Varying levels of food energy self-reporting are associated with between-group, but not within-subject, differences in food intake

In-Depth Analysis of Diet Diary and Urine pH Measurements Improved Food Diet Reporting in Postmenopausal Women with RUTI

Introduction

We proceeded with an in-depth review of diet diaries for nutrient analysis from a cohort of women suffering from uncomplicated recurrent urinary tract infection (RUTI) to validate the accuracy of our current food diet record (FDR) form and evaluate possible domains of improvement.

Materials and Methods

As part of an IRB-approved study, this previously published cohort of NHANES-comparable women was analyzed for consistency of the nutrient intake over 3 days, the influence of the time between meals and urine pH, the effect of nutrient intake over interval time between meals, and seasonal and before/during the COVID-19 pandemic changes. Intrarater reliability for nutrient analysis and intrapatient variability for urine pH were computed to test for consistency.

Results

Intrarater reliability for diet analysis was 91% accurate for foods and beverage matching and nutrient analysis. Mean standard deviation of urine pH readings within study participants was 0.4 (95% CI: 0.4, 0.5). An association was noted between total calories and fat consumed at breakfast and an increase in time to lunch. Calories consumed were unaffected across seasons or during the COVID-19 pandemic. Water intake during summer was significantly lower than that during fall and winter (both, p < 0.001). The patients who reported drinking water had a significantly lower average urine pH than women who did not report drinking water (5.8 vs. 6.2; p = 0.026).

Conclusion

In this cohort of postmenopausal women with RUTIs, in-depth analysis of our current FDR findings led to several actionable items, which will improve our current food diet self-reporting process by our patients.

Macronutrient intake associated with weight gain in adolescent girls with anorexia nervosa

OBJECTIVE

Adolescents and women with anorexia nervosa (AN) are known to severely restrict total calorie and fat intake. However, data are limited regarding specific macronutrient intake associated with weight gain in AN.

OBJECTIVE

To prospectively investigate dietary macronutrient composition associated with weight gain in adolescent girls with AN.

METHOD

A prospective naturalistic study of 90 girls 12-18 years old; 45 with AN and 45 healthy normal-weight-controls over a 6-12-month period. Participants completed four-day food diaries and underwent body composition assessment using dual energy X-ray absorptiometry. Weight gain was defined as a ≥10% increase in body mass index (BMI) from baseline.

RESULTS

Baseline clinical characteristics did not differ between girls with AN who did not gain weight (AN-0) versus those who did (AN-1) over the following 6-12 month period except for percentage of calories from proteins (p = 0.046). At 6-12 month follow-up, AN-1 consumed a lower percentage of total calories from protein (p = .001), and a higher percentage of total calories from fat (p = .02) compared to AN-0. AN-1 had a significant increase in the percentage of total calories obtained from and poly-unsaturated-fatty acids (PUFA) (p = 0.006) compared to AN-0, between baseline and follow-up. Within the AN group, BMI at follow-up was associated positively with percentage of total calories obtained from fat, MUFA, and PUFA (p < .05) at 6/12 months, and inversely with the percentage of total calories obtained from carbohydrates and proteins (p = .03).

DISCUSSION

Consuming a greater proportion of total calories from fat is associated with weight gain in adolescent girls with AN.

Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting

In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. We conducted a pilot study comparing body mass index (BMI) changes between two arms (i) PCP in-person clinic visits plus obesity specialist tele-visits ( PCP visits + specialist tele-visits) and (ii) PCP in-person clinic visits only ( PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Patients (N = 40, 10-17 years, BMI ≥ 95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (-0.11 vs. -0.05, P = 0.049) following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (-0.11, P = 0.0006) but not Group 2 (-0.06, P = 0.08); however, decrease in BMI at 6 months did not differ between groups. After crossover, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. An integrated care model utilizing telehealth holds promise for treating children with obesity.

Higher proportion of total and fat energy intake during the morning may reduce absolute intake of energy within the day. An observational study in free-living Japanese adults

BACKGROUND

Although the distribution of energy intake throughout the day appears to impact overall daily energy intake, little is known about the ad libitum distribution of energy intake.

OBJECTIVE

Our aim was to investigate associations between the distribution of energy intake during the day and subsequent or overall energy intake, and food choice in free-living adults.

DESIGN

A total of 119 women and 116 men completed 16-day semi-weighed dietary records. The longitudinal dietary intake data for each participant were analyzed using a mixed model to examine the effect of energy intake at various times of day on subsequent or overall energy intake.

RESULTS

Mean proportion of total energy intake in the morning (4:00 a.m.-10:29 a.m.), afternoon (10:30 a.m.-4:59 p.m.) and evening (5:00 p.m.-3:59 a.m.) meal was 22.6%, 33.8% and 43.6% in men, and 24.7%, 36.5%, 38.8% in women, respectively. Proportion of energy intake (%) in the morning meal was significantly and negatively associated with energy intake (kcal) in the subsequent afternoon and evening meals, and consequently in the whole day in both sexes. This significant and negative association was also observed for proportion of energy intake (%) of fat, but not of carbohydrate or protein, in both sexes. Proportion of energy intake (%) in the morning meal was negatively associated with overall energy intake (kcal) from the group of meats, fish, and eggs in both sexes, and from the group of confectioneries and soft drinks in women.

CONCLUSIONS

More energy in the morning meal may reduce energy intake, especially that from fat, in the subsequent meals, and consequently in the whole day.

Glycaemic index of meals affects appetite sensation but not energy balance in active males

BACKGROUND

Foods with low glycaemic index (LGI) are reported to suppress appetite mainly in overweight population but have not been investigated in athletic adults.

OBJECTIVE

The aim of this study was to compare the short-term effects of LGI and high GI (HGI) meals over a day on subsequent subjective appetite sensation, energy intake, energy expenditure, energy balance and resting metabolic rate in physically active males.

METHODS

This cross-sectional randomized crossover study included 14 active males (mean ± SD; age 34.5 ± 8.9 years, body mass index 22.8 ± 2.1 kg m(-2)) to consume LGI and HGI meals on two separate days. On each trial day, participants consumed a breakfast in the laboratory and then left with a packed lunch, dinner and snacks. Appetite scores, energy intake and expenditure were assessed.

RESULTS

The area under the curve for appetite scores of the HGI trial was significantly smaller than that of the LGI trial during the laboratory period (p = 0.027) and throughout the day (p = 0.009). No significant differences in energy intake, energy expenditure, energy balance and resting metabolic rate were found between groups, between the trial days and between the corresponding post-trial days.

CONCLUSIONS

These results show that frequent ingestion of the HGI meals, contrary to the previous reports, suppresses appetite more than that of LGI meals, but did not affect energy balance in physically active normal-weight males.

Overweight and obese humans overeat away from home

The built environment has been implicated in the development of the epidemic of obesity. We investigated the differences in the meal patterns of normal weight vs. overweight/obese individuals occurring at home vs. other locations. The location of meals and their size in free-living participants were continuously recorded for 7 consecutive days. Study 1: 81 males and 84 females recorded their intake in 7-day diet diaries and wore a belt that contained a GPS Logger to record their location continuously for 7 consecutive days. Study 2: 388 males and 621 females recorded their intake in diet diaries for 7 consecutive days. In both studies, compared to eating at home, overweight/obese participants ate larger meals away from home in both restaurants and other locations than normal weight participants. Overweight/obese individuals appear to be more responsive to environmental cues for eating away from home. This suggests that the influence of the built environment on the intake of overweight/obese individuals may contribute to the obesity epidemic.

The loss of metabolic control on alcohol drinking in heavy drinking alcohol-dependent subjects

Background

Most physiological studies interested in alcohol-dependence examined ethanol as a pharmacological agent rather than a nutrient. We conducted two studies, which assessed the metabolic and endocrine factors involved in the regulation of alcohol and nutrient intake in alcohol-dependent (AD) subjects. We also examined the potential role of a disruption in energy balance in alcohol-dependence.

Methods and Results

In Study-1, quantitative dietetic interviews of eating and drinking habits were conducted with 97 AD subjects. The population was split around a median alcohol intake value of 12.5 kcal/kg/day. The results showed that the “low alcohol” drinking AD subjects had high Body Mass Index (BMI) and Fat Mass (FM) and alcohol intake was compensated for by a decrease in non-alcoholic intakes. “High alcohol” drinking AD subjects, on the other hand, had low BMI and FM and the total caloric intakes were largely above norms. In Study-2, 24 AD inpatients were submitted to dietetic interviews, calorimetry and blood samplings for the measurement of biomarkers of the regulation of metabolism and satiety, on day 2, 5 and 16 of abstinence. These patients were compared with 20 controls matched for age and gender. We observed in AD patients an increase in cortisol, leptin and PYY plasma levels and a decrease in ghrelin, which might explain the observed decrease in non-alcoholic intakes. However, alcoholic and non-alcoholic intakes correlated positively with basal metabolism and negatively with leptin and leptin/BMI.

Conclusion

For individuals consuming below12.5 kcal/kg/day of alcohol, alcohol intake is compensated for by a decrease in non-alcoholic nutrient intakes, probably due to changes in metabolic and satiety factors. For individuals consuming above 12.5 kcal/kg/day of alcohol, alcohol accelerates metabolism and decreases fat mass and leptin levels, and the total caloric intake largely exceeds norms. A dual model for regulation of energy intake in AD subjects is proposed.

Social desirability, not dietary restraint, is related to accuracy of reported dietary intake of a laboratory meal in females during a 24-hour recall

Underreporting in self-reported dietary intake has been linked to dietary restraint (DR) and social desirability (SD), however few investigations have examined the influence of both DR and SD on reporting accuracy and used objective, rather than estimated, measures to determine dietary reporting accuracy. This study investigated accuracy of reporting consumption of a laboratory meal during a 24-hour dietary recall (24HR) in 38 healthy, college-aged, normal-weight women, categorized as high or low in DR and SD. Participants consumed a lunch of four foods (sandwich wrap, chips, fruit, and ice cream) in a laboratory and completed a telephone 24HR the following day. Accuracy of reported energy intake of the meal=((reported energy intake-measured energy intake)/measured energy intake)×100 [positive numbers=overreporting]. Overreporting of energy intake occurred in all groups (overall accuracy rate=43.1±49.9%). SD-high as compared to SD-low more accurately reported energy intake of chips (19.8±56.2% vs. 117.1±141.3%, p<0.05) and ice cream (17.2±78.2% vs. 71.6±82.7%, p<0.05). SD-high as compared to SD-low more accurately reported overall energy intake (29.8±48.2% vs. 58.0±48.8%, p<0.05). To improve accuracy of dietary assessment, future research should investigate factors contributing to inaccuracies in dietary reporting and the best methodology to use to determine dietary reporting accuracy.

Dietary energy density and diet variety as risk factors for relapse in anorexia nervosa: a replication

OBJECTIVE

To replicate our previous findings of an association between energy density and diet variety in recently weight-restored patients with anorexia nervosa (AN) and clinical outcome in the year following treatment.

METHOD

Nineteen hospitalized, weight-restored women with AN completed a food record, from which a diet energy density score (DEDS) and a diet variety score (DVS) were calculated. After hospital discharge, patients were contacted regularly; at the end of one year, clinical outcome was determined using modified Morgan-Russell criteria. As in our previous study, outcome was dichotomized into "full, good, or fair" and "poor" groups.

RESULTS

Data from 16 subjects were available. The DEDS was significantly lower (p < .05) in the poor outcome group (0.7 ± 1) compared with the "full, good, or fair" outcome group (0.9 ± 1). Although the DVS was also lower in the poor outcome group (13.9 ± 2) compared with the "full, good or fair" outcome group (15.7 ± 1.8), this difference was not statistically significant.

DISCUSSION

In recently weight-restored patients with AN, a lower DEDS, but not DVS, is associated with poor clinical outcome after inpatient treatment. This finding may be important in the assessment of risk for relapse in patients with AN.

Food choice and diet variety in weight-restored patients with anorexia nervosa

Anorexia nervosa is a serious psychiatric illness associated with substantial morbidity and mortality. Weight-restored females with anorexia nervosa with limited diet variety, assessed by a diet variety score, have been reported to have poor outcomes. Using the same patient cohort, the objective of the current study was to provide a detailed description of the types of foods from which patients restrict variety in their diets. Forty-one weight-restored patients, hospitalized between June 2000 and July 2005, who completed a 4-day food record before discharge were followed for up to 1 year. Patient outcomes were categorized as a success (n=29) or failure (n=12) using Morgan-Russell criteria. Although the total number of foods selected did not differ between the success and failure groups (73±14 vs 74±13, respectively; P=0.741), a significant difference in the total number of different foods was observed: the failure group selected fewer and the success group selected more (43±9 vs 51±7; P=0.005). Outcomes groups also differed significantly in the variety of foods selected from 5 of 17 food groups. Results suggest that a diet limited in total variety and specifically limited in variety from five food groups may be associated with relapse in patients with anorexia nervosa.

Alternative methods of accounting for underreporting and overreporting when measuring dietary intake-obesity relations

Misreporting characterized by the reporting of implausible energy intakes may undermine the valid estimation of diet-disease relations, but the methods to best identify and account for misreporting are unknown. The present study compared how alternate approaches affected associations between selected dietary factors and body mass index (BMI) by using data from the European Prospective Investigation Into Cancer and Nutrition-Spain. A total of 24,332 women and 15,061 men 29-65 years of age recruited from 1992 to 1996 for whom measured height and weight and validated diet history data were available were included. Misreporters were identified on the basis of disparities between reported energy intakes and estimated requirements calculated using the original Goldberg method and 2 alternatives: one that substituted basal metabolic rate equations that are more valid at higher BMIs and another that used doubly labeled water-predicted total energy expenditure equations. Compared with results obtained using the original method, underreporting was considerably lower and overreporting higher with alternative methods, which were highly concordant. Accounting for misreporters with all methods yielded diet-BMI relations that were more consistent with expectations; alternative methods often strengthened associations. For example, among women, multivariable-adjusted differences in BMI for the highest versus lowest vegetable intake tertile (β = 0.37 (standard error, 0.07)) were neutral after adjusting with the original method (β = 0.01 (standard error, 07)) and negative using the predicted total energy expenditure method with stringent cutoffs (β = -0.15 (standard error, 0.07)). Alternative methods may yield more valid associations between diet and obesity-related outcomes.

Appetite control: methodological aspects of the evaluation of foods

This report describes a set of scientific procedures used to assess the impact of foods and food ingredients on the expression of appetite (psychological and behavioural). An overarching priority has been to enable potential evaluators of health claims about foods to identify justified claims and to exclude claims that are not supported by scientific evidence for the effect cited. This priority follows precisely from the principles set down in the PASSCLAIM report. The report allows the evaluation of the strength of health claims, about the effects of foods on appetite, which can be sustained on the basis of the commonly used scientific designs and experimental procedures. The report includes different designs for assessing effects on satiation as opposed to satiety, detailed coverage of the extent to which a change in hunger can stand alone as a measure of appetite control and an extensive discussion of the statistical procedures appropriate for handling data in this field of research. Because research in this area is continually evolving, new improved methodologies may emerge over time and will need to be incorporated into the framework. One main objective of the report has been to produce guidance on good practice in carrying out appetite research, and not to set down a series of commandments that must be followed.

Evaluating energy intake measurement in free-living subjects: when to record and for how long?

OBJECTIVE

To nutritionally analyse mean energy intake (EI) from different 3 d intervals within a 7 d recording period and to evaluate the seasonal effect on energy and nutrient intake.

DESIGN

Cross-sectional study of dietary intake collected with 7 d food diaries.

SETTING

Aberdeen, north-east Scotland, UK, between 2002 and 2004.

SUBJECTS

Participants from two long-term trials were pooled. These trials, investigating genetic and environmental influences on body weight, were the Genotyping And Phenotyping (GAP) study and a cohort observational study, Rowett Assessment of Childhood Appetite and metaboLism (RASCAL). There were 260 Caucasian adults, BMI range 16.7-49.3 kg/m2, age range 21-64 years.

RESULTS

Mean EI for Wednesday, Friday and Saturday had the closest approximation to the 7 d mean (0.1 % overestimate). A gender x season interaction (P = 0.019) with a different intake pattern for females and males was observed. For females, lower mean (se) EI was recorded in summer (8117 (610) kJ) and autumn (7941 (699) kJ) compared with spring (8929 (979) kJ) and winter (8132 (1041) kJ). For males, higher mean (se) EI was recorded in summer (10 420 (736) kJ) and autumn (10 490 (1041) kJ) compared with spring (9319 (1441) kJ) and winter (9103 (1505) kJ).

CONCLUSIONS

The study results indicate that 3 d weighed intakes recorded from Wednesday, Friday and Saturday are most representative of 7 d habitual intake in free-living subjects. They also indicate that seasonality has a limited effect on EI and no effect on macronutrient intake.

A small-changes approach reduces energy intake in free-living humans

OBJECTIVE

America On the Move (AOM) is a national weight gain prevention initiative that promotes small lifestyle changes by increasing walking by 2000 steps/day and reducing energy intake by about 100 kcal/day. The study's intent was to determine the impact of these small changes recommendations on steps/day and energy intake.

METHODS

In this cross-sectional study, food and fluid intake and physical activity in 116 healthy overweight adults (BMI: 25-36 kg/m(2); age: 18-60y) was compared between a non-intervention and an intervention week using diet diaries and pedometers. The major outcomes were steps/day, daily caloric intake, macronutrient intake and meal size. Within subject ANOVAs were conducted to compare results between intervention and non-intervention weeks.

RESULTS

Total energy intake was lower during intervention week than non-intervention week (P < .01), including macronutrient contents (all P's < .01), meal size (P < .01), consumption of sugar (P < .01), sugared sodas (P < .01) and sodium (P < .01). Steps/day were higher during intervention week than non-intervention week (P < .01).

CONCLUSIONS

The results support previous research showing that the message to increase steps/day results in an increase in physical activity. The results demonstrate for the first time that the message to reduce intake by 100 kcal/day does actually result in a lower intake in the short term. People seem to be able to make positive changes in diet and physical activity in response to these messages. If these small changes can be sustained, this approach could be effective in preventing further weight gain in the population.

When, how much and what foods are eaten are related to total daily food intake

Intake in the morning is associated with a reduction in the total intake for the day, while intake at night is associated with greater overall daily intake. These associations are macronutrient specific, with morning carbohydrate intake associated with reduced daily carbohydrate intake, morning fat intake associated with reduced daily fat intake and morning protein intake associated with reduced daily protein intake. Since different types of foods contain differing proportions of macronutrients, the present study investigated the associations of different types of foods ingested at various times of day with total daily and macronutrient intakes. The intakes of 388 male and 621 female free-living individuals reported in 7 d diet diaries were reanalysed. The intakes of twenty-four different types of foods and seven different drinks occurring during the morning (04.00-10.29 hours), afternoon (10.30-16.59 hours) and evening (17.00-02.00 hours) were identified and related to overall daily intakes. Dairy foods, ice cream, beef, other meats, potatoes, pastry, nuts, chips and snacks, condiments, alcohol and soda were significantly associated with higher total intake over the day, while fruit, soup, breakfast cereal, pasta, pizza, water, coffee/tea and diet soda were either not associated or were associated with lower overall intake. Dietary energy density appeared to mediate the associations between particular foods and beverages and overall energy intake. This suggests that eating low-density foods in the morning and avoiding high-density foods at night might aid in reducing overall intake and may be useful in dietary interventions for overweight and obesity.

Dietary energy density and diet variety as predictors of outcome in anorexia nervosa

BACKGROUND

Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. Successful treatment results in weight restoration, but recidivism is common, and the rate of relapse is estimated to be as high as 50%. Maintenance of a healthy diet is central to the recovery process, but the relation between diet and relapse has not been investigated in AN patients.

OBJECTIVE

The objective of the study was to determine whether diet energy density and diet variety in recently weight-restored women with AN predict outcome.

DESIGN

After gaining weight to a body mass index (BMI; in kg/m(2)) of > or = 20, 47 hospitalized women completed 4-d food records, from which a mean diet energy density score (DEDS) and a mean diet variety score (DVS) were calculated. Outcome was determined at study end by using modified Morgan-Russell criteria, and it was dichotomized as "treatment success" or "treatment failure." Data were analyzed by using Student's t test. A logistic regression model was constructed to evaluate the effects of DEDS, DVS, and caloric intake on outcome.

RESULTS

Groups did not differ significantly in mean measures of age, admission and weight-restored BMI, or caloric intake. However, DEDS and DVS were significantly higher in the success group than in the failure group. The success and failure groups were followed for a mean of 240 and 170 d, respectively. In the logistic regression model, DEDS (P = 0.016) and DVS (P = 0.048) but not caloric intake (P = 0.585) significantly predicted outcome.

CONCLUSION

In recently weight-restored women with AN, lower DEDS and DVS but not caloric intake were associated with poor outcome.

The time of day and the proportions of macronutrients eaten are related to total daily food intake

Intake in the morning is particularly satiating and associated with lower total amounts ingested for the day while intake at night is associated with greater overall daily intake. But, the influence of carbohydrates, fats or proteins ingested at various times of the day is unknown. The intakes of 375 male and 492 female free-living individuals that were acquired with 7 d diet-diary reports were reanalysed. The intakes of carbohydrates, fats and proteins, and the density of intake occurring during three 6 h periods (06.00 to 11.59 hours (morning), 12.00 to 17.59 hours (afternoon) and 18.00 to 23.59 hours (evening)) were identified and related to overall daily and meal intakes. Energy density of intake during all periods was found to be positively related to overall intake. When the proportion of daily carbohydrate ingested in the morning was high, less total food energy and carbohydrate were ingested over the entire day. When the proportion of daily fat ingested in the morning was high, less total food energy and carbohydrate and fat were ingested over the entire day. When the proportion of daily protein ingested in the morning was high, less protein was ingested over the entire day. Conversely, when intake was relatively high in the evening of either total food energy, carbohydrate or fat, then overall daily energy intakes tended to be higher. The results suggest that the morning intake association with reduced total intake is macronutrient specific, with morning carbohydrate, fat and protein intake associated with reduced daily carbohydrate, fat and protein intake, respectively.