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Effect of reduced dietary intake on energy expenditure, protein turnover, and glucose cycling in man.

The effect of a 50% reduction in food intake on energy expenditure, protein metabolism, glucose cycling, and body composition was investigated in eight moderately overweight men. The prestudy mean calorie and protein intake was determined for eight subjects. They were then maintained on this diet for 6 weeks (mean +/- SEM, 3,269 +/- 75 kcal/d, 20.0 +/- 0.5 g N/d, period I), after which the diet was reduced uniformly in the major foodstuffs by 50% for the next 4 weeks (1,555 +/- 38 kcal/d, 9.6 +/- 5 g N/d, period II). At the end of each period we measured (1) body fat and fat free mass by underwater weighing, (2) 24-hour energy expenditure by indirect calorimetry in a calorimeter, (3) whole body protein synthesis and breakdown rates with 15N glycine, and (4) glucose cycling between glucose and glucose-6-phosphate and fructose cycling between fructose-6-phosphate and fructose-1,6 bisphosphate with 6,6-D2- and 2-D1-labeled glucose. The results were subjects lost 4.0 +/- 0.1 kg fat (by underwater weighing) during the 4 weeks on the reduced-energy regimen. Protein turnover and glucose cycling were reduced by 20% and 15%, respectively. Twenty-four-hour energy expenditure was 2,553 +/- 166 kcal/d for period I and 2,369 +/- 69 kcal/d for period II, giving a difference of 184 +/- 34 kcal/d between the two periods. In conclusion, (1) although energy intake was reduced by 50%, the decrease in energy expenditure was small due to the buffering effect of body fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

Homeostatic and non-homeostatic pathways involved in the control of food intake and energy balance.

A neural network sensitive to leptin and other energy status signals stretching from the hypothalamus to the caudal medulla has been identified as the homeostatic control system for the regulation of food intake and energy balance. While this system is remarkably powerful in defending the lower limits of adiposity, it is weak in curbing appetite in a world of plenty. Another extensive neural system that processes appetitive and rewarding aspects of food intake is mainly interacting with the external world. This non-homeostatic system is constantly attacked by sophisticated signals from the environment, ultimately resulting in increased energy intake in many genetically predisposed individuals. Recent findings suggest a role for accumbens-hypothalamic pathways in the interaction between non-homeostatic and homeostatic factors that control food intake. Identification of the neural pathways that mediate this dominance of cortico-limbic processes over the homeostatic regulatory circuits in the hypothalamus and brainstem will be important for the development of behavioral strategies and pharmacological therapies in the fight against obesity.

Appetite↗

Nutritional status of institutionalized and free-living elderly in Alexandria.

Because of an increase in the number of elderly and the problems of nutrition associated with them, it is of interest to study the nutritional status of elderly persons in Alexandria City. The purpose of this study was to assess the nutritional status of elderly population and to compare between the nutritional status of those institutionalized and those living free. The study was conducted on 240 elderly persons (120 institutionalized and 120 free living) selected randomly from institutions and from different sites. The basic data, weight, height, body mass index (BMI) of each were recorded. Dietary intake study was done by using 24 hours recall for 3 consecutive days and food frequency were used to obtain the best estimate of food intake. Energy and nutrient intakes were obtained and compared with the recommended dietary allowance (RDAs). The main findings of the study revealed that the mean age of the institutionalized elderly was greater than those living free. Percent of obesity among females was 71.7% among free living and 45% among institutionalized. Under-nutrition was present in 11.7% and 8.3% of institutionalized males and females respectively. Food habits showed that institutionalized subjects consume more amounts of many food items than free-living. Total daily energy intake was found to be below the recommendation for all subjects, with higher intake among institutionalized than free living. Nutrient intakes among institutionalized and free living elderly were inadequate except thiamin, riboflavin, vitamin C and iron. The nutrients least adequately supplied in the diets of elderly are vitamin A and calcium along with energy deficits. In conclusion both institutionalized and free living are at risk for developing nutrient deficiencies. Deficient energy, calcium and vitamin A are common problems among most subjects. The composition of the diet among free living subjects seem to be also poor in some micronutrients. We recommended a nutrition intervention program and nutrition education to improve nutritional status of elderly people.

Aged↗

Dietary fat intake does affect obesity!

There is a difference of opinion about whether the percentage of dietary fat plays an important role in the rising prevalence of overweight and in its treatment once it has developed. We believe that ample research from animal and clinical studies, from controlled trials, and from epidemiologic and ecologic analyses provides strong evidence that dietary fat plays a role in the development and treatment of obesity. A reduction in fat intake reduces the gap between total energy intake and total energy expenditure and thus is an effective strategy for reducing the present epidemic of obesity worldwide. A review of the results from 28 clinical trials that studied the effects of a reduction in the amount of energy from fat in the diet showed that a reduction of 10% in the proportion of energy from fat was associated with a reduction in weight of 16 g/d. We thus conclude that dietary fat plays a role in the development of obesity. To reduce the prevalence of obesity, there must be an increase in energy expenditure, a reduction in total energy intake, or both. This goal can be facilitated by reducing the amount of fat in the diet.

Animals↗

Obesity management--new perspectives.

Obesity represents a growing threat for the health of population worldwide. The decline of physical activity and the passive overconsumption of energy-dense, high-fat diets are important factors that explain the increased prevalence of obesity. Despite many efforts, the prevention and the treatment of obesity are often a failure. Since obesity development is due to a chronic imbalance between energy intake and energy expenditure, the most important advice for the prevention and the treatment of this nutritional disorder remains the reduction of high-fat foods and the stimulation of fat oxidation by promoting physical activity. The recent advances in our understanding of the control of food intake and of energy expenditure offer the hope that new therapeutic agents will become available over the next decade. This article briefly presents our present understanding of the main mechanisms which are responsible for the increased prevalence of obesity and some new areas of research which may be promising for the prevention and treatment of this disease.

Anti-Obesity Agents↗

Children with coeliac disease and insulin dependent diabetes mellitus--growth, diabetes control and dietary intake.

We aimed to assess the growth, diabetes control, dietary intake and compliance with a gluten-free diet in children with insulin dependent diabetes mellitus (IDDM) and coeliac disease in a major paediatric and adolescent diabetes clinic. Children with IDDM and biopsy-proven coeliac disease aged <18 years were included and compared with IDDM controls matched for age, sex and duration of diabetes. Twenty patients with coeliac disease and IDDM participated (15 female, age 7.4-17.3 yr), with two matched IDDM controls for each (age 6.9-17.4 yr). The prevalence of coeliac disease in this diabetes clinic population was 2.6%. All patients completed a 3 day food record (3DFR) and a 7 day food frequency questionnaire (FFQ) to assess dietary intake and gluten-free compliance. Diabetes control measured by HbA1c was not different between groups or compared to the overall clinic population (8.48 +/- 0.98% for coeliac patients vs 8.87 +/- 1.46 for IDDM controls vs 8.60 +/- 1.30 for overall clinic population aged 5.0-17.9 yr). Height, weight and BMI standard deviation scores were not different between coeliac patients and IDDM controls. No clinically significant differences were found in intake of energy, macronutrients or micronutrients. The proportion of energy intake from carbohydrate, protein and fat was within recommended ranges, except for a higher saturated fat intake. Only 30% of coeliac patients complied with a strict gluten-free diet, but growth parameters were unaffected by dietary compliance. Thus, we found that children and adolescents with coexisting IDDM and coeliac disease have normal growth, equivalent diabetes control and no differences in energy or nutrient intake compared to matched IDDM controls in our clinic population.

Adolescent↗

Liquid versus solid carbohydrate: effects on food intake and body weight.

BACKGROUND: Beverages are contributing an increased proportion of energy to the diet. Because they elicit a weak compensatory dietary response, they may increase risk of positive energy balance. OBJECTIVES: This study aimed to document the differential effects of matched liquid and solid carbohydrate loads on diet and body weight. DESIGN: In a cross-over design, seven males and eight females consumed dietary carbohydrate loads of 1880 kJ/day as a liquid (soda) or solid (jelly beans) during two 4 week periods separated by a 4 week washout. Subjects were permitted to consume the loads however they chose. In addition to baseline measurements, diet records were obtained on random days throughout the study, body composition was measured weekly, physical activity was assessed before and after treatments and hunger was assessed during washout and midway through each treatment. RESULTS: Free-feeding energy intake during the solid period was significantly lower than intake prior to this period. Dietary energy compensation was precise (118%). No decrease in free-feeding energy intake occurred during the liquid period. Total daily energy intake increased by an amount equal to the load resulting in dietary compensation of -17%. Consequently, body weight and BMI increased significantly only during the liquid period. Physical activity and hunger were unchanged. CONCLUSIONS: This study indicates that liquid carbohydrate promotes positive energy balance, whereas a comparable solid carbohydrate elicits precise dietary compensation. Increased consumption of energy-yielding fluids may promote positive energy balance.

Adult↗

Estimation of energy requirements for adults: Tehran lipid and glucose study.

OBJECTIVE: This study was conducted to determine the energy intake of adult residents of district 13 of Tehran and compare the results with their energy requirements. DESIGN: In this cross-sectional study, 403 subjects were selected by random sampling, including 145 men and 151 women aged 25-50 years and 57 men and 50 women over 50 years old in the framework of Tehran Lipid and Glucose Study (TLGS). MEASUREMENTS: Height, body weight, waist and hip circumferences were measured, and the body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Mean energy requirements for each sex-age group were estimated by multiplying specific coefficients (allocated to each group) by body weight and resting energy expenditure (REE), and the results of both methods were compared with mean energy values recommended by Food and Agriculture Organization (FAO)/World Health Organization (WHO) and the U.S. recommended dietary allowance (RDA). Dietary assessment was performed by 48-hour diet recall. A ratio of energy intake to basal metabolic rate lower than 1.27 was considered as under-reporting. Physical activity was evaluated by standard questionnaire of the Lipid Research Clinics (LRC). RESULTS: Women were significantly more overweight and obese than men (p < 0.001) and older women were more obese than younger ones (p < 0.05). Only one-third of the study population had adequate physical activity. Women had significantly lower physical activity than men (p < 0.01). Energy requirements for both age and sex groups were lower than recommended daily allowances for energy: men 25-50; 2576 vs. 2900; men > 50: 2155 vs. 2300; women 20-50: 2045 vs. 2200 and women > 50: 1817 vs. 1900 kilocalories (kcal). Reported energy intake of men was higher and that of women was lower than the RDA. Forty percent of women and 14% of men under-reported their energy intake. CONCLUSION: The energy requirement of the average Tehranian is lower than daily allowances; conditions of obesity and overweight are more prevalent in women. There is high frequency of under-reporting of energy intake in women. Lifestyle modifications to improve dietary habits and to increase physical activity are recommended to decrease overweight and obesity in urban population of Tehran.

Adult↗

The independent and combined effects of 16 weeks of vigorous exercise and energy restriction on body mass and composition in free-living overweight men--a randomized controlled trial.

This study assessed the effects of 16 weeks of energy restriction and vigorous exercise on body mass and body composition. Sixty sedentary men, mean body mass (mean +/- SD) 96.3 (13.9) kg and mean age 42.4 (5.0) years, were randomly assigned to either continue their normal energy intake or restrict energy intake by 4,186 to 6,279 kJ. d(-1). Each group was further randomized to a control light exercise program, or a vigorous exercise program for 3 half-hour sessions per week. Vigorous exercise improved maximum oxygen consumption (Vo(2max)) by approximately 24% (0.56 [95% confidence interval, 0.47 to 0.65) L. min(-1), P <.001) with no significant changes in body mass, body composition, or fat distribution. With energy restriction there was a significant reduction in body mass of 10.1 (8.0 to 12.2) kg, lean body mass (LBM) of 2.4 (1.5 to 3.3) kg, fat mass (FM) of 7.7 (5.9 to 9.6) kg, waist to hip ratio (WHR) of 0.03 (0.01 to 0.04), and the sum of 6 skinfolds of 26.9 (15.4 to 38.4) mm (P <.001). Combining vigorous exercise with energy restriction resulted in no further changes in measures of body composition. We conclude that in sedentary free-living overweight men, 16 weeks of energy restriction, but not vigorous intensity exercise, results in substantial reductions in body mass, LBM, and FM. Furthermore, vigorous intensity exercise when combined with energy restriction did not modify or enhance the changes in body fat distribution or body composition seen with energy restriction alone. The independent effects of exercise to induce changes in body mass and composition in the longer term in free-living overweight subjects on an energy-restricted diet deserve further study.

Adipose Tissue↗

Body fat percentage of children varies according to their diet composition.

OBJECTIVE: To ascertain the association between diet composition and body fat percentage in 9- and 10-year-old children. Also, to examine the influence of gender, total energy intake, fitness, physical activity, and parental body mass on the relationship between diet composition and adiposity. DESIGN: Diet composition was assessed using the National Cancer Institute food frequency questionnaire, and adiposity was measured using the average of results determined using two skinfold equations. Fitness levels and physical activity were ascertained using the 1-mile run/walk test and a self-report 15-item scale, respectively. SUBJECTS: A sample of 262 children (162 boys and 100 girls, mean age = 9.8 +/- 0.5 years) participated. STATISTICAL ANALYSIS: Regression analysis was used to determine the extent to which diet composition contributed to adiposity without statistical control for any potentially confounding variables. Partial correlations were calculated to assess the relationship between macronutrient intake and adiposity after potential confounders (gender, total energy intake, physical fitness, and parental body mass) were controlled statistically. RESULTS: Energy intake was positively related to adiposity. Fat intake, calculated as a percentage of total energy, was also positively related to adiposity, before and after control for potential confounding variables. Percentage of energy derived from carbohydrate was inversely related to adiposity, before and after controlling for potential confounders. APPLICATIONS: These findings indicate that the macronutrient intake of children, particularly dietary fat and carbohydrate intake, may play a role in adiposity, independent of the influence of total energy intake, gender, physical fitness, and parental body mass index.

Adipose Tissue↗

Changes with malnutrition in the concentration of plasma vitamin D binding protein in growing rats.

The work presented here examines the possible effects of nutritional deficiencies on the characteristics of the plasma transport protein for vitamin D and its metabolites (vitamin D binding protein, DBP) in the growing rat. Deficiencies in both dietary protein intake and dietary energy intake may decrease the concentration of DBP in the circulation, although plasma DBP was not affected by dietary Ca deficiency. None of the dietary factors examined appears to influence the affinity of DBP for its major ligand, 25-hydroxycholecalciferol (25(OH)D(3)). Protein-deficient rats seemed to have difficulty in maintaining adequate concentrations of 1,25-dihydroxycholecalciferol (1,25(OH)(2)D(3)) in the circulation. The sensitivity of DBP to dietary protein and energy intake may constitute a novel mechanism that may help to explain the observed associations between malnutrition and the development of metabolic bone disease, through alterations to the cellular availability of vitamin D ligands to DBP.

25-Hydroxyvitamin D 2↗

Interrelation among dietary energy and fat intakes, maternal body fatness, and milk total lipid in humans.

The relationship between maternal dietary intakes of energy or fat maternal body composition and the milk fat concentration is an important element in understanding the role of breast-milk in infant nutrition. In most studies in both developing and developed countries, no relation between maternal energy intake and milk fat content was observed. In only one published study, in which maternal fat intake comprised a very low 5% of calories, was a short term reduction in milk lipid observed in some subjects. On the other hand, a positive relation between maternal fatness and milk fat is evident in both well-nourished and under-nourished women when appropriate methodologies have been used. Low milk fat concentrations are associated with higher milk volumes probably because infant demand determines milk intake, compensating, at least partially, for low milk fat. No impairment of infant growth was associated with low milk fat, in studies where it has been measured. The mechanism for the relationship between body fat and milk fat is a fertile field for additional investigation.

Adipose Tissue↗

Effect of fish oil on cancer cachexia and host liver metabolism in rats with prostate tumors.

The aim of this study was to investigate whether tumor-induced cachexia and aberrations in host liver metabolism, induced by the MAT-LyLu variant of the Dunning prostate tumor, could be prevented by omega 3 fatty acids from fish oil. On day 0, adult Copenhagen-Fisher rats fed normal chow ad libitum were inoculated with 10(6) MAT-LyLu cells (n = 14) or saline (n = 9). On day 7, when tumors were palpable, four tumor-bearing (TB) and four nontumor-bearing (NTB) rats were put on isocaloric diets with 50% of total energy as fish oil. The introduction of fish oil-enriched diets caused a reduction in energy intake to less than half of the energy intake by animals fed normal diets during days 7-14 (difference by dietary group: NTB, P < 0.001; TB, P < 0.001). During days 14-21, energy intake in fish oil-fed animals returned to approximately 75% of energy intake by animals fed normal diets (difference by dietary group: NTB, P < 0.003; TB, P = 0.001). Carcass weight of animals on day 21, when the study was terminated, was significantly related to initial weight (P = 0.05) and mean food intake during the study (P = 0.01). When data were adjusted for these variables using analysis of covariance, with NTB animals on normal diets being the reference group, significant loss of carcass weight was observed in TB animals on normal diets only (mean +/- SEM 58 +/- 10 g loss, P < 0.001), but not in TB animals on fish oil diets (8 +/- 18 g loss, P = 0.67).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Resistant starch as energy.

OBJECTIVE: This study was designed to compare the metabolizable energy of two starch sources, standard cornstarch and high amylose cornstarch. METHODS: Diets containing 70% amylose (AM) or 70% amylopectin (AP) cornstarches were fed to 10 control and 14 hyperinsulinemic men for 14 weeks. During the last 4 weeks of each period, subjects were fed a controlled diet containing 34% of total energy from fat, 15% from protein and 51% from carbohydrate (55% of carbohydrate provided AM or AP). Duplicate food and all urine and feces were collected during the second week of the controlled diets for energy, nitrogen, fiber and starch determinations. Metabolizable energy (ME) was calculated as [energy intake minus (fecal plus urinary energy excretion)]. RESULTS: Total fiber uncorrected for resistant starch was 35.2 g and 48.8 g in the AP and AM diets, respectively. The AM diet contained an average of 29.7 g resistant starch (16% of total starch) while the AP diet averaged 0.8 g (less than 0.01%). ME was not significantly different between the AM and AP diets nor between the control and hyperinsulinemic subjects. Fecal energy and nitrogen was significantly higher after the AM compared to AP diet. Based on energy intake and fecal excretion from all subjects, the partial digestible energy value for the resistant starch averaged 11.7 kJ/g resistant starch which was 67.3% of the energy of standard cornstarch. Control and hyperinsulinemic subjects differed in their ability to digest resistant starch, averaging 81.8% and 53.2, respectively. The hyperinsulinemic, but not control, subjects had significantly higher breath hydrogen expirations (LS means, p > 0.05) in the fasting, 1-5 hours and 7 hour collections after consuming the AM when compared to the AP tolerance meal. CONCLUSIONS: The type of starch consumed in the diet did not statistically affect metabolizable energy. Based on ME and breath hydrogen expiration, amylose and the resistant starch from amylose appears to be utilized as an energy source. Resistant starch averaged 2.8 kcal/g for all 24 subjects but only 2.2 kcal/g in the hyperinsulinemic subjects.

Adult↗

Do highly physically active females have a lowered basal metabolic rate?

In several studies estimated energy intake has been found to be low compared with estimated energy expenditure in female athletes. It has therefore been suggested that female athletes may have a depressed basal energy expenditure (BMR). The main purpose of the present study was to explore this possibility by measuring BMR in physically extremely active females. Eight female dancers and 7 controls with low physical activity, all musicians, were studied; the variables measured included body weight, height, skinfold thickness and total body potassium. BMR was measured by indirect calorimetry. In conclusion, the present study lends no support to the idea of a lowered basal metabolic rate in female athletes as an explanation of the general finding of a lower estimated energy intake than energy expenditure in this type of subjects.

Adult↗

Effects of marginally negative energy balance on insulin binding to erythrocytes of normal men.

Six healthy male volunteers were confined to a metabolic unit for 105 days. Energy intake (EI) and energy expenditure (EE) were varied in order to achieve either a marginally negative (-15%) or an equilibrated energy balance (EB), in different metabolic periods (MP) as follows: MP I: EE = 1, EI = 1, EB = 0; MP II: EE = 1, EI = 0.85, EB = -15%; MP III: EE = 0.85, EI = 0.85, EB = 0; MP IV: EE = 0.85, EI = 0.70, EB = -15%; MP VI: EE = 1.15, EI = 1.15, EB = 0; MP VII: EE = 1.15, EI = 1, EB = -15%. An egg protein formula diet was fed throughout the study. The amount given in MP I was sufficient to maintain body weight constant. Assigned physical activity consisted of regulated walking and cycling. During MP I, this physical activity accounted for 15% of the energy intake. Serum insulin, insulin binding to erythrocytes and body fat content were determined at the end of each MP. No significant changes were found in serum insulin level throughout the study, but specific insulin binding did change significantly. Binding increased with increased physical activity by 23% at the end of MP VI and an additional 35% at the end of MP VII. The maximum percentage of insulin binding to erythrocytes correlated inversely with the percentage of body fat in each MP. These data suggest that insulin binding to erythrocytes, in normal men, is sensitive to a small change in energy balance, and especially to physical activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Children with congenital heart disease: a nutrition challenge.

Growth in children with congenital heart disease (CHD) is often compromised. For several decades, investigators have tried to identify the factors affecting growth in children with CHD. Cardiac malformations are undoubtedly responsible for malnutrition, which may range from mild undernutrition to severe failure to thrive (FTT). Malnutrition may then significantly undermine the outcome of corrective surgical operations and postoperative recovery. Mechanisms linking CHD to malnutrition may be related either to decreased energy intake and/or to increased energy requirements. Decreased energy intake can involve deficiencies of specific nutrients, or insufficient total caloric intake. Increased respiratory rate accompanying congestive heart failure may be responsible for increased energy requirements. Different types of cardiac malformations and consequent interventions may have different effects on growth and require diverse strategies. Most treatment strategies aim to facilitate "catch-up" growth, providing extra calories and protein that exceed the Recommended Dietary Allowance for age. However, there is no generally accepted set of guidelines that define appropriate caloric intake for catch-up growth. We attempt to identify the most important causes of malnutrition and highlight the most effective nutrition strategies for children with CHD.

Energy Intake↗

A low-fat intake and greater activity level are associated with lower weight regain 3 years after completing a very-low-calorie diet.

OBJECTIVE: To examine the roles of diet, exercise, and lifestyle factors in determining long-term weight regain after weight loss with a very-low-calorie diet (VLCD). SUBJECTS: Twenty-seven of 38 women who lost weight with a VLCD. DESIGN: Graduates of a weight loss intervention study returned for follow-up 3 years after program completion. Percentage of initial weight loss that was regained was correlated with subjects' fat intake (assessed via 7-day food records and a Diet Habit Survey), energy intake (assessed via 7-day food records), activity level and lifestyle factors (assessed via questionnaires) that are supportive of weight loss maintenance. STATISTICAL ANALYSES PERFORMED: Regression analysis was used to assess the relationship of weight regain with fat intake, activity level, and energy intake. Contingency table analysis was used to assess the association between weight regain and lifestyle factors. RESULTS: Subjects followed experienced a -20.7kg+/-9.2kg (-19.2%+/-7%) (mean+/-standard deviation) weight change during the original VLCD program and a 13.9kg+/-11.3kg (76.6%+/-52.1%) weight change 3 years post-VLCD. Fat intake, assessed by a 7-day food diary, was positively correlated with weight regain at 3 years (r=0.66, P=.0004). Less weight regain was also seen with a lower percent fat intake as reflected by a higher Diet Habit Survey score (r=-0.55, P=.004). Women with the lowest tertile of reported fat intake (<25% of energy) from the Diet Habit Survey regained the least amount of weight (P=.05). Activity level was negatively correlated with weight regain (r=-0.53, P=.005). After correction for multiple comparisons, there was no association between total energy intake and weight regain. Lifestyle factors were also not associated with weight regain. APPLICATIONS/CONCLUSIONS: Identifying strategies to maintain weight loss is crucial because of the negative health effects and increasing prevalence of obesity. For women who have lost weight on a VLCD, limiting dietary fat intake and maintaining physical activity are both important factors for the prevention of weight regain. To promote better weight loss outcomes, registered dietitians should help clients who have lost weight limit their fat intake to less than 30% of energy and encourage high activity levels.

Adult↗