Accuracy of self-reports of food intake in obese and normal-weight individuals: effects of obesity on self-reports of dietary intake in adult females

Obese individuals do not underreport dietary intake to a greater extent than nonobese individuals when data are allometrically‐scaled

Objective

The aim of this study was to assess the extent of misreporting in obese and nonobese adults on an absolute, ratio‐scaled, and allometrically‐scaled basis.

Method

Self‐reported daily energy intake (EI) was compared with total energy expenditure (TEE) in 221 adults (106 male, 115 female; age 53 ± 17 years, stature 1.68 ± 0.09 m, mass 79.8 ± 17.2 kg) who participated in a doubly‐labeled water (DLW) subsection of 2013–2015 National Diet and Nutrition Survey. Data were log transformed and expressed as absolute values, according to simple ratio‐standards (per kg body mass) and adjusted for body mass allometrically. Absolute and ratio‐scaled misreporting were examined using full‐factorial General Linear Models with repeated measures of the natural logarithms of TEE or EI as the within‐subjects factor. The natural logarithm of body mass was included as a covariate in the allometric method. The categorical variables of gender, age, obesity, and physical activity level (PAL) were the between‐factor variables.

Results

On an absolute‐basis, self‐reported EI (2759 ± 590 kcal·d⁻¹) was significantly lower than TEE measured by DLW (2759 ± 590 kcal·d⁻¹: F_1,205 = 598.81, p < .001, η_p² =0.75). We identified significantly greater underreporting in individuals with an obese BMI (F_1,205 = 29.01, p <.001, η_p² =0.12), in more active individuals (PAL > 1.75; F_1,205 = 34.15, p <.001, η_p² =0.14) and in younger individuals (≤55 years; F_1,205 = 14.82, p < .001, η_p² =0.07), which are all categories with higher energy needs. Ratio‐scaling data reduced the effect sizes. Allometric‐scaling removed the effect of body mass (F_1,205 =0.02, p = 0.887, η_p² =0.00).

Conclusion

In weight‐stable adults, obese individuals do not underreport dietary intake to a greater extent than nonobese individuals. These results contradict previous research demonstrating that obesity is associated with a greater degree of underreporting.

Discrepancies Between Clinician and Participant Intervention Adherence Ratings Predict Percent Weight Change During a Six-Month Behavioral Weight Loss Intervention

BACKGROUND

Individuals receiving behavioral weight loss treatment frequently fail to adhere to prescribed dietary and self-monitoring instructions, resulting in weight loss clinicians often needing to assess and intervene in these important weight control behaviors. A significant obstacle to improving adherence is that clinicians and clients sometimes disagree on the degree to which clients are actually adherent. However, prior research has not examined how clinicians and clients differ in their perceptions of client adherence to weight control behaviors, nor the implications for treatment outcomes.

PURPOSE

In the context of a 6-month weight-loss treatment, we examined differences between participants and clinicians when rating adherence to weight control behaviors (dietary self-monitoring; limiting calorie intake) and evaluated the hypothesis that rating one's own adherence more highly than one's clinician would predict less weight loss during treatment.

METHODS

Using clinician and participant-reported measures of self-monitoring and calorie intake adherence, each assessed using a single item with a 7- or 8-point scale, we characterized discrepancies between participant and clinician adherence and examined associations with percent weight change over 6 months using linear mixed-effects models.

RESULTS

Results indicated that ratings of adherence were higher when reported by participants and supported the hypothesis that participants who provided higher adherence ratings relative to their clinicians lost less weight during treatment (p < 0.001).

CONCLUSIONS

These findings suggest that participants in weight loss treatment frequently appraise their own adherence more highly than their clinicians and that participants who do so to a greater degree tend to lose less weight.

An Exploration of Health Behaviors in a Mind-Body Resilience Intervention for Parents of Children with Developmental Disabilities

OBJECTIVE

Parents of children with special needs such as learning and attentional disabilities (LADs) and autism spectrum disorder (ASD) are at high risk for stress-related disorders. The demands of parenting may compete with time for self-care behaviors such as physical activity, healthy eating, and adequate sleep. The objective was to describe health behaviors among this understudied population and assess the changes after a resilience intervention.

METHODS

This was a secondary data analysis of a randomized controlled pilot virtual mind-body resilience intervention (Stress Management and Resiliency Training: A Relaxation Response Resiliency Program) trial for parents of children with LADs (n = 52) and ASD (n = 47). Parents completed self-report questionnaires about their weekly physical activity, eating behaviors, sleep duration, and fatigue before and after the 8-week intervention. Descriptive statistics and pre-post intervention effect sizes (Cohen's d) were calculated.

RESULTS

Both parent groups reported suboptimal levels of health behaviors at baseline, but ASD parents reported lower health behaviors than LAD parents. LAD parents improved more on physical activity, with a higher percentage meeting recommendations at postintervention follow-up (d = 0.71) than ASD parents (d = 0.01). Eating behaviors showed small effect size improvements for both groups. Although sleep duration improved only with small or medium effect sizes for both groups, ASD parents rated their fatigue lower after the intervention (d = 0.81).

CONCLUSION

Parents of children with special needs who participated in a virtual resilience intervention demonstrated suboptimal health behaviors. There is a need for targeted interventions for health behaviors that can promote resilience in these high-stress populations.

People with a body mass index ⩾30 under-report their dietary intake: A systematic review

Under-reporting of total energy intake is a common and well-known source of measurement error in dietary assessment, and evidence suggests that this bias is particularly significant in obese individuals. After a multi-stage selection process of eligible papers, this literature review appraised 34 papers detailing the accuracy of self-reported dietary intake in people with an obese body mass index (BMI ⩾ 30). The available literature to date shows that having a body mass index ⩾30 is associated with significant under-reporting of food intake. Future research should look into identifying effective techniques to reduce this bias in clinical practice.

Adequacy of nutrient intake in women with restrictive anorexia nervosa

OBJECTIVE

The aim of the present study was to assess energy and nutrient intake in a group of women with restrictive AN (r-AN) compared with a control group.

METHODS

Thirteen r-AN patients and 13 healthy female controls completed 7-d food records. Intake of macro- and micronutrients was compared between the two groups as well as to the Dietary Reference Intake for the Italian Population (LARN) for specific ages. Additionally, the r-AN patients underwent indirect calorimetry for measuring resting energy expenditure (REE).

RESULTS

Total energy intake was significantly lower in the r-AN group than in controls (906 ± 224 vs 1660 ± 139, respectively; P < 0.01). Nutrient composition significantly differed, as well. Mean intake of sodium, phosphorus, and zinc was higher in controls than in the women with r-AN (P < 0.01), but neither group of women met LARN recommendations for potassium, calcium, or iron intake. With respect to vitamins, no significant differences were found for riboflavin or vitamins A, B₁₂, or C between groups, whereas levels of other vitamins differed (P < 0.01). Both groups failed to meet the LARN recommendation for vitamin D intake; moreover, none of the r-AN patients met recommended intake levels of vitamin E, thiamine, niacin, and folate.

CONCLUSIONS

Intakes reported by r-AN patients did not meet requirements for most micronutrients evaluated in this study and, as expected, both energy needs and specific dietary patterns differed between groups. Therefore, a careful evaluation of food consumption should be recommended to reduce nutritional gaps in these patients. According to these preliminary observations, nutritional counseling, mainly focused on calcium and vitamin D intake, should be suggested for healthy women, as well.

Tell Me a Story About Healthy Snacking and I Will Follow: Comparing the Effectiveness of Self-Generated Versus Message-Aided Implementation Intentions on Promoting Healthy Snacking Habits Among College Students

In the context of healthy snacking, this study examines whether the quality of mental imagery determines the effectiveness of combining the implementation intention (II) intervention with mental imagery. This study further explores whether providing narrative healthy snacking scenarios prior to forming an II enhances people's mental imagery experience when they are not motivated to snack healthfully. A 2 × 2 factorial design was employed to test the main effect of providing healthy snacking scenarios prior to II formation, and whether such effect depends on people's motivation level. The results from the experiment (N =148) showed significant main as well as interaction effects of the manipulation (with vs. without reading healthy snacking scenarios prior to II formation) and motivation level on ease and vividness of mental imagery. The regression model with the experiment and follow-up survey data (n = 128) showed a significant relationship between ease of mental imagery and actual snacking behavior after controlling for habit strength. The findings suggest that adding a narrative message to the II intervention can be useful, especially when the intervention involves mental imagery and invites less motivated people.

Accuracy of predictive equations for resting metabolic rates and daily energy expenditures of police officials doing shift work by type of work

The purpose of this study was to analyze the accuracy of predictive equations for resting metabolic rate (RMR) and daily energy expenditure in policemen on a rotating shift. Subjects were 28 healthy policemen on a rotating shift (males) age of 23-46 years. The participants' RMR was measured by using indirect calorimetry (TrueOne2400) and also calculated from various predicted equations of RMR (Harris-Benedict, Schofield(W)/(WH), FAO/WHO/UNU(W)/(W/H), Cunningham, Mifflin, Liu, Owen, IMNA and Henry(W)/(WH)). The accuracy of these equations were evaluated on basis of accurate prediction (the percentage of subjects whose RMR was predicted within 90% to 110% of the RMR measured), mean difference, root mean squared prediction error, mean % difference, limits of agreement of Bland-Altman method between predicted and measured RMR. The measured RMR value of subjects was 1748 ± 205.9 kcal. Of the predictive equations tested, the Harris-Benedict equation (mean difference: -14.8 kcal/day, RMSPE: 195.8 kcal/day, mean % difference: 0.1%) was the most accurate and precise, but accuracy in prediction of the equation were only 35.7%. The daily energy expenditure at night-duty was 3062 kcal calculated as multiplying RMR by its physical activity level. Subsequently, daily energy expenditure of day-duty was 2647 kcal and the lowest daily energy expenditure was, 2310 kcal at holiday duty. Daily energy intake of all study participants was 2351 kcal at day-duty, 1959 kcal at night-duty and 1796 kcal at holiday-duty in order. The estimated energy requirements for policemen on a rotating shift on day shift, night shift and holiday came to 2743.6 kcal/day, 2998.6 kcal/day and 2576.9 kcal/day, respectively. These results suggest that estimated energy requirements (EER) of policemen on a rotating shift should be differently proposed by a proper equation which can closely reflect their metabolic status at each time shift.

Accuracy of self-reported energy intake in weight-restored patients with anorexia nervosa compared with obese and normal weight individuals

OBJECTIVE

To compare self-reported and measured energy intake in weight-restored patients with anorexia nervosa (AN), weight-stable obese individuals (OB), and normal weight controls (NC).

METHOD

Forty participants (18 AN, 10 OB, and 12 NC) in a laboratory meal study simultaneously completed a prospective food record.

RESULTS

AN patients significantly (p = .018) over-reported energy intake (16%, 50 kcal) and Bland-Altman (B-A) analysis indicated bias toward over-reporting at increasing levels of intake. OB participants significantly (p = .016) under-reported intake (19%, 160 kcal) and B-A analysis indicated bias toward under-reporting at increasing levels of intake. In NC participants, NS (p = .752) difference between reported and measured intake was found and B-A analysis indicated good agreement between methods at all intake levels.

DISCUSSION

Self-reported intake should be cautiously interpreted in AN and OB. Future studies are warranted to determine if over-reporting is related to poor outcome and relapse in AN, or under-reporting interferes with weight loss efforts in OB.

The association between self-reported acrylamide intake and hemoglobin adducts as biomarkers of exposure

BACKGROUND

The validity of epidemiological studies assessing a lifetime cancer risk due to environmental factors, such as nutrition or smoking behavior strongly depends on the validity of the patient's history.

OBJECTIVES

This study assesses whether a standardized questionnaire is a valid tool to identify exposure with acrylamide by relating the self-reported food and smoking history with a biomarker, namely hemoglobin-adduct levels of acrylamide.

METHODS

Objective parameters of previous exposure, such as hemoglobin-adduct levels of acrylamide and of the smoking-specific acrylonitrile, respectively, were related to self-reported data in 1,008 volunteers of the general population in bivariate analyses and a multiple linear regression analysis using the log-transformed biomarker levels as outcome.

RESULTS

Smoking was significantly associated with adduct levels of acrylamide (p < 0.0001) and had a main contribution to the internal burden with acrylamide. In cigarette smokers a strong correlation between the number of cigarettes smoked daily and the corresponding biomarkers was observed. Focusing on non-smokers (n = 828), a significant but weak correlation was found in bivariate analyses (Spearman rank correlation coefficient: 0.178 (95% CI: 0.089-0.268) in females and 0.168 (95% CI: 0.063-0.273) in males. A multiple linear regression analysis similarly yielded evidence of a significant association between the highest intake category and adduct levels; however, explained variability was very small (R(2) = 0.08).

CONCLUSION

Self-reported data concerning smoking behavior were highly valid, while self-reported food intake is apparently not as useful for estimating food-related acrylamide exposure.

Dietary patterns of adolescent girls in Hawaii over a 2-year period

OBJECTIVE

To describe changes in dietary patterns of adolescent girls in Hawaii from 2001 to 2003.

DESIGN

Cohort study, with exams 2 years apart.

SUBJECTS/SETTING

One hundred fifty-one girls of Asian, white, and mixed ethnicity who were aged 9 to 14 years at exam 1 and aged 11 to 16 years at exam 2 and lived on the island of Oahu, HI.

METHODS

Three-day diet records were obtained at each exam. Mean nutrient and food group intakes and weight, height, and body mass index were determined and compared between the two exams.

STATISTICAL ANALYSES

Data are summarized as means+/-standard deviation unless otherwise stated. Differences in values between groups were analyzed for significance using paired t tests and multiple regression.

RESULTS

Girls at exams 1 and 2 had mean carbohydrate intakes of 233 g and 241 g, respectively, and protein intakes of 67 g and 65 g, respectively. None of the carbohydrate intakes were below the Estimated Average Requirement (EAR) at exam 1 and only one girl was below at exam 2. Three percent of girls had protein intakes that were below the EAR at exam 1 whereas 9% were below at exam 2. For iron intakes, 3% of girls were below the EAR at exam 1 and 14% of girls were below at exam 2. Girls at exams 1 and 2 had mean calcium intakes of 733 mg and 732 mg, respectively, and fiber intakes of 11.2 g and 11.4 g, respectively; lower than the Adequate Intake recommendation. The percentage of energy from macronutrients in exams 1 and 2, respectively, was in range of the Appropriate Macronutrient Distribution Range for more than 70% of girls (76% for exam 1, 79% for exam 2), but the mean percentage intake of saturated fat intake was higher than the recommended range for more than 65% of the girls at both exams 1 and 2 (69% at exam 1, 73% at exam 2). However, no significant differences were found in percent contribution of or in total intake of macronutrients between the two exams. More than half of girls (51% to 100%) did not consume the recommended number of Food Guide Pyramid Servings for any food group at either exam 1 or 2. A significant increase was found for sweetened carbonated beverage intake (from 130 g to 179 g; P<0.05) and for added sugar intake (from 16 tsp to 18 tsp; P<0.01) between exams 1 and 2, a level well above recommendations. As expected, mean body weight and mean body mass index increased significantly between exams 1 and 2 (P<0.05).

CONCLUSIONS

These data suggest high dietary intakes of dietary fat and sugar, and increasing intakes of sweetened carbonated beverages and other high-sugar drinks during adolescence among girls in Hawaii.

High levels of low energy reporting on 24-hour recalls and three questionnaires in an elderly low-socioeconomic status population

Studies of low energy reporting in the elderly are limited, yet changes in energy balance and the incidence of chronic disease make this a critical time to assess energy intake in this population. The objective of this study was to assess low energy reporting on 24-h recalls (24HR), a FFQ, a picture sort FFQ (PSFFQ), and a meal pattern questionnaire (MPQ), and to relate low energy reporting status to personal characteristics and dietary characteristics, including the Healthy Eating Index. Monthly 24HR were completed over 6 mo, followed by 3 interviewer-administered questionnaires. The Goldberg equation was used to determine reporting status for the dietary assessment methods among older, rural, low socioeconomic status, white, African American, and Native American men and women. The relations of variables of interest to low energy reporting were considered one at a time and in multiple logistic regression models. The percentage of participants classified as accurate reporters varied from 40% (FFQ) to 63% (PSFFQ) among men and 60% (24HR, PSFFQ, MPQ) to 63% (FFQ) among women; high energy reporting was observed on the MPQ. Low energy reporters on the FFQ tended to be men and to be overweight or obese (P < 0.05). Underreporting seemed to be due to omitting foods from major food groups as well as from omitting discretionary energy foods. There was a high degree of low energy reporting in this population, particularly by men, even with six 24HR.

Diet and overweight and obesity in populations of African origin: Cameroon, Jamaica and the UK

OBJECTIVES

To determine the relationship of diet to overweight and obesity among populations of African origin.

DESIGN AND SETTING

Cross-sectional data were obtained from adults aged 25-74 years in rural Cameroon (n = 686), urban Cameroon (n = 975), Jamaica (n = 924) and Afro-Caribbeans in the UK (n = 257). Dietary data were collected using food-frequency questionnaires specifically designed for each site. Body mass index (BMI) was used as a measure of overweight.

RESULTS

The expected gradient in the distribution of overweight across sites was seen in females (rural Cameroon, 9.5%; urban Cameroon, 47.1%; Jamaica, 63.8%; UK, 71.6%); however, among males overweight was less prevalent in Jamaica (22.0%) than urban Cameroon (36.3%). In developing countries increased risks of overweight (BMI > or = 25 kg m(-2) were influenced by higher energy (urban Cameroonian men) and protein (Jamaican women) intakes. No dietary variables were associated with obesity (BMI > or = 30 kg m(-2) in Cameroon or Jamaica. In the UK, energy intakes were inversely related with overweight whereas increased risks of being overweight were associated with higher protein (men) and fat (women) intakes. Similarly, whereas higher protein and fat intakes in UK men and women were associated with obesity, carbohydrate intakes were associated with decreased risks of obesity in men.

CONCLUSIONS

Diet and overweight were associated in the UK but few dietary variables were related to overweight in Jamaica and the Cameroon. These findings suggest that associations between diet and overweight/obesity are not generalisable among populations.

Normal-weight adults consume more fiber and fruit than their age- and height-matched overweight/obese counterparts

OBJECTIVES

To assess differences in dietary intake of overweight/obese subjects and sex-, age-, and height-matched controls and to identify dietary components associated with increased deposition of body fat.

DESIGN/SUBJECTS

A convenience sample of 52 overweight/obese and 52 normal-weight adults matched for sex, age (+/-1 year), and height (+/-1 inch) were recruited from the local area. Dietary intake was assessed with the Block 60-item food frequency questionnaire, physical activity was measured by the Yale Physical Activity Survey, and percent body fat was measured via dual-energy x-ray absorptiometry.

STATISTICAL ANALYSES PERFORMED

Independent t tests compared between-group consumption of dietary components. The ability of dietary components to predict percent body fat before and after controlling for age-, sex-, and physical activity-related energy expenditure and other macronutrients was assessed with multiple regression analyses. Spearman correlation coefficients examined relationships among nutrients, Food Guide Pyramid servings, and percent body fat.

RESULTS

Overweight/obese subjects consumed more total fat, saturated fat, and cholesterol and less carbohydrate, complex carbohydrate, and dietary fiber than control subjects. Reported intake of dietary fiber was inversely related to percent body fat without (R(2)=0.052, P=0.02) and with (R(2)=0.045, P=0.013) control for potential confounding factors. Servings of fruit per day were negatively related to percent body fat (r=-0.40, P<0.01).

CONCLUSIONS

These findings suggest that the composition of a diet, especially low dietary fiber and fruit intake, plays a role in the etiology of obesity.

Diet and personality: Associations in a population-based sample

BACKGROUND

Large portions of the population of the United States of America fail to follow dietary recommendations. Psychological factors may contribute to non-adherence.

OBJECTIVE

Establish the associations between heritable personality styles, attitudes towards food, and habitual eating behavior.

DESIGN

Variables were assessed by questionnaire in a population-based sample of 629 subjects. Associations were established using correlation and regression analysis, taking gender, demographic, lifestyle and other factors into account.

RESULTS

Differences in personality style were reflected in diet. For example, hostility and anxiety-proneness was associated with greater likelihood to continue eating when satiated, while sociability and low impulsivity correlated with greater monitoring and control of dietary intake and body weight. Immaturity, aloofness, self-consciousness and self-gratification were associated with greater susceptibility to hunger and lack of persistence with increased snack and alcohol consumption. These associations differed for the sexes and were stronger for attitudes towards food than actual eating behavior. Taking other factors into account reduced the number of significant associations between diet and personality, particularly for habitual eating behavior.

CONCLUSIONS

Associations exist between personality and diet. However, the strength of these associations is influenced by demographic, lifestyle and other factors. These findings have implications for future studies and efforts aimed at changing unhealthy dietary habits.

Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women

BACKGROUND

National surveys of food intake rely on the 24-h dietary recall method for assessing the nutrient intakes of Americans.

OBJECTIVES

This observational validation study was conducted under controlled conditions to test the effectiveness of the US Department of Agriculture (USDA) 5-step multiple-pass method for dietary recall; to test the ability of normal weight, overweight, and obese women to recall food intake; and to test the accuracy of macronutrient recall.

DESIGN

Women (n = 49) aged 21-65 y with a body mass index (in kg/m(2)) of 20-45 selected all meals and snacks for 1 d from a wide variety of foods. A 24-h dietary recall with the use of the USDA 5-step multiple-pass method was administered by telephone the following day. Analysis of variance and covariance tested the overall accuracy of recall and the effect of BMI on dietary recall.

RESULTS

As a population, the women overestimated their energy and carbohydrate intakes by 8-10%. No significant differences between mean actual and recalled intakes of energy and the macronutrients were observed in the obese women. Normal-weight and overweight women significantly (P < 0.01) overestimated their energy, protein, and carbohydrate intakes. Recalled fat intake was not significantly different from actual intake in women across the BMI range studied.

CONCLUSIONS

The USDA 5-step multiple-pass method effectively assessed mean energy intake within 10% of mean actual intake on the previous day. Obese women more accurately recalled food intake than did overweight and normal-weight women despite undereating on the day of the study.

Social and dietary determinants of body mass index of adult Jamaicans of African origin

OBJECTIVES

To determine the relationships between body mass index (BMI) and diet, social and behavioural factors among adult Jamaicans of African origin.

DESIGN

Cross-sectional.

SETTING

Urban communities in Jamaica, West Indies.

SUBJECTS

Three-hundred and sixty-three males and 561 females of African origin, aged 25-74 y.

RESULTS

Women had higher mean BMIs (27.5+/-6.4 kg/m(2)) than men (23.4+/-4.3 kg/m(2)); 30.7% of women compared with 6.7% of men were obese. There was a tendency for obese men to have higher percentage of intakes from fat and less from carbohydrate, and women reported diets in which the percentage contribution of protein increased significantly with increasing BMI. In multivariate analyses, BMI was not explained by energy but was associated with protein intakes in females only. Predictors of relative weight were inversely related. Social (marital status) and behavioural (cigarette smoking) factors predicted BMI in both genders; older age in men and increased fibre intakes in women were associated with lower BMI.

CONCLUSIONS

Social and behavioural factors are important determinants of body weight. Further investigations are needed which consider factors such as physical activity, genetic and other environmental variables as predictors of relative weight.

Habitual fat intake and basal fat oxidation in obese and non-obese Caucasians

OBJECTIVE

To examine the relationship between habitual fat intake and basal fat oxidation in obese and non-obese Caucasian men and women.

METHODS

Habitual fat intake was assessed by 7-day weighed dietary records and resting fat oxidation was determined after an overnight fast in 132 weight stable non-diabetic subjects (38 males, 94 females). All subjects were characterized for weight, height, waist-to-hip ratio, physical activity, plasma glucose and insulin response to an oral glucose load, plasma catecholamine and leptin levels. Under-reporters, defined according to plausibility of the relationship between energy expenditure and energy intake, were excluded from the analyses.

RESULTS

The mean age was 53.1+/-10.6 y (19-72 y) and mean body mass index (BMI) was 30.7+/-5.8 kg/m(2) (19.4-45.8 kg/m(2)). Sixty-eight subjects were obese (BMI>30 kg/m(2)). Univariate regression analysis revealed a significant, albeit modest, relationship between absolute fat intake and BMI (r(2)=0.06; P<or=0.05) but not between fat intake and fat mass (r(2)=0.026; P=0.08). However, multiple regression analysis revealed significant effects of body fat mass (FM) and sex on basal fat oxidation (bFO) explaining 33% of the variation of bFO (P<or=0.0001; radical s.e.=18.0 g/24 h). In univariate regression analysis, habitual fat intake was significantly related to adjusted fat oxidation, explaining 12% of the variation (P<or=0.0001; radical s.e.=11.7 g/24 h).

CONCLUSION

Habitual fat intake has a significant, albeit modest, effect on basal fat oxidation, even when adjusted for sex and body FM. The rather modest effect of habitual fat intake on fat oxidation may in part explain the increased propensity to gain FM on a high-fat diet.

Influence of body composition on the accuracy of reported energy intake in children

OBJECTIVE

Mis-reporting dietary intake is a substantial barrier to understanding the role of dietary behavior in disease. Work with adults indicates that heavier individuals under-report dietary intake and that under-reporting may be macronutrient-specific. Whether weight status and macronutrient intake influence the accuracy of dietary reports among children, however, is less clear. This research evaluated children's dietary reporting accuracy as a function of their relative weight, body composition, and macronutrient intake.

RESEARCH METHODS AND PROCEDURES

Participants included 146 4- to 11-year-old children. Reported energy intake was determined by interviewing children in the presence of parents, using three multiple pass, 24-hour recalls. Children were classified as having had an under-reported, accurately reported, or over-reported dietary intake relative to total energy expenditure, as measured by doubly labeled water. Reporting accuracy was examined as a function of children's body weight, body composition (using dual energy x-ray absorptiometry), and macronutrient intake.

RESULTS

Average reported intake was, on average, 14% greater than children's estimated expenditure (p < 0.01). Reporting accuracy varied as a function of children's relative weight and body composition; under-reporting tended to occur among heavier children, having the highest body fat content (p < 0.0001) and relative weight (p < 0.0001).

DISCUSSION

These findings suggest that weight status influences the accuracy of dietary reports made by children and their parents. More research is needed to address possible psychological and social factors that introduce bias in reporting children's dietary data.

Types of fat intake and body mass index in a Mediterranean country

BACKGROUND

Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity.

OBJECTIVE

To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil.

SUBJECTS

The study was carried out in Spain among 23 289 women and 14 374 men, aged 29-69 years, who were participants of a large European prospective cohort.

METHODS

: Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI >/= 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting.

RESULTS

The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men.

CONCLUSIONS

The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.

[Factors associated with the accumulation of abdominal fat estimated with anthropometric indexes]

BACKGROUND

To evaluate lifestyle and dietary intake factors influencing the accumulation of abdominal fat in a Mediterranean population.

SUBJECTS AND METHOD

A cross-sectional study was carried-out in Spain (Asturias, Granada, Murcia, Navarra and Guipuzkoa) among 23,228 women and 14,332 men aged 29-69 years, participants of a large European prospective cohort (EPIC). Information on usual food intake and other non-dietary factors were collected by interviews. Height, weight, waist circumference and hip circumference were taken by previously trained interviewers.

RESULTS

In a multiple-linear regression analysis sports activities and educational level were negatively associated with abdominal obesity, while body mass index, age, tobacco and alcohol consumption, saturated fat intake and increased prevalence of hypertension, diabetes and myocardial infarction were positively associated. All dietary and non-dietary variables accounted for 22 and 27% of variance in the waist/hip ratio and 74 and 66% of variance in the waist circumference, in women and men respectively.

CONCLUSIONS

Body mass index and age are the most important factors influencing the accumulation of abdominal fat. Dietary factors and other lifestyle factors seem to play a minor role in increasing abdominal obesity.

Genetic and environmental influences on eating patterns of twins aged >/=50 y

BACKGROUND

Clinicians and researchers could benefit from a greater understanding of the role of genetic and environmental factors in human eating behavior.

OBJECTIVE

Our aim was to estimate the relative influence of genetic and environmental factors on habitual eating patterns in middle-aged and elderly men and women.

DESIGN

Male and female twins (n = 4640) aged >/=50 y completed a mailed version of the National Cancer Institute food-frequency questionnaire. Factor analysis was performed to identify eating patterns among respondents. Estimates of genetic, common environmental (shared by family members), and specific environmental (unique to an individual) influences were obtained for food use, serving size, and consumption frequency by comparing monozygotic and dizygotic twin-pair groups with structural equation analysis.

RESULTS

Two independent eating patterns were identified: the first consisted of items high in fat, salt, and sugar, and the second reflected healthful eating habits. Although the influence of environmental factors was larger, between 15% and 38% of the total variation in pattern 1 and between 33% and 40% in pattern 2 were explained by genetic influences. Models accounting for sex differences in genetic and environmental estimates fit the data significantly better for food use and serving size of foods in eating pattern 1 and for food use in eating pattern 2.

CONCLUSION

Although 60-85% of the variability in eating patterns was associated with environmental factors, genetic influences were also apparent and there was some evidence of sex specificity. These findings may be important in crafting dietary interventions and predicting adherence to these interventions.

Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents

OBJECTIVE

The purpose of this study was to determine whether obese adolescents eat more high-calorie low-nutrient-dense foods than non-obese adolescents.

RESEARCH METHODS AND PROCEDURES

Using a cross-sectional design, 22 non-obese and 21 obese adolescents kept 14-day food records. Records provided estimates of total daily energy intake and caloric intake from five categories of high-calorie, low-nutrient-dense (HC) foods: candy, chips, soda, baked goods, and ice cream. Body composition was determined by 18O dilution and daily energy expenditure by doubly labeled water. Percentage of energy intake reported (%report) was calculated as the ratio of reported energy intake to measured energy expenditure (x 100%).

RESULTS

Both groups underreported energy intake, but the percentage reported was significantly greater in the non-obese group (78.2+/-20.5% non-obese vs. 55.5+/-21.8% obese, p<0.001). Consumption of calories from chips and soda was similar among non-obese and obese adolescents. However, total energy intake from all HC foods was higher in the non-obese group than among the obese (617+/-356 kcal/day vs. 362+/-223 kcal/day; p<0.01) and represented 27.2+/-10.5% and 19.9+/-9.6% of reported energy intake in the non-obese and obese groups, respectively. After adjustment for under-reporting, the percentage of calories provided by each of the HC foods was similar in the obese and non-obese groups except for ice cream, which remained significantly greater in the non-obese group (p<0.05).

DISCUSSION

Our findings suggest that both non-obese and obese adolescents consume a substantial portion of reported calories from HC foods and that obese adolescents do not consume more calories from these foods than non-obese adolescents. These data offer no evidence to support the widespread notion that obese adolescents eat more "junk food" than non-obese adolescents. Health professionals who treat obese adolescents must be aware that the excess calories in their diets may come from a variety of food sources and not solely from high-calorie snack foods.

Estimation of food intake: effects of the unit of estimation

While many studies have shown that individuals under-estimate caloric intake, few studies have examined how individuals estimate intake when using other units of measurement (e.g. cups, ounces). Forty-one women (21 obese, 20 normal weight) ate a test meal of Häagen-Dazs chocolate ice cream and were asked to estimate the amount they ate in both calories and cups. As expected, participants under-estimated intake when asked to estimate how much they ate in calories, but considerably over-estimated their intake when measured in cups. Thus, individuals can both under- and over-estimate how much of the same food they have eaten, depending on the unit they are asked to use for estimation. Obesity and eating disorders treatment programs should take into account the tendency to over-estimate volumetric portions as well as under-estimate caloric intake.

The relationship of cognitive restraint to the spontaneous food and fluid intake of free-living humans

How the desire to restrain intake, cognitive restraint, may influence the amount or pattern of food and fluid intake was investigated by studying the spontaneous intake of free-living humans. The Three-Factor Eating Questionnaire and the Restraint Scale were completed by 358 adults who also were paid to maintain 7-day diaries of their intake. For both males and females, higher cognitive restraint ws associated with lower and less variable overall intake, especially of fat and carbohydrate. This resulted from the ingestion of smaller and less variable meals that contained less fat. In addition, high restraint was associated with smaller deprivation ratios, and lower estimated before and after meal stomach contents. Although females were higher in restraint than males, comparable levels of restraint had equivalent effects upon intake. The results suggest that restrained subjects simply eat less because they require less with cognitive restraint as a secondary consequence.

Dietary fat, sugar, and fiber predict body fat content

OBJECTIVE

This study was conducted to determine the relationships among the specific components of dietary fat and carbohydrate and body fatness in lean and obese adults.

DESIGN

Body composition determination was performed on each subject by hydrostatic weighing at residual volume. Subsequently, the individual components of dietary fat and carbohydrate were examined relative to body fatness using a 3-day food diary and a food frequency questionnaire.

SUBJECTS

Subjects were 23 lean (11.1 +/- 2.9% body fat) men, 23 obese (29.2 +/- 3.8% body fat) men, 17 lean (16.7 +/- 3.3% body fat) women, and 15 obese (42.7 +/- 3.9% body fat) women who volunteered for free diet and body composition analyses. Inclusion criteria were 15% body fat for lean men, 25% for obese men, 20% for lean women, and 35% for obese women.

STATISTICAL ANALYSIS PERFORMED

Group comparisons for dietary variables were made with a multivariate analysis of variance.

RESULTS

No differences were found between lean and obese subjects for energy intake or total sugar intake, but obese subjects derived a greater portion of their energy from fat (33.1 +/- 2.6% and 36.3 +/- 2.3% for obese men and women, respectively, vs 29.1 +/- 1.3% and 29.6 +/- 2.0%, lean men and women, respectively). Percent of fat intake for saturated, monounsaturated, and polyunsaturated fats was not different among groups. Obese subjects derived a greater percentage of their sugar intake from added sugars than lean subjects (38.0 +/- 3.5% vs 25.2 +/- 2.0%, respectively, for men; 47.9 +/- 8.0% vs 31.4 +/- 3.4%, respectively, for women). Dietary fiber was lower for obese men (20.9 +/- 1.8 g) and women (15.7 +/- 1.1 g) than for lean men (27.0 +/- 1.8 g) and women (22.7 +/- 2.1 g).

APPLICATIONS/CONCLUSIONS

Obesity is maintained primarily by a diet that is high in fat and added sugar and relatively low in fiber. Alterations in diet composition rather than energy intake may be a weight control strategy for overweight adults.

Behaviour modification in obese subjects with type 2 diabetes mellitus

We have followed prospectively, 46 obese, type 2 diabetic patients for a 55-week period, in order to evaluate the efficiency of an educational programme based on behaviour modification to enhance weight loss and changes of other cardiovascular risk factors. No patient received pharmacological treatment during the study. At the end of the follow-up the patients obtained an average weight loss of 9.250 kg (range: 0.500-17.500 kg); the BMI was reduced from 34.2 +/- 0.8 kg/m2 to 30.6 +/- 1.1 kg/m2 (P less than 0.01); fasting serum glucose descended from 7.9 +/- 0.4 to 6.1 +/- 0.5 mM (P less than 0.05); SBP (systolic blood pressure) decreased from 145.7 +/- 3 to 126.4 +/- 5.1 mmHg (P less than 0.01); DBP (diastolic blood pressure) decreased from 83.5 +/- 2.5 to 65 +/- 2.6 mmHg (P less than 0.01); triglyceride levels were lowered from 164.5 +/- 12 to 109.7 +/- 10 mg/dl (P less than 0.01); HDL-cholesterol levels increased from 1.27 +/- 0.05 to 1.53 +/- 0.12 mM (P less than 0.01). Serum glucose 2 h after a 75 g glucose oral load decreased from 14.9 +/- 0.6 to 12.7 +/- 0.9 mM (P less than 0.05) on week 35 of follow-up. Twelve patients no longer presented a diabetic curve (8 normal oral glucose tolerance test (OGTT) curves, and 4 impaired glucose tolerance (IGT) curves). No significant changes in the parameters studied were obtained in the group of patients on conventional treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Truncal vagotomy reduces food and liquid intake in man

Truncal vagotomy reduces food and liquid intake in laboratory animals but has not been studied in man. Seven (6F) morbidly obese patients kept 4-day dietary diaries with validation by urine nitrogen analysis before and 3 and 9 months after truncal vagotomy without drainage. Significant reductions in body weight were accompanied by reductions in self-reported total calorie intake from 2800 kcal/day to 1800 at 3 months and 2000 kcal/day at 9 months. The correlation between reported and validated protein intake was .72 (p less than 0.001) with a mean underreporting of protein intake by at least 27%. Macronutricant postoperative reductions in total volume and calorie density of liquid intake. Liquid calories were reduced by 47% at 3 months and 50% at 9 months and solid calories by 33% at 3 months and 27% at 9 months. It is concluded that truncal vagotomy reduces food and liquid intake in man preferentially through liquid reduction. These results have implications for surgical treatment of morbid obesity.