Physical activity and the prevention of childhood obesity--Europe versus the United States.
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Adolescent↗
Biomedical subjects
K R Westerterp
Publications and source records attributed to K R Westerterp.
Physical activity assessment with accelerometers.
OBJECTIVE: Evaluation of motion sensors, specifically accelerometers, as an objective tool for the assessment of physical activity in large populations, over periods long enough to be representative of normal daily life and with minimal discomfort to the subjects. METHOD: Review of validation studies of accelerometers with indirect calorimetry as a reference method. Accelerometers were commercially available one-axial accelerometers: Caltrac, Computer Science Application (CSA) accelerometer, Mini Motionlogger Actigraph; the tri-axial accelerometer Tritrac-R3 D; and an tri-axial accelerometer for movement registration (Tracmor) from our laboratory. RESULTS: There is no clear difference for correspondence between indirect calorimetry and accelerometer counts during level walking, whether one-axial or tri-axial and placed at the wrist, hip or low back. Sedentary activities are better reflected with a tri-axial accelerometer than with a one-axial accelerometer. Two accelerometers were validated in free living conditions with doubly labeled water. The highest correlation between accelerometer output and activity induced energy expenditure was found for Tracmor. CONCLUSIONS: From all accelerometers tested, the tri-axial accelerometer for movement registration is an objective method that can be used to distinguish differences in activity levels between individuals and assess the effect of interventions on physical activity within individuals.
Adolescent↗
Doubly labelled water validation of three physical activity questionnaires.
This study investigated the validity of the Baecke Questionnaire, the Five City Project Questionnaire, and the Tecumseh Community Health Study Questionnaire in 19 Flemish males, using correlation and multiple stepwise regression analyses. The three questionnaires are commonly used physical activity questionnaires in epidemiological studies. The physical activity level (PAL) as measured with the doubly labelled water method was used as the criterion. The Baecke total activity index showed the highest correlation coefficient with PAL (r = 0.69, p < 0.001). Also the sweat index from the Five City Project Questionnaire, and total daily energy expenditure from the Tecumseh Community Health Study Questionnaire showed significant associations with PAL, respectively 0.57 (p < 0.05) and 0.64 (p < 0.01). Multiple stepwise regression analyses supported the findings from the correlation study. The largest individual contribution in PAL was from the activity index (45%) for the Baecke Questionnaire, the sweat index (29%) for the Five City Project Questionnaire, and total daily energy expenditure (38%) for the Tecumseh Community Health Study Questionnaire. In conclusion, the questionnaires, and certainly the Baecke Questionnaire, can provide valid data about physical activity. Therefore they are useful in epidemiological studies.
Adult↗
Underreporting of habitual food intake is explained by undereating in highly motivated lean women.
Underreporting of habitual food intake can be explained by underrecording and/or undereating. This study was designed to discriminate between the two errors mentioned, by measuring energy and water balance. Twenty-four lean female dieticians were recruited as subjects. Energy intake and water intake were measured for 1 wk with a weighed dietary record. Energy expenditure was estimated from measurements of resting metabolic rate, and measured physical activity with a triaxial accelerometer for movement registration. Water loss was estimated with deuterium-labeled water. Energy balance was determined by measuring the change in body mass over a nonrecording week (preceding the recording week) and over the recording week. Mean energy and water intake were 8.5 +/- 1.0 MJ/d and 2.3 +/- 0.5 L/d. The change in body mass in the nonrecording week was 0.1 +/- 0.6 kg and in the recording week -0.6 +/- 0.8 kg (paired t test; P = 0.02), indicating 16% undereating. Recorded water intake plus calculated metabolic water closely matched measured water loss (r = 0.93; P = 0.0001), which indicated a high recording precision. In conclusion, in the studied group of highly motivated lean women, there was 16% underreporting of habitual food intake, which could be explained by undereating.
Adult↗
Assessment of physical activity level in relation to obesity: current evidence and research issues.
PURPOSE: Validations of methods for the assessment of physical activity and studies on the relation between energy expenditure of activity and obesity were reviewed, with suggestions for further research. DESIGN: Validation studies of field methods for the assessment of physical activity against doubly labeled water were evaluated, studies on the relation between doubly labeled water assessed energy expenditure of activity and obesity are discussed. METHODS: Three field methods for the assessment of physical activity, validated with doubly labeled water as a criterion method, were included: activity questionnaires, heart rate monitoring, and motion sensors. RESULTS: The triaxial accelerometer came out as the best field method for the assessment of physical activity, followed by the Baecke activity questionnaire. The majority of obese subjects are moderately active, and an increase in the activity level of obese subjects is limited by the ability to perform exercise of higher intensity. CONCLUSIONS: Accelerometers are an objective tool for the assessment of physical activity in large populations over periods long enough to be representative for normal daily life and with minimal discomfort to the subjects. The accelerometer can be used to distinguish differences in activity levels between individuals and to assess the effect of interventions on physical activity within individuals.
Deuterium↗
Appetite at "high altitude" [Operation Everest III (Comex-'97)]: a simulated ascent of Mount Everest.
We hypothesized that progressive loss of body mass during high-altitude sojourns is largely caused by decreased food intake, possibly due to hypobaric hypoxia. Therefore we assessed the effect of long-term hypobaric hypoxia per se on appetite in eight men who were exposed to a 31-day simulated stay at several altitudes up to the peak of Mt. Everest (8,848 m). Palatable food was provided ad libitum, and stresses such as cold exposure and exercise were avoided. At each altitude, body mass, energy, and macronutrient intake were measured; attitude toward eating and appetite profiles during and between meals were assessed by using questionnaires. Body mass reduction of an average of 5 +/- 2 kg was mainly due to a reduction in energy intake of 4.2 +/- 2 MJ/day (P < 0.01). At 5,000- and 6,000-m altitudes, subjects had hardly any acute mountain sickness symptoms and meal size reductions (P < 0.01) were related to a more rapid increase in satiety (P < 0.01). Meal frequency was increased from 4 +/- 1 to 7 +/- 1 eating occasions per day (P < 0. 01). At 7,000 m, when acute mountain sickness symptoms were present, uncoupling between hunger and desire to eat occurred and prevented a food intake necessary to meet energy balance requirements. On recovery, body mass was restored up to 63% after 4 days; this suggests physiological fluid retention with the return to sea level. We conclude that exposure to hypobaric hypoxia per se appears to be associated with a change in the attitude toward eating and with a decreased appetite and food intake.
Adult↗
Effects of medroxyprogesterone acetate on food intake, body composition, and resting energy expenditure in patients with advanced, nonhormone-sensitive cancer: a randomized, placebo-controlled trial.
BACKGROUND: Anorexia and cachexia are well-known sequelae of cancer that contribute to morbidity and mortality. In several studies in patients with non-hormone-sensitive tumors, synthetic progestogens were shown to exert beneficial effects on appetite and weight loss. The current study was undertaken to investigate the effects of medroxyprogesterone acetate (MPA) on food intake, body composition, and resting energy expenditure (REE). METHODS: Fifty-four patients with non-hormone-sensitive cancer, generally characterized by substantial weight loss and hypermetabolism, received either MPA, 500 mg, or placebo twice daily for 12 weeks (double-blind study). Food intake was measured by dietary history, body composition was assessed by deuterium dilution (fat mass, fat-free mass), and REE was obtained by indirect calorimetry. RESULTS: Compared with placebo, 12 weeks of MPA led to an increase in energy intake (between-group difference, 426 kcal/day; P = 0.01) that was significantly associated (r = 0.68, P = 0.003) with an increase in fat mass (between-group difference, 2.5 kg; P = 0.009). Fat-free mass was not significantly influenced. REE increased during MPA treatment: at 6 weeks, the between-group difference in change was 135 kcal/day (P = 0.009); after 12 weeks, this difference was 93 kcal/ day (P = 0.07). CONCLUSIONS: The authors conclude that MPA is able to stimulate increased food intake significantly and to reverse fat loss concomitantly in patients with non-hormone-sensitive cancer.
Aged↗
A comparison of the effect of free access to reduced fat products or their full fat equivalents on food intake, body weight, blood lipids and fat-soluble antioxidants levels and haemostasis variables.
OBJECTIVES: To compare the effects of free access to reduced fat products or their full fat equivalents on fat and energy intake, body weight, plasma lipids and fat-soluble antioxidants concentrations and haemostasis variables. DESIGN: A multicentre open randomised controlled trial in which intervention and control groups were followed in parallel for six months. Volunteers had free access to 44 different foods either in reduced fat or full fat version, covering between 30 and 40% of energy intake. The remainder of energy intake was covered by foods bought in regular shops. SETTING: Zeist, Wageningen and Maastricht, The Netherlands. SUBJECTS: Two hundred and forty-one non-obese healthy volunteers who had no intention to lose weight. MAIN OUTCOME MEASURES: Food intake, body weight, plasma lipid, vitamin E, beta-carotene, lycopene and fibrinogen concentrations, plasma factor VII clotting activity, and plasminogen-activator-inhibitor-I antigen level. RESULTS: One hundred and three volunteers in the full fat group and 117 volunteers in the reduced fat group completed the study. Energy and fat intake from the free access products was lower in the reduced fat group, but no difference in energy and fat intake of other products occurred. Body weight, energy-, fat- and vitamin E intake and percentage of energy derived from fat decreased in the reduced fat group. No other statistical significant intervention effects were observed. Blood lipid concentrations, factor VII activity and plasminogen-inhibitor-activator-1 level were reduced after consumption of reduced fat products. CONCLUSIONS: When subjects without intention to lose weight limit fat intake by switching from ad libitum consumption of full fat products to reduced fat products body weight gain is prevented, and fat and energy intake are reduced. Such a switch may have beneficial effects on biochemical cardiovascular risk factors. We concluded that reduced fat products will help in a population strategy aimed at preventing overweight and obesity, they will also be effective in maintaining a lower body weight after slimming. Ad libitum consumption of reduced fat products will be ineffective for those individuals that want to reduce body weight because they are currently overweight or obese.
Adult↗
Reduction of sleeping metabolic rate after vertical banded gastroplasty.
OBJECTIVE: To investigate whether long-term weight loss after vertical banded gastroplasty (VBG) results in a sustained reduction of sleeping metabolic rate (SMR) as a persistent risk factor for weight regain. DESIGN: Longitudinal clinical intervention study of morbidly obese patients undergoing VBG. PATIENTS: Group I: Six patients in which body composition and SMR were measured before and at 3, 6 and 12 months after VBG. Group II (long-term effect): nine patients in which body mass (BM) was measured before VBG, and body composition and SMR were measured 98+/-30 months after VBG. MEASUREMENTS: Body composition was assessed by deuterium dilution and hydrostatic weighing. SMR was measured (SMRm) in a respiration chamber and predicted (SMRp) based on body composition. RESULTS: In group I, fat mass and fat free mass decreased significantly after VBG (P < 0.05). SMRm decreased from 11.1+/-1.8 (s.d.) MJ/d before VBG to 8.1+/-0.9 MJ/d (P < 0.05) at 12 months after VBG. In group II at a mean of 98 months after VBG, the SMRm (6.9+/-0.7 MJ/d) was lower than the preoperative value of group I (P < 0.05). SMRm was lower than SMRp at all intervals after VBG (P < 0.05). The ratio measured vs predicted SMR was in group I: 1.02+/-0.05 before VBG, 0.91+/-0.08 at 12 months after VBG (P<0.05), and in group 11: 0.94+/-0.08 at a mean of 98 months after VBG (P < 0.05). CONCLUSION: The reduction of SMR adjusted for body composition after VBG is sustained as long as weight loss is maintained. The sustained and disproportional reduction of SMR may reflect the persistent susceptibility of the postobese to weight regain.
Adult↗
Energy utilization and growth in breast-fed and formula-fed infants measured prospectively during the first year of life.
This study is the first to report approximations of energy requirements for male and female breast-fed and formula-fed infants based on individual estimates of total daily energy expenditure (TDEE) and energy deposition derived from total body fat (TBF) and fat-free mass (FFM) gain as determined by total-body electrical conductivity. In 46 healthy, full-term infants the effect of > or = 4 mo of exclusive breast-feeding compared with formula feeding on macronutrient and energy intake, TDEE, energy deposition, and growth were investigated prospectively. Metabolizable energy intake (MEI) was assessed from macronutrient intake by test weighing (MEI-TW) and from the sum of TDEE and energy deposition (MEI-Pred). At 1-2, 2-4, 4-8, and 8-12 mo of age MEI-Pred averaged 431 +/- 38, 393 +/- 33, 372 +/- 33, and 355 +/- 21 kJ x kg(-1) x d(-1) for boys, and 401 +/- 59, 376 +/- 25, 334 +/- 33, and 326 +/- 17 kJ x kg(-1) x d(-1) for girls. No significant difference between breast-fed and formula-fed infants was found with respect to weight, length, head circumference, TBF, FFM, and TDEE at all ages, or for gain in length, weight, TBF, and FFM. MEI-TW was significantly different between feeding groups at 1-4 mo of age (formula-fed being greater than breast-fed, P < 0.005). This feeding effect, however, was not significant for MEI-Pred (MJ/d). MEI-TW differed from MEI-Pred only in breast-fed infants at 1-4 mo (P < 0.05 at 2-4 mo). The data from this study indicate that energy requirements in infants are lower than the recommendations in guidelines currently in use.
Age Factors↗
Alterations in energy balance with exercise.
The doubly labeled water method for measuring average daily metabolic rate (ADMR) in combination with resting metabolic rate (RMR) allows one to assess the relation between exercise and energy balance. Three topics were included in an analysis of available data: 1) the limits of energy turnover in relation to physical performance for the achievement of energy balance, 2) the effect of an exercise intervention on daily energy turnover and its components, and 3) the effect of exercise on body composition. In the general population, physical activity level (PAL: ADMR/RMR) ranges between 1.2 and 2.2-2.5. There is no sex difference in the level of physical activity. Higher PAL values can be maintained by training and supplementation of the diet with energy-dense, carbohydrate-rich formulas. Exercise training does not influence spontaneous activity except in the elderly. In sedentary subjects, exercise training does not influence RMR when body weight is maintained. An exercise-induced increase in ADMR is about twice the training load. Exercise induces an increase in fat-free mass, especially in women, and a decrease in fat mass. Women tend to preserve energy balance and consequently loss of fat mass is significantly less.
Adolescent↗
Effect of protein source and quantity on protein metabolism in elderly women.
To study sequentially the effect of meal feeding and the effect of protein source and quantity on whole-body protein metabolism, 12 elderly women consumed 3 diets differing in both the quantity and source of protein (diet A: 5.3% of energy intake provided by animal protein and 5.0% by vegetable protein; diet B: 14.5% of energy provided by animal protein and 5.1% by vegetable protein; diet C: 5.0% of energy provided by animal protein and 15.1% by vegetable protein). The diets were consumed for 2 wk with a 2-wk interval between diets. At the end of each dietary period, nitrogen balance and protein turnover were measured. Protein turnover was measured during 4 h of fasting followed by 4 h of feeding. Comparisons were made between fasted and fed periods (within one diet) and between the diets to study the effect of the protein source and quantity. Mean nitrogen balance did not differ significantly from zero during diets B and C and was not affected by the protein source. Meal feeding resulted in increased protein flux and protein oxidation and decreased protein breakdown compared with the postabsorptive values; there was no effect of feeding on protein synthesis. With the high-vegetable-protein diet, protein breakdown in the absorptive state was not inhibited to the same extent as during the high-animal-protein diet, resulting in less net protein synthesis during the high-vegetable-protein diet than during the high-animal-protein diet.
Aged↗
Are skinfold measurements suitable to compare body fat between children with spastic cerebral palsy and healthy controls?
The aim of this study was to assess whether percentage of body fat (BF) can be predicted adequately from skinfold measurements in comparative studies of children with spastic cerebral palsy (CP) and healthy control children. The deuterium dilution technique (D2O) was used as a reference method. In contrast with what was expected, %BF predicted from skinfold measurements was considerably lower than that determined by the D2O method in children with CP, whereas in the controls this was not seen. A proportionally large internal fat deposit and a different distribution of subcutaneous fat in children with CP may be responsible for this. It was concluded that skinfold measurements are not suitable for predicting %BF in comparative studies of children with CP and control children. For evaluation of diet- or exercise-related interventions in children with CP, the use of skinfold measurements seems to be justified. However, it may be more appropriate to use skinfold thicknesses without converting them to BF.
Adipose Tissue↗
Fat balance in obese subjects: role of glycogen stores.
In a previous study, we showed that lean subjects are capable of rapidly adjusting fat oxidation to fat intake on a high-fat (HF) diet when glycogen stores are lowered by exhaustive exercise. However, it has been proposed that obese subjects have impaired fat oxidation. We therefore studied the effect of low glycogen stores on fat oxidation after a switch from a reduced-fat (RF) diet to an HF diet in obese subjects. Ten healthy, obese male and female subjects (26 +/- 2 yr, body mass index 31.8 +/- 1.4, maximal power output 228 +/- 14 W) consumed an RF diet (30, 55, and 15% of energy from fat, carbohydrate, and protein, respectively) at home for 3 days on four occasions (days 1-3). On two occasions, subjects came to the laboratory on day 3 at 1500 to perform an exhaustive glycogen-lowering exercise test (Ex), after which they went into a respiration chamber for a 36-h stay. On the other two occasions, subjects directly entered the respiration chamber at 1800 for a 36-h stay. In the respiration chamber, they were fed, in energy balance, either an HF diet (60, 25, and 15% of energy from fat, carbohydrate, and protein, respectively) or an RF diet. All diets were consumed as breakfast, lunch, dinner, and two or more snacks per day. Twenty-four-hour respiratory quotient was 0.91 +/- 0.01, 0.89 +/- 0.01, 0.84 +/- 0.01, and 0.81 +/- 0.01 with RF diet, RF + Ex, HF, and HF + Ex treatments, respectively. With the HF treatment, fat oxidation was below fat intake, indicating the slow change of oxidation to intake on an HF diet. After the HF + Ex treatment, however, fat oxidation matched fat intake. In conclusion, obese subjects are capable of rapidly adjusting fat oxidation to fat intake when glycogen stores are lowered by exhaustive exercise.
Adipose Tissue↗
Energy balance as a function of adjustment of energy intake.
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Energy Intake↗
Energy requirements assessed using the doubly-labelled water method.
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Adult↗
Energy and fat compensation during long-term consumption of reduced fat products.
The objective of this study was to investigate the behavioral response to the long term realistic consumption of reduced fat products. During six months, a control group of 103 subjects had free access to about 45 commercially available full-fat products, and a reduced-fat group of 117 subjects had access to the reduced fat equivalents. These experimental products covered about 37% of total energy intake in the control group and 30% of energy intake in the reduced fat group. Other non-experimental food products were bought in regular shops. The results showed that, compared to a baseline measurement before the start of the study, energy intake increased from 10.4 MJ/day to 11.2 MJ/d in the control group, whereas it remained constant at 10.2 MJ/d in the reduced fat group. Fat intake in the control group increased from 99 g/d (35.6en%) to 123g/d (40.6en%), whereas fat intake in the reduced fat group decreased from 95 g/d (34.en%) to 90 g/d (32.7en%). The energy and fat intake from experimental products was lower in the reduced fat group (3.1 MJ/d, 37 g fat/d) than in the control group (4.2 MJ/d, 71 g fat/d). There was some compensatory response in the consumption of experimental products: the ingested amount of experimental products was about 10% higher in the reduced fat group (447 g/d) than in the control group (399 g/d)[t = 2.6; p < 0.01]. There was no compensatory response in the consumption of non-experimental products. Both the control and reduced fat group consumed about 7.1 MJ/d and 53 g fat/d from non-experimental products. It is concluded that long term consumption of reduced fat products leads to a lower energy and fat intake, compared to the consumption of full-fat products.
Adult↗
Physical activity assessment: comparison between movement registration and doubly labeled water method.
The doubly labeled water method for the measurement of average daily metabolic rate (ADMR), combined with a measurement of resting metabolic rate, permits the calculation of energy expenditure for physical activity under normal daily living conditions. This procedure was used to evaluate the use of movement registration for physical activity assessment under daily living conditions. Subjects were 16 men and 14 women with normal weight (body mass index (BMI) 24.6 +/- 2.4 kg/m2). Their body movement was registered with a triaxial accelerometer over a 7-day interval, simultaneous with an ADMR measurement with a doubly labeled water method. Resting metabolic rate was measured overnight in a respiration chamber (sleeping metabolic rate (SMR)) at the start of the ADMR measurement. Subjects did wear the accelerometer during waking hours. Accelerometer output (AO, counts/min) was related to physical activity as quantified by adjustment of ADMR for SMR. Additional studies were performed in 11 subjects with anorexia nervosa (BMI 16.7 +/- 1.7 kg/m2) and 8 subjects with morbid obesity (BMI 45.3 +/- 6.8 kg/m2). AO explained most of the variation in ADMR, after adjustment for SMR (R2 = 0.64, SEE = 0.9 MJ/d) Average AO was 1108 +/- 293, 1144 +/- 318, and 946 +/- 391 for subjects with normal weight, anorexia nervosa, and morbid obesity, respectively, and was not significantly different between the three groups. However, in the anorectics AO was significantly related to body mass index (r = 0.84, (p < 0.01), subjects with a BMI17 kg/m2 were equally or more active compared with control subjects, while subjects with a BMI < 17 kg/m2 were equally or less active compared with control subjects. In the morbid obese group, 5 of the 8 subjects had a low activity level (AO < 900 counts/day) and the other 3 had a high activity level (AO1150 counts/day). The triaxial accelerometer is an objective method that can be used to quantify physical activity related energy expenditure and to distinguish differences in activity levels between individuals.
Activities of Daily Living↗