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The present study assessed whether total daily energy expenditure measured via doubly labeled water (TDEEDLW) could be accurately estimated via 24-hour physical activity recall (24hPAR) and whether different MET estimates impacted TDEE. The participants comprised a convenience sample of 40 adults (21 women and 19 men) from an urban tropical setting. Laboratory staff took anthropometric measurements, assessed basal metabolic rate via indirect calorimetry, took a baseline urine sample, and administered a DLW dose. Over the following 14 days, participants collected daily urine samples and answered four 24hPARs. The agreement between the measured and estimated methods was investigated. Means (SD) were: 30.4 (11.0) years for age; 23.1 (2.7) kg/m2 for BMI; and 1.75 (0.26) for physical activity level (TDEEDLW/basal metabolic rate). Data from 24hPARs allowed estimation of TDEE using metabolic equivalent (MET) codes from the Compendium of Physical Activities with its traditional resting MET value or by estimating resting values via sex-specific equations derived from a probability sample of Niteroian adults (METN). Mean TDEEDLW was 2350.8 (527.9) kcal/d and was significantly overestimated by 24hPAR TDEE, when using the traditional MET value, at 2699.7 (537.6) kcal/d (+17.7%, P = 0.0001), and by +26.7% (P < 0.0001) for women only. In contrast, mean 24hPAR TDEE, when using the METN values, did not differ significantly for the entire group (-0.2%, P = 0.9333), neither for women (+5.5%, P = 0.1867), nor for men (–5.6%, P = 0.1516). Among urban Brazilians, TDEE using sex-specific MET values from relevant population-specific equations can be feasibly and accurately estimated via 24hPAR, and, for men only, when using the conventional MET. •Total daily energy expenditure was measured by doubly labeled water in a sample of urban Brazilian adults.•24-hour physical activity recall can accurately estimate total daily energy expenditure.•Using the traditional MET value overestimates total daily energy expenditure in women, which makes scientists impart bias into their results.•Using sex-specific MET values accurately estimates total daily energy expenditure.

OBJECTIVE:--Muscle-strengthening activities (MSAs) may increase insulin sensitivity, thereby reducing the risk of diabetes. The purpose of this study was to assess the relationship between MSAs and insulin sensitivity among American adults. RESEARCH DESIGN AND METHODS--We analyzed data on 4,504 adults without diabetes, aged 20-79 years, who participated in the National Health and Nutrition Examination Survey 1999-2004 and had information on MSAs. Self-reported frequency (times/week) of MSAs was grouped as low (<1), moderate (1-2.9), or high (>=3). Insulin sensitivity was measured by the fasting quantitative insulin sensitivity check index x 100 (QUICKI). RESULTS:--After adjustment for age, race/ethnicity, physical activity other than MSAs, BMI, smoking, alcohol consumption, and daily total caloric intake, the mean values for QUICKI by low, moderate, and high MSA were 33.6, 33.9, and 34.2, respectively (P for linear trend = 0.008) for men and 34.2, 34.6, 34.6, respectively (P for linear trend = 0.009) for women. Mean fasting insulin (picomols per liter) concentrations were 75.0, 68.9, and 65.9, respectively (P for linear trend = 0.017) for men and 66.9, 63.3, 61.2, respectively (P for linear trend = 0.007) for women. There were no significant differences across MSA groups for fasting glucose among men or women. CONCLUSIONS:--MSA is independently associated with higher insulin sensitivity among U.S. adults. Efforts to increase MSA may be a realistic, feasible, and effective method of reducing insulin resistance among the U.S. population.

Community-Based Lifestyle Interventions to Prevent Type 2 Diabetes Dawn W. Satterfield , RN, PHD, CDE 1 , Michele Volansky , MPH 2 , Carl J. Caspersen , PHD, MPH 1 , Michael M. Engelgau , MD 1 , Barbara A. Bowman , PHD 1 , Ed W. Gregg , PHD 1 , Linda S. Geiss , MA 1 , Gwen M. Hosey , RNP, MSN, CDE 1 , Jeannette May , MPH 1 and Frank Vinicor , MD, MPH 1 1 Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia 2 Westat, Atlanta, Georgia Address correspondence and reprint requests to Dawn Satterfield, RN, PhD, CDE, CDC Division of Diabetes Translation, 2858 Woodcock Blvd., Davidson Building, Rm. 1028, Atlanta, GA 30341-4002. E-mail: dxs9{at}cdc.gov Abstract OBJECTIVE —To conduct a literature review of community-based interventions intended to prevent or delay type 2 diabetes. RESEARCH DESIGN AND METHODS —Recently published findings about the potential to prevent or delay type 2 diabetes with intensive lifestyle interventions prompted a literature search for community-based diabetes prevention interventions. The literature review design was a search of databases for publications in 1990–2001 that identified reports on community-based interventions designed to prevent or modify risk factors for type 2 diabetes. RESULTS —The search revealed 16 published interventions, 8 of which were conducted in the U.S. and involved populations disproportionately burdened by diabetes (e.g., American Indians, Native Hawaiians, Mexican Americans, and African Americans). Of the studies reporting results among youth, there were posttest improvements in intervention groups in knowledge, preventive behaviors, and self-esteem. Among studies reporting results among adults, most reported improvements in intervention groups in knowledge or adoption of regular physical activity. Several investigators offered important reflections about the process of engaging communities and sharing decision making in participatory research approaches, as well as insights about the expectations and limitations of community-based diabetes prevention research. Many of the studies reported limitations in their design, including the lack of control or comparison groups, low response rates or lack of information on nonresponders, or brief intervention periods. CONCLUSIONS —There is a critical need to conduct and publish reports on well-designed community-based diabetes prevention research and share information on the process, results, and lessons learned. Armed with recent positive findings about diabetes prevention and literature documenting community-based efforts, advocates at local, state, and national levels can collaborate to stem the rising tide of diabetes in communities. BIA, bioelectrical impedance analysis IGT, impaired glucose tolerance Footnotes A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Accepted May 11, 2003. Received October 14, 2002. DIABETES CARE

Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for$64.8 billion (56%) of direct diabetes medical costs, $ 41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults.

To estimate the prevalence of diagnosed arthritis among U.S. adults and the proportion of arthritis-attributable activity limitation (AAAL) among those with arthritis by diagnosed diabetes mellitus (DM) status. We estimated prevalences and their ratios using 2008-2010 U.S. National Health Interview Survey of noninstitutionalized U.S. adults aged ≥ 18 years. Respondents' arthritis and DM status were both based on whether they reported a diagnosis of these diseases. Other characteristics used for stratification or adjustment included age, sex, race/ethnicity, education level, BMI, and physical activity level. Among adults with DM, the unadjusted prevalences of arthritis and proportion of AAAL among adults with arthritis (national estimated cases in parentheses) were 48.1% (9.6 million) and 55.0% (5.3 million), respectively. After adjusting for other characteristics, the prevalence ratios of arthritis and of AAAL among arthritic adults with versus without DM (95% CI) were 1.44 (1.35-1.52) and 1.21 (1.15-1.28), respectively. The prevalence of arthritis increased with age and BMI and was higher for women, non-Hispanic whites, and inactive adults compared with their counterparts both among adults with and without DM (all P values < 0.05). Among adults with diagnosed DM and arthritis, the proportion of AAAL was associated with being obese, but was not significantly associated with age, sex, and race/ethnicity. Among U.S. adults with diagnosed DM, nearly half also have diagnosed arthritis; moreover, more than half of those with both diseases had AAAL. Arthritis can be a barrier to physical activity among adults with diagnosed DM.

In the past, active transportation to school offered an important source of daily physical activity for youth; more recently, however, factors related to distance, safety, or physical or social environments may have contributed to the proportion of children who travel to school by motorized vehicle. The authors examine the characteristics of children who use active transportation to school (ATS) as an important first step in developing effective strategies for intervention. No national study, however, has elucidated the characteristics of youth who use ATS. The present study uses a national sample of boys and girls in grades 4-12. A computer-assisted telephone interview is conducted from 1,458 parent-child pairs residing in the U.S. The interviewers asked each parent and a randomly selected child from the same household about patterns of physical activity and characteristics thought to predict such activity. Significant characteristics (p< .05) from univariate logistic regression analyses were included in multivariate logistic regression analyses using SAS (version 8.2; SAS Institute, Cary, NC). Overall, 14% of children and adolescents reported ATS. ATS was more frequent among boys (16.6%) than girls (11.1%), and among children in lower than upper grades: 20.5% in grades 4-6 and 12.4% in grades 7-9 versus 8.0% in grades 10-12. The cross-sectional analysis suggests that having sidewalks is an important element of a child's environment to promote ATS. The analysis also indicates that girls and students in the highest grades (10-12) need assistance to increase ATS.

Because diabetes represents an economic burden, the financial pressure that it places on public health systems might cause these systems to collapse. [...]there is a need to reformulate policies and programs for diabetes in older adults by emphasizing greater investments in public health actions for promotion and prevention. Carl J. Caspersen, PhD, MPH G. Darlene Thomas, BA Letia A. Boseman, MPH Gloria L. A. Beckles, MD, MSc Ann L. Albright, PhD, RD About the Authors Carl J. Caspersen and Gloria L. A. Beckles are with the Epidemiology and Statistics Branch, and G. Darlene Thomas, Letia A. Boseman, and Ann L. Albright are with the Office of the Director of the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA.