Food and nutrient intakes in Swedish diabetic children.

Food and energy intakes in diabetic children, 7-9 and 12-14 years of age, were studied by the 7-d record method. The mean duration of diabetes in the younger group was 3.0 years and in the older group 4.2. The children had 3 main meals and 3.4 light meals daily. The median daily number of sandwiches was 7, often offered as snacks. All children used a low-fat margarine, low-fat cheese and low-fat milk. Sweets and diabetic food were seldom used. Of the energy intake protein contributed 18 per cent, fat 32 per cent and carbohydrates 50 per cent, including sucrose 2 per cent. Mean daily intake of fibre was 20 g. Compared to healthy children of the same age and from the same areas of Sweden the diabetics had a more regular meal pattern, their energy intakes did not differ, but the diet of diabetics was lower in fat and sucrose and higher in protein. The mean height, weight and BMI did not differ from healthy children.

Measuring children's diets: evaluation of dietary assessment techniques in infancy and childhood.

Epidemiological studies of dietary habits in infancy and childhood face a number of difficulties, which are more or less specific for these ages. In connection with studies on dietary habits of Swedish infants and children an evaluation of different dietary assessment techniques was performed. Breastfeeding data obtained in retrospective interviews at six months had good validity. The reliability of breastfeeding and weaning data decreased over time. Short questions on food frequencies, often used in research and clinical practice, were shown to be a poor screening instrument and suffered from biases when used in groups of four- and eight-year-old children. Group mean estimations of dietary intake of four- and eight-year-old children obtained by 24-hour recalls were close to those of seven-day records from the same individuals. Dietary intake in a 13-year-old group according to 24-hour recall and dietary history differed significantly; the dietary history gave much higher estimations. The reliability of dietary history in a small group of 13-year-old boarding school children was fairly good. The internal validity of food recording was examined by use of chemical analysis of duplicate portions. Generally, there was good agreement between the records and the analysed duplicates. The intake of a number of nutrients varied during the week, often showing a maximum towards the weekend. The intake of vitamin C was higher in winter time, otherwise no seasonal variation was found. The intra-individual variation in dietary intake is illustrated and its consequences for dietary studies are discussed.

Energy expenditure and body composition during weight reduction in hyperplastic obese women.

The energy expenditure and body composition changes in out-patients during a long-term weight reduction with a diet recommended to provide 1100 kcal were studied in eight hyperplastic obese women. The study was focused on finding plausible explanations for the decreasing weight loss rate after several weeks of successful weight reduction. Using a heart rate monitoring method, the energy expenditure was measured four times at selected intervals during the study. Then, the energy intake was calculated on the basis of three dietary recordings lasting from 4 to 7 days. The recorded energy intake increased at the end of the weight reduction, but no changes in daily energy expenditure were found. The oxygen consumption during standardized cycling, walking, and domestic work decreased, but when the patient was at rest, no changes occurred during the weight reduction. The weight loss predicted from the energy balance and body composition changes was considerably greater than the actually determined weight loss. Large discrepancies were found after 5 weeks on the weight reducing regimen between the recorded dietary intake and what could be calculated from urinary nitrogen losses. With the available methods for determining energy intake and expenditure, it was considered impossible to fully explain the reason for the weight plateau observed after long-term weight reduction in out-patients.

The study of women in Gothenburg 1968-1969. Intake of energy and nutrients in five age groups.

Women from five age groups (38, 46, 50, 54, and 60 years), participating in the population study "Women in Gothenburg 1968-1969", were subjected to a 24-hour recall dietary interview (n = 1361). In a randomized subsample (n = 418), a dietary history was obtained and individuals in another randomized subsample (n = 755) submitted a 24-hour urine specimen for nitrogen analyses. There were significant differences between the 24-hour recall and dietary history figures in all five age groups with respect to energy and all nutrients. The mean protein intake calculated indirectly from the urinary nitrogen excretion came close to the figures calculated from the dietary histories in four out of five age groups. The energy intake and, consequently, the intake of most nutrients calculated from the dietary histories were higher than generally ascribed to Swedish women, as most previous data have been obtained by 24-hour dietary recall interviews. Most women (71-89% in the different age groups) consumed too much fat and most women of fertile age (80-92%) consumed too little iron. A significant decrease in the mean energy intake was apparent only in the age group 60, i.e. 1870 kcal versus 1965--2 105 in the other groups.

Adipose tissue cellularity in relation to prognosis for weight reduction.

Ninety obese adult women were analysed with respect to adipose tissue cellularity and divided into hypertrophic, hyperplastic and combined groups of obesity. Their spontaneous body weight development was analysed over a period of six years. A reference group, with normal body weight, gained weight at an average of 0.25 kg per year. Patients with hyperplastic and combined forms of obesity gained significantly more (2.5 and 3.1 kg per year, respectively) when essentially untreated. The increase for the patients with hypertrophic obesity did not differ significantly from the reference group. During a standardized treatment period on an energy reduced diet (1100 kcal/day or 4600 kJ/day) the hypertrophic, hyperplastic and combined groups reduced by 11, 15 and 20 kg, respectively. There were strong positive correlations between total weight reduction and rate of weight reduction on the one hand and FCN and initial body weight on the other. The combined and hyperplastic groups were on average able to maintain their reduced weight for 12 and 15 weeks, respectively, while the hypertrophic group managed for 51 weeks. There was a strong negative correlation between duration of steady weight after weight reduction and FCN. When the relapse started the rate of regain was three times faster in the hyperplastic and combined groups than in the hypertrophic group. The rate of regain correlated positively with FCN. Thus, the patients demonstrated a characteristic three phase pattern in weight change with a period of reduction followed by periods of steady weight and of weight gain. The higher FCN, the faster this cycle was completed. It is concluded that the long-term prognosis for weight reduction is worse for hypercellular forms of obesity than for the hypertrophic form. However, this does not mean that patients with hypercellular forms of obesity should not be treated at all since their serious spontaneous weight development might be lessened by repeated treatments.

Effect of an energy-reduced dietary regimen in relation to adipose tissue cellularity in obese women.

Twenty-eight obese women were divided after arbitrary statistical guidelines obtained from control studies into hyperplastic (increase in fat cell number) (n equal to 10), hypertrophic obesity (increase in average fat cell size) (n equal to 11), and a remaining group (n equal to 7). All these subjects were treated on an outpatient basis with an energy-reduced diet (1,100 kcal/day) until weight decrease failure occurred. The fat cells of the femoral and gluteal regions were larger than in the abdominal region in hypertrophic obese subjects. This regional fat cell size profile was found also in middle-aged and young controls. The hyperplastic obese subjects on the other hand had larger fat cells in the abdominal site. At failure of therapy enlarged fat cells in either of the two obesity groups had decreased to the size of fat cells of controls. Fat cell number remained unchanged. Thus the hypertrophic obese patients ended up with a normal body fat while hyperplastic obese subjects had a pronounced remaining obesity. The results suggest that when the fat cell size in different regions of an individual are known, as well as the total fat cell number, the success of an energy-reduced dietary regimen might be approximately predicted both in terms of remaining total body fat and in regional fat depot decrease.