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PubMed2004

Effects of energy density of daily food intake on long-term energy intake.

An important question that has been raised recently is whether it is mainly the energy density (ED) of the food consumed or its macronutrient composition that determines daily energy intake (EI). In this scope, the effect of ED on EI has been assessed in short-term as well as long-term experiments. Over the short term, i.e., during a meal, it was found that ED affects EI directly; then subjects mainly monitor the weight of the food ingested. Over the long term, the effects of ED on EI are modulated. Average daily energy intake (ADEI) does not only consist of meals but also includes snacks and drinks. ADEI appears to be related to ED of the food and drinks where ED is at least determined by specific macronutrients (primarily fat and carbohydrate), but not when ED is determined only by the weight of water. With respect to the separate effects of the ED of foods and of drinks on ADEI, only ED from foods had a significant relationship with total EI. Moreover, during daily food intake, subjects seem to adapt their portion sizes to estimated EDs. Long-term studies have shown that dietary restraint compensates for the effect of increases in ED on ADEI, whereas unrestrained eaters compensate for the effect of decreases in ED on ADEI. In conclusion, ED determines short-term EI. This cannot be extrapolated to the long term because only the ED of food, and not the ED of drinks, determines total EI. In addition, over the long term, the short-term effect is modulated by dietary restraint and adapted portion sizes. ED is not a universal concept that determines EI, yet rather a characteristic of the macronutrients: mainly fat and carbohydrate contributing to variation in EI.

Beverages↗

PubMed2002

Energy imbalance and prostate cancer.

In this review, the emerging evidence that excessive energy intake relative to energy expenditure increases the risk of prostate cancer is discussed. The adverse effects of energy imbalance can be inferred from an experimental study demonstrating reduced prostate tumor growth, lower circulating concentrations of insulin-like growth factor-I and decreased expression of vascular endothelial growth factor with energy restriction in transplantable tumor models. The effects of energy restriction on factors mediating greater proliferation relative to apoptosis and angiogenesis suggest that energy imbalance may act late in the carcinogenic pathway. Energy intake also has been evaluated in relation to prostate cancer risk in 23 analytic epidemiologic studies. Among studies reporting effect estimates, 8 of 14 case-control studies support a direct association [top versus bottom quantile, OR(summary) = 1.3; 95% confidence interval (CI), 1.1-1.4], but none of four cohort studies do (RR(summary) = 1.0; 95% CI, 0.8-1.2). The four case-control studies that evaluated advanced disease suggest a higher risk with higher energy intake (OR(summary) = 1.6; 95% CI, 1.2-2.0). However, none of these studies considered the balance of energy intake with body size and physical activity, the major determinants of variability in energy demand. Numerous research questions remain to be addressed, including, Which biological pathways are adversely affected by energy imbalance? Does energy imbalance act early or late in prostate carcinogenesis? What is the optimal energy balance for minimizing risk of clinically important prostate cancer? Evidence is beginning to show that energy intake in excess of expenditure may affect prostate carcinogenesis and, in particular, risk of advanced disease.

Animals↗

PubMed1998

Effects of sibutramine on resting metabolic rate and weight loss in overweight women.

Sibutramine, a monoamine re-uptake inhibitor, has recently been approved by the Food and Drug Administration as a weight loss agent. Sibutramine lowers bodyweight in rodents by reducing energy intake and increasing energy expenditure. Sibutramine facilitates weight loss in human subjects, but it is not clear whether it acts on energy intake, energy expenditure, or both. The present study was a randomized clinical trial designed to assess the effects of sibutramine (at 10 or 30 mg/day) on body weight and resting metabolic rate (RMR). Forty-four overweight women were randomized to 1) placebo (n=15); 2) sibutramine at 10 mg/day (n=15) or, 3) sibutramine at 30 mg/day (n=14). All subjects were instructed to consume a 1200 kcal/day diet for 8 weeks while receiving drug or placebo. RMR was assessed by indirect calorimetry at baseline, at 3 hours after the first dose of drug (or placebo), and at the end of the 8-week weight-loss period. Sibutramine reduced body weight-relative to placebo, but there was no difference between weight loss on the two sibutramine doses. No significant differences in RMR between sibutramine and placebo were seen, either 3-hour post dose or after the 8-week weight-loss period. After the weight loss period, all groups were taken off medication and kept weight stable for another 4 weeks. RMR was measured again and was not different among groups. That there was no change in RMR when sibutramine was stopped further suggests that the drug does not directly affect RMR. In summary, while sibutramine was shown to be an effective weight-loss agent over 8 weeks, we found no evidence that it increased RMR.

Adolescent↗

PubMed1997

A comparison of dietary reference values for energy of different countries.

Dietary reference values for food energy for population groups are set at the level of average energy requirement without a safety margin to avoid any risk of inadequate energy intake. Average energy requirements and hence reference values for energy can be determined from either energy intake data or energy expenditure. In this article, the present reference values for energy of 12 countries, the FAO/WHO/UNU and the Scientific Committee on Food (SCF/EC) are compared regarding the level of their standards and underlying concepts. Methods for estimating energy requirements of different population groups and data sources for reference values for energy are summarized. Furthermore, reference values for energy for males and females of all ages are presented in separate graphs. The comparison of national standards illustrates that the level of reference values for energy for individual countries is dependent on variables such as methodology, data sources, allowances for physical activity, reference body weight, and age range. Standards for adolescents and elderly persons reveal that differences in reference values are most apparent in population groups for which only limited data on energy requirements are available. Although it is not possible to evaluate the adequacy of reference values for energy by comparing data of different countries, many differences in the level of reference values can be explained on the basis of underlying concepts.

Adolescent↗

PubMed1999

Growth and nutrition in South African children with cystic fibrosis.

OBJECTIVES: To study nutritional status and its dietary correlates in a South African cystic fibrosis (CF) population. DESIGN: Cross-sectional survey. POPULATION: Thirty-eight children and adolescents attending the CF clinic at Red Cross War Memorial Children's Hospital, Cape Town. METHODS: Standard anthropometry and a 3-day weighted food record. RESULTS: Median percentage expected weight for height (WFH) was 93 (interquartile range 84-101). Sixteen per cent of patients were below the 5th percentile for height. The proportion of patients who were malnourished (WFH less than 90) was greater among those over 10 years of age (47% v. 14.3%, chi 2 = 4.33, P = 0.037). Sixty-eight per cent of patients consumed less than the recommended daily intake of energy. There was no correlation between WFH and energy intake. Fat intake represented 29.6% (interquartile range 27.5-33%) of daily energy intake. CONCLUSIONS: Young South African children with CF are growing well despite relatively low intakes of energy and fat. Greater attention needs to be given to overcoming malnutrition among older children.

Adolescent↗

PubMed1998

[Weight loss by increasing energy consumption and thermogenesis].

Obesity is caused by a chronic imbalance between energy intake and energy expenditure. The increasing incidence of obesity over the last years is partly caused by the decreased physical activity following industrialization. Weight reduction can be achieved by decreasing energy intake and increasing energy expenditure. The fat loss induced by physical activity, however, is relatively small. Exercise helps to prevent the otherwise inevitable loss of muscle during caloric restriction. Due to the low success rate of conventional weight loss programs, the development of drugs to increase thermogenesis is subject to worldwide research. While in animal experiments stimulation of beta-3 adrenergic receptors leads to a significant weight loss, in humans these drugs fail to stimulate energy expenditure probably due to the lack of significant amounts of brown adipose tissue. The recently identified uncoupling proteins (UCP) 2 and 3 dissipate the protone gradient, thereby releasing stored energy as heat. These proteins might therefore act as potential targets for antiobesity drugs.

Animals↗

PubMed2004

Energy balance in cystic fibrosis when stable and during a respiratory exacerbation.

BACKGROUND AND AIMS: Undernutrition is common in young adult patients with cystic fibrosis (CF) and implies an imbalance between energy intake and total energy expenditure (TEE). The aim of this study was to measure energy intake and TEE expenditure in a group of patients when they were clinically stable at home and during an exacerbation of respiratory symptoms when they were in hospital receiving intravenous antibiotics. METHODS: Eleven patients aged between 15 and 40 years with moderate respiratory disease, mean FEV(1) 51.4% predicted took part. An exacerbation was defined as>15% decrease in FEV(1), an increase in sputum production and a decision to treat in hospital with intravenous antibiotics. Resting energy expenditure (REE) was measured using indirect calorimetry and energy intake by 3 day food diaries. TEE expenditure was measured using 24 h heart rate and doubly isotopically labelled water. RESULTS: REE was higher at the beginning of an exacerbation than the end, P<0.05. There was no significant difference in TEE during the stable period compared to the exacerbation 10.53(2.39)MJ/day compared to 8.77(1.59)MJ/day using doubly isotopically labelled water. There was no difference in energy intake during the exacerbation compared to the stable period, 11.19(2.31)MJ/day compared to 11.77(2.30)MJ/day. CONCLUSIONS: There was no difference in TEE and energy intake when patients were unwell in hospital compared to when they were stable at home despite an increase in REE.

Adolescent↗

PubMed1988

Energy-nitrogen balances and protein turnover in small and appropriate for gestational age low birthweight infants.

The aim of the present study was to compare, under the same nursing conditions, the energy-nitrogen balance and the protein turnover in small for gestational age (SGA) and appropriate for gestational age (AGA) low birthweight infants. We compared 8 SGA's (mean +/- s.d.: gestational age 35 +/- 2 weeks, birthweight 1520 +/- 330 g) to 11 AGA premature infants (32 +/- 2 weeks, birthweight 1560 +/- 240 g). When their rate of weight gain was above 15 g/kg/d (17.6 +/- 3.0 and 18.2 +/- 2.6 g/kg/d, mean postnatal age 18 +/- 10 and 20 +/- 9 d respectively) they were studied with respect to their metabolizable energy intake, their energy expenditure, their energy and protein gain and their protein turnover. Energy balance was assessed by the difference between metabolizable energy and energy expenditure as measured by indirect calorimetry. Protein gain was calculated from the amount of retained nitrogen. Protein turnover was estimated by a stable isotope enrichment technique using repeated nasogastric administration of 15N-glycine for 72 h. Although there was no difference in their metabolizable energy intakes (110 +/- 12 versus 108 +/- 11 kcal/kg/d), SGA's had a higher rate of resting energy expenditure (64 +/- 8 versus 57 +/- 8 kcal/kg/d, P less than 0.05). Protein gain and composition of weight gain was very similar in both groups (2.0 +/- 0.4 versus 2.1 +/- 0.4 g protein/kg/d; 3.5 +/- 1.1 versus 3.3 +/- 1.4 g fat/kg/d in SGA's and AGA's respectively). However, the rate of protein synthesis was significantly lower in SGA's (7.7 +/- 1.6 g/kg/d) as compared to AGA's (9.7 +/- 2.8 g/kg/d; P less than 0.05). It is concluded that SGA's have a more efficient protein gain/protein synthesis ratio since for the same weight and protein gains, SGA's show a 20 per cent slower protein turnover. They might therefore tolerate slightly higher protein intakes. Postconceptional age seems to be an important factor in the regulation of protein turnover.

Blood Urea Nitrogen↗

PubMed1995

[Nutrition and nutritional status of female somatic nursing home patients].

OBJECTIVE: To determine if the intake of energy and particular nutrients is adequate among elderly non-demented nursing home patients, and to identify possible causes of a marginal status. SETTING: A nursing home, neighbouring service flat and a group of independently living elderly in Zeist, the Netherlands. DESIGN: Descriptive cross-sectional study. METHOD: Data were collected about habitual food consumption, anthropometry and indicators of nutritional status from 51 female nursing home patients (response 65%), 29 elderly women living in service flats (response 56%) and 52 independently living elderly women. Comparisons were made among the groups, with the recommended dietary allowance and with cut off values. RESULTS: The mean daily energy intake of 5.9 MJ (SD: 1.4) by the group of nursing home patients was lower than the recommended allowance (7.8 MJ). Mean values for the anthropometric measurements hardly varied among the groups. This suggested that the low energy intake was in accordance with the actual energy requirement. Especially among the nursing home women low blood levels were frequently seen of folic acid, pyridoxine, 25-hydroxy-vitamin D, vitamin C and selenium. A lower food consumption and unfavourable food choices were considered to be mainly responsible. Low mobility and pathological processes may also play a part. CONCLUSION: Low blood levels among non-demented nursing home patients were caused by low food consumption, unfavourable food choices and probably by health status. Prevention may include: more physical activity (whenever possible), giving information to patient and nurse, supplying food with higher nutrient density, presenting more menu choices, reporting to physician or dietician when food offered is not eaten.

Activities of Daily Living↗

PubMed2001

Pathogenesis of obesity and diabetes mellitus: insights provided by indirect calorimetry in humans.

Energy homeostasis is the balance between energy intake and energy expenditure. Assessment of energy intake is unreliable, especially in obese individuals. On the contrary it is possible to assess energy expenditure by means of different techniques. In this review, the contributions of indirect calorimetry to its assessment and to the comprehension of the pathogenic mechanisms of obesity and diabetes mellitus are discussed. Knowledge regarding energy expenditure and its components (basal metabolic rate, food-induced thermogenesis, expenditure related to physical activity), obtained in obese individuals by means of indirect calorimetry, is summarized. The effects of dietetic manipulation of the relative fractions of macronutrients (fat, carbohydrate and protein) and fiber intake on energy expenditure are described with implications regarding the pathogenesis of obesity. Besides environmental factors, energy expenditure is strongly influenced by inherited features. The application of indirect calorimetry to study recently discovered polymorphisms of genes strongly related to energy expenditure in humans is also summarized. The role of indirect calorimetry in the identification of the glucose metabolic pathways (oxidative and non-oxidative) affected in the insulin resistance syndrome is also described. Indirect calorimetry has been useful in realizing that the alterations typical of insulin resistance are reproducible in vivo in healthy humans, increasing the availability of free fatty acids. In fact, indirect calorimetry contributed to understanding the in vivo mechanisms of substrate competition, which was hypothesized more than forty years ago. In this field of application, the identification of simple (non-invasive and inexpensive) markers of insulin resistance is urgent for primary and secondary prevention of these diseases with high morbidity and mortality. The postabsorptive assessment of resting energy expenditure and macronutrient partitioning in fuel metabolism may be helpful and is discussed with advantages and limitations. The treatment of multifactorial diseases will probably require the use of poly-therapeutic interventions. In fact, drugs that act purely on one pathogenic factor of these diseases frequently fail. To better design strategic therapeutic approaches for each patient, to achieve significant long-term efficacy in the treatment of these diseases and to prevent their complications, indirect calorimetry has to be considered a landmark of quality control for nutritional support.

Calorimetry, Indirect↗

PubMed1997

Drug therapy for obesity in the elderly.

The prevalence of obesity is increasing rapidly in the US and other developed countries. Even though the percentage of older individuals is increasing worldwide, obesity has only recently become a recognised problem in this population. Obesity occurs when energy intake chronically exceeds energy expenditure. Moreover, advancing age is associated with an inability to couple energy intake with energy expenditure. Obesity contributes to many adverse health outcomes, including non-insulin-dependent (type II) diabetes mellitus, as well as to an increase in both cardiovascular and all-cause mortality. Only recently has the medical community begun to accept obesity as a disease with a multifactorial pathogenesis that requires systematic lifestyle changes and pharmacological treatment. Several groups of drugs are available for the pharmacotherapy of obesity; anorectic medications (e.g. fenfluramine, dexfenfluramine); substances affecting energy expenditure and body composition [e.g. chromium (chromium picolinate), ephedrine, anabolic steroids, beta 3-adrenoceptor agonists]; and drugs affecting the absorption of nutrients (e.g. orlistat). To date, few drugs have produced and sustained a significant bodyweight loss. However, some drugs induce a significant short term reduction in bodyweight compared with placebo. Moreover, there is a paucity of information regarding the effectiveness of these drugs in the treatment of obesity in the elderly. Furthermore, it is even debated whether obesity should be treated with drug intervention in the elderly. Clinicians prescribing medications for obesity treatment in the elderly need to carefully consider the benefit: risk ratio, given the high prevalence of polypharmacy in elderly patients. Furthermore, physiological changes that occur with aging may affect the pharmacokinetics of administered drugs and need to be taken into consideration.

Aged↗

PubMed1991

Dietary intakes and food use of groups of elite Australian male athletes.

The present study conducted dietary surveys of four groups of Australian male athletes: triathletes, marathon runners, Australian Rules football players, and Olympic weightlifters. Their training diets were assessed via a 7-day food record from which mean daily intakes of energy, macronutrients, and key micronutrients were estimated. The data were compared between groups as well as to recommendations in the literature for athlete nutrition. Results showed major differences between groups. The contribution of carbohydrate to total energy intake was greater for triathletes and marathon runners than for the other two groups. There was no difference between all four groups in the total amount of fat consumed, yet its contribution to total energy intake was significantly lower for triathletes and marathon runners. The football players and weightlifters consumed a similar fat:energy ratio as the typical Australian diet. Furthermore, the micronutrient density of the football players' diets was significantly lower than that of the other groups.

Attitude to Health↗

PubMed2004

Secular trends in dietary intake in the United States.

This review focuses on dietary intake and dietary supplement use among the U.S. population age 1-74 based on four National Health and Nutrition Examination Surveys conducted in 1971-74, 1976-80, 1988-94, and 1999-2000. Secular trends in intake of energy, macronutrients, cholesterol, sodium, calcium, iron, folate, zinc, vitamins A and C, fruits, vegetables, and grain products are summarized. During the 30-year period, mean energy intake increased among adults, and changed little among children age 1-19, except for an increase among adolescent females. Factors contributing to increases in energy intake include increases in the percentage of the population eating away from home (particularly at fast-food restaurants), larger portion sizes of foods and beverages, increased consumption of sweetened beverages, changes in snacking habits, and improved dietary methodology. Dietary supplement use increased among adult men and women, decreased among children age 1-5, and was stable for children age 6-11 and adolescents.

Adolescent↗

PubMed2005

Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients.

RATIONALE: Nutritional depletion is a common problem in chronic obstructive pulmonary disease (COPD) patients. It is caused, to a large extent, by an imbalance between low-energy intake and high-energy requirements. This problem adversely affects morbidity and mortality. However, the use of nutritional supplements to reach their energy necessities requires optimisation between positive and adverse effects on outcome before being used systematically as part of their comprehensive care. PURPOSE: The aim of our study was to investigate the effects of oral nutritional repletion on quality of life in stable COPD patients. METHODS: Prospective, randomised and multi-centre study. Stable COPD patients with a body mass index 22, a fat-free mass index 16, and/or a recent involuntary weight loss (5% during last month, or 10% during the last 3 months) were studied. Exclusion criteria were to present signs of an airway infection, to have a cardiovascular, neurological, or endocrine disease, to be treated with oral steroids, immunosuppressors or oxygen therapy at home, and to receive nutritional supplements. During 12 weeks, patients were encouraged to ingest a total daily defined energy intake. Randomly, in patients from group A the total daily energy load was Resting Energy Expenditure (REE)x1.7, and those from group B, REE x1.3. Total daily energy intake was achieved with regular food plus, if necessary, oral nutritional supplement rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants. Primary end-point variable was quality of life. Secondary end-point outcomes included body weight, body composition, lung function, handgrip strength, and compliance with the energy intake previously planned. Data were treated with a SAS System. Student's test, Wilcoxon's rank sum test, and Mann-Whitney's test were used. RESULTS: At baseline both groups of patients were comparable. All patients needed oral nutritional supplements to achieve total daily defined energy intake. After 12 weeks of follow-up, patients in both groups significantly increased energy intake. Patients in group A increased body weight (P=0.001), triceps skin fold thickness (P=0.009) and body fat mass (P=0.02), and decreased body fat-free mass index (P=0.02). In this group a marked increase in airflow limitation was observed. A tendency to increase body weight and handgrip strength, and to decrease airflow limitation was observed in patients from group B. Furthermore, patients in the later group showed a significant improvement in the feeling of control over the disease (P=0.007) and a tendency to better the other criteria in a quality of life scale. CONCLUSIONS: According to our results, total daily energy intake of REE x 1.3 is preferable to REE x 1.7 in mild stable COPD patients. The administration of oral nutritional supplements, rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants, to achieve total daily defined energy intake in patients in group B was followed by a significant improvement of one criteria (mastery) among many others in a quality of life scale.

Anthropometry↗

PubMed1985

Intakes of energy, protein and calcium and weaning pattern of a group of Dutch infants aged 6-12 months.

The intakes of energy, protein and calcium of 76 infants aged 6-12 months was investigated using a five day weighing record method. Average daily energy intake was 380 kJ/kg/day; the average daily intake of protein was 3.8 g/kg/day and the average calcium intake was 785 mg per day. Milk and milk products were the main source of these nutrients and supplied 41%, 59% and 83% respectively of the total daily intake of energy, protein and calcium. The weaning pattern was investigated retrospectively. At age of 6 months the infants were eating a variety of foods rich in protein and calcium.

Animals↗

PubMed2001

Dietary intakes of elite female athletes in Greece.

BACKGROUND: Although there is a great interest in sports in Greece, there are very few data regarding dietary intakes and habits of Greek elite female athletes. The present study assesses the dietary intakes and the energy balance of elite female athletes of four different sports (volleyball, middle distance running, ballet dancing, and swimming) and a non-athletic control group. METHODS: Data were collected over two seasons, the training and the competitive, using 7-day weighed dietary records. Energy expenditure was calculated from 7-day activity records. Anthropometric measurements were also taken for all athletes. RESULTS: Athletes and controls had similar BMI values. Per cent body fat was lower for athletes compared with controls. Between sports, middle distance runners had the lowest per cent body fat. No significant differences were found between mean energy intake of athletes and controls. Mean energy intake was found lower than calculated energy expenditure, for all four teams. Macronutrient and micronutrient intakes of the athletes were not statistically different from those of the non-athletic control group. Mean micronutrient intakes were found above the recommended values with the exception of iron. Both athletes and controls had a high intake of vitamin C that is a characteristic of the population of the Mediterranean countries. CONCLUSIONS: Energy intakes varied between sports and between athletes of the same sport. Calculated energy expenditure was higher from the reported energy intake for most athletes. Athletes with the lowest energy intakes reported menstrual abnormalities.

Adipose Tissue↗

PubMed2003

Dietary intake and eating patterns of elderly people in Israel: who is at nutritional risk?

OBJECTIVE: To determine dietary intake and eating patterns of older persons in Israel and to identify factors associated with low intake. DESIGN: A cross-sectional study. SETTING: Community-dwelling participants living in the Beer-Sheva area were interviewed at home, using a 24 h food questionnaire with additional questions regarding health and eating habits. Dietary intake was compared between people aged 65-74 and 75 y and older. SUBJECTS: A total of 377 people over the age of 65 224 aged 65-74 and 153>75, were randomly selected from the Negev population. RESULTS: Dietary intake of energy, fat, carbohydrates, vitamins E, C and B(1) were significantly lower for people aged 75 and older compared with people aged 65-74. Low energy intake was associated with lower subjective health status for men (P<0.01), poor appetite (P<0.01) and more gastrointestinal problems (P<0.05) for women and lower snack consumption (P<0.01) for both genders. In a multivariate model, low energy intake was associated with low appetite and higher use of medication for both sexes and with frequency of eating alone and not consuming snacks for men. CONCLUSIONS: Dietary intake is lower among individuals older than 75 than in 65-74 y old. Risk factors for low intake include poor appetite and health status, gastrointestinal problems, and eating alone. Snacking enhanced dietary intake and should be encouraged in this group.

Age Factors↗

PubMed1983

Energy balance and nitrogen balance in growing low birthweight infants fed human milk or formula.

Energy and nitrogen balances were measured in growing low birthweight infants fed either mother's expressed breast milk or a 20 kcal per ounce formula to determine whether or not there were differences between the two dietary groups in (1) the partition of energy among excretion, expenditure, and storage and (2) the relation of energy storage and nitrogen retention to weight gain. There were no significant differences between the human milk fed infants and formula fed infants in gross energy intake, metabolizable energy intake, nitrogen intake, or nitrogen retention. Energy expenditure was significantly lower in the human milk fed infants than in formula fed infants (221 kJ/(kg. day) and 244 kJ/(kg. day), respectively). There was no difference in mean energy storage between the two groups. Although weight gains were similar in both dietary groups, the ratio of energy storage to weight gain was significantly greater in infants fed with human milk (15.3 kJ/g, S.D. 2.0) than in infants fed formula (13.2 kJ/g S.D. 1.8). There was no significant difference between the two groups in the ratio of nitrogen stored to weight gain.

Body Weight↗