Self-reported Energy Intake Research Articles

Effect of a dairy- and calcium-rich diet on weight loss and appetite during energy restriction in overweight and obese adults: a randomized trial

Background/ObjectivesA diet rich in dairy and calcium (Ca) has been variably associated with improvements in body composition and decreased risk of type 2 diabetes. Our objective was to determine if a dietary pattern high in dairy and Ca improves weight loss and subjective appetite to a greater extent than a low dairy/Ca diet during energy restriction in overweight and obese adults with metabolic syndrome.Subjects/Methods49 participants were randomized to one of two treatment groups: CONTROL [low dairy, ~700 mg/day Ca, −500 kcal/d] or DAIRY/CA [high dairy, ~1400 mg/day Ca, −500 kcal/d] for 12wk. Body composition, subjective ratings of appetite, food intake, plasma satiety hormones, glycemic response and inflammatory cytokines were measured.ResultsCONTROL (−2.2±0.5 kg) and DAIRY/CA (−3.3±0.6 kg) had similar weight loss. Based on self-reported energy intake, the percent of expected weight loss achieved was higher with DAIRY/CA (82.1±19.4%) than CONTROL (32.2±7.7%)(P=0.03). Subjects in the DAIRY/CA group reported feeling more satisfied (P=0.01) and had lower dietary fat intake (P=0.02) over 12wk compared to CONTROL. Compared to CONTROL, DAIRY/CA had higher plasma levels of peptide tyrosine tyrosine (PYY, P=0.01) during the meal tolerance test at wk12. Monocyte chemoattractant protein-1 was reduced at 30 min with DAIRY/CA compared to CONTROL (P=0.04).ConclusionsIn conclusion, a dairy and Ca rich diet was not associated with greater weight loss than control. Modest increases in plasma PYY concentrations with increased dairy/Ca intake, however, may contribute to enhanced sensations of satisfaction and reduced dietary fat intake during energy restriction. Registered Trial: ClinicalTrials.gov (NCT00564551).

Using a Wearable Camera to Increase the Accuracy of Dietary Analysis

Food diaries are commonly used to assess individual dietary intake in both the general and sporting populations. Despite the widespread use of such diaries, evidence suggests that individuals' self-reported energy intake frequently and substantially underestimate true energy intake. To examine the use of the Microsoft SenseCam wearable camera to help more accurately report dietary intake within various sporting populations. In 2011, a total of 47 participants were recruited to take part in this study (17 trainee jockeys, 15 elite Gaelic footballers, and 15 healthy physically active university students). Participants wore a SenseCam for 1 day (from morning until night) while simultaneously keeping a 1-day food diary. Comparisons were made between the energy intake reported in the food diary alone and the food diary in conjunction with information gathered from the SenseCam. Data analysis was conducted in 2012. Mean total calorie intake using diary alone and diary and SenseCam were 2349±827.9 kcals vs 2631±893.4 kcal for the trainee jockeys; 2600±521.9 kcal vs 3191±770.2 kcal for the Gaelic footballers, and 2237±318.5 kcal vs 2487±404.6 kcal for the university students. This represented a difference of 10.7% (p≤0.001); 17.7% (p≤0.001); and 10.1% (p≤0.01) among measurement methods for trainee jockeys, Gaelic footballers, and university students, respectively. Results from this first-generation study suggest that a more accurate estimate of total energy intake is provided when combining the use of a conventional food diary and a SenseCam. Additional information on portion size, forgotten foods, leftovers, and brand names can be obtained by using this novel sensing technology in conjunction with the diary, with improved dietary assessment a potential outcome.

Polydextrose results in a dose-dependent reduction inad libitumenergy intake at a subsequent test meal

Previous studies have reported that polydextrose can reduce food intake; however, the optimal dose required to achieve this effect is currently unknown. The present study investigated the effects of consuming a range of doses of polydextrose on appetite and energy intake (EI) using a randomised within-subject, cross-over design. For this purpose, twenty-one participants (n 12 men, n 9 women) consumed an 837 kJ liquid preload containing 0 g (control), 6.3, 12.5 or 25 g polydextrose. Subjective appetite ratings were collected using visual analogue scales and an ad libitum test meal was served 90 min later. Participants recorded EI for the remainder of the day in a food diary. Test meal EI following the control preload (5756 (sem 423) kJ) was significantly higher than following the 6.3 g (5048 (sem 384) kJ), 12.5 g (4722 (sem 384) kJ) and 25 g (4362 (sem 316) kJ) preloads (P< 0.05), and EI following the 6.3 g preload was significantly higher than following the 25 g preload (P< 0.01). There were no differences in self-reported EI during the remainder of the day between the preloads containing the varying doses of polydextrose. Total EI (breakfast+preload+ad libitum test meal+remainder of the day) was significantly higher when the control preload was consumed (12,051 (sem 805) kJ) compared with either the 12.5 g (10,854 (sem 589) kJ) or 25 g (10,658 (sem 506) kJ) preload (P< 0.05). These differences in EI were not accompanied by corresponding differences in subjective appetite ratings. In summary, polydextrose effectively reduces subsequent EI in a dose-dependent manner.

Decreased energy density and changes in food selection following Roux-en-Y gastric bypass

The main objective was to test the hypothesis that dietary energy density (DED) decreases after Roux-en-Y gastric bypass (gastric bypass). A total of 43 patients (31 women and 12 men) aged 43 (s.d. 10) years, with body mass index (BMI) 44.3 kg/m(2) (4.9), were assessed preoperatively at 6 weeks and 1 and 2 years after gastric bypass. Self-reported energy intake (EI), food weight (FW) and food choice were assessed using a dietary questionnaire. DED was calculated by dividing EI by FW (kcal/g). Number of dropouts was 4 of 203 visits. Percent weight loss (%WL) was 13.5% at 6 weeks, 30.7% at 1 year and 31.8% at 2 years post surgery (P<0.001 for all). EI decreased from 2990 to 1774, 2131 and 2425 kcal after 6 weeks and 1 and 2 years postoperatively, respectively (P<0.001 at all time points). FW changed from 2844 to 1870 g/day at 6 weeks (P<0.001) and 2416 g/day after 1 year (P<0.05), but was not significantly different from baseline 2 years postoperatively (2602 g/day, P=0.105). DED decreased from 1.07 to 0.78 kcal/g at 6 weeks (P<0.001) and 0.90 kcal/g (P<0.001) and 0.96 kcal/g (P=0.001) after 1 and 2 years, respectively. All statistical comparisons were made from baseline. There was no correlation between changes in DED and %WL, neither after 1 year (r=-0.215; P=0.183) nor after 2 years (r=-0.046; P=0.775) post surgery. Besides substantial reduction in EI and large variation in FW, patients reported decreased DED over 2 years following gastric bypass. Despite lack of association between the reduction in DED and percentage weight loss, changes in food choice were overall nutritionally beneficial.

Self-reported energy intake of male &amp; female bodybuilders in the scientific literature

Background Nutrient intake is critical to a bodybuilder in terms of improving the overall muscular appearance of their physique. Total energy intake and the proportion of the kilocalories derived from carbohydrates, protein, and fats are often precisely planned and implemented to maximize skeletal muscle hypertrophy and reduce body fat. The purpose of this study is to describe the self-reported energy intakes of male and female bodybuilders and to determine if differences exist between the genders in regards to total energy intake and macronutrient composition.

Self-Reported Energy Intake by Age in Overweight and Healthy-Weight Children in NHANES, 2001–2008

Variation in energy intake by weight status at different ages may explain inconsistencies in previous research on energy intake and obesity. Therefore, our objective was to determine the relationship between reported daily energy intake and categorized weight status across childhood. We examined dietary reports of children ages 1 to 17 years by using the National Health and Nutrition Examination Survey, 2001-2008 (N = 12648). Using measured height and weight, we categorized weight status based on weight-for-length percentile (age <2 years) or BMI percentile (ages 2-17 years) using current recommendations. Dietary intake was reported by using the repeatedly validated automated multiple pass method, a detailed 2-day 24-hour recall. We used ordinary least squares regression to examine the interactions of age and weight category on total energy intake, controlling for gender, race, ethnicity, and income. Weight status and age both have positive associations with self-reported energy intake. However, the interaction between weight and age demonstrates a negative effect throughout childhood, such that young obese/overweight children reported consuming significantly more calories and obese/overweight adolescents reported consuming fewer calories than their same-age healthy-weight peers. In a nationally representative cross-sectional sample, overweight and obese girls older than 7 years and boys older than 10 years reported consuming fewer daily calories than their healthy-weight peers. One explanation for this would be that increased energy intake in early childhood is related to the onset of obesity, but other mechanisms, such as differences in energy expenditure, may contribute more to maintaining obese/overweight status through adolescence.

The degree of misreporting of the energy-adjusted intake of protein, potassium, and sodium does not differ among under-, acceptable, and over-reporters of energy intake

It is unclear whether misreporting of nutrient intakes differs according to energy reporting status. We examined misreporting of dietary protein, potassium, and sodium in under-, acceptable, and over-reporters of energy intake. Our hypothesis was that degree of misreporting of these three nutrients differs among under-, acceptable, and over-reporters. Participants were 1043 Japanese women aged 18 to 22 years. Self-reported dietary intake was obtained using a diet history questionnaire. Under-, acceptable, and over-reporters of energy intake were identified based on the ratio of self-reported energy intake to estimated energy requirement (<0.70 [17.2%], 0.70-1.30 [78.1%], and >1.30 [4.7%], respectively). Misreporting of dietary protein, potassium, and sodium was assessed against the corresponding biomarker-based estimate derived from 24-hour urinary excretion. On average, the degree of misreporting of intake of energy and the three nutrients varied considerably. Absolute intake (amount per day) of the three nutrients was under-reported in under-reporters of energy intake and over-reported in over-reporters compared with acceptable reporters. However, mainly because of high correlations between the ratio of self-reported energy intake to estimated energy requirement and the ratio of self-reported to biomarker-based estimates of absolute intake of three nutrients (Pearson correlation coefficient: 0.64 for protein, 0.51 for potassium, and 0.37 for sodium), the degree of misreporting of the energy-adjusted intake of these nutrients based on the density method did not differ across categories of energy reporting status. In conclusion, these findings may lend support to the usefulness of adjustment for energy misreporting and the futility of merely excluding energy misreporters from analysis.

Self-Reported Energy Intake by Age in Overweight and Healthy-Weight Children in NHANES, 2001-2008

Self-Reported Energy Intake by Age in Overweight and Healthy-Weight Children in NHANES, 2001-2008

Case Study of a Female Ocean Racer: Prerace Preparation and Nutritional Intake During the Vendée Globe 2008

The Vendée Globe is a solo round-the-world sailing race without stopovers or assistance, a physically demanding challenge for which appropriate nutrition should maintain energy balance and ensure optimum performance. This is an account of prerace nutritional preparation with a professional and experienced female racer and assessment of daily nutritional intake (NI) during the race using a multimethod approach. A daily energy intake (EI) of 15.1 MJ/day was recommended for the race and negotiated down by the racer to 12.7 MJ/day, with carbohydrate and fluid intake goals of 480 g/day and 3,020 ml/day, respectively. Throughout the 99-day voyage, daily NI was recorded using electronic food diaries and inventories piloted during training races. NI was assessed and a postrace interview and questionnaire were used to evaluate the intervention. Fat mass (FM) and fat-free mass (FFM) were assessed pre- (37 days) and postrace (11 days) using dual-energy X-ray absorptiometry, and body mass was measured before the racer stepped on the yacht and immediately postrace. Mean EI was 9.2 MJ/day (2.4-14.3 MJ/day), representing a negative energy balance of 3.5 MJ/day under the negotiated EI goal, evidenced by a 7.9-kg loss of body mass (FM -7.5 kg, FFM -0.4 kg) during the voyage, with consequent underconsumption of carbohydrate by ~130 g/day. According to the postrace yacht food inventory, self-reported EI was underreported by 7%. This intervention demonstrates the practicality of the NI approach and assessment, but the racer's nutrition strategy can be further improved to facilitate meeting more optimal NI goals for performance and health. It also shows that evaluation of NI is possible in this environment over prolonged periods, which can provide important information for optimizing nutritional strategies for ocean racing.

Accuracy of self‐reported energy intake in weight‐restored patients with anorexia nervosa compared with obese and normal weight individuals

To compare self-reported and measured energy intake in weight-restored patients with anorexia nervosa (AN), weight-stable obese individuals (OB), and normal weight controls (NC). Forty participants (18 AN, 10 OB, and 12 NC) in a laboratory meal study simultaneously completed a prospective food record. AN patients significantly (p = .018) over-reported energy intake (16%, 50 kcal) and Bland-Altman (B-A) analysis indicated bias toward over-reporting at increasing levels of intake. OB participants significantly (p = .016) under-reported intake (19%, 160 kcal) and B-A analysis indicated bias toward under-reporting at increasing levels of intake. In NC participants, NS (p = .752) difference between reported and measured intake was found and B-A analysis indicated good agreement between methods at all intake levels. Self-reported intake should be cautiously interpreted in AN and OB. Future studies are warranted to determine if over-reporting is related to poor outcome and relapse in AN, or under-reporting interferes with weight loss efforts in OB.

Associations between eating patterns, dietary intakes and eating behaviors in premenopausal overweight women

The regulation of energy intake is complex and many biological, psychosocial and environmental influences have been identified. To our knowledge, no study has yet investigated how eating patterns could mediate associations between eating behaviors and self-reported energy intake in premenopausal overweight women. Therefore, objectives of this study were to examine associations between eating behaviors and eating patterns in premenopausal overweight women and to test if eating patterns could mediate the associations between eating behaviors and self-reported energy intake. Women completed a 3-day food record and the Three-Factor Eating Questionnaire was used to assess eating behaviors (dietary restraint, disinhibition, hunger). In the total sample of women, flexible restraint was negatively (r=−0.18; p=0.03) and binge eating severity was positively (r=0.24; p=0.004) associated with self-reported energy intake. Moreover, flexible restraint was positively associated with the proportion of energy intake at breakfast (r=0.24; p=0.004), whereas disinhibition and binge eating severity were positively associated with the proportion of energy intake from snacks consumed after 5:00 pm (r=0.22, p=0.007 and r=0.22, p=0.01, respectively). In addition, mediational analyses showed that proportion of energy intake from snacks consumed after 5:00 pm explained 24.1% of the association between binge eating severity and self-reported energy intake. In conclusion, these results suggest that eating patterns are important factors to consider in order to explain the associations between eating behaviors and self-reported energy intake.

Self-Reported Energy Intake by Age in Overweight and Healthy-Weight Children in NHANES, 2001-2008

Self-Reported Energy Intake by Age in Overweight and Healthy-Weight Children in NHANES, 2001-2008

The Association between Self-Reported Energy Intake and Intra-Abdominal Adipose Tissue in Perimenopausal Women

We have previously shown that physical activity predicts intra-abdominal adipose tissue (IAT), but it is unknown whether energy intake predicts IAT independently of physical activity in a community-based, naturalistic environment. The association of energy intake with IAT was explored cross-sectionally in women, recruited between 2002 and 2005 for a study of fat patterning in midlife. IAT at L4-L5 vertebral interspace was assessed by computed tomography, energy intake by the Block Food Frequency Questionnaire, and physical activity by the Kaiser Physical Activity Survey. Linear regression models were used for the principal analyses. Among the 257 women, 48% were African American and 52% were Caucasian. Women were 52 ± 3 years old, and 49% were postmenopausal. Every 500 kcal increase in energy intake was associated with a 6% higher IAT (P = 0.02), independent of physical activity (P = 0.02), after adjustment for ethnicity, menopausal status, age, smoking, income, and DXA-assessed percent body fat. Energy intake had a significant interaction with ethnicity (P = 0.02), but not with physical activity. Models using the IAT to subcutaneous abdominal adipose tissue ratio as an outcome had similar associations. In conclusion, self-reported EI was associated with preferential IAT accumulation in midlife women, independent of physical activity. This association was significantly stronger in Caucasian than African American women. Future longitudinal studies are needed to explore lifestyle predictors of IAT accumulation during the menopausal transition.

Self-reported energy intake by FFQ compared with actual energy intake to maintain body weight in 516 adults

It is generally assumed that a FFQ is not suitable to estimate the absolute levels of individual energy intake. However, in epidemiological studies, reported nutrients by FFQ are often corrected for this intake. The objective of the present study was to assess how accurately participants report their energy intakes by FFQ. We compared reported energy intake with actual energy intake needed to maintain stable body weights during eleven controlled dietary trials. FFQ were developed to capture at least 90 % of energy intake. Participants, 342 women and 174 men, with a mean BMI of 22.8 (SD 3.1) kg/m2 filled out the FFQ just before the trials. Energy intakes during the trials were calculated from provided foods and reported free-food items, representing 90 and 10 % of energy intake, respectively. Mean reported energy intake was 97.5 (SD 12.7) % of actual energy intake during the trials; it was 98.9 (SD 15.2) % for women and 94.7 (SD 16.3) % for men (P = 0.004 for difference between sexes). Correlation coefficients between reported and actual energy intakes were 0.82 for all participants, 0.74 for women and 0.80 for men. Individual reported energy intake as a percentage of actual intake ranged from 56.3 to 159.6 % in women and from 43.8 to 151.0 % in men. In conclusion, the FFQ appeared to be accurate for estimating the mean level of energy intakes of these participants and for ranking them according to their intake. However, the large differences found on the individual level may affect the results of epidemiological studies in an unknown direction if nutrients are corrected for energy intakes reported by FFQ.

Evaluation of a University-Based Community Outreach Weight Management Program

This study tested the effectiveness of a 6-month university-based community outreach weight management program for overweight/obese adults that utilized standard guidelines from the National Heart, Lung, and Blood Institute (NHLBI). This article also provides practical observations for clinicians desirous to employ a similar program. Fifty-one overweight/obese (34.8 ± 6.6 kg/m(2)) middle-aged (46.6 ± 12.4 y) adults (42 females; 9 males) participated. Participants met weekly for 3 months to be weighed, to report weekly diet and physical activity (PA) data, and to receive instruction for weight management. Participants followed a self-selected dietary plan that included decreasing energy intake by ∼500-1000 kcal/d and consuming a combined 5 fruits and/or vegetables (FV) daily. Participants progressed to a minimum of 150 min of PA per week, wore a pedometer, and recorded daily step counts. Additionally, there was a 3-month follow-up during which participants met monthly but continued tracking FV, PA, and pedometer counts. Body weight decreased significantly (∼0.4-2.1 lbs per week; P < 0.01) during the first 3 months. Weight loss was maintained during the 3-month follow-up. Self-reported energy intake tended to increase during the first 3 months (P < 0.01). PA increased significantly (P < 0.05) beyond recommended minimums and pedometer counts increased significantly (P < 0.01). FV intake averaged below 5 per day and did not change across the study (P = 0.75). Standard treatment guidelines produce modest but consistent weight loss and improvements in PA. The NHLBI recommended approach to weight management is effective for a majority of participants and can be incorporated into a clinical program with relative ease.

Dietary energy density and successful weight loss maintenance

Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI = 27–45 kg/m 2), normal weight adults (NW: BMI = 19–24.9 kg/m 2), and weight loss maintainers (WLM: current BMI = 19–24.9 kg/m 2 [lost ≥ 10% of maximum body weight and maintained loss for ≥ 5 years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW = 97, NW = 85, WLM = 105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food + all beverages except water [F + AB], food + caloric beverages [F + CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM = 1.39 ± 0.45 kcal/g; NW = 1.60 ± 0.43 kcal/g; OW = 1.83 ± 0.42 kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM = 4.9 ± 3.1 servings/day; NW = 3.9 ± 2.0 servings/day; OW = 3.4 ± 1.7 servings/day; whole grains: WLM = 2.2 ± 1.8 servings/day; NW = 1.4 ± 1.2 servings/day; OW = 1.3 ± 1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials.

Agreement between observed and participant self-reported energy intake in adolescent netball players

The aim was to explore the agreement over 24 h between observed and participant self-reported energy intake in adolescent netball players (habitual exercisers). Thirteen girls; age 16±1 years; stature 1.68±0.06 m; mass 61.1±8.0 kg; body mass index 21.6±2.5 kg/m2; body fat 21.5±6.9%; dietary restraint 2.13±0.63 (average category for high school females)1 and maturity offset 2.7±0.5 years from peak height velocity (positive maturity offset). The participants spent 12 h at Northumbria University, from 08:00 in the morning to 20:00 in the evening. They were provided with breakfast, lunch and dinner, along with ad libitum snacks throughout the day and for the period between 20:00 and 08:00 the following morning. All items were pre weighed or measured by the observer to determine the energy intake (MJ) content. These were then numerically coded and the participants could collect food and drink items at their discretion throughout the day. The participants were instructed to inform a member of the research team of the numerical code of each item collected to later calculate observed energy intake (MJ), taking into account all leftover food or drink items. Participant recorded energy intake (MJ) was calculated using a combined self-reported, weighed food record, where all food and drink items were manually weighed or measured and recorded in a food diary by the participants and confirmed during a 24-h recall interview with the observer the following morning. Agreement between observer and participant self-reported energy intake was calculated. Energy intake mean bias±random error equated to 0.46±1.5 MJ (1.96 SD of the mean difference), therefore the 95% limits of agreement was large, ranging from −1.04 to 1.96 MJ/days. The 95% CI for bias, however, ranged from 0.00 to 0.92 MJ/days. Overall, the combined self-reported, weighed food diary and 24-h recall interview technique indicated good agreement at the group level, therefore providing a means for assessing self-reported energy intake in habitual exercisers.

Accuracy of Self‐Reported Energy Intakes in Low‐Income Urban 4th Grade Minority Children

We examined the accuracy of self-reported energy intake (rEI) in low-income, urban minority school-aged children at risk for obesity and associated diabetes utilizing a relatively new, simple previously published prediction equation for identifying inaccurate reports of dietary energy intake. Participants included 614 nine-year-old boys (51%) and girls (49%). Three 24-h dietary recalls were collected. Children's height, weight (used to calculate BMI), and percent body fat (%BF) were measured. Physical fitness, reported family history of diabetes, and ethnicity were also collected. A previously published prediction equation was used to determine the validity of rEIs in these children to identify under-, plausible-, and over-reporters. Additionally, we examined the question of whether there is a difference in reporting by sex, ethnicity, BMI, and %BF. On average, 18% of the children were at risk of being overweight, 43% were already overweight at baseline, yet these children reported consuming fewer calories on average than recommended guidelines. Additionally, reported caloric intake in this cohort was negatively associated with BMI and %BF. Using the previously described methods, 49% of participants were identified as under-reporters, whereas 39 and 12% were identified as plausible- and over-reporters, respectively. On average, children reported caloric intakes that were almost 100% of predicted energy requirement (pER) when the sedentary category was assigned. Inactivity and excessive energy intake are important contributors to obesity. With the rising rates of obesity and diabetes in children, accurate measures of energy intake are needed for better understanding of the relationship between energy intake and health outcomes.

Protein Intake and Incident Frailty in the Women's Health Initiative Observational Study

To evaluate the association between protein intake and incident frailty. Prospective cohort study. Subset of the Women's Health Initiative Observational Study conducted at 40 clinical centers. Twenty-four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes (600-5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ). Baseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24-hour urinary nitrogen). After 3 years of follow-up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand-36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake. Of the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8-16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23-50%) lower risk of frailty. Higher protein consumption, as a fraction of energy, is associated with a strong, independent, dose-responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.

Misreporting of Energy Intake in the Elderly Using Doubly Labeled Water to Measure Total Energy Expenditure and Weight Change

Background: One of the major problems in dietary assessment is inaccuracy in reporting diet.Objective: To examine the association between self-reported energy intake (EI) by food frequency questionnaire (FFQ) and energy expenditure (EE), measured by doubly labeled water (DLW), among older persons.Design: EE was assessed in 298 high-functioning, community-dwelling older adults (70–79 years of age) over a 2-week period using DLW. Dietary intake was assessed using a Block FFQ. The ratio between reported EI and total energy expenditure (TEE) was calculated. Misreporting was defined as follows: participants with an EI/TEE ratio of <0.77 were categorized as low energy reporters, while participants with an EI/TEE ratio >1.28 were categorized as high energy reporters. Participants with an EI/TEE ratio of 0.77–1.28 were categorized as “true” energy reporters. One-year percent weight change prior to EE visit was used as another validation indicator. Participants who were low energy reporters but lost >2% of their body weight were categorized as undereaters.Results: Two hundred ninety-six participants provided both FFQ and DLW measurements. Forty-three percent of participants were low energy reporters; among them, almost 30% lost weight and, therefore, were categorized as undereaters. The undereaters consumed significantly fewer calories. No difference in the frequency of low energy reporting was detected between genders or racial groups. Underreporters had significantly higher body weight than “true” or high reporters. Undereaters tended to have higher body mass index than the underreporters.Conclusions: Undereating is prevalent in the elderly and may be falsely perceived as underreporting. It should be further addressed and characterized in future studies.