Rachel K. Johnson

Comparison of Multiple-Pass 24-Hour Recall Estimates of Energy Intake With Total Energy Expenditure Determined By the Doubly Labeled Water Method in Young Children

OBJECTIVE This study determined the accuracy of the multiple-pass 24-hour recall method for estimating energy intake in young children by comparing it with measurements of total energy expenditure made using the doubly labeled water method. DESIGN Three multiple-pass 24-hour recalls were obtained over a 14-day period to estimate mean energy intake. Total energy expenditure was measured over the same 14-day period under free-living conditions using the doubly labeled water technique. SUBJECTS/SETTING Twenty-four children between the ages of 4 and 7 years were tested at the General Clinical Research Center/Sims Obesity Nutrition Research Center at the University of Vermont. STATISTICAL ANALYSIS t Tests, paired t tests, Pearson product-moment correlation coefficients, pairwise comparison to show relative bias and limits of agreement, and regression analysis were used to test the relationships among study variables. RESULTS No difference was found between 3-day mean energy intake and total energy expenditure for the group (t = 2.07, P = .65). The correlation between individual measures of energy intake and total energy expenditure was not statistically significant (r = .25, P = .24). CONCLUSIONS Data from 3 days of multiple-pass 24-hour recalls were sufficient to make valid group estimates of energy intake. The method was not precise for individual measurements of energy intake.

Literacy and body fatness are associated with underreporting of energy intake in US low-income women using the multiple-pass 24-hour recall : A doubly labeled water study

OBJECTIVE The accuracy of the multiple-pass 24-hour recall method for estimating energy intake in low-income women in the United States was ascertained by comparing the method with measurements of total energy expenditure. The multiple-pass 24-hour recall is designed to provide respondents with multiple cues and opportunities to report their food intake. It consists of 3 distinct passes: the quick list, detailed description, and review. Predictors of energy intake misreporting (energy intake--total energy expenditure) in the sample were determined. DESIGN Four multiple-pass 24-hour recalls (2 in person, 2 by telephone) were obtained over a 14-day period to estimate energy intake. Total energy expenditure was measured over the same 14-day period using the doubly labeled water method. Body composition was measured using dual energy x-ray absorptiometry, and literacy was measured by the Wide Range Achievement Test (WRAT) for reading and spelling. SUBJECTS/SETTINGS Thirty-five low-income women between the ages of 19 and 46 years were tested at the General Clinical Research Center at the University of Vermont, Burlington. Low income was defined as a household income at or below 130% of the federal poverty level. STATISTICAL ANALYSIS Pearson product moment correlation coefficients, t tests, paired t tests, and stepwise multiple regression analysis were used to test the relationships among study variables. RESULTS Mean energy intake was significantly lower than mean total energy expenditure (2,197 +/- 607 vs 2,644 +/- 503 kcal, P = .001) and the correlation between the 2 measures was poor (r = .22, P = .20). Percentage body fat and the combined age-adjusted reading and spelling WRAT scores were the best predictors of misreporting of energy intake (R = .52, P = .006). CONCLUSIONS The multiple-pass 24-hour recall did not generate a group measure of energy intake that was accurate or unbiased in this sample. Underreporting was strongly associated with increased body fatness. The ability to read and spell as measured by the WRAT improved the accuracy of the womens recall of their food intake. APPLICATIONS Dietetics professionals should take into consideration the problem of underreporting whenever conclusions are made about associations between diet and health and/or when evaluating the impact of food assistance programs on dietary intake.

Physical activity related energy expenditure and fat mass in young children

OBJECTIVE: To examine whether body fat content in pre-pubertal children is influenced by physical activity related energy expenditure (AEE) and/or more qualitative aspects of physical activity. DESIGN: Cross-sectional study. SUBJECT: 101 pre-pubertal children were examined in Study 1: (age: 5.3±0.9 y; weight: 20.2±3.6 kg). In Study 2: 68 of the original children were re-examined (age: 6.3±0.9 y; weight: 23.6±5.0 y). MEASUREMENT: Fat mass (FM) and fat free mass (FFM) were determined by bioelectrical resistance and skinfolds; AEE was estimated from the difference between total energy expenditure (TEE) by doubly labeled water and post-prandial resting energy expenditure (REE) by indirect calorimetry; qualitative information on activity was derived by questionnaire. RESULTS: AEE was significantly correlated with FFM (r=0.32 in both Studies) and body weight (r=0.28 in Study 1; r=0.29 in Study 2), but not FM. There were no significant relationships between AEE and any of the variables from the activity questionnaire in children (including TV time, playing time, and an accumulated activity index in h/week). After adjusting for FFM, age, and gender, FM was inversely related to activity time in h/week (partial r=−0.24 in Study 1; partial r=−0.32 in Study 2) but not AEE (P>0.5). CONCLUSION: After adjusting for FFM, age, and gender, a small portion of the variance in body fat mass in children (∼10%) is explained by time devoted to recreational activity, whereas none of the variance is explained by the combined daily energy expenditure related to physical activity.

In-person vs Telephone-administered Multiple-pass 24-hour Recalls in Women: Validation with Doubly Labeled Water

OBJECTIVE To determine the accuracy of energy intakes estimated with the multiple-pass 24-hour recall method in women by conducting in-person and telephone interviews. Doubly labeled water measurements of total energy expenditure were used for validation. SUBJECTS Thirty-five weight-stable women (mean age = 30 years, range = 19 to 46 years) participated. DESIGN Total energy expenditure was measured over a 14-day period using the doubly labeled water method. During this time, 4 multiple-pass 24-hour recalls were obtained from the women (2 in-person, 2 by telephone) who were provided 2-dimensional food models to estimate portion sizes. The Food Intake Analysis System was used to analyze recall data. STATISTICAL ANALYSES Paired t tests were conducted to examine differences between energy intake estimated from the telephone and in-person interviews. Agreement between the energy intake estimates from the telephone recalls and the in-person recalls was assessed using the technique of Bland and Altman. Paired t tests were used to compare energy intake estimated from the telephone and in-person recalls to total energy expenditure. RESULTS No significant difference in mean daily energy intake was found between the telephone (2,253 +/- 688 kcal) and in-person (2,173 +/- 656 kcal) interviews (P = .36). However, the mean energy intake from each interview method was significantly lower than total energy expenditure (2,644 +/- 503 kcal) (P = .006 and .001, respectively). APPLICATIONS/CONCLUSIONS Underreporting of energy intake was widespread in the sample. Although the multiple-pass 24-hour recall method did not generate a group measure of energy intake that was accurate or unbiased, the telephone-administered multiple-pass 24-hour recall was just as effective in estimating energy intake as the recall administered in-person. Dietetics professionals should be aware of the pervasive and serious problem of under-reporting of self-reported food intakes.

Nonnutritive Sweeteners: Current Use and Health Perspectives A Scientific Statement From the American Heart Association and the American Diabetes Association

A 2009 American Heart Association scientific statement titled “Dietary Sugars Intake and Cardiovascular Health”1 concluded that current intake of added sugars among Americans greatly exceeds discretionary calorie allowances based on the 2005 US Dietary Guidelines.2 For this reason, the American Heart Association Nutrition Committee recommended population-wide reductions in added sugars intake. The present statement from the American Heart Association and the American Diabetes Association addresses the potential role of nonnutritive sweeteners (NNS) in helping Americans to adhere to this recommendation in the context of current usage and health perspectives. By definition, NNS, otherwise referred to as very low-calorie sweeteners, artificial sweeteners, noncaloric sweeteners, and intense sweeteners, have a higher intensity of sweetness per gram than caloric sweeteners such as sucrose, corn syrups, and fruit juice concentrates. As a caloric sweetener replacement, they are added in smaller quantities; hence, they provide no or few calories. In our current food supply, NNS are widely used in thousands of beverages and other food products such as diet soft drinks, yogurts, desserts, and gum. Food manufacturers often use a blend of NNS or use a blend of sugar and NNS to improve the flavor acceptability of NNS. In developing this scientific statement, the writing group reviewed issues pertaining to NNS in the context of data on consumer attitudes, consumption patterns, appetite, hunger and energy intake, body weight, and components of cardiometabolic syndrome. The objective was to review the literature to determine whether there were adequate data to provide guidance for the use of NNS. The focus of the statement is on the 6 NNS that are described in Table 1. Aspartame, acesulfame-K, neotame, saccharin, and sucralose are regulated as food additives by the US Food and Drug Administration and therefore had to be approved as safe before being marketed. Regarding stevia, …

Determinants of resting energy expenditure in young children

Resting energy expenditure (REE) in adults is influenced by fat-free mass (FFM) and fat mass (FM), and is significantly higher in men than in women. There are limited data, however, on the physiologic determinants of REE in children. We therefore measured REE in 113 prepubertal children (39 white girls, 41 white boys, 21 Mohawk girls, and 12 Mohawk boys), 3.9 to 7.8 years of age, representing a wide range of body weight (14.7 to 34.0 kg), height (0.97 to 1.30 m), FFM (10.3 to 25.0 kg), and FM (1.7 to 13.7 kg; 9.4% to 40.3%). The REE was measured in duplicate by indirect calorimetry (range, 830 to 1405 kcal/day) while the children were in a postprandial state and viewing a cartoon film. The FM and FFM values were determined by bioelectrical resistance by means of the Kushner equation. In stepwise regression analysis, the combination of FFM (p < 0.001; partial r = 0.77), sex (p = 0.001; partial r = 0.12), and FM (p = 0.01; partial r = 0.16) explained 63% of the variation in REE. The regression coefficients were 31.9 kcal/kg FFM, 53 kcal for boys, 0 for girls, and 13 kcal/kg FM. Mohawk background, age, fat distribution, heart rate, and physical activity were not independently associated with REE. After REE was adjusted for the aforementioned significant factors, there were no significant correlations with parental factors (body composition, physical activity, age, and REE) other than normalized maternal REE (r = 0.19; p = 0.05). We conclude that the effects of FFM, sex, and FM on REE in children are similar to those in adults. The higher REE in young boys suggests that the previously reported higher REE in adult men cannot be explained entirely by differences in sex hormones. Finally, our data do not support the hypothesis that REE in children is negatively influenced by obesity in children or in parents.

Predicting body composition from anthropometry in pre-adolescent children

The objectives of this paper were to: a) evaluate the accuracy and precision of previously published pediatric body composition prediction equations and b) develop additional prediction equations from a large, heterogeneous group of Caucasian (n=133) and African-American (n=69) children. The combined cohort of 202 children included a wide range of ages (4.0–10.9 y), weights (14.0–70.8 kg), fat mass (FM: 1.2–28.5 kg) and percent body fat (% body fat: 6.2–49.6%). Skinfold measurements were obtained using a Lange caliper and body fat was measured with a Lunar DPX-L densitometer. The previously published equations of Slaughter et al and Goran et al did not accurately predict body fat. The entire cohort was randomly divided into two sub-groups for purposes of deriving and cross-validating a new prediction equation. In stepwise regression analysis in the development group (n=135), weight, triceps skinfold, gender, ethnicity and abdominal skinfold estimated FM measured by dual energy x-ray absorptiometry (DEXA) with a model R2 of 0.95. The new prediction equation was cross-validated in the control group (n=67) and each ethnic and gender subgroup. We conclude that a) the equations of Slaughter et al and Goran et al did not accurately predict FM in a heterogeneous group of children and b) a new anthropometric prediction equation is proposed that may provide accurate estimates of FM in both Caucasian and African-American children aged 4–10 y with a wide range of FM and body composition.

Drinking flavored or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in US children and adolescents.

OBJECTIVE Little research has been conducted on health effects associated with consumption of flavored milk. The purposes of this study were to compare nutrient intakes and body measures among children and adolescents drinking flavored milk (with or without plain milk), exclusively plain milk, and no milk. DESIGN Data used in the study included intakes reported in 24-hour dietary recalls and height and weight measurements collected during a physical examination in the 1999--2002 National Health and Nutrition Examination Surveys. The milk drinking status of each person was identified, and nutrient intakes and body mass index (BMI) measures were determined by milk drinking status. SUBJECTS The study population included 7,557 children and adolescents aged 2 to 18 years. STATISTICAL ANALYSIS Comparisons among mean milk intakes, energy and nutrient intakes, and BMI measures by milk drinking status were completed using linear regression analysis. RESULTS Children and adolescents who included flavored milk in their diets reported higher total milk intakes than consumers of exclusively plain milk (P<0.05). Intakes of vitamin A, calcium, phosphorus, magnesium, potassium, and saturated fat (adjusted for energy intake and age) were generally comparable among milk drinking groups, whereas intakes by milk nondrinkers were significantly lower (P<0.05). Among females aged 12 to 18 years, calcium intakes by flavored and exclusively plain milk drinkers were 992+/-41.5 and 1,038+/-22.5 mg/day, respectively, whereas intake by nondrinkers was 576+/-11.7 mg/day. Intake of added sugars did not differ between flavored milk drinkers and milk nondrinkers. BMI measures of milk drinkers were comparable to or lower than measures of nondrinkers (P<0.05). CONCLUSIONS Findings from this study suggest that consumption of either flavored or plain milk is associated with a positive influence on nutrient intakes by children and adolescents and is not associated with adverse effects on BMI measures.

Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association.

A 2009 American Heart Association scientific statement titled “Dietary Sugars Intake and Cardiovascular Health” (1) concluded that current intake of added sugars among Americans greatly exceeds discretionary calorie allowances based on the 2005 U.S. Dietary Guidelines (2). For this reason, the American Heart Association Nutrition Committee recommended population-wide reductions in added sugars intake. The present statement from the American Heart Association and the American Diabetes Association addresses the potential role of nonnutritive sweeteners (NNS) in helping Americans to adhere to this recommendation in the context of current usage and health perspectives. By definition, NNS, otherwise referred to as very low-calorie sweeteners, artificial sweeteners, noncaloric sweeteners, and intense sweeteners, have a higher intensity of sweetness per gram than caloric sweeteners such as sucrose, corn syrups, and fruit juice concentrates. As a caloric sweetener replacement, they are added in smaller quantities; hence, they provide no or few calories. In our current food supply, NNS are widely used in thousands of beverages and other food products such as diet soft drinks, yogurts, desserts, and gum. Food manufacturers often use a blend of NNS or use a blend of sugar and NNS to improve the flavor acceptability of NNS. In developing this scientific statement, the writing group reviewed issues pertaining to NNS in the context of data on consumer attitudes, consumption patterns, appetite, hunger and energy intake, body weight, and components of cardiometabolic syndrome. The objective was to review the literature to determine whether there were adequate data to provide guidance for the use of NNS. The focus of the statement is on the 6 NNS that are described in Table 1. Aspartame, acesulfame-K, neotame, saccharin, and sucralose are regulated as food additives by the U.S. Food and Drug Administration and therefore had to be approved as safe before being marketed. Regarding stevia, …

Physical activity related energy expenditure in children by doubly labeled water as compared with the Caltrac accelerometer

OBJECTIVE: The objective of this study was to determine whether the Caltrac accelerometer was a meaningful predictor of physical activity related energy expenditure (AEE) in free-living, pre-adolescent children.SUBJECTS: The sample consisted of 31 children (14 girls, 17 boys; 22 Caucasian, 9 Mohawk) with a mean age of 8.3 (±2.0) y.MEASUREMENTS: AEE was measured by subtracting postprandial resting metabolic rate (RMR), measured via indirect calorimetry, from total daily energy expenditure (TDEE), derived from the doubly labeled water (DLW) method. Average daily activity counts (AC) were measured using a Caltrac accelerometer, which was worn for three days, two weekdays and one weekend day, within the DLW dosing period.RESULTS: AEE was related to gender (r=0.42, P=0.02), fat mass (FM, r=0.32; P=0.07), and fat free mass (FFM, r=0.32; P=0.07), but not to AC (r=−0.09; P=0.63). After adjusting for gender, race, FM and FFM using multiple correlation regression analysis (R=0.53), AC did not significantly increase the amount of variation explained in AEE. An estimate of the calories expended in physical activity was derived from AC using a formula developed by Sallis et al. This estimate was significantly higher than AEE (956 kcal/d vs 469 kcal/d, respectively, t=5.9, P<0.001).CONCLUSION: The Caltrac was not a meaningful predictor of AEE in our sample. The caloric estimates of energy expended in physical activity derived from the Caltrac AC, were significantly higher in comparison with measured AEE in these free-living children.