Rebecca J. Hill

The validity of self-reported energy intake as determined using the doubly labelled water technique.

In the 1980s the development of the doubly labelled water (DLW) technique made it possible to determine the validity of dietary assessment methods using external, independent markers of intake in free-living populations. Since then, the accuracy of self-reported energy intake (EI) has been questioned on a number of occasions as under-reporting has been found to be prevalent in many different populations. This paper is a review of investigations using the DLW technique in conjunction with self-reported EI measures in groups including adults, children and adolescents, obese persons, athletes, military personnel and trekking explorers. In studies where a person other than the subject is responsible for recording dietary intake, such as parents of young children, EI generally corresponds to DLW determined energy expenditure. However, in instances where the subjects themselves report their intake, EI is generally under-reported when compared with energy expenditure. It was originally believed that this phenomenon of under-reporting was linked to increased adiposity and body size, however, it is now apparent that other factors, such as dietary restraint and socio-economic status, are also involved. This paper therefore aims to present a more comprehensive picture of under-reporting by tying in the findings of many DLW studies with other studies focusing particularly on the characteristics and mechanisms for under-reporting. Awareness of these characteristics and mechanisms will enable researchers to obtain more accurate self-reports of EI using all dietary recording techniques.

Asthma and insulin resistance in children

Background and objective:  Increased BMI is a risk factor for asthma in children and may be related to adipokines. Adipokines affect insulin‐stimulated glucose uptake in vitro but, to date there is little evidence for such a role in vivo. We explored relationships between obesity and allergic asthma in children.

Assessment of foot-to-foot bioelectrical impedance analysis for the prediction of total body water

Objective: To investigate the accuracy of foot-to-foot impedance methodology for the prediction of total body water and whether leg length rather than stature should be used in the prediction of total body water.Design: Cross-sectional study using volunteers from the community.Setting: University laboratory.Subjects: 57 subjects (29 male; 28 female) aged 19–56 y.Interventions: Total body water was measured using a deuterium oxide dilution technique. Total body water was also predicted using foot-to-foot impedance apparatus (Tanita Inc, Tokyo, Japan, Model TBF 305).Results: Mean values for predicted and measured total body water differed by 0.7 l. However this bias was not constant across all individuals with a progressive underestimation of total body water by foot-to-foot impedance technology as the water content of the body increases. Also the use of leg length did not improve the accuracy of the prediction equation.Conclusions: At the population level predictions of total body water obtained from foot-to-foot impedance technology compare well with measured total body water. However the significant correlation between the difference between predicted and measured total body water and the absolute value for total body water is a concern especially if the technology is used for body composition assessment during a weight loss program.Sponsorship: RJH was in receipt of a Queensland University of Technology Vacation Scholarship.

Media Influence on the Body Image of Children and Adolescents

To study the media messages portrayed to children, 925 students, from 9 to up to 14 years of age, completed “The Sociocultural Influences Questionnaire.” The media section is the focus of this paper, and the responses from three questions were selected to examine the medias influence to be slimmer, increase weight, or increase muscle size. While the girls and boys exhibited different levels of agreement with each media influence, both genders disagreed that media messages were implying they should gain weight. This is in agreement with the belief that the media perpetuates the ideal of thinness and there is a negative stigma associated with being overweight.

Infant Colic—what works: A Systematic Review of Interventions for Breast-fed Infants

Objectives: To determine the strength of evidence for commonly used interventions for colic in breast-fed and mixed-fed infants younger than 6 months. Methods: Searches of PubMed, CINAHL, Embase, AMED, and Web of Science databases were conducted from July 2014 to July 2015. Included studies were randomised controlled trials involving mothers and their colicky infants younger than 6 months; assessed colic against the Wessel or modified Wessel criteria; and included phytotherapies, prescription medicines, and maternal dietary interventions. Studies with <16 participants were excluded. Meta-analyses were conducted where data were sufficient to enable pooling. Quality was assessed against the Cochrane Risk Bias Assessment Tool. Results: A total of 17 articles met the inclusion criteria for this review. The 6 studies included for subgroup meta-analysis on probiotic treatment, notably Lactobacillus reuteri, demonstrated that probiotics appear an effective treatment, with an overall mean difference in crying time at day 21 of −55.8 min/day (95% CI −64.4 to −47.3, P = 0.001). The 3 studies included for subgroup meta-analysis on preparations containing fennel suggest it to be effective, with an overall mean difference of −72.1 min/day (95% CI −126.4 to −17.7, P < 0.001). Conclusions: Probiotics, in particular L reuteri, and preparations containing fennel oil appear effective for reducing colic, although there are limitations to these findings. The evidence for maternal dietary manipulation, lactase, sucrose, glucose, and simethicone is weak. Further well-designed clinical trials are required to strengthen the evidence for all of these interventions.

Quality of life in children with Crohn disease.

Objectives: Quality of life (QOL) is reportedly poor in children with Crohn disease (CD) but improves with increasing disease duration. This article aims to detail QOL in a cohort of Australian children with CD in relation to disease duration, disease activity, and treatment. Materials and Methods: QOL, assessed using the IMPACT-III questionnaire, and disease activity measures, assessed using the Pediatric Crohns Disease Activity Index (PCDAI), were available in 41 children with CD. For this cohort, a total of 186 measurements of both parameters were available. Results: QOL was found to be significantly lower, and disease activity significantly higher (F = 31.1, P = 0.00), in patients within 6 months of their diagnosis compared with those up to 2.5 years, up to 5 years, and beyond 5 years since diagnosis. Higher disease activity was associated with poorer QOL (r = −0.51, P = 0.00). Total QOL was highest in children on nil medications and lowest in children on enteral nutrition. The PCDAI (t = −6.0, P = 0.00) was a significant predictor of QOL, with the clinical history (t = −6.9, P = 0.00) and examination (t = −2.9, P = 0.01) sections of the PCDAI significantly predicting QOL. Disease duration, age, or sex was neither related to nor significant predictors of QOL, but height z score and type of treatment approached significance. Conclusions: Children with CD within 6 months of their diagnosis have impaired QOL compared with those diagnosed beyond 6 months. These patients, along with those with growth impairment, ongoing elevated disease activity with abdominal pain, diarrhoea and/or perirectal and extraintestinal complications, may benefit from regular assessments of QOL as part of their clinical treatment.

Energy expenditure during 2 wk of an ultra-endurance run around Australia.

PURPOSE For ultra-endurance athletes, whose energy expenditure is likely to be at the extremes of human tolerance for sustained periods of time, there is increased concern regarding meeting energy needs. Due to the lack of data outlining the energy requirements of such athletes, it is possible that those participating in ultra-endurance exercise are compromising performance, as well as health, as a result of inadequate nutrition and energy intake. To provide insight into this dilemma, we have presented a case study of a 37-yr-old ultra-marathon runner as he runs around the coast of Australia. METHODS Total energy expenditure was measured over a 2-wk period using the doubly labeled water technique. RESULTS The average total energy expenditure of the case subject was 6321 kcal x d(-1). Based on the expected accuracy and precision of the doubly labeled water technique the subjects total energy expenditure might range between 6095 and 6550 kcal x d(-1). The subjects average daily water turnover was 6.083 L over the 14-d period and might range between 5.9 L and 6.3 L x d(-1). CONCLUSIONS This information will provide a guide to the energy requirements of ultra-endurance running and enable athletes, nutritionists, and coaches to optimize performance without compromising the health of the participant.

Features of feeding difficulty in children with Autism Spectrum Disorder

Abstract Parents of children with Autism Spectrum Disorders (ASD) commonly report concerns regarding feeding difficulties and poor nutrition. Feeding difficulties, in the form of undesirable mealtime behaviours and/or skill deficits, can cause parental concern and impact on family dynamics. Poor nutrition can have an impact on development and health outcomes. The purpose of this paper was to review recent research regarding feeding difficulties in children with ASD, in order to describe: (1) the most frequently reported undesirable mealtime behaviours and skill deficits; and (2) dietary intake and weight patterns as markers of nutrition. While the ASD population is a somewhat heterogeneous group, this literature review of 44 research studies identified a number of common issues for these children. Restricted dietary variety, food neophobia, food refusal, limiting diet based on texture, and a propensity towards being overweight were frequently reported. Gaining a better understanding of the common features of feeding difficulties experienced by children with ASD will assist in directing intervention studies. Findings from such studies have the potential to enhance developmental and nutritional outcomes for this group. Well-designed longitudinal research would be valuable in monitoring the impact of feeding difficulties for these children as they age.

The validity of a four day weighed food record for measuring energy intake in female classical ballet dancers

Objectives: To assess the validity of a four day weighed food record in the measurement of energy intake in female classical ballet dancers.Design: Twelve classical ballet dancers volunteered to take part in this study.Setting: Queensland University of Technology.Subjects: Twelve classical ballet dancers. Data collected from one subject was not used due to poor compliance with the requirements of the study.Interventions: Measurements of energy intake via a four day weighed record and total energy expenditure via the doubly labelled water technique.Results: There was a mean bias to under‐reporting energy intake of 667 kcal/day or 21% of real intake.Conclusions: Results of dietary data obtained via a four day weighed intake should be viewed with caution in the light of the evidence of major under‐reporting in this cohort.Sponsorship: RJH was in receipt of a Queensland University of Technology, Faculty of Health Scholarship.

Bone Health in Children With Inflammatory Bowel Disease: Adjusting for Bone Age

Objectives: Clinical results of bone mineral density for children with inflammatory bowel disease are commonly reported using reference data for chronological age. It is known that these children, particularly those with Crohn disease, experience delayed growth and maturation. Therefore, it is more appropriate to compare clinical results with bone age rather than chronological age. Materials and Methods: Areal bone mineral density (aBMD) was measured using dual energy x-ray absorptiometry, and bone age was assessed using the Tanner-Whitehouse 3 method from a standard hand/wrist radiograph. Results were available for 44 children ages 7.99 to 16.89 years. Areal bone mineral density measurements were converted to z scores using both chronological and bone ages for each subject. Results: Areal bone mineral density z scores calculated using bone age, as opposed to chronological age, were significantly improved for both the total body and lumbar spine regions of interest. When subjects were grouped according to diagnosis, bone age generated z scores remained significantly improved for those with Crohn disease but not for those diagnosed with ulcerative colitis. Grouping of children with Crohn disease into younger and older ages produced significantly higher z scores using bone age compared with chronological for the older age group, but not the younger age group. Conclusions: Our findings, in accordance with those presented in the literature, suggest that aBMD results in children with Crohn disease should include the consideration of bone age, rather than merely chronological age. Bone size, although not as easily available, would also be an important consideration for interpreting results in paediatric populations.