Metabolic, psychological, and health correlates of dietary restraint in healthy postmenopausal women

Effect of high dietary restraint on energy availability and menstrual status

INTRODUCTION

Dietary restraint (DR) is a key eating behavior associated with menstrual disturbances (MD) in exercising women. However, the association between DR and energy availability (EA) has not been examined.

PURPOSES

The objective of this study is 1) to compare EA in women when categorized by DR score, to include an evaluation of the frequency of women with low EA, and 2) to compare the distribution of subclinical and clinical MD between DR groups.

METHODS

Exercising women (23 ± 4 yr; body mass index, 21.1 ± 1.9 kg·m; and exercise volume, 333 ± 198 min·wk) were retrospectively categorized by DR score into two groups: 1) women with high DR (n = 30) and 2) women with normal DR (n = 56). DR scores were obtained from the Three-Factor Eating Questionnaire. High DR score was defined as ≥13. Body composition was measured using dual-energy x-ray absorptiometry. EA was defined as energy intake - exercise energy expenditure per kilogram lean body mass (LBM). Low EA was defined as <30 kcal·kg LBM. Menstrual status was determined using daily urinary samples assayed for reproductive hormones.

RESULTS

EA was lower in the high DR versus the normal DR group (35.0 ± 12.9 vs 42.0 ± 12.9 kcal·kg LBM, P = 0.018). There was no difference (P = 0.866) in frequency of low EA between DR groups. There was a greater frequency of MD (amenorrhea, oligomenorrhea, anovulation, or luteal phase defect) in the high DR group (21/28, 75.0%) versus the normal DR group (24/47, 51.1%) (χ = 4.2, P = 0.041).

CONCLUSION

Our findings demonstrate that exercising women with high DR exhibited lower EA and a greater frequency of MD (subclinical and clinical) compared with women with normal DR. However, high DR was not associated with low EA in exercising women.

Basic ADL disability and functional limitation rates among older AMERICANS from 2000-2005: the end of the decline?

BACKGROUND

This study sought to determine whether the rates of basic activities of daily living (ADL) disabilities and functional limitations declined, remained the same, or increased between 2000 and 2005 when (a) only community-dwelling Americans aged 65 and older were examined and (b) when institutionalized older adults were included.

METHOD

Using data from the American Community Survey and the National Nursing Home Survey, we calculated annual prevalence rates of basic ADL disabilities and functional limitations and fitted regression lines to examine trends over time.

RESULTS

The rates of basic ADL disabilities among community-dwelling adults aged 65 and older increased 9% between 2000 and 2005. When institutionalized elders were included, basic ADL disability rates were stable among men but increased among women. Functional limitation rates did not significantly change between 2000 and 2005.

CONCLUSION

These findings suggest an end of the decline in disability rates among older Americans, which, if confirmed, could have important implications for health care.

Dietary restraint and low bone mass in female adolescent endurance runners

BACKGROUND

Because disordered eating (DE) has been related to menstrual irregularity (MI) and low bone mineral density (BMD) in some studies of female athletes but not in others, it seems beneficial to assess the DE attitudes and behaviors most associated with these conditions.

OBJECTIVE

We aimed to determine the relation between Eating Disorder Examination Questionnaire (EDE-Q) subscale scores, pathologic behaviors, MI, and low BMD in adolescent female runners.

DESIGN

Participants were 93 female competitive cross-country runners 13-18 y old. The EDE-Q, composed of subscales for weight concern, shape concern, eating concern, and dietary restraint, was used to assess DE. Menstrual history was determined by using a questionnaire derived from a medical history form administered before participation in high school athletics. The International Society for Clinical Densitometry and the World Health Organization criterion of <or=-2 or <or=-1 SD, respectively, was used to categorize runners as having low BMD.

RESULTS

Runners with elevated restraint had a significantly (P<0.001) greater incidence of low BMD than did runners with elevated weight and shape concern. After adjustment for possible confounding variables (including menstrual history), lumbar spine BMD, bone mineral content, and BMD z score values were lowest in runners with elevated restraint. In addition, total-body BMD and total-body BMD z scores were significantly (P<0.05) lower in runners with elevated restraint than in those with elevated weight or shape concern. Elevated EDE-Q scores for weight or shape concern, pathologic behaviors, or any combination of the 3 without concurrent dietary restraint were not significantly associated with low bone mass.

CONCLUSION

These findings suggest that, in adolescent female runners, dietary restraint may be the DE behavior most associated with negative bone health effects.

Aspects of eating behaviors "disinhibition" and "restraint" are related to weight gain and BMI in women

OBJECTIVE

The causes of adult weight gain leading to obesity are uncertain. We examined the association of adult weight gain and obesity with subscales of eating behavior characteristics in older women.

METHODS AND PROCEDURES

Current height and weight, eating behavior subscales (disinhibition subscales-habitual, situational, and emotional; restraint subscales-flexible and rigid; hunger subscales-internal and external) as assessed using the Eating Inventory (EI), and self-reported body weight at six prior age intervals were reported by 535 women aged 55-65 years. Multiple regression analysis was used to examine the relationships between EI subscale scores and weight change from the age interval of 30-39 to 55-60 years and current BMI.

RESULTS

The strongest correlate of weight gain over 20 years was susceptibility to overeating in response to everyday cues within the environment (habitual disinhibition; partial correlation coefficient (r) = 0.25, P < 0.001); susceptibility to overeating in response to emotional states such as depression (emotional disinhibition) was a quantitatively weaker but significant correlate (partial r = 0.17, P < 0.001), and susceptibility to overeating in response to specific situations such as social occasions (situational disinhibition) was not associated with weight gain. Flexible control of dietary restraint attenuated the influence of habitual disinhibition in particular on weight gain and BMI, and was less effective in attenuating associations of emotional or situational disinhibition.

DISCUSSION

Lifestyle modification programs for prevention and treatment of adult-onset obesity currently focus on reducing situational and emotional overeating; the results of this study suggest that a stronger emphasis on strategies that target habitual overeating may be warranted.

The Eating Inventory, body adiposity and prevalence of diseases in a quota sample of Czech adults

OBJECTIVE

To study the relationships between the Eating Inventory (EI) factors (restraint, disinhibition and hunger), body adiposity and prevalence of selected diseases in a quota sample of Czech adults.

SUBJECTS AND METHODS

The sample included 1429 men and 1624 women who were interviewed individually by trained investigators. The sample was quota representative--for gender, age, size of residential location, region and socioeconomic status in Czech adults. Anthropometric data, socioeconomic and lifestyle information were obtained. Subjects filled out the EI questionnaire. Physicians reported about subjects' morbidity.

RESULTS

Backward stepwise regression analysis revealed that restraint and disinhibition were significant predictors of body mass index (BMI) along with gender, age, parental obesity, weight loss attempts, present dieting and educational level. The same factors plus income predicted the waist circumference. BMI and waist circumference were negatively related to restraint but positively to disinhibition. According to logistic regression analysis restraint and disinhibition were significantly associated with hypertension, cardiovascular diseases and hyperlipidaemia. Diabetes was significantly related to restraint and hunger scores. The observed association between EI factors and diseases remained significant even when BMI and age were taken into account.

CONCLUSION

As shown in earlier studies, disinhibition was positively and restraint negatively associated with BMI and waist circumference. For the first time, factors of the EI were also identified as significant predictors of diseases characterizing the metabolic syndrome.

Failure of fat cell proliferation, mitochondrial function and fat oxidation results in ectopic fat storage, insulin resistance and type II diabetes mellitus

BACKGROUND

It is widely accepted that increasing adiposity is associated with insulin resistance and increased risk of type II diabetes. The predominant paradigm used to explain this link is the portal/visceral hypothesis. This hypothesis proposes that increased adiposity, particularly in the visceral depots, leads to increased free-fatty acid flux and inhibition of insulin-action via Randle's effect in insulin-sensitive tissues.

OBJECTIVES

In this review, limitations of this paradigm will be discussed and two other paradigms that may explain established links between adiposity and insulin resistance/diabetes will be presented. (A) Ectopic fat storage syndrome. Three lines of evidence support this concept. Firstly, failure to develop adequate adipose tissue mass (also known as 'lipodystrophy') results in severe insulin resistance and diabetes. This is thought to be the result of ectopic storage of lipid into liver, skeletal muscle and the pancreatic insulin-secreting beta cell. Secondly, most obese patients also shunt lipid into the skeletal muscle, the liver and probably the beta cell. The importance of this finding is exemplified by several studies demonstrating that the degree of lipid infiltration into skeletal muscle and liver highly correlates with insulin resistance. Thirdly, increased fat cell size is highly associated with insulin resistance and the development of diabetes. Increased fat cell size may represent the failure of the adipose tissue mass to expand and therefore to accommodate an increased energy influx. Taken together, these observations support the 'acquired lipodystrophy' hypothesis as a link between adiposity and insulin resistance. Ectopic fat deposition is therefore the result of additive or synergistic effects including increased dietary intake, decreased fat oxidation and impaired adipogenesis. (B) Endocrine paradigm. This concept was developed in parallel with the 'ectopic fat storage syndrome' hypothesis. Adipose tissue secretes a variety of endocrine hormones such as leptin, interleukin-6, angiotensin II, adiponectin and resistin. From this viewpoint, adipose tissue plays a critical role as an endocrine gland, secreting numerous factors with potent effects on the metabolism of distant tissues.

CONCLUSIONS

The novel paradigms of ectopic fat and fat cell as an endocrine organ probably will constitute a new framework for the study of the links between our obesigenic environment and the risk of developing diabetes.

Women with high scores for cognitive dietary restraint choose foods lower in fat and energy

Women with high dietary restraint typically report restricting energy intake and using reduced-kilocalorie foods in an effort to achieve or maintain a certain body weight. However, previous studies of food choices associated with dietary restraint have been limited by the self-report of participants' food selections. We provided all foods consumed during a free-living 24-hour period to 62 normal-weight women with high (n=33) or low (n=29) dietary restraint, and observed choices from among similar foods varying in fat, fiber, and energy content. Women with high dietary restraint consumed less energy and chose reduced-kilocalorie and reduced-fat foods more frequently than unrestrained eaters. Group differences in choices of milk, cream cheese, mayonnaise, salad dressing, and soda were noted. Dietitians may consider frequent use of reduced-kilocalorie and reduced-fat foods a potential indicator of high dietary restraint, which may have health consequences. Accordingly, further exploration of clients' tendency to restrict dietary intake may be warranted.

Metabolic aging and predicted longevity: results of a cross-sectional study in post-menopausal women

BACKGROUND AND AIMS

The extent to which general characteristics of metabolic aging contribute to differences in life span among individuals remains uncertain. The objective of this study was to examine the association of age-related physiological and metabolic variables with predicted longevity in postmenopausal women.

METHODS

Subjects were 33 healthy women aged 55-65 years. Total and resting energy expenditure, body temperature, immune function as assessed by a delayed-type hypersensitivity skin test (DTH), lipid profile, and reported dietary intake were measured.

RESULTS

There were no significant associations between longevity, energy expenditure, body temperature, lipid profile, or dietary intake. However, there was a significant association of predicted longevity with DTH (partial r=0.44, p=0.023).

CONCLUSIONS

These results suggest that immune function may predict familial differences in longevity, while energy expenditure, body temperature, lipid profile, and dietary intake are unrelated. Although the small sample size may have limited the ability to detect metabolic effects on longevity in this study, the general approach may be broadly applicable to examinations of metabolic aging in humans.

Facilitated feeding in disabled elderly

Nutrition and health are major concerns to older individuals. Whereas illness associated with overnutrition has been well characterized, poor health associated with undernutrition has received less attention. Malnutrition continues to plague the elderly in developed and underdeveloped countries alike, and is becoming of more concern as global demographic changes predict increasing proportions of elderly in all societies. Nutrition influences many chronic disease processes affecting older individuals. In addition, changes in physiology, metabolism, and function accompanying aging result in altered nutritional requirements. The enhancement and maintenance of health and function are now more possible with the new knowledge of nutritional needs in old age. Designing nutritional therapy to treat malnutrition associated with illness in older patients requires an understanding of the aging processes, a careful setting of treatment goals, and multidisciplinary collaboration.

The association of eating behavior with risk for morbidity in older women

BACKGROUND

Although an influence of eating behavior on dietary intake and physiology has been documented in several studies, the extent to which eating behavior influences long-term health is uncertain.

METHODS

Current dietary restraint, disinhibition, and hunger were assessed using the Eating Inventory in 1252 nonsmoking women aged 55 to 65 years. In addition, subjects reported the presence or absence of 22 specific morbidities, along with general demographic information. Logistic regression was used to examine associations between eating behavior scores and morbidity, adjusting for age, prior smoking status, hormone replacement therapy, education level, and body mass index (BMI).

RESULTS

In adjusted models excluding BMI, higher disinhibition scores were associated with small increased risks for hypercholesterolemia (odds ratio [OR] 1.04, p =.045), leg cramps (OR 1.05, p =.044), indigestion (OR 1.06, p =.020), and cataract (OR 1.09, p =.036), and a decreased risk of eczema (OR 0.91, p =.008). In addition, higher hunger scores were associated with increased risk of eczema (OR 1.09, p =.026). However, after adjusting for confounding variables plus BMI, higher disinhibition scores were associated with increased risks for low back pain (OR 1.06, p =.031) and constipation (OR 1.10, p =.004), and associations of disinhibition and hunger with eczema were unchanged (OR 0.90, p =.008 and OR 1.09, p =.024, respectively). Dietary restraint was not associated with morbidity in any model.

CONCLUSIONS

Higher disinhibition and hunger scores were associated with small alterations in reported morbidity risk in a large population of nonsmoking older women. Although our cross-sectional study design makes the directionality of these relationships unclear, our results suggest at most a relatively minor independent influence of eating behavior constructs on long-term health.