Andrew Prentice

Energy expenditure of Gambian women during peak agricultural activity measured by the doubly-labelled water method.

The doubly-labelled water (2H218O) method was used to measure total energy expenditure (TEE) in ten non-pregnant, non-lactating (NPNL), six pregnant (P) and fourteen lactating (L) women in a rural Gambian community. Measurements were made on free-living subjects at a period of peak energetic stress when high agricultural work loads coincided with a hungary season to induce moderately severe negative energy balance. TEE averaged 10.42 (SD 2.08) MJ/d, equivalent to 1.95 (SD 0.38) times resting metabolic rate (RMR). The energy cost of physical activity plus thermogenesis, derived as TEE-RMR, averaged 4.94 (SD 1.96) MJ/d. Expressed per kg body-weight (103 kJ/kg per d) this component of expenditure was 2.5 times greater than comparative values from inactive, affluent women studied previously (39 kJ/kg per d). Estimated energy intake (EI) in a subset of the women (n 13) was only 4.80 (SD 1.58) MJ/d, yielding an apparent deficit of 6.08 MJ/d between EI and TEE. Weight changes suggested that endogenous fat oxidation accounted for only about 0.85 MJ/d, leaving an unexplained difference of over 5 MJ/d. Critical analysis of possible errors suggests that the new doubly-labelled water method has provided the most reliable estimates and that the estimates of EI were substantially in error. This finding has important consequences for other food intake studies.

UNEXPECTEDLY LOW LEVELS OF ENERGY EXPENDITURE IN HEALTHY WOMEN

A new method for measuring total energy expenditure (TEE) with stable isotopically labelled water (2H218O) was used to measure average daily energy expenditure over 14-21 day periods in 12 healthy women following their normal activity patterns. TEE expressed as a multiple of basal metabolic rate (TEE/BMR) averaged only 1 X 38 +/- 0 X 04. This result is at variance with the widely held assumption that minimum maintenance requirements are 1 X 5 times BMR.

Intra-individual variability and measurement noise in estimates of energy expenditure by whole body indirect calorimetry

1. Four men were each studied continuously over 12 d in a whole-body calorimeter. Dietary intake and daily activities were kept constant throughout the study. 2. Day-to-day coefficients of variation in energy expenditure within subjects were found to be 1.97% over 24 h, 5.93% during basal metabolic rate measurement, 2.40% overnight and 3.22% in exercise. 3. The contribution of measurement system noise to the observed variability was analysed and shown to be generally small. The source of this noise was considered. 4. The results reinforce and extend other comparable reports and show that within-subject variability forms a small part of reported observations of between-subject variability.

Is obesity an eating disorder

It is simplistic to imagine that the entire problem of obesity is, or is not, an eating disorder. One of the few consensus views in this field is that obesity is a multi-factorial entity, in which the aetiology and treatment are unlikely to follow a single unified line of reasoning. Yet it is probable that an understanding of the nature of eating disorders, and their relevance to subgroups of the obese population, may assist our understanding and treatment of this complex problem.

Breast-feeding : early influences on later health

Contributing Authors. Preface. 1 Growth and organ development T.J. Cole. 2 Nutrient transfer: mammary gland regulation S.L. Kelleher and B. Lonnerdal. 3 Micronutrient transfer: infant absorption B. Lonnerdal and S. L. Kelleher. 4 Developmental aspects of the mucosal immune system: role of external environment, mucosal microflora and milk P.L. Ogra. 5 Infant feeding and growth K.G. Dewey. 6 Intestinal flora C. Kunz, S. Kuntz and S. Rudloff. 7 Transenteric signalling: mammary messages or white noise? L.T. Weaver. 8 Immune function L.A. Hanson, S-A. Silfverdal, M. Hahn-Zoric, L. Haversen, I. Mattsby Baltzer, M. Moisei and C. Motas. 9 Flavour programming during breast-feeding J.A. Mennella. 10 Methodological challenges in studying long-term effectors of breast-feeding M.S. Kramer. 11 The long term effects of early postnatal diet on adult health S.E. Ozanne. 12 Protective effect of breast-feeding against obesity in childhood: can a meta-analysis of published observational studies help to validate the hypothesis? S. Arenz and R. Von Kries. 13 Breast-feeding influences on later life - cardiovascular disease D.A. Leon and G. Ronalds. 14 Do infants who are breast-fed have an altered risk of developing cancer? R. Martin, G. Davey Smith and D.Gunnell. 15 Effects of breast-feeding on cognitive function K.F. Michaelsen, L. Lauritzen and E L. Mortensen. 16 Developmental origins of osteoporotic fracture C. Cooper, S. Westlake, N. Harvey and E. Dennison. 17 The long-term effects of breast-feeding on asthma and atopic disease W.H. Oddy. 18 Evolution of human lactation and complementary feeding: Implications for understanding contemporary cross-cultural variation D.W. Sellen. 19 Macy-gyorgy prize lecture: my milky way L.A. Hanson. 20 Exclusive breast-feeding and hiv infection L. Kasonka, S. Filteau, and The Breast-Feeding and Postpartum Health Project Team. 21 Breast-feeding practices in relation to hiv in india A.V. Shankar. 22 Breast-feeding and hiv-1infection: maternal health P.A. Otieno. 23 Early breast-feeding cessation and infant mortality in low-income countries: Workshop summary K.B. Simondon. 24 Measuring trace immune factors in human milk: Workshop summary S. Filteau. 25 Abstracts of poster presentations Various authors. Index.

Unilateral breast dysfunction in lactating Gambian women.

Approximately 3% of lactating women in a rural Gambian village displayed long-term unilateral breast dysfunction as evidenced by abnormal milk composition and virtual cessation of suckling by the infant. This paper presents case histories of four such women studied over two successive lactations. The average breast-milk output of these women did not differ significantly from the mean value for the remainder of the community, indicating that the non-affected breast was usually able to compensate for the dysfunction. This was confirmed by the fact that the child-rearing record of three of the four women was better than the community average. In two of the women the breast which was dysfunctioning in one lactation reverted completely to normal for the next lactation. It is suggested that in such cases the dysfunction is self-perpetuating and may be alleviated by counselling mothers to persevere with feeding from the affected breast.

Models of endometriosis and their utility in studying progression to ovarian clear cell carcinoma.

Endometriosis is a common benign gynaecological condition affecting at least 10% of women of childbearing age and is characterized by pain – frequently debilitating. Although the exact prevalence is unknown, the economic burden is substantial (∼

Premenopausal abnormal uterine bleeding and risk of endometrial cancer

50 billion a year in the USA alone) and it is associated with considerable morbidity. The development of endometriosis is inextricably linked to the process of menstruation and thus the models that best recapitulate the human disease are in menstruating non‐human primates. However, the use of these animals is ethically challenging and very expensive. A variety of models in laboratory animals have been developed and the most recent are based on generating menstrual‐like endometrial tissue that can be transferred to a recipient animal. These models are genetically manipulable and facilitate precise mechanistic studies. In addition, these models can be used to study malignant transformation in epithelial ovarian carcinoma. Epidemiological and molecular evidence indicates that endometriosis is the most plausible precursor of both clear cell and endometrioid ovarian cancer (OCCA and OEA, respectively). While this progression is rare, understanding the underlying mechanisms of transformation may offer new strategies for prevention and therapy. Our ability to pursue this is highly dependent on improved animal models but the current transgenic models, which genetically modify the ovarian surface epithelium and oviduct, are poor models of ectopic endometrial tissue. In this review we describe the various models of endometriosis and discuss how they may be applicable to developing our mechanistic understanding of OCCA and OEA.

The medical management of endometriosis

Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear.

Factors associated with adverse clinical outcomes among obstetrics trainees

Abstract • Endometriosis is a chronic recurring disease in many women. • Can be asymptomatic but usually presents as pelvic pain or infertility. • The COCP, Danazol, progestogens and GnRHa have similar efficacy in relief of symptoms. • Treatment needs to be individualised, and may be determined by the side effect profile. • There is no role for medical therapy in the treatment of endometriosis infertility.