Reduction In Total Energy Intake Research Articles

Estimated changes in free sugar consumption one year after the UK soft drinks industry levy came into force: controlled interrupted time series analysis of the National Diet and Nutrition Survey (2011–2019)

BackgroundThe UK soft drinks industry levy (SDIL) was announced in March 2016 and implemented in April 2018, encouraging manufacturers to reduce the sugar content of soft drinks. This is the...

Reducing dietary intake of added sugars could affect the nutritional adequacy of vitamin A in adolescents: the Costa Rica case

BackgroundIn countries where sugar fortification with vitamin A is mandatory, strategies to reduce the prevalence of overweight/obesity in adolescents that involve lowering added sugar intake could lead to vitamin A inadequate intakes, since vitamin A-fortified sugar for home consumption contributes to a high proportion of this vitamin intake in the adolescent diet.MethodsThe study employed a hierarchical linear model to perform a mediation analysis on a cross-sectional sample of adolescents (13–18 years old) in the province of San José, Costa Rica.ResultsLowering the total energy intake derived from added sugars to less than 10% significantly increases the prevalence of vitamin A inadequate intake in adolescents by 12.1% (from 29.6% to 41.7%). This is explained by the mediation model in which, the reduced adequacy of vitamin A intake is mediated by a reduction in total energy intake derived from added sugars fortified with vitamin A.ConclusionsThe vitamin A fortification of sugar for household consumption should be reassessed according to the current epidemiological profile in Costa Rica to promote strategies that reduce the prevalence of overweight/obesity in adolescents by lowering the consumption of added sugars without affecting vitamin A intake.

Estimating the health impacts of sugar-sweetened beverage tax for informing policy decisions about the obesity burden in Vietnam.

Taxation on sugar-sweetened beverages (SSBs) has been adopted in more than 40 countries but remained under discussion in Vietnam. This study aimed to estimate the health impacts of different SSBs tax plans currently under discussion to provide an evidence base to inform decision-making about a SSBs tax policy in Vietnam. Five tax scenarios were modelled, representing three levels of price increase: 5%, 11% and 19-20%. Scenarios of the highest price increase were assessed across three different tax designs: ad valorem, volume-based specific tax & sugar-based specific tax. We modelled SSBs consumption in each tax scenario; how this reduction in consumption translates to a reduction in total energy intake and how this relationship in turn translates to an average change in body weight and obesity status among adults by applying the calorie-to weight conversion factor. Changes in type 2 diabetes burden were then calculated based on the change in average BMI of the modelled cohort. A Monte Carlo simulation approach was applied on the conversion factor of weight change and diabetes risk reduction for the sensitivity analysis. We found that the taxation that involved a 5% price increase gave relatively small impacts while increasing SSBs' price up to 20% appeared to impact substantially on overweight and obesity rates (reduction of 12.7% and 12.4% respectively) saving 27 million USD for direct medical cost. The greatest reduction was observed for overweight and obesity class I. The decline in overweight and obesity rates was slightly higher for women than men. This study supports the SSB tax policy in pursuit of public health benefits, especially where the tax increase involves around a 20% price increase. The health benefit and revenue gains were evident across all three tax designs with the specific tax based on sugar density achieving greatest effects.

Compliance of participants undergoing a ‘5-2’ intermittent fasting diet and impact on body weight

Intermittent fasting (IF) has grown in popularity as a weight loss tool, where caloric intake is fully/partially restricted on a recurring basis. This study aimed to assess compliance with IF fast-day calorie restriction and whether 5-2 IF leads to reduced overall energy intake, weight loss and compensatory increased energy intake on non-fast days. Participants completed diet diaries at baseline and 28 days post 5-2 IF in a repeated measures within-subjects design. 5-2 IF required restricted energy intake to 500kcal/day (women), 650kcal/day (men) on two 'fast' days/week whilst eating ad-libitum on other days. 52 participants were included (n=42 female; age 44±11.2yrs). Median weight loss after 28 days 5-2 IF was statistically significant (1.8 [-2 - 7.3 IQR=2.2]kg; 2.8 [-2.7-11.2 IQR=2.5]% p < 0.001). There was a significant reduction in total energy intake during 5-2 IF compared with pre-diet (median 1288.0 [IQR 423.8]kcal and median 1751.5 [IQR 505.3]kcal respectively, p<0.001). Carbohydrate, protein and fat consumption proportionately reduced during 5-2 IF. Participants had significantly higher energy intake (p<0.001) on non-fast days that followed a fast day (1928.4±711.9kcal) compared to non-fast days not following a fast day (1316.2±310.0kcal). 55.8% complied with fast day calorie restrictions. 5-2 IF was associated with significantly reduced energy intake, and weight loss over a 28-day period. Compliance rate was lower than most previous studies. Participants had significantly higher energy intake on non-fast days following fast days suggesting fasting may lead to over-compensation. Further research should investigate strategies to improve compliance and long-term sustainability of IF diets.

Effects of Varying Avocado Intake on Energy and Nutrient Intake of Hispanic Families: A Cluster Randomized Trial

Abstract Objectives Avocados are nutrient-dense and could be a favorable component of a healthy dietary pattern, yet there are limited data on the effects of avocado intake on nutritional status. To test if avocados impact energy intake, we examined the effects of two levels of avocado intake, plus a standard nutrition education intervention, on energy and nutrient intake in families of Hispanic Heritage. Methods Between April 2017 and June 2018, we conducted a cluster randomized controlled trial in families consisting of at least 3 members residing in the same home, at least 5 years of age, free of severe chronic disease, not on specific diets, and self-identified of Hispanic heritage. Seventy-two (n = 72) families were randomized to one of two groups: nutrition education with low avocado allotment (3 avocados/family/week) or nutrition education with high avocado allotment (14 avocados/family/week). Community health workers (i.e., Promotoras) led 12 bi-weekly in-home nutrition education sessions per family and delivered weekly avocado allotments. Dietary patterning, energy and nutrient intake were measured at baseline, and after 3- and 6-months. The primary outcome was change in a family's total energy intake after 6 months. Secondary outcome measures included differences in macro- and micronutrients between groups. Results Over the 6-month follow-up period, the mean difference in energy intake for the high versus low avocado intervention group was −1884 kcals/family/day (95% CI −3205 to −563 kcals, P &amp;lt; 0.01). The high avocado intake group also had significant reductions in carbohydrate, animal and vegetable protein saturated and polyunsaturated fat calcium, magnesium, sodium, potassium, iron, and vitamin D intakes (P &amp;lt; 0.05 for all). There were no significant changes in MUFA or dietary fiber intakes. Conclusions In families of Hispanic heritage, an intervention including nutrition education combined with 14 avocados/week, compared to 3 avocados per week, resulted in a significant reduction in calories and select macro- and micronutrients. This trial suggests interventions with specific plant foods, but without specific counseling on energy restriction, may lead to reductions in total energy intake. Future studies should investigate the effects of avocado intake in other populations. Funding Sources Hass Avocado Board.

Development of a Genetic Score to Predict an Increase in HDL Cholesterol Concentration After a Dietary Intervention in Adults with Metabolic Syndrome

Dietary intervention (DI) is a primary strategy to attenuate some of the metabolic abnormalities associated with metabolic syndrome (MetS), including low HDL cholesterol. There is no biomarker that can identify individuals who respond to DI by increasing HDL cholesterol. The aim of this study was to assess the predictive power of a genetic predisposition score (GPS) in Mexican adults with MetS to identify HDL cholesterol responders to DI. This study followed a prospective cohort design. Sixty-seven Mexican adults aged 20-60 y (21% men) with BMI ≥25 and ≤39.9 kg/m², who had at least 3 of 5 positive criteria for MetS, were included. Participants consumed a low saturated fat diet for 2.5 mo (<7% energy as saturated fat, <200 mg of cholesterol/d) and reduced their usual diet by ∼440 kcal/d, a reduction in total energy intake of about 25%. Anthropometry and serum biochemical markers, including HDL cholesterol, were measured before and after DI. A multilocus GPS was constructed using previously reported genetic variants associated with response to diet in subjects with MetS. GPS values, designed to predict the response of HDL cholesterol to the DI, were computed for each individual as the sum of the number of effect alleles across 14 SNPs. Individuals were dichotomized as high and low GPS according to median GPS (-2.12) and we observed a difference in HDL cholesterol changes on DI of +3 mg/dL (6.3%) in subjects with low GPS, whereas those with high GPS had HDL cholesterol decreases of -3 mg/dL (-7.9%) (P=0.04). Individuals with low GPS showed greater increases in their HDL cholesterol than those with high GPS. Therefore, the GPS can be useful for predicting the HDL cholesterol response to diet.

Low-calorie sweetener use, weight, and metabolic health among children: A mini-review.

A reduction in the consumption of added sugars and sugar-sweetened beverages (SSBs) is a key focus of public health recommendations for a healthy diet among children. One approach to lower added sugar intake is to instead use low-calorie sweeteners (LCSs), which contain no or few calories. Consumption of LCSs is increasing worldwide, with the most marked rise observed among children and adolescents. However, the extent to which LCS consumption is helpful or harmful for weight management is controversial, particularly when LCS consumption begins in childhood. Herein, we summarize the limited existing literature examining effects of paediatric LCS consumption on appetite, energy intake, and body weight. While positive associations between LCS consumption and weight gain are reported in observational analyses, the majority of intervention studies, some of which blinded children to the contents of the drinks, report benefits of LCSs for reducing excessive child weight gain. Several potential mechanisms have been proposed to explain LCS effects on body weight, including LCS-induced promotion of appetite and energy intake. Yet studies assessing effects of beverages with LCSs (LCSBs) compared with SSBs on child appetite report mixed findings. Some demonstrate that children completely compensate for the diluted energy content of LCSBs by eating more solid food calories at subsequent meals compared with children administered SSBs, while others report a reduction in total energy intake with LCSB ingestion. Given the limited studies and resulting uncertainty as to whether LCSs benefit or worsen weight and metabolic health in children is integral that effects of LCS use during childhood continue to be investigated in future prospective studies.

Fruit consumption and adiposity status in adults: A systematic review of current evidence

ABSTRACTThe aim of this review was to update current understanding of the potential association between fruit consumption and adiposity status in adult populations. Electronic databases were searched from January 1, 1997 to the search date of August 15, 2014, retrieving 4382 abstracts that were reviewed for eligibility: randomized controlled trial (RCT) or prospective cohort (PC), published in English, assessing the effect of whole fruit or fruit juice consumption on adiposity in healthy adult populations. Quality ratings for the 11 included RCTs were either positive (n = 2), neutral (n = 8), or negative (n = 1), while the six included PCs were either positive (n = 4) or neutral (n = 2). Consumption of whole fruit was found to contribute to a reduced risk for long-term weight gain in middle-aged adults. Experimental trials suggest this beneficial effect of whole fruit is mediated by a reduction in total energy intake. Fruit juice, however, had an opposing effect, promoting weight gain over the long term. This review reinforces national food-based dietary guidelines, encouraging the consumption of whole fruits and replacing fruit juices with plain water, as part of a broader set of dietary strategies to reduce total dietary energy intake in adult populations.

Effects of two diet techniques and delivery mode on weight loss, metabolic profile and food intake of obese adolescents: a fixed diet plan and a calorie-counting diet.

The aim of this study is to compare the weight loss of obese adolescents on two different low-calorie diets: fixed diet plan and calorie-counting diet. This is a randomized clinical study with 66 obese adolescents (body mass index Z score (ZBMI)>+3, 13.7±0.7 years, 60.6% male) with anthropometric, food intake, physical activity, laboratory, body composition and stage of pubertal development data evaluated. There was a reduction in the ZBMI in both groups (P<0.0001), without significant difference between them (P=0.87). There was a significant reduction in insulin, and homeostasis model assessment insulin resistance (HOMA-IR), with no difference between groups. A reduction in total energy intake of the groups was found, with an increase in the proportion of protein and reduction in carbohydrates. In this cohort of severely obese adolescents, fixed diet plan and calorie-counting diet led to a similar reduction of ZBMI, metabolic markers and total energy intake.

Efficacy of Commercial Weight Loss Programs on Metabolic Syndrome

ObjectiveCommercial weight loss programs offer consumers a pre‐programmed means of managing weight. However, such programs differ in dietary advice and physical activity recommendations. The aim of this investigation was compare the Curves® Complete 90‐day Challenge (CC), Weight Watchers® Points Plus (WW), Jenny Craig® At Home (JC), and Nutrisystem® Advance Select™ (NS) on metabolic syndrome (MetS) and weight loss.MethodsWe examined 133 sedentary overweight women (47±11 yr, 86±14 kg, 35.4±6 kg/m2) randomized into CC (n=29), WW (n=29), JC (n=27), NS (n=28), or control (n=20) for 12‐wks. Body mass and MetS were obtained at baseline and follow‐up (12 w). The primary outcome was MetS expressed as a categorical variable and summed z‐score (zMetS) as a continuous variable. Secondary outcomes included total caloric intake, body mass, respective anthropometry and measured physical activity (PA). Data were analyzed using a chi‐square and general linear model covaried for age and prevalence of MetS at baseline. Data are mean ± SD and mean change ± 95% CI when applicable.ResultsWe observed significant reductions in total energy intake for all treatment groups except Control (−103 kcal, 95% CI, −277, 70): CC (−413 kcal, 95% CI, −573, −254), WW (−531 kcals, 95% CI, −675, −387), JC (−604 kcal, 95% CI, −753, −455), NS (−631 kcal, 95% CI, −778, −485). While post‐hoc analysis showed JC and NS to be greater than CC, weight loss was similar for all groups (−4.0 ± 4.2 kg). At baseline, the prevalence of MetS was: CC (35%), WW (31%), JC (37%), NS (39%) and control (45%). At follow‐up we observed a significant trend (p=0.008) in reduction of MetS prevalence such that CC (14%) and WW (28%) was significantly lower than JC (42%), NS (50%) and control (55%); however, WW was not significantly different than JC, NS, or control. When expressed as zMetS, only the CC group demonstrated a significant reduction in zMetS (−0.11, 95% CI −0.21, −0.004) vs. WW (−0.89, 95% CI −0.18, 0.02), JC (−0.05, 95% CI −0.16, −.06), NS (−0.06, 95% CI −0.16, 0.05) and control (−0.05, 95% CI, −0.18, 0.07). Other than exercise contained within the CC program, no significant changes were otherwise noted in total PA for any treatment group: CC (4645 MET min/week; 95% CI, −1638, 10929), Weight Watchers (−3361 MET min/week; 95% CI, 3208, 2988), Jenny Craig (−448 MET min/week; 95% CI, −6949, 6053), Nutrisystem (−967 MET min/week; 95% CI, −7401, 5468) or Control (5128 MET min/week; 95% CI, −2529, 12785).ConclusionsNotwithstanding the minor differences in energy intake favoring JC and NS, each program demonstrated similar amounts of weight loss. However, a significant reduction in MetS was demonstrated only in CC and WW via categorical analysis and CC via zMetS. Thus, despite recommendations by each program to increase PA, the program including a structured fitness routine in conjunction with diet exhibited the greatest impact on changes in MetS.Support or Funding InformationCurves International

Translational research for Diabetes Self-Management in Sri Lanka: A randomized controlled trial

AimsThe study tested the hypothesis that a theory driven Diabetes Self-Management (DSM) intervention delivered by trained nurses would result in a clinically significant improvement in glycaemic control. MethodsPatients with an HbA1c >7.5% (58mmol/mol) and free of diabetes complications were enrolled into a randomized controlled trial (n=85). Intervention consisted of four sessions and monthly follow up for 6 months. Biochemical tests, and diet and physical activity assessments were done in both groups. Analysis of covariance was used to test the effectiveness of the intervention. ResultsAt 6 months, there was a significant difference (P=0.001) in HbA1c between the groups controlling for baseline values and other variables. Based on the primary outcome, 28% in the intervention group achieved the target value of 6.5% HbA1c, compared to 8% in the “usual care” group (P<0.001; η2=0.65). The reduction in total energy intake and increase in physical activity was significant in the intervention group between baseline and follow up. ConclusionsThe DSM intervention has resulted in a clinically significant impact on glycaemia, change in diet and physical activity, and has demonstrated the feasibility of using it within existing care arrangements in a developing country setting.

Deep brain stimulation of the nucleus accumbens shell induces anti-obesity effects in obese rats with alteration of dopamine neurotransmission

The aim of this study was to assess the anti-obesity effects of nucleus accumbens shell (NAc-sh) deep brain stimulation (DBS) in diet-induced obese (DIO) and chow-fed (chow) rats. The influence of DBS on dopamine (DA) signaling in the NAc-sh was also evaluated. DIO and chow rats were subjected to DBS for 14 consecutive days. Food intake and weight gain were measured daily. The gene expression of the dopamine D1 and D2 receptors was evaluated by qPCR. In addition, the extracellular levels of DA and its metabolite, dihydroxyphenylacetic acid (DOPAC), were determined by microdialysis. We observed that chronic DBS induced significant reductions in total energy intake (596.0±65.0kcal vs. 1161.6±22.2kcal, p<0.001) and weight gain (1.45±0.57% vs. 9.64±0.38%, p<0.001) in DIO rats compared to sham-DIO rats. Up-regulated D2 receptor gene expression (2.43±0.12 vs. 0.64±0.04, p<0.001) and increased DA levels (2.73±0.15pmol/mL vs. 0.62±0.05pmol/mL, p<0.001) were observed in DIO rats compared to sham-DIO rats. DBS had no influence on food intake, weight gain, or DA neurotransmission in chow rats. Our results support an association of the anorexigenic effects of NAc-sh DBS with mesolimbic DA signaling and indicate that the positive alteration of DA function in DIO rats may be responsible for the different effects of DBS in DIO and chow rats.

Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis

A common dietary recommendation for weight loss, especially in lay public outlets, is to eat more fruit and vegetables (F/Vs). Without a compensatory reduction in total energy intake, significant weight loss would be unlikely. We aimed to synthesize the best available evidence on the effectiveness of the general recommendation to eat more F/Vs for weight loss or the prevention of weight gain. We searched multiple databases for human randomized controlled trials that evaluated the effect of increased F/V intake on body weight. Inclusion criteria were as follows: ≥15 subjects/ treatment arm, ≥8-wk intervention, a stated primary or secondary outcome of body weight, the stated goal of the intervention was weight or fat loss or the prevention of weight or fat gain, and food intake provided or prescribed was of a variety of F/Vs that remained minimally processed. Two studies met all criteria; 5 other studies met all criteria but one. The primary analysis indicated an effect size of weight change (outcome of interest) from baseline [standardized mean difference (SMD) for studies that met all criteria] of -0.16 (95% CI: -0.78, 0.46) (P = 0.60). The SMD for 7 studies that met all or most criteria was 0.04 (95% CI: -0.10, 0.17) (P = 0.62). Studies to date do not support the proposition that recommendations to increase F/V intake or the home delivery or provision of F/Vs will cause weight loss. On the basis of the current evidence, recommending increased F/V consumption to treat or prevent obesity without explicitly combining this approach with efforts to reduce intake of other energy sources is unwarranted. This systematic review and meta-analysis was registered at http://www.crd.york.ac.uk/PROSPERO/ as CRD42013004688.

Dietary changes and associations with metabolic improvements in adults with type 2 diabetes during a patient-centred dietary intervention: an exploratory analysis

ObjectivesDescribe dietary intake of participants enrolled in a non-prescriptive dietary intervention and dietary changes at 6 months and explore whether these changes had a role in observed improvements in glycated...

Effect of a Low‐Intensity Parent‐Focused Nutrition Intervention on Dietary Intake of 2‐ to 5‐Year Olds

Community-based nutrition interventions aimed at influencing child dietary intake are rarely evaluated. We hypothesised that providing self-directed nutrition and parenting resources to parents living in rural northern New South Wales, Australia, would positively affect the dietary patterns of children ages 2 to 5 years. A total of 146 parent-child dyads (76 boys, ages 2.0-5.9 years) were randomly assigned to either a 12-month parent-centred intervention involving self-directed education provided in CD and DVD formats, or a participant-blinded control group who received generic nutrition and physical activity information. Data were collected at baseline, 3, and 12 months. Total reported energy from nutrient-dense food groups and percentage energy from energy-dense, nutrient-poor foods were high at baseline relative to estimated total energy expenditure for child age. Using random effects modelling, there were significant group-by-time effects for a reduction in mean (standard deviation) total energy intake (EI) at 12 months (-461 kJ/day (196); P = 0.04). An intervention group-by-time effect on carbohydrate intake (-17.4 g/day (10.6); P < 0.05) was largely attributable to decreased consumption of breads and cereals (-180 g/day (80); P = 0.007). Decreases in energy-dense, nutrient-poor foods were not statistically significant. The proportion of total EI from noncore foods in children in rural New South Wales is high and did not improve in response to a low-intensity nutrition intervention. Parents reported small changes in consumption frequency for core and noncore food intakes, leading to a reduction in total EI. Strategies to increase resource use such as prompting via e-mail are required to further explore the effectiveness of nutrition resource dissemination at a population level.

Predictors of Sustained Reduction in Energy and Fat Intake in the Diabetes Prevention Program Outcomes Study Intensive Lifestyle Intervention

BackgroundFew lifestyle intervention studies examine long-term sustainability of dietary changes. ObjectiveTo describe sustainability of dietary changes over 9 years in the Diabetes Prevention Program and its outcomes study, the Diabetes Prevention Program Outcomes Study, among participants receiving the intensive lifestyle intervention. DesignOne thousand seventy-nine participants were enrolled in the intensive lifestyle intervention arm of the Diabetes Prevention Program; 910 continued participation in the Diabetes Prevention Program Outcomes Study. Fat and energy intake derived from food frequency questionnaires at baseline and post-randomization Years 1 and 9 were examined. Parsimonious models determined whether baseline characteristics and intensive lifestyle intervention session participation predicted sustainability. ResultsSelf-reported energy intake was reduced from a median of 1,876 kcal/day (interquartile range [IQR]=1,452 to 2,549 kcal/day) at baseline to 1,520 kcal/day (IQR=1,192 to 1,986 kcal/day) at Year 1, and 1,560 kcal/day (IQR=1,223 to 2,026 kcal/day) at Year 9. Dietary fat was reduced from a median of 70.4 g (IQR=49.3 to 102.5 g) to 45 g (IQR=32.2 to 63.8 g) at Year 1 and increased to 61.0 g (IQR=44.6 to 82.7 g) at Year 9. Percent energy from fat was reduced from a median of 34.4% (IQR=29.6% to 38.5%) to 27.1% (IQR=23.1% to 31.5%) at Year 1 but increased to 35.3% (IQR=29.7% to 40.2%) at Year 9. Lower baseline energy intake and Year 1 dietary reduction predicted lower energy and fat gram intake at Year 9. Higher leisure physical activity predicted lower fat gram intake but not energy intake. ConclusionsIntensive lifestyle intervention can result in reductions in total energy intake for up to 9 years. Initial success in achieving reductions in fat and energy intake and success in attaining activity goals appear to predict long-term success at maintaining changes.

Improvements in Glucose Metabolism and Insulin Sensitivity with a Low-Carbohydrate Diet in Obese Patients with Type 2 Diabetes

Objective: The optimal diet for weight loss in type 2 diabetes remains controversial. This study examined a low-carbohydrate, high-fat diet with detailed physiological assessments of insulin sensitivity, glycemic control, and risk factors for cardiovascular disease. Methods: Fourteen obese patients (body mass index [BMI] 40.6 ± 4.9 kg/m2) with type 2 diabetes were recruited for an “Atkins”-type low-carbohydrate diet. Measurements were made at 0, 12, and 24 weeks of weight, insulin sensitivity, HbA1c, lipids, and blood pressure. Results: Twelve completers lost a mean of 9.7 ± 1.8 kg over 24 weeks attributable to a major reduction in carbohydrates and resultant reduction in total energy intake. Glycemic control significantly improved (HbA1c −1.1 ± 0.25%) with reductions in hypoglycemic medication. Fasting glucose, homeostasis model assessment (HOMA), and area under the curve (AUC) glucose (intravenous glucose tolerance test [IVGTT]) were significantly reduced by week 12 ( p < 0.05). There were nonsignificant improvements in insulin sensitivity (SI) at week 12 ( p = 0.19) and week 24 ( p = 0.31). Systolic blood pressure was reduced (mean −10.0 mmHg between weeks 0 and 24, p = 0.13). Mean high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol all increased. The ratio of total: HDL cholesterol and triglycerides was reduced. Conclusion: A low-carbohydrate diet was well tolerated and achieved weight loss over 24 weeks in subjects with diabetes. Glycemic control improved with a reduction in requirements for hypoglycemic agents.

Total energy intake and breast cancer risk in sisters: the Breast Cancer Family Registry

Energy restriction inhibits mammary tumor development in animal models. Epidemiologic studies in humans generally do not support an association between dietary energy intake and breast cancer risk, although some studies suggest a more complex interplay between measures of energy intake, physical activity, and body size. We examined the association between total energy intake jointly with physical activity and body mass index (BMI) and the risk of breast cancer among 1,775 women diagnosed with breast cancer between 1995 and 2006 and 2,529 of their unaffected sisters, enrolled in the Breast Cancer Family Registry. We collected dietary data using the Hawaii-Los Angeles Multiethnic Cohort food frequency questionnaire. Using conditional logistic regression to estimate the odds ratios (OR) and 95 % confidence intervals (CI) associated with total energy intake, we observed an overall 60-70 % increased risk of breast cancer among women in the highest quartile of total energy intake compared to those in the lowest quartile (Q4 vs. Q1: OR = 1.6, 95 % CI: 1.3-2.0; P (trend) < 0.0001); these associations were limited to pre-menopausal women or women with hormone receptor-positive cancers. Although the associations were slightly stronger among women with a higher BMI or lower level of average lifetime physical activity, we observed a positive association between total energy intake and breast cancer risk across different strata of physical activity and BMI. Our results suggest that within sisters, high energy intake may increase the risk of breast cancer independent of physical activity and body size. If replicated in prospective studies, then these findings suggest that reductions in total energy intake may help in modifying breast cancer risk.

Food and nutrient intakes and their associations with lower BMI in middle-aged US adults: the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP)

Clinical trial data show that reduction in total energy intake enhances weight loss regardless of the macronutrient composition of the diet. Few studies have documented dietary patterns or nutrient intakes that favor leanness [BMI (in kg/m²) ≤25] in free-living populations. This investigation examined associations of usual energy, food, and nutrient intakes with BMI among US participants of the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). The INTERMAP is an international cross-sectional study of dietary factors and blood pressure in men and women (ages 40-59 y) that includes 8 US population samples. The present study included data from 1794 Americans who were not consuming a special diet and who provided four 24-h dietary recalls and 2 timed 24-h urine collections. Multivariable linear regression with the residual method was used to adjust for energy intake; sex-specific associations were assessed for dietary intakes and urinary excretions with BMI adjusted for potential confounders including physical activity. Lower energy intake was associated with lower BMI in both sexes. Univariately, higher intakes of fresh fruit, pasta, and rice and lower intakes of meat were associated with lower BMI; these associations were attenuated in multivariable analyses. Lower urinary sodium and intakes of total and animal protein, dietary cholesterol, saturated fats, and heme iron and higher urinary potassium and intakes of carbohydrates, dietary fiber, and magnesium were associated with lower BMI in both sexes. The consumption of foods higher in nutrient-dense carbohydrate and lower in animal protein and saturated fat is associated with lower total energy intakes, more favorable micronutrient intakes, and lower BMI.

Efeitos da intervenção multidisciplinar sobre a ingestão alimentar em adolescentes obesos

Introdução: A ingestão alimentar constitui-se em uma das maiores barreiras para intervenções em adolescentes obesos. Objetivos: Analisar os efeitos da intervenção multidisciplinar sobre a ingestão alimentar de adolescentes obesos. Métodos: Este estudo caracteriza-se como pré-experimental e descritivo. A amostra foi composta por 33 adolescentes obesos, com idade entre 12 e 18 anos. Os adolescentes receberam intervenção nutricional, psicológica, clínica e física. Utilizou-se o registro alimentar de três dias e o valor energético total da dieta foi estimado por meio do software Nutwin (antes e após 12 semanas). Diferenças entre os momentos foram determinadas utilizando-se o teste “t” de Student para amostras dependentes. Resultados: A intervenção foi eficiente na redução da ingestão energética total (p=0,05), ingestão de lipídios (p=0,02), proteínas (p=0,01) e sódio (p=0,02). Conclusões: A intervenção multidisciplinar foi capaz de alterar os hábitos alimentares dos adolescentes, o que é essencial para a redução ponderal e manutenção da massa corporal.