The Role of Energy Intake on Fitness-Adjusted Racial/Ethnic Differences in Central Adiposity Using Quantile Regression

  • Samantha M. McDonaldEmail author
  • Andrew Ortaglia
  • Christina Supino
  • Matteo Bottai



Energy intake (EI) is suggested to be associated with adiposity and may explain previously observed fitness-adjusted racial disparities in waist circumference (WC).


The purpose of this study was to comprehensively evaluate the role of EI on the fitness-adjusted racial/ethnic disparities in WC in a nationally representative sample of females using quantile regression.


Our sample consisted of 3874 female participants (aged 12 to 49 years) from the 1999–2004 National Health and Nutrition Examination Survey. The role of EI was assessed in separate analyses via estimation using a 24-hour dietary recall (DR) and the Institute of Medicine total daily energy expenditure equations. Age-stratified quantile regression models were used to estimate the differences in WC between minority groups and non-Hispanic (NH) white, adjusting for EI, CRF, age, and height.


Results from the quantile regression analyses adjusting for EI via DR showed significant differences in WC between NH black and NH white at the 25th–90th WC percentiles (5.9–11.1 cm) for females 20–49 and at the 90th WC percentile (10.1 cm) for females 16–19. For females 12–15, no significant differences were observed between NH black and NH white. Analyses adjusting for EI via IOM showed significant differences in WC between NH black and NH white only for females aged 20–49 years, at the 50th and 75th percentile (1.7–3.6 cm). Compared to NH White, Mexican American females, in all age groups, tended to have significantly greater WC.


These results highlight the importance of rigor in energy intake assessments, suggesting that EI, if adequately assessed, may explain a substantial part of the racial/ethnic differences in WC between NH black and NH white females. Additionally, the observed persistence of estimated differences in WC with advancing age suggests other factors (e.g., hormones) may play a role.


Adiposity Race/ethnicity Diet Fitness Nutrition 


Author Contributions

SM and AO conceptualized and drafted the manuscript. AO and MB performed all statistical analyses. SM, AO, MB, and CS edited the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Frieden TR. CDC Health Disparities and Inequalities Report - United States, 2013. Foreword. MMWR Suppl. 2013;62:1–2.PubMedGoogle Scholar
  2. 2.
    Jackson CL, Szklo M, Ye HC, et al. Black-white disparities in overweight and obesity trends by educational attainment in the United States, 1997-2008. J Obes. 2013;140743Google Scholar
  3. 3.
    Freedman DS, Ford ES. Are the recent secular increases in the waist circumference of adults independent of changes in BMI? Am J Clin Nutr. 2015;101(3):425–31.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Cossrow N, Falkner B. Race/ethnic issues in obesity and obesity-related comorbidities. J Clin Endocrinol Metab. 2004;89(6):2590–4.PubMedGoogle Scholar
  5. 5.
    Kumanyika SK. Special issues regarding obesity in minority populations. Ann Intern Med. 1993;119(7 Pt 2):650–4.PubMedGoogle Scholar
  6. 6.
    Beydoun MA, Wang Y. Gender–ethnic disparity in BMI and waist circumference distribution shifts in US adults. Obes (Silver Spring). 2009;17(1):169–76.Google Scholar
  7. 7.
    Swain DP, Brawner C. Cardiorespiratory exercise prescription. In: Swain DP, editor. ACSM’s resource manual for guidelines for exercise testing and prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2014. p. 448–62.Google Scholar
  8. 8.
    McDonald SM, Ortaglia A, Bottai M, et al. Differential association of cardiorespiratory fitness and central adiposity among US adolescents and adults: a quantile regression approach. Prev Med. 2016;88:1–7.PubMedGoogle Scholar
  9. 9.
    Anderssen SA, Cooper AR, Riddoch C, Sardinha LB, Harro M, Brage S, et al. Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country, age and sex. Eur J Cardiovasc Prev Rehabil. 2007;14(4):526–31.PubMedGoogle Scholar
  10. 10.
    McDonald S, Ortaglia A, Supino C, Kacka M, Clenin M, Bottai M. Fitness adjusted racial disparities in central adiposity among women in the USA using quantile regression. Obes Sci Pract. 2017;3(2):153–61.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Celis-Morales C, Livingtone KM, Affleck A, et al. Correlates of overall and central obesity in adults from seven European countries: findings from the Food4Me Study. Eur J Clin Nutr. 2018;72(2):207–19. Scholar
  12. 12.
    Puia A, Corneliu-Leucuta D. Children’s lifestyle behaviors in relation to anthropometric indices: a family practice study. Clujul Med. 2017;90(4):385–91.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Gepner Y, Shelef I, Schwarzfuchs D, Zelicha H, Tene L, Yaskolka Meir A, et al. Effect of distinct lifestyle interventions on mobilization of fat storage pools: the central magnetic resonance imaging randomized controlled trial. Circulation. 2018;137(11):1143–57. Scholar
  14. 14.
    Singleton CR, Affuso O, Sen B. Decomposing racial disparities in obesity prevalence: variations in retail food environment. Am J Prev Med. 2016;50(3):365–72.PubMedGoogle Scholar
  15. 15.
    Subar AF, Kipnis V, Troiano RP, Midthune D, Schoeller DA, Bingham S, et al. Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol. 2003;158(1):1–13.PubMedGoogle Scholar
  16. 16.
    Archer E, Hand GA, Blair SN. Validity of US nutritional surveillance: National Health and Nutrition Examination Survey caloric energy intake data, 1971–2010. PLoS One. 2013;8(10):e76632.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Brooks GA, Fahey TD, Baldwin KM. Chronicle of the Institute of Medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr. 2004;79(5):921S–30S.PubMedGoogle Scholar
  18. 18.
    Johnson CL, Paulose-Ram R, Ogden CL, et al. National health and nutrition examination survey: analytic guidelines, 1999–2010. Vital Health Stat 2. 2013;161:1–24.Google Scholar
  19. 19.
    Centers for Disease Control and Prevention. NHANES Cardiovascular Fitness Procedures Manual. Centers for Disease Control and Prevention, National Center for Health Statistics. Revised 2005.256 p. Available from: Accessed 12 June 2015.
  20. 20.
    Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES): Anthropometry Procedures Manual. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics. Revised 2004.110 p. Available from: Manual.pdf. Accessed on 11 July 2015.
  21. 21.
    Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey MEC In-Person Dietary Interviewers Procedure Manual. Centers for Disease Control and Prevention, National Center for Health Statistics. Revised 2009.343 p. Available from Accessed April 2017.
  22. 22.
    Blair SN, Kohl HW, Paffenbarger RS, et al. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262(17):2395–401.PubMedGoogle Scholar
  23. 23.
    Cureton KJ, Warren GL. Criterion-referenced standards for youth health-related fitness tests: a tutorial. Res Q Exerc Sport. 1990;61(1):7–19.PubMedGoogle Scholar
  24. 24.
    Jackson DM, Djafarian K, Stewart J, et al. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med. 2009;169(19):1781–7.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Lumley T. Complex surveys: a guide to analysis using R. Hoboken: John Wiley & Sons; 2010. p. 251–3.Google Scholar
  26. 26.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(11):806–14.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Bergouignan A, Momken I, Lefai E, et al. Activity energy expenditure is a major determinant of dietary fat oxidation and trafficking, but the deleterious effect of detraining is more marked than the beneficial effect of training at current recommendations. Am J Clin Nutr. 2013;98(3):648–58.PubMedGoogle Scholar
  28. 28.
    Curioni CC, Lourenço PM. Long-term weight loss after diet and exercise: a systematic review. Int J Obes. 2005;29(10):168.Google Scholar
  29. 29.
    Miller W, Koceja D, Hamilton E. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes. 1997;21(10):941–7.Google Scholar
  30. 30.
    Sharp TA, Bell ML, Grunwald GK, Schmitz KH, Sidney S, Lewis CE, et al. Differences in resting metabolic rate between White and African-American young adults. Obes Res. 2002;10(8):726–32.PubMedGoogle Scholar
  31. 31.
    Forman J, Miller W, Szymanski L, Fernhall B. Differences in resting metabolic rates of inactive obese African-American and Caucasian women. Int J Obes. 1998;22(3):215–21.Google Scholar
  32. 32.
    Ravussin E, Lillioja S, Anderson TE, Christin L, Bogardus C. Determinants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber. J Clin Invest. 1986;78(6):1568–78.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Kushner RF, Racette SB, Neil K, et al. Measurement of physical activity among black and white obese women. Obes Res. 1995;3(Suppl 2):261s–5s.PubMedGoogle Scholar
  34. 34.
    Geissler CA, Aldouri MS. Racial differences in the energy cost of standardised activities. Ann Nutr Metab. 1985;29:40–7.PubMedGoogle Scholar
  35. 35.
    Rising R, Harper IT, Fontvielle AM, Ferraro RT, Spraul M, Ravussin E. Determinants of total daily energy expenditure: variability in physical activity. Am J Clin Nutr. 1994;59(4):800–4.PubMedGoogle Scholar
  36. 36.
    Albu J, Shur M, Curi M, Murphy L, Heymsfield SB, Pi-Sunyer FX. Resting metabolic rate in obese, premenopausal black women. Am J Clin Nutr. 1997;66(3):531–8.PubMedGoogle Scholar
  37. 37.
    Hannon TS, Janosky J, Arslanian SA. Longitudinal study of physiologic insulin resistance and metabolic changes of puberty. Pediatr Res. 2006;60(6):759–63.PubMedGoogle Scholar
  38. 38.
    Ahmed ML, Ong KK, Morrell DJ, Cox L, Drayer N, Perry L, et al. Longitudinal study of leptin concentrations during puberty: sex differences and relationship to changes in body composition. J Clin Endocrinol Metab. 1999;84(3):899–905.PubMedGoogle Scholar
  39. 39.
    Gunnar MR, Wewerka S, Frenn K, Long JD, Griggs C. Developmental changes in hypothalamus–pituitary–adrenal activity over the transition to adolescence: normative changes and associations with puberty. Dev Psychopathol. 2009;21(1):69–85.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Heymsfield SB, Gallagher D, Poehlman ET, Wolper C, Nonas K, Nelson D, et al. Menopausal changes in body composition and energy expenditure. Exp Gerontol. 1994;29(3–4):377–89.PubMedGoogle Scholar
  41. 41.
    Hale GE, Burger HG. Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause. Best Pract Res Obstet Gynaecol. 2009;23(1):7–23.Google Scholar
  42. 42.
    Pinheiro SP, Holmes MD, Pollak MN, et al. Racial differences in premenopausal endogenous hormones. Cancer Epidemiol Biomark Amp Prev. 2001;14(9):2147–53.Google Scholar
  43. 43.
    Manson JM, Sammel MD, Freeman EW, Grisso JA. Racial differences in sex hormone levels in women approaching the transition to menopause. Fertil Steril. 2001;75(2):297–304.PubMedGoogle Scholar
  44. 44.
    Richards RJ, Svec F, Bao W, Srinivasan SR, Berenson GS. Steroid hormones during puberty: racial (black-white) differences in androstenedione and estradiol--the Bogalusa Heart Study. J Clin Endocrinol Metab. 1992;75(2):624–31.PubMedGoogle Scholar
  45. 45.
    Williams DR, Yu Y, Jackson JS, et al. Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997;2(3):335–51.PubMedGoogle Scholar
  46. 46.
    Fradkin C, Wallander JL, Elliot MN, et al. Associations between socioeconomic status and obesity in diverse, young adolescents: variation across race/ethnicity and gender. Health Psychol. 2014;34(1):1–9.PubMedGoogle Scholar
  47. 47.
    Jackson JS, Knight KM, Rafferty JA. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health. 2010;100(5):933–9.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Rosmond R, Dallman MF, Björntorp P. Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab. 1998;83(6):1853–9.PubMedGoogle Scholar
  49. 49.
    Caetano R, Kaskutas LA. Changes in drinking patterns among whites, blacks and Hispanics, 1984-1992. J Stud Alcohol. 1995;56(5):558–65.PubMedGoogle Scholar
  50. 50.
    Parker R, Kim S-J, Gao B. Alcohol, adipose tissue and liver disease: mechanistic links and clinical considerations. Nat Rev Gastroenterol Amp Hepatol. 2018;15(1):50–9.Google Scholar
  51. 51.
    Arif AA, Rohrer JE. Patterns of alcohol drinking and its association with obesity: data from the third national health and nutrition examination survey, 1988–1994. BMC Public Health. 2005;5(5):126.PubMedPubMedCentralGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Physical Education, Sport and Human Performance, College of EducationWinthrop UniversityRock HillUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaUSA
  3. 3.College of Osteopathic MedicineUniversity of New EnglandBiddefordUSA
  4. 4.Division of Biostatistics, Institute of Environmental MedicineKarolinska InstitutetStockholmSweden

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