Significant Decrease In Energy Intake Research Articles

Body mass index and nutritional intake following Elexacaftor/Tezacaftor/Ivacaftor modulator therapy in adults with cystic fibrosis

BackgroundElexacaftor/Tezacaftor/Ivacaftor (ETI) modulator therapy is often associated with increased body mass index (BMI) in people with cystic fibrosis (CF). This is thought to reflect improved clinical stability and increased appetite and nutritional intake. We explored the change in BMI and nutritional intake following ETI modulator therapy in adults with CF. MethodsDietary intake, measured with myfood24®, and BMI were collected from adults with CF at baseline and follow-up as part of an observational study. Changes in BMI and nutritional intake in participants who commenced ETI therapy between time points were assessed. To contextualize findings, we also assessed changes in BMI and nutritional intake between study points in a group on no modulators. ResultsIn the pre and post ETI threapy group (n = 40), BMI significantly increased from 23.0 kg/m2 (IQR 21.4, 25.3) at baseline to 24.6 kg/m2 (IQR 23.0, 26.7) at follow-up (p<0.001), with a median of 68 weeks between time points (range 20–94 weeks) and median duration of ETI therapy was 23 weeks (range 7–72 weeks). There was a significant decrease in energy intake from 2551 kcal/day (IQR 2107, 3115) to 2153 kcal/day (IQR 1648, 2606), p<0.001. In the no modulator group (n = 10), BMI and energy intake did not significantly change between time points (p>0.05), a median of 28 weeks apart (range 20–76 weeks). ConclusionsThese findings tentatively suggest that the increase in BMI with ETI therapy may not simply be attributable to an increase in oral intake. Further exploration into the underlying aetiology of weight gain with ETI therapy is needed.

Factors Associated With Growth in Patients Treated With the Classic Ketogenic Diet for Drug-Resistant Epilepsy

BackgroundSuboptimal growth and malnutrition are often cited as complications of ketogenic diet therapy in patients with drug-resistant epilepsy; however, there is conflicting evidence on the factors that contribute to growth. MethodsThis is an observational, case-based study to evaluate growth in patients with drug-resistant epilepsy treated with the classic ketogenic diet for at least 12 months. Age, gender, height, weight, and body mass index (BMI) were collected at baseline and epilepsy clinic standard-of-care visits (one month, six months, and 12 months after diet initiation). Dietary intake and laboratory measures including glucose, bicarbonate, and beta-hydroxybutyrate were also collected. Results119 patients were included. After ketogenic diet initiation, there was a significant fall in height z score from baseline to 12 months (−0.15, P = 0.001) but no other significant changes in weight, weight-for-length/BMI, or height z scores were noted between any time points within the 12 months after diet initiation. When separated by age, height z score changes were limited to those aged zero to three years. This was accompanied by a significant decrease in energy intake 12 months after treatment in this age group. When separated by diet route, weight z scores at each time point were significantly lower in the group eating by mouth than tube. ConclusionsOur study provides further evidence that the classic ketogenic diet impacts growth. Our population demonstrated restriction in linear growth in those aged zero to three years, which correlated with declines in energy intake, and weight declines limited to patients fed by mouth.

Virgin Coconut Oil: A Dietary Intervention for Dyslipidaemia in Patients with Diabetes Mellitus.

Hyperlipidaemia is causally related to coronary artery diseases (CAD) and peripheral artery diseases (PAD) in people with Diabetes Mellitus (DM). An in vivo study confirmed that virgin coconut oil (VCO) could maintain levels of lipids in the blood as effectively as conventional therapy. Therefore, this study aimed to determine the effect of VCO on the lipid profiles and ankle-brachial index (ABI) of patients with DM. In this experimental study with pre- and post-test design and a control group, the participants were selected purposively. The ABI was evaluated on the first visit. Baseline lipid profile readings were taken. Each participant took 1.2 mL/kgBW of VCO daily and divided it into three doses. After 30 days of taking VCO, laboratory examinations and ABI were repeated, and adverse events were evaluated. The dependent t-test and Wilcoxon sign rank test with a significance level of α ≤ 0.05 showed a significant decrease in low-density lipoprotein (LDL) (p = 0.002), a significant increase in high-density lipoprotein (HDL) levels (p = 0.031), a significant decrease in energy intake (p = 0.046) and cholesterol intake (p = 0.023) at the endpoint in the VCO group. In conclusion, this therapy is beneficial for maintaining lipid profile when combined with dietary therapy. Future studies should investigate the duration and dosage of VCO on patients to maintain lipid-linked protein.

Effects of Face-to-Face and eHealth Blended Interventions on Physical Activity, Diet, and Weight-Related Outcomes among Adults: A Systematic Review and Meta-Analysis.

An increasing number of studies are blending face-to-face interventions and electronic health (eHealth) interventions to jointly promote physical activity (PA) and diet among people. However, a comprehensive summary of these studies is lacking. This study aimed to synthesize the characteristics of blended interventions and meta-analyze the effectiveness of blended interventions in promoting PA, diet, and weight-related outcomes among adults. Following the PRISMA guidelines, PubMed, SPORTDiscus, PsycINFO, Embase, and Web of Science were systematically searched to identify eligible articles according to a series of inclusion criteria. The search was limited to English language literature and publication dates between January 2002 and July 2022. Effect sizes were calculated as standardized mean difference (SMD) for three intervention outcomes (physical activity, healthy diet, and weight-related). Random effect models were used to calculate the effect sizes. A sensitivity analysis and publication bias tests were conducted. Of the 1561 identified studies, 17 were eligible for the systematic review. Studies varied in participants, intervention characteristics, and outcome measures. A total of 14 studies were included in the meta-analyses. There was evidence of no significant publication bias. The meta-analyses indicated that the blended intervention could lead to a significant increase in walking steps (p < 0.001), total PA level (p = 0.01), and diet quality (p = 0.044), a significant decrease in energy intake (p = 0.004), weight (p < 0.001), BMI (p < 0.001), and waist circumferences (p = 0.008), but had no influence on more moderate-to-vigorous physical activity (MVPA) or fruit and vegetable intake among adults, compared with a control group. The study findings showed that blended interventions achieve preliminary success in promoting PA, diet, and weight-related outcomes among adults. Future studies could improve the blended intervention design to achieve better intervention effectiveness.

Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings

Short sleep duration has been recognized as a risk factor for obesity. Whether extending sleep duration may mitigate this risk remains unknown. To determine the effects of a sleep extension intervention on objectively assessed energy intake, energy expenditure, and body weight in real-life settings among adults with overweight who habitually curtailed their sleep duration. This single-center, randomized clinical trial was conducted from November 1, 2014, to October 30, 2020. Participants were adults aged 21 to 40 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 25.0 and 29.9 and had habitual sleep duration of less than 6.5 hours per night. Data were analyzed according to the intention-to-treat principle. After a 2-week habitual sleep period at baseline, participants were randomized to either an individualized sleep hygiene counseling session that was intended to extend their bedtime to 8.5 hours (sleep extension group) or to continue their habitual sleep (control group). All participants were instructed to continue daily routine activities at home without any prescribed diet or physical activity. The primary outcome was change in energy intake from baseline, which was objectively assessed as the sum of total energy expenditure and change in body energy stores. Total energy expenditure was measured by the doubly labeled water method. Change in body energy stores was computed using regression of daily home weights and body composition changes from dual-energy x-ray absorptiometry. Sleep duration was monitored by actigraphy. Changes from baseline were compared between the 2 groups using intention-to-treat analysis. Data from 80 randomized participants (mean [SD] age, 29.8 [5.1] years; 41 men [51.3%]) were analyzed. Sleep duration was increased by approximately 1.2 hours per night (95% CI, 1.0 to 1.4 hours; P < .001) in the sleep extension group vs the control group. The sleep extension group had a significant decrease in energy intake compared with the control group (-270 kcal/d; 95% CI, -393 to -147 kcal/d; P < .001). The change in sleep duration was inversely correlated with the change in energy intake (r = -0.41; 95% CI, -0.59 to -0.20; P < .001). No significant treatment effect in total energy expenditure was found, resulting in weight reduction in the sleep extension group vs the control group. This trial found that sleep extension reduced energy intake and resulted in a negative energy balance in real-life settings among adults with overweight who habitually curtailed their sleep duration. Improving and maintaining healthy sleep duration over longer periods could be part of obesity prevention and weight loss programs. ClinicalTrials.gov Identifier: NCT02253368.

EATING VEGETABLES BEFORE CARBOHYDRATES DECREASE ENERGY INTAKE OF TYPE-2 DIABETES MELLITUS PATIENTS

Diabetes mellitus is a non-communicable disease that has increased significantly in Indonesia and worldwide. Dietary arrangements through diet therapy are beneficial for improving the performance of the pancreas in producing and stimulating the work of insulin. This study aimed to determine the effect of the order of vegetable and carbohydrate consumptions on the decrease of energy intake. Method used randomized control trial with pre-post design. A total of 24 people with non-complicating type-2 diabetes mellitus aged 18-65 years were assigned into 3 groups ; control group (C), vegetable before carbohydrate group (P1), and vegetable with carbohydrate group (P2) . Energy intake before and after the intervention was measured using a 24-hour food recall. To compare pre-post intervention, paired T-test were used, meanwhile to compare difference among groups data were analysed using ANOVA. A significant decrease in energy intake was found in P1 where the mean values of C and P1 were 17.75 ± 12.40 calories and 155.27 ± 23.40 calories (p &lt; 0.001), and mean values of P1 and P2 were 155.27 ± 23.40 calories and 4.54 ± 48.99 calories (p &lt; 0.001). The order of vegetable before carbohydrate consumption decreases energy intake of type-2 diabetes mellitus patients.

The Physiological and Cardiologic Effects of Long Video Gaming Sessions in Adult Males.

The effect of long gaming sessions on energy intake, caffeine intake, blood pressure, heart rate, heart rate variability, and biochemical cardiac injury markers is unknown. The objective of this exploratory study was to investigate the changes in healthy male adults during two consecutive 18-hour sedentary video gaming sessions. Nine participants were enrolled in the study. Energy intake was noted in food diaries. Heart rate variability was monitored continuously; blood pressure and cardiac injury markers were measured every three to six hours. During the 42-hour study, the participants had an energy and caffeine intake of 8004.9 kcal and 1354.4 mg, respectively. The participants had a significant decrease in energy intake in the second session (p=0.01). A strong, negative correlation was found between body mass index and total energy intake (R=–0.84, p=0.005) and waist circumference and total energy intake (R=–0.70, p=0.036) in the first session. No nightly dip in blood pressure or heart rate was observed. Based on this study, long-term adverse effects of gaming cannot be ruled out. The non-dip of HR and BP suggests that long gaming sessions could be detrimental to cardiovascular health long term.

Ingesta calórica y de macronutrientes en los primeros seis meses post cirugía bariátrica

BACKGROUND Bariatric surgery (BS) is the most effective procedure in the management of obesity, achieving a significant decrease in energy intake. AIM To measure calorie and macronutrient intake in patients subjected to gastric bypass (GBP) or sleeve gastrectomy (SG). MATERIAL AND METHODS We studied 53 patients subjected to SG and 27 subjected to GBP, who were in the first, second or sixth postoperative month. A food frequency consumption survey was applied by specialized nutritionists and their nutritional status was assessed. RESULTS Mean calorie intake in months 1, 2 and 6 were 505, 600 and 829.8 kcal, respectively. A significantly higher intake was observed at month 1 in patients with those subjected to SG, compared with GBP patients. Protein consumption was <60 g/d, except at 6 months in patients with GBP. At months 1, 2 and 6, mean consumption of lipids were 17, 28 and 30 g/day, respectively. The figures for carbohydrates were 42, 31 and 77 g/day, respectively. At month 1, patients with GBP had a higher BMI, equalizing at 6 months with those of SG. At 6 months 37% of patients had a normal body mass index and 17% remained obese. A negative correlation was observed between weight loss and energy intake during the first month (rho: -0.40; p = 0.033). CONCLUSIONS Patients subjected to BS had a low calorie and macronutrient intake in the first six postoperative months. Their calorie intake is negatively associated with weight loss, mainly during the first postoperative month.

A Mobile-Based Intervention for Dietary Behavior and Physical Activity Change in Individuals at High Risk for Type 2 Diabetes Mellitus: Randomized Controlled Trial.

BackgroundIntensive lifestyle modifications have proved effective in preventing type 2 diabetes mellitus (T2DM), yet the efficiency and effectiveness of these modifications need to be improved. Emerging social media interventions are considered useful in promoting these lifestyles; nevertheless, few studies have investigated the effectiveness of combining them with behavior theory.ObjectiveThis study aims to examine the effectiveness of a 6-month mobile-based intervention (DHealthBar, a WeChat applet) combined with behavioral theory compared with a printed intervention in improving dietary behaviors, physical activity, and intention to change these behaviors among populations at high risk for T2DM.MethodsParticipants aged 23 to 67 years were recruited offline in Beijing, China, and were randomized into the intervention group or the control group, which received educational content via DHealthBar or a printed handbook, respectively. Educational materials were culturally tailored recommendations on improving dietary behaviors, physical activity, and intention to change based on the transtheoretical model. Participants in the intervention arm received push notifications twice per week on WeChat and had access to the educational content for the 6-month study period. Participants in the control arm received the same intervention content through printed materials. The outcomes of participants’ behavior change, intention to change behavior, and anthropometric characteristics were collected via online measuring tools at baseline, 3 months, and 6 months.ResultsIn this study, 79 enrolled individuals completed baseline information collection (control: n=38 vs intervention: n=41), and 96% (76/79) completed the 6-month follow-up visit. Attrition rates did not differ significantly between the 2 groups (χ21=0.0, P=.61). Baseline equivalence was found. Participants in both groups reported a statistically significant decrease in energy intake at the 2 follow-up assessments compared with baseline (3 months, control: exp[β]=0.83, 95% CI 0.74-0.92 vs intervention: exp[β]=0.76, 95% CI 0.68-0.85; 6 months, control: exp[β]=0.87, 95% CI 0.78-0.96 vs intervention: exp[β]=0.57, 95% CI 0.51-0.64). At 6 months, a significantly larger decrease was observed in the intervention group in energy, fat, and carbohydrate intake, accompanied with a significantly larger increase in moderate-intensity physical activity compared with the control group (energy: exp[β]=0.66, 95% CI 0.56-0.77; fat: exp[β]=0.71, 95% CI 0.54-0.95; carbohydrates: exp[β]=0.83, 95% CI 0.66-1.03; moderate-intensity physical activity: exp[β]=2.05, 95% CI 1.23-3.44). After 6 months of the intervention, participants in the intervention group were more likely to be at higher stages of dietary behaviors (exp[β]=26.80, 95% CI 3.51-204.91) and physical activity (exp[β]=15.60, 95% CI 2.67-91.04) than the control group.ConclusionsDHealthBar was initially effective in improving dietary behavior, physical activity, and intention to change these behaviors among populations who were at high risk of developing T2DM, with significant differences in the changes of outcomes over the 6-month intervention period.Trial RegistrationChinese Clinical Trial Registry ChiCTR2000032323; https://tinyurl.com/y4h8q4uf

Pituitary Adenylate Cyclase-Activating Polypeptide Excites Proopiomelanocortin Neurons: Implications for the Regulation of Energy Homeostasis

Objective: We examined whether pituitary adenylate cyclase-activating polypeptide (PACAP) excites proopiomelanocortin (POMC) neurons via PAC1 receptor mediation and transient receptor potential cation (TRPC) channel activation. Methods: Electrophysiological recordings were done in slices from both intact male and ovariectomized (OVX) female PACAP-Cre mice and eGFP-POMC mice. Results: In recordings from POMC neurons in eGFP-POMC mice, PACAP induced a robust inward current and increase in conductance in voltage clamp, and a depolarization and increase in firing in current clamp. These postsynaptic actions were abolished by inhibitors of the PAC1 receptor, TRPC channels, phospholipase C, phosphatidylinositol-3-kinase, and protein kinase C. Estradiol augmented the PACAP-induced inward current, depolarization, and increased firing, which was abrogated by estrogen receptor (ER) antagonists. In optogenetic recordings from POMC neurons in PACAP-Cre mice, high-frequency photostimulation induced inward currents, depolarizations, and increased firing that were significantly enhanced by G_q-coupled membrane ER signaling in an ER antagonist-sensitive manner. Importantly, the PACAP-induced excitation of POMC neurons was notably reduced in obese, high-fat (HFD)-fed males. In vivo experiments revealed that intra-arcuate nucleus (ARC) PACAP as well as chemogenetic and optogenetic stimulation of ventromedial nucleus (VMN) PACAP neurons produced a significant decrease in energy intake accompanied by an increase in energy expenditure, effects blunted by HFD in males and partially potentiated by estradiol in OVX females. Conclusions: These findings reveal that the PACAP-induced activation of PAC1 receptor and TRPC5 channels at VMN PACAP/ARC POMC synapses is potentiated by estradiol and attenuated under conditions of diet-induced obesity/insulin resistance. As such, they advance our understanding of how PACAP regulates the homeostatic energy balance circuitry under normal and pathophysiological circumstances.

UCP2 I/D Modulated Change in BMI During a Lifestyle Modification Intervention Study in Japanese Subjects

Polymorphisms in uncoupling protein (UCP) genes have been strongly associated with energy expenditure and obesity. This study aimed at investigating the effects of UCP gene polymorphisms (UCP1 -3826A/G, UCP2A/V, UCP2 I/D, and UCP3 -55C/T) on change in body mass index (BMI) during a lifestyle modification program in Japanese subjects. Intervention induced a significant decrease in energy intake (-8.6% ± 17.0%) and a significant increase in energy expenditure (7.7% ± 7.4%). As a result, participants experienced a significant decrease in their BMI of -1.8% ± 2.7%. In a multivariate regression analysis, only UCP2 D/I among the selected UCP gene polymorphisms was associated with a change in BMI independent of the effects of gender, age, baseline BMI, changes in energy intake, and expenditure. Further regression analysis revealed that, in contrast to the DD genotype group, the DI+II genotype group showed no significant association between weight loss and change in energy expenditure suggesting this polymorphism altered the effects of this parameter on change in BMI. The study found UCP2 D/I to be associated with change in BMI by altering the effect of change in energy expenditure on change in BMI.

Weight loss and resting energy expenditure in patients with chronic hepatitis C before and during standard treatment

ObjectiveInfection with hepatitis C virus (HCV) is a serious public health problem worldwide. In clinical studies, weight loss has been reported in 11% to 29% of patients treated with pegylated interferon-α-2a/2b. Few reports have tried to explain such a weight loss. The aim of this study was to evaluate nutritional status, body composition, and resting energy expenditure (REE) in patients with chronic hepatitis C before and during treatment with pegylated interferon and ribavirin. MethodsThis was a prospective study with the evaluation of patients with hepatitis C virus before and after 12 wk of treatment with pegylated interferon and ribavirin. The evaluation consisted of anthropometry (weight, height, body mass index, and waist circumference), and body composition was determined by bioelectrical impedance analysis. The REE of each individual was obtained by indirect calorimetry. To compare the two phases of treatment, the Wilcoxon test was used. The significance level was 5%. ResultsSubjects had significant weight loss during treatment with a consequent decrease in body mass index. This weight decrease was accompanied by a significant decrease in body fat and no decrease in fat-free mass. There was a significant decrease in energy intake as assessed by 24-h recall. However, there was no change in REE and in REE corrected for fat-free mass. ConclusionOur study of patients with hepatitis C treatment showed that these patients had significant weight loss and this was not associated with changes in energy expenditure. However, we observed a significant decrease in energy intake, pointing to a possible need for intervention measures to decrease the damage.

The role of nutritional profile in the orexigenic neuropeptide secretion in nonalcoholic fatty liver disease obese adolescents

Little progress has been made to identify the central neuroendocrine pathway involved in the energy intake control in nonalcoholic fatty liver disease (NAFLD) patients. To assess the influence of orexigenic neuropeptides in the nutritional aspects of NAFLD obese adolescents submitted to a long-term interdisciplinary approach. Fifty adolescents aged 15-19 years, with body mass index at least 95th percentile, consisting of 25 patients without NAFLD and 25 with NAFLD. The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic transaminases, and lipid profile. Insulin resistance was estimated by Homeostasis Model Assessment Insulin Resistance Index. Neuropeptide Y (NPY) and agouti related protein concentrations were measured by enzyme-linked immunosorbent assay. Analyses of food intake were made by 3 days recordatory inquiry. At baseline conditions, the patients with NAFLD had significantly higher values of body mass, body mass index, visceral fat, triglycerides, VLDL-C, and hepatic transaminases. After the long-term intervention, they presented a significant reduction in these parameters. In both the groups, it was observed a significant decrease in energy intake, macronutrients and dietetic cholesterol. Only the patients with NAFLD presented a positive correlation between the saturated fatty acids intake and the orexigenic neuropeptides NPY and agouti related protein, and carbohydrate with NPY. Indeed, it was observed a positive correlation between energy intake, lipid (%) and saturated fatty acids with visceral fat accumulation. Our findings showed an important influence of diet composition in the orexigenic system, being essential consider that the excessive saturated fatty acids intake could be a determinant factor to increase nonalcoholic fatty liver disease.

Effect of a Six-Week National Cholesterol Education Program Step 1 Diet on Plasma Sex Hormone-Binding Globulin Levels In Overweight Premenopausal Women

Low circulating sex hormone-binding globulin (SHBG) concentrations have been associated with the presence of several features of the metabolic syndrome in both men and women. Nutritional factors including dietary lipids and fibers in particular have been suggested to modulate plasma SHBG levels. The primary objective of the present study was to investigate the effect of an oat bran-rich supplement in conjunction with the National Cholesterol Education Program (NCEP) Step 1 diet (< 30% of total energy from fat, < 10% of energy from saturated fat, and < 300 mg cholesterol per day) on plasma SHBG levels in 35 overweight premenopausal women. Subjects (age 38.6 +/- 7.4 years) had normal menstrual cycles and were tested in the midluteal phase. Since no effect of the oat bran supplement was observed on plasma SHBG levels, data were analyzed according to the 6-week NCEP Step 1 diet. The NCEP Step 1 nutritional intervention caused a significant decrease in energy intake ( -11%, p < 0.05), percent fat intake (-10%, p < 0.005), as well as saturated (-20%, p < 0.005) and monounsaturated (-10%, p < 0.05) fatty acid intake. Body mass index (BMI) decreased slightly but significantly (from 29.2 +/- 4.5 to 28.8 +/- 4.3 kg/m(2), p < 0.005). Plasma SHBG levels increased significantly (from 70.6 +/- 17.7 to 79.9 +/- 15.3 pmol/L, p < 0.0005) following the 6-week NCEP Step 1 diet, whereas plasma insulin levels were not modified significantly. Significant correlations were observed between the change in plasma SHBG levels and baseline BMI (r = 0.36, p < 0.04), as well as baseline (r = -0.42, p < 0.05) and postintervention (r = -0.35, p < 0.05) HDL cholesterol levels. We observed that a 6-week NCEP Step 1 diet significantly increased plasma SHBG levels, despite the finding that fasting insulin was not modified. Further studies are needed to elucidate physiological mechanisms underlying a direct effect of dietary composition on SHBG production by the liver.

The Effects of Self-Monitoring and a Correspondance-Based Intervention on Weight Loss, Eating and Exercise Behavior

PURPOSE: This study examined the effect of two METHODS of self-monitoring (detailed vs. less detailed) and a correspondence-based approach to weight loss in sedentary adults and further examined the effectiveness of such an approach on changes in body weight and physical activity. METHODS: Forty-two men and women (BMI = 32.0+1.6 kg/m2, age = 36.0+6.4 years) participated in a 16-week correspondence weight loss program. Subjects were randomly assigned to complete self-monitoring diaries in either a detailed (DSM = specific calories, fat, exercise) or less detailed (TSM = rating of meals and indicating duration of exercise) manner, and these diaries were mailed to the intervention team weekly. Subjects were mailed a behavioral lesson weekly along with feedback on the recently submitted self-monitoring diary. The intervention consisted of energy intake prescribed at 1200–1500 kcal/day and dietary fat to <30% of total calories. Exercise was prescribed as home-based and progressed from 20 to 40 min/d for 5 d/wk. RESULTS: Weight loss was not statistically different between groups for analysis of study completers (DSM = −7.5 ±5.3 kg, TSM = −7.6 ±5.5 kg) and for intention to treat analysis (DSM = −3.9+5.3 kg, TSM = −4.3+5.8 kg). There was a significant decrease in energy intake (DSM = 826 ± 965 kcal/d; TSM = 571 ± 765 kcal/d; p = .001) and percent dietary fat intake (DSM = 9.8% ± 8.1%; TSM = 5.3% ± 8.1%; p = <. 001). There was a significant increase in energy expenditure from leisure-time physical activity for DSM (1382 ±1100 to 2825 ± 3288 kcal/wk) and TSM (1254 ±628 to 1521 ± 682 kcal/wk) (p = .04). There was no significant difference between DSM and TSM for energy intake, dietary fat intake, or physical activity. CONCLUSIONS: Significant decreases in body weight can be achieved with a correspondence-based intervention, and this may have the capability of reaching a greater number of people at a more economical cost compared to traditional face-to-face programs. Moreover, a less detailed self-monitor ing method may be as effective as detailed self-monitor ing of eating and exercise behaviors. Research should examine for whom correspondence-based weight loss interventions would be most effective.

Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women

Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into ‘before crisis’, ‘transition’ and ‘during crisis’. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels ( P=0.00) and from different socio-economic groups ( P=0.00). ‘During transition’, a significant decrease in energy intake was experienced by urban poor women ( P=0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. ‘During crisis’, energy intake improved among vulnerable groups, perhaps reflecting government intervention.

Shift from a dairy product-rich to a dairy product-free diet: influence on cytotoxicity and genotoxicity of fecal water--potential risk factors for colon cancer

Several epidemiologic studies have suggested that dairy product intake is associated with a decreased incidence of colon cancer. To determine whether the cytotoxicity and genotoxicity of the aqueous portion of human stool (two potential risk markers for the disease) were affected by a change in dairy product intake, 18 healthy male and female volunteers were randomly divided into two groups. In a crossover design, the volunteers shifted from their normal dairy product-rich diet to a dairy product-free diet. Nutritional analysis of the food consumed during the study period showed a significant decrease in energy intake from 9000 to 7866 kJ/d because of a decreased intake of protein and fat. Carbohydrate and fiber intakes remained unchanged during the intervention. Calcium intake decreased significantly from 1488 to 372 mg/d, with similar significant decreases in phosphate and vitamin D intakes. Cytotoxicity of fecal water, analyzed by the HT-29 cytotoxicity assay, indicated a significant decrease in cell survival from 34% to 20% when dairy products were excluded from the participants' diets. Single-cell gel electrophoresis (COMET assay), used to analyze genotoxicity of fecal waters, indicated no differences brought about by the dietary intervention. In conclusion, our findings indicate that a shift from a dairy product-rich to a dairy product-free diet resulted in a significant effect on an accepted risk marker for colon cancer and may suggest that the mechanism by which dairy products are protective is at the level of tumor promotion rather than initiation.

Changes in measured resting energy expenditure after Roux-en-Y gastric bypass for clinically severe obesity

Background . Roux-en- Y gastric bypass (RYGB) results in sustained weight loss and amelioration of comorbid conditions in patients with clinically severe obesity. The mechanism of weight loss after RYGB is not well defined. The objective of this study was to document the changes in measured resting energy expenditure (MREE) over time in patients with clinically severe obesity after RYGB. Methods. We prospectively studied MREE in 70 patients (11 male, 59 female; body mass index [BMI], 40 to 80 kg/m 2) treated by RYGB. MREE was measured by indirect calorimetry before operation and at 6 weeks and 3, 6, 12, 18, and 24 months after operation. Patients were stratified to hypometabolic ([HM] MREE less than 85% of Harris-Benedict [HB] predicted; n = 22) or normal metabolic rate ([NM] MREE ±15% HB predicted; n = 48) before operation; mean BMIs were HM, 53.4 ± 11.0 kg/m 2; NM, 51.4 ± 9.8 kg/m 2; p = not significant. MREE, weight loss, percent excess body weight loss (EWL), and energy intake were determined at each time point. Results. Overall, MREE was significantly less than HB-predicted REE before operation (90 ± 28%), but rose to become equal to the HB-predicted REE by 6 weeks (96 ± 15%) and remained so. When stratified by initial metabolic rate, MREE increased significantly in the HM patients by 6 weeks, from 1329 ± 604 kcal/day (55% of HB predicted) to 1882 ± 398 kcal/day (88% of HB predicted) (p < 0.001), and MREE remained normal (2332 ± 484 kcal/day to 2029 ± 410 kcal/day) in the NM patients. Percent EWL was similar in both groups at each time. Energy intake was 2603 ± 982 kcal/day before operation and fell to 815 ± 196 kcal/day at 3 months, 969 ± 241 kcal/day at 6 months, 1095 ± 307 kcal/day at 12 months, 1259 ± 466 kcal/day at 18 months, and 1373 ± 620 kcal/day at 24 months, and was similar between the groups at each time point. Percent HB-predicted REE increased significantly after operation despite a significant decrease in energy intake. Conclusions. RYGB is associated with significant changes in MREE over time. In NM patients MREE fell over time consistent with weight loss but remained normal, whereas patients who were hypometabolic exhibited increases in MREE toward normal. These changes in MREE occurred despite reduced energy intake comparable to a very low calorie diet. This paradoxical effect on MREE may contribute to the enhanced weight loss associated with RYGB.