Cristina Maria Mendes Resende

Under-reporting of food intake and body fatness in independent older people: a doubly labelled water study

BACKGROUND there are no accurate methods for the assessment of food intake in older populations, under-reporting of intake being highly prevalent. There is controversy about which dietary assessment method and what persons characteristics are associated with greater under-reporting rates. OBJECTIVE to assess the correlation between under-reporting of energy intake (EI) and different percentages of body fat in independent older people. DESIGN cross-sectional study. SETTTING area assisted by the Family Health Program of the Ribeirão Preto Medical School, University of São Paulo, Brazil. SUJECTS one hundred volunteers aged 60-70 years. METHODS all volunteers had their body composition assessed by dual-energy x-ray absorptiometry. In second phase, 41 volunteers were evaluated, representing the four quartiles of fat percentage. Total energy expenditure (TEE) was measured by the doubly labelled water method, and EI was assessed by 24-h recalls and a food frequency questionnaire (FFQ). TEE and EI values, EI-to-TEE ratios and EI-TEE values were compared. RESULTS TEE was 2,220 ± 601 kcal, while the EI was 1,919 ± 602 kcal (24-h recall) and 2,119 ± 670 kcal (FFQ). The proportion of under-reporters was 31 and 40.5%, respectively. Under-reporting was more frequent in subjects with higher percentage of body fat and in females (P < 0.05). CONCLUSION under-reporting was more frequent among older persons with higher percentage of body fat in both methods of assessment of food intake. Older persons follow the same profile of under-reporting as younger adults.

Body composition measures of obese adolescents by the deuterium oxide dilution method and by bioelectrical impedance

The objectives of the present study were to describe and compare the body composition variables determined by bioelectrical impedance (BIA) and the deuterium dilution method (DDM), to identify possible correlations and agreement between the two methods, and to construct a linear regression model including anthropometric measures. Obese adolescents were evaluated by anthropometric measures, and body composition was assessed by BIA and DDM. Forty obese adolescents were included in the study. Comparison of the mean values for the following variables: fat body mass (FM; kg), fat-free mass (FFM; kg), and total body water (TBW; %) determined by DDM and by BIA revealed significant differences. BIA overestimated FFM and TBW and underestimated FM. When compared with data provided by DDM, the BIA data presented a significant correlation with FFM (r = 0.89; P < 0.001), FM (r = 0.93; P < 0.001) and TBW (r = 0.62; P < 0.001). The Bland-Altman plot showed no agreement for FFM, FM or TBW between data provided by BIA and DDM. The linear regression models proposed in our study with respect to FFM, FM, and TBW were well adjusted. FFM obtained by DDM = 0.842 x FFM obtained by BIA. FM obtained by DDM = 0.855 x FM obtained by BIA + 0.152 x weight (kg). TBW obtained by DDM = 0.813 x TBW obtained by BIA. The body composition results of obese adolescents determined by DDM can be predicted by using the measures provided by BIA through a regression equation.

Calibration of the food list and portion sizes of a food frequency questionnaire applied to free-living elderly people

OBJECTIVE To calibrate the food list and relative portion sizes of a food frequency questionnaire (FFQ) for application to a free-living, healthy, elderly population. METHODS Cross-sectional study. One hundred free-living, healthy participants, aged from 60 to 75 y, randomly selected from among individuals in the area served by the Family Health Program, School of Medicine of Ribeirao Preto, University of São Paulo. A Food Frequency Questionnaire (FFQ) and a Diet History Questionnaire (DH) were applied by trained dietitians. Each food item of the FFQ had its portion size recalculated according to the percentiles referenced by the volunteers in the DH (25th = small, 50th = medium, and 75th = large). The list of foods and portion sizes of the original FFQ and those obtained by the application of the DH were compared. The percent contribution of energy, protein, fat, carbohydrate, folic acid, vitamin C, calcium, and fiber of each food item mentioned in the FFQ was determined from the data obtained by the application of the DH. RESULTS FFQ, as compared with the DH, provided good estimation of the intake of protein, calcium, folic acid, and fiber (paired t test P < 0.05). Portion sizes of the FFQ differed from those obtained by the application of the DH (-23% to 300%). CONCLUSIONS Adjustments to the FFQ in particular, new portion sizes and a reduction of the food list were found to be appropriate for application to healthy, urban, free-living elderly people in Ribeirao Preto, Brazil.

Accurate determination of energy needs in children and adolescents with cancer.

Studies on children with cancer have suggested that energy expenditure may indeed be greater than predicted for healthy children. Nutritional assessment is important for intervention and for the prevention of complications associated with malnutrition. The present study aimed to describe the nutritional status, energy expenditure, and substrate utilization of children and adolescents with cancer compared to healthy children matched for age, sex, and body mass index. Subjects were evaluated by anthropometry, food intake pattern, and body composition analysis. Energy expenditure and substrate oxidation were measured by indirect calorimetry. Indirect calorimetry data, energy, and macronutrient intake, anthropometry, and body composition parameters showed no significant differences between groups. There was no evidence of increased energy expenditure or of a change in substrate utilization in children with cancer compared to the healthy group. The data regarding usual food consumption showed no significant differences between groups.

Body Composition in Obese Adolescents: Deuterium Oxide Dilution Method, Bioelectrical Impedance and Predictive Equations

Background & Aims: Considering that obese adolescents present alterations in the quantity of body water, fat and lean body mass, specific formulae need to be adjusted through a reference method. This study aimed to describe and compare the body composition data obtained by bioelectrical impedance analysis (BIA) and the deuterium oxide dilution method (DODM). To identify possible correlations and agreement between these two techniques and adjust linear regression models for the prediction of DODM values on the basis of BIA results. Methods: Anthropometric measurements were accomplished for obese adolescents, and their body composition was assessed by the BIA and DODM techniques. Results: Compared to the DODM technique, BIA overestimated the fat-free mass (FFM) and the total body water (TBW) and underestimated the fat mass (FM). There was a significant positive correlation but no agreement between the FFM (kg), FM (kg), and TBW (L) data achieved via DODM and BIA. The application of linear regression model adjustments to the values measured by BIA enabled prediction of the DODM values for body composition in obese adolescents. Conclusion: These formulas have been demonstrated to improve the agreement between the two methods, so a more accurate tool that is closer to the DODM reference technique has been made available for use in clinical practice.

Resting energy expenditure adaptation after short-term caloric restriction in morbidly obese women

Objective:The objective of this study was to describe changes in the resting energy expenditure, substrate oxidation rate, and body composition in morbidly obese women subjected to short-term caloric restriction. Methods:This was a prospective study that included ten obese women with body mass index greater than 40 kg/m2 and aged between 20-50 years. The participants were hospitalized for eight days and received a controlled conventional low-calorie diet, 1200 kcal/day, for seven days. Body weight, body mass index, abdominal circumference, body composition, resting energy expenditure, and substrate oxidation rate were evaluated at the beginning and at the end of the study. Results:A significant reduction in body weight (p=0.005), body mass index (p=0.005), abdominal circumference (p=0.005), fat mass (p=0.005) and fat-free mass (p=0.008) was observed at the end of the study. There was an average reduction in resting energy expenditure of approximately 124 kcal/day (5%). Substrate oxidation rate did not show statistically significant changes. There was a positive correlation only between body weight reduction and fat-free mass reduction (r=0.753; p=0.012). Conclusion:There was an adaptive response of the resting energy expenditure with short-term energy restriction in morbidly obese women with a 5% reduction in resting energy expenditure and a positive correlation between weight loss and the fat-free mass, which indicates the influence of fat-free mass on the decrease in resting energy expenditure. Therefore, short-term caloric restriction in morbidly obese women led to a decrease in resting energy expenditure and fat-free mass, which suggests a rapid adaptation of energy expenditure.