Validity of self-reported energy intake in lean and obese young women, using two nutrient databases, compared with total energy expenditure assessed by doubly labeled water

OBJECTIVE

To compare self-reported total energy intake (TEI) estimated using two databases with total energy expenditure (TEE) measured by doubly labeled water in physically active lean and sedentary obese young women, and to compare reporting accuracy between the two subject groups.

DESIGN

A cross-sectional study in which dietary intakes of women trained in diet-recording procedures were analyzed using the Minnesota Nutrition Data System (NDS; versions 2.4/6A/21, 2.6/6A/23 and 2.6/8.A/23) and Nutritionist III (N3; version 7.0) software. Reporting accuracy was determined by comparison of average TEI assessed by an 8 day estimated diet record with average TEE for the same period.

RESULTS

Reported TEI differed from TEE for both groups irrespective of nutrient database (P<0.01). Measured TEE was 11.10+/-2.54 and 11.96+/-1.21 MJ for lean and obese subjects, respectively. Reported TEI, using either database, did not differ between groups. For lean women, TEI calculated by NDS was 7.66+/-1.73 MJ and by N3 was 8.44+/-1.59 MJ. Corresponding TEI for obese women were 7.46+/-2.17 MJ from NDS and 7.34+/-2.27 MJ from N3. Lean women under-reported by 23% (N3) and 30% (NDS), and obese women under-reported by 39% (N3) and 38% (NDS). Regardless of database, lean women reported higher carbohydrate intakes, and obese women reported higher total fat and individual fatty acid intakes. Higher energy intakes from mono- and polyunsaturated fatty acids were estimated by NDS than by N3 in both groups of women (P< or =0.05).

CONCLUSIONS

Both physically active lean and sedentary obese women under-reported TEI regardless of database, although the magnitude of under-reporting may be influenced by the database for the lean women.

SPONSORSHIP

USDA Hatch Project award (ARZT-136528-H-23-111) to LB Houtkooper and WH Howell.

Validation of the Arizona Activity Frequency Questionnaire using doubly labeled water

PURPOSE

Physical activity questionnaires (PAQs) are considered the most cost-efficient method to estimate total energy expenditure (TEE) in epidemiological studies. However, relatively few PAQs have been validated using doubly labeled water (DLW) in women or in samples with diverse ethnic backgrounds. This study was conducted to validate the Arizona Activity Frequency Questionnaire (AAFQ) for estimation of TEE and physical activity energy expenditure (PAEE) over 1 month using DLW as a reference method.

METHODS

Thirty-five relatively sedentary women completed the AAFQ before participating in an 8-d DLW protocol to measure TEE. TEE and PAEE were estimated from the AAFQ by calculating resting metabolic rate (RMR) using the equation of Mifflin et al. (AAFQmif), by measuring RMR using indirect calorimetry (AAFQic), and using MET conversion (AAFQmet). A predictive equation for TEE was generated.

RESULTS

The mean +/- SD for TEE and PAEE from DLW were 9847 +/- 2555 kJ x d(-1) and 5578 +/- 2084 kJ x d(-1), respectively. Formulas using RMR to calculate the TEE and PAEE from the AAFQ tended to underestimate TEE and PAEE, whereas those that included only weight tended to overestimate TEE and PAEE. On the basis of the Mifflin et al. equation, the AAFQ tends to underestimate PAEE by 13%. This underestimation may be explained by the low lean body mass of the sample population and by effectiveness of the METs/RMR ratio in the obese. The following predictive equation was calculated: TEE (kJ x d(-1)) = (86.0 * average total daily METs) + (2.23 * RMRmif) - 6726. When the predictive equation is used, TEE calculated from the AAFQ is highly correlated with DLW TEE (adjusted r(2) = 0.70, P < 0.001).

CONCLUSION

The AAFQ is an effective tool for the prediction of TEE and PAEE in epidemiological studies.

Weight loss is correlated with an improved lipoprotein profile in obese postmenopausal women

BACKGROUND

Changes in plasma lipid and lipoprotein distributions that occur after menopause increase the risk of cardiovascular disease in women, especially in those who are overweight.

OBJECTIVE

The purpose of this study was to evaluate the impact of a nine-month weight reduction program on plasma lipids, dietary intake and abdominal fat obesity.

DESIGN

A partial crossover design was used to study a weight loss treatment consisting of Phentermine hydrochloride (Fastin, SmithKline Beecham Pharmaceuticals, Philadelphia, PA) therapy plus a low energy diet (5040 kJ/d). Forty-seven obese, postmenopausal Caucasian women (BMI of 30-38 kg/m2) were randomized into two groups, both of which received drug and diet treatment over six months. However, Group I started the intervention program three months later than Group II. Plasma total, HDL and LDL cholesterol and triacylglycerol were measured, body composition was assessed by anthropometry and dual energy x-ray absorptiometry, and food frequency records were collected at four timepoints.

RESULTS

Over nine months, women in Group II reduced body weight (14.4%), lowered plasma concentrations of LDL cholesterol (14% to 26%) and triacylglycerol (15%) and raised plasma HDL cholesterol concentration (15%). These plasma lipid changes decreased the total cholesterol/HDL cholesterol ratio from 4.3 to 3.2. All subjects decreased abdominal fat measurements and energy and cholesterol intakes, as well as percentage of energy derived from total and saturated fat during the study. Most subjects also increased dietary fiber consumption.

CONCLUSION

Both weight loss and diet modifications are associated with an improved plasma lipid profile in obese postmenopausal women.

A comparison of bioimpedance methods for detection of body cell mass change in HIV infection

The maintenance of body cell mass (BCM) is critical for survival in human immunodeficiency virus (HIV) infection. Accuracy of bioimpedance for measuring change (Delta) in intracellular water (ICW), which defines BCM, is uncertain. To evaluate bioimpedance-estimated DeltaBCM, the ICW of 21 weight-losing HIV patients was measured before and after anabolic steroid therapy by dilution (total body water by deuterium - extracellular water by bromide) and bioimpedance. Multiple-frequency modeling- and dilution-determined DeltaICW did not differ. The DeltaICW was predicted poorly by 50-kHz parallel reactance, 50-kHz impedance, and 200 - 5-kHz impedance. The DeltaICW predicted by 500 - 5-kHz impedance was closer to, but statistically different from, dilution-determined DeltaICW. However, the effect of random error on the measurement of systematic error in the 500 - 5-kHz method was 12-13% of the average measured DeltaICW; this was nearly twice the percent difference between obtained and threshold statistics. Although the 500 - 5-kHz method cannot be fully rejected, these results support the conclusion that only the multiple-frequency modeling approach accurately monitors DeltaBCM in HIV infection.

The relevance of hearing a crack in ankle injuries

OBJECTIVE

To examine the predictive value of a crack noise or sensation in the history of injury in the diagnosis of ankle fracture.

METHODS

A short questionnaire was filled in on 464 patients with isolated ankle injuries attending the accident and emergency department in a three month period from July to September. These patients were seen in the usual way in the department and the need for x ray assessed according to clinical judgement and existing departmental guidelines. Cases which subsequently proved to be other than ankle injuries, for example, fractured calcaneus, were excluded from the study.

RESULTS

A positive history of hearing or feeling a crack did not indicate the need for an x ray or increase the possibility of a fracture; indeed the history of a crack made the presence of a fracture less likely. The clinical diagnosis of absence of fracture without radiological examination may require careful explanation to the patient.

CONCLUSIONS

Hearing a crack in the ankle does not suggest a fracture.

Tetanus immunisation in the elderly population

OBJECTIVE

To emphasise that tetanus still occurs in the United Kingdom, particularly in elderly people-as illustrated by two case reports-and to examine the state of tetanus immunity in elderly people.

METHODS

111 elderly people (over 65 years) were studied: 43 males, mean age 77.7 years, range 67-94; 68 females, mean age 81.3 years, range 67-95. They were either attending the accident service or were hospital inpatients. An attempt was made to obtain an immunisation history and antitetanus antibody titres were measured.

RESULTS

Immunisation history was uncertain and unreliable. Measurement of antibody titres showed that they were inadequate to ensure protection in 50% of those studied. Low levels were particularly prevalent in the over 80 age group and in females. Questioning about military service confirmed that this had predominantly involved males.

CONCLUSIONS

Elderly people are at risk of contracting tetanus and should be targeted for community immunisation. Extra precautions in the form of passive immunisation with human anti-tetanus immunoglobulin should be used in this age group in addition to the usual wound management measures when the elderly sustain tetanus prone injuries.

Older adults with lifelong intellectual handicap in New Zealand: prevalence, disabilities and implications for regional health authorities

AIM

To find and describe the total population of persons in New Zealand born before 1940 with lifelong intellectual disability and to provide health and services data for regional health authorities.

METHOD

An intensive community based case finding process identified 197 (19%) people not known to the two major service producers, the public hospitals and New Zealand Society for the Intellectually Handicapped (IHC). Prime caregivers provided information about personal characteristics, health status, and services utilisation and needs.

RESULTS

One thousand and sixty-three people with lifelong intellectual disability were identified and surveyed. Forty two percent lived in public hospitals, 7% with family, 13% in rest homes and 38% in community based facilities. The national prevalence was 1.43 with wide regional variation. Prevalence in Southern RHA was 2.34, in Central 1.76, in Midlands 0.70 and in North Health 0.87. The age range was 51 to 88, with 56% aged between 51 and 60 years, 32% between 61 and 70 and 12% over the age of 71 years. Twenty three percent had no major condition, disability or disease, 28% had some unspecified neurological impairment, 4% cerebral palsy, 13% Down's syndrome, 17% epilepsy, 21% musculoskeletal impairment, 14% cardiovascular disease and 25% a psychiatric diagnosis. A significantly higher number of physical disabilities was found in people living in hospitals, including 15 of the 17 blind people and 41 of the 53 people with mobility problems. There was wide variation among RHA areas in demand for therapeutic services, community and social support services.

CONCLUSION

Past policies and practices of hospitalization have impacted on the present distribution of the study group. The services system must now accommodate regional differences and characteristics of this population and new demands to achieve goals of community integration.

Copper deficiency shifts energy substrate utilization from carbohydrate to fat and reduces fat mass in rats

The influence of copper deficiency on energy metabolism and body composition was examined in rats. Weanling male Sprague-Dawley rats were assigned to two dietary treatments: copper-adequate (102.2 mumol/kg) and copper-deficient (9.0 mumol/kg). After 4 wk of treatment, rats were individually housed in metabolic cages within indirect calorimetry units for measurements of respiratory quotient to determine substrate utilization. Body composition was measured by total body electrical conductivity. Net energetic efficiency and fasting heat production were determined from regression analysis of metabolizable energy intake and energy retention (metabolizable energy intake-heat production). Rats were given free access to their respective diets for almost the entire study but were restricted to 70% of normal energy intake for 2 d to provide a range of energy intake required for the regression analysis. Energetic evaluations were determined for 12 d at normal intake and 2 d at a modest restriction (30%). Copper deficiency reduced the respiratory quotient values (0.85 to 0.80), carbohydrate utilization (7.9 to 5.2 g/d), energy retention [8.4 to -66.9 kJ/kg0.75.d)] and energy efficiency (97.8 to 87.7%). However, daily metabolizable energy intake and absolute fasting heat production were not altered. Reductions in final body weights (289 to 263 g), absolute fat mass (65.7 to 51.5 g) and proportion of body fat (22.7 to 19.6 g/100 g) were observed in copper-deficient rats compared with controls when all indirect calorimetry measurements were completed after 7 wk of treatment. Thus, copper deficiency increased utilization of fat as substrate for energy and reduced body fat mass in rats.

SED88: a Pascal program for the analysis of sedimentation equilibrium data

Analytical ultracentrifugation is commonly used for the determination of molecular weights (sedimentation equilibrium) and sedimentation coefficients (sedimentation rate) of biological macromolecules in solution. A Turbo Pascal program for the analysis of sedimentation equilibrium centrifugation data produced by absorbance optical systems is described. The user may enter data from a scan of absorbance versus distance from the centre of rotation, via a graphics tablet (or ASCII file). This is subsequently manipulated to yield an apparent weight average molecular weight for the given sample. Plots of ln (absorbance) versus (radius2) may also be produced. The method described uses readily available computational equipment requiring only a graphics tablet in addition to an IBM PC compatible computer. This technique and the software developed have been used to investigate the molecular weight range of two International Humic Substances Society (IHSS) reference samples from the Suwannee River.

Gliosarcoma developing in close relationship to an abscess cavity injected with thorotrast

A case of an unusual tumor developing at the site of an abscess is reported. The tumor presented 21 years after burr hole drainage of the abscess and instillation of the contrast medium thorotrast. The bizarre nature of the tumor and its immediate proximity to the thorotrast lead the authors to believe that the tumor was caused by the contrast medium.

Occurrence and distribution of hepatitis B infection in the aboriginal population of Western Australia

In 1986, the prevalences of hepatitis B surface antigen (HBsAg), and other serological markers of infection with hepatitis B virus in the Western Australian adult Aboriginal population, were estimated using a stratified random sample of 1,150 subjects. When the estimates were standardised to the age and sex distribution of the total population of aborigines aged 12 years or over, the prevalence of HBsAg was 7% (95% confidence interval 6-9%). The prevalence of any marker, that is HBsAg and/or hepatitis surface antibody (anti-HBs), was 49% (44-54%). The follow-up blood specimens obtained from three-fifths of the antigenemic subjects indicated that 96% (88-99%) were hepatitis B carriers. Male subjects had twice the prevalence of HBsAg (10%; 7-13%) when compared with females (4%; 3-6%). However, there was only a modest elevation of the prevalence of any marker in men (53%) compared with women (46%). There was evidence that the prevalence of HBsAg increased with age, but this was not the case with any marker. Geographically, there was substantial variation in hepatitis B infection rates. The Eastern Goldfields region had the highest prevalence (HBsAg 12%; any marker 66%), followed by the Kimberley, Pilbara and Central regions (HBsAg 7-9%; any marker 56-59%). The lowest rates were evident in Perth and the South West (HBsAg 3-5%; any marker 23-25%). The highest prevalence of markers in any discrete community was observed in the desert people of Warburton (HBsAg 22%; any marker 85%). These data indicate that, according to World Health Organisation criteria, the aboriginal population of Western Australia has an intermediate to high risk of infection with hepatitis B.

Metastatic oligodendroglioma presenting as a leukoerythroblastic anaemia

The clinical course of a patient with oligodendroglioma, treated initially with surgery and radiotherapy, is described. The patient later presented with leukoerythroblastic anaemia due to metastasis to bone marrow. This behaviour had not been previously described in oligodendroglioma.