Dissecting the energy needs of the body

Phosphorus Intake and Potential Dietary Influences Examined via 24-Hour Urinary Biomarker Measurements in German Children and Adolescents Over 3 Decades

BACKGROUND

Increases in phosphorus intake have been observed over the past years in adult populations. However, biomarker-based data are lacking on whether or not phosphorus intake also increased in children.

OBJECTIVE

The aim of this study was to examine 24-hour urinary phosphate excretion (PO4-Ex) and diet-related biomarkers potentially influencing phosphorus status in German children and adolescents from 1985 to 2015.

DESIGN

This longitudinal noninvasive biomarker-based cohort study examined 24-hour urine samples from children and adolescents of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, collected over 3 decades.

PARTICIPANTS/SETTING

Examined individuals (n = 1,057) were healthy participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, situated in Dortmund, Germany, who had been asked to collect one yearly 24-hour urine sample. Six thousand seven hundred thirty-seven samples collected from participants aged 3 to 17 years between 1985 (baseline) and 2015, were included.

MAIN OUTCOME MEASURES

phosphorus intake was examined biomarker-based by analyzed PO4-Ex in 24-hour urine samples. Whether acid-base status and intakes of protein, salt, and fruits and vegetables, may have relevantly contributed to PO4-Ex levels was assessed by determining 24-hour excretions of net acid, urea-nitrogen, and sodium as well as specific standardized excretions of potassium plus oxalate.

STATISTICAL ANALYSES PERFORMED

Trend analysis over 30 years and potentially influencing diet factors were examined using linear mixed-effect regression models (PROC-MIXED). Adjustments for sex, age, and body surface area were performed.

RESULTS

No change was identifiable for PO4-Ex over the 3 decades; neither in 3 to 8, 9 to 13, nor in 14 to 17 year olds. However, sodium excretion increased (P = .001). PROC-MIXED analysis on intraindividual changes in PO4-Ex revealed direct relationships with net acid excretion, urea-nitrogen, and sodium excretion and an inverse relationship with a biomarker of fruit and vegetable intake.

CONCLUSIONS

Despite a direct relationship between PO4-Ex and a biomarker of industrially processed food consumption; that is, sodium excretion, which showed an increasing time trend, phosphorus intake was found to remain stable over decades in children and adolescents.

Effect of nutritional therapy in Emery-Dreifuss muscular dystrophy: a case report

Emery-Dreifuss muscular dystrophy (EDMD) is a rare, inherited human disease. Similar to other neuromuscular dystrophies, EDMD is clinically characterized by muscle atrophy and weakness, multi-joint contractures with spine rigidity, and cardiomyopathy. Over time, muscular weakness can lead to dysphagia and a severe lowering of body mass index (BMI), worsening the prognosis. We present the case of a young male patient affected by EDMD, admitted to the hospital for pneumothorax in a severe state of undernourishment. The patient was treated with total parenteral nutrition (TPN) with Smofkabiven®, supplemented with micronutrients (vitamins and trace elements), and with minimal enteral nutrition through food. Within a year, the patient gained 8.5 kg and kept his body weight stable for the 6 years of the follow-up. In this study, we show that TPN ensures the nutritional requirements of EDMD patients in a safe and well-tolerated manner, allowing a considerable and stable improvement in nutritional status, which has a positive impact on the disease itself and the patients' quality of life.

Cross-Validation of a New General Population Resting Metabolic Rate Prediction Equation Based on Body Composition

Current prediction equations for resting metabolic rate (RMR) were validated in a relatively small sample with high-individual variance. This study determined the accuracy of five common RMR equations and proposed a novel prediction equation, including body composition. A total of 3001 participants (41 ± 13 years; BMI 28.5 ± 5.5 kg/m²; 48% males) from nutrition clinics in Israel were measured by indirect calorimetry to assess RMR. Dual-energy X-ray absorptiometry were used to evaluate fat mass (FM) and free-fat mass (FFM). Accuracy and mean bias were compared between the measured RMR and the prediction equations. A random training set (75%, n = 2251) and a validation set (25%, n = 750) were used to develop a new prediction model. All the prediction equations underestimated RMR. The Cunningham equation obtained the largest mean deviation [-16.6%; 95% level of agreement (LOA) 1.9, -35.1], followed by the Owen (-15.4%; 95% LOA 4.2, -22.6), Mifflin-St. Jeor (-12.6; 95% LOA 5.8, -26.5), Harris-Benedict (-8.2; 95% LOA 11.1, -27.7), and the WHO/FAO/UAU (-2.1; 95% LOA 22.3, -26.5) equations. Our new proposed model includes sex, age, FM, and FFM and successfully predicted 73.5% of the explained variation, with a bias of 0.7% (95% LOA -18.6, 19.7). This study demonstrates a large discrepancy between the common prediction equations and measured RMR and suggests a new accurate equation that includes both FM and FFM.

Assessment of resting energy expenditure in patients with cirrhosis

BACKGROUND

Malnutrition affects 20% to 50% of patients with cirrhosis. It may be associated with serious complications and has a direct impact on prognosis. Resting energy expenditure (REE) is an important parameter to guide the optimization of therapy and recovery of nutritional status in patients with cirrhosis. However, the REE of patients with cirrhosis is still unclear, casting doubt upon the optimal nutritional management approach.

AIM

To identify the best method that predicts the REE of cirrhotic patients, using indirect calorimetry (IC) as the gold standard.

METHODS

An observational study was performed on 90 patients with cirrhosis. REE was assessed by IC, bioelectrical impedance analysis (BIA), and predictive formulas, which were compared using Bland-Altman plots and the Student’s t-test.

RESULTS

REE values measured by IC (1607.72 ± 257.4 kcal) differed significantly from those determined by all other methods (BIA: 1790.48 ± 352.1 kcal; Harris & Benedict equation: 2373.54 ± 254.9 kcal; IOM equation: 1648.95 ± 185.6 kcal; Cunningham equation: 1764.29 ± 246.2 kcal), except the Food and Agriculture Organization of the United Nations, World Health Organization, and United Nations University (FAO/WHO/UNU) (1616.07 ± 214.6 kcal) and McArdle (1611.30 ± 241.8 kcal) equations. We found no significant association when comparing IC and 24-h dietary recall among different Child-Pugh classes of cirrhosis.

CONCLUSION

The IOM and FAO/WHO/UNU equations have the best agreement with the CI. These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.

Metabolic Adaptations to Weight Loss: A Brief Review

ABSTRACT

Martínez-Gómez, MG and Roberts, BM. Metabolic adaptations to weight loss: A brief review. J Strength Cond Res XX(X): 000-000, 2021-As the scientific literature has continuously shown, body mass loss attempts do not always follow a linear fashion nor always go as expected even when the intervention is calculated with precise tools. One of the main reasons why this tends to happen relies on our body's biological drive to regain the body mass we lose to survive. This phenomenon has been referred to as "metabolic adaptation" many times in the literature and plays a very relevant role in the management of obesity and human weight loss. This review will provide insights into some of the theoretical models for the etiology of metabolic adaptation as well as a quick look into the physiological and endocrine mechanisms that underlie it. Nutritional strategies and dietetic tools are thus necessary to confront these so-called adaptations to body mass loss. Among some of these strategies, we can highlight increasing protein needs, opting for high-fiber foods or programming-controlled diet refeeds, and diet breaks over a large body mass loss phase. Outside the nutritional aspects, it might be wise to increase the physical activity and thus the energy flux of an individual when possible to maintain diet-induced body mass loss in the long term. This review will examine these protocols and their viability in the context of adherence and sustainability for the individual toward successful body mass loss.

Sports and Functional Training Improve a Subset of Obesity-Related Health Parameters in Adolescents: A Randomized Controlled Trial

To investigate the effects of two different modes of physical activity on body composition, physical fitness, cardiometabolic risk, and psychological responses in female adolescents participating in a multi-disciplinary program. The 12-week randomized intervention included 25-adolescents with overweight divided into two groups: sports practice-SPG and functional training-FTG. The SPG intervention was divided into three sports: basketball, handball, and futsal. SPG participants performed one sport 3-times/week, over the course of 1 month. The FTG performed concurrent exercises 3-times/week. This study was registered in Clinical Trials Registry Platform under number: RBR-45ywtg and registered in Local Ethics Committee number: 2,505.200/2018. The intensity of physical exercises-PE was matched between groups by the rating of perceived exertion. The primary outcome was body composition, and secondary outcomes were physical fitness, cardiometabolic risk, and psychological responses. There was a significant time-effect for body mass, body mass index, and low-density lipoprotein (LDL-c), all being reduced. There were increases over time for musculoskeletal mass, aerobic fitness, and high-density lipoprotein (HDL-c) (p < 0.05). There was a group time interaction with body fat percentage being lower post-intervention in the SPG (p < 0.05). No significant differences were observed for the other variables. Both physical activity models were effective in improving a subset of obesity-related health parameters. The findings should be extended by further investigation using more sophisticated measures of energy expenditure. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-45ywtg.

The acute effect of metabolic cofactor supplementation: a potential therapeutic strategy against non-alcoholic fatty liver disease

The prevalence of non-alcoholic fatty liver disease (NAFLD) continues to increase dramatically, and there is no approved medication for its treatment. Recently, we predicted the underlying molecular mechanisms involved in the progression of NAFLD using network analysis and identified metabolic cofactors that might be beneficial as supplements to decrease human liver fat. Here, we first assessed the tolerability of the combined metabolic cofactors including l-serine, N-acetyl-l-cysteine (NAC), nicotinamide riboside (NR), and l-carnitine by performing a 7-day rat toxicology study. Second, we performed a human calibration study by supplementing combined metabolic cofactors and a control study to study the kinetics of these metabolites in the plasma of healthy subjects with and without supplementation. We measured clinical parameters and observed no immediate side effects. Next, we generated plasma metabolomics and inflammatory protein markers data to reveal the acute changes associated with the supplementation of the metabolic cofactors. We also integrated metabolomics data using personalized genome-scale metabolic modeling and observed that such supplementation significantly affects the global human lipid, amino acid, and antioxidant metabolism. Finally, we predicted blood concentrations of these compounds during daily long-term supplementation by generating an ordinary differential equation model and liver concentrations of serine by generating a pharmacokinetic model and finally adjusted the doses of individual metabolic cofactors for future human clinical trials.

A Diet Induced Maladaptive Increase in Hepatic Mitochondrial DNA Precedes OXPHOS Defects and May Contribute to Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD), an increasingly prevalent and underdiagnosed disease, is postulated to be caused by hepatic fat mediated pathological mechanisms. Mitochondrial dysfunction is proposed to be involved, but it is not known whether this is a pathological driver or a consequence of NAFLD. We postulate that changes to liver mitochondrial DNA (mtDNA) are an early event that precedes mitochondrial dysfunction and irreversible liver damage. To test this hypothesis, we evaluated the impact of diet on liver steatosis, hepatic mtDNA content, and levels of key mitochondrial proteins. Liver tissues from C57BL/6 mice fed with high fat (HF) diet (HFD) and Western diet (WD, high fat and high sugar) for 16 weeks were used. Steatosis/fibrosis were assessed using haematoxylin and eosin (H&E) Oil Red and Masson’s trichome staining and collagen content. Total DNA was isolated, and mtDNA content was determined by quantifying absolute mtDNA copy number/cell using quantitative PCR. Selected mitochondrial proteins were analysed from a proteomics screen. As expected, both HFD and WD resulted in steatosis. Mouse liver contained a high mtDNA content (3617 ± 233 copies per cell), which significantly increased in HFD diet, but this increase was not functional, as indicated by changes in mitochondrial proteins. In the WD fed mice, liver dysfunction was accelerated alongside downregulation of mitochondrial oxidative phosphorylation (OXPHOS) and mtDNA replication machinery as well as upregulation of mtDNA-induced inflammatory pathways. These results demonstrate that diet induced changes in liver mtDNA can occur in a relatively short time; whether these contribute directly or indirectly to subsequent mitochondrial dysfunction and the development of NAFLD remains to be determined. If this hypothesis can be substantiated, then strategies to prevent mtDNA damage in the liver may be needed to prevent development and progression of NAFLD.

Effects of the Order of Physical Exercises on Body Composition, Physical Fitness, and Cardiometabolic Risk in Adolescents Participating in an Interdisciplinary Program Focusing on the Treatment of Obesity

The main objective of this study was to investigate the effects of the order of physical exercises on body composition, physical fitness, and cardiometabolic risk in adolescents participating in an interdisciplinary program focusing on the treatment of obesity. The final 12-week analyses involved 33 female adolescents who were split into two groups of concurrent training (CT): resistance plus aerobic training and aerobic plus resistance training, with equalization performed in all physical exercises. The only difference between the two groups was the order in which the exercises were performed. The results showed reductions in fat mass, body fat, and waist circumference, as well as increases in musculoskeletal mass and resting metabolic rate (p < 0.05) following the multiprofessional intervention period. However, no significant differences were observed in regard to body mass, body mass index, neck circumference, or arm circumference (p > 0.05). Maximal isometric strength and maximal oxygen consumption showed significant increases after the intervention period (p < 0.05). There were reductions in insulin, HOMA-IR, total cholesterol, triglycerides, and low-density lipoproteins (p < 0.05), and an interaction within the resistance plus aerobic training group showed lower values for triglycerides when compared to itself (p = 0.002). No difference was found in fasting glycemia for either group (p > 0.05). It is worth noting that the equalization training variables presented no differences between the two groups (p > 0.05). Based on these results, both CT methods were found to be effective in promoting health parameters in overweight and obese female adolescents, and triglyceride values decreased more in the resistance plus aerobic group. Future studies with larger samples and feeding control should be conducted to confirm or refute our findings.

Children's physical activity and sedentary time compared using assessments of accelerometry counts and muscle activity level

Background

This research compared accelerometry (ACC)-derived and muscle electromyography (EMG)-based estimates of physical activity (PA) and sedentary time in typical PA tasks and during the daily lives of children.

Methods

Data was included from two exploratory studies. In Study I, 6–7-year-old children (n = 11, 64% girls) were assessed for eight PA tasks (walking, stair negotiation, climbing, crawling, swinging, balancing, trampoline jumping and a game of tag). In Study II, 7–9-year-old children (n = 14, 38% girls) were assessed for six PA tasks (walking, sitting, static squat, single leg hops, jump for height and standing long jump), and daily PA during one day with and one day without structured exercise. Quadriceps and hamstring muscle activity and inactivity using EMG shorts and acceleration by waist-mounted accelerometer were simultaneously measured and classified as sedentary, light, moderate and vigorous activity. Data from ACC was further analyzed using five different published cut-off points and varying time windows (1−60 s) for comparison with EMG.

Results

In the PA tasks ACC counts and EMG amplitude showed marked differences in swinging, trampoline jumping, crawling, static squat, single leg hops, standing long jump and jump for height, the difference being over 170% when signals were normalized to that during walking. Furthermore, in walking, swinging, trampoline jumping, stair negotiation and crawling ACC classified over 60% of the time as vigorous-intensity activity, while EMG indicated primarily light- and moderate-intensity activities. During both days with and without exercise, ACC resulted in greater proportion of light activity (p < 0.01) and smaller proportion of moderate activity compared to EMG (p < 0.05). The choice of cut-off points and epoch length in ACC analysis influenced the classification of PA level and sedentary time. In the analysis of daily activities the cut-off points by Evenson et al. (2008) with epochs of 7.5 s and 15 s yielded the smallest difference (less than 10% of recording time at each intensity) against EMG-derived PA levels.

Discussion

This research provides novel insight on muscle activity and thereby on neuromuscular loading of major locomotor muscles during normal daily activities of children. While EMG and ACC provided similar estimates of sedentary time in 13 typical PA tasks, duration of light, moderate and vigorous PA varied considerably between the methods especially during walking, stair negotiation, crawling, swinging and trampoline jumping. Evenson et al.’s (2008) cut-off points with ≤15 s epoch provided similar classification of PA than EMG during daily life. Compared to impacts recorded using ACC, EMG can provide understanding on children’s neuromuscular loading during motor tasks that is useful when studying effects of PA interventions on, and development of, motor competence and coordination.

Overweight adult cats have significantly lower voluntary physical activity than adult lean cats

Objectives The objectives of the current pilot study were to evaluate whether body condition score (BCS) and body weight are significantly related to physical activity counts, and to evaluate potential interaction between BCS and voluntary physical activity measured over a 14 day period. Methods Ten (five lean, five overweight), neutered, adult American Shorthair cats were selected for this study (median age 4 ± 0.5 years). Cats with a BCS of ⩽3.0 were considered lean, whereas cats with a BCS >3.0 were considered overweight, using a 5-point scale. Cats were housed in a free-living environment with indoor/outdoor access and were individually fed once daily a commercially available dry extruded diet and allowed 1 h to eat. Voluntary physical activity was measured consecutively for 14 days using the Actical Activity Monitors that were worn parallel to the ribs and attached via a harness. Results Lean cats had a greater mean total daily voluntary physical activity ( P = 0.0059), and a greater voluntary physical activity during light ( P = 0.0023) and dark ( P = 0.0446) periods, with overweight cats having 60% of the physical activity of lean cats. Lean cats were more active before feeding and during animal care procedures. These data suggest that lean cats have a greater anticipatory physical activity prior to feeding and are more eager to have social interaction with humans than overweight cats. A significant interaction was observed between day of physical activity measurement and BCS for total daily voluntary physical activity ( P = 0.0133) and activity during the light period ( P = 0.0016) where lean cats were consistently more active than overweight cats. In general, cats were more active during weekdays vs weekends. Conclusions and relevance The results of this study suggest that overweight cats are less active than lean cats and that voluntary physical activity level appears to be influenced by social interaction with humans.

International society of sports nutrition position stand: diets and body composition

Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of diet types (macronutrient composition; eating styles) and their influence on body composition. The ISSN has concluded the following. 1) There is a multitude of diet types and eating styles, whereby numerous subtypes fall under each major dietary archetype. 2) All body composition assessment methods have strengths and limitations. 3) Diets primarily focused on fat loss are driven by a sustained caloric deficit. The higher the baseline body fat level, the more aggressively the caloric deficit may be imposed. Slower rates of weight loss can better preserve lean mass (LM) in leaner subjects. 4) Diets focused primarily on accruing LM are driven by a sustained caloric surplus to facilitate anabolic processes and support increasing resistance-training demands. The composition and magnitude of the surplus, as well as training status of the subjects can influence the nature of the gains. 5) A wide range of dietary approaches (low-fat to low-carbohydrate/ketogenic, and all points between) can be similarly effective for improving body composition. 6) Increasing dietary protein to levels significantly beyond current recommendations for athletic populations may result in improved body composition. Higher protein intakes (2.3–3.1 g/kg FFM) may be required to maximize muscle retention in lean, resistance-trained subjects under hypocaloric conditions. Emerging research on very high protein intakes (>3 g/kg) has demonstrated that the known thermic, satiating, and LM-preserving effects of dietary protein might be amplified in resistance-training subjects. 7) The collective body of intermittent caloric restriction research demonstrates no significant advantage over daily caloric restriction for improving body composition. 8) The long-term success of a diet depends upon compliance and suppression or circumvention of mitigating factors such as adaptive thermogenesis. 9) There is a paucity of research on women and older populations, as well as a wide range of untapped permutations of feeding frequency and macronutrient distribution at various energetic balances combined with training. Behavioral and lifestyle modification strategies are still poorly researched areas of weight management.

Negative effects of obesity analyzed through bioimpedance, indirect calorimetry, the sympathovagal index and the orthoclinostatic test

Early analysis of the negative effects of obesity is important to prevent the development of chronic diseases related to this condition. There is a need to monitor these effects through simple instrumentation that measures fat-free mass (FFM) catabolism. Obesity leads to a decrease in the FFM energy expenditure and to an increase in the autonomic nervous system (ANS) activity. Thus, the measurement of FFM dynamic catabolism can provide information regarding the effects of obesity. The hypothesis is that this increased ANS activity produces an increase of energy expenditure of carbohydrates and fats when the subjects are under stress; in this case after an 8-hour fast and while they are undergoing an orthoclinostatic test. A pilot study was conducted on 29 volunteers, 16 women and 13 men. The results show significant statistical differences (p&#60;0.1) in fat and carbohydrate utilization during the orthoclinostatic tests: A move from the clinostatic to the orthostatic positions produced the following: Fat metabolism varied from 97.2 to 105.9 gr/day of fat for women and 24.9 to 35.7 gr/day of fat for men; carbohydrate metabolism changed from 38 to 39 gr/day for women and 239 to 277 gr/day for men; FFM averages were 47 Kg for women and 57.6 Kg for men; changes in the sympathovagal index (SVI) averages were 0.4 to 1.8 for women and 0.8 to 2.7 for men. The conclusions show that the methodology's sensitivity is such that gender differences can be used as a model to prove FFM metabolic differences. We believe that further studies will lead to the development of a robust methodology for the early detection of the negative effects of obesity.

Active metabolic weight estimation using bioimpedance, indirect calorimetry and the clino-ortho maneuver

The resting energy expenditure (REE) and substrate utilization are computed by indirect calorimetry technique (ICT). The REE represents 80-85% of the total energy expenditure (TEE) but only accounts for the 7% of the actual body weight (ABW). The TEE is produced by the organs plus muscles, whereas the REE accounts only for the main organs. An important problem comes up when the REE is computed throughout the fat free mass (FFM) computation or anthropometric measurements because they do not explain the tremendous catabolic variability by ICT when subjects show the same body composition. Therefore, the aim of this work is to develop a method to compute the metabolic active weight (MAW) as a new form that may help to understand the catabolic activity of the body composition. The premise was the clino-ortho maneuver can split the ABW in two parts: one in which the MAW reflects the FFM catabolism while the second part was not considered since there is not energy requirement in it. The experiment design studied 37 young volunteers undergoing the clino-ortho maneuver during fast and postprandial conditions. The results showed REE increments of 21% during phase I (fast), while in phase II (postprandial) only 14% was achieved in ortho-postprandial. Therefore, the computed MAWs were 65.5Kg and 58Kg, respectively, when the ABW average was 70 Kg and the FFM was 50 Kg. One first conclusion was that the 15.5 Kg of the MAW above the FFM could explain a catabolic equivalence which can be exclusively related to the fast-ortho position which can help to classify exclusively the dynamic over activity of the FFM.

Mechanisms of sepsis-induced organ dysfunction

BACKGROUND

The past several years have seen remarkable advances in understanding the basic cellular and physiologic mechanisms underlying organ dysfunction and recovery relating to sepsis. Although several new therapeutic approaches have improved outcome in septic patients, the far-reaching potential of these new insights into sepsis-associated mechanisms is only beginning to be realized.

AIM

The Brussels Round Table Conference in 2006 convened >30 experts in the field of inflammation and sepsis to review recent advances involving sepsis and to discuss directions that the field is likely to take in the near future.

FINDINGS

Current understanding of the pathophysiology underlying sepsis-induced multiple organ dysfunction highlights the multiple cell populations and cell-signaling pathways involved in this complex condition. There is an increasing appreciation of interactions existing between different cells and organs affected by the septic process. The intricate cross-talk provided by temporal changes in mediators, hormones, metabolites, neural signaling, alterations in oxygen delivery and utilization, and by modifications in cell phenotypes underlines the adaptive and even coordinated processes beyond the dysregulated chaos in which sepsis was once perceived. Many pathologic processes previously considered to be detrimental are now viewed as potentially protective. Applying systems approaches to these complex processes will permit better appreciation of the effectiveness or harm of treatments, both present and future, and also will allow development not only of better directed, but also of more appropriately timed, strategies to improve outcomes from this still highly lethal condition.

Protein and overtraining: potential applications for free-living athletes

Despite a more than adequate protein intake in the general population, athletes have special needs and situations that bring it to the forefront. Overtraining is one example. Hard-training athletes are different from sedentary persons from the sub-cellular to whole-organism level. Moreover, competitive, "free-living" (less-monitored) athletes often encounter negative energy balance, sub-optimal dietary variety, injuries, endocrine exacerbations and immune depression. These factors, coupled with "two-a-day" practices and in-season demands require that protein not be dismissed as automatically adequate or worse, deleterious to health. When applying research to practice settings, one should consider methodological aspects such as population specificity and control variables such as energy balance. This review will address data pertinent to the topic of athletic protein needs, particularly from a standpoint of overtraining and soft tissue recovery. Research-driven strategies for adjusting nutrition and exercise assessments will be offered for consideration. Potentially helpful nutrition interventions for preventing and treating training complications will also be presented.

Correction of anemia in patients with congestive heart failure increases resting energy expenditure

BACKGROUND & AIM

Congestive heart failure (CHF) and anemia were reported to affect resting energy expenditure (REE). The aim of this study was to evaluate the effect of the correction of anemia on REE in subjects with CHF.

PATIENTS AND METHODS

Nine anemic patients with compensated CHF and CRF were studied before and after correction of anemia. REE was studied by an open circuit indirect calorimeter, body composition by dual-energy-X-ray absorption and total body and extracellular water by multi-frequency bioelectrical impedence. Four anemic and 5 non-anemic CHF patients who did not receive any new treatment served as controls.

RESULTS

After the correction of their anemia patients tended to increase weight (P<0.06), but no significant changes were observed in body composition. Daily caloric intake increased significantly (P<0.02). Ejection fraction increased (P<0.05) and pulse rate decreased significantly (P<0.001). REE and REEPP were in the normal range before correction but increased significantly afterwards (1402+/-256 vs. 1496+/-206 kcal/d, and 101+/-9 vs. 109+/-8, P<0.023 and P<0.006, respectively).

CONCLUSION

Correction of anemia in patients with CHF increases their REE. This can be related either to improved tissue oxygenation and/or to increased caloric intake.

Increased resting energy expenditure in subjects with Emery-Dreifuss muscular dystrophy

We have studied changes in energy expenditure and body composition in adult males with Emery-Dreifuss muscular dystrophy, age-matched males with hyperCKemia and age-matched healthy controls. All participants were studied twice, 2-3 years apart. Resting energy expenditure was studied by indirect calorimetry, lean body mass and body fat by dual X-ray absorptiometry, and muscle mass was estimated based on 24-h urinary creatinine excretion. At baseline and 2-3 years later, body fat was significantly higher (P < 0.011 and P < 0.003, respectively) and lean body mass significantly lower (P < 0.024 and P < 0.012, respectively) in patients with Emery-Dreifuss muscular dystrophy as compared to subjects with hyperCKemia and healthy controls. Resting energy expenditure, over the study period, increased significantly in patients with Emery-Dreifuss muscular dystrophy (P < 0.031), but not in patients with hyperCKemia nor in healthy controls. Our study suggests that patients with Emery-Dreifuss muscular dystrophy may have increased energy expenditure relative to healthy subjects. If not met by increased caloric intake, this greater energy expenditure may partially contribute to a further deterioration in their muscle performance.

A critical approach to nutritional assessment in critically ill patients

BACKGROUND AND AIMS

Nutritional assessment enhances quality of nutritional care, however, its practice bemuses professionals. This prospective study aimed to identify a feasible/informative nutritional parameter in intensive care.

METHODS

44 patients (APACHE II: 23.8+/-10.1), age 58.4+/-18.6 years, were evaluated at admission: clinical data, height, weight, body mass index (BMI), tricep skinfold thickness, mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), albumin, total protein and lymphocyte count. Anthropometric parameters' performance was evaluated isolated or assembled according to Blackburn and McWhirter criteria.

RESULTS

Oedema increased %IW and BMI (P<0.01); muscle depletion was frequent and agreed with MAC or MAMC ranked by both criteria, P=0.02. %IW and BMI overestimated well-nourished/overweight patients, whilst arm anthropometry, mostly MAC/MAMC, shifted towards +/-50% malnutrition. Patients were not equally ranked by both criteria; McWhirter's by using percentiles clarified the distribution and showed agreement between MAC and MAMC, P=0.007, unlike Blackburn's. Mortality was higher in patients with MAC<5th percentile, P=0.003; MAC;<15th percentile was able to predict mortality and major complications. In invasive ventilated patients, severe muscle depletion was associated with mortality, P=0.05.

CONCLUSION

In intensive care most nutritional assessment methods are useless; MAC is simple, feasible and if classified by percentiles may prove functional with prognostic value.