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PubMed2004

Predictors of body size in the first 2 y of life: a high-risk study of human obesity.

OBJECTIVE: To ascertain the predictors of body size at 2 y of age. DESIGN: : Prospective, longitudinal study of risk factors for weight gain of infants at high or low risk of obesity by virtue of their mothers' obesity or leanness. SUBJECTS: A total of 40 infants of obese mothers and 38 infants of lean mothers, equally divided among boys and girls. METHODS: Measurement of dependent variables: weight, length and skinfold thicknesses at 3, 6, 9, 12, 18 and 24 months and percent body fat at 3, 12 and 24 months. Measurement of independent variables: average daily caloric consumption at 3, 6, 9, 12, 18 and 24 months; and, at 3 months, nutritive sucking behavior during a test meal, total energy expenditure (TEE), sleeping energy expenditure (SEE), estimation of nonsleeping energy expenditure (TEE-SEE) and socioeconomic status. Parental weights and heights were obtained by self-report at the time of recruitment. Partial correlation and mixed effects linear regression analyses were performed. RESULTS: Measures of body size (weight, length, skinfold thicknesses) and percent of body fat were almost identical between high- and low-risk groups at all times. Energy intake during six occasions over the 2 y, sucking behavior, family income and TEE predicted weight gain, controlling for body length. Parental body mass index was not associated with the child's body size during the first 2 y. During the first year, there were strong lagged correlations between energy intake and body weight and smaller correlations between protein intake and body weight. CONCLUSION: Energy intake, and not energy expenditure, was the determinant of body size in these infants at 2 y of age, as it had been at 1 y. Sucking behavior and TEE (positively) and family income (negatively) also contributed to body weight at 2 y. The novel finding of a lagged correlation between energy intake and body weight early in life suggests that energy intake is programmed for future growth and development.

Body Constitution↗

PubMed2006

Weight loss in Parkinson's disease.

Weight loss is frequent in patients with Parkinson's disease (PD). Reduced energy intake and/or increased energy expenditure have been postulated as the cause. Dysphagia, anorexia, and gastrointestinal dysfunction may be possible causes of reduced energy intake; whereas, rigidity, tremor, and levodopa-induced dyskinesia may increase energy expenditure. Levodopa may enhance glucose metabolism resulting in enhanced energy expenditure. Depression, anti-parkinsonian drugs, and medical complications such as pneumonia and malignancies also may facilitate weight loss in PD. Combinations of various degrees of these factors, especially in advanced PD, may produce weight loss. Such weight loss is associated with malnutrition which may precipitate infection and decubitis; accelerate motor, behavioral, and autonomic impairment; consequently spoiling one's quality of life. Attention must be paid as well to motor symptoms to prevent or reverse weight loss in PD patients.

Humans↗

PubMed2005

Adequate feeding and the usefulness of the respiratory quotient in critically ill children.

OBJECTIVE: We determined incidences of underfeeding and overfeeding in children who were admitted to a multidisciplinary tertiary pediatric intensive care and evaluated the usefulness of the respiratory quotient (RQ) obtained from indirect calorimetry to assess feeding adequacy. METHODS: Children 18 y and younger who fulfilled the criteria for indirect calorimetry entered our prospective, observational study and were studied until day 14. Actual energy intake was recorded, compared with required energy intake (measured energy expenditure plus 10%), and classified as underfeeding (<90% of required), adequate feeding (90% to 110% of required), or overfeeding (>110% of required). We also evaluated the adequacy of a measured RQ lower than 0.85 to identify underfeeding, and an RQ higher than 1.0 to identify overfeeding. RESULTS: Ninety-eight children underwent 195 calorimetric measurements. Underfeeding, adequate feeding, and overfeeding occurred on 21%, 10%, and 69% of days, respectively. An RQ lower than 0.85 to identify underfeeding showed low sensitivity (63%), high specificity (89%), and high negative predictive value (90%). An RQ higher than 1.0 to indicate overfeeding showed poor sensitivity (21%), but a high specificity (97%) and a high positive predictive value (93%). Food composition, notably high-carbohydrate intake, was responsible for an RQ exceeding 1.0 in the overfed group. CONCLUSION: Children admitted to the intensive care unit receive adequate feeding on only 10% of measurement days during the first 2 wk of admission. The usefulness of RQ to monitor feeding adequacy is limited to identifying (carbohydrate) overfeeding and excluding underfeeding.

Adolescent↗

PubMedDate not supplied

Does a liquid supplement improve energy and protein consumption in nursing home residents?

One popular strategy to improve the acceptance and efficacy of oral liquid supplements in long-term care is dispensing them during the medication pass, although few studies support its effectiveness. This study evaluated the impact of a supplement medication pass program on energy and nutrient consumption and weight in nursing home residents. Findings indicate that residents maintained their prestudy weight and had a 29% decrease in supplement energy intake, a 19% increase in food energy intake, and a 17% decrease in net energy intake (supplement plus food). Supplement and food protein intake remained stable. Over longer periods, this reduced energy consumption could lead to weight loss, so routine monitoring and periodic evaluations of resident intake (both food and supplement) are recommended to ensure residents are receiving and consuming adequate amounts of daily energy and nutrients.

Aged↗

PubMed1991

Genetic parameters of growth, feed intake, feed conversion and carcass composition of dual-purpose bulls in performance testing.

Genetic parameters for growth, total energy intake, feed conversion ratio, average daily energy intake and carcass composition were estimated in an experiment with 650 bull calves from 31 half-sib groups of Holstein Friesian or Brown Swiss sires. All traits analyzed had an amount of additive genetic variance that allows for considerable response to selection. No interaction between genotype (sire group) and proportion of roughage in the diet was found. Daily gain was strongly correlated negatively with feed conversion ratio but positively correlated with daily energy intake. Results indicate that genetic selection for either daily gain or average daily energy intake would decrease carcass fatness at a constant slaughter weight. However, the environmental correlation between daily energy intake and carcass fatness was positive.

Animals↗

PubMed1989

Food and nutrient intakes in Swedish diabetic children.

Food and energy intakes in diabetic children, 7-9 and 12-14 years of age, were studied by the 7-d record method. The mean duration of diabetes in the younger group was 3.0 years and in the older group 4.2. The children had 3 main meals and 3.4 light meals daily. The median daily number of sandwiches was 7, often offered as snacks. All children used a low-fat margarine, low-fat cheese and low-fat milk. Sweets and diabetic food were seldom used. Of the energy intake protein contributed 18 per cent, fat 32 per cent and carbohydrates 50 per cent, including sucrose 2 per cent. Mean daily intake of fibre was 20 g. Compared to healthy children of the same age and from the same areas of Sweden the diabetics had a more regular meal pattern, their energy intakes did not differ, but the diet of diabetics was lower in fat and sucrose and higher in protein. The mean height, weight and BMI did not differ from healthy children.

Adolescent↗

PubMed2002

Strategies for the management of patients with obesity.

The prevalence of overweight and obesity is increasing worldwide. During the last two decades, the prevalence of adults in the higher body mass index (BMI) categories in the US has increased the most, as much as 300% for those with a BMI above 40kg/m2. In children and adolescents, a doubling of the prevalence of severe overweight poses a serious health risk to future generations of young adults who may develop chronic diseases normally associated with aging. The simple definition of obesity, an imbalance between energy intake and energy expenditure, ignores the complexity of, and largely unknown interactions between, genes, food intake and physical activity, which together determine bodyweight and fat distribution. Although the etiology and manifestations of overweight and obesity are complex, the assessment of overweight and obesity requires only an accurate measurement of bodyweight, height and abdominal circumference, as well as a history and physical examination attuned to the morbidities that commonly accompany overweight and obesity such as diabetes mellitus, hypertension, dyslipidemia and sleep apnea. The treatment of patients with overweight and obesity continues to be based on changes to diet and physical activity. Simple behavior modification techniques are within the reach of busy clinicians. The additional use of available bodyweight reduction medications can reliably lead to a 5 to 10% reduction from initial bodyweight, a loss that has been shown to provide significant health benefit. The use of meal replacements has also been shown to be effective and is probably an under-appreciated treatment resource. Surgery is the most successful treatment for those with severe obesity and should be discussed as an option for those in the appropriate bodyweight categories. Because societal trends favor the greater intake of calorie-dense foods and less physical activity to accomplish the activities of daily life, the future of obesity treatment will require the development of bodyweight reduction medications that work by a variety of mechanisms to decrease food intake or increase energy expenditure. Such medications should not be viewed as a 'crutch' but rather as a 'helping hand' that enable people to better adhere to a healthier lifestyle.

Anti-Obesity Agents↗

PubMed1976

The diets of preschool children in Newcastle upon Tyne, 1968-71.

1. Ninety-one families containing 140 children under 4 years of age at enrolment were studied. At 1-monthly intervals, the children were weighed and measured and qualitative information about feeding habits was obtained. Weighed dietary surveys for periods of 5 d were made at approximately 8 months, 3 years, and 5 years of age; there were forty-six failures in 260 surveys attempted. 2. At the four specified ages, mean energy intakes were 3-75, 5-03, 5-82 and 6-75 MJ (896, 1203, 1392 and 1613 kcal)/d respectively. At 8 months, milk products provided on average, 43% of the total energy intake, and commerical baby foods provided 17%. These values decreased to 21 and 2% respectively at 20 months and there was little further change therafter. 3. Average intake of energy and of most nutrients met recommended intakes (Department of Health and Social Security, 1969). Iron intakes were marginal, and vitamin D intakes were low. 4. The energy intake of boys was significantly higher than that of the girls at 3 years of age, but the boys were not significantly heavier. The energy intake of children from "manual-worker" families was higher than that from "non-manual" families. Similarly, the energy intake of children from larger families was higher than that of children from smaller families. 5. Energy intakes were correlated with body-weights and with rates of gain in weight. Irrespective of body-weight, "big eaters" at 20 months tended to be "big eaters" at 3 years also.

Age Factors↗

PubMed2001

Effect of nutrition on endocrine parameters, ovarian physiology, and oocyte and embryo development.

Reproductive efficiency in high yielding dairy cows has decreased over the past 50 years, despite significant gains in genetic selection for increased milk output. One possible reason for this decline has been a change in the nutritional intake to meet the increased energy and protein demands for higher milk production. Excess energy intake in sheep will lead to significant reductions in progesterone concentrations; the effects in cattle are not so clear. Nutrition, unless radically changed, will have little effect on gonadotropin concentrations in ruminants, and this is in contrast to the situation for pigs and for primates, where very short-term nutritional changes manifest themselves in altered gonadotropin secretion. Cattle with reduced energy intake have smaller dominant follicles and more three-wave cycles, compared with animals on higher feed intakes. One of the main areas where nutrition influences reproductive efficiency is at the level of embryo production. Several studies indicate that excess energy intake reduces the response to superovulation and also decrease the yield of embryos and alters expression of some gene constructs within the developing embryo. The mechanism of this effect is not clear but indications are that the quality of the oocytes may be compromised. Indeed recent data indicate that nutritional changes around the time of mating may have detrimental effects on the establishment of pregnancy in heifers. Thus, nutritional balancing is critical for high-yielding dairy cows, in particular. The challenge remains to modify nutritional and management strategies in such cows to maintain the levels of production made possible by genetic selection and still maintain an acceptable level of fertility.

Animal Nutritional Physiological Phenomena↗

PubMed1986

Maintenance energy requirement and net energetic efficiency in mice with a major gene for rapid postweaning gain.

Previous research in this laboratory demonstrated the existence of a major gene (hg), expressed as a homozygous recessive, which increases postweaning growth by 60% in C57Bl/6 mice (line Ch) compared to the same genetic stock without the major gene (line CH). The effect of the hg gene on the maintenance energy requirement and net energetic efficiency of mice between 21 and 42 d of age was examined in a comparative slaughter experiment. Regressions of changes in body energy per kilogram0.75 on metabolizable energy intake per kilogram0.75 indicated that the maintenance energy requirements averaged 164 kcal/(kg0.75 X d) and 155 kcal/(kg0.75 X d) for lines CH and Ch, respectively. Net efficiency of energy utilization was 38.5 and 49.5% for lines CH and Ch, respectively. Ad libitum-fed mice of line Ch gained 46% more total body energy per unit of metabolic body weight (kilogram0.75) than ad libitum-fed mice from line CH while their energy intake per kilogram0.75 was equal. It was estimated that the decreased maintenance energy requirement and increased net energetic efficiency accounted for approximately 25 and 75%, respectively, of the increased energy gain of ad libitum-fed mice of line Ch as compared to CH. The increased energy gain of line Ch was largely (78%) due to an increase fat energy deposition. Regressions of fat energy gain per kilogram0.75 on metabolizable energy intake per kilogram0.75 indicated that the increased fat energy gain was due to an increased efficiency of fat deposition and/or an increased proportion of metabolizable energy available for gain used for fat gain.

Animals↗

PubMed1993

Activity, milk intake and energy consumption in free-living ringed seal (Phoca hispida) pups.

Measurements of growth, activity and energy consumption and estimates of milk intake were made in free-living, nursing ringed seal (Phoca hispida) pups. This was accomplished through the simultaneous use of time-depth recorders and the doubly labelled water technique. The pups spent an average of 52 +/- 7% of their time hauled out on the ice, 37 +/- 5% of the time in the water at the surface, and 11 +/- 5% of the time diving. Average daily mass gain of the pups (n=3) throughout the duration of the study period was 0.35 +/- 0.08 kg. The composition of the mass gain was 76% fat, 6% protein, and 18% water. The total water flux was measured to be 52 +/- 10 ml.kg-1.day-1. Average CO2 production was 0.85 +/- 0.16 ml.g-1.h-1, corresponding to a field metabolic rate of 0.55 +/- 0.10 MJ.kg-1.day-1, or 3.8 +/- 0.6 times the predicted basal metabolic rate based on body size (Kleiber 1975). Average daily milk intake was estimated to be 1379 +/- 390 ml. The field metabolic rate for the different components of seal pup activity budgets were calculated to be FMRhaul out = 1.34 BMR, FMRsurface = 6.44 BMR, and FMRdiving = 5.88 BMR.

Animals↗

PubMed2002

Fat intake affects adiposity, comorbidity factors, and energy metabolism of sprague-dawley rats.

OBJECTIVE: Childhood obesity is an emerging health problem. This study assesses the effects of three levels of dietary fat (10%, 32%, and 45% measured by kilocalories) on weight gain, body composition, energy metabolism, and comorbidity factors in rats from weaning through maturation. RESEARCH METHODS AND PROCEDURES: The role of dietary fat on the susceptibility to obesity was assessed by feeding diets containing three levels of dietary fat to rats from weaning through 7 months of age. Body composition was analyzed by DXA after 6 and 12 weeks of dietary treatment. Energy metabolism was measured by indirect calorimetry. RESULTS: Energy intake, weight gain, fat mass, and plasma glucose, cholesterol, triglyceride, free fatty acid, leptin, and insulin levels increased dose-dependently with increased dietary fat. No difference in absolute lean mass among the three groups was observed. Therefore, the differences in weight gain are accounted for primarily by increased fat accretion. Compared with rats that were relatively resistant to obesity when on a 45% fat diet, diet-induced obesity-prone rats were in positive energy balance and had an elevated respiratory quotient, indicating a switch in energy substrate use from fat to carbohydrate, which promotes body-fat accretion. DISCUSSION: Our data support the hypothesis that administration of increasing amount of dietary fat to very young rats enhances susceptibility to diet-induced obesity and its comorbidities.

Adipose Tissue↗

PubMed2003

Energy balance in obesity.

The current epidemic of human obesity implies that whilst energy balance appears to be regulated, the extent of this regulatory process is being overwhelmed in large numbers of the population by environmental changes. Clearly, the shift towards positive energy balance reflects both alterations in energy intake and decreases in physical activity. Increased energy intake and, in particular, the rising proportion of energy from fat is linked with obesity. However, on a population level reduced levels of activity probably play the predominant role. It is apparent that individual susceptibility to weight gain varies enormously. The factors underlying this susceptibility are an area of intense research interest. Variations in BMR from that predicted appear to be linked to the propensity to gain weight. The genes responsible for this variation may include uncoupling proteins-2 and -3, with a number of studies showing a link with obesity. However, in vivo studies of these proteins have not yet demonstrated a physiological role for them that would explain the link with obesity. Non-exercise activity thermogenesis may also protect from weight gain, but the regulation of this type of thermogenesis is unclear, although the sympathetic nervous system may be important. A profusion of hormones, cytokines and neurotransmitters is involved in regulating energy intake, but whilst mutations in leptin and the melanocortin-3 receptor are responsible for rare monogenic forms of obesity, their wider role in common polygenic obesity is not known. Much current work is directed at examining the interplay between genetic background and environmental factors, in particular diet, that both lead to positive energy balance and seem to make it so hard for many obese subjects to lose weight.

Basal Metabolism↗

PubMed1997

Malnutrition in geriatric patients: a neglected problem?

The nutrient intake in geriatric long-stay patients and the mortality risk associated with low energy intake were studied in 61 patients, 43 women and 18 men, with a mean age of 87 years, at a geriatric long-stay care hospital during a 6-month follow-up. Dietary intake was assessed with a 9-day dietary record. Energy expenditure was calculated assuming a physical activity level of 1.33 x basal metabolic rate (BMR), predicted from equations given by FAO/WHO. Mean energy intakes were 1557 kcal in men and 1280 kcal in women; 84% of the patients had an intake below estimated energy expenditure and 30% were below estimated BMR. Only 5% received dietary supplement. Eleven out of the 61 patients died during the follow-up and the deceased had lower energy intake than the others (1185 kcal vs 1401 kcal, P < 0.05). An energy intake below median (1378 kcal) was associated with an age adjusted increased 6-month mortality risk, odds ratio 12.5. A high proportion of geriatric long-stay patients report dietary intake far below present recommendations and are thereby at risk for having/developing malnutrition. Improved surveillance of geriatric long-stay patients' dietary habits seems justified.

Activities of Daily Living↗

PubMed2004

Oral supplements differing in fat and carbohydrate content: effect on the appetite and food intake of undernourished elderly patients.

BACKGROUND & AIMS: Since fat, relative to other macronutrients, has low satiety and high energy density, it may have therapeutic application for supplementing energy intake. This study compared the effect of isoenergetic (1050 kJ) high fat or high carbohydrate oral supplements, given at breakfast, on the short-term appetite and energy intake in undernourished elderly subjects. METHODS: Sixteen hospitalised, undernourished (body mass index: 20 +/- 3 kg/m2), elderly (77 +/- 8 yr) people were randomly allocated to a control or 1 of 2 supplement groups [fat: carbohydrate: protein (% energy) was 70:25:5 or 25:70:5]. In each group, energy intake (24-h food consumption) and appetite (visual analogue scales) were assessed over 3 consecutive days. RESULTS: Mean energy intake significantly (P = 0.0035) increased following supplementation: high fat 6973 kJ/d, high carbohydrate 6906 kJ/d vs. control 6079 kJ/d but mean voluntary 24-h energy intake remained unaffected. Compared to controls, supplemented subjects experienced reduced hunger (P = 0.07) between breakfast and lunch, but showed no difference over the whole day (P = 0.55). CONCLUSIONS: Under these study conditions a 1050 kJ oral supplement, irrespective of macronutrient composition, does not cause voluntary short-term energy intake compensation in undernourished elderly people.

Administration, Oral↗

PubMed2001

Effects of a liquid diet supplement containing structured medium- and long-chain triacylglycerols on bodyfat accumulation in healthy young subjects.

The effects of a liquid-formula diet supplement containing structured medium- and long-chain triacylglycerols (SMLCT) composed of medium- (10%) and long-chain (90%) fatty acids were compared with those of long-chain triacylglycerols (LCT) on bodyfat accumulation in 13 healthy male volunteers aged 18-20 years. The subjects were randomly assigned the SMLCT or LCT group. The subjects in each group received a liquid-formula diet supplement of the SMLCT or LCT, which provided 1040 kJ plus daily energy intake for 12 weeks. Mean energy intake containing liquid diet throughout the 12-week period did not differ between the SMLCT and LCT groups. Bodyweight of subjects in both groups increased slightly from the baseline throughout the 12-week period, but the differences were not significant. Rates of variation of bodyfat percentage were significantly lower in the SMLCT group than in the LCT group throughout the 12-week period. Comparisons between the SMLCT and LCT groups at baseline and 12 weeks showed no significant differences in any of the biochemical blood parameters. These results suggest that replacing LCT with SMLCT over long periods of time could produce bodyfat loss in the absence of reduced energy intake.

Adipose Tissue↗

PubMed1997

Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy.

Weight gain, a common side effect among breast cancer patients receiving adjuvant chemotherapy, may decrease quality of life and impair survival. Weight gain during treatment is a well-known problem and has been studied by many investigators. However, few controlled studies have been conducted to determine reasons to explain this apparent energy imbalance. An exploratory study was undertaken to quantitate potential changes in energy intake and specific components of energy expenditure in breast cancer patients receiving adjuvant chemotherapy. The research hypothesis was that a reduction in resting metabolic rate (RMR) would be observed during the period in which women received adjuvant chemotherapy. Twenty premenopausal patients with stage I or II breast cancer and receiving cyclophosphamide+doxorubicin+5-fluorouracil; cyclophosphamide +methotrexate+5-fluorouracil+/-doxorubicin; doxorubicin +cyclophosphamide+/-leucovorin; or methotrexate+5-fluorouracil +leucovorin chemotherapy were recruited. RMR, diet-induced thermogenesis, energy intake, physical activity, and body composition were assessed before the initiation and throughout the course of therapy. Complete data on 18 subjects suggest that RMR decreased significantly from baseline to midtreatment (P = 0.02) and rebounded to levels similar to those at baseline on completion of chemotherapy. Overall, levels of physical activity and energy intake also decreased significantly during treatment compared with baseline levels (P = 0.04 and P = 0.03, respectively). These findings suggest that chemotherapy provokes many significant changes in body composition and metabolic requirements. Additional research in this area will provide valuable insight into creating optimal interventions to curb weight gain in women with breast cancer.

Adult↗

PubMed1998

Is macronutrient composition of dietary intake data affected by underreporting? Results from the EPIC-Potsdam Study. European Prospective Investigation into Cancer and Nutrition.

OBJECTIVE: To investigate whether subjects with low reported relative energy intake differ from those with higher relative energy intake according to characteristics such as obesity, physical activity, and macronutrient composition of the diet. DESIGN: Cross-sectional data from a cohort study employing a semi-quantitative food frequency questionnaire (SFFQ). To determine energy intake relative BMR the ratio of reported energy intake (EI) to BMR was used and categorized by quintiles. SETTING: East German (Potsdam) cohort of the EPIC study (European Prospective Investigation into Cancer and Nutrition) SUBJECTS: 2862 women and 2356 men taking part in the EPIC-Potsdam study from January 1st to December 31st 1995. RESULTS: A significant declining trend could be observed for BMI, percentage of body fat, and body weight from the lower to the highest quintile of EI/BMR. BMR was slightly decreasing, whereas physical activity was slightly increasing with quintiles of EI/BMR. Absolute macronutrient intake was directly related to EI/BMR. Percent macronutrient intake indicated lower fat intake, and higher carbohydrate and protein intake in low energy reporters. Energy adjusted macronutrient intake by the residual method showed no dependencies on EI/BMR. CONCLUSIONS: Underestimation of energy intake is related to obesity and affects the relation of macronutrients in the reported diet. This implies, that the assumption of adequate ranking of subjects by a SFFQ cannot be maintained. Energy adjusted intake values according to the residual method should be employed in diet-disease risk analysis since they are found to be independent of the methodological influence of underreporting.

Adult↗