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PubMed1979

Folate intake by teenage girls and by pregnant women.

In a dietary analysis comprising 110 girls aged 13-15 years and 87 pregnant women the mean folate intake proved to be less than one-third of the Recommended Dietary Allowances. Among the girls there was a significantly positive correlation between folate intake and energy intake, while this did not apply to the pregnant women. The reason was that the excess energy intake during pregnancy was only modest, and in many cases it was met by energy calories of low nutritional value. If supplements of folic acid are needed during pregnancy, it is recommended to start prophylaxis as early as possible, as folate intakes by potential mothers (teenage girls) are insufficient to secure a high depot level for folates before pregnancy.

Adolescent↗

PubMed1985

Efficiency of feed energy utilization for protein and fat gain in Hereford and Charolais steers.

Two multiple regression models were used to estimate energetic efficiency of protein and fat gain for 84 grade British steers, predominantly Hereford, and 84 Charolais steers using data obtained from a comparative slaughter feeding trial. In Model One, metabolizable energy intake was regressed on energy gain as fat and protein; the intercept was an estimate of maintenance. For Model Two, maintenance requirements were estimated by regression of log heat production (kcal/kg.75) on metabolizable energy intake (kcal/kg.75) and iterating to the point at which heat production was equal to metabolizable energy intake. Energy intake above maintenance was then regressed on energy gained as fat and protein. Results from Model One showed the efficiencies of protein and fat gain to be 10 and 49%, while Model Two indicated these efficiencies were 11 and 58%. Breeds did not appear to differ significantly in the efficiency with which they used metabolizable energy for protein or fat deposition.

Animal Feed↗

PubMed1996

Nutritional status of patients with Alzheimer's disease: a 1-year study.

OBJECTIVE: To describe the effects of activity level and energy intake over time on the body weight of patients with Alzheimer's disease compared with cognitively normal subjects. DESIGN: Repeated measures, case-control design with measurements taken at quarterly intervals for 12 months. Subjects were grouped by gender and activity level (sedentary or active) within cognitive status. SETTING: The Alzheimer's disease Special Care Unit, The Clinical Research Center at University of California, San Diego, and the Fred Kasch Exercise Physiology Laboratories at San Diego State University. PATIENTS: Seventeen institutionalized subjects with Alzheimer's disease and 23 community-dwelling control subjects successfully completed the 1-year study. MEASUREMENTS: Before admission to the nursing home, the patients with Alzheimer's disease had a formal assessment for dementia, which showed that they met the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association work group for probable or possible Alzheimer's disease. Control subjects were screened using the Information-Memory-Concentration Mental Status Test and were found to have no cognitive disabilities. Baseline and quarterly measurements included height, weight, bioimpedance for body composition, and activity by accelerometer counts. Dietary intake of energy and protein was determined at baseline and at 6 and 12 months. RESULTS: Patients with Alzheimer's disease had a significantly higher energy intake than patients in the control group. Both women and men with Alzheimer's disease maintained their weight. Women with Alzheimer's disease had higher percentage of fat-free mass than the control group, but there were no differences in body composition between the groups of men. CONCLUSION: Subjects with Alzheimer's disease can maintain their weight if they are given a diet with adequate energy (35 kcal/kg of body weight).

Aged↗

PubMed2006

Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: a randomized, controlled trial.

OBJECTIVES: Television viewing and physical inactivity increase the risk of obesity in youth. Thus, identifying new interventions that increase physical activity and reduce television viewing would be helpful in the prevention and treatment of pediatric obesity. This study evaluated the effects of open-loop feedback plus reinforcement versus open-loop feedback alone on physical activity, targeted sedentary behavior, body composition, and energy intake in youth. METHODS: Thirty overweight or obese 8- to 12-year-old children were randomly assigned to an intervention (n = 14) or control group (n = 16). Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors. For children in the open-loop feedback plus reinforcement (intervention) group, accumulating 400 counts of physical activity on pedometers earned 1 hour of television/VCR/DVD time, which was controlled by a Token TV electronic device. Open-loop feedback control subjects wore activity monitors but had free access to targeted sedentary behavior. RESULTS: Compared with controls, the open-loop feedback plus reinforcement group demonstrated significantly greater increases in daily physical activity counts (+65% vs +16%) and minutes per day of moderate-to-vigorous physical activity (+9.4 vs +0.3) and greater reductions in minutes per day spent in television viewing (-116.1 vs +14.3). The intervention group also showed more favorable changes in body composition, dietary fat intake, and energy intake from snacks compared with controls. Reductions in sedentary behavior were directly related to reductions in BMI, fat intake, snack intake, and snack intake while watching television. CONCLUSIONS: Providing feedback of physical activity in combination with reinforcing physical activity with sedentary behavior is a simple method of modifying the home environment that may play an important role in treating and preventing child obesity.

Behavior Therapy↗

PubMed1997

Diet, body size, physical activity, and the risk of endometrial cancer.

Endometrial cancer is associated with increased weight and body size, diabetes, and other conditions that may result from an excess in calories or lack of physical activity. Although a few studies have explored the effect of dietary constituents on the risk of endometrial cancer, the nature of the joint association of these constituents and obesity, energy intake, or energy expenditure with risk is unknown. A population-based case-control study was conducted in Hawaii to examine the association of diet, body size, and physical activity with the risk of endometrial cancer. Subjects included 332 histologically confirmed, primary endometrial cancer cases and 511 controls identified between 1985 and 1993. Cases and controls were residents of Oahu, Hawaii who were between 18 and 84 years of age and were from one of the following ethnic groups: Japanese, Caucasian, Native Hawaiian, Filipino, and Chinese. Cases were identified through the Hawaii Tumor Registry and matched to the controls on age (+/-2.5 years) and ethnicity. In-person interviews, conducted in the subjects' homes, included dietary, reproductive, menstrual, and medical histories and use of exogenous hormones, physical activity, and other lifestyle variables. Weight, girth, and skinfold measurements were taken at the time of the interview. We found a strong dose-response relation of increased body size to the development of endometrial cancer after adjustment for energy intake. The odds ratio (OR) for endometrial cancer among women in the highest quartile of body mass index (BMI; kg/m2) was more than four times that among women in the lowest quartile. Waist, hip, midarm, and wrist girths were positively associated with the estimated risk of endometrial cancer after adjustment for total calories and other nondietary risk factors, although the trends in the ORs were attenuated after adjustment for BMI. Physically active women had a modest reduction in their risk of disease compared with inactive women. Cases consumed a greater percentage of their calories from fat and a lower percentage of their calories from carbohydrates than did controls. Adjustment for BMI reduced the ORs for the highest compared with the lowest quartile of fat calorie intake from 2.0 (95% confidence interval, 1.3-3.2) to 1.6 (95% confidence interval, 1.0-2.6), suggesting that part of the association is explained by obesity. There was a differential effect of fat on endometrial cancer according to BMI. For all components of fat, the associations with endometrial cancer were either minimal or absent among leaner women (i.e., those with BMI below the median), whereas, among more obese women, two-fold differences in risk were observed between women above and below the median of fat intake. Foods that are high in fat and cholesterol, such as red meat, margarine, and eggs, were positively associated with endometrial cancer, whereas cereals, legumes, vegetables, and fruits, particularly those high in lutein, were inversely associated. These findings suggest that women who avoid being overweight and who consume a diet low in plant and animal fats and high in complex carbohydrates are at a reduced risk of endometrial cancer.

Adult↗

PubMed2006

Intake of macronutrients as predictors of 5-y changes in waist circumference.

BACKGROUND: The diet may influence the development of abdominal obesity, but the few studies that have prospectively examined the relations between diet and changes in waist circumference (WC) have given inconsistent results. OBJECTIVE: Associations between total energy intake, energy intake from macronutrients, and energy intake from macronutrient subgroups based on different food sources and 5-y differences in WC (DWC) were investigated. DESIGN: A Danish cohort of 22 570 women and 20 126 men aged 50-64 y with baseline data on WC, diet, BMI, and potential confounders reported their WC 5 y later. Associations of baseline diet with DWC were assessed by multiple linear regression analysis. RESULTS: Neither total energy intake nor energy intake from each of the macronutrients was associated with DWC, except for an inverse association with protein, especially animal protein. In women, positive associations with DWC were seen for carbohydrate from refined grains and potatoes and from foods with simple sugars, whereas carbohydrate from fruit and vegetables was inversely associated and significantly different from any other carbohydrate subgroup. The results for men resembled those for women, although none were significant. Vegetable fat was positively associated with DWC for both men and women in a combined analysis. A U-shaped association between alcohol from wine and DWC was present for both sexes, and alcohol from spirits was positively associated with DWC in women. CONCLUSIONS: Although no significant associations with total energy or energy from fat, carbohydrate, or alcohol were observed, protein intake was inversely related to DWC, and some macronutrient subgroups were significantly associated with DWC.

Abdominal Fat↗

PubMed2004

Carbohydrate and weight control: where do we stand?

PURPOSE OF THE REVIEW: The Atkins diet has been criticized and vilified by much of the scientific community since it was proposed 30 years ago, because it challenged nutritional recommendations and dietary guidelines for a healthy diet. However, in spite of such recommendations the prevalence of obesity continues to rise. The present review evaluates recent scientific evidence and attempts to reach consensus on the confusion of weight-reducing diets. RECENT FINDINGS: Many dietary macronutrient paradigms have been proposed for the treatment of obesity. Since obesity in its dynamic phase is the result of energy intake exceeding energy expenditure, intuitively to lose weight energy intake should be less than energy expenditure, and one might expect that the macronutrient composition of the diet would have very little, if any, effect. However, short- and long-term therapies with low-carbohydrate or high-protein diets appear to offer advantages over conventional weight-loss regimens for weight loss, body composition and cardiovascular risk factors. SUMMARY: Low-carbohydrate, Atkins-type diets have been demonstrated to have positive effects on weight loss and biomarkers of cardiovascular risk, which has prompted some researchers to question the validity of present-day dietary guidelines. Although evidence is accumulating in their favour, the safety and efficacy of low-carbohydrate, high-protein diets needs further long-term verification.

Body Composition↗

PubMedDate not supplied

[Characteristics of the dietary intake of French children from 3 to 24 months of age. Diet of French infants].

The food consumption of 543 French infants, aged 3 to 24 months, was recorded during a 3 day period. The nutrient intake data were calculated by a computerized food table. The 1981 recommended dietary amounts proposed by the Committee of the Centre National de Coordination des Etudes et Recherches sur la Nutrition et l'Alimentation were used to assess adequacy of intake. Our results showed a great variability between individuals considering the caloric intake. The mean energy intakes were greater than the recommended amounts for the age range of 6 to 12 months: therefore a revision of the recommended amounts appears necessary. A marked decrease of the consumption of infant formulas was noted between 4-5 months (57% of the total energy intake) and 6-7 months (18% of the total energy intake). The consumption of the other baby foods was the highest at 6-7 months (23% of the total energy intake). The probability that a French infant has a protein intake less than the recommended amounts was less than 0.02. This probability was 0.04 for calcium intake and 0.50 to 0.78 for iron intake according to age. An increase of the iron intake from 4-5 months is a justified dietary goal. The mean intake of linoleic acid was the smallest at a mean age of 8 to 12 months and represented less than 2% of the caloric intake.

Calcium, Dietary↗

PubMed1977

The study of women in Gothenburg 1968-1969. Intake of energy and nutrients in five age groups.

Women from five age groups (38, 46, 50, 54, and 60 years), participating in the population study "Women in Gothenburg 1968-1969", were subjected to a 24-hour recall dietary interview (n = 1361). In a randomized subsample (n = 418), a dietary history was obtained and individuals in another randomized subsample (n = 755) submitted a 24-hour urine specimen for nitrogen analyses. There were significant differences between the 24-hour recall and dietary history figures in all five age groups with respect to energy and all nutrients. The mean protein intake calculated indirectly from the urinary nitrogen excretion came close to the figures calculated from the dietary histories in four out of five age groups. The energy intake and, consequently, the intake of most nutrients calculated from the dietary histories were higher than generally ascribed to Swedish women, as most previous data have been obtained by 24-hour dietary recall interviews. Most women (71-89% in the different age groups) consumed too much fat and most women of fertile age (80-92%) consumed too little iron. A significant decrease in the mean energy intake was apparent only in the age group 60, i.e. 1870 kcal versus 1965--2 105 in the other groups.

Adult↗

PubMed1979

The effect of parietal cell vagotomy and selective vagotomy with pyloroplasty on body weight and dietary habits. A prospective randomized study.

Body weight and dietary habits were studied in 32 male patients in a consecutive randomized series of parietal cell vagotomy (PCV) and selective vagotomy with pyloroplasty (SV + P). There were 16 patients in each group. One month after surgery all patients had lost weight. During the first 2 postoperative years following PCV most patients regained their preoperative weight. SV + P led to an impaired ability to gain weight. Following PCV the consumption of fat was reduced but the carbohydrate consumption increased, leading to an unchanged total daily energy intake. The daily energy intake decreased following SV + P in spite of an increased consumption of protein-rich foods such as meat, fish, and eggs. The decreased energy intake was due to a reduced intake of fat, sugar, and milk following SV + P. It is concluded that dumping is a contributory cause of the reduced energy intake following SV + P.

Adult↗

PubMed1975

Nitrogen balance of men with marginal intakes of protein and energy.

Present protein allowances are based on amounts of nitrogen (N) that maintain balance in adults in laboratory tests. In most tests of minimum N need, energy intakes were higher than present allowances and generally the participants maintained body weight or gained. To evaluate the relative importance of energy and protein intakes in the near-adequate range on the N equilibrium, healthy men were given two levels of protein with energy constant and three levels of energy with protein constant. In the first two 12-day periods, diets provided 5 and 7% of energy (E) from egg white protein with enough E to maintain weight essentially constant (39.6 plus or minus 4.4 kcal/kg). N balance data with these diets were used to select an individual protein intake level nearest to need (5, 6, or 7%), and that level was fed for the next three periods with the same E intake as before (100 E) and 85 or 115% of it. Crude N balance (dietary-fecal-urinary N) was minus0.26 g/day with 5% diet and 0.33 g/day with 7%. Balance was improved by 280 mg/g N fed between these levels. Predicted minimum N need to maintain crude N balance at 100 E is 89 plus or minus 18 mg/kg body weight or 3.76 plus or minus 0.61 mg/basal kcal. N balance fell to minus0.61 g/day with 85 E and increased to 0.59 g/day with 115 E. N balance changed by 174 mg/100 kcal between 85 and 100 E and 112 mg/100 kcal between 100 and 115 E. Energy intake appears to have a much greater effect on N balance than does protein intake in the marginally adequate ranges of intake.

Adult↗

PubMed1994

Intake from an energy-dense porridge liquefied by amylase of germinated wheat: a controlled trial in severely malnourished children during convalescence from diarrhoea.

OBJECTIVE: To evaluate the role of an energy-dense diet liquefied with amylase-rich flour from germinated wheat (ARF) in increasing the energy intake in severely malnourished infants and young children and its acceptability to mothers. DESIGN: A randomized controlled clinical trial with two sets of controls. SETTING: Nutrition rehabilitation unit of a large diarrhoea treatment centre where mothers stay with their very severely malnourished children. SUBJECTS: 78 severely malnourished children aged 5-18 months just recovered from diarrhoea. INTERVENTION: Children were randomly assigned to receive either an energy-dense porridge made liquid by adding ARF (test diet) or an unaltered thick porridge of similar energy density (control 1 diet), or the porridge made liquid with addition of water to have the same viscosity as the test diet but of lower energy (control 2 diet), in four major meals a day for 5 days and intake was measured; breast-milk was measured by test weighing. Children also received an additional three milk-cereal meals a day. RESULTS: The mean energy intake (95% CI, P value for difference between test and control) was 385 (339-431), 289 (251-327, P < 0.005), and 255 (222-289, P < 0.001) kJ/kg.d respectively. Feeding test diet was not associated with significant adverse effects e.g. on diarrhoea, vomiting, breast-milk intake, and was well accepted by mothers. CONCLUSION: The results suggest that use of an energy-dense ARF-treated liquefied porridge increases calorie intake by very severely malnourished children during convalescence from diarrhoea, and that it does not produce any adverse effect.

Amylases↗

PubMed2001

American College of Sports Medicine position stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults.

In excess of 55% of adults in the United States are classified as either overweight (body mass index = 25-29.9 kg.m(-2)) or obese (body mass index > or = 30 kg.m(-2)). To address this significant public health problem, the American College of Sports Medicine recommends that the combination of reductions in energy intake and increases in energy expenditure, through structured exercise and other forms of physical activity, be a component of weight loss intervention programs. An energy deficit of 500-1000 kcal.d-1 achieved through reductions in total energy intake is recommended. Moreover, it appears that reducing dietary fat intake to <30% of total energy intake may facilitate weight loss by reducing total energy intake. Although there may be advantages to modifying protein and carbohydrate intake, the optimal doses of these macronutritents for weight loss have not been determined. Significant health benefits can be recognized with participation in a minimum of 150 min (2.5 h) of moderate intensity exercise per week, and overweight and obese adults should progressively increase to this initial exercise goal. However, there may be advantages to progressively increasing exercise to 200-300 min (3.3-5 h) of exercise per week, as recent scientific evidence indicates that this level of exercise facilitates the long-term maintenance of weight loss. The addition of resistance exercise to a weight loss intervention will increase strength and function but may not attenuate the loss of fat-free mass typically observed with reductions in total energy intake and loss of body weight. When medically indicated, pharmacotherapy may be used for weight loss, but pharmacotherapy appears to be most effective when used in combination with modifications of both eating and exercise behaviors. The American College of Sports Medicine recommends that the strategies outlined in this position paper be incorporated into interventions targeting weight loss and the prevention of weight regain for adults.

Adult↗

PubMed1996

Photoperiod duration and energy balance in the pigeon.

Energy balance, and daily rhythms in feeding activity, body temperature (Tb), metabolic rate (O2 consumption), and RQ (CO2/O2) that affect that balance, were studied in pigeons when the duration of the photophase gradually lengthened (LP group) or shortened (SP group) from an initial starting point at LD 12:12. The end point of change for the LP group was LD 21:3, and for the SP group was LD 3:21. Standard laboratory conditions were in effect (moderate ambient temperature; ad lib food and water). On LD 12:12, energy balance was positive (the ratio of gross energy intake to energy expenditure approximated 1.25). In the light phase, a bimodal pattern of feeding was accompanied by elevated levels in Tb, O2 consumption, and RQ; in the dark phase, Tb and O2 consumption fell at lights-off, and prior to lights-on there were anticipatory rises in both measures and a drop in RQ. Energy balance was remarkably constant over a wide range of photoperiods, but at the shortest photoperiods energy balance became more positive (approximately 1.45) because energy intake increased without much change in energy expenditure. Changes in the daily rhythms of the various measures provided some bases for understanding the changes in energy balance. Analysis of the Tb rhythms indicated that the circadian system of the pigeon appears to be capable of adjusting to a wide range of photoperiods. It is suggested that the increase in energy balance at short photoperiods may occur because of inadequate feedback from nutritional and metabolic signals, or may reflect anticipatory winter seasonal adjustments triggered by photoperiod duration.

Animals↗

PubMed1989

Overall intake of energy and key nutrients: data for middle-aged and older middle-class adults.

The reported 7-day dietary intake is described for 60 middle-aged and older middle-class adults aged 45-75 years. The 30 men, who apparently were mostly still moderately active (reported average energy intake for 7-day recording period 11.7 +/- 3.6 MJ/day) showed few deficiencies in the intake of key nutrients relative to standard dietary recommendations. The 30 women were relatively inactive (reported average energy intake 8.1 +/- 1.9 MJ/day). In consequence, some of them had less than an optimal intake of vitamin A, riboflavin and thiamin, while 25 of 60 subjects (17 women, 8 men) had a calcium intake of less than 800 mg/day. Calcium intake was quite closely correlated to total energy intake. Given that a low level of physical activity was apparently responsible for the failure to meet recommended dietary allowances, an increase of habitual physical activity may thus be commended as a simple approach to the optimisation of diet in the sedentary and economically comfortable older adult.

Aged↗

PubMed1985

What sort of teenager has high intakes of energy and nutrients?

An alternative statistical technique, based on analysis of the 75th percentile, was used to examine teenagers' diets. The technique was developed to identify personal characteristics that affected the prevalence of high energy and nutrient intakes. It provided useful information not obtainable from methods based on average intakes. The study sample was a representative sample of 1055 high-school students in Tasmania, Australia, aged 11-16 years. Among girls, the prevalence of high intakes of energy and several nutrients was not affected by any of the fifteen characteristics studied. (In this context, 'high' was defined as above the 75th percentile for girls.) Fatter, heavier girls were less likely to have high intakes of carbohydrate, iron and niacin-equivalent, and also of meat and 'empty-energy' foods. Girls from small families were less likely to have high calcium intakes, and girls from government schools less likely to have high thiamin intakes. Among boys, age generally had the greatest influence on the prevalence of high intakes ('high' being defined as above the 75th percentile for boys). Older boys were more likely to have high intakes of energy and most nutrients, as well as meat, cereals and fruit and vegetables. These age-related changes were, however, rather asynchronous. High fat intakes were more common among boys who had drunk more than five glasses of alcoholic beverages in the preceding week. High Ca intakes were more frequent among those who exercised vigorously, and high vitamin A intakes less common among the sons of well-educated mothers.

Adolescent↗

PubMed1990

Energy imbalance and cancer of the breast, colon and prostate.

In Western societies, energy imbalance is characterized by obesity and sedentary life styles and is associated with increased morbidity and mortality from all causes of cancer, including cancer of the breast, colon and prostate. The interrelationships of energy intake and energy retention, to energy expenditure and physical fitness need further investigation from the physiologic, metabolic, endocrine and genetic aspects of cancer development, since obesity, energy expenditure and cancer have a familial predisposition. The effects of exercise on estrogen and prostaglandin metabolism and their relationship to cancer development require further investigation. Although the exact amount and intensity of exercise that confers benefit is not known, physical activity and physical fitness are inversely associated with all-cause mortality, including cancer. These findings have important public health implications, because about one-third of persons in industrialized societies are quite sedentary, and the prevalence of low physical fitness is quite high. The balance between total energy intake and expenditure may be more important in cancer development than the intake of any given dietary component or energy source. Exercise increases prostacyclin and decreases the aggregation of platelets and possibly decreases the platelet derived growth factors (PDGF). One could speculate that exercise may in turn decrease the probability of developing colon cancer in those who are predisposed to it, since the SIS oncogene is in fact a variant of PDGF.

Breast Neoplasms↗

PubMed1997

Dietary, anthropometric, hematological and biochemical assessment of the nutritional status of centenarians and elderly people in Okinawa, Japan.

OBJECTIVE: The population of old people has increased and nutritional disorders are common among them. The assessment of nutritional status and dietary intakes of this population is necessary in order to improve their nutritional status and reduce risk to infection and mortality. In the present study, data on the nutritional status of healthy elderly and centenarians is provided. SUBJECTS: Participants were free-living healthy volunteers (39 centenarians; 11 male and 28 female and 44 elderly in their 70s; 13 male and 31 female). METHODS: Their nutritional status was assessed by anthropometric measurements, hematological and biochemical variables. Activities of daily living (ADL) of 11 items were scored depending upon their activities with a maximum score of 5.0. Dietary survey by food recording was done for 2 days and food models were used to obtain the best estimate of food intake. Energy and nutrient intakes were compared with Japanese recommended dietary allowances (RDAs). RESULTS: The elderly had complete independence of physical activities, good sensory function and cognitive abilities. The physical activities of male centenarians were between the category of completely independent and independent but slow. In female centenarian participants, their physical activities were independent but slow or independent with difficulty. The functions of auditory acuity and eyesight of the centenarians were poor but their cognitive abilities were still good. The elderly subjects had short stature whereas their body weight and body mass index (BMI) were not low, especially among the women, compelling female elderly to reduce their food intake to control the weight. Energy intake of female centenarians was low. The ADL in the female centenarians was positively related to energy, suggesting that the low energy intake of the female centenarians was mainly due to their low ADL. Anthropometric, hematological and biochemical variables of the centenarians were lower or near the lower reference limit except serum lipids. All the hematological and biochemical variables were statistically lower (p < 0.05) in the centenarians than in the elderly particularly for females with some minor exceptions. CONCLUSION: The results of the present study showed that the nutritional status assessed by ADL and anthropometric, hematological and biochemical parameters was poor in the centenarian subjects but was maintained in the elderly subjects except height and that the diet was not the major factor of their problems in the nutritional status.

Activities of Daily Living↗