Estimated Energy Requirements Research Articles

Predicted estimates of resting energy expenditure have limited clinical utility in patients with cirrhosis

Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis. Accurate assessment of energy requirements is needed to optimize dietary intake. Resting energy expenditure (REE), the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE). This study assessed the usefulness of predicted estimates of REE in this patient population. Individual mREE data were available for 900 patients with cirrhosis (mean [±1 SD] age 55.7±11.6 years-old; 70% men; 52% south-east Asian) and 282 healthy controls (mean age 36.0±12.8 years-old; 52% men; 18% south-east Asian). Metabolic status was classified using thresholds based on the mean ± 1 SD of the mREE in the healthy controls. Comparisons were made between mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. Stepwise regression was used to build 3 new prediction models which included sex, ethnicity, body composition measures, and model for end-stage liver disease scores. The mean mREE was significantly higher in patients than controls when referenced to dry body weight (22.4±3.8 cf. 20.8±2.6 kcal/kg/24 hr; p <0.001); there were no significant sex differences. The mean mREE was significantly higher in Caucasian than Asian patients (23.1±4.4 cf. 21.7±2.9 kcal/kg/24 hr; p <0.001). Overall, 37.1% of Caucasian and 25.3% of Asian patients were classified as hypermetabolic. The differences between mREE and pREE were both statistically and clinically relevant; in the total patient population, pREE estimates ranged from 501 kcal/24 hr less to 548 kcal/24 hr more than the mREE. Newly derived prediction equations provided better estimates of mREE but still had limited clinical utility. Prediction equations do not provide useful estimates of REE in patients with cirrhosis. REE should be directly measured. People with cirrhosis are often malnourished and this has a detrimental effect on outcome. Provision of an adequate diet is very important and is best achieved by measuring daily energy requirements and adjusting dietary intake accordingly. Prediction equations, which use information on age, sex, weight, and height can be used to estimate energy requirements; however, the results they provide are not accurate enough for clinical use, particularly as they vary according to sex and ethnicity.

Alleviation of Dyslipidemia via a Traditional Balanced Korean Diet Represented by a Low Glycemic and Low Cholesterol Diet in Obese Women in a Randomized Controlled Trial.

A traditional balanced Korean diet (K-diet) may improve energy, glucose, and lipid metabolism. To evaluate this, we conducted a randomized crossover clinical trial, involving participants aged 30–40 years, who were randomly assigned to two groups—a K-diet or westernized Korean control diet daily, with an estimated energy requirement (EER) of 1900 kcal. After a 4-week washout period, they switched the diet and followed it for 4 weeks. The carbohydrate, protein, and fat ratios based on energy intake were close to the target values for the K-diet (65:15:20) and control diet (60:15:25). The glycemic index of the control diet and the K-diet was 50.3 ± 3.6 and 68.1 ± 2.9, respectively, and daily cholesterol contents in the control diet and K-diet were 280 and 150 mg, respectively. Anthropometric and biochemical parameters involved in energy, glucose, and lipid metabolism were measured while plasma metabolites were determined using UPLC-QTOF-MS before and after the 4-week intervention. After the four-week intervention, both diets improved anthropometric and biochemical variables, but the K-diet significantly reduced them compared to the control diet. Serum total cholesterol, non-high-density lipoprotein cholesterol, and triglyceride concentrations were significantly lower in the K-diet group than in the control diet group. The waist circumference (p = 0.108) and insulin resistance index (QUICKI, p = 0.089) tended to be lower in the K-diet group than in the control diet group. Plasma metabolites indicated that participants in the K-diet group tended to reduce insulin resistance compared to those in the control diet group. Amino acids, especially branched-chain amino acids, tyrosine, tryptophan, and glutamate, and L-homocysteine concentrations were considerably lower in the K-diet group than in the control diet group (p < 0.05). Plasma glutathione concentrations, an index of antioxidant status, and 3-hydroxybutyric acid concentrations, were higher in the K-diet group than in the control diet group. In conclusion, a K-diet with adequate calories to meet EER alleviated dyslipidemia by decreasing insulin resistance-related amino acids and increasing ketones in the circulation of obese women.

Postoperative Dietary Intake Achievement: A Secondary Analysis of a Randomized Controlled Trial.

Sufficient postoperative dietary intake is crucial for ensuring a better surgical outcome. This study aimed to investigate the postoperative dietary intake achievement and predictors of postoperative dietary intake among gynecologic cancer patients. A total of 118 participants were included in this secondary analysis. Postoperative dietary data was pooled and re-classified into early postoperative dietary intake achievement (EDIA) (daily energy intake (DEI) ≥ 75% from the estimated energy requirement (EER)) and delay dietary intake achievement (DDIA) (DEI < 75% EER) There was a significant difference in postoperative changes in weight (p = 0.002), muscle mass (p = 0.018), and handgrip strength (p = 0.010) between the groups. Postoperative daily energy and protein intake in the EDIA was significantly greater than DDIA from operation day to discharged (p = 0.000 and p = 0.036). Four significant independent postoperative dietary intake predictors were found: preoperative whey protein-infused carbohydrate loading (p = 0.000), postoperative nausea vomiting (p = 0.001), age (p = 0.010), and time to tolerate clear fluid (p = 0.016). The multilinear regression model significantly predicted postoperative dietary intake, F (4, 116) = 68.013, p = 0.000, adj. R2 = 0.698. With the four predictors’ recognition, the integration of a more specific and comprehensive dietitian-led supportive care with individualized nutrition intervention ought to be considered to promote functional recovery.

A narrative review on the application of doubly labeled water method for estimating energy requirement for Koreans.

Research articles were reviewed to validate the estimated energy requirements (EERs) equations developed by the Institute of Medicine of the National Academies (IOM). These equations are based on total energy expenditure (TEE) measured by the doubly labeled water (DLW) method. We subsequently aimed to provide the basis for the suitability to apply the IOM equations as EER equations for Koreans, and develop relevant equations for EER in the Dietary Reference Intake for Koreans (KDRI). Additionally, besides the EER(IOM) equations, other equations were examined for EER estimation. Research papers demonstrating the validation of the EER(IOM) equations based on TEE(DLW) were searched through PubMed (up to September 2019). Of the 637 potentially relevant articles identified, duplicates and unsuitable titles and abstracts were excluded. Furthermore, papers with irrelevant subject and inappropriate study design were also excluded. Finally, 11 papers were included in the review. Among the reviewed papers, 8 papers validated the application of the EER(IOM) equations for EER based on TEE(DLW). These included 3 studies for children (USA 1, Korea 2), 1 for adolescents (Portugal), 2 for adults (Korean), and 2 for the elderly (Korea, USA). EER(IOM) equations were found to be generally acceptable for determining EER by using the DLW method, except for Korean boys at 9–11 yrs (overestimated) and female athletes at 19–24 yrs (underestimated). Additionally, 5 papers include the validation of other EER equations, beside EER(IOM) for EER based on TEE(DLW). In Japanese dietary reference intake and recommended dietary allowance, EER equations are acceptable for determining EER based on TEE(DLW). The EER(IOM) equations is generally acceptable for determining EER using the DLW method in Koreans as well as several populations, although certain defined groups were found to be unfit for the estimation. Additionally, the concept of healthy body mass index of Koreans and physical activity levels need to be considered, thereby providing the basis for developing relevant equations of EER in KDRI.

Sex differences in refeeding among hospitalized adolescents and young adults with eating disorders.

To determine sex differences in refeeding (i.e., short-term nutritional rehabilitation) outcomes among hospitalized adolescents and young adults with eating disorders. We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical and nutritional management between May 2012 and August 2020. Descriptive statistics, crude, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes and predictors of length of stay. A total of 588 adolescents and young adults met eligibility criteria (16% male, mean [SD] age 15.96 [2.75], 71.6% anorexia nervosa, admission percent median body mass index [%mBMI] 87.1 ± 14.1). In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980, p=.188); however, males had higher estimated energy requirements (EER, kcal) (3,694 vs. 2,925, p < .001). In linear regression models adjusting for potential confounders, male sex was associated with higher prescribed kcals at discharge (B=835 kcal, p < .001), greater weight change (B=0.47 kg, p=.021), and longer length of stay (B=1.94 days, p=.001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in a linear regression model. These findings support the development of individualized approaches for males with eating disorders to improve quality of care and health care efficiency among an underserved population.

Nutrition priorities in obese critically ill patients.

During critical illness, several neuroendocrine, inflammatory, immune, adipokine, and gastrointestinal tract hormone pathways are activated; some of which are more intensified among obese compared with nonobese patients. Nutrition support may mitigate some of these effects. Nutrition priorities in obese critically ill patients include screening for nutritional risk, estimation of energy and protein requirement, and provision of macronutrients and micronutrients. Estimation of energy requirement in obese critically ill patients is challenging because of variations in body composition among obese patients and absence of reliable predictive equations for energy expenditure. Whereas hypocaloric nutrition with high protein has been advocated in obese critically ill patients, supporting data are scarce. Recent studies did not show differences in outcomes between hypocaloric and eucaloric nutrition, except for better glycemic control. Sarcopenia is common among obese patients, and the provision of increased protein intake has been suggested to mitigate catabolic changes especially after the acute phase of critical illness. However, high-quality data on high protein intake in these patients are lacking. Micronutrient deficiencies among obese critically ill patients are common but the role of their routine supplementation requires further study. An individualized approach for nutritional support may be needed for obese critically ill patients but high-quality evidence is lacking. Future studies should focus on nutrition priorities in this population, with efficient and adequately powered studies.

Size-mediated competition and community structure in a Late Cretaceous herbivorous dinosaur assemblage

ABSTRACT It has been argued that, throughout the Mesozoic, the immature growth forms of megaherbivorous dinosaurs competitively excluded small herbivorous dinosaur species, leading to the left-skewed species richness-body mass distributions of their fossil assemblages. By corollary, where large and small herbivores coexisted over a geologically significant period of time, they must have exhibited niche partitioning. We use multivariate ecomorphological analysis of the Late Cretaceous ornithischian dinosaur assemblage of North America to examine this prediction. Our results indicate good ecomorphological separation of most, but not all, species at small body size, although more work is required to demonstrate that these patterns were adaptive. Calculation of browse profiles using corrected abundance data and bracketed estimates of energy requirements suggests that immature megaherbivores – most particularly hadrosaurids – outstripped coexisting small ornithischian species in their control of the resource base.

Association between Water and Energy Requirements with Physical Activity and Fat-Free Mass in Preschool Children in Japan.

Water and energy are essential for the human body. The doubly labeled water (DLW) method measures water turnover (WT) and total energy expenditure (TEE), which serves as a benchmark for the adequate intake (AI) of water and estimated energy requirements (EER). The objective of the current study was to examine the association of WT and TEE with physical activity and body composition in Japanese preschool children. We included 41 preschool children (22 girls, 19 boys) aged 3–6 in this study. WT, TEE, and fat-free mass (FFM) were obtained using DLW. Physical activity was measured using a triaxial accelerometer and categorized as light (LPA; 1.5–2.9 Metabolic equivalents, METs) and of moderate-to-vigorous intensity (MVPA; ≥3.0 METs). Exercise duration (Ex) was defined as ≥4.0 METs of physical activity. WT and TEE moderately positively correlated with Ex, but not with LPA. WT moderately positively correlated with BW and FFM while TEE strongly. We established predictive equations for WT and TEE using body weight (BW), FFM, step count, and Ex to guide the AI of water and EER in Japanese preschool children. We found that FFM and step count are the determinants of TEE, and that BW and Ex are the determinants of WT in preschool children.

Dietary intake of first- and third-year female dietetics students at a South African university

Objective: A survey was undertaken to evaluate and compare dietary intakes of first- and third-year female dietetics students. Design: This was a cross-sectional survey. Setting: The University of Pretoria (UP) was the site of the survey. Population: The study encompassed first- (2012–2015) and third- (2012–2017) year female dietetics students (N = 368). Outcome: Dietary intake data from multiple-day weighed food records were analysed on nutrient, food group and meal and snacking pattern levels. Results: Recorded energy intakes of participants (n = 105 first years, n = 166 third years; response rate: 73.6%) were below Estimated Energy Requirements. Across year groups, intakes exceeded and fell below the Acceptable Macronutrient Distribution Range for fat and carbohydrates respectively; however, third years consumed cereals, grains and starchy vegetables more often. Over 50% of first and third years exceeded Estimated Average Requirements of respectively 3 and 6 of 10 tested micronutrients. Third years recorded higher (all p < 0.001) intakes of protein, magnesium, calcium, zinc and vitamin A than first years. Similarly, their Nutrient Adequacy Ratios were higher (all p < 0.001) for magnesium, calcium and vitamins A, B6 and B12. Average Mean Adequacy Ratios were 70% (first years) and 77% (third years). The year groups differed in terms of food group intake. The number of daily eating occasions decreased over weekends for first and third year students, yet intakes of energy (p < 0.05) and fat (p < 0.001) were higher over weekends. Conclusions: Amidst likely under-recording and/or under-eating, UP female dietetics students’ intakes of some micronutrients may be low. Recorded intakes of third years exceeded those of first years. Recorded nutrient intake improved from the first to the third year of the study in dietetics students.

Development of a gas-permeable bag photobioreactor for energy-efficient oxygen removal from algal culture

Closed photobioreactors are ideal for the production of high-purity and high-value microalgal and cyanobacterial products. However, dissolved oxygen accumulation in closed reactors is detrimental to the growth. Conventional aeration for oxygen removal comprises up to 40% of the total culture cost, and energy-efficient dissolved oxygen removal is demanded. In this study, a novel gas-permeable bag photobioreactor was developed by the incorporation of a gas-permeable film. A hydrophobic microporous film was the most effective for both oxygen permeability and cost compared to silicone or fluororesin. The microporous film was placed on the backside of the reactor as an irradiation reflector. In a culture of Euhalothece sp., less than half of the steady-state dissolved oxygen concentration was demonstrated in the gas-permeable reactor than a non-permeable reactor. The gas-permeable reactor exhibited an oxygen transfer coefficient of 0.084 min−1 under continuous mixing, which is high enough to maintain approximately 300% dissolved oxygen concentration with 58 mg L−1 h−1 biomass productivity without aeration (equivalent to 1.4 g L−1 d−1 under 24-h light). The estimated energy requirement for the gas-permeable reactor can be less than 1% of the aerated reactor of the same size. These results suggested the effectiveness of the gas-permeable reactor for energy-efficient algal mass culture.

Results of 15 Years of Precision Feeding of Hyper Prolific Gestating Sows.

Simple SummaryBody condition at farrowing influences the short-term performance of sows (e.g., farrowing progression, milk production, appetite during lactation) and their long-term reproduction and longevity potentials. In the context of increased prolificacy, farmers increasingly focus on managing maternal reserves. Measurements of backfat thickness and body weight at insemination can be used to monitor the feed allowance during gestation and to maintain body condition throughout farrowing. Regular analysis of data collected on farms can identify the ideal backfat thickness and expected body weight at farrowing (as a function of age). Model-based assessment of nutritional requirements can consider housing conditions, prolificacy, initial characteristics of the sow at insemination (i.e., age, body weight and backfat thickness) and final expected characteristics. On a demonstration farm, feed was provided on an individual basis based on the energy requirements calculated for each sow during gestation under different housing conditions. The risk of high variability in backfat thickness within each batch was reduced at farrowing.The increase in prolificacy at weaning is less than that at farrowing due to increased loss of piglets. As a result, farmers focus more on solutions that can prevent difficult parturition or a decrease in milk production. The body condition of the sow influences both factors. A model developed to estimate energy requirements of gestating sows was used to monitor the body weight and back fat thickness (BT) at farrowing, through the creation of a demonstration farm that included 7 batches of 24 sows. Daily feed allowance was adapted to characteristics of each sow at the beginning of gestation. Based on data collected since 2005 from 5140 gestations in different housing systems, the BT averaged 19.3 mm at farrowing, with no significant differences among housing systems. Within-batch variability in BT ranged from 3–4 mm and is expected to improve in the future by using sensors to automatically weigh and measure physical activity towards a real-time assessment of energy requirements. The next step in reducing feed costs and environmental impacts is to consider amino-acid and phosphorus requirements in the precision-feeding strategy.

Dynamic changes in energy expenditure in response to underfeeding: a review.

The observation that 64% of English adults are overweight or obese despite a rising prevalence in weight-loss attempts suggests our understanding of energy balance is fundamentally flawed. Weight-loss is induced through a negative energy balance; however, we typically view weight change as a static function, in that energy intake and energy expenditure are independent variables, resulting in a fixed rate of weight-loss assuming a constant energy deficit. Such static modelling provides the basis for the clinical assumption that a 14644 kJ (3500 kcal) deficit translates to a 1 lb weight-loss. However, this '3500 kcal (14644 kJ) rule' is consistently shown to significantly overestimate weight-loss. Static modelling disregards obligatory changes in energy expenditure associated with the loss of metabolically active tissue, i.e. skeletal muscle. Additionally, it disregards the presence of adaptive thermogenesis, the underfeeding-associated fall in resting energy expenditure beyond that caused by loss of fat-free mass. This metabolic manipulation of energy expenditure is observed from the onset of energy restriction to maintain weight at a genetically pre-determined set point. As a result, the observed magnitude of weight-loss is disproportionally less, followed by earlier weight plateau, despite strict compliance to a dietary intervention. By simulating dynamic changes in energy expenditure associated with underfeeding, mathematical modelling may provide a more accurate method of weight-loss prediction. However, accuracy at an individual level is limited due to difficulty estimating energy requirements, physical activity and dietary intake in free-living individuals. In the present paper, we aim to outline the contribution of dynamic changes in energy expenditure to weight-loss resistance and weight plateau.

Estimated Energy Requirements of Infants and Young Children up to 24 Months of Age.

ABSTRACTBackgroundEstablishing energy requirements in infants and young children is important in developing age-appropriate diet recommendations but most published guidelines for energy requirements have 1 or more limitations related to the data underlying the calculations.ObjectiveTo develop a comprehensive set of daily energy requirements for infants and young children aged 0–24 mo meeting the ideals of worldwide applicability to all healthy children based on the use of the doubly labeled water (DLW) technique to measure total energy expenditure (TEE), the use of recent, international growth charts, and calculation of values across a wide range of body weight.MethodsDaily estimated energy requirements (EERs) were calculated in 1-mo increments from 0 to 24 mo for boys, girls, and combined, using as inputs the following: 1) TEE measured using the DLW technique, 2) energy deposition estimates from the Institute of Medicine, and 3) body weight values from the 25th to 75th percentiles from the 2006 WHO growth charts. EERs were combined for age groups 0 to <6, 6–8, 9–11, and 12–24 mo by averaging EERs from individual months. The EER calculations were supported by a systematic literature review and a meta-regression of existing studies.ResultsEnergy requirements naturally increase with age and are slightly higher in boys than in girls. The EERs derived in this study are similar to those in other recent international efforts.ConclusionsThis updated set of EERs for infants and young children expand and improve upon the methodology used to establish previous published guidelines. These estimates have multiple potential uses including planning age-appropriate menus for the complementary feeding period, the development of foods that are more precisely targeted to the needs of infants and children at particular ages, and establishing macronutrient requirements within specific age groups based on a percentage of energy, such as dietary fat.

Which is the best route to achieve nutritional goals in pediatric ECMO patients?

ObjectivesEstimating caloric intake and choosing route of administration are fundamental in the nutritional support of patients being supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to review the nutritional intervention carried out in a pediatric cohort in a third-level hospital. MethodsThis was a prospective descriptive study. Age, sex, underlying pathology, Pediatric Risk of Mortality score, ECMO indication, type of care, duration of ECMO support, and prognosis were collected. Type of nutritional support, route of administration, kcal/kg achieved, estimated energy requirements, and percentage of caloric objective (%CO) reached on days 3 and 5 after cannulation were recorded. ResultsTwenty-four venoarterial ECMO runs in 23 patients over a period of 2 y were recorded. Of the 23 patients, 15 were <1 y of age. The underlying pathology in 56.5% was cardiac disease. Three groups were identified: parenteral nutrition (group 0, n = 7), enteral nutrition (group 1, n = 8), and mixed nutrition (group 2, n = 7). The median of the %CO was 33.34 (0–84) on day 3 and 87.75% (78.4–100) on day 5 of ECMO, respectively for group 0; 75.5 (42.25–98.5) and 85% (24.4–107.7) in group 1 and 68.7 (44.4–82.2) and 91.2% (35.5–92) in group 2 (P > 0.05). Children <12 mo of age and cardiac patients represented 85.71% and 71.43% of total patients in group 0. Among the eight episodes of exclusive enteral nutrition, no complications were identified. ConclusionEnteral nutrition appears to be safe in the setting of hemodynamic stability and absence of contraindications and is equivalent to other nutritional interventions in terms of compliance with estimated energy requirements.

Analysis of the Diet Quality and Nutritional State of Children, Youth and Young Adults with an Intellectual Disability: A Multiple Case Study. Preliminary Polish Results.

(1) Background: Considering the limited amount of available data on the diet quality of children, adolescents, and young adults with an intellectual disability (ID) in Poland, as well as the higher incidence of nutritional disorders among people with ID in comparison to the general population, a study was conducted to assess the quality of diet in community-dwelling young individuals with ID. (2) Methods: A multiple-case study was carried out to obtain data on anthropometric parameters and food records over a three-day observation period for 18 subjects with ID. The nutritional value of the products and dishes consumed by the subjects was calculated using the commercial computer program Kcalmar.pro (Hermax, Poland), which contains the Polish database of the nutritional value of food products and dishes. The results presented here are those of a pilot study of a wider research project. (3) Results: The study group consisted of seven women (38.9%) and 11 men (61.1%) with an average age of 12.94 years (range 4.00–22.00) and an average BMI of 25.2 (range 14.5–35.4). The obtained results confirmed the suboptimal pattern of nutrition in children and adolescents with ID. Regarding energy intake and dietary macronutrients, only in 27.8% of cases, energy intake exceeded the Estimated Energy Requirement corresponding to age, sex, body weight, and height. Most of the respondents were characterized by correct intake of proteins, fats, and carbohydrates, and 83.3% showed excessive intake of saturated fatty acids. Excessive intake of vitamins B1, B2, and B6 was observed in all subjects, and that of vitamins B3 (niacin), B12, A, and C in the vast majority of subjects, while deficiency of vitamin D was observed in all individuals and folic acid in 22.2% of individuals. Excessive intake of minerals, such as sodium, phosphorus, and magnesium was noted among most of the respondents, while the intake of calcium and iodine was found to be insufficient. Compared to people with less severe ID (grades 1 and 2), people with grade 3 ID showed significantly lower intake/reference fulfillment of dietary components such as vitamin B6, potassium, phosphorus, iron, copper, iodine, magnesium, and zinc. No significant differences were noted in the nutritional reference fulfillment for various nutrients among the groups distinguished by sex, nutritional status, or the cause of ID. (4) Conclusion: Health supervision guidelines proposed for persons with ID should take into account the dietary practices of the families caring for them, with an emphasis on the prevention and correction of irregularities that may reduce the effectiveness of rehabilitation and deteriorate the health of the affected people. Caregivers/parents of each person with ID who took part in the study were given individualized dietary advice aimed at correcting the dietary abnormalities.

Relationship of Weight Perceptions on Dietary Intake Behaviors in Healthy Weight and Overweight/Obese Adults: National Health and Nutrition Survey (2011-2014)

Compare energy balance and diet quality differences of healthy weight and overweight/obese adults who perceive their weight status accurately versus inaccurately. Weight status can affect health outcomes, but weight misperceptions can cause altered health behaviors. This study assessed relationships between weight misperceptions, energy balance, and overall dietary quality in healthy weight and overweight/obese adults. Participants (n=7,599) included adults participating in the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Weight status and weight perception, based on the question “How do you consider your weight?”, were recoded into four categories: healthy weight accurate perceptions (HWaccurate), healthy weight inaccurate perceptions (HWinaccurate), overweight/obese accurate perceptions (OWaccurate), and overweight/obese inaccurate perceptions (OWinaccurate). Percent energy balance was calculated using actual energy intake divided by estimated energy requirements. The Healthy Eating Index (HEI-2015) was computed using two, 24-hour recalls. Multiple linear regression assessed differences in percent energy balance and HEI-2015 by weight perception category while adjusting for demographic factors. After adjusting for covariates, percent energy balance of HWinaccurate (72.82% SE 2.51, ß=-6.67, p=0.014), OWaccurate (69.59% SE 0.78, ß=-10.31, p<0.001), and OWinaccurate (70.95% SE 1.13, ß=-5.84, p<0.001) groups were significantly lower than HWaccurate group (79.66%, SE 0.81). HEI-2015 scores for OWaccurate participants were significantly lower than HWaccurate (HEI 53.61 SE 0.35 vs. HEI 56.72 SE 0.70, ß=-1.79, p<0.001), but were not significantly different from either inaccurate group. Healthy weight adults who perceive their weight accurately consume diets more closely matching their energy needs and dietary recommendations than do overweight/obese adults or those who perceive their weight inaccurately. This suggests that weight perceptions, not just weight status, should be considered during nutrition counseling for adults.

Development of alternatives to estimate resting metabolic rate from anthropometric variables in paralympic swimmers

ABSTRACT The resting metabolic rate (RMR) is one of the most representative components of total daily energy expenditure (TDEE). Multiple equations have been developed to estimate RMR, but none have been described for Para-Athletes. This study aimed to; i) develop and validate new RMR estimation models from anthropometric variables; and ii) explore the level of agreement between the RMR determined by indirect calorimetry (IC) and the developed models, as well as a selection of existent estimation models in Para-Athletes. Fifteen young Paralympic swimmers (age, 18.7±6.5 years) underwent assessments of RMR by IC and anthropometric batteries. Four RMR estimation models (M1-M4) were developed. The anthropometric variables which explained most of the variance were biacromial breadth (M3-37%), stature (M1-45%; M2-49%), and estimated stature from half arm span (M4-24%). However, the neck girth corrected by the submandibular skinfold entered in all four models. The 95% limits of agreement between IC and M3 equation (best performance model) ranged from -142.02 to 172.39 kcal×day−1 (bias 15.19 kcal×day−1). Concerning the commonly used equations, Harris & Benedict equation was the most consistent when compared to IC. The results of this study suggest four novel RMR equations that may assist in the estimation of energy requirements in elite Para-Athletes.

The role of non-dietetic healthcare professionals in managing interventions among adults at risk of malnutrition: A systematic review

Malnutrition is estimated to affect over three million people in the UK resulting in serious consequences on both the individuals' health and healthcare system. While dietitians are uniquely qualified to provide nutritional interventions, they have one of the lowest workforce numbers in the NHS making it difficult to tackle the malnutrition burden alone. Thus, innovative ways of working are needed. Non-dietetic health care professionals are often involved in the identification, assessment and treatment of malnutrition and research has shown benefits of their involvement in identification and management of nutritional issues, however their role in delivering nutritional interventions has not yet been evaluated. The aim of this systematic review is to collate evidence on the potential roles and effectiveness of non-dietetic healthcare professionals in providing nutritional interventions and their impact on patient-centred outcomes in malnourished or at-risk individuals. Three electronic databases were searched on 10th October 2019. Titles and abstracts were initially screened, followed by full texts, against inclusion criteria and included/excluded studies by two authors independently. Data were extracted and tabulated where possible and grouped according to type of intervention and outcomes. Risk of bias and quality of evidence was assessed using the GRADE approach. Data were combined in the form of a narrative synthesis. Eighteen eligible studies were included; five involved feeding assistance, 10 involved implementing individualised nutrition monitoring or care plans and three were multi-factorial interventions. Interventions took place in a range of settings including hospital and long term care facilities. Very low and low quality evidence suggests that non-dietetic HCP interventions may improve weight, percent of patients reaching estimated energy requirements, quality of life, falls and frailty rate and patient satisfaction. Very low quality evidence suggests that non-dietetic HCP interventions may not improve mid-arm circumference, energy or protein intake, activities of daily living, handgrip strength or length of hospital stay. Low quality evidence suggests that non-dietetic HCP interventions have no effect on mortality. A lack of good quality evidence on the effectiveness of non-dietetic HCP delivered interventions on the management of malnutrition in adults makes it difficult to draw conclusions. However, this review has highlighted the types of interventions and potential roles of non-dietetic HCPs, providing a groundwork for further high-quality research such as feasibility studies in this area, for the effective management of malnutrition within clinical and community practice.

A comparison of the remote food photography method and the automated self-administered 24-h dietary assessment tool for measuring full-day dietary intake among school-age children.

The limitations of self-report measures of dietary intake are well-known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self-Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent-child dyads participated in two, 3-d dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake between assessments, and between each assessment method and the Estimated Energy Requirement (EER). Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (P = 0·0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (P = 0·008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = -148 kcal, P = 0·09). Median satisfaction and ease of use scores were five out of six for both methods. A higher proportion of parents reported that the ASA24 was more time-consuming than the RFPM (74·4 % v. 25·6 %, P = 0·002). Utilisation of both methods is warranted given their high satisfaction among parents.

Effects of intermittent (5:2) or continuous energy restriction on basal and postprandial metabolism: a randomised study in normal-weight, young participants

Background/objectivesIntermittent energy restriction (IER) may overcome poor long-term adherence with continuous energy restriction (CER), for weight reduction. We compared the effects of IER with CER for fasting and postprandial metabolism and appetite in metabolically healthy participants, in whom excess weight would not confound intrinsic metabolic differences.Subjects/methodsIn a 2-week randomised, parallel trial, 16 young, healthy-weight participants were assigned to either CER (20% below estimated energy requirements (EER)) or 5:2 IER (70% below EER on 2 non-consecutive days; 5 days at EER, per week). Metabolic and appetite regulation markers were assessed before and for 3 h after a liquid breakfast; followed by an ad libitum lunch; pre- and post-intervention.ResultsWeight loss was similar in both groups: −2.5 (95% CI, −3.4, −1.6) kg for 5:2 IER vs. −2.3 (−2.9, −1.7) kg for CER. There were no differences between groups for postprandial incremental area under the curve for serum insulin, blood glucose or subjective appetite ratings. Compared with CER, 5:2 IER led to a reduction in fasting blood glucose concentrations (treatment-by-time interaction, P = 0.018, η2p = 0.14). Similarly, compared with CER, there were beneficial changes in fasting composite appetite scores after 5:2 IER (treatment-by-time interaction, P = 0.0003, η2p = 0.35).ConclusionsThere were no significant differences in postprandial insulinaemic, glycaemic or appetite responses between treatments. However, 5:2 IER resulted in greater improvements in fasting blood glucose, and beneficial changes in fasting subjective appetite ratings.