Havana Woman. Body composition analysis and changes according to risk factors

Enviado por csantos

Original Article

Abstract

Introduction: There are few studies on risk factors about quality life on Cuban woman. One well-recognized sequel of sedentary life habits is obesity. Material and methods: In a population-based sample of 1074 women (age 20-70 years, obtained during the years from 1998 to 2002, taking into account ethnical origin and criteria from the International Biological Program, we evaluated body composition and bone density at total body and four skeletal sites by dual-energy x-ray absorptiometry (DXA). Data are given as mean, standard deviation and percentile distribution. In multivariate analysis of determinants of total body composition among an aged-stratified sample obesity frequency was studied, considering those that were above 95th percentile of their native critical limits for total body fat (%), adiposity index, body fat trunk (%), body fat legs (%) and body fat arm (%). Bone mass loss was estimated using odd ratio test by Mantel-Haenszel with the following risk factors: physical activity, coffee intake, and daily calcium intake on puberty and previous week. Multiple regression analysis step by step was performed. All data were recorded in a database system using SPSS for Windows, version 10.1

Results: Different patterns of age-related change were found on our patients for adiposity index and regional fat distribution. It was observed a strong tendency showing that body fat arm, body fat trunk and body fat leg increased according with age (p< 0.00). Obesity frequency considering adiposity index was 48% on women between 50-59 years old. Conclusions: We conclude there exists an increase probability risk of diabetes, hypertension, osteoporosis and cardiovascular disease in women from fifty years old on. Physical activity habits, kind of daily diet at critical moments and biosocial background on which the Cuban woman develops her life, mark her quality life on aging.

Key words: adiposity index, obesity, body composition, lean mass, risk, osteoporosis, native critical limit and Havana woman.

Introduction

In spite of the concern that now-a –days exists in the world by an esthetic ideal of slenderness, populations tend, in an increasing way, to a life style that promotes obesity. Additionally, there are evidences that obesity, type II diabetes and cardiovascular disease share common genetic background, as well as the environmental risk. 1, 2

In the Cuban environment these metabolic aspects in women have been poorly studied. Author Teresa Lazka describes that in the sixties of the last Century young women from Havana presented development rhythms that were higher to the ones described by Rouma in 1920, and comments the roll of this old tendency that accomplishes during the years 1880 to 1950 increases of more than 1 cm by decade in adults3,4..

This facts, together with a menarche at significant low age, characterizes the young Cuban with an acceleration of mature rhythms, that this researcher explained as a result of the interaction between genetic and environmental factors, such as climate, considering them as adjustment mechanisms.

It has been demonstrated that the dietetic consume of calcium during puberty has a significant influence in both physical and bone development in the Cuban population studied. This information coincides with the appreciation of another authors about the ingestion of calcium as protector factor during the critical moments of growth5, 6, 7..

Body fat trunk and sedentary habits increase with age, being more evident in women with amenorrhea of more than 5 years, in contrast with women that are still in reproductive age7, 8, 9.

Remodeling changes of the corporal composition in young women from the East and the West of our country, studied during 17 months during the years 1989 to 1990, presented significant increases in lean mass and tricipital fat, that contrasted with the diminishing of bicipital fat and that of the legs [p<0,05)] after a controlled regime of daily physical exercises and a well equilibrated diet10

The purpose of this research about female population is to contribute to an integral evaluation of the problem related to corporal composition and the expectation of quality life for women during the third age in our environment.

Material and Methods

This paper presents the results of a transversal study11 about the corporal composition in total bodies, as well as the figures of bone density in four anatomical places in a Havana population of 1074 healthy women between 20 and 70 years old, obtained from1998 to 2002, that were considered regarding the ethnical origin in accordance with the criteria of the International Biological Program12.

The medical records were studied in order to disregard, as an exclusion criteria, smoking habit, chronic kidney disease, endocrinal, hepatic or metabolic disorders, early menopause or ophorectomy before 50 years old, nephrolitiasis or use of medication like corticoids, anticonvulsant, heparin or hormonal replacement therapy and/or ingestion of mineral supplements. As menopausal women were considered those with more than six months of amenorrhea.

Methods

We established the composition of lean mass (kg), adiposity index [fat tissue (kg)/lean mass (kg)], fat tissue (kg) and its relative composition (%) for total body and by anatomical regions (trunk, arms and legs), as well as the bone mineral density (BMD) in grams and by square centimeter for lumbar vertebras [L1 – L4] in anterior-posterior view, femur neck, Ward triangle and trochanter for the whole sample, by the measurement of the total body and of the regions using the technique of dual-energy x-ray absorptiometry (DXA).

The data are considered and compared with the references of bone density in Cuban female population from 20 to 39 years old, Mexican and North American, as well as the peak of bone mass for femur neck, Ward triangle, trochanter and lumbar vertebras (anterior-posterior view) obtained in this investigation and the percentiles distributions for each age group. Risk of osteoporosis is evaluated by the criteria from the World Health Organization13.

The frequency, by ages, of women with adiposity index and corporal composition higher than percentile 95 and two standard deviation above the mean of fat and lean mass, determined by the technique of densitometry of total body in absolute and relative values, as well as by anatomical regions according to the peak expression in our population between 20 and 29 years old is established. This is compared with groups of Cuban and Spanish population measured by anthropometrical techniques14 15 16.

Variation coefficients for vertebras, femur neck and total body were of 0, 8%, 1% and 0, 8% respectively.

Data processing

Results are shown in percentiles, means and distribution measurements, such as, standard deviation, analysis of variance (Anova) and Student test for independent samples, with the purpose of determining the differences according to age, amenorrhea appearance and ethnical origin in relation to the critical limits established by the World Health Organization and peak values of bone density in young Cuban population. Declination has been compared with the maximum value of the peak obtained between 20 and 29 years old (%). In order to avoid the influence of the body size on the variables of bone density, coefficients for height were used.

Risk variables, such as calcium consumption in puberty (mg/day), coffee consumption in the previous week of the study (cups/day) and frequency of physical exercises (more than three times per week in the previous two years) are analyzed in their association with the loss of bone density, according to different anatomical places (trabecular and cortical) in the female population less than 40 years old. The study was made via control cases by pairs as stipulates the criteria of Odds ratios from Mantel-Haenszel, using confident intervals and Chi Square estimation with a level of confidence of 95%17,18.

Dependent and independent character of the variables was considered, by means of double classification analysis of variance for normal distributions and Friedman test for non-lineal ones. Logarithm transformation was applied to variables with semilogarithm distribution.

The dietetic survey was performed using the criteria of frequency of consumption through interviews made by a nutritionist, emphasizing the ingestion of calcium during ages between 11 and 16 years old and in the previous week of the measurements. These figures have been compared with the ones recommended by the European Economic Community that establish as sufficient ingestion of calcium the amount of 700 mg per day and as critical level 400 mg per day19. All the statistical analysis was performed using the SPSS/PC software version 10, 01 from Chicago, Illinois.

RESULTS

Women in this study, from the fourth decade of live on; maintain a sustained increase in corporal fat that reaches its maximum in the seventh decade of live (increase of 8,5 kg as average after 30 years old). The percentile distribution of corporal composition in Havana women from this research presents interesting changes when women go from the third to the fourth decade of life. The average increase is 6.6 kilogram of corporal fat (+42,3% of change) with its corresponding outstanding increase of fat in the analysis of the relative composition, mainly taking into account that height, lean mass and bone density do not experiment substantial changes in this stage of live. (Tables 1 and 2, 2a, 2b).

Accumulation of fat in the region of trunk and arms are the ones that are most impressive in this analysis, presenting increases of +41,8% and +37,6% respectively and with changes that are highly significant (p<0,001) from 34 years old on, as shows the analysis of variance. (Graphics 1 and 2).

Fat in legs shows an interesting behavior. It presents a sustained increase from 30 years old on as the rest of the variables mentioned, but its main change occurs from 60 years old on (+36,6% of change) that is highly significant according to the analysis of variance (p<0,00).(table 2a and graph 2).

Sedentarily(leisure time) as a dependent variable, presents a highly significant association (p<0,00) in the step by step linear regression, with F values of 22,0; 20,8; 19.0; 18.6; 11.4; 11.4 and 10.4 for fat in arms, legs, trunk and whole body (%) and for vertebral density, Ward triangle and trochanter in the population under 40 years old.(table 2b).

Risk variables such as dietetic consumption of calcium and coffee and systematic exercise, also showed significant association and specific relation with the type of bone tissue (trabecular and/or cortical).

Calcium consumption during puberty (p<0, 05) and coffee ingestion in the week previous to this study (p<0,001) resulted significantly associated with bone loss in the anatomical places that are trabecular predominant. The index of association between exercise and calcium consumption, in the previous week to the measurements made, in relation to bone density loss show a probability that is highly significant (p<0,00) for both types of anatomical places. (Table 3)

The effect of the type of exercise on the adiposity at different places can be clearly seen in Graphic 3 in women less than 40 years old, emphasizing that activities such as dancing and aerobic gymnasia produce changes in corporal remodeling with significant differences for fat in arms (p<0,05) as a multivariable analysis by linear regression shows.

A tendency to moderate the frequency of the estimation in obese women according to the relative total fat (%) criteria is observed, with values higher than percentile 95 of the population of reference, that represent 48 % of the cases between women from 50 to 59 years old. When the evaluation is made using as limit two standard deviations above the average of the population of reference, the frequency of obesity goes to 66%. (Table 4)

The frequency of our young women above two standard deviations from the average relative trunk fat is only 6 %, 6% between 30 and 39 years old and 8% between 40 and 49 years old.

From 50 years old on an increase in this regional accumulation appears, and produces that 67% could be considered obese of central type according to this criteria. These differences by analysis of variance according to age are highly significant for a t value of 7, 2 (p<0, 00). Table 5.

The analysis of corporal composition in relation with the ethnical origin shows highly significant differences (t = 5, 12, p<0,000) regarding lean mass. The women in the European ethnic group present a lower average than those with African roots or half-breeds, in the stage below 30 years old and in all the others.

Fat in arms and legs were significantly inferior (t = 3.14 and 2.3, p < 0, 05) in half-breeds and Havana Afro up to 39 years old, with no relation to the systematic practice of exercise or not. The adiposity index does not present differences regarding the ethnical origin.

Table 6 shows the risk of bone breaking in women from 50 to 59 years old in a comparative way to other authors. It can be accepted that regarding hip fracture our average women has a lower risk than those of the populations in the comparative analysis; this risk is lower in the relation total body density/height to that of the female population in Minnesota34.

Taking into account the ethnic origin and anatomical place of bone density of women between 50 and 59 years old, a higher risk index was found for bone fracture in European ethnic group women in the relation total body/height and femur neck and Ward triangle in the hip. In half-breed women only predominates the risk for lumbar vertebras with a highly significant difference (p>0, 00). (Table 6)

The average age of the beginning of menopause in these women, presents differences according to the ethnical origin, corresponding to the Havana European ethnic group 47,3 years old, 50,7 years old to the half-breeds and 51,7 years old to the Afro ones.

The time of amenorrhea and the changes that correspond to the precocious postmenopausal period are evident starting from 49 years old, confirming that bone density in the different anatomical places and relative fat trunk present changes associated with climacteric in its first five years.

Declination for normalized bone mass according to the relation with height present a regional and ethnical behavior, being Ward triangle, femur neck and lumbar vertebras the places more affected for our European type and half-breed women (p<0,00) as the Student t test shows. On the other hand, in the Havana Afro women declination changes associated to time of amenorrhea are not significant.

Variations in fat composition regarding total body associated with time of amenorrhea in women older than 45 years old show an interesting behavior (p<0, 00) in the multiple regression analysis; the dependent variable exercise practice gives total fat a predominant place of first order (F 8, 2), to trunk fat (F 7, 9) and to the variables fat in legs and lean mass (F 7, 1 and F 4, 02). Trunk fat present highly significant changes (p< 0,007). This is highlighted in Graphic 4.

Discussion

Increase from early stages of sedentarily attitudes, fat deposited and its relation to type II diabetes, cardiovascular disease and osteoporosis constitute a gloomy shadow over the expectation in the quality of life of the third age population20 21 22,23 24.

In our environment the tendency to abdominal adiposity has been previously described by Díaz15, 16, that although does not analyzes the ethnical origin and uses indirect estimates that are based on anthropometrical techniques, which limitations are well known now-a-days, does study with more depth the distribution patterns of fat tissue in the body and shows the modifications in the corporal composition regarding the age in concordance with the relative reduction of lean mass, results that correspond with our research too.

Alastrue in Spain has made an evaluation of the anthropometry of adiposity, starting from estimates of skin fold thickness in arm, abdomen and sub scapular. When changes are analyzed according to age, the percentile distribution of the relative corporal fat (%) in his women is similar to the one found in our research using densitometry techniques14.

Since the sixties, Durnin and Womersley had already opened the door to estimates of adiposity though measures of skin fold thickness. The appearance of the dual- photon absorptiometry technique for studying the total bodies allowed the measurement of the skeleton and the composition of soft parts. In the last 30 years this technique has been enhanced and constitutes a direct technique that offers the highest resolution and precision for the total body and its regions26 27 28 29,30.

The adiposity index presented in this study considers the relation of two direct quantitative variables: lean mass and fat tissue. It gives more precise information about the "gold standard" of autochthones measurements by dual – photon densitometry in total bodies. According to this indicator, our women between 50 and 59 years old present an obesity frequency of 48%.

A necessary reflection is that simultaneously with the changes observed in the composition of relative fat in our women after 40 years old, a diminution of approximately 2 kilogram of lean mass and a regional redistribution of fat mainly in trunk and arms is observed.

According to these results and due to a predominant model of fat distribution in trunk and arms, it is necessary to meditate about its great probability of association with a higher risk of hypertension, dislipidemia and type II diabetes for our female population from 50 years old on. (Table 5)

This type of regional distribution of fat, "apple" type has been extendedly commented by different authors for its metabolic implications like insulin resistance, overload in the flow of fat acids to the liver and its association with high figures of arterial tension and higher secretion of cortisol by stress 20, 21,22, 23.

Practice of systematic exercise is a protective factor after 60 years old, as showed Nelson in his studies. This author determines through hydrostatic weight that his sedentary women has 26,8 kg of corporal fat, composition similar to the percentile 50 of our women from 60 to 69 years old that sit for 11,2 hours a day35.

The research developed has demonstrated the importance of some osteoporosis risk factors. This coincides with the alert given by the MEDOS study that was completed in the Mediterranean countries31, the Mexican consensus32 for osteoporosis and some preliminary findings in Cuba7. These findings state that age, height, calcium ingestion during puberty, coffee intake, alcohol consumption and systematic exercise or sport practice have a significant association with bone mass loss. The results are supported by multivariable analysis7.

Our women increase the number of hours they stay sitting and coffee intake from 30 years old on. This raises the question of how working environment and life style habits can be influencing the consumption of a substance with proved antagonist effects with calcium absorption, as well as introducing sedentary life habits.

Another interesting appreciation is the protector character of half-breeding in the ethnical origin. According to some estimates our population is composed by 51% of half-breeds and 37% of European origin, which constitutes an important factor in the demographic composition of the current Cuban population38.

We have to accept that in the complex phenomena studied some evidences stated by another authors are corroborated. They concur in affirming the effect of the variables studied and the impossibility of isolating them in their multiple actions from genetic factors, age, ethnical origin, climacteric time, type and frequency of physical activity, diet and its action in determined critical moments 1, 2, 39,40,41,42,43, 44.

.Conclusions

The Health World Organization has recently estimated that more than 143 million people suffer from non-insulin dependent diabetes. Our country was placed with a tendency from 75 to 349 people per 1000 habitants for the year 202525.

The results of our research show a clear tendency in the women studied to develop fat accumulation in the body central region, increase of sedentary habits and declination of bone mass according to the cycle of life. These results coincide with findings already described8,9,11,15,36,37. Osteoporosis as a health problem occupies a special place in this analysis about the expectation of the quality of life in the third age women population.

The roll of environmental factors in the genesis of the changing phenomena analyzed in this study can be considered controversial. They could not be isolated from the demonstrated polygenic character43 nor from the consensus to accept that bone mass, corporal weight and gonad functions have common endocrinal regulations44, 45.

These are only the first steps to an analysis in which our ethnical mixture can not be ignored, as well as idiosyncrasy, habits of time and type of physical activity, exposition to sun light, diet composition in critical moments and bio-psycho-social organization in which Cuban women develops.

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Table 1

Body composition

Percentile distribution, n = 238

Women 20 – 29 years

Havana city, Cuba 2003

Percentile	weight kg	height cms	Lean mass kg	Adiposity index	fat kg	Arms fat %	Relative fat %	Legs fat %	Trunk fat %
3	45.0	147.0	29.9	0.28	10.5	30.0	21.9	20.5	18.8
5 *	46.5	150.0	30.1	0.29	10.6	30.0	22.3	20.5	18.8
10	50.0	154.0	32.9	0.32	11.9	31.8	24.5	20.9	21.3
25	54.5	157.0	34.8	0.39	13.9	37.4	28.2	26.0	25.3
50	57.0	160.0	36.5	0.44	15.6	41.4	30.6	29.2	28.9
75	62.0	162.5	39.6	0.53	20.5	48.5	34.3	32.7	32.9
90	74.0	170.0	43.6	0.66	26.2	51.7	39.2	36.6	37.8
95 *	78.0	173.0	47.7	0.79	34.2	52.0	44.6	40.2	42.3
97	82.0	175.0	48.1	0.82	35.0	52.0	45.3	40.2	42.3
Mean And Standard deviation	58.9 _+_8.8	160.5 _+_5.7	37.5 _+_4.2	0.47 _+_0.13	17.7 _+_5.7	41.8 _+_6.8	31.4 _+_5.3	29.1 _+_5.2	29.1 _+_5.8

Table 1a

Body composition

Percentile distribution

30 – 39 years, n =285

Percentile	weight kg	height cms	Lean mass kg	Adiposity index	fat kg	Arms fat %	Relative fat %	Legs fat %	Trunk fat %
5	44.6	150.4	32.8	0.24	8.04	23.4	19.1	18.6	15.1
25	54.0	156.0	34.4	0.48	16.7	39.8	32.1	24.6	29.1
50	63.0	160.0	36.8	0.62	22.2	47.7	38.1	32.5	34.9
75	73.0	163.0	39.2	0.76	28.4	53.1	43.3	37.2	39.1
90	82.2	167.8	41.1	0.91	36.4	54.9	47.7	43.1	41.3
95	89.0	176.0	43.2	1.33	47.1	55.8	56.9	43.5	44.0
Mean And Standard deviation	64.1 _+_11.7	160,6 _+_5,9	37.1 _+_3.0	0.64 _+_0.24	23.6 _+_9.1	45.9 _+_8.8	37.6 _+_8.5	31.7 _+_7.8	33.0 _+_7.3

Table 1b

Body composition

Percentile distribution

40 – 49 years, n = 161

Percentile	weight kg	height cms	Lean mass kg	Adiposity index	fat kg	Arms fat %	Relative fat %	Legs fat %	Trunk fat %
5	54.3	147.6	31.6	0.50	17.3	41.7	33.1	25.2	29.7
25	58.0	154.0	32.8	0.65	21.5	46.6	36.7	30.1	32.2
50	62.5	159.0	35.6	0.70	25.6	52.1	42.2	35.7	37.2
75	75.8	162.0	40.9	0.82	31.7	54.2	45.5	40.1	39.5
90	86.0	164.0	42.9	0.99	40.4	57.4	46.6	41.5	40.7
95	88.4	170.0	46.3	0.99	42.4	57.9	46.7	41.8	40.8
Mean And Standard deviation	67.6 _+_11.5	158.9 _+_5.6	36.8 _+_4.5	0.73 _+_0.15	27.2 _+_7.7	51.1 _+_4.7	41.9 _+_4.9	34.4 _+_5.6	36.1 _+_3.8

Table 1c

Body composition

Percentile distribution

50 – 59 years, n = 280

Percentile	weight kg	height cms	Lean mass kg	Adiposity Index	fat kg	Arms fat %	Relative fat %	Legs fat %	Trunk fat %
5	52.9	146.0	29.9	0.46	16.4	44.7	31.9	26.9	29.9
25	58.0	155.0	32.9	0.65	22.5	51.4	39.5	34.3	38.2
50	66.0	157.0	35.5	0.77	30.0	54.6	43.4	37.8	41.0
75	74.3	161.3	39.1	0.87	32.2	57.7	46.3	40.1	43.8
90	80.3	167.1	42.9	0.91	34.3	60.3	47.6	41.3	45.1
95	86.2	170.1	44.2	0.96	39.5	60.3	49.0	42.3	46.2
Mean And Standard deviation	67.2 _+_9.9	157.8 _+_6.2	36.2 _+_4.0	0.76 _+_0.13	27.6 _+_6.3	54.4 _+_4.5	42.7 _+_4.5	36.9 _+_3.9	40.8 _+_4.1

Table 1d

Body composition

Percentile distribution

60 – 69 years, n = 110

Percentile	weight kg	height cms	Lean mass kg	Adiposity index	fat kg	Arms fat %	Relative fat %	Legs fat %	Trunk fat %
5	41.0	137.0	33.3	0.65	24.2	45.0	39.2	33.2	37.2
25	64.3	152.5	33.6	0.75	26.5	49.4	44.7	37.4	38.8
50	65.5	157.0	34.6	0.81	27.4	57.0	52.6	39.2	41.0
75	85.8	163.8	38.1	1.11	38.9	61.0	52.9	46.6	46.0
90	96.0	170.6	39.6	1.12	43.8	62.3	52.9	48.3	46.2
95	96.0	173.0	39.6	1.12	43.9	62.3	52.9	48.3	46.2
Mean And Standard deviation	71.4 _+_16.2	156.8 _+_9.2	35.5 _+_2.5	0.88 _+_0.19	31.3 _+_7.6	55.5 _+_6.6	46.3 _+_5.4	41.0 _+_5.4	41.9 _+_3.6

Table 2

Body composition changes according age

Median and variation ( % ) *

Havana city, Cuba

1998-2003

Body composition

20 a 29

30 a 39

40 a 49

50 a 59

60 a 69

weight

10.5+

62.5

9.6+

*15.8+

65.5

*14.9+

height cms

160

159

-0.6

157

**-1.8

157

**-1.8

Lean mass

36.5

36.8

0.8+

35.6

*- 2.4

35.5

*-2.7

34.6

*- 5.2

*fat

15.6

22.2

*42.3+

25.6

*64.1+

*92.3+

27.4

*75.6+

*Arms

fat

41.4

47.7

*15.2+

52.1

*25.8+

54.6

*31.8+

*37.6+

* high significant difference change p <0.001
** significant difference change p <0.05

Table 2a

Body composition changes according age

Median and variation (%) *

Havana city, Cuba

1998-2003

Body composition	20 a 29	30 a 39	%	40 a 49	%	50 a 59	%	60 a 69	%
*Leg fat %	29.2	32.5	11.3+	35.7	**22.6+	37.8	*29.4+	39.9	*36.6+
*Trunk fat %	28.9	34.9	*20.7+	37.2	*28.7+	41	*41.8+	41.0	*41.8+
*Relative fat %	30.6	38.1	*24 . 5+	41	*33.9+	43.4	*41.8+	52.6	*71.8+
Adiposity index *	0.44	0.62	*40.9+	0.70	*59+	0.77	*75+	0.81	*84+

* high significant difference change p <0.001

Table 2b

Body composition changes according age

Mean , standard deviation and variation (%) *

Havana city, Cuba

1998-2003

Density

20 a 29

30 a 39

40 a 49

50 a 59

60 a 69

*Vert/

height

0,76

_+_

0,08

0,76

_+_

0,08

0,76

_+_

0,10

0,69

_+_

0,10

-9,2*

0,65

_+_

0,10

-14,5*

*Femur/

height

0,65

_+_

0,08

0,65

_+_

0,08

0,64

_+_

0,09

–

1,5

0,58

_+_

0,09

–

10,8*

0,55

_+_

0,08

–

15,4*

*Ward/ height

0,62

_+_

0,09

0,60

_+_ 0,11

–

3,2

0,57

_+_

0,12

–

8,07*

0,50

_+_

0,11

–

19,4*

0,46

_+_

0,10

–

25,8*

*Troch./ height

0,51

_+_ 0,06

0,51

_+_ 0,06

0,52

_+_

0,08

1,96

0,49

_+_

0,08

–

3,9

0,48

_+_

0,08

–

5,9*

Whole body/

height

0,72

_+_ 0,05

0,74

_+_ 0,04

2,8

0,77

_+_

0,05

0,72

_+_

0,06

1,4

0,73

_+_

0,05

1,4

*Coffee

Cups

0.9

_+_1.6

2.3

_+_1.9

155**

_+_1.6

233*

4.1

_+_1.9

355*

*leisure

Hours

8.5

_+_3.3

9.9

_+_3.2

16. 5**

_+_3.1

29.4*

10.3

_+_3.2

21. 2*

11.2

_+_3.1

31.8*

*high significant difference change p <0.001
** significant difference change p <0.05

Table 3

Odd ratio risk according skeletal site (a)(b)

Female population under 40 years old

Havana city, Cuba 1998-2003

Variable

Odds ratio

confident intervals

p value

Observation

Calcium consumption

During puberty

mg/day

3.26

2.70

1.06 – 11.22

0.58 – 17.35

0.0233(a)

0.1754(b)

significant

p < 0.05 ** (a)

No significant p >

0.05 (b)

Calcium consumption

in the week previous

mg/day

0.22

0.33

0.09 – 0.55

0.15 – 0.75

0.0001(a)

0.0029(b)

Highly significant

p < 0.01 * (a)(b)

Coffee cups

/ day

7.08

2.50

1.60 – 33.73

0.49 – 13.13

0.0022(a)

0.2059(b)

highly

significant p < 0.001 * (a)

No significant p >

0.05 (b)

Sport practice

hours/week

2.01

2.06

1.23 –3.26

1.20 – 3.53

0.0026(a)

0.0046(b)

highly

significant p < 0.001 * (a((b)

(a) lumbar vertebrae and Ward s triangle
(b) femoral neck.

Table 4

Nutritional assessment criteria

Above critical limit reference frequency %

according female population body composition indicators *

Havana city, Cuba 1998-2003

Age

indicators

< 2

standard deviation

> 2

standard deviation

5 percentile

95 percentile

20 – 29

Adiposity

index

Relative total fat

0,21 *

20,8 *

0,73 *

42 *

4,8

4,5

0,29 *

22,3 *

4,8

4,5

0,79 *

44,6 *

4,8

4,5

30 – 39

Adiposity

Index

Relative total fat

4,5

31,8

36,4

4,5

13,6

40 – 49

Adiposity

Index

Relative total fat

36,8

33,3

50 – 59

Adiposity

Index

Relative total fat

47,6

60 – 69

Adiposity

Index

Relative total fat

Table 5

Obesity assessment criteria

Above critical limit reference * frequency %

according female population body composition indicators

Havana city, Cuba 1998-2003

Age

Indicators

> 2 standard deviation *

>95 percentile *

20 – 29

Trunk fat

(a)

Arms fat

(b)

Legs fat

( c )

40,5

55,0

39.6

6,3

42.3

52,0

40.2

30 – 39

Trunk fat

(a)

Arms fat

(b)

Legs fat

( c )

6,3

12,5

6,3

12,5

40 – 49

Trunk fat

(a)

Arms fat

(b)

Legs fat

( c )

8,3

16,7

25,0

50,0

25,0

50 – 59

Trunk fat

(a)

Arms fat

(b)

Legs fat

( c )

66,0

47,0

27,0

40,0

73,0

20,0

60 – 69

Trunk fat

(a)

Arms fat

(b)

Legs fat

( c )

67,0

50,0

33,3

67,0

33,3

(a) variance analysis accordin age.. highly significant t 7.2, p<0.00,.
(b) " " " t 9.85, p<0.00,
( c ) " " " t 6.9, p<0.00.

Table 6

Osteoporosis risk

Prevalence according skeletal site (%)

Havana women 50-59 years old according ethnical procedence

(> – 2,5 standard deviation (a))

comparative analysis using different reference data (b)(c)

Cuba, 2003

Skeletal

Site

Havanan

women

(mean)

(a)

European

Havanan

women

(a)

half-breeds Havanan

women

(a)

Afro

Havanan

women

(a)

North

Mexico

(b)

Center

Mexico

(b)

Rochester

Minnesota

Vertebra

g/cm2(a-p)

6,5

14,8

5,6

30,3

15,4

7,5

Vertebra / height(a-p)

9,5

16,7

5,6

Femoral neck

g/cm2

2,5

5,4

12,3

14,2

28,4

Femoral neck

/height

10,1

Ward triangle g/cm2

5,4

9,4

5,3

44,7

Ward triangle/

height

18,8

10,9

44,3

Trochanter g/cm2

4,7

1,9

Trochanter/

height

3,1

Whole body

g/cm2

13,3

9,1

13,3

Whole body /

height

6,7

9,1

9,7

Height

Cms

157,07

_+_ 5,9

157,02

_+_5,4

156,3

_+_6,6

159,9

_+_6,7

(b) Deleze ,M., Cons-Molina, F., Villa, A.R.,Morales-Torres, J., et al.Geographic differences in bone mineral density of mexican women.Osteoporos Int (2000) 11: 562-569

(c ) Melton III,L.J., Khosla, S.,Achenbach, S.J., O´Connor, M.K., et al.Effects of body size and skeletal site on the estimated prevalence of Osteoporosis in women and men. Osteoporos Int (2000) 11: 977-983

Dra. Carmen Santos Hernandez

Centre of Medical Surgery Investigations. CIMEQ. Havana city, Cuba