Analysis Of Food Diaries Research Articles

O-287 Body composition analysis and metabolic monitoring before fertility treatment: hype or hope?

Abstract The effect of body mass index on both spontaneous and assisted fertility is well known: both lower and high indexes are correlated with negative outcome including live birth rate. Asides the dysmetabolic infertility that can develop by inflammation, insulin resistance and hyperandrogenemia, psychological and social factors deserve attention: a sexual self-image dysfunction is present in up to 20% of obese people with lower sexual desire and arousal. A positive note is that ART patients want to know about the impact of diet on fertility and ART success, asides the safety of the treatment and coping strategies, when asked about research priorities. Nevertheless, research in the field of preconception weight loss in the case of obesity in non-conclusive. The difference may lay in the strategy followed: lifestyle interventions may differ in approach, new weight-losing drugs might be involved or avoided, and targets and endpoints differ between studies. A first statement is to be made: body weight is a parameter of the past. In the world of nutrition, BMI is used to describe populations but fails to give accurate information about a single person. Body composition is more refined and can be used in follow-up. Asides dual energy X-ray absorptiometry (DXA), Bio Electrical Impedance Vector Analysis (BIVA) is used to endotype patients. Magnetic Resonance Imaging can, in a whole-body approach, provides very detailed information. In general, fat mass, fat free mass, phase angle (quantitative information) and fat infiltration of muscle (qualitative aspect) are considered ‘the kg of the future’. Associations between higher amounts of fat and poorer ART outcomes are published. As body composition is the result of food intake balanced to total energy expenditure (composed from basal energy expenditure, diet induced thermogenesis and physical activity level), the knowledge of these aspects can form a basis for a personalized approach. Techniques used in clinical practice relevant to this topic are food diary analysis by specialized dietitians (quantitative and qualitative analysis of food intake) and indirect calorimetry. This device will measure oxygen consumption and carbon dioxide production and calculate the basal metabolic rate in kcal/day. The concept of nutrition intake balanced to energy expenditure is validated in critically ill patients where it reduces mortality. It also showed benefit in a cancer population during active treatment. In a tertiary, university hospital in Brussels, Belgium, the forces of the fertility clinic and the nutrition department were combined: FerMet (Fertility-Metabolism). Patients seeking ART with a BMI <18;5 or higher than 30 are directed. Biophysical endotyping is performed by both metabolic screening, food intake analysis and baseline testing: body composition by BIVA and metabolic measurement by indirect calorimetry. A personalized intervention plan is developed in co-operation with the patient(s) by the dietitian and the supervising MD. Psychological reference or physical activity coaching is initiated if needed. Interim results: a total of 3793 men and woman in 3,5 years. In the population with a BMI below 20, which is only 6.4% of the entire group, body composition analysis reveals: only 9% are confirmed with alarmingly low body fat mass, such as seen in eating disorders. 23% has a fat mass percentage comparable to the general population and 66% represents what is known as ‘constitutional lean’. This might open opportunities to refine criteria to withhold ART based on body weight. In the overweight population, interventions can be tailored on individual metabolic rates and eating patterns, which is unique in the setting of ART. Whole Body MRi can be used in research settings. Benefits of this Biophysical Endotype based interventions to increase fertility outcomes need to be proven by further research.

P069 Ultra-processed food intake and dietary insufficiencies are common in adults with Crohn’s Disease in remission. The INTICO 2 Study

Abstract Background Adults with Crohn’s Disease (CD) may have dietary restrictions and micronutrient inadequacies. Consumption of ultra processed foods (UPF) has been associated with an increased need for IBD-related surgery and is a growing area of research. This study aimed to investigate the habitual diet of adults with CD during disease remission to understand the nutritional adequacy, diet diversity and diet quality. Methods 196 adult CD outpatients in remission (Harvey Bradshaw Index <5 and calprotectin <250µg) were recruited from a single UK IBD centre outpatients as part of the INTICO 2 observational study. Seven-day food diaries were electronically recorded using Nutritics® (Libro) software. UPF intake was determined using NOVA Score . Data cleaning was undertaken by a dietitian prior to analysis to identify input errors. NOVA Score1 criteria was utilised to determine UPF intake. Product ingredient lists were examined using supermarket websites and ‘Open food Facts’ by two research dietitians to assign a NOVA score. Consensus on NOVA Scoring was achieved, and a data dictionary was prospectively updated to justify the assigned score. Results 97% (189/195) of those who underwent food diary analysis had at least one micronutrient below the LNRI. The intake was below the LNRI for a mean of 6 (SD 4.2) micronutrients per subject. The number of subjects who failed to meet the LNRI from diet (with and without inclusion of usual supplements) is listed for each micronutrient in table 1. Of note, 93% (181/195) of subjects failed to meet the SACN recommended 30g of fibre per day (median intake 17.7g). 33% of dietary intake was classified as UPF (Nova 4) and 13% processed (NOVA 3). Conclusion Both micronutrient insufficiencies and UPF intake are common in a CD remission population and should be considered alongside one another in studies of dietary intake. UPF intake should be interpreted with caution as NOVA does not account for nutritional content. Blanket recommendations to avoid UPFs need to be carefully considered within this already nutritionally vulnerable population as avoidance of UPF products such as fortified cereals or oral nutritional supplements could lead to increased dietary inadequacies.

Early time-restricted carbohydrate consumption vs conventional dieting in type 2 diabetes: a randomised controlled trial

Aims/hypothesisEarly time-restricted carbohydrate consumption (eTRC) is a novel dietary strategy that involves restricting carbohydrate-rich food intake to the morning and early afternoon to align with circadian variations in glucose tolerance. We examined the efficacy, feasibility and safety of eTRC in individuals with type 2 diabetes under free-living conditions.MethodsIn this randomised, parallel-arm, open label, controlled trial, participants with type 2 diabetes and overweight/obesity (age 67.2±7.9 years, 47.8% women, BMI 29.4±3.7 kg/m2, HbA1c 49±5 mmol/mol [6.6±0.5%]) were randomised, using computer-generated random numbers, to a 12 week eTRC diet or a Mediterranean-style control diet with matched energy restriction and macronutrient distribution (50% carbohydrate, 30% fat and 20% protein). The primary outcome was the between-group difference in HbA1c at 12 weeks. Body composition, 14 day flash glucose monitoring and food diary analysis were performed every 4 weeks. Mixed meal tolerance tests with mathematical beta cell function modelling were performed at baseline and after 12 weeks.ResultsTwelve (85.7%) participants in the eTRC arm and 11 (84.6%) participants in the control arm completed the study, achieving similar reductions in body weight and fat mass. The two groups experienced comparable improvements in HbA1c (−3 [−6, −0.3] mmol/mol vs −4 [−6, −2] mmol/mol, corresponding to −0.2 [−0.5, 0]% and −0.3 [−0.5, −0.1]%, respectively, p=0.386), fasting plasma glucose, flash glucose monitoring-derived glucose variability and mixed meal tolerance test-derived glucose tolerance, insulin resistance, insulin clearance and plasma glucagon levels, without changes in model-derived beta cell function parameters, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide and non-esterified fatty acid levels. The two diets similarly reduced liver function markers and triglyceride levels, being neutral on other cardiometabolic and safety variables. In exploratory analyses, diet-induced changes in body weight and glucometabolic variables were not related to the timing of carbohydrate intake.Conclusions/interpretationThe proposed eTRC diet provides a feasible and effective alternative option for glucose and body weight management in individuals with type 2 diabetes, with no additional metabolic benefits compared with conventional dieting.Trial registrationClinicalTrials.gov NCT05713058FundingThis study was supported by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the Italian Society of Diabetology (SID).Graphical

Analysis of the features of the formation of nutrition highly qualified endurance athletes

The issue of nutrition of highly qualified athletes and their timely correction is relevant. Methods. Energy expenditure at rest was determined by indirect calorimetry (Fitmate, Cosmed, Italy; Oxycon Mobile, Germany). 50 highly qualified athletes specializing in biathlon and academic rowing participated in the study. The actual composition of the diets was assessed by individual food diaries. Analysis of rations was carried out using special programs. The results. The actual nutrition of athletes differs from the recommended intake of energy and essential nutrients. The total caloric content of the daily ration at the educational and training meeting in the preparatory period of the annual macrocycle did not meet the minimum recommended norm. However, the individual energy value of the diet varied widely. A reduced relative content of carbohydrates was observed. The average actual content of proteins and fats in the diet of athletes corresponded to the norm. However, if you analyze their minimum and maximum number, you can observe a different picture - a deficit of the minimum and an excess of the maximum number. Conclusions. The analysis of food diaries of athletes revealed non-compliance with the basic principles of ration construction, namely: inconsistency of the energy value of the ration with the average daily energy expenditure, imbalance of the ration according to the main nutrients, inefficient distribution of the ration during the day taking into account the mode and nature of training. A significant deficit of carbohydrates in the diets of qualified athletes has been established. For example, in biathlon women's average carbohydrate consumption from the lower limit of the recommended range is only 60%, in men – 72%, and in academic rowing – 87%.

P400 Identifying Nutritional targets in Crohn’s disease: INTICO1: a time-limited trial of exclusive enteral nutrition during adult CD remission

Abstract Background During clinical remission in adult Crohn’s disease (CD), impaired health reacted quality of life and fatigue is common, and the nutritional state may be affected by factors such as restrictive eating and altered anatomy from previous inflammation or surgeries. Adults with CD in clinical remission do not routinely undergo nutritional assessments or intervention. The INTICO1 study used a time-limited trial of exclusive enteral nutrition (EEN) to expose and explore nutritionally sensitive aspects of in adults with CD during remission. The extent to which the nutritional state relates to the quality of CD remission and the potential role for nutritional therapies is neither well described nor understood. Methods This was a single arm longitudinal observation study with a dietary intervention. 24 adults in CD remission (Harvey Bradshaw <5, faecal calprotectin <250) underwent assessment of nutritional state at 3 time points; after habitual diet (assessment 1), after 7 days of polymeric EEN (assessment 2) and after a 2-week gradual return to habitual diet (assessment3). Assessments comprised food diary analysis, anthropometry, bio-electrical impedance analysis, routine pathology measures of micronutrient concentration, and patient reported outcome measures (PROMs). Results Assessment 1 (habitual diet) identified individuals with multiple inadequacies of intake (7% (26/368)) micronutrients bloods below the normal laboratory range (see table for analytes) reduced lean mass, low phase angle (PhA) and excessive fatigue (reduced SF-36 vitality). At assessment 2 (post EEN), subjects had fewer deficiencies 4% (16/368), with significant increases seen in Vitamins A, D, E, B2, B6, B9 and the minerals Ca, Cu, Po4 and Se. At visit 3 (return to free diet), micronutrient concentrations reverted toward assessment 1 level, although B6 and B9 remained significantly higher (pairwise comparison visit 1 vs visit 3). BIA measures of nutritional status (PhA) and the SF36 physical function score improved 1 and 2 (5.2 vs 5.4 p<0.01 and 95 v100 p<0.05) and returned to baseline levels on return to free diet (Assessment 3). Conclusion A time-limited trial (7 days) of EEN, given in this setting of adults in CD remission led to changes in micronutrient biochemistry, objective improvement in the bioelectrical properties of the body (increased phase angle) and an improvement in fatigue among the subjects as captured by the SF36-PF. The study suggests that impaired nutritional state and excessive fatigue is likely to be prevalent among adults with CD during remission and may be sensitive to nutritional intervention.

Effectiveness of Mediterranean Diet's Adherence in children with Inflammatory Bowel Diseases.

Background: Nutritional support is very important in the treatment of Paediatric Inflammatory Bowel Disease (IBD). The role of the Mediterranean Diet (MD) has been understudied in children with IBD. The aims of this study were to assess the dietary intakes of IBD children in comparison with healthy controls (HCs), their adherence to MD; and the relationship between inflammation and dietary behaviors. Methods: Paediatric IBD patients in clinical remission and HCs were enrolled. The nutritional status and adherence to the Mediterranean Diet was evaluated through a 3-day food diary and the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). Results: The analysis of food diaries showed a significantly higher kilocalorie intake in IBD patients compared to HCs (p = 0.012), an increase in carbohydrates (p = 0.015) and in protein intake (p = 0.024). Both IBD and HCs have an intermediate adherence to MD. The comparison between Crohn’s disease (CD) and Ulcerative colitis (UC) patients showed significant difference in protein intake in CD patients (p = 0.047), as well as for vitamin D (p = 0.044) and iron intake (p = 0.023). Interestingly; in IBD patients we found a significant association between adherence to MD and a low level of fecal calprotectin (p = 0.027). Conclusion: Children with IBD in remission have a sub-optimal food intake compared to HCs. MD seems to correlate to decreased intestinal inflammation.

MODERN RESOURCES OF CELIAC DISEASE TREATMENT EFFECTIVENESS IMPROVEMENT

Relevance. Although monotherapy with a gluten-free diet (BGD) for celiac disease is highly effective, it does not in all cases achieve complete remission of the disease. Therefore, an additional comprehensive examination of patients for the purpose of prescribing reasonable therapy is relevant.
 Objective: to study the causes of the persistence of clinical symptoms in patients with celiac disease who are on a gluten-free diet for 6 months.
 Materials and methods. Patients with celiac disease (n = 41) who were on a gluten-free diet (GFD) for 6 months were studied. The average age is 35.42 ± 0.45 years. Group 1 (n = 17) – patients who subjectively noted a positive dynamics of treatment and with a significant improvement in general condition, but without complete clinical remission. Group 2 (n = 24) – patients with unsatisfactory treatment results, no clinical effect from treatment, or weak positive dynamics on the background of GFD. The study included two stages: 1) assessment of patients' compliance and their diet (through the analysis of food diaries) in order to identify disorders of a gluten-free diet as the main cause of the persistence of clinical symptoms; 2) identification of other causes of the persistence of symptoms: exocrine pancreas insufficiency (EPI), lactase deficiency (LD) and the syndrome of increase bacterial growth (SIBR). A C13 triglyceride breath test (IRIS analyzer) was performed to diagnose EPI. To diagnose LD and SIBR in the small intestine, hydrogen breath tests (Micro H2-meter analyzer) were used – a test with lactose and D-xylose, respectively. Also, the titer of antibodies to tissue transglutaminase (TTG) to deaminated gliadin peptides (DPG) was determined in all patients, and their DPG/TTG ratio was calculated.
 Results. The main reason for the ineffectiveness of treatment is a violation of a gluten-free diet, found in 63.4% of subjects (incompletely formed mushy stool, polyfaeces, steatorrhea; recurrent abdominal pain, bloating, flatulence). Revision of food intake and elimination of sources of latent gluten from the diet of patients with celiac disease allowed to achieve complete serological remission (normalization of titers specific for celiac disease antibodies) in all patients, but complete clinical remission was achieved in only 34.6%. Therefore, it is concluded that there are other causes of incomplete remission of celiac disease associated with concomitant diseases of the digestive tract. Using carbon and hydrogen breath tests, it was found that, in addition to diet, the reasons for the lack of complete remission in patients with celiac disease are EPI (19%), SIBR in the small intestine (16%), LD (47%) and a combination of EPI with SIBR.
 Conclusion. The inclusion of respiratory tests (C13-triglyceride, hydrogen with lactose, and D-xylose) in a comprehensive examination of patients with celiac disease can significantly improve treatment outcomes and reduce the duration of clinical remission.

Nutrikids, a Smartphone Application to Improve the Quality of Paediatrical Dietary Assessments: Feasability Study.

Collecting accurate food consumption data is challenging for nutrition practitioners. Mobile devices are interesting alternatives to traditional ways of collecting assessments by reducing burden of use. Our objective was to develop and evaluate a mobile application for food intake documentation, targeting particularly the parents of pediatric patients. NutriKids is an application designed to guide users step by step in their assessment by asking relevant questions and taking advantage of the camera function. The quality of nutritional assessment using NutriKids was evaluated through the analysis of food diaries completed during two days under real-life conditions (home use). NutriKids demonstrated to provide satisfying degree of quality in 84% of the reported items. A detailed analysis of quality components highlighted that NutriKids interface could be improved for quantitative estimation and for specific information on added fat or sugar. Besides, a feedback survey highlighted the high acceptability of the application by the participants. These findings demonstrate the potential of this guided approach application. With further development of NutriKids and controlled based assessment with larger populations, we hypothesize that our results would reach statistical significance in all aspects of nutritional assessment quality.

Ensuring a healthy approach to long‐term weight management: Review of the Slimming World programme

AbstractWeight management programmes have been shown to be effective interventions that encourage clinically relevant weight loss. The aim of a weight management programme is not only to achieve weight loss, but also to support long‐term weight maintenance and for that reason their suitability in helping people to meet the key dietary recommendations for health must be considered. The British Nutrition Foundation was asked to investigate whether the Slimming World weight management programme is consistent with current nutrient and food‐based recommendations, and whether Slimming World members following the programme are typically eating diets meeting these recommendations in the ‘real world’. This was to help inform any potential refinements to their dietary approach. A three‐stage approach included a review of Slimming World's dietary approach resources, nutritional analysis of Slimming World's example menu plans and dietary analysis of 40 7‐day weighed food diaries completed by adult female Slimming World members. The Slimming World dietary approach reflects many of the main messages in the UK's Eatwell Guide and generally accepted healthy eating advice. Several observations were made with indications for potential changes in relation to key food groups. Nutritional analysis of the 7‐day menu plans suggests that a Slimming World member following a provided example menu plan could meet many of the UK dietary recommendations that were analysed in this review. Food diary analysis suggests the Slimming World study sample on average met dietary recommendations for total fat, saturated fat, calcium, salt and 5 A DAY. In comparison, national dietary surveys report that the average UK adult female population meets the total fat and calcium recommendations, but is not meeting the recommendations for saturated fat, salt and 5 A DAY. The study sample did not meet the recommendations for intakes of fibre and free sugars and oil‐rich fish, but these were still closer to recommendations than the average UK adult female population. High intakes of red and processed meat and alcohol were observed amongst some of the study sample. Overall, the findings suggest that despite a reduction in energy intake, adult females following this weight management programme may be consuming a diet that more closely meets UK dietary guidelines when compared with the average UK adult female population.

Genotype C/C 13910 of the Lactase Gene as a Risk Factor for the Formation of Insulin-Resistant Obesity in Children.

To reduce the risk of insulin resistance in obesity in children with lactase gene genotypes, we studied the factors that stimulate the chronic inflammatory process. 109 children 6-18 years of age were investigated. The main group (n = 56) was presented by children with signs of insulin-resistant obesity according to the criteria of the European Society of Endocrinology and the Pediatric Endocrine Society. The control group (n = 53) included obese children without insulin resistance. A comprehensive clinical examination, food diary analysis, genotyping of the lactase gene by means of the polymerase chain reaction, the Immunochemical Test Method with Electrochemiluminescent Detection of basal insulinemia, Hydrogen breath test with lactose load, sequential analysis, ROC analysis were carried out. Clinical manifestations of lactose maldigestion in a child increased the risk of possible insulin resistance (prognostic coefficient (PC +2.6), as well as the presence of the lactase C/C 13910 gene genotype (PC +5.8) did. The genotype C/T 13910 in children had a protective effect on the risk of obesity (PC -2.9). The lowest risk of insulin-resistant obesity in observed among children with the genotype T/T 13910 (PC -12). The presence of the C/C 13910 genotype of the lactase gene is the main factor formation of insulin resistance in children's obesity. What is known? The genotype C/C 13910 of the lactase gene as a risk factor for the chronic inflammatory process in the body. What is New? Genotype C/C 13910 of the lactase gene as a risk factor for insulin-resistant obesity in children.

Low Adherence To Nutritional Recommendations In Patients With Cirrhosis: A Prospective Observational Study

AIM: The aim of the study was to evaluate patients’ adherence to the current nutritional recommendations adapted to the individual clinical status. MATERIALS AND METHODS: 192 outpatients with cirrhosis were prospectively evaluated. 161 were considered at risk of impaired nutrition as they present at least one of the following factors: altered body mass index score, non-volitional body weight changes, ascites, peripheral edema, hepatic encephalopathy, or diabetes.Patients at risk were offered a nutritional assessment by a nutritionist, including a 3-days food diary and hand-grip strength (HGS) test. Only 78 patients returned the diaries properly filled in. RESULTS: The analysis of food diaries showed a low-level adherence to the nutritional recommendations: caloric intake was insufficient, in excess or adequate in 75%, 13% and 12% of cases, respectively. An appropriate consumption of carbohydrates, protein and fibers was found only in 10-15% of cases, while the intake of simple sugars, lipids, and water resulted adequate in up to 55%. The protein intake was more frequently insufficient in patients with more advanced disease. HGS test was altered in 49% of patients. 27 subjects (17%) refused the nutritional assessment: these patients presented a significantly less severe disease and a lower number of risk factors. CONCLUSIONS: Patients with cirrhosis have inadequate nutritional intake and poor adherence to the recommendations provided during the normal path of care. Therefore, a multidisciplinary approach with a nutritionist should be recommended, starting in the early stage of the disease when the awareness of patients regarding the importance of nutrition appears to be lower.

P200 Food diary analysis and growth: do they correlate? A pilot study

P200 Food diary analysis and growth: do they correlate? A pilot study

Food Logging and Blogging Toward Healthier Nutrition: Bringing the Curriculum Out of the Classroom and Into the 21st Century

This article focuses on the benefits of promoting lifelong, healthy eating habits within a student-centered blog. A learning community, located in an urban, northeastern section of the United States, was formed between two fifth grades from different socioeconomic backgrounds and college students enrolled in a nutrition class. Components of this unit, Food Logging and Blogging, include students’ completion and analysis of food diaries, face-to-face discussions regarding healthy eating habits, and a blog. Blogging, still a fairly new form of communication in the classroom environment, promotes engaging conversations and has increased nutrition knowledge. Advantages of blogging include authenticity with audience, transparency that gives students a platform to speak candidly, improved digital literacy savvy, and higher order thinking skills. It also offers prospective health teachers and professionals an alternative form of communication.

Exercise Prescription On Mental Health And Nutrition Habits In Patients With Non Communicable Diseases

PURPOSE: Quality of life is one of the most important aspect in non communicable diseases. Physical exercise can have an impact if regularly practiced. The study aims to verify the possible improvement of mental health and eating habits during a period of moderate and unsupervised physical activity program. MATERIAL AND METHODS: 40 patients, aged 53 ±15 from different chronic disease (cancer, hypertension and diabete), were submitted to an unsupervised exercise as prescription program for at least 6 months for 3 times a week for at least 30 minutes for each session. They were investigated at the onset and after 6 months by two different questionnaires: SF36 for menthal health and a questionnaire for the nutrition habits. The energy intake consumption, frequency of meals/day, macronutrient distribution and consumption of fruits and vegetables daily were considered. The BMI (body mass index), body folds (biceps, triceps, subscapular and supra- iliac) were considered. Statistical analysis was performed using the paired Student T, and r correlation test. RESULTS: Physical Activity level perception increases significantly (T0: 76.53± 17 %;T6:86.15± 12.1; p<.001) : mental health (T0: 67.07 ±19.53% ; T6: 71.07 ± 14.8% p<0.01), role and emotional status(T0: 64.1± 44.0 % ;T6: 89.74 ± 21.01 %; p<.01) health perception (T0:55.3± 22.87; T6: 57.15± 19.13 p<0.01)pain perception decreases (T0:26.15± 20.22;T6:16.92± 18.43 P<0.01). From the analysis of food diaries, there was a significant reduction of frequency of meals per day (T0:3.08± 0.48; T6:3.69± 0.63;p<0.05) and a very significant reduction of quantity of food intake (T0: 1893.23± 315.59;T6:1660 ± 182.8p < 0.01). The anthropometrics parameters showed as the triceps fold were significantly reduced (T0:17.7± 8.31;T6:17.66±6.4 p<0.05) and with a negative correlation with the nutrition habits ; r = -.647; p<.05).PA level perception correlates also significantly with frequency of meals(r:.706;p<.01) and also with role and emotional behavior(r:.746;p<.01).PA correlates negatively with pain perception(r:-0.593;p<0.05) and also with the vitality(r:0.690;p<0.01). CONCLUSION: Not supervised exercise program modifies significantly mental health and eating habits in MCD, producing a positive effects on the metabolic risk’s factors.

Selective eating: searching for clarity in complexity

Selective Eating (SE) refers to those children who significantly restrict their eating, but demonstrate no apparent concerns about weight or shape. Typically children with SE eat a very limited range of foods, usually over a number of years. In severe cases of SE there is anecdotal evidence that the child's growth is affected, but more commonly parents report that the child's eating patterns result in marked family distress and conflict as well as impairment in social functioning. This category of eating disorders is diagnostically unclear, with no formal criteria, and a paucity of empirical research. This research set out to understand more clearly the nature of SE starting with investigation of the level of concern about the problem and associated demographic factors. An objective measure of SE was developed based on analysis of food diaries, which was crucial in both ongoing research and assessing this ill-defined problem. Finally psychological aspects of the problem were investigated by comparing children with SE with a control group. Parents of SE's were more stressed and also more involved with their child's eating. The children themselves often had a history of developmental issues such as gagging or sensory aversion, but also had an anxious temperament and behavioural difficulties when younger, and features of anxiety and particularly OCD when older. These results highlight the complexity in assessing and treating this phenomenon. This abstract was presented in the Service Initiatives: Child and Adolescent stream of the 2014 ANZAED Conference.

PWE-117 Responses to dietary intervention guided by follow-up duodenal biopsy in coeliac disease

IntroductionBritish Society of Gastroenterology guidance on repeating the intestinal biopsy in coeliac patients on diet is ambiguous and suggests that dietary advice is the same irrespective of the follow-up biopsy...

Systemic Acid Load from the Diet Affects Maximal-Exercise RER

A maximal-exercise RER (RER(max) ≥ 1.10 is commonly used as a criterion to determine whether a "true" maximal oxygen uptake (V˙O(2max)) has been attained during maximal-effort exercise testing. Because RER(max) is heavily influenced by CO2 production from acid buffering during maximal exercise, we postulated that dietary acid load, which affects acid-base regulation, might contribute to variability in RER(max). The study's purpose was to determine whether a habitual dietary intake that promotes systemic alkalinity results in higher RER(max) during V˙O(2max) testing. Sedentary men and women (47-63 yr, n = 57) with no evidence of cardiovascular disease underwent maximal graded treadmill exercise tests. V˙O(2max) and RER(max) were measured with indirect calorimetry. Habitual diet was assessed for its long-term effect on systemic acid-base status by performing nutrient analysis of food diaries and using this information to calculate the potential renal acid load (PRAL). Participants were grouped into tertiles on the basis of PRAL. The lowest PRAL tertile (alkaline PRAL) had higher RERmax values (1.21 ± 0.01, P ≤ 0.05) than the middle PRAL tertile (1.17 ± 0.01) and highest PRAL tertile (1.15 ± 0.01). There were no significant differences (all P ≥ 0.30) among PRAL tertiles for RER at submaximal exercise intensities of 70%, 80%, or 90% V˙O2max. After controlling for age, sex, V˙O(2max), and HRmax, regression analysis demonstrated that 19% of the variability in RER(max) was attributed to PRAL (r = -0.43, P = 0.001). Unexpectedly, HRmax was lower (P ≤ 0.05) in the low PRAL tertile (164 ± 3 beats·min⁻¹) versus the highest PRAL tertile (173 ± 3 beats·min⁻¹). These results suggest that individuals on a diet that promotes systemic alkalinity may more easily achieve the RER(max) criterion of ≥ 1.10, which might lead to false-positive conclusions about achieving maximal effort and V˙O(2max) during graded exercise testing.

The use of mobile phones in dietary assessment in young people with Type 1 diabetes

Background: Food is often a contentious issue for people with diabetes (Nutrition Sub‐Committee of Diabetes Care Advisory Committee of the UK, 2003) and being an adolescent with Type 1 diabetes (T1DM) can be extremely challenging (Cartwright et al., 2003). Tailoring interventions to engage with adolescents is essential for maintaining an effective and productive relationship with the healthcare team (Hampson et al., 2000). The use of modern technology, such as mobile phone cameras, may be a way of engaging with this client group. Food diaries are routinely used for dietary assessment in this group, although there may be difficulties with patient recall, establishing portion sizes and compliance with completion (Tefft &amp; Boniface, 2000). This study aimed to assess the effect of mobile phones in dietary assessment in adolescents with T1DM.Methods: Fifteen adolescent patients with T1DM attending the Tayside Paediatric Diabetic Clinics were recruited. Participants were asked to complete food diaries for 4 days and to photograph (using the mobile phones provided) all food and drink consumed during that period. Photographs were downloaded to a computer using Bluetooth technology®. A dietitian estimated portion sizes from the diaries and photographs. The number of items ovn each day for each method was recorded. Dietary intake information was analysed for total energy intake and percent energy from carbohydrate, fat and protein using the dietary analysis package Dietplan 6 (Forestfield Software Ltd, Horsham, West Sussex, UK). Dietary recommendations for this client group (Hanas et al., 2006) are shown in Table 1. The dietary analyses with and without the use of mobile phones were compared using paired Student's t‐tests. Results are expressed as mean (SD) and range, as appropriate.Results: Eight participants [14.3 (1.8) years; duration of diabetes 8.4 months–11.2 years; HbA1C 9.5% (2.0%)] returned completed diaries and full sets of photographs. No statistically significant differences were seen in the number of items recorded by using food diaries 27.8 (7.8) and mobile phones 24.2 (9.6). Dietary analysis of the food diaries is shown in Table 1; there were no significant differences between the two groups. The effect of photographs taken by mobile phone on the dietary analysis of food diaries [mean (SD)] Food diary Food diary with photos Recommended intakes Protein (% total energy) 17.3 16.7 15 Fat (% total energy) 35.2 34.9 35 Carbohydrate (% total energy) 46.9 48.3 40 Discussion: Although there were no significant differences in macronutrient intake as recorded in food diaries with and without the use of mobile phones, photographs provided additional information that facilitated the estimation of portion sizes in this client group. The almost ubiquitous use of mobile phones may provide a perfect medium for engaging young people in diabetes self‐management issues (Franklin et al., 2006), although their use in dietary assessment requires further exploration.Conclusions: Photographs taken using mobile phones may be a useful tool in the dietetic management of T1DM in adolescents.References Cartwright, M., Wardle, J., Steggles, N., Simon, A.E., Croker, H., &amp; Jarvis, M.J. (2003) Stress and dietary practices in adolescents. Health Psychol. 22, 362–369.Franklin, V., Waller, A., Pagliari, C. &amp; Greene, S. (2006) A randomized controlled trial of ‘Sweet Talk’, a text‐messaging system to support young people with diabetes. Diabet. Med.23, 1332–1338.Hampson, S.E., Skinner, T.C., Hart, J., Storey, L., Gage, H. &amp; Foxcroft, D. (2000) Behavioural interventions for adolescents with type 1 diabetes: how effective are they? Diabetes Care23, 1416–1422.Hanas, R., Donaghue, K., Klingensmith, G. &amp; Swift, P.G. (2006) International Society for paediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines. Paediatr. Diabetes 7, 341–342.Nutritional SubCommittee of Daibetes Care Advisory Committee of the UK (2003) The dietitians challenge: the implementation of nutritional advice for people with diabetes. J. Hum. Nutr. Diet. 16, 421–452.Skinner, H., Biscope. S., Poland, B. &amp; Goldberg, E. (2003) How adolescents use technology for health information: implications for health professionals from focus group studies. J. Med. Internet Res.5, E32.Tefft, M.E. &amp; Boniface, D.R. (2000) Estimating food and nutrient intake from food frequency questionnaire data by reference to a standard weighed diet survey. J. Hum. Nutr. Diet.13, 219–224.

A Comparison of Antibody Testing, Permeability Testing, and Zonulin Levels with Small-Bowel Biopsy in Celiac Disease Patients on a Gluten-Free Diet

Active celiac disease is associated with positive endomysial (EMA) and tissue transglutaminase (TTG) antibodies, elevated zonulin levels, and increased intestinal permeability. There is little known about what happens to these immunologic and structural abnormalities in patients on a gluten-free diet and their correlation with small-bowel biopsy changes. Adult patients previously diagnosed with celiac disease and on a gluten-free diet for greater than 1 year were considered for the study. All patients underwent the following: measurement of EMA and TTG antibodies, serum zonulin levels, intestinal permeability (IP) testing with lactulose/mannitol ratios, food diary analysis for gluten ingestion and small- bowel biopsy. A total of 21 patients on a gluten-free diet for a mean of 9.7 years completed the study. There were ten patients who had normalization of intestinal biopsies, IP and TTG, and EM antibodies. Six patients had Marsh type 2 or 3 lesions and all had either abnormal IP (5/6) or TTG antibody (4/6). In patients with Marsh type 3 lesions, there was a correlation between IP and zonulin levels. A subgroup of patients with celiac disease on a gluten-free diet has complete normalization of intestinal biopsies, intestinal permeability defects, and antibody levels. Patients with Marsh type 3 lesions have abnormal TTG antibodies and intestinal permeability with zonulin levels that correlate with IP. These abnormalities may be due to continued gluten ingestion. Further study is needed to determine the clinical utility of TTG antibodies and IP testing in following patients with celiac disease.

Continuous Ambulatory Peritoneal Dialysis Patients Are Unable to Increase Dietary Intake to Recommended Levels

This study's objective was to determine whether offering dietary advice was effective in supporting patients in adjusting energy intake. We performed a prospective, randomized, controlled trial of dietary intervention involving 59 patients on continuous ambulatory peritoneal dialysis over a 4-month follow-up period. The study involved outpatients on home-based renal replacement therapy. All participants were adult patients on continuous ambulatory peritoneal dialysis. All eligible patients were invited to take part. Subjects were randomized into two groups: control and intervention. Those with diabetes mellitus, malabsorption, malignancy, or eating disorders were excluded. Baseline measurements to assess current dietary intake and nutritional status were performed in all subjects. Measurements included a 5-day food diary, subjective global assessment (SGA), anthropometry, and serum biochemistry. After analysis of the food diaries, the participants in the control group were given follow-up dietary advice that would enable them to match intake with current dietary recommendations for this group of 1.2 g of protein per kilogram of ideal body weight, 25 cal/kg ideal body weight. Participants in the intervention group were given follow-up dietary advice that would encourage them to match energy intake with an estimate of total energy expenditure based on their calculated basal metabolic rate and physical activity level as designated using information from SGA, with a significantly lower protein intake of 0.8 to 1.0 g/kg ideal body weight and an emphasis on calories from carbohydrate and fat. Both groups completed further 5-day food diaries at 2 and 4 months to assess their ability to make the recommended changes. SGA, anthropometry, and biochemistry were all remeasured at the end of the study period. Differences in energy and protein intakes between and within the two groups from baseline to 4 months were assessed. Protein and energy intakes did not change during 4 months in either group, and there was no significant difference in intake between the two groups. In the control group (n = 27), 18 subjects (69%) matched their reported dietary energy intake to the recommended intake. In the intervention group (n = 28), 17 subjects (63%) matched their reported dietary intake to their estimated total energy expenditure. In the control group (n = 27), 8 subjects (28%) achieved the protein intake recommended to them of 1.2 g/kg. In the intervention group (n = 28), 23 subjects (85%) achieved the protein intake recommended to them of greater than 0.8 g/kg. Patients not meeting their dietary prescription did not adjust their intake to match the recommended advice they had been given from a dietitian. Food diary analysis showed that subjects ate less than the recommended intakes for energy and protein. This inability to change suggests that subjects may be eating to the limit of their appetite. SGA sections concerning appetite, body weight, body mass index, and estimates of energy expenditure support the view that energy intake matches requirements.