Annelies H. C. Goris

Validity of the assessment of dietary intake: problems of misreporting.

Purpose of reviewThis is a review of recent studies on the analysis of misreporting of food intake and on the consequences of misreporting for the interpretation of dietary surveys. Bias in the assessment of dietary intake was analysed from studies comparing reported intake with doubly labelled water assessed energy expenditure. Recent findingsThere is not yet a method for the accurate determination of dietary intake. Physical and psychological characteristics of study participants play an important role in the observed reporting bias. The degree of misreporting might increase with repeated dietary assessment in the same subjects, confounding the results of intervention studies. SummaryCampaigns aimed at changing food intake might not be as successful as concluded from the results of national food consumption measurements. Subjects might be reporting according to expected instead of real intake. In a clinical setting, the increased awareness of the nursing staff has been observed to result in overreporting of intake.

Detection of Type, Duration, and Intensity of Physical Activity Using an Accelerometer

OBJECTIVE The aim of this study was to develop models for the detection of type, duration, and intensity of human physical activity using one triaxial accelerometer. METHODS Twenty subjects (age = 29 +/- 6 yr, BMI = 23.6 +/- 3.2 kg.m) performed 20 selected activities, including walking, running, and cycling, wearing one triaxial accelerometer mounted on the lower back. Identification of activity type was based on a decision tree. The decision tree evaluated attributes (features) of the acceleration signal. The features were measured in intervals of defined duration (segments). Segment size determined the time resolution of the decision tree to assess activity duration. Decision trees with a time resolution of 0.4, 0.8, 1.6, 3.2, 6.4, and 12.8 s were developed, and the respective classification performances were evaluated. Multiple linear regression was used to estimate speed of walking, running, and cycling based on acceleration features. RESULTS Maximal accuracy for the classification of activity type (93%) was reached when the segment size of analysis was 6.4 or 12.8 s. The smaller the segment size, the lower the classification accuracy achieved. Segments of 6.4 s gave the highest time resolution for measuring activity duration without decreasing the classification accuracy. The developed models estimated walking, running, and cycling speeds with a standard error of 0.20, 1.26, and 1.36 km.h, respectively. CONCLUSIONS This study demonstrated the ability of a triaxial accelerometer in detecting type, duration, and intensity of physical activity using models based on acceleration features. Future studies are needed to validate the presented models in free-living conditions.

Improving assessment of daily energy expenditure by identifying types of physical activity with a single accelerometer

Accelerometers are often used to quantify the acceleration of the body in arbitrary units (counts) to measure physical activity (PA) and to estimate energy expenditure. The present study investigated whether the identification of types of PA with one accelerometer could improve the estimation of energy expenditure compared with activity counts. Total energy expenditure (TEE) of 15 subjects was measured with the use of double-labeled water. The physical activity level (PAL) was derived by dividing TEE by sleeping metabolic rate. Simultaneously, PA was measured with one accelerometer. Accelerometer output was processed to calculate activity counts per day (AC(D)) and to determine the daily duration of six types of common activities identified with a classification tree model. A daily metabolic value (MET(D)) was calculated as mean of the MET compendium value of each activity type weighed by the daily duration. TEE was predicted by AC(D) and body weight and by AC(D) and fat-free mass, with a standard error of estimate (SEE) of 1.47 MJ/day, and 1.2 MJ/day, respectively. The replacement in these models of AC(D) with MET(D) increased the explained variation in TEE by 9%, decreasing SEE by 0.14 MJ/day and 0.18 MJ/day, respectively. The correlation between PAL and MET(D) (R(2) = 51%) was higher than that between PAL and AC(D) (R(2) = 46%). We conclude that identification of activity types combined with MET intensity values improves the assessment of energy expenditure compared with activity counts. Future studies could develop models to objectively assess activity type and intensity to further increase accuracy of the energy expenditure estimation.

Estimation of free-living energy expenditure using a novel activity monitor designed to minimize obtrusiveness.

The aim of this study was to investigate the ability of a novel activity monitor designed to be minimally obtrusive in predicting free‐living energy expenditure. Subjects were 18 men and 12 women (age: 41 ± 11 years, BMI: 24.4 ± 3 kg/m2). The habitual physical activity was monitored for 14 days using a DirectLife triaxial accelerometer for movement registration (TracmorD) (Philips New Wellness Solutions, Lifestyle Incubator, the Netherlands). TracmorD output was expressed as activity counts per day (Cnts/d). Simultaneously, total energy expenditure (TEE) was measured in free living conditions using doubly labeled water (DLW). Activity energy expenditure (AEE) and the physical activity level (PAL) were determined from TEE and sleeping metabolic rate (SMR). A multiple‐linear regression model predicted 76% of the variance in TEE, using as independent variables SMR (partial‐r2 = 0.55, P < 0.001), and Cnts/d (partial r2 = 0.21, P < 0.001). The s.e. of TEE estimates was 0.9 MJ/day or 7.4% of the average TEE. A model based on body mass (partial‐r2 = 0.31, P < 0.001) and Cnts/d (partial‐r2 = 0.23, P < 0.001) predicted 54% of the variance in TEE. Cnts/d were significantly and positively associated with AEE (r = 0.54, P < 0.01), PAL (r = 0.68, P < 0.001), and AEE corrected by body mass (r = 0.71, P < 0.001). This study showed that the TracmorD is a highly accurate instrument for predicting free‐living energy expenditure. The miniaturized design did not harm the ability of the instrument in measuring physical activity and in determining outcome parameters of physical activity such as TEE, AEE, and PAL.

Repeated measurement of habitual food intake increases under-reporting and induces selective under-reporting.

The aim of the current study was to measure differences in reporting behaviour between a first occasion of 7 d food recording and a second occasion of 7 d food recording 12 weeks later, in a group of elderly men (n 17) and women (n 17). Half the group followed an exercise intervention. The mean age was 61 (sd 5) years and mean BMI was 26.2 (sd 3.8) kg/m2. Reported energy intake was compared with energy expenditure as calculated from measured BMR and physical activity assessed with a tri-axial accelerometer for movement registration. Total under-reporting was divided into undereating and under-recording. Undereating was calculated from the change in body mass over the recording week and the under-recording was measured using the water balance technique. In the first period, the total under-reporting was 21 % and increased to 27% in the second period In the first period there was no indication for subjects eating less during the recording week, however, in the second period subjects lost body mass during the food recording indicating undereating. The amount of under-recording was calculated at 21% in the first period and 18% in the second period of recording (P 0.28). During the second period subjects selectively under-reported their fat intake and over-reported their protein intake. In conclusion, repeated assessment of food intake caused a higher quantitative and a qualitative under-reporting of food intake. The effect of interventions (dietary or otherwise) on habitual food intake might be confounded by changes in food-reporting behaviour.

Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation

Patients with chronic obstructive pulmonary disease (COPD) often suffer from weight loss. The aim of the present study was to gain insight into the energy balance of depleted ambulatory COPD patients, in relation to their habitual level of physical activity and consumption of oral nutritional supplements. Clinically stable and weight-stable patients (n 20; BMI 19.8+/- SD 2.0 kg/m2) were studied 1 and 3 months after rehabilitation or recovery in the clinic and were at random assigned to a control or intervention group with regard to nutritional supplementation. Energy intake was measured with a 7 d food record. Energy expenditure was estimated from a simultaneous 7 d assessment of physical activity with a tri-axial accelerometer for movement registration in combination with measured BMR. Body mass was measured at several time points. The body mass remained stable in both groups after 1 or 3 months and mean energy balances were comparable for both groups. The mean body-mass change between month 1 and 3 was negatively related to the mean physical activity level (r -0.49; P=0.03). Weight change over the 3 months was negatively associated with the physical activity level. These results suggest that knowledge about the individual physical activity level is necessary for the estimation of the energy need of the COPD patient.

Physical activity, fat intake and body fat.

The body fatness of a subject is a long-term reflection of the energy balance, the more intake exceeds expenditure the more energy is stored as fat. There is not yet a clear answer on the question whether the current obesity epidemic is a consequence of gluttony or sloth. Review studies do not show a reduction of physical activity over the years, and food intake is difficult to measure in daily life conditions. Food intake can only be derived from self-report, where under-reporting of food intake and selective underreporting of fat intake are major issues. Fat intake might be an important factor in the increase of body weight. Many studies suggest the capacity of the body to oxidize dietary fat is a major risk factor for a positive energy balance. Additionally, there is evidence that most of the fat consumed is stored before oxidation. Obesity prone subjects might be characterized by a higher storage of dietary fat. The only way to increase the oxidation of dietary fat, other than consuming more dietary fat, is to increase energy expenditure by an increase of physical activity. Indeed, there are indications that physical activity is an important determinant of fat oxidation. Based on the evidence presented, it is concluded that the obesity epidemic is mainly due to a high dietary intake, especially as fat, and that physical activity can be a tool to modulate the effect of fat intake on body fat.

Improved reporting of habitual food intake after confrontation with earlier results on food reporting.

The aim of the present study was to improve the reporting of food intake by confronting subjects with their way of reporting food intake, e.g. under-recording and/or under-eating. To minimize portion size errors, eighteen female dietitians were recruited as subjects. Energy- and water intake were measured for 1 week with a weighed dietary record. Resting metabolic rate was measured with an open-circuit ventilated-hood indirect calorimeter, and physical activity was measured with an accelerometer for movement registration. Water loss was estimated with 2H-labelled water. Energy balance was checked for by measuring empty body-weight 1 week before the start, at the start and at the end of the recording week. In the first part of the study, the change in body weight in the non-recording week was 0.14 kg and in the recording week -0.45 kg (P 0.02), indicating 12% under-eating. Total water intake closely matched measured water loss, indicating a high recording precision. There was under-reporting of habitual food intake that could be fully explained by under-eating. In the second part of the study, subjects were confronted with these results and the protocol was repeated. This time there was no significant change in body weight in the recording week, indicating no under-eating. The reporting of habitual food intake had been improved. In conclusion, in the studied group of highly motivated lean women, under-reporting of habitual food intake (here due to under-eating) could be eliminated by confrontation with the results of this phenomenon.

Water loss as a function of energy intake, physical activity and season.

Although water is an important nutrient, there are no recommended intake values. Here, water intake, energy intake, physical activity and water loss was measured over 1 week in summer and in winter. Subjects were healthy volunteers, forty-two women and ten men, mean age of 29 (SD 7) years and mean BMI 21.8 (SD 2.2) kg/m2. Water intake was measured with a 7 d food and water record. Physical activity level (PAL) was observed as the ratio of total energy expenditure, as measured with doubly labelled water, to resting energy expenditure as measured in a respiration chamber. Water loss was measured with the deuterium elimination method. Water loss was highly reproducible and ranged from 0.20 to 0.35 l/MJ, independent of season and activity level, with higher values in women. Water loss was related to water and energy intake in summer (r 0.96, P<0.0001 and r 0.68, P<0.001, respectively) as well as in winter (r 0.98, P<0.0001 and r 0.63, P<0.01, respectively). Water loss was, for men, higher in subjects with a higher physical activity in summer (r 0.94, P<0.0001) and in winter (r 0.70, P<0.05). Normalizing water loss for differences in energy expenditure by expressing water loss in litres per MJ resulted in the same value for men in summer and winter. For women, physical activity-adjusted values of water loss were higher, especially in summer. In men, water turnover was determined by energy intake and physical activity, while seasonal effects appeared through energy expenditure. Women showed a higher water turnover that was unrelated to physical activity.

Exercise-induced oxidative stress in older adults as a function of habitual activity level.

OBJECTIVES It has been suggested that regular physical activity might maintain and promote the antioxidant defense capacity against oxidative stress. Therefore, we assessed exercise-induced oxidative stress in relation to habitual physical activity level (PAL) in older adults. DESIGN The study included a 2-week observation period for the measurement of average daily metabolic rate (ADMR) and PAL. Exercise-induced oxidative stress was measured during a 45-minute cycling test at submaximal intensity. SETTING A university medical research center. PARTICIPANTS Twenty-six subjects volunteered for the study (n = 26; mean age +/- standard deviation 60 +/- 1; body mass index 27 +/- 1 kg/m2). MEASUREMENTS PAL was determined as ADMR combined with a measurement of basal metabolic rate (BMR): PAL = ADMR/BMR. ADMR was measured over 2 weeks with the doubly labeled water method, preceded by a BMR measurement with a ventilated hood. Antipyrine oxidation was used as marker for oxidative stress in vivo. Reaction of antipyrine with hydroxyl radicals results in the formation of para-hydroxyantipyrine (p-APOH) and ortho-hydroxyantipyrine (o-APOH), where o-APOH is not formed through alternative oxygenetic pathways. RESULTS PAL was inversely related to the exercise-induced increase in the ratio of o-APOH to native antipyrine (r = 0.49, P = .010). The relationship between PAL and exercise-induced increase in the ratio of p-APOH (r = 0.30, P = .140) or thiobarbituric acid reactive species (r = 0.31, P = .130) did not reach the level of significance. CONCLUSION Physically active older adults have a reduced exercise-induced oxidative stress than older adults with a lower level of physical activity. It seems that regular physical activity improves the antioxidant defense capacity.