ 0.80) who had been participating in a nutrition education (total of nine times) and dietary habits and life style modification programs (total of six times) for 12 weeks. The abdominal obesity management program focused on the nutrition provided by breakfast, lunch, and dinner, proper dietary habits, and practices to improve life style. The subjects were divided into a WHR decrease group and a WHR increase group according to changes in the WHR. Daily nutrient intake was assessed with a 3-day food record, body measurements and blood vessel age, stress index, and a health index that were measured at baseline and after 12 weeks. After the intervention, weight, waist circumference, hip circumference, WHR, and body mass index (BMI) decreased significantly in the WHR decrease group. Energy intake increased from 1486.2 kcal to 1541.4 kcal with a significant improvement in nutrient density for animal protein, total fat, animal fat, fiber, calcium, phosphorus, zinc, vitamin B6, vitamin C, vitamin E, and saturated fatty acids in the WHR decrease group. Additionally, dietary diversity increased significantly in the WHR decrease group compared to that in the WHR increase group. The WHR decrease group showed a significant improvement in the stress and health indices. Changes in WHR were correlated with changes in nutrient intake (animal protein, total fat, animal fat, plant fat, fiber, calcium, iron, potassium, vitamin A, vitamin B2, vitamin B6, vitamin C, and folate) and medical index profiles (stress and indices) adjusted for age, birth status, baseline BMI, and baseline WHR. These results show that an abdominal obesity management program was effective not only for reducing the WHR but also to improve dietary intake and the stress index in abdominally obese women.
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Table 1.
Content of comprehensive abdominal obesity management program
Table 2.
General characteristic of the subjects
| WHR decrease (n = 100) | WHR increase (n = 95) | Significance 1) | |
|---|---|---|---|
| Age (years), mean | 27.8 ± 5.6 2) | 28.2 ± 6.9 | NS 3) |
| Waist hip ratio | 0.88 ± 0.04 | 0.88 ± 0.05 | NS |
| Body mass index (kg/m2) | 23.3 ± 2.8 | 23.6 ± 3.1 | NS |
| Employment status | |||
| Employed | 96 (96.0) 4) | 86 (90.5) | χ2 = 0.221 df = 1 |
| Unemployed | 4 ( 4.0) | 9 ( 9.5) | df = 1 p = 0.367 |
| Experience of child birth | |||
| Yes | 21 (21.0) | 15 (15.8) | χ2 = 0.745 df = 1 |
| Not | 79 (79.0) | 80 (84.2) | p = 0.477 |
| Marital status | |||
| Married | 24 (24.0) | 19 (20.0) | χ2 = 0.032 df = 1 |
| Single | 76 (76.0) | 76 (80.0) | p = 0.490 |
| History of disease | |||
| Yes | 24 (24.0) | 21 (22.1) | χ2 = 0.219 df = 1 |
| No | 76 (76.0) | 74 (77.9) | p = 0.320 |
| Regularity of meal | |||
| Regular | 18 (18.0) | 15 (15.8) | χ2 = 0.195 df = 1 |
| Irregular | 82 (82.0) | 80 (84.2) | p = 0.320 |
| Sleeping time (hours/day) | |||
| ≥7 | 39 (39.0) | 46 (48.4) | |
| 5-6 | 43 (43.0) | 38 (40.0) | χ2 = 1.865 df = 3 |
| ＜5 | 9 ( 9.0) | 7 ( 7.4) | p = 0.727 |
| Irregularity | 9 ( 9.0) | 9 ( 4.2) | |
| Physical activity (kcal) | 299.2 ± 91.0 | 322.9 ± 103.6 | NS |
Table 3.
Change in body measurements in WHR decrease and WHR increase groups
| WHR decrease (n = 100) | WHR increase (n = 95) | |||||
|---|---|---|---|---|---|---|
| Baseline | Final | % Change | Baseline | Final | % Change | |
| Height (cm) | 161.7 ± 4.4 1) | 161.7 ± 4.4 | - | 160.8 ± 7.2 | 160.8 ± 7.2 | - |
| Weight (kg) | 60.9 ± 8.3 | 58.2 ± 7.7∗∗∗2),†††3) | -4.4†† | 61.1 ± 9.7 | 61.8 ± 8.7∗ | 1.1 |
| Waist circumference (cm) | 85.1 ± 7.9 | 82.0 ± 7.0∗∗∗†† | -3.6†† | 84.1 ± 8.3 | 85.3 ± 8.7∗ | 1.4 |
| Hip circumference (cm) | 96.7 ± 15.2 | 94.3 ± 14.6∗∗∗†† | -2.5†† | 96.3 ± 14.9 | 96.7 ± 17.8∗ | 0.4 |
| Waist-hip ratio | 0.88 ± 0.04 | 0.87 ± 0.05∗∗∗† | -1.1† | 0.87 ± 0.07 | 0.88 ± 0.08∗ | 1.1 |
| Body mass index (kg/m2) | 23.3 ± 2.8 | 22.3 ± 2.5∗∗∗†† | -4.3†† | 23.6 ± 3.1 | 23.9 ± 5.4∗ | 1.3 |
Table 4.
Change in daily nutrient intakes per 1,000kcal in WHR decrease and WHR increase groups
| WHR decrease (n = 100) | WHR increase (n = 95) | |||||
|---|---|---|---|---|---|---|
| Baseline | Final | % Change | Baseline | Final | % Change | |
| Total energy (kcal) | 1486.2 ± 275.11) | 1541.4 ± 304.7∗∗∗2) | 3.7 | 1589.3 ± 321.2 | 1580.9 ± 369.0 | -0.5 |
| Total protein (g) | 45.9 ± 8.9 | 47.7 ± 4.9†3) | 3.9 | 43.9 ± 5.9 | 45.6 ± 6.5∗∗ | 3.9 |
| Animal protein (g) | 22.3 ± 7.6 | 21.6 ± 8.4∗∗ | -3.1† | 20.9 ± 8.9 | 22.5 ± 10.5∗ | 7.7 |
| Plant protein (g) | 23.6 ± 4.6 | 26.1 ± 5.4∗∗∗ | 10.6 | 23.0 ± 4.8 | 23.1 ± 6.4 | 0.4 |
| Total fat (g) | 27.4 ± 5.9 | 27.3 ± 3.1†3) | -0.4†† | 27.8 ± 7.1 | 29.9 ± 3.8∗ | 7.6 |
| Animal fat (g) | 12.9 ± 5.8 | 11.6 ± 6.6†† | -10.1†† | 12.8 ± 9.3 | 14.6 ± 9.6 | 14.1 |
| Plant fat (g) | 14.5 ± 5.7 | 15.8 ± 4.8∗ | 9.0 | 15.0 ± 4.2 | 15.3 ± 6.1 | 2.0 |
| Carbohydrate (g) | 146.4 ± 11.0 | 147.0 ± 12.5 | 0.4 | 146.5 ± 11.7 | 142.1 ± 9.8 | -3.1 |
| Fiber (g) | 14.5 ± 1.9 | 17.3 ± 2.4∗∗ | 19.3†† | 15.8 ± 2.4 | 16.1 ± 2.2 | 1.9 |
| Calcium (g) | 376.9 ± 85.0 | 384.9 ± 77.2∗∗†† | 2.1††† | 395.9 ± 93.2 | 334.3 ± 66.2∗∗ | -15.6 |
| Phosphorus (mg) | 673.1 ± 85.9 | 695.9 ± 85.3∗∗dagger; | 3.4†† | 680.3 ± 95.8 | 673.9 ± 82.1∗∗ | -0.9 |
| Iron (mg) | 9.1 ± 1.0 | 11.0 ± 1.5∗ | 20.9 | 8.6 ± 1.2 | 10.3 ± 1.6∗∗ | 19.8 |
| Sodium (mg) | 2681.9 ± 588.6 | 2794.7 ± 567.9∗ | 4.2 | 2609.2 ± 550.6 | 2739.9 ± 657.8∗∗ | 5.0 |
| Potassium (mg) | 1922.2 ± 277.0 | 2149.0 ± 333.1∗∗∗ | 11.8 | 1811.9 ± 315.1 | 2086.2 ± 286.2∗∗∗ | 15.1 |
| Zinc (mg) | 5.8 ± 0.6 | 5.9 ± 0.9 | 1.7††† | 5.5 ± 0.8 | 4.6 ± 0.6∗∗† | -16.4 |
| Vitamin A (µgRE) | 677.9 ± 148.2† | 793.3 ± 245.0∗∗∗† | 17.0 | 611.3 ± 109.8 | 751.3 ± 175.9∗∗ | 22.9 |
| Vitamin B1 (mg) | 0.8 ± 0.1 | 0.8 ± 0.1 | 0 | 0.7 ± 0.2 | 0.7 ± 0.2 | 0 |
| Vitamin B2 (mg) | 0.7 ± 0.1 | 0.8 ± 0.2∗∗ | 14.3 | 0.7 ± 0.2 | 0.8 ± 0.1 | 14.3 |
| Vitamin B6 (mg) | 1.4 ± 0.1 | 1.6 ± 0.2∗∗ | 14.3† | 1.4 ± 0.2 | 1.5 ± 0.2 | 7.1 |
| Niacin (mgNE) | 10.6 ± 1.6 | 11.6 ± 2.1∗ | 9.4 | 10.9 ± 1.9 | 11.2 ± 2.8∗ | 2.8 |
| Vitamin C (mg) | 76.3 ± 22.3 | 87.3 ± 23.8∗∗,† | 14.4† | 67.0 ± 26.3 | 70.5 ± 23.2∗ | 5.2 |
| Folate (µgDFE) | 221.1 ± 45.1† | 260.5 ± 36.6∗∗∗† | 17.8 | 195.3 ± 32.3 | 254.3 ± 40.8∗∗ | 30.2 |
| Vitamin E (mg) | 10.2 ± 2.1 | 11.2 ± 2.1∗ | 9.8† | 10.3 ± 2.9 | 10.6 ± 1.5 | 2.9 |
| Cholesterol (mg) | 188.7 ± 109.6 | 177.0 ± 95.0∗∗† | -6.2 | 196.1 ± 96.2 | 192.1 ± 156.8 | -2.0 |
| Saturated fatty acid (g) | 5.5 ± 3.4 | 4.9 ± 2.9∗ | -10.9† | 5.0 ± 2.6 | 5.1 ± 2.9 | 2 |
| Monounsaturated fatty acid (g) | 6.9 ± 3.8 | 6.6 ± 3.4 | -4.3 | 6.6 ± 3.3 | 6.6 ± 3.3 | 0 |
| Polyunsaturated fatty acid (g) | 6.6 ± 3.2 | 7.2 ± 3.4∗ | 9.1 | 6.7 ± 3.0 | 6.8 ± 3.4 | 1.5 |
Table 5.
Change in INQ in the WHR decrease and WHR increase groups
| WHR decrease (n = 100) | WHR increase (n = 95) | |||
|---|---|---|---|---|
| Baseline | Final | Baseline | Final | |
| INQ 1) | ||||
| Protein | 2.0 ± 0.4 2) | 2.1 ± 0.4 ∗3) | 1.9 ± 0.3 | 2.2 ± 0.3∗ |
| Calcium | 0.8 ± 0.3 | 1.4 ± 0.2∗∗∗ | 0.7 ± 0.3 | 0.7 ± 0.2 |
| Phosphorus | 1.1 ± 0.3 | 1.2 ± 0.2∗∗ | 1.0 ± 0.2 | 1.0 ± 0.3∗ |
| Iron | 1.0 ± 0.3 | 1.2 ± 0.3†4) | 1.0 ± 0.3 | 1.1 ± 0.3 |
| Vitamin A | 1.5 ± 0.5† | 1.8 ± 1.2∗∗,† | 1.3 ± 0.4 | 1.6 ± 0.9∗ |
| Vitamin B1 | 1.4 ± 0.4† | 1.6 ± 0.4∗∗,† | 1.5 ± 0.4 | 1.4 ± 0.5∗ |
| Vitamin B2 | 1.3 ± 0.4 | 1.4 ± 0.4∗∗ | 1.4 ± 0.5 | 1.5 ± 0.4 |
| Niacin | 1.4 ± 0.5 | 1.5 ± 0.4 | 1.4 ± 0.3 | 1.5 ± 0.5 |
| Vitamin C | 1.3 ± 0.9 | 1.4 ± 0.8∗∗,† | 1.1 ± 1.0 | 1.2 ± 1.1 |
| MAR 5) | 0.86 0.04 | 0.96 0.02∗∗∗,† | 0.87 0.04 | 0.91 0.02∗ |
| Meal distribution | ||||
| Breakfast (%) | 20.8 ± 3.4 | 26.3 ± 4.6∗∗ | 20.8 ± 4.1 | 25.6 ± 4.9 |
| Lunch (%) | 31.6 ± 5.1 | 38.2 ± 6.5∗ | 32.1 ± 4.9 | 31.6 ± 4.1 |
| Dinner (%) | 37.8 ± 6.1 | 32.0 ± 5.2∗ | 35.3 ± 5.7 | 34.1 ± 5.1 |
| Snack (%) | 9.8 ± 1.9 | 3.5 ± 0.3∗∗ | 10.2 ± 2.0 | 8.7 ± 1.9 |
Table 6.
Change of dietary diversity in the WHR decrease and WHR increase groups
| WHR decrease (n = 100) | WHR increase (n = 95) | |||
|---|---|---|---|---|
| Baseline | Final | Baseline | Final | |
| Meat and meat products | 1.6 ± 1.1 1) | 1.6 ± 1.2 | 1.7 ± 1.4 | 1.5 ± 1.0∗∗ |
| Fishes and shellfish | 1.7 ± 1.3 | 1.8 ± 1.4∗∗2) | 1.8 ± 1.2 | 1.7 ± 1.5 |
| Eggs and egg products | 1.0 ± 0.7 | 0.8 ± 0.8∗∗ | 0.8 ± 0.9 | 0.7 ± 0.9∗∗ |
| Milk and milk products | 0.6 ± 0.6 | 0.6 ± 0.4†3) | 0.6 ± 0.8 | 0.6 ± 0.8 |
| Fat and oil | 4.7 ± 2.1 | 4.5 ± 2.7 | 4.0 ± 2.1 | 4.2 ± 2.1 |
| Cereal and cereal products | 5.2 ± 2.3 | 5.4 ± 1.8† | 5.0 ± 1.8 | 4.8 ± 1.5 |
| Potatoes and starch products | 0.6 ± 0.7 | 0.6 ± 1.0 | 0.6 ± 0.8 | 0.8 ± 1.1∗∗ |
| Beans and bean products | 1.6 ± 1.5 | 1.9 ± 1.7∗∗† | 1.6 ± 1.4 | 1.8 ± 1.4 |
| Nut seeds and products | 1.1 ± 1.4 | 1.3 ± 1.7∗ | 1.1 ± 1.3 | 0.9 ± 1.1∗ |
| Vegetables | 16.1 ± 5.9 | 19.0 ± 9.1∗∗∗ | 16.6 ± 7.1 | 17.1 ± 8.3∗∗ |
| Mushrooms | 0.5 ± 0.8 | 0.6 ± 0.8∗† | 0.4 ± 0.7 | 0.5 ± 0.6 |
| Seaweeds | 1.1 ± 1.1 | 0.9 ± 0.9∗∗ | 1.1 ± 1.4 | 0.8 ± 0.9∗∗ |
| Fruits | 0.6 ± 0.8 | 0.6 ± 0.7 | 0.6 ± 0.8 | 0.5 ± 0.7 |
| Sugar and sugar products | 1.7 ± 1.3 | 1.5 ± 1.1∗∗† | 1.6 ± 1.2 | 2.0 ± 1.3∗∗∗ |
| Seasoning | 9.0 ± 5.2 | 9.3 ± 4.6 | 9.1 ± 4.3 | 8.8 ± 4.7 |
| Total | 47.1 ± 27.5 | 50.4 ± 32.0∗∗ | 46.6 ± 27.5 | 46.7 ± 27.8 |
Table 7.
Change in medical index profiles 1) in the WHR decrease and WHR increase groups
| WHR decrease (n = 100) | WHR increase (n = 95) | |||||
|---|---|---|---|---|---|---|
| Baseline | Final | % Change | Baseline | Final | % Change | |
| Age | 27.8 ± 5.6 2) | - | 28.2 ± 6.9 | - | ||
| Blood vessel age | 31.9 ± 6.8 | 31.7 ± 8.1 | -0.6 | 30.9 ± 6.0 | 30.8 ± 6.1 | -0.3 |
| Stress index | 6.5 ± 3.5 | 6.2 ± 2.8∗∗∗3)††4) | -4.6†† | 6.5 ± 4.3 | 6.5 ± 2.1 | 0 |
| Health index | 72.7 ± 11.5 | 74.2 ± 9.7∗∗ | 2.1 | 73.4 ± 8.7 | 73.1 ± 9.9∗ | -0.4 |
Table 8.
Pearson's correlation coefficients between changes1) waist hip ratio and changes in nutrient density and medical index
| Variables | Unadjusted2) | Adjusted 3) |
|---|---|---|
| Nutrient density changes (%) | ||
| Total protein | -0.288 | -0.274 |
| Animal protein | 0.359∗∗ | 0.314† |
| Plant protein | -0.310∗ | -0.378† |
| Total fat | 0.429∗∗ | 0.400†† |
| Animal fat | 0.645∗∗ | 0.611† |
| Plant fat | -0.321∗ | -0.300† |
| Carbohydrate | 0.141 | 0.119 |
| Fiber | -0.426∗∗∗ | -0.327†† |
| Calcium | -0.212∗∗∗ | -0.279† |
| Phosphorus | -0.212∗ | -0.196 |
| Iron | -0.389∗∗ | -0.319† |
| Sodium | 0.222 | 0.270 |
| Potassium | 0.374∗∗∗ | -0.378††† |
| Zinc | -0.411∗∗∗ | -0.401††† |
| Vitamin A | -0.496∗∗ | -0.326† |
| Vitamin B1 | -0.126 | -0.215 |
| Vitamin B2 | -0.314∗ | -0.301† |
| Vitamin B6 | -0.315∗∗ | -0.264† |
| Niacin | -0.298 | -0.199 |
| Vitamin C | -0.375∗∗ | -0.397† |
| Folate | -0.418∗∗∗ | -0.392†† |
| Vitamin E | -0.279 | -0.251 |
| Cholesterol | 0.300∗ | 0.297 |
| Saturated fatty acid | 0.415∗∗ | 0.350 |
| Monounsaturated fatty acid | 0.315∗ | 0.328 |
| Polyunsaturated fatty acid | -0.213 | -0.189 |
| Medical index profiles changes (%) | ||
| Blood vessel age | 0.125 | 0.137 |
| Stress index | 0.428∗∗∗ | 0.398†† |
| Health index | -0.326∗ | -0.325† |
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