Validity of the assessment of dietary intake: problems of misreporting

Impact of water intake on energy intake and weight status: a systematic review

The effects of consuming water with meals rather than drinking no beverage or various other beverages remain under-studied. This systematic review of studies reported in the English-language literature was performed to compare the effects of drinking water and various beverage alternatives on energy intake and/or weight status. Relevant clinical trials, epidemiologic studies, and intervention studies were identified and findings across the literature were summarized. From the clinical trials, average differences were calculated in total energy intake at test meals (DeltaTEI) for each of several beverage categories in comparison with water. The available literature for these comparisons is sparse and somewhat inconclusive. However, one of the most consistent sets of findings was related to adults drinking sugar-sweetened beverages (SSBs) versus water before a single meal. In these comparisons, total energy intakes were 7.8% higher (DeltaTEI range, -7.5 to 18.9) when SSBs were consumed. Studies comparing non-nutritive sweeteners with water were also relatively consistent and found no impact on energy intake among adults (DeltaTEI, -1.3; range, -9 to 13.8). Much less conclusive evidence was found in studies replacing water with milk and juice, with estimated increases in TEI of 14.9% (range, 10.9 to 23.9%). These findings from clinical trials, along with those from epidemiologic and intervention studies, suggest water has a potentially important role to play in reducing energy intake, and consequently in obesity prevention. A need for randomized-controlled trials to confirm this role exists.

How well does patient self-report predict asthma medication possession? Implications for medication reconciliation and adherence assessment

BACKGROUND

Self-report is the most commonly used method for collecting information regarding asthma medication possession and adherence in clinical practice.

OBJECTIVE

To determine the agreement between self-report and pharmacy claims data for asthma medication possession.

METHODS

This is a retrospective study that examined pharmacy claims data 12 months before and after participants completed a structured asthma survey. This study was performed in a sample of health care workers and dependents >17 years old in a large, self-insured Midwestern United States health care center. The main outcome measure was agreement (kappa calculation) between self-report and pharmacy claims data of asthma medication possession.

RESULTS

Self-report of asthma medication use agreed moderately with pharmacy claims data for short-acting albuterol (κ=0.47 ± 0.03), salmeterol (κ=0.79 ± 0.04), and montelukast (κ=0.69 ± 0.03) but only slightly for inhaled corticosteroids (κ=0.18 ± 0.03) and prednisone (κ=0.10 ± 0.03) (n=1050 respondents). Both under self-reporting and over self-reporting were common with inhaled corticosteroids (14.4% and 23.1%, respectively) and varied significantly by specific drug type.

CONCLUSIONS

Self-report moderately agrees with asthma medication possession for most adult asthma patients, though the agreement differs considerably between and within asthma medication classes.

Effect of smoking status on total energy expenditure

Individuals who smoke generally have a lower body mass index (BMI) than nonsmokers. The relative roles of energy expenditure and energy intake in maintaining the lower BMI, however, remain controversial. We tested the hypothesis that current smokers have higher total energy expenditure than never smokers in 308 adults aged 40-69 years old of which 47 were current smokers. Energy expenditure was measured by doubly labeled water during a two week period in which the subjects lived at home and performed their normal activities. Smoking status was determined by questionnaire. There were no significant differences in mean BMI (mean ± SD) between smokers and never smokers for either males (27.8+5.1 kg/m2 vs. 27.5+4.0 kg/m2) or females (26.5+5.3 kg/m2 vs. 28.1+6.6 kg/m2), although the difference in females was of similar magnitude to previous reports. Similarly, total energy expenditure of male smokers (3069+764 kcal/d) was not significantly different from that of never smokers (2854+468 kcal/d), and that of female smokers (2266+387 kcal/d) was not different from that of never smokers (2330+415 kcal/d). These findings did not change after adjustment for age, fat-free mass and self-reported physical activity. Using doubly labeled water, we found no evidence of increased energy expenditure among smokers, however, it should be noted that BMI differences in this cohort also did not differ by smoking status.

FTO variant, energy intake, physical activity and basal metabolic rate in Caucasians. The HAPIEE study

The FTO gene variants are the most important genetic determinants of body weight and obesity known so far, but the mechanism of their effect remains unclear. We have analyzed FTO rs17817449 variant (G>T in first intron) in 6024 adults aged 45-69 years to assess the potential mediating role of diet and physical activity. Diet was assessed by a 140-item food frequency questionnaire. Physical activity was measured by hours spent during a typical week by sport, walking and other activities outside of work requiring heavy and medium physical activity. Basal metabolic rate was calculated according Schofield formula. The FTO variant was significantly associated with body mass index (means in GG, GT and TT carriers were 28.7, 28.2 and 27.8 kg/m(2), p<0.001) and basal metabolic rate (BMR) (means in GG, GT and TT were 1603, 1588 and 1576 kcal per day, respectively, p<0.008) but it was not associated with physical activity, total energy intake or with energy intakes from fat, carbohydrates, proteins or alcohol. Results were essentially similar in men and women and the adjustment for physical activity or dietary energy intake did not reduce the effect of the FTO polymorphism. Means of BMR per kg of body weight was lowest in GG carriers (20.09, 20.21 for GT and 20.30 for TT, p<0.006) and this effect was more pronounced in females. These results suggest that the effect of the FTO rs17817449 variant on BMI in Caucasian adults is not mediated by energy intake or physical activity, but some effect on BMR per kg of body weight is possible.

Lack of association between serum magnesium and the risks of hypertension and cardiovascular disease

BACKGROUND

Experimental studies have linked hypomagnesemia with the development of vascular dysfunction, hypertension, and atherosclerosis. Prior clinical studies have yielded conflicting results but were limited by the use of self-reported magnesium intake or short follow-up periods.

METHODS

We examined the relationship between serum magnesium concentration and incident hypertension, cardiovascular disease (CVD), and mortality in 3,531 middle-aged adult participants in the Framingham Heart Study offspring cohort. Analyses were performed using Cox proportional hazards regressions, adjusted for traditional CVD risk factors.

RESULTS

Follow-up was 8 years for new-onset hypertension (551 events) and 20 years for CVD (554 events). There was no association between baseline serum magnesium and the development of hypertension (multivariable-adjusted hazards ratio per 0.15 mg/dL 1.03, 95% CI 0.92-1.15, P = .61), CVD (0.83, 95% CI 0.49-1.40, P = .49), or all-cause mortality (0.77, 95% CI 0.41-1.45, P = .42). Similar findings were observed in categorical analyses, in which serum magnesium was modeled in categories (<1.5, 1.5-2.2, >2.2 mg/dL) or in quartiles.

CONCLUSIONS

In conclusion, data from this large, community-based cohort do not support the hypothesis that low serum magnesium is a risk factor for developing hypertension or CVD.

Calcium intake and body composition in African-American children and adolescents at risk for overweight and obesity

This study examined the role of calcium intake on body composition in 186 African-American adolescents at risk for overweight and obesity. The average weight of 89.8 kg ± 23.6 (SD) had a mean BMI z score of 2.2. Females with a calcium intake of <314 mg/day had higher percent fat mass compared to those with the highest calcium intakes that were ≥634 mg/day. Compared to those with a low calcium intake (<365 mg/day), those with the highest calcium intake of >701 mg/day had higher intake of thiamin, folate, cobalamin, vitamin D, phosphorus, iron, zinc.

Protein intake induced an increase in exercise stimulated fat oxidation during stable body weight

BACKGROUND

Protein-rich weight-loss diets spare fat-free mass at the cost of fat mass. The objective was to examine if there is a change in stimulated fat oxidation related to protein intake during stable body weight.

METHODS

Subjects' (BMI 22±2kg/m(2), age 25±8 years) maximal fat oxidation (Fat(max)) was assessed during a graded bicycle test, before and after a 3-month dietary-intervention of 2MJ/day supplements exchanged with 2MJ/d of habitual energy intake. The parallel design consisted of protein-rich supplements in the protein group and an isocaloric combination of carbohydrate and fat supplements in the control group. Daily protein intake was determined according to 24-h urine nitrogen. Body composition was measured according to a 4-compartment model by a combination of underwater-weighing technique, deuterium-dilution technique and whole-body dual-energy X-ray absorptiometry (DXA).

RESULTS

Subjects were weight stable and did not change their physical activity. The protein group (n=12) increased protein intake (11±14g, P<0.05) and had significantly higher daily protein intake vs. control (n=4) (80±21 vs.59±11g, P<0.05). Fat(max) increased significantly in the protein group (0.08±0.08g/min, P<0.01). Fat-free mass increased independent of change in body weight (P<0.01), and fat mass and fat percentage decreased (P<0.05). Change in Fat(max) was a function of change in protein intake (r=0.623, P<0.05), and not of changes in body composition or VO(2)max.

CONCLUSION

Increased stimulated fat oxidation was related to increased protein intake.

Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD): 1-year follow-up

Nutritional studies in patients with chronic obstructive pulmonary disease (COPD) are often based on oral nutritional supplementation and are of short duration. Our aim was to study the changes in body weight and physical performance in COPD patients after receiving the dietary advice for 1 year. Thirty-six patients with COPD as a primary diagnosis (mean age: 68.5±7.8 years), referred to a pulmonary rehabilitation program were studied. Each patient received dietary advice individually. Body weight had increased significantly by 1.3 kg (p=0.02) and walking distance by 83.2 m (p=0.007) after 1 year. There was an increase in mean handgrip strength after 1 year (1.6 kg, p=0.07). The mean intake of energy and protein expressed as percent of energy and protein requirement had increased after 1 year (15%, p<0.001, and 5.6%, p=0.09, respectively). Handgrip strength correlated significantly with energy (r=0.53, p=0.002), fat (r=0.50, p=0.02) and protein intake (r=0.41, p=0.002) after 1 year. In conclusion, positive effects on body weight, handgrip strength and walking distance in patients with COPD were seen after receiving dietary advice with a 1-year follow-up.

An outbreak of hepatic veno-occlusive disease in Western afghanistan associated with exposure to wheat flour contaminated with pyrrolizidine alkaloids

Pyrrolizidine alakloids (PAs) are known to cause hepatic veno-occlusive disease (VOD). Outbreaks have occurred in Western Afghanistan since 1974, the latest in February 2008. We conducted an outbreak investigation using a case-control design. Sixty-seven cases of VOD were compared with 199 community controls. Consumption of bread was strongly associated with disease (adjusted odds ratio: 35.8 [95%CI: 7.6–168.2]). Toxic doses of PA were found in plant extracts and in samples of wheat flour taken from the study area. Compared to wheat flour there was 1000 times less PA in milk and whey and in water samples the PA content was zero. Although direct analysis was not possible, contaminated wheat flour used to make bread was the likely source of PA causing the outbreak. Eating a more varied diet including meat and fruit may be protective. Prevention and control measures will rely on community awareness and agricultural interventions to ensure safety of the food supply.

Dietary intakes in infertile women a pilot study

BACKGROUND

The reproductive axis is closely linked to nutritional status. The purpose of this study was to compare the nutritional status in two groups of young infertile women, without clinically overt eating disorders: hypothalamic amenorrhea (HA) and polycystic ovary syndrome (PCOS).

METHODS

Eighteen young infertile women (10 HA, 8 PCOS) attending an outpatient gynecological endocrinology unit, underwent evaluation of anthropometry, body composition, dietary intakes by means of a food frequency questionnaire (FFQ) and a seven-day food diary (7DD), and psychological characteristics by means of EDI2 and SCL90 tests.

RESULTS

HA women had lower BMI and body fat compared to PCOS women. Habitual intake derived from FFQs showed a similar macronutrient distribution between groups (about 16% protein, 33% fat, 52% carbohydrates). The psychometric profiles of the two groups did not differ significantly. The underreporting of dietary intakes (measured as habitual energy intake by FFQs/basal metabolic rate) was found to be negatively correlated with the interpersonal sensitivity SCL-90 subscale scores (r = -0.54, p = 0.02).

CONCLUSION

Our study identified differences in body composition but not in dietary habits between HA and PCOS infertile women. We documented, for the first time, a relationship between the accuracy of dietary surveys and the psychological characteristics of subjects with anovulation. This finding suggests that it may be important to be aware of the psychological terrain when planning a dietary survey in infertile women.

Plasma pharmacokinetics of alkylresorcinol metabolites: new candidate biomarkers for whole-grain rye and wheat intake

BACKGROUND

Alkylresorcinols are phenolic compounds that are present almost exclusively in rye and wheat fiber. Alkylresorcinols are absorbed and thereafter metabolized to 3,5-dihydroxybenzoic acid (DHBA) and 3-(3,5-dihydroxyphenyl)-1-propanoic acid (DHPPA), which have been detected in human urine and plasma.

OBJECTIVE

The objective was to determine the plasma pharmacokinetics of DHBA and DHPPA in human subjects to estimate whether they show potential as biomarkers for whole-grain rye and/or wheat intake.

DESIGN

Fifteen human volunteers followed a low-alkylresorcinol diet for 2 d before ingesting a single dose of high-fiber rye bread containing 100 mg alkylresorcinols [corrected]. Plasma samples were collected for 25 h, and the alkylresorcinol metabolites were quantified by HPLC with coulometric electrode array detection.

RESULTS

Maximum concentrations were reached at approximately 6 h for both metabolites, although interindividual variation was found. The half-life was significantly (P < 0.0002) longer for DHPPA (16.3 h) than for DHBA (10.1 h). No significant differences were discovered between women and men in the half-life of each metabolite, which, from a pharmacokinetic point of view, is the most important parameter. The area under the curve differed significantly between DHBA and DHPPA (P < 0.0001) and between women and men (P = 0.03 for DHBA and P = 0.01 for DHPPA). However, when corrected for body weight, the difference between sexes was no longer significant.

CONCLUSIONS

Our results suggest that DHBA and DHPPA are both good candidate biomarkers for whole-grain rye and/or wheat intake; however, DHPPA is the better indicator because of its longer half-life. This could provide a practical tool when investigating the association between diet and diseases.

The feasibility of serving liquid yoghurt supplemented with probiotic bacteria, Lactobacillus rhamnosus LB 21, and Lactococcus lactis L1A--a pilot study among old people with dementia in a residential care facility

BACKGROUND

Constipation and body weight loss are prevalent among old people. Treatment with different species of lactic acid bacteria has been suggested for various forms of gastrointestinal disorders. OBJECTIVE, PARTICIPANTS AND INTERVENTION: This pilot study was performed to assess the feasibility of administering and consuming a drinkable yoghurt containing Lactobacillus rhamnosus LB 21 and Lactococcus L1A, and to evaluate the influence on bowel movements and body weight in 15 people with dementia, aged 65-95 years in residential care facility.

DESIGN

A drinkable yoghurt (Verum Drickyoghurt) with added bacteria was served daily for 6 months in conjunction with ordinary food intake. Body weight, bowel movement frequency and consistency, food and fluid intake and time spent in various activities were recorded for two weeks pre-intervention, and 3 times during the follow-up period.

RESULT

This study showed that the yoghurt was easy to serve, with few side effects for the participants and that the various recording forms and diaries were easy for the staff to complete. The extra intake of yoghurt did not have any detectable beneficial effect on bowel movements. The overnight fast was almost 15 hours per day. Body weight decreased by 0.65 kg/month (95% confidence interval. 0.27-0.97).

CONCLUSIONS

The present study design was feasible in this group of old people with dementia. The absence of any detectable effect of the supplement on constipation, but rather a considerable loss in body weight, indicate that further research is needed in a large randomised controlled trial, if associations between dementia, constipation and energy balance are to be understood.

Association between intake of dietary protein and 3-year-change in body growth among normal and overweight 6-year-old boys and girls (CoSCIS)

OBJECTIVE

Growth hormone (GH) affects linear growth and body composition, by increasing the secretion of insulin-like growth factor-I (IGF-I), muscle protein synthesis and lipolysis. The intake of protein (PROT) as well as the specific amino acids arginine (ARG) and lysine (LYS) stimulates GH/IGF-I secretion. The present paper aimed to investigate associations between PROT intake as well as intake of the specific amino acids ARG and LYS, and subsequent 3-year-change in linear growth and body composition among 6-year-old children.

DESIGN

Children's data were collected from Copenhagen (Denmark), during 2001-2002, and again 3 years later. Boys and girls were separated into normal weight and overweight, based on BMI quintiles. Fat-free mass index (FFMI) and fat mass index (FMI) were calculated. Associations between change (Delta) in height, FMI and FFMI, respectively, and habitual PROT intake as well as ARG and LYS were analysed by multiple linear regressions, adjusted for baseline height, FMI or FFMI and energy intake, age, physical activity and socio-economic status.

SETTING

Eighteen schools in two suburban communities in the Copenhagen (Denmark) area participated in the study.

SUBJECTS

In all, 223 children's data were collected for the present study.

RESULTS

High ARG intake was associated with linear growth (beta = 1.09 (se 0.54), P = 0.05) among girls. Furthermore, in girls, DeltaFMI had a stronger inverse association with high ARG intake, if it was combined with high LYS intake, instead of low LYS intake (P = 0.03). No associations were found in boys.ConclusionIn prepubertal girls, linear growth may be influenced by habitual ARG intake and body fat gain may be relatively prevented over time by the intake of the amino acids ARG and LYS.

Individual responsiveness to exercise-induced fat loss is associated with change in resting substrate utilization

Fat loss in response to exercise training varies between individuals, even when differences in compliance to the exercise program are accounted for. The purpose of this study was to investigate whether individual variation in change in fasting respiratory quotient (RQ) after exercise training contributes to this interindividual variability. Fifty-five premenopausal women participated in a 7-week endurance-type exercise training program; and fitness, body composition, and resting substrate utilization and metabolic rate in the fasted state were assessed at baseline and postintervention. Total net energy expenditure of the exercise intervention (exEE) was determined from heart rate obtained in all exercise sessions and individualized calibration of the heart rate vs oxygen uptake relationship. Dietary intake and physical activity (by constant heart rate monitoring) were assessed at baseline and during the final week of the intervention. Mean change in fat mass for the group was -0.97 kg (range, +2.1 to -5.3 kg). The strongest correlate of change in fat mass was exEE (r = 0.60, P < .0005). Change in fasting RQ correlated significantly (r = -0.26, P = .05) with the residual for change in fat mass after adjusting for the effects of both exEE and change in energy intake, explaining 7% of the variance. In multiple regression analysis, exEE (P < .0005) and change in fasting RQ (P = .02) were the only statistically significant independent predictors of change in fat mass, together explaining 40.2% of the variance. Thus, fat loss in response to exercise training depends not only on exercise energy expenditure but also on exercise training-induced changes in RQ at rest. This suggests that development of strategies to maximize the change in resting fat oxidation in response to an exercise training program may help individuals to maximize exercise-induced fat loss.

Low-fat dairy intake and body weight and composition changes in college students

Dairy calcium may help prevent excess weight gain and obesity when consumed in adequate amounts (three or more servings per day) and combined with energy balance. This prospective cohort study was conducted to evaluate dairy intake and examine the association between low-fat dairy intake and body weight and composition changes in college students. Seventy-six college students (65 women and 11 men; mean age+/-standard error [SE]=19.2+/-0.2 years) completed 7-day food records, body height (cm), weight (kg), and waist circumference (cm) measurements twice (September 2004 and April 2005). Percentage of truncal fat and percentage of total body fat were measured by dual-energy x-ray absorptiometry. One-way multivariate analysis of covariance was conducted. Overall (mean+/-SE) total dairy (1.4+/-0.1 servings/day), low-fat dairy (0.5+/-0.1 servings/day), and calcium (815+/-41 mg/day) intakes were low. Subjects who consumed a higher amount of low-fat dairy products (mean+/-SE=0.8+/-0.1 servings/day) had better diet quality, gained less body weight, and had reductions in waist circumference, percentage truncal fat, and percentage total body fat compared to those with lower intake (mean+/-SE=0.1+/-0.0 servings/day). Low-fat dairy intake may be associated with better diet quality and weight management in college students. Nutrition interventions in young adults should promote low-fat dairy intake as part of an overall healthful lifestyle.

The genetic contribution to non-syndromic human obesity

The last few years have seen major advances in common non-syndromic obesity research, much of it the result of genetic studies. This Review outlines the competing hypotheses about the mechanisms underlying the genetic and physiological basis of obesity, and then examines the recent explosion of genetic association studies that have yielded insights into obesity, both at the candidate gene level and the genome-wide level. With obesity genetics now entering the post-genome-wide association scan era, the obvious question is how to improve the results obtained so far using single nucleotide polymorphism markers and how to move successfully into the other areas of genomic variation that may be associated with common obesity.

Bite weight prediction from acoustic recognition of chewing

Automatic dietary monitoring (ADM) offers new perspectives to reduce the self-reporting burden for participants in diet coaching programs. This paper presents an approach to predict weight of individual bites taken. We utilize a pattern recognition procedure to spot chewing cycles and food type in continuous data from an ear-pad chewing sound sensor. The recognized information is used to predict bite weight. We present our recognition procedure and demonstrate its operation on a set of three selected foods of different bite weights. Our evaluation is based on chewing sensor data of eight healthy study participants performing 504 habitual bites in total. The sound-based chewing recognition achieved recalls of 80% at 60%-70% precision. Food classification of chewing sequences resulted in an average accuracy of 94%. In total, 50 variables were derived from the chewing microstructure, and were analyzed for correlations between chewing behavior and bite weight. A subset of four variables was selected to predict bite weight using linear food-specific models. Mean weight prediction error was lowest for apples (19.4%) and largest for lettuce (31%) using the sound-based recognition. We conclude that bite weight prediction using acoustic chewing recordings is a feasible approach for solid foods, and should be further investigated.

Comparison of a dietary survey and the duplicate plate method for determining dietary fluoride ingested by young children: a pilot study

BACKGROUND

Investigators have attempted to establish the diet's contribution to the total body burden of fluoride in response to a reported trend towards an increase in fluoride intake.

AIM

The aim of this study was to compare the suitability of two methods to collect dietary data for fluoride intake assessment.

DESIGN

Assessments were made in 12 children using the duplicate plate and dietary diary methods following a randomized cross-over design. Foods and beverages were analysed for fluoride, and total fluoride intake per day was calculated. Results from each method were compared.

RESULTS

Mean beverage fluoride intake was estimated at 316 +/- 120 and 422 +/- 195 microg/day utilizing the diary and duplicate plate methods, respectively. Mean food fluoride intake was estimated at 188 +/- 48 microg/day using the diary, whereas it was 130 +/- 41 microg using the duplicate plate method. Total fluoride intake was 504 +/- 138 and 552 +/- 192 microg/day utilizing the diary and duplicate methods. Large variations in daily fluoride intake from both beverages and food were observed between and within children.

CONCLUSIONS

Both methods had inherent shortcomings and sources of error. The duplicate method was more labour intensive and costly; however, the diary method required a large number of assumptions. A combination of both methods seems to be most suitable to obtain reliable data.

Meal patterns among children and adolescents and their associations with weight status and parental characteristics

OBJECTIVES

To describe the meal patterns of Jena schoolchildren and their associations with children's weight status and parental characteristics.

DESIGN

Cross-sectional study.

SETTING

Twenty schools in Jena (100,000 inhabitants), south-east Germany.

SUBJECTS

A total of 2054 schoolchildren aged 7-14 years with information on BMI standard deviation score (BMI-SDS) and weight status (based on German reference values), of whom 1571 had additional information about their parents (parental education and employment status, weight status according to WHO guidelines) and meal patterns (school lunch participation rate, meal frequencies, breakfast consumption and frequency of family meals).

RESULTS

Weight status of the children was associated with weight status, education and employment status of the parents. Meal patterns were strongly dependent on children's age and parental employment. As age increased, the frequency of meal consumption, participation rate in school lunches and the number of family meals decreased. Using linear regression analysis, a high inverse association between BMI-SDS and meal frequency was observed, in addition to relationships with parental weight status and paternal education.

CONCLUSIONS

Age-specific prevention programmes should encourage greater meal frequency. The close involvement of parents is essential in any strategy for improving children's (families') diets.

The effect of exercise and estrogen on osteoprotegerin in premenopausal women

BACKGROUND

The benefits of exercise are widely recognized, however physically active women can develop exercise associated menstrual cycle disturbances such as amenorrhea (i.e., estrogen deficiency) secondary to a chronic energy deficiency.

OBJECTIVE

To assess the effects of exercise status and estrogen deficiency on osteoprotegerin (OPG) and its relationship to bone resorption in premenopausal exercising women.

DESIGN

Cross-sectional study of serum OPG, urinary c-telopeptides (uCTX), urinary estrone 3-glucuronide (E1G), urinary pregnanediol 3-glucuronide (PdG) and bone mineral density (BMD) measured on multiple occasions in 67 women. Volunteers were retrospectively grouped: 1) sedentary menstruating group (SedMen n=8), 2) exercising menstruating group (ExMen, n=36), and 3) exercising amenorrheic group (ExAmen, n=23). One-way ANOVAs were performed, and LSD post-hoc tests were performed when differences were detected.

RESULTS

Subjects were similar with respect to age (24.2+/-1.0 years), weight (57.8+/-1.7 kg), and height (164.3+/-1.3 cm) (p>0.05). ExMen and ExAmen groups were more aerobically fit (p=0.003) and had less body fat (p=0.002) than the SedMen group. Resting energy expenditure/fat free mass was lowest (p=0.001) in the ExAmen groups. Mean E1G across the measurement period (p<0.001) and overall E1G exposure as assessed by E1G area under the curve (AUC) (p<0.001) were lower in the ExAmen group vs. the SedMen and ExMen groups. U-CTX-I was elevated (p=0.033) in the ExAmen group (281.8+/-40.3 microg/L/mmCr), compared with the SedMen and ExMen groups (184.5+/-22.4, 197.2+/-14.7 microg/L/mmCr, respectively). OPG was suppressed (p=0.005) in the ExAmen group (4.6+/-0.2 pmol/L) vs. ExMen group (5.2+/-0.2 pmol/L), and OPG was lower in the SedMen group (4.1+/-0.3 pmol/L) compared with the ExMen group. Findings were translated to BMD; the ExAmen group had suppressed total body BMD (p=0.014) and L2-L4 BMD (p=0.015) vs. the ExMen group.

CONCLUSIONS

Our results suggest that OPG responds to the bone loading effect of exercise, and that suppressed OPG may play a role in the etiology of increased bone resorption observed in exercising women with chronic estrogen deficiency secondary to hypothalamic amenorrhea.

Fourth graders' reports of fruit and vegetable intake at school lunch: does treatment assignment affect accuracy?

OBJECTIVE

Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition.

DESIGN

Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention.

SUBJECTS/SETTING

Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day.

MAIN OUTCOME MEASURES

Food items were coded as: "match," "omission," or "intrusion." Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake.

ANALYSES

Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or chi(2) analyses.

RESULTS

Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report.

CONCLUSIONS

Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.

Associations between the portion sizes of food groups consumed and measures of adiposity in the British National Diet and Nutrition Survey

The objective of the present study was to examine the associations between the portion sizes of food groups consumed with measures of adiposity using data from the National Diet and Nutrition Survey of British adults. Seven-day weighed dietary records, physical activity diaries and anthropometric measurements were used. Foods eaten were assigned to thirty different food groups and analyses were undertaken separately for men and women. The median daily portion size of each food group consumed was calculated. The potential mis-reporting [corrected] of dietary energy intake (EI) was identified using the following equation: EI--estimated energy requirements/EER [corrected] x 100 = percentage of under-reporting (UR) of energy needs. Multinomial logistic regression (adjusted for age, social class, physical activity level and UR) was used to determine the portion sizes of food groups most strongly associated with obesity status. Few positive associations between the portion sizes of food groups consumed and obesity status were found. However, UR was prevalent, with a median UR of predicted energy needs of 34 and 33 % in men and women, respectively. After the adjustment was made for UR, more associations between the food groups and obesity status became apparent in both sexes. The present study suggests that the true effect of increased portion size of foods on obesity status may be masked by high levels of UR. Alternatively, these data may indicate that an increased risk of obesity is not associated with specific foods/food groups but rather with an overall increase in the range of foods and food groups being consumed.

The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women

BACKGROUND

Bone loss in amenorrheic athletes has been attributed to energy deficiency-related suppression of bone formation, but not increased resorption despite hypoestrogenism.

OBJECTIVE

To assess the independent and combined effects of energy deficiency and estrogen deficiency on bone turnover markers in exercising women.

DESIGN

PINP, osteocalcin, U-CTX-I, TT3, leptin, and ghrelin were measured repeatedly, and bone mineral density (BMD) was measured once in 44 exercising women. Resting energy expenditure (REE) was used to determine energy status (deficient or replete) and was corroborated with measures of metabolic hormones. Daily levels of urinary estrone and pregnanediol glucuronides (E1G, PdG), were assessed to determine menstrual and estrogen status. Volunteers were then retrospectively categorized into 4 groups: 1) Energy Replete+Estrogen Replete (EnR+E2R), (n=22), 2) Energy Replete+Estrogen Deficient (EnR+E2D), (n=7), 3) Energy Deficient+Estrogen Replete (EnD+E2R), (n=7), and 4) Energy Deficient+Estrogen Deficient (EnD+E2D), (n=8).

RESULTS

The groups were similar (p>0.05) with respect to age (24.05+/-1.75 yrs), weight (57.7+/-2.2 kg), and BMI (21.05+/-0.7 kg/m2). By design, REE/FFM (p=0.028) and REE:pREE (p<0.001) were lower in the EnD vs. EnR group, and the E2D group had a lower REE:pREE (p=0.005) compared to the E2R group. The EnD+E2D group had suppressed PINP (p=0.034), and elevated U-CTX-I (p=0.052) and ghrelin (p=0.028) levels compared to the other groups. These same women also had convincing evidence of energy conservation, including TT3 levels that were 29% lower (p=0.057) and ghrelin levels that were 44% higher (p=0.028) than that observed in the other groups. Energy deficiency was associated with suppressed osteocalcin, and TT3 (p<0.05), whereas estrogen deficiency was associated with decreased E1G (p<0.02), and lower L2-L4 BMD (p=0.033). Leptin was significant in predicting markers of bone formation, but not markers of bone resorption.

CONCLUSIONS

When the energy status of exercising women was adequate (replete), there were no apparent perturbations of bone formation or resorption, regardless of estrogen status. Estrogen deficiency in exercising women, in the presence of an energy deficiency, was associated with bone loss and involved suppressed bone formation and increased bone resorption. These findings underscore the importance of avoiding energy deficiency, which is associated with hypoestrogenism, to avoid bone health problems.

A short history of beverages and how our body treats them

Numerous studies have demonstrated that beverages containing sugar, high fructose corn syrup (HFCS) or alcohol are handled differently by the body than when sugar or HFCS are incorporated in solid foods and as a result the overall caloric intake from solid food does not adjust to account for the calories in these beverages. A consideration of our evolutionary history may help to explain our poor compensatory response to calories from fluids. This paper reviews the history of eight important beverages: milk, beer, wine, tea, coffee, distilled alcoholic beverages, juice and soft drinks. We arrive at two hypotheses. First, humans may lack a physiological basis for processing carbohydrate or alcoholic calories in beverage because only breast milk and water were available for the vast majority of our evolutionary history. Alternatives to those two beverages appeared in the human diet no more than 11,000 years ago, but Homo sapiens evolved between 100,000 and 200,000 years ago. Second, carbohydrate and alcohol-containing beverages may produce an incomplete satiation sequence which prevents us from becoming satiated on these beverages.

Do aggregates of multiple questions better capture overall fish consumption than summary questions?

Objective

To compare intake estimates, validity and reliability of two summary questions to measure fish consumption with information from a detailed semi-quantitative food-frequency questionnaire (FFQ) on fish consumption.

Design

Population-based, cross-sectional study. Participants completed an FFQ and provided blood samples for erythrocyte membrane eicosapentaenoic acid (EPA) analysis. Aggregate measures of consumption of fresh/frozen/canned fish (fresh fish) and smoked/salted/dried fish (preserved fish) were generated from the FFQ and were compared with responses to the summary questions regarding intakes of similar items. Both methods were tested for validity, using correlation and linear regression techniques with EPA, and retest reliability.

Setting

Perth metropolitan area, Western Australia.

Subjects

One hundred and nine healthy volunteers of both sexes, aged 21–75 years.

Results

The summary fresh fish measure underestimated frequency and grams per week given by the aggregate question by about 50%, while estimates from the summary preserved fish measure were approximately three times that of the aggregate measure. Multiple linear regression analysis suggested that the aggregates accounted for more of the variation in EPA levels, but the difference was minimal. Intra-class correlations confirmed that both methods were reliable.

Conclusions

Our study indicates that extensive questioning results in different absolute intakes of fish compared with brief questioning, but does not add any information if ranking individuals according to overall consumption of fish.

Alteration of dietary fat intake to prevent weight gain: Jayhawk Observed Eating Trial

OBJECTIVE

To examine the effects of ad libitum diets with three distinct levels of fat intake for the prevention of weight gain in sedentary, normal-weight and overweight men and women.

METHODS AND PROCEDURES

Three hundred and five participants were randomized to one of three diets. The diets targeted <25% of energy from fat (low fat (LF)), between 28 and 32% of energy from fat (moderate fat (MF)), or >35% of energy from fat (high fat (HF)). Participants consumed two meals per day on weekdays and one meal per day on weekends in a university cafeteria over a 12-week period. Energy and nutrient content of cafeteria foods were measured by digital photography. All meals and snacks consumed outside the cafeteria were measured by dietary recall. All analysis of energy and nutrient content was completed using Nutrition Data System for Research (NDS-R) version 2005.

RESULTS

Two hundred and sixty participants completed the study. LF gained 0.1 +/- 3.1 kg, MF gained 0.8 +/- 2.5 kg, and HF gained 1.0 +/- 2.2 kg and there was no gender or age effect. Longitudinal mixed modeling indicated a significant difference among the groups in weight over time (P = 0.0366). When adjusting for total energy intake, which was a significant predictor of weight over time, the global effect for the group was eliminated. Thus, increasing weight was a function of increasing energy but not increasing percentage of fat intake.

DISCUSSION

Energy intake, but not percentage of energy from fat, appears responsible for the observed weight gain. LF diets may contribute to weight maintenance and HF diets may promote weight gain due to the influence of fat intake on total energy intake.

Physical activity, fat intake and body fat

The body fatness of a subject is a long-term reflection of the energy balance, the more intake exceeds expenditure the more energy is stored as fat. There is not yet a clear answer on the question whether the current obesity epidemic is a consequence of gluttony or sloth. Review studies do not show a reduction of physical activity over the years, and food intake is difficult to measure in daily life conditions. Food intake can only be derived from self-report, where under-reporting of food intake and selective underreporting of fat intake are major issues. Fat intake might be an important factor in the increase of body weight. Many studies suggest the capacity of the body to oxidize dietary fat is a major risk factor for a positive energy balance. Additionally, there is evidence that most of the fat consumed is stored before oxidation. Obesity prone subjects might be characterized by a higher storage of dietary fat. The only way to increase the oxidation of dietary fat, other than consuming more dietary fat, is to increase energy expenditure by an increase of physical activity. Indeed, there are indications that physical activity is an important determinant of fat oxidation. Based on the evidence presented, it is concluded that the obesity epidemic is mainly due to a high dietary intake, especially as fat, and that physical activity can be a tool to modulate the effect of fat intake on body fat.

Stemming the obesity epidemic: a tantalizing prospect

OBJECTIVE

Obesity is a growing problem worldwide, but there are no good methods to assess the future course of the epidemic and the potential influence of interventions. We explore the behavior change needed to stop the obesity epidemic in the U.S.

RESEARCH METHODS AND PROCEDURES

We modeled the population distribution of BMI as a log-normal curve of which the mean shifts upward with time due to a positive population energy balance. Interventions that decrease food intake or increase physical activity result in more favorable trends in BMI.

RESULTS

The recently observed trend in average BMI implies that the average U.S. adult over-consumes by approximately 10 kcal/d. If this trend continues unaltered, obesity prevalence will exceed 40% for men and 45% for women in 2015. To stop the epidemic, it suffices to decrease caloric consumption by approximately 10 kcal or walk an extra 2 to 3 minutes per day, on average.

DISCUSSION

This leads to a paradox: little behavior change seems sufficient to halt the epidemic, but in practice this proves hard to achieve. The obesogenic environment is the likely culprit. Individuals trying to maintain a healthy weight need to be supported by environments that stimulate physical activity and do not encourage over-consumption. Research should show what measures are effective.

Estimating under-reporting of energy intake in dietary surveys using an individualised method

Under-reporting (UR) of energy intake (EI) by self-reported dietary methods is well-documented but the methods used to estimate UR in population-based studies commonly assume a sedentary lifestyle. We compared estimated UR using individualised estimates of energy requirements with a population cut-off based on minimum energy needs. UR was estimated for 1551 adults aged 19-64 years enrolled in the National Diet and Nutrition Survey. Physical activity diaries and 7 d weighed dietary records were completed concurrently. Mean daily EI (kJ/d) was calculated from the dietary records. Reported physical activity was used to assign each subject's activity level, and then to calculate estimated energy requirements (EER) from published equations. UR was calculated both as EER - EI with an adjustment for daily EER and EI variation, and also by a population method. By the individual method UR was approximately 27 % of energy needs in men and 29 % in women, with 75 % of men and 77 % of women classified as under-reporters; by the population method 80 and 88 % were classified as under-reporters respectively. When subjects who reported their eating being affected by dieting or illness during dietary recording were excluded, UR was 25 % of energy needs in both sexes. UR was higher in overweight and obese men and women compared with their lean counterparts (P < 0.001). UR of EI must be considered in dietary surveys. The EER method allows UR to be quantified and takes into account an individual's activity level. Measures of physical activity and questions to identify under-eating during dietary recording may help to evaluate secular trends in UR.

Water loss as a function of energy intake, physical activity and season

Although water is an important nutrient, there are no recommended intake values. Here, water intake, energy intake, physical activity and water loss was measured over 1 week in summer and in winter. Subjects were healthy volunteers, forty-two women and ten men, mean age of 29 (sd 7) years and mean BMI 21·8 (sd 2·2) kg/m2. Water intake was measured with a 7 d food and water record. Physical activity level (PAL) was observed as the ratio of total energy expenditure, as measured with doubly labelled water, to resting energy expenditure as measured in a respiration chamber. Water loss was measured with the deuterium elimination method. Water loss was highly reproducible and ranged from 0·20 to 0·35 l/MJ, independent of season and activity level, with higher values in women. Water loss was related to water and energy intake in summer (r0·96,P<0·0001 andr0·68,P<0·001, respectively) as well as in winter (r0·98,P<0·0001 andr0·63,P<0·01, respectively). Water loss was, for men, higher in subjects with a higher physical activity in summer (r0·94,P<0·0001) and in winter (r0·70,P<0·05). Normalizing water loss for differences in energy expenditure by expressing water loss in litres per MJ resulted in the same value for men in summer and winter. For women, physical activity-adjusted values of water loss were higher, especially in summer. In men, water turnover was determined by energy intake and physical activity, while seasonal effects appeared through energy expenditure. Women showed a higher water turnover that was unrelated to physical activity.

Validation of dietary intake data in black women with type 2 diabetes

The validity of baseline dietary intake data in women participating in a culturally competent intervention study for black women with type 2 diabetes was assessed. The relationship of sociodemographic and physiologic factors with underreporting of dietary intake was determined. Criterion validity of dietary intake, which had been assessed using the Nutritionist Five Collection Form, a combination of a standard 2-day dietary recall and a modified, culturally appropriate food frequency questionnaire, was determined. Data were analyzed using First Data Bank Nutritionist Five (version 2.3, 2000, First Data Bank, San Bruno, CA) software. Validation of baseline dietary data in 109 women was performed by calculating the ratio of energy intake to resting metabolic rate. Chi(2) and t tests were used to assess relationships between underreporting and sociodemographic and physiologic factors. Mean ratio of energy intake to resting metabolic rate was 1.46 (+/-0.4). Using a lower limit of 1.35, the prevalence of underreporting was 46.8%. Underreporting was significantly associated with body mass index (P< or =0.001) and waist circumference (P<0.001). Use of this combined dietary recall and modified food frequency questionnaire might, therefore, provide more accurate dietary assessment in this population. Additional modification and validity testing is warranted in this and other populations.

Appetite sensations and satiety quotient: predictors of energy intake and weight loss

PURPOSE

The aim of this study was to further evaluate the validity and clinical meaningfulness of appetite sensations to predict overall energy intake as well as body weight loss.

METHODS

Men (n = 176) and women (n = 139) involved in six weight loss studies were selected to participate in this study. Visual analogue scales were used to measure appetite sensations before and after a fixed test meal. Fasting appetite sensations, 1 h post-prandial area under the curve (AUC) and the satiety quotient (SQ) were used as predictors of energy intake and body weight loss. Two separate measures of energy intake were used: a buffet style ad libitum test lunch and a three-day self-report dietary record.

RESULTS

One-hour post-prandial AUC for all appetite sensations represented the strongest predictors of ad libitum test lunch energy intake (p < or = 0.001). These associations were more consistent and pronounced for women than men. Only SQ for fullness was associated with ad libitum test lunch energy intake in women. Similar but weaker relationships were found between appetite sensations and the 3-day self-reported energy intake. Weight loss was associated with changes in appetite sensations (p < or = 0.01) and the best predictors of body weight loss were fasting desire to eat; hunger; and PFC (p < or = 0.01).

CONCLUSIONS

These results demonstrate that appetite sensations are relatively useful predictors of spontaneous energy intake, free-living total energy intake and body weight loss. They also confirm that SQ for fullness predicts energy intake, at least in women.

Ácidos graxos como marcadores biológicos da ingestão de gorduras

Os ácidos graxos da dieta têm sido associados ao desenvolvimento de doenças crônicas. Os inquéritos alimentares, utilizados em estudos clínicos e epidemiológicos para estimativa da ingestão de nutrientes, apresentam limitações na coleta de informações. Nesse sentido, a utilização da composição de ácidos graxos do plasma e do tecido adiposo como marcadores do tipo de gordura alimentar pode fornecer uma medida mais acurada da ingestão de gorduras. Esta pesquisa tem como objetivo evidenciar aspectos metabólicos de alguns ácidos graxos e o papel como marcadores da ingestão de gorduras, e apresentar as técnicas analíticas empregadas na sua determinação. A biópsia do tecido adiposo, com determinação da composição de ácidos graxos, fornece uma informação a longo prazo da ingestão de gorduras, enquanto que a avaliação da composição das frações lipídicas séricas representa a ingestão a curto e médio prazos. Os ácidos graxos essenciais, os ácidos graxos saturados com número ímpar de carbonos (15:0 e 17:0) e os ácidos graxos trans, por não apresentarem síntese endógena, são utilizados como marcadores biológicos da ingestão de gorduras ou de sua própria ingestão. As principais técnicas utilizadas para a determinação de ácidos graxos são a cromatografia gasosa e a cromatografia líquida de alta precisão. No presente momento, o uso de marcadores biológicos para a ingestão de gorduras, associados aos inquéritos alimentares, representa a forma mais completa de avaliação da ingestão de gorduras.

Perception, passive overfeeding and energy metabolism

The palatability of a diet is an important determinant of energy intake. Due to a high palatability, a relatively high energy density, and a weak effect on satiation, the consumption of high-fat foods induces passive overfeeding. It is well known that a high-fat diet often leads to a loss of portion control of tasty foods. Here, studies are reviewed on the effect of overfeeding on substrate utilization and energy expenditure. It is often suggested that humans differ in the susceptibility to weight gain in response to overfeeding. Six years ago, non-exercise activity thermogenesis was presented as a new mechanism to explain differences in weight gain between subjects. Activation of non-exercise activity thermogenesis could dissipate excess energy to preserve leanness and only failure to activate non-exercise activity thermogenesis resulted in ready fat gain. However, there is still little evidence for this form of adaptive thermogenesis from additional studies. The conclusion is that the fat content has an effect on body fat as a function of the effect of dietary fat on energy intake.

Oral protein energy supplements for children with cystic fibrosis: CALICO multicentre randomised controlled trial

OBJECTIVE

To determine whether oral protein energy supplements, used long term in children with cystic fibrosis who are moderately malnourished, improve nutritional and other outcomes.

DESIGN

Multicentre randomised controlled trial.

SETTING

Seven specialist paediatric cystic fibrosis centres and their associated shared care clinics and seven smaller paediatric cystic fibrosis clinics.

PARTICIPANTS

102 children with cystic fibrosis, aged between 2 and 15 years, who were moderately malnourished.

INTERVENTIONS

Oral protein energy supplements in addition to usual dietary advice compared with dietary advice alone, for 12 months.

MAIN OUTCOME MEASURE

Change in body mass index centile over one year.

RESULTS

Use of supplements was not associated with a change in body mass index centile (mean difference 2.99 centile points, 95% confidence interval -2.70 to 8.68) or other nutritional and spirometric outcomes in this group of children.

CONCLUSIONS

Long term use of oral protein energy supplements did not result in an improvement in nutritional status or other clinical outcomes in children with cystic fibrosis who were moderately malnourished. Oral protein energy supplements should not be regarded as an essential part of the management of this group of children.

TRIAL REGISTRATION

ISRCTN: 95744468.

Trends in energy and macronutrient intakes in non-under-reporters vary with the method used to identify under-reporters

OBJECTIVE

To investigate effects of using different methods to identify under-reporters on trends in dietary intake and physical activity level (PAL) in non-under-reporters.

DESIGN

Dietary intake and activity pattern were recorded by 887 female university students from 1988 to 2003. Energy expenditure (EE) and PAL were measured using a factorial method. Nine methods were used to identify under-reporters. Trends between 1988 and 2003 were determined from linear regression of median data for each year.

RESULTS

Prevalence of under-reporting varied with the method used, ranging from 22.2% to 66.7%. Trends that were consistent using all methods were a decrease in per cent of energy from fat and no change in alcohol intake or PAL (P<0.05). Trends in energy and macronutrient intakes varied with the method used. Using the four methods that excluded the most under-reporters there were increases in energy and gram carbohydrate (CHO) intakes (P<0.05), but no change in gram fat intake. Using the four methods that excluded the fewest under-reporters there was no change in energy or gram CHO intake, but a decrease in gram fat intake (P<0.05).

CONCLUSION

Trends in energy, fat and CHO intakes in non-under-reporters varied with the method used to identify under-reporters.

The Psychosocial and Behavioral Characteristics Related to Energy Misreporting

Energy underreporting occurs in 2% to 85% and overreporting in 1% to 39% of various populations. Efforts are needed to understand the psychosocial and behavioral characteristics associated with misreporting to help improve the accuracy of dietary self-reporting. Past research suggests that higher social desirability and greater eating restraint are key factors influencing misreporting, while a history of dieting and being overweight are more moderately associated. Eating disinhibition, body image, depression, anxiety, and fear of negative evaluation may be related to energy misreporting, but evidence is insufficient. This review will provide a detailed discussion of the published associations among psychosocial and behavioral characteristics and energy misreporting.

Validity of reported energy expenditure and reported intake of energy, protein, sodium and potassium in rheumatoid arthritis patients in a dietary intervention study

OBJECTIVES

The aim of the study was to validate a diet history interview (DHI) method and a 3-day activity registration (AR) with biological markers.

SUBJECTS AND STUDY DESIGN

The reported dietary intake of 33 rheumatoid arthritis patients (17 patients on a Mediterranean-type diet and 16 patients on a control diet) participating in a dietary intervention study was assessed using the DHI method. The total energy expenditure (TEE), estimated by a 3-day AR, was used to validate the energy intake (EI). For nine subjects the activity registration was also validated by means of the doubly labelled water (DLW) method. The excretion of nitrogen, sodium and potassium in 24-h urine samples was used to validate the intake of protein, sodium and potassium.

RESULTS

There was no significant difference between the EI and the TEE estimated by the activity registration or between the intake of protein, sodium and potassium and their respective biological markers. However, in general, the AR underestimated the TEE compared to the DLW method. No significant differences were found between the subjects in the Mediterranean diet group and the control diet group regarding the relationship between the reported intakes and the biological markers.

CONCLUSION

The DHI could capture the dietary intake fairly well, and the dietary assessment was not biased by the dietary intervention. The AR showed a bias towards underestimation when compared to the DLW method. This illustrates the importance of valid biological markers.

Differences in food habits and cardiovascular disease risk factors among Native Americans with and without diabetes: the Inter-Tribal Heart Project

OBJECTIVE

To examine differences in food habits among Native Americans with and without diabetes.

DESIGN

A cross-sectional epidemiological study in which participants underwent a physical examination and answered an extensive interviewer-administered questionnaire to assess differences in food servings, preparation and eating habits.

SETTING/PARTICIPANTS

Participants aged >/=25 years were randomly selected from three reservations in Minnesota and Wisconsin. There were 990 persons without diabetes, 294 with a prior diagnosis of diabetes, and 80 with fasting glucose >125 mg dl(-1) but no prior diabetes diagnosis.

RESULTS

Persons with prior diabetes diagnosis were less likely than those without diabetes to report eating fast-food meals two or more times per week, eat visible fat on meat or the skin on poultry, eat fried chicken or fried fish, to add fat to cooked vegetables and drink whole milk. Persons with previously undiagnosed diabetes were more likely than previously diagnosed persons to report eating fast-food meals two or more times per week, eat visible fat on meat and the skin on poultry, drink whole milk and eat fried fish, but were less likely to drink low-fat milk. Previously undiagnosed persons were more likely than either diagnosed persons or persons without diabetes to consume lard from cooked foods and use it when cooking.

CONCLUSION

Persons with diagnosed diabetes showed healthier eating patterns than those without diabetes, while undiagnosed persons showed some less favourable patterns. Because virtually all persons with diabetes in these communities receive nutrition education, the results suggest that nutrition education programmes for diabetics may be associated with healthier eating patterns.

Food habits and appetite of elderly women at the time of a femoral neck fracture and after nutritional and anabolic support

OBJECTIVE

To study appetite and food choices in lean elderly women at the time of a femoral neck fracture and after 6 months of nutritional and anabolic intervention.

SUBJECTS AND METHODS

Forty-five nondemented women >70 years of age (mean +/- SD: 83 +/- 5 years) with a recent hip fracture and body mass index <24 kg/m2 (mean: 20.5 +/- 2.3) were interviewed about their appetite and dietary habits prior to fracture. The patients were randomized to treatment with a protein-rich liquid supplement (PR; 200 kcal and 20 g protein day(-1)) alone or in combination with nandrolone decanoate injections (PR/N) 25 mg i.m. every third week or to a control group (C). A second interview was conducted 6 months later.

RESULTS

Reduced appetite before the fracture was reported by 60%. Half of the patients did not have dessert with any of their daily meals, one-third used low-fat margarines and one-third drank water with their meals. The estimated mean daily energy intake was 6.4 +/- 1.2 MJ (1541 +/- 304 kcal) indicating that three of four subjects did not meet their energy needs. At 6 months, 40% reported reduced appetite. There was no difference in the change of appetite between the three randomized groups. Still, half of the subjects appeared to not meet their energy needs. Protein intake increased in the PR and PR/N groups, in contrast to the controls (P = 0.002).

CONCLUSION

Reduced appetite and insufficient energy intake was recorded in lean elderly women with a femoral neck fracture. Nutritional supplementation alone or in combination with an anabolic steroid increased protein intake without adversely affecting appetite.

Alcohol energy intake and habitual physical activity in older adults

Alcohol forms a significant component of many diets and it supplements rather than displaces daily energy intake. Surprisingly, alcohol intake does not systematically increase body weight. The present study assessed whether a higher level of habitual physical activity in the daily environment is associated with a higher alcohol intake. Alcohol intake as part of total food intake was measured with a 7 d dietary record while at the same time physical activity was monitored with a tri-axial accelerometer for movement registration. Subjects were twenty women and twenty-four men, aged 61+/-5 years, of BMI 27.1+/-4.6 kg/m(2). Between subjects, there was a positive association between the level of habitual physical activity and alcohol intake (r 0.41; P<0.01). The subjects with higher alcohol intake had a higher activity level. On days with and days without alcohol consumption there was no difference in physical activity within subjects. In conclusion, it was shown that subjects with higher alcohol consumption are habitually more active. This may explain the lack of increasing body weight through additional energy intake from alcohol.