Changes In Total Energy Intake Research Articles

Changes in Food Consumption, BMI, and Body Composition in Youth in the US during the COVID-19 Pandemic.

Rates of childhood overweight/obesity have risen for decades; however, data show the prevalence increased at a faster rate during the COVID-19 pandemic. Pandemic-associated increases in youth's body mass index (BMI; kg/m2) have been attributed to decreases in reported physical activity; few studies have examined changes in food intake. We therefore examined changes in total energy, nutrient consumption, BMI, BMIz, and adiposity longitudinally over 3 years, comparing healthy youth aged 8-17 years assessed twice prior to the pandemic, to youth seen once before and once during the pandemic. The total energy intake and percent macronutrient consumption were assessed using a standardized, laboratory-based, buffet-style meal. Height and weight were measured and adiposity was collected via dual energy X-ray absorptiometry. Generalized linear model univariate analyses investigated differences between groups. One-hundred-fifteen youth (15.6 + 2.8 years 47.8% female; 54.8% White) from the Washington D.C., Maryland, and Virginia greater metropolitan area participated. In this secondary analysis, neither changes in total energy intake (p = 0.52) nor changes in nutrient consumption were significantly different between the two groups (ps = 0.23-0.83). Likewise, changes in BMI, BMIz, and adiposity (ps = 0.95-0.25) did not differ by group. Further research should investigate food intake and body composition, comparing youth with and without overweight/obesity to better identify those at greatest risk of excess weight gain during the pandemic.

Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage.

Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage.

Incorporating the Dietary Guidelines for Americans Vegetable Recommendations into the Diet Alters Dietary Intake Patterns of Other Foods and Improves Diet Quality in Adults with Overweight and Obesity

BackgroundUnderstanding how vegetables are incorporated into the diet, especially in the types and amounts recommended by the Dietary Guidelines for Americans, and how this alters dietary intake patterns is vital for developing targeted behavior change interventions. ObjectiveTo determine how a provision of vegetables was incorporated into the diet of adults with overweight and obesity; whether or not the provided vegetables displaced other foods; and what, if any, effect this had on diet quality and body weight and composition. DesignThis study investigated secondary outcomes from the Motivating Value of Vegetables Study, a community-based, randomized, parallel, nonblinded controlled trial. Participants were randomly assigned to a provided vegetable intervention or attention control group using a one to one allocation ratio. Participants/settingMen and women with self-reported low vegetable consumption, aged 18 to 65 years, with a body mass index ≥25 were recruited from Grand Forks, ND, between October 2015 and September 2017. Only participants randomized to the provided vegetable intervention group (n = 51; attrition = 8%) were included in this secondary analysis. InterventionDietary Guidelines for Americans recommended types and amounts of vegetables were provided weekly for 8 weeks. Main outcome measuresHow the provided vegetables were incorporated into the diet was measured using daily self-report and 24-hour dietary recalls. Diet quality was assessed via the Healthy Eating Index 2015. Body weight and composition were measured before and after the intervention. Statistical analyses performedData were assessed using generalized linear mixed models where phase (pre, post) was the within-subject factor and subject was the random effect. ResultsParticipants self-reported using 29% of the provided vegetables as substitutes for other foods. With the increase in vegetable consumption, there were decreases in total grains (mean difference ± standard deviation; –0.97 ± 3.23 oz-equivalents; P = 0.02), protein foods (–1.24 ± 3.86 oz-equivalents; P = 0.01), saturated fats (–6.44 ± 19.63 g; P = 0.02), and added sugars (–2.44 ± 6.78 tsp-equivalents; P = 0.02) consumed. Total Healthy Eating Index 2015 scores increased (+4.48 ± 9.63; P = 0.001) and dietary energy density decreased (–0.44 ± 0.52 kcal/g; P < 0.0001). There was no change in total energy intake or body weight and composition. ConclusionsIncreasing vegetable consumption to meet Dietary Guidelines for Americans recommendations alters dietary intake patterns, improving diet quality and energy density. These findings highlight the importance of characterizing how individuals incorporate Dietary Guidelines for Americans recommendations into their diet.

Dietary Changes During COVID-19 Lockdown in Adults With Type 1 Diabetes on a Hybrid Artificial Pancreas.

In this retrospective analysis, we examine the impact of the lockdown of the coronavirus pandemic (COVID-19) on eating habits in individuals with type 1 diabetes (T1D) on a hybrid artificial pancreas (HAP). Dietary composition before and during lockdown was assessed by 7-day food records of 12 participants with T1D on HAP (three men and nine women, ages 38 ± 13 years, HbA1c 6.8 ± 0.3%, M ± SD). Continuous glucose monitoring (CGM) metrics and lifestyle changes (online questionnaire) were also assessed. Compared to prelockdown, reported body weight tended to increase during lockdown with no changes in total energy intake. Participants significantly decreased animal protein intake (−2.1 ± 3.7% of total energy intake, p = 0.048), but tended to increase carbohydrate intake (+17 ± 28 g/day, p = 0.052). These changes were induced by modifications of eating habits at breakfast and lunch during weekdays. Patients consumed more cereals (+21 ± 33 g/day, p = 0.038), whole grain (+22 ± 32 g/day, p = 0.044), and sweets (+13 ± 17 g/day, p = 0.021), and less animal protein sources (−42 ± 67 g/day, p = 0.054). Participants showed a more regular meal timing and decreased physical activity. Blood glucose control remained optimal (time-in-range 76 ± 8 vs. 75 ± 7% before lockdown), and daily total insulin infusion increased (42 ± 10 vs. 39 ± 12 I.U., p = 0.045). During the lockdown, patients with T1D on HAP modified dietary habits by decreasing animal protein and increasing carbohydrate intake. This increase, mainly concerning whole grain and low-glycemic-index products, did not influence blood glucose control.

Energy Balance and Risk of Mortality in Spanish Older Adults.

Clinical data on the direct health effects of energy deficit or surplus beyond its impact on body weight are scarce. We aimed to assess the association with all-cause, cardiovascular and cancer mortality of (1) sustained energy deficit or surplus, calculated according to each individual’s en-ergy intake (EI) and theoretical energy expenditure (TEE), and (2) mid-term change in total EI in a prospective study. In 7119 participants in the PREDIMED Study (PREvención con DIeta MEDi-terránea) with a mean age of 67 years, energy intake was derived from a 137-item food frequency questionnaire. TEE was calculated as a function of age, sex, height, body weight and physical ac-tivity. The main exposure was the proportion of energy requirement covered by energy intake, cumulative throughout the follow-up. The secondary exposure was the change in energy intake from baseline. Cox proportional hazard models were used to estimate hazard ratios and 95% con-fidence intervals for all-cause, cardiovascular and cancer mortality. Over a median follow-up of 4.8 years, there were 239 deaths (excluding the first 2 years). An energy intake exceeding energy needs was associated with an increase in mortality risk (continuous HR10% over energy needs = 1.10; 95% CI 1.02, 1.18), driven by cardiovascular death (HR = 1.26; 95% CI 1.11, 1.43). However, consum-ing energy below estimated needs was not associated with a lower risk. Increments over time in energy intake were associated with greater all-cause mortality (HR10% increase = 1.09; 95% CI 1.02, 1.17). However, there was no evidence that a substantial negative change in energy intake would reduce mortality risk. To conclude, in an older Mediterranean cohort, energy surplus or increase over a 5-year period was associated with greater risk of mortality, particularly cardiovascular mortality. Energy deficit, or reduction in energy intake over time were not associated with mortal-ity risk.

Menopausal Transition Is Not Associated with Dietary Change in Swiss Women

BackgroundAdherence to a healthy diet could contribute to maintaining adequate health throughout the menopausal transition, but data are scarce. ObjectiveWe evaluated the association between menopausal status and changes in dietary intake in Swiss adult women. MethodsCross-sectional (n = 2439) and prospective analyses (n = 1656) were conducted between 2009 and 2012 (first follow-up) among women (mean age ± SD, 58.2 ± 10.5 y) living in Lausanne, Switzerland. In both visits, dietary intake was assessed using a validated FFQ, and menopausal status was classified based on the presence or absence of menstruations. Multivariable linear and logistic regression models were used to investigate the cross-sectional association of menopausal status (postmenopausal compared with premenopausal) at the first follow-up with food intake and dietary recommendations. To examine whether menopausal status (premenopausal as reference group, menopausal transition, and postmenopausal) during 5 y of follow-up was associated with longitudinal changes in diet, including adherence to dietary Swiss recommendations, we applied multivariable linear and logistic mixed models adjusted for several covariates. ResultsAt the first follow-up, postmenopausal women consumed less (P < 0.002) meat [median (IQR) 57.2 (35–86.2) compared with 62.5 (41.2–95.2) g/d], pasta [61.8 (37.5–89.2) compared with 85 (57.8–128) g/d], and added sugar [0.1 (0–4) compared with 0.7 (0–8) g/d] and more dairy products [126 (65.4–214) compared with 109 (64.5–182) g/d] and fruit [217 (115–390) compared with 174 (83.2–319) g/d] than premenopausal women. However, linear regression analysis adjusted for potential confounding factors showed no independent (cross-sectional) associations of menopausal status with total energy intake (TEI) and individual macro- or micronutrient intakes. In the prospective analysis, compared with women who remained premenopausal during follow-up (n = 244), no differences were found in changes in TEI, dietary intakes, or adherence to the Swiss dietary recommendations in women transitioning from premenopausal to postmenopausal (n = 229) and who remained postmenopausal (n = 1168). ConclusionThe menopausal transition is not associated with changes in dietary habits among Swiss women.

Associations between fruit juice and milk consumption and change in BMI in a large prospective cohort of U.S. adolescents and preadolescents.

There are concerns that fruit juice and milk contribute to childhood obesity. Determine the relationship between fruit juice and milk intakes and body mass index (BMI) change among preadolescents/adolescents. Participants aged 9 to 16 years old from the Growing Up Today Study II completed surveys including validated food frequency questionnaires in 2004, 2006 and 2008. The contributions of one serving of juice or milk to total energy intake and 2-year change in BMI were evaluated using multiple linear regression. Additional analyses were conducted with subgroups of juice (orange juice and other fruit juice) and milk (low fat and high fat). Missing values for BMI were imputed using a multiple imputation approach, after which data from 8173 participants and 13 717 2-year interval observations were analysed. Baseline fruit juice consumption was inversely associated with BMI change in girls (β=-.102 kg/m2 , SE=0.038, P value=.008) but not boys after controlling for race, age, baseline BMI, and baseline and 2-year changes in total energy intake and physical activity. Orange juice was inversely associated with BMI change among girls (β=-.137 kg/m2 , SE=0.053, P value=.010) while other fruit juice, low fat and high fat milk were not associated with BMI change. Orange juice was inversely associated with 2-year BMI change among preadolescent/adolescent girls but not boys and there were no significant associations with other juices or milk among either gender.

Effect of Increased Daily Water Intake and Hydration on Health in Japanese Adults

Increased hydration is recommended as healthy habit with several merits. However, supportive data are sparse. To assess the efficacy of increased daily water intake, we tested the effect of water supplementation on biomarkers in blood, urine, and saliva. Twenty-four healthy Japanese men and 31 healthy Japanese women with fasting blood glucose levels ranging from 90–125 mg/dL were included. An open-label, two-arm, randomized controlled trial was conducted for 12 weeks. Two additional 550 mL bottles of water on top of habitual fluid intake were consumed in the intervention group. The subjects drank one bottle of water (550 mL) within 2 h of waking, and one bottle (550 mL) 2 h before bedtime. Subjects increased mean fluid intake from 1.3 L/day to 2.0 L/day, without changes in total energy intake. Total body water rate increased with associated water supplementation. There were no significant changes in fasting blood glucose and arginine vasopressin levels, but systolic blood pressure was significantly decreased in the intervention group. Furthermore, water supplementation increased body temperature, reduced blood urea nitrogen concentration, and suppressed estimated glomerular filtration rate reduction. Additionally, existence of an intestinal microbiome correlated with decreased systolic blood pressure and increased body temperature. Habitual water supplementation after waking up and before bedtime in healthy subjects with slightly elevated fasting blood glucose levels is not effective in lowering these levels. However, it represents a safe and promising intervention with the potential for lowering blood pressure, increasing body temperature, diluting blood waste materials, and protecting kidney function. Thus, increasing daily water intake could provide several health benefits.

Dietary and Weight Loss Benefits of a National Sugar-sweetened Beverage Health Warning Policy: A Microsimulation Analysis (OR28-02-19)

ObjectivesOverconsumption of sugar-sweetened beverages (SSBs) is a major contributor to obesity in the United States. To reduce SSB consumption, five U.S. states have proposed requiring front-of-package health warnings on SSBs. Randomized trials indicate that SSB health warnings reduce SSB purchases, but uncertainty remains regarding how these reductions translate into population-level dietary and health outcomes. We aimed to quantify the effects of a national SSB health warning policy on U.S. adults’ dietary behaviors and weight outcomes. MethodsWe developed and validated a Monte Carlo microsimulation model of dietary behaviors and bodyweight using dietary and anthropometric data from the National Health and Nutrition Examination Survey. Using estimates from existing literature, we simulated how an SSB health warning policy would affect SSB intake and, in turn, how changes in SSB intake would affect total energy intake. We then incorporated a validated model of weight change to translate changes in total energy intake into changes in weight over time. We used the model to simulate the impact of a national SSB health warning policy on SSB intake, total energy intake, body mass, and obesity among U.S. adults over a five-year period. Uncertainty analyses simulated scenarios when varying assumptions about three key model parameters: (1) the extent to which warnings would reduce SSB intake, (2) the degree of caloric compensation following a reduction in SSB intake, and (3) the extent to which warnings’ impact would increase or decrease over time. ResultsImplementing a national SSB health warning policy would reduce average SSB intake by 26.2 calories/day (95% uncertainty interval [UI] = −32.8, −19.4) and total energy intake by 32.4 calories/day (95% UI = −37.9, −26.7). These dietary changes would reduce average BMI by 0.6 kg/m2 (95% UI = −0.7, −0.5) and obesity prevalence by 2.1 percentage points (95% UI = −3.2pp, −0.9pp). BMI reductions would be largest among adults who are Black or Hispanic, have low educational attainment, or have low income. Obesity reductions persist when assuming warning efficacy decreases over time and when using conservative estimates of warning impact or caloric compensation. ConclusionsImplementing a national SSB health warning policy could reduce SSB consumption, average BMI, and obesity among U.S. adults. Funding SourcesNational Institutes of Health. Supporting Tables, Images and/or Graphs▪▪▪▪

Erratum: Total energy intake according to the level of skeletal muscle mass in Korean adults aged 30 years and older: an analysis of the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011.

[This corrects the article on p. 222 in vol. 12, PMID: 29854328.].

Total energy intake according to the level of skeletal muscle mass in Korean adults aged 30 years and older: an analysis of the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011.

BACKGROUND/OBJECTIVESSince gain or loss of skeletal muscle mass is a gradual event and occurs due to a combination of lifestyle factors, assessment of dietary factors related to skeletal muscle is complicated. The aim of this study was to investigate the changes in total energy intake according to the level of skeletal muscle mass.SUBJECTS/METHODSA total of 8,165 subjects ≥ 30 years of age from the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008–2011 were included in the analysis, and multivariate-adjusted regression analyses were performed to analyze the association of the quartiles of sarcopenia index (SI) with energy intake of the study population after adjusting for age and metabolic parameters.RESULTSThe increase in SI quartile was in proportion to the gradual decrease in systemic lipids and the anthropometric measurement of fat accumulation (P < 0.001). Subjects in higher SI quartiles tended to consume more total energy and energy-producing nutrients than those in lower quartiles (P < 0.001). After age, body weight, alcohol consumption, and metabolic parameters were adjusted in the analysis, total energy intake gradually increased according to the increase in SI quartile, and the association between total energy intake and SI was more pronounced in men. However, the risk (odd ratio) of having a low SI was not affected by any single macronutrient intake.CONCLUSIONSIn this study, total energy intake was positively associated with SI and relative skeletal mass in both men and women. However, no significant association or a weak association was observed between any single macronutrient intake and skeletal muscle mass. The data indicated that acquiring more energy intake within the normal range of energy consumption may help to maintain skeletal muscle mass.

Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study

Background: Approximately 20-30% of obese patients do not achieve successful weight outcomes after bariatric surgery.Objective: We examined whether short-term changes (≤0.5 y postsurgery) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change.Design: Participants were recruited from the Swedish Obese Subjects (SOS) study, which was a matched (nonrandomized) prospective trial that compared bariatric surgery with usual care for obese patients. A total of 2010 patients who underwent bariatric surgery were included in the study. Physical examinations (e.g., weight) and questionnaires (e.g., dietary questionnaire) were completed before and 0.5, 1, 2, 3, 4, 6, 8, and 10 y after surgery. For the main analytic strategy, a linear mixed model was implemented, which included repeated measures with a random intercept and an unstructured covariance matrix.Results: Short-term changes in energy intake (P < 0.001) and in relative proportions of energy from carbohydrates (P < 0.001), fat (P < 0.001), and protein (P < 0.05) were associated with 10-y weight change after bariatric surgery. At the 10-y follow-up, men and women with the largest reductions in energy intake had lost 7.3% and 3.9% more weight, respectively, compared with that of subjects with the smallest intake reductions (P < 0.001). Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition (P < 0.05).Conclusions: The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss. Weight loss is also associated with a changing dietary macronutrient composition. This trial was registered at clinicaltrials.gov as NCT01479452.

Effect of a Brown Rice Based Vegan Diet and Conventional Diabetic Diet on Glycemic Control of Patients with Type 2 Diabetes: A 12-Week Randomized Clinical Trial.

ObjectiveSeveral intervention studies have suggested that vegetarian or vegan diets have clinical benefits, particularly in terms of glycemic control, in patients with type 2 diabetes (T2D); however, no randomized controlled trial has been conducted in Asians who more commonly depend on plant-based foods, as compared to Western populations. Here, we aimed to compare the effect of a vegan diet and conventional diabetic diet on glycemic control among Korean individuals.Materials and MethodsParticipants diagnosed with T2D were randomly assigned to follow either a vegan diet (excluding animal-based food including fish; n = 46) or a conventional diet recommended by the Korean Diabetes Association 2011 (n = 47) for 12 weeks. HbA1c levels were measured at weeks 0, 4, and 12, and the primary study endpoint was the change in HbA1c levels over 12 weeks.ResultsThe mean HbA1c levels at weeks 0, 4, and 12 were 7.7%, 7.2%, and 7.1% in the vegan group, and 7.4%, 7.2%, and 7.2% in the conventional group, respectively. Although both groups showed significant reductions in HbA1C levels, the reductions were larger in the vegan group than in the conventional group (-0.5% vs. -0.2%; p-for-interaction = 0.017). When only considering participants with high compliance, the difference in HbA1c level reduction between the groups was found to be larger (-0.9% vs. -0.3%). The beneficial effect of vegan diets was noted even after adjusting for changes in total energy intake or waist circumference over the 12 weeks.ConclusionBoth diets led to reductions in HbA1c levels; however, glycemic control was better with the vegan diet than with the conventional diet. Thus, the dietary guidelines for patients with T2D should include a vegan diet for the better management and treatment. However, further studies are needed to evaluate the long-term effects of a vegan diet, and to identify potential explanations of the underlying mechanisms.Trial RegistrationCRiS KCT0001771

Dietary micronutrient intake during pregnancy is a function of carbohydrate quality

Despite normal gestational weight gain, dietary studies in pregnant women show intakes below the recommendations for energy and micronutrients. This study compared changes in dietary intake from the second to third trimester with emphasis on energy intake and carbohydrate quality. These post hoc analyses were based on 566 women participating in the Pregnancy and Glycemic Index Outcomes study, a randomized controlled trial comparing the effect of low-glycemic index (GI) dietary advice with healthy eating advice on selected pregnancy outcomes. With the use of multilevel mixed-regression analysis, changes in total energy intake, starch, sugar, fiber intake, GI, and glycemic load (GL) were correlated with intake of different micronutrients. Energy intake decreased in the third trimester, and most women did not meet the national recommended amounts for iron, folate, and dietary fiber from food sources alone. After adjustment for age, ethnicity, prepregnancy body mass index, and intervention group, change in energy intake was positively related to change in intake of all micronutrients (P < 0.001). GI, GL, and starch intake were inversely related to micronutrient intake (P < 0.001), whereas higher total sugars predicted higher intake (P < 0.001). Associations with dietary fiber were inconsistent. Normal pregnancy can be associated with a decline in energy and micronutrient intake from diet. Low dietary GI and GL were the best predictors of a favorable micronutrient profile. This trial was registered at www.anzctr.org.au as ACTRN12610000174088.

Oral protein calorie supplementation for children with chronic disease.

BackgroundPoor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009.ObjectivesTo examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems.Search methodsTrials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted.Most recent search of the Group's Trials Register: 24 February 2015.Selection criteriaRandomised or quasi‐randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease.Data collection and analysisWe independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials.Main resultsFour studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases.Authors' conclusionsOral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We identified a small number of studies assessing these products in children with cystic fibrosis and paediatric malignant disease, but were unable to draw any conclusions based on the limited data extracted. We recommend a series of large, randomised controlled trials be undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we suggest these products are used with caution.

Reduction in Food Away from Home Is Associated with Improved Child Relative Weight and Body Composition Outcomes and This Relation Is Mediated by Changes in Diet Quality

BackgroundReducing consumption of food away from home is often targeted during pediatric obesity treatment, given the associations with weight status and gain. However, the effects of this dietary change on weight loss are unknown. ObjectiveOur aim was to evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment. It is hypothesized that reduced consumption of food away from home will be associated with improved dietary intake and greater reductions in anthropometric outcomes (standardized body mass index [BMI] and percent body fat), and the relationship between food away from home and anthropometric outcomes will be mediated by improved child dietary intake. DesignWe conducted a longitudinal evaluation of associations between dietary changes and child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric data were collected at baseline and 16 weeks. Participants/settingParticipants were 170 overweight and obese children ages 7 to 11 years who completed a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site randomized controlled trial conducted in two cohorts between 2010 and 2011 (clinical research trial). InterventionDietary treatment targets during family-based behavioral weight-loss treatment included improving diet quality and reducing food away from home. Main outcome measuresThe main outcome measures in this study were child relative weight (standardized BMI) and body composition (percent body fat). Statistical analysesWe performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates. ResultsAs hypothesized, decreased food away from home was associated with improved diet quality and greater reductions in standardized BMI (P<0.05) and percent body fat (P<0.01). Associations between food away from home and anthropometric outcomes were mediated by changes in diet quality. Specifically, change in total energy intake and added sugars mediated the association between change in food away from home and standardized BMI, and change in overall diet quality, fiber, added sugars, and added fats mediated the association between change in food away from home and percent body fat. Including physical activity as a covariate did not significantly impact these findings. ConclusionsThese results suggest that reducing food away from home can be an important behavioral target for affecting positive changes in both diet quality and anthropometric outcomes during treatment.

Energy Gap in the Aetiology of Body Weight Gain and Obesity: A Challenging Concept with a Complex Evaluation and Pitfalls

The concept of energy gap(s) is useful for understanding the consequence of a small daily, weekly, or monthly positive energy balance and the inconspicuous shift in weight gain ultimately leading to overweight and obesity. Energy gap is a dynamic concept: an initial positive energy gap incurred via an increase in energy intake (or a decrease in physical activity) is not constant, may fade out with time if the initial conditions are maintained, and depends on the ‘efficiency' with which the readjustment of the energy imbalance gap occurs with time. The metabolic response to an energy imbalance gap and the magnitude of the energy gap(s) can be estimated by at least two methods, i.e. i) assessment by longitudinal overfeeding studies, imposing (by design) an initial positive energy imbalance gap; ii) retrospective assessment based on epidemiological surveys, whereby the accumulated endogenous energy storage per unit of time is calculated from the change in body weight and body composition. In order to illustrate the difficulty of accurately assessing an energy gap we have used, as an illustrative example, a recent epidemiological study which tracked changes in total energy intake (estimated by gross food availability) and body weight over 3 decades in the US, combined with total energy expenditure prediction from body weight using doubly labelled water data. At the population level, the study attempted to assess the cause of the energy gap purported to be entirely due to increased food intake. Based on an estimate of change in energy intake judged to be more reliable (i.e. in the same study population) and together with calculations of simple energetic indices, our analysis suggests that conclusions about the fundamental causes of obesity development in a population (excess intake vs. low physical activity or both) is clouded by a high level of uncertainty.

Seasonal Resting Metabolic Rate and Food Intake of Captive Pacific White-Sided Dolphins (Lagenorhynchus obliquidens)

Like many marine mammals, Pacific white-sided dolphins (Lagenorhynchus obliquidens) consume prey that change seasonally in numbers, distribution, and energy density. However, it is not known whether these ecological factors are associated with underlying seasonal changes in energy requirements. We investigated these potential seasonal shifts in physiology by measuring resting metabolic rate (a conserved physiological trait) and recording associated daily food energy intake of three captive adult Pacific white-sided dolphins over 12 consecutive months. Two dolphins that met the criteria for measuring resting metabolism had a mean (± SE) massspecific rate of 0.31 ± 0.0047 MJ kg -1 day -1 (~34 MJ day -1 ), which was higher than that of other species of small cetaceans. Resting metabolic rates of Pacific white-sided dolphins did not vary seasonally and, hence, were not related to observed seasonal changes in water or air temperature, total energy intake, or body mass. Overall, resting metabolism accounted for ~70% of total energy intake. However, total food energy intake changed seasonally and was highest during the fall (October to December). While levels of food intake were not predicted by resting metabolic rate, body mass, or water and air temperatures, the increased intake in the fall resulted in the seasonal increase in body mass exhibited by all three dolphins. Our estimates of resting metabolic rates and relative changes in total energy intake can be used to parameterize bioenergetic models needed to estimate the ecological impacts and energetic requirements of Pacific white-sided dolphins in the wild, which will have conservation implications.

Causes of Increased Energy Intake Among Children in the U.S., 1977–2010

Changes in total energy intake have been reported among children and adolescents, but the extent to which the components of total energy-energy density; portion size; and the number of eating/drinking occasions (EO)-drive these changes is unknown. The objective of the current study was to examine the relative contribution to changes in daily total energy. Using cross-sectional nationally representative data from the Nationwide Food Consumption Survey (1977-1978); the Continuing Survey of Food Intake of Individuals (1989-1991); and the National Health and Nutrition Examination Surveys (1994-1998 and 2005-2010) for children and adolescents (aged 2-18 years), changes in total energy (kcal/day) were mathematically decomposed to determine the relative contributions of its three component parts: portion size (g/EO); energy density (kcal/g/EO); and eating/drinking occasions (n). Analyses were completed in 2012. Over the full period, there was an increase in total energy intake (+108 kcal/day) and the number of daily eating/drinking occasions (+1.2). The average portion size per eating/drinking occasion increased between 1977-1978 and 1989-1991, and then dropped by about 85 g/EO between 1989-1991 and 2005-2010. The average energy density per eating/drinking occasion has fluctuated over time, reaching its highest level in 2005-2010 (1.24 kcal/g/EO). The decomposition results show that between 1977-1978 and 2005-2010, changes in the number of eating/drinking occasions per day and portion size per eating occasion were the largest contributors to annualized changes in daily total energy (+19 and -13 kcal/day/year, respectively). Variations in trends were observed for race/ethnicity and parental education subgroups. These findings highlight potentially important intervention targets for reducing energy imbalances in U.S. youth.

Cutting 5 billion calories from the English diet: estimation of the effect on obesity prevalence

BackgroundIn October, 2011, the UK Health Minister called on the food and drinks industry to cut 5 billion calories from the nation's daily diet. The subsequent effect on obesity has not been formally modelled. We sought to establish the potential effect on overweight and obesity in the English population. MethodsWe developed a spreadsheet-based model to estimate the effect of a mean reduction of 100 calories per person per day in England (equivalent to a daily reduction of 5 billion calories). The parameters used in the model were developed by Christiansen and Garby (2002) and are based on principles of conservation of energy. These parameters estimate change in body-mass index (BMI) on the basis of change in total energy intake and change in physical activity levels. Physical activity levels were assumed to remain constant. Baseline obesity levels were taken from the Health Survey of England (2006). Two scenarios were modelled for all adults (≥16 years) in England: (1) a reduction of 100 calories per person per day; and (2) a calorie reduction dependent on baseline BMI. In the first scenario we modelled a uniform shift in the obesity curve, with the assumption of a log normal distribution (a shift in the mean with a fixed SD). In the second scenario the distribution of BMI was divided into a series of discrete 2·5 kg/m2 strata and the change in BMI for each stratum was calculated separately. We modelled a linear increase in calorie reduction from 100 calories for those with a BMI greater than 22·5 kg/m2 to 222 calories for those with a BMI greater than 47·5 kg/m3, such that the mean daily calorie reduction was 100 calories. FindingsScenario 1 predicts a reduction in the prevalence of obesity from 25% to 14%, a reduction of 11 percentage points; and a reduction in the prevalence of overweight or obese from 63% to 50%, a reduction of 13 percentage points. This reduction is equivalent to 4·5 million fewer adults with obesity. The percentage of the population with a BMI less than 17·5 kg/m3 would rise from 1·5% to 3·6%, an increase of nearly 900 000. Scenario 2 predicts a reduction in the prevalence of obesity from 25% to 14%, a reduction of 11 percentage points; and a reduction in the prevalence of overweight or obese from 63% to 48%, a reduction of 15 percentage points. There was no rise in the percentage of the population with a BMI less than 17·5 kg/m3. InterpretationRemoval of 5 billion calories from our daily diet, if achieved, would nearly halve the number of adults with obesity. It is unlikely to fully reverse the rise in overweight and obesity recorded in the past 30 years. Both scenarios result in a similar effect on the proportion of the population classified as overweight or obese. However, weighting the calorie reduction towards the population overweight and obese avoids the potential harm of increasing the number of underweight individuals. FundingOTM is an NIHR-funded academic trainee in public health. PS is funded by the British Heart Foundation. No explicit funding was sought for this work.