Background Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people, the efficacy of interventions targeted specifically at these deficits has not been carefully studied. Methods We conducted a randomized, placebo-controlled trial comparing progressive resistance exercise training, multinutrient supplementation, both interventions, and neither in 100 frail nursing home residents over a 10-week period. Results The mean (±SE) age of the 63 women and 37 men enrolled in the study was 87.1 ±0.6 years (range, 72 to 98); 94 percent of the subjects completed the study. Muscle strength increased by 113 ±8 percent in the subjects who underwent exercise training, as compared with 3 ±9 percent in the nonexercising subjects (P<0.001). Gait velocity increased by 11.8 ±3.8 percent in the exercisers but declined by 1.0 ±3.8 percent in the nonexercisers (P = 0.02). Stair-climbing power also improved in the exercisers as compared with the nonexercis...

https://www.nejm.org/doi/pdf/10.1056/NEJM199406233302501

Exercise training and nutritional supplementation for physical frailty in very elderly people

A self-administered diet history questionnaire has been developed for epidemiologic and clinical use. Both the food list and the nutrient values to be associated with it were developed using dietary data from 11,658 adult respondents to the Second National Health and Nutrition Examination Survey (NHANES II). Food items were selected on the basis of their contribution to total population intake of energy and each of 17 nutrients in the NHANES II data, and represent over 90% of each of those nutrients. Associated nutrient composition values were determined from the NHANES II database using frequency of consumption data in that survey. Portion sizes to be associated with each food item were derived from observed portion size distributions in NHANES II, based on three-dimensional models. The resulting food list and its corresponding brief data base, when used to calculate nutrients from a diet record, yielded correlations of r greater than 0.70 with the more detailed method. Field administration produced mean values comparable to national data.

A data-based approach to diet questionnaire design and testing

Context: Altered vitamin D and calcium homeostasis may play a role in the development of type 2 diabetes mellitus (type 2 DM). Evidence Acquisition and Analyses: MEDLINE review was conducted through January 2007 for observational studies and clinical trials in adults with outcomes related to glucose homeostasis. When data were available to combine, meta-analyses were performed, and summary odds ratios (OR) are presented. Evidence Synthesis: Observational studies show a relatively consistent association between low vitamin D status, calcium or dairy intake, and prevalent type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM prevalence, 0.36 (0.16–0.80) among nonblacks for highest vs. lowest 25-hydroxyvitamin D; metabolic syndrome prevalence, 0.71 (0.57–0.89) for highest vs. lowest dairy intake]. There are also inverse associations with incident type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM incidence, 0.82 (0.72–0.93) for highest vs. lowest combined vitamin D an...

/pdf/the-role-of-vitamin-d-and-calcium-in-type-2-diabetes-a-2zpmm7zote.pdf

The Role of Vitamin D and Calcium in Type 2 Diabetes. A Systematic Review and Meta-Analysis

https://pubag.nal.usda.gov/download/21951/PDF

The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes

Energy intake (EI) is the foundation of the diet, because all other nutrients must be provided within the quantity of food needed to fulfill the energy requirement. Thus if total EI is underestimated, it is probable that the intakes of other nutrients are also underestimated. Under conditions of weight stability, EI equals energy expenditure (EE). Because at the group level weight may be regarded as stable in the timescale of a dietary assessment, the validity of reported EI can be evaluated by comparing it with either measured EE or an estimate of the energy requirement of the population. This paper provides the first comprehensive review of studies in which EI was reported and EE was measured using the doubly labeled water technique. These conclusively demonstrate widespread bias to the underestimation of EI. Because energy requirements of populations or individuals can be conveniently expressed as multiples of the basal metabolic rate (BMR), EE:BMR, reported EI may also be expressed as EI:BMR for comparison. Values of EI:BMR falling below the 95% confidence limit of agreement between these two measures signify the presence of underreporting. A formula for calculating the lower 95% confidence limit was proposed by Goldberg et al. (the Goldberg cutoff). It has been used by numerous authors to identify individual underreporters in different dietary databases to explore the variables associated with underreporting. These studies are also comprehensively reviewed. They explore the characteristics of underreporters and the biases in estimating nutrient intake and in describing meal patterns associated with underreporting. This review also examines some of the problems for the interpretation of data introduced by underreporting and particularly by variable underreporting across subjects. Future directions for research are identified.

Markers of the Validity of Reported Energy Intake

The number of days of food intake data needed to estimate the intake of 29 male (n = 13) and female (n = 16) adult subjects, individually and as a group, was determined for food energy and 18 nutrients. The food intake records were collected in a year-long study conducted by the U.S. Department of Agriculture's Beltsville Human Nutrition Research Center. Each individual's average intake of nutrients and standard deviation over the year were assumed to reflect his or her "usual" intake and day-to-day variability. Confidence intervals (P less than 0.05) for each individual's usual intake were constructed, and from these the number of days of dietary records needed for estimated individual and group intake to be within 10% of usual intake was calculated. The results indicated that the number of days of food intake records needed to predict the usual nutrient intake of an individual varied substantially among individuals for the same nutrient and within individuals for different nutrients; e.g., food energy required the fewest days (averaging 31) and vitamin A the most (averaging 433). This was considerably higher than the number of days needed to estimate mean nutrient intake for this group, which ranged from 3 for food energy to 41 for vitamin A. Fewer days would be needed for larger groups.

Number of days of food intake records required to estimate individual and group nutrient intakes with defined confidence.

A review of research on effects of fiber intake on man.

Effect of fiber from fruits and vegetables on metabolic responses of human subjects, II. Calcium, magnesium, iron, and silicon balances.

Effect of fiber from fruits and vegetables on metabolic responses of human subjects I. Bowel transit time, number of defecations, fecal weight, urinary excretions of energy and nitrogen and apparent digestibilities of energy, nitrogen, and fat

The literature indicates that phytate:zinc and phytate X calcium:zinc millimolar ratios of a diet may provide useful indexes of the bioavailability of dietary zinc. However, there is little information on the phytate:zinc and phytate X calcium:zinc millimolar ratios for total human diets. We have therefore determined the phytate:zinc and phytate X calcium:zinc millimolar ratios of self-selected diets of 29 American omnivores, 23 American vegetarians, 30 Asian Indian immigrant vegetarians, and 26 Nepalese lactating vegetarians. Criteria for selection of subjects were: good health, no extreme dietary habits, and no intake of nutrient supplements. According to the limited literature, the suggested critical values for phytate:zinc and phytate X calcium:zinc millimolar ratios in animal diets and retrospective calculations from human diets are greater than 10 and greater than 200, respectively. The mean phytate:zinc and phytate X calcium:zinc millimolar ratios of American omnivorous diets in the present study were less than 10 and 200, respectively. Confirmation of the critical molar ratios as indexes of the bioavailability of zinc in human diets has not been established by experimentation. However, if the data from animal studies are applicable to human diets, the present study suggests that phytate has little influence on zinc bioavailability of most American diets. In contrast, the mean phytate:zinc and phytate X calcium:zinc millimolar ratios of all vegetarian diets were above the proposed critical levels. Those data, therefore, suggest that phytate might increase the risk of impaired zinc bioavailability for vegetarians consuming a relatively high level of calcium.

June L. Kelsay

Papers

Number of days of food intake records required to estimate individual and group nutrient intakes with defined confidence.

A review of research on effects of fiber intake on man.

Effect of fiber from fruits and vegetables on metabolic responses of human subjects, II. Calcium, magnesium, iron, and silicon balances.

Effect of fiber from fruits and vegetables on metabolic responses of human subjects I. Bowel transit time, number of defecations, fecal weight, urinary excretions of energy and nitrogen and apparent digestibilities of energy, nitrogen, and fat

Phytate:zinc and phytate X calcium:zinc millimolar ratios in self-selected diets of Americans, Asian Indians, and Nepalese.