Showing papers in "European Journal of Clinical Nutrition in 1991"

Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording.

Abstract: This paper uses fundamental principles of energy physiology to define minimum cut-off limits for energy intake below which a person of a given sex, age and body weight could not live a normal life-style. These have been derived from whole-body calorimeter and doubly-labelled water measurements in a wide range of healthy adults after due statistical allowance for intra- and interindividual variance. The tabulated cut-off limits, which depend on sample size and duration of measurements, identify minimum plausible levels of energy expenditure expressed as a multiple of basal metabolic rate (BMR). CUT-OFF 1 tests whether reported energy intake measurements can be representative of long-term habitual intake. It is set at 1.35 x BMR for cases where BMR has been measured rather than predicted. CUT-OFF 2 tests whether reported energy intakes are a plausible measure of the food consumed during the actual measurement period, and is always more liberal than CUT-OFF 1 since it has to allow for the known measurement imprecision arising from the high level of day-to-day variability in food intake. The cut-off limits can be used to evaluate energy intake data. Results falling below these limits must be recognized as being incompatible with long-term maintenance of energy balance and therefore with long-term survival.

Body Mass Index variations: centiles from birth to 87 years.

Abstract: This report provides Body Mass Index (weight/height2) values for the French population from birth to the age of 87 years. BMI curves increase during the first year, decrease until the age of 6, increase again up to 65 years and decrease thereafter. These variations reflect the total changes of fat body mass during life. The 50th centile values of Wt/Ht2 at the ages of 20, 40, 60, 80 years are 21.5, 24.6, 25.4, 24.4 kg/m2 for men and 20.6, 22.6, 24.1, 23.4 kg/m2 for women. The values for the 3rd, 50th and 97th centiles in the middle years are approximately 18, 24 and 32 kg/m2. Graphs for these and four other percentiles are plotted against age, and two other graphs summarising the variation and skewness of the Wt/Ht2 distribution are provided to calculate exact percentiles and Z-scores for individuals.

Critical evaluation of energy intake data using fundamental principles of energy physiology: 2. Evaluating the results of published surveys.

Abstract: The fundamental principles of energy physiology were used to evaluate the validity of reported energy intake (EI) in 37 published dietary studies of adults providing 68 subgroups when classified according to sex and dietary method. EI was expressed as a multiple of BMR estimated using the reported heights and weights of the study populations (EI:BMR(est)). This ratio was compared with a study-specific cut-off value representing the lowest value for EI:BMR(est) that could, within defined bounds of statistical probability, reflect the habitual energy expenditure of a sedentary life-style. Mean EI:BMR(est) was 1.43 (0.19) compared with an expected requirement of 1.55. In 46 out of the 68 groups (68%), EI:BMR(est) was below the study-specific cut-off value. EI:BMR(est) was 1.37 (SD = 0.13) for women and 1.50 (SD = 0.16) for men (P less than 0.001). This could reflect either better reporting by men or a more active life-style. When categorized according to dietary assessment method, 64%, 88% and 25% of results fell below the acceptable cut-off value for studies by diet records, diet recall and diet history, respectively. These data indicate that dietary assessment methods have a strong bias towards underestimation of habitual energy intake.

Determinants of weight gain and overweight in adult Finns.

Abstract: We studied sociodemographic and behavioural factors as predictors of weight gain in 12,669 adult Finns examined twice with a median interval of 5.7 years. The association of these factors with the prevalence of obesity (body mass index greater than or equal to 30 kg/m2) was also studied in a subsequent cross-sectional survey of 5673 Finns. In uni- and multivariate analyses, the risk of substantial weight gain (greater than or equal to 5 kg/5 years) was greatest for persons with a low level of education, chronic diseases, little physical activity at leisure or heavy alcohol consumption, and for those who got married or quit smoking between the examinations. Parity and energy intake predicted weight gain in women. The prevalence of obesity was inversely associated with the level of education and physical activity, and positively associated with alcohol consumption in men and parity in women. There were no significant differences in the prevalence of obesity by smoking or marital status. The recognition of socioeconomic and behavioural factors as important determinants of weight gain and overweight helps the planning of effective treatment and preventive programmes tailored for subjects at highest risk of obesity.

New predictive equations for the estimation of basal metabolic rate in tropical peoples.

Abstract: The measurement of basal metabolic rate (BMR) is an important element in the estimation of energy requirements in man. Based on a survey of 2822 BMR measurements conducted in the tropics, a series of new predictive equations to estimate BMR in tropical peoples is presented. These new equations based on bodyweight show that the current FAO/WHO/UNU predictive equations overestimate BMR of peoples living in the tropics by an average of 8 per cent, and by up to 11.5 per cent for males over 30 years old. These differences were significant over between 65 and 100 per cent of the normal bodyweight range found in our data, for both males and females over 10 years old. However, for younger ages, 3-10 years, the FAO/WHO/UNU equations predicted BMR quite accurately. The inclusion of height made no significant difference to the predictive equation. Although caution must be exercised in interpreting these results, it is concluded that the lower BMR in the tropics appears to be a general and genuine phenomenon in adults. Further discussion of energy requirements in tropical peoples must consider these observed deviations in BMR from the FAO/WHO/UNU predictive equations.

Diet and other life-style factors in high and low socio-economic groups (Dutch Nutrition Surveillance System).

Abstract: Insight into the occurrence of and the association between certain socio-economic variables and life-style characteristics is necessary for preventive nutrition and health policy. The prevalence of and the interdependencies among these variables were examined in 1930 men and 2204 women aged 19 to 85 who participated in the Dutch National Food Consumption Survey 1987-1988. Dietary data were based on a two-day record. The associations among discrete variables were analysed using log-linear models. Analysis of covariance was used to explore the effects of the aggregate socio-economic status (SES) on dietary intake and anthropometry, whereas differences in food intake and SES were assessed by the non-parametric test of Kruskal and Wallis. In comparison to subjects with a high SES in people with a low SES a higher proportion of smokers (48 vs 32 per cent) was observed, a higher prevalence of obesity (39 vs 28 per cent), a higher percentage of heavy coffee drinkers (greater than six cups per day, 23 vs 17 per cent), and more subjects who skipped breakfast (19 vs 11 per cent). In the highest SES class more subjects used nutritional supplements (18 vs 11 per cent), more subjects followed a dietary rule (five vs two per cent), such as a vegetarian diet, and a higher proportion used more than three alcoholic drinks per day (19 vs 15 per cent). A higher SES was associated with a lower fat intake, but the differences (expressed as per cent of energy intake) were rather small and even absent among women when the contribution of alcohol to energy was not taken into account. In general, dietary intake among subjects in higher SES groups tended to be closer to dietary recommendations. The results indicate that a lower SES is accompanied by a higher prevalence of several indicators of an unhealthy life-style.

On the importance of processing conditions, product thickness and egg addition for the glycaemic and hormonal responses to pasta: a comparison with bread made from 'pasta ingredients'.

Abstract: The importance of processing conditions, product thickness and effect of egg addition for the glycaemic and hormonal responses to pasta was studied. Healthy subjects were given test meals with an equivalent amount of available carbohydrate from extruded high-temperature dried spaghetti and three varieties of fresh roll-sheeted linguine (thick, thin, thin with egg) made from the same ingredients (durum wheat, water and monoglycerides). As a reference bread was baked from the same ingredients as in the pasta products. Glucose, insulin and C-peptide levels were measured over a 3 h period. Glycaemic, insulin and C-peptide indexes (GI, II, CI) were calculated using 120 min areas under the curves. Glycaemic index was also calculated using the 90 min area. Also studied were the rates of in vitro starch digestion. The four pasta products produced significantly lower peak values (glucose, insulin, C-peptide) and lower GI (90 min), II (120 min) and CI (120 min) than the corresponding bread. The rate of in vitro starch digestion in pasta was also slower than in bread. In contrast to the pasta products, bread resulted in a prominent hypoglycaemia in the late phase, that is a drop below fasting blood glucose level. Minor differences in metabolic responses also appeared in the pasta products. In particular, the insulin and C-peptide response to the thin linguine was accentuated in the phase around 120 min.

Inter-observer variability in the measurement of body composition.

Abstract: The inter-observer variation in simple bedside assessments of body composition has been evaluated in 12 healthy adult subjects (6 male and 6 female) by 6 observers. Systematic bias between observers was found to be evident in each of the basic measurements (except height) and in each of the estimates of body composition (except those derived from weight and height alone). The largest residual coefficients of variation (rCV) for the basic measurements were found for skinfold thickness (11-18 per cent for individual skinfold thicknesses, and 9 per cent for the sum of four skinfold thicknesses), and the lowest for weight (0.01 per cent for digital scales, and 0.05 per cent for beam balance) and height (0.4 per cent). The rCV for whole-body resistance (1.2 per cent), forearm resistance (5.4 per cent) and near infra-red interactance (optical density 1: 5.6 per cent and optical density 2: 6.2 per cent) measurements were found to have intermediate values. The variability in the estimate of body fat obtained by skinfold thickness (rCV = 4.6 per cent) and near infra-red interactance methods (rCV = 4.2 per cent) was found to be greater than that from the resistance method (rCV = 2.6 per cent) and by methods based on weight and height alone (rCV = 1.1 per cent). The variability in the estimate of fat-free mass showed the same trend as that for body fat, but the rCVs were less due to the greater mass of the fat-free body compared to body fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Calculating the energy values of foods: towards new empirical formulae based on diets with varied intakes of unavailable complex carbohydrates.

Abstract: A statistical analysis has been made by generalised linear regression of the relationship between the availability of digestible energy (DE) and the intakes of dietary gross energy (E) and of dietary 'fibre' or unavailable complex carbohydrate (U), for published observations on 43 human diets with varied intakes and sources of U (2-93 g daily) and varied intakes of E (7598-15104 kJ or 1816-3610 kcal daily). Simple formulae were devised also for the availability of metabolizable energy (ME) assuming urinary energy losses of 30 kJ or 7 kcal/g nitrogen (N) intake. For the calculation of DE and ME in mixed human diets with accuracy greater than obtained with previously published methods, the following linear formulae are proposed and their limitations discussed: DE (kJ) = 0.96E(kJ)-9U(g) ME (kJ) = 0.96E(kJ)-9U(g)-30N(g) DE (kcal) = 0.96E(kcal)-2U(g) ME (kcal) = 0.96E(kcal)-2U(g)-7N(g) The equations devised are used to identify atypical observations on faecal energy excretion, and their possible causes are considered. In particular diets high in whole-grain cereal cause faecal energy losses greater than predicted by these equations which is possibly explained by more carbohydrate reaching the colon than expected from current compositional analytical methods.

A double-blind trial of zinc supplementation in pregnancy.

Abstract: A double-blind randomised trial of oral zinc supplementation was carried out during the last two trimesters of pregnancy. Fifty-six women at risk of delivering a small-for-gestational-age baby received either zinc supplement (22.5 mg daily) or placebo. Twenty-nine of the women were compliant. Zinc significantly reduced the incidence of intrauterine growth retardation, and most measured indices of labour and fetal health were better in the supplemented group. Larger studies are now needed to confirm a role for selective zinc supplementation in at-risk pregnancies.

Influence of the feeding frequency on nutrient utilization in man: consequences for energy metabolism.

Abstract: A study was conducted to investigate whether there is a diurnal pattern of nutrient utilization in man and how this is affected by meal frequency to explain possible consequences of meal frequency for body weight regulation. When the daily energy intake is consumed in a small number of large meals, there is an increased chance to become overweight, possibly by an elevated lipogenesis (fat synthesis and accumulation) or storage of energy after the meal. Thirteen subjects, two males and eleven females, were fed to energy balance in two meals per day (gorging pattern) and seven meals per day (nibbling pattern) over 2-day intervals. On the second day on each feeding regimen, the diurnal pattern of nutrient utilization was calculated from simultaneous measurements of oxygen consumption, carbon dioxide production and urinary nitrogen excretion over 3 h intervals in a respiration chamber. A gorging pattern of energy intake resulted in a stronger diurnal periodicity of nutrient utilization, compared to a nibbling pattern. However, there were no consequences for the total 24 h energy expenditure (24 h EE) of the two feeding patterns (5.57 +/- 0.16 kJ/min for the gorging pattern; 5.44 +/- 0.18 kJ/min for the nibbling pattern). Concerning the periodicity of nutrient utilization, protein oxidation during the day did not change between the two feeding patterns. In the gorging pattern, carbohydrate oxidation was significantly elevated during the interval following the first meal (ie from 1200 h to 1500 h, P less than 0.01) and the second meal (ie from 1800 h to 2100 h, P less than 0.05). The decreased rate of carbohydrate oxidation observed during the fasting period (from rising in the morning until the first meal at 1200 h), was compensated by an increased fat oxidation from 0900 to 1200 h to cover energy needs. In the nibbling pattern, carbohydrate and fat oxidation remained relatively constant during the active hours of the day.(ABSTRACT TRUNCATED AT 250 WORDS)

Basal metabolic rates and metabolic economy in chronic undernutrition.

Abstract: Basal metabolic rates (BMR) and body composition were measured in 130 adult Indian males, selected from three socio-economic groups. Results show a significantly lower BMR in the chronically undernourished, with a greater dependence on carbohydrate as fuel in the fasted state. When expressed as per kg body weight or kg fat-free mass (FFM), the BMRs are significantly higher in these individuals. The latter observations suggest variations in the contribution of viscera and skeletal muscle to the FFM, with a relatively greater visceral to muscle mass ratio. However, on adjustment for differences in weight and FFM by means of an analysis of covariance, the chronically undernourished (both urban and rural) have significantly lower BMRs. This indicates a 'metabolic economy' in these individuals, which could be attributable in part to their significantly lower serum T3 levels. When the subjects are classified on the basis of grades of chronic energy deficiency (CED), individuals with low body mass index (BMI) (less than 17 and below) are not similar in their basal metabolism. Those individuals from good socio-economic backgrounds with access to ad libitum energy and protein intake but with low BMI have comparable BMRs to the well nourished. It may therefore be unwise to classify all individuals with low BMI 'across the board' as suffering from CED. Socio-economic scaling may be a useful addition to the present classification of CED.

The impact of feeding problems on growth and energy intake in children with cerebral palsy.

Abstract: Retrospective data on growth and cross-sectional data on growth outcome, anthropometric measurements and energy intake have been analysed according to the presence or absence of feeding problems in 42 children with cerebral palsy (CP) between 1 and 13 years of age The mean age for boys and girls was 51 and 59 years, respectively The study revealed a high frequency of feeding problems (50%) and growth retardation (48%) in the group The results of weight for height, triceps skinfold thickness and energy intake indicate that 15% of the children were undernourished at the time of study The cross-sectional analyses showed that children with feeding problems at the time of study (n = 22) had significantly lower height for age, weight for height, triceps skinfold thickness and upper-arm circumference than children without problems (P less than 005) Children with feeding problems also tended to have lower energy intake, but the differences were not significant The feeding problems were most frequent among the severely disabled children This study has shown that the presence of feeding problems is one important predictor of low growth outcome in children with CP When parents report on feeding problems, feeding evaluation, training and nutritional intervention should be offered immediately This is important for alleviating the heavy care-load for parents and health-workers and for some children it may be necessary to maintain an acceptable nutritional state

The dose-to-mother method to measure milk intake in infants by deuterium dilution: a validation study.

Abstract: A validation study of the dose-to-mother deuterium dilution method to measure breast-milk intake has been carried out on ten infants from a Nutrition Recovery Centre in Santiago, Chile. Formula milk labelled with exponentially decreasing doses of deuterium oxide represented milk from a 'pseudo mother' of these exclusively bottle-fed infants. Unlabelled formula represented milk from other sources. Deuterium levels in the infants' body water were measured on saliva samples by mass spectroscopy. The data were fitted in a two-compartment steady-state model of the mother-child system to estimate the flow of labelled water from the 'mother' to the infant and the 'mother' and infant's water elimination constants. A dose-to-child experiment was also carried out on each infant to determine the deuterium dilution space and total daily water intake. Total and labelled water flows from deuterium dilution were used to calculate total, labelled and unlabelled formula milk intakes which were compared to the same quantities measured by bottle weighing. Water elimination constants calculated from the dose-to-mother experiments underestimated by 17 per cent the initially set mother constant and overestimated by 21 per cent the infant constants calculated from the dose-to-child experiments. Rate constants, however, have little effect on the estimated water flows so that there was good agreement between values from deuterium dilution and from direct weighing. Mean (SD) total formula, labelled formula and unlabelled formula intakes were 865 (129) g/d, 417 (74) g/d and 448 (106) g/d, respectively, when measured by deuterium dilution, compared with 856 (116) g/d, 414 (71) g/d and 441 (68) g/d when measured by direct weighing. The mean per cent differences were 1.1 per cent, 0.7 per cent and 1.6 per cent and the mean absolute differences for individuals, 4.3 (1.9) per cent, 4.8 (3.1) per cent and 9.7 (6.6) per cent, respectively.

Effects of reviewing risk-relevant behavior on perceived vulnerability among women Marines.

Abstract: People generally tend to underestimate their vulnerability to negative life events. Such behavior stems from a tendency to focus upon ones risk-reducing behavior without considering others risk-reducing behavior and ones own risk-increasing behaviors. Questionnaires were administered to a group of women at relatively high risk for unplanned pregnancy to study the effects of reviewing subjects sexual and contraceptive behavior on perceived vulnerability to unplanned pregnancy. 432 women with mean age 19.6 years graduating from U.S. Marine Corps recruit training were study subjects. Respondents perceptions of the likelihood of oneself other Marines and civilians becoming pregnant and/or contracting HIV during the upcoming 12 months were queried. Further questions were also asked about sexual behavior contraceptive behavior attitudes toward pregnancy and birth control method efficacy. Prior to initiating Marine Corps training these women had an average 5.5 sex partners and engaged in intercourse an average 2.2 times/week during the 3 months prior to commencement of training. While 27% had been pregnant at least once 83% claimed to use contraceptives with 64% employing methods of greater than 85% effectiveness. Reviewing pregnancy-related behaviors decreased perceived vulnerability among respondents for whom unplanned pregnancy was not undesirable and those having most confidence in their contraceptive behavior. Perceived vulnerability to HIV infection was however significantly increased. Study findings support the hypothesis that selective focus on preventive behavior is a strongly pervasive source of the illusion of invulnerability. A complex relationship between increasing awareness of risk behaviors and decreasing illusions of unique invulnerability is suggested.

Validity of the dietary history method in elderly subjects. Euronut SENECA investigators.

Abstract: The modified dietary history, which was used for assessment of food consumption in the Euronut SENECA study, was validated against a 3-day weighed record in a subsample of 82 elderly subjects from 11 of the 19 participating centres. The modified dietary history provided consistently higher intakes of energy and nutrients than the weighed record, with a median difference of 14% (energy) of the record mean. Unattenuated correlation coefficients for nutrient intakes varied from 0.18 (vitamin A) to 0.79 (water) with a median coefficient of 0.58 (energy). On the whole there was a fair agreement between the dietary history and the 3-day weighed record when nutrients were expressed in weight units and a good agreement when standardized for the apparently lower energy intake by the record method.

Effect of refeeding on the energy metabolism of adolescent girls who have anorexia nervosa.

Abstract: The effect of refeeding on resting energy expenditure (REE) and substrate utilization was studied in 18 hospitalized adolescent girls (aged 12.9-19.1 years) suffering from anorexia nervosa. Changes in body composition were monitored weekly and included weight, fat body mass (FBM), lean body mass (LBM) and total body potassium (TBK). REE was studied weekly by open-circuit calorimetry. Weight gain was noted in all patients (38.2 +/- 5.6 to 44.5 +/- 5.3 kg), involving increased FBM and LBM. REE increased per kg of weight (91.6 +/- 15.1 to 101.7 +/- 18.0 kJ kg-1 d-1) and LBM over the first weeks of refeeding (P less than 0.025) and then stabilized. Substrate utilization showed an increase in carbohydrate and protein utilization (P less than 0.001) during the first few weeks of refeeding. We also studied the thermic effect of food (TEF) in 14 of the 18 subjects. Upon admission the subjects had a reduced TEF (36.4 +/- 24.3 kJ 2 h-1) (P less than 0.001). With refeeding TEF rose to a peak or plateau, then decreased to normal levels (61.9 +/- 36.0 kJ 2 h-1) before discharge from hospital. We conclude that the energy metabolism of adolescent girls adapts to semi-starvation by a reduction in both REE and TEF; with refeeding there is reversal of this adaptive function.

Attained height of lacto-ovo vegetarian children and adolescents.

Abstract: The relationship between diet and attained height was studied in children and adolescents in Southern California. Diet pattern was determined from an extensive food frequency questionnaire in 1765 Caucasian children of 7-18 years, attending state schools (452 m and 443 f) and Seventh-day Adventist schools (427 m and 443 f). The major difference in diet pattern between state and Adventist school children was in meat consumption. The Adventist children were split evenly between three categories of frequency in meat consumption (less than 1/week, 1/week-less than 1/d, and greater than or equal to 1/d), while 92 percent of state school children consumed meat daily. Vegetarians (those consuming meat less than 1/week) differed significantly in the consumption of other major food groups, such as fruit and vegetables. All school and diet subgroups were at or above the 50th percentile of the National Center for Health Statistics. Age-adjusted regression analysis showed that on average Adventist vegetarian children were taller than their meat-consuming classmates (2.5 and 2.0 cm for boys and girls, respectively). These results did not change materially when adjusting for other food groups. Nor did adjustment for parental height and socioeconomic factors in a sub-sample of 518 children. The results indicate that vegetarian children and adolescents on a balanced diet grow at least as tall as children who consume meat.

Nutritional status: anthropometry. Euronut SENECA investigators

Abstract: In 19 towns and cities across Europe anthropometric data--body weight, height, skinfold thicknesses and circumferences--have been obtained from 2332 elderly subjects born between 1913 and 1918, according to a strictly standardized methodology. Large variations exist among research towns even within countries. For body weight, means ranged from 70.1 +/- 15.4 kg to 78.2 +/- 10.7 kg in men and from 56.8 +/- 8.1 to 71.4 +/- 11.4 kg in women. In the North European towns and cities both men and women were taller than their counterparts in the southern towns. Mean body mass index varied from 24.4 +/- 3.8 kg m-2 to 30.3 +/- 5.2 kg m-2 among men. In women the range of means was from 23.9 +/- 3.6 kg m-2 to 30.5 +/- 5.1 kg m-2. Triceps skinfold thicknesses suggest that females had more fat at subcutaneous sites than the males, and the waist-hip ratio was consistently lower in elderly women.

Nutritional status: blood vitamins A, E, B6, B12, folic acid and carotene. Euronut SENECA investigators.

Abstract: This chapter describes the vitamin plasma concentration data collection, preliminary analysis and results of the Euronut SENECA study. Blood plasma was collected from approximately 2500 elderly subjects born in 1913-1918 living in 17 small towns in 11 European countries, and the plasma levels of carotene, retinol, alpha-tocopherol, vitamin B12, folic acid and pyridoxal 5'-phosphate were determined. There were very large within- and between-centre differences in vitamin levels with no definite geographical pattern emerging. The vitamin status for retinol and folic acid was adequate in all centres. The prevalence of biochemical vitamin B6 deficiency was widespread and reached over 50% in some centres. Vitamin B12 biochemical deficiency was limited to ten centres and its prevalence was 1.6%-10%. Vitamin E biochemical deficiency was found in seven centres and varied from 0.5% to 25%.

Design, methods and participation. Euronut SENECA investigators.

Abstract: At the initiative of EC/Euronut a European Community project (SENECA) began in 1988, with 19 research groups working on the major nutritional issues affecting the growing number of elderly people in Europe. Some 2600 people born between 1913 and 1918 were studied, using strictly standardized methodology. Data have been collected on the dietary intake of these people, their nutritional status, physical activity, life-style, health and performance. It is envisaged that the SENECA project will be continued according to a mixed longitudinal design. The mean response rate in a group of 18 communities in which a non-participation study was conducted was 51%, while 60% of the non-responders were prepared to complete a non-responders' questionnaire. On the basis of the data collected from both responders and non-responders, it was found that males, non-smokers, healthy and better educated persons participated better in the SENECA study than females, smokers, persons who judged their health to be poor, and persons with comparatively poor education, respectively. Housing (having a garden), age, and marital state (single) were only of minor importance for the participation. Persons who did not eat a cooked meal daily, generally participated less, but this differed between towns. It is demonstrated how stratum-specific weighting factors can be calculated to partially remove bias due to selectivity in participation.

The timing of nutritional status determination: implications for interventions and growth monitoring.

Abstract: A population-based birth cohort of 1226 urban Brazilian children underwent anthropometric examinations at, on average, ages 11, 23 and 47 months. Multiple regression analyses showed that while birth weight was the single most important factor in predicting nutritional status at age 11 months, a wide range of other social, biological and morbidity factors also appeared to play a significant role. Environmental and dietary factors, however, showed no significant association. Nutritional status at age 11 months was a very strong predictor of nutritional status at ages 23 and 47 months and the other explanatory factors made a minimal additional contribution to the regression models. These results suggest that, in this population, childhood nutritional status is primarily determined before the end of the first year of life. These findings have implications for the timing and nature of nutritional interventions and for mechanisms for identifying those children who will suffer from poor nutritional status later in childhood.

Body impedance measurements during dialysis.

Abstract: Changes in body weight in relation to changes in body impedance were studied in six male and four female patients before and during dialysis. Before dialysis, fat-free mass from skinfolds was 46.5 +/- 6.8 kg, and total body water calculated from bio-electrical impedance was 36.9 +/- 5.2 kg. Body water expressed as a percentage of fat-free mass was calculated to be 80 +/- 4%. Mean weight loss, which was assumed to be only loss of water, was 2.7 +/- 0.7 kg. Total body impedance increased by 80 +/- 16 omega from 495 +/- 39 omega to 575 +/- 47 omega. Weight loss and increase in body impedance were highly correlated (r = -0.91, P less than 0.001). However, based on prediction formulas for total body water from bio-electrical impedance, the observed weight (water) loss should be associated with an increase in impedance of only 39 +/- 11 omega. It is concluded that the impedance value before dialysis is a relatively low value, due to the low specific resistivity of the excess of extra-cellular water in the body before dialysis. As a consequence, prediction formulas for body composition from bio-electrical impedance, developed in normal hydrated subjects, overestimate body composition (total body water, fat-free mass) in subjects with oedema.

Effect on lipid metabolism of beet fibre in desert nomads with low habitual fibre intake.

Abstract: The present study was conducted to test the efficacy of fibre supplementation for hypercholesterolaemia in subjects from the desert Nomads. Ten males (53 +/- 8 years of age) participated in this study which consisted of three phases: baseline-1 period (2 weeks) in which subjects were on their normal, habitual dietary intake, followed by a period of fibre supplementation (5 weeks) in which subjects were supplemented with 26 g fibre/d, and baseline-2 period (4 weeks) in which fibre supplement was withdrawn. Fibre supplementation resulted in a significant decrease in levels of total serum cholesterol (10 per cent decrease, P less than 0.005 during the second week; and 13.4 per cent decrease, P less than 0.0005 during the fifth week) and LDL-cholesterol (14.3 per cent decrease, P less than 0.01 during the second week; and 16.8 per cent decrease, P less than 0.005 during the fifth week. The LDL/HDL ratio dropped 5.2 per cent (P less than 0.005) during the second week and 10.4 per cent (P less than 0.0001) during the fifth week of the fibre supplementation period. Concentrations of serum triglycerides decreased 4.8 per cent (not significant) during the second week and 9.5 per cent (P less than 0.01) during the fifth week. Daily intake of nutrients, body weight, and HDL-cholesterol levels did not change significantly. We conclude that, in populations such as the desert Nomads, where dietary manipulation and/or therapeutic options are quite limited, fibre supplementation may provide an alternative and effective therapy for the control of hypercholesterolaemia.

Intake of vitamins and minerals. Euronut SENECA investigators.

Abstract: In 18 towns of 12 European countries, 1217 men and 1241 women born between 1913 and 1918 participated in a dietary survey (modified dietary history). Each country used its own nutrient data bank for the conversion of food intake data into vitamin and mineral intakes. Information on the use of nutrient supplements was collected through a questionnaire answered by the participants. Enormous variability in nutrient dietary intake was observed between and even within the different sites. The dietary intake of vitamin A was higher in northern towns and, conversely, the intake of beta-carotene and vitamin C was lower. A considerable percentage of the elderly in some towns had intakes of some nutrients below the lowest European recommended daily intakes (RDIs) and so might be at risk of vitamin and mineral deficiencies. Women in almost all towns had diets of higher nutrient density than men, except for iron. There was great variability in supplementation practices between different towns, even within a country. In northern towns, supplements were used much more frequently than in the other sites, but their use was not nutrition-oriented. Sometimes vitamin supplements were taken in large quantities, with risk of toxicity. Differences between the sexes in supplementation practices were not consistent.

Incidence of premature rupture of membranes in pregnant women with low leukocyte levels of vitamin C.

Abstract: The present study was undertaken to explore the association between vitamin C nutritional status in pregnant women with premature rupture of the chorioamniotic membranes (PRM). A case-control cross-sectional study was carried out in 10 women with PRM and 19 women without PRM. The women were evaluated in the first hours postpartum while hospitalized: 10 ml of blood were obtained from each woman to determine vitamin C expressed as micrograms/10(8) leucocytes or microgram/mg of leucocyte protein. Data on fruit and vegetable consumption was collected by a frequency dietary survey and the hospital clinical records were reviewed to obtain their obstetric history and data on the presence of infection during pregnancy, in placenta and/or in fetal membranes. Low vitamin C levels were considered at a cut-off point equal or less than 26.33 micrograms/10(8) leucocytic cells and 3.15 micrograms/mg leucocyte protein. An association was found between low vitamin C levels and cases with PRM. No difference was found in the frequency of consumption of fruit and vegetables between the two groups. Infections were more frequently found in the PRM group, when the women had low levels of vitamin C, and when both risk factors were present simultaneously the proportion of PRM cases identified was greater than 0.75.