Assessment of energy intake in women with chronic obstructive pulmonary disease: a doubly labeled water method study.

OBJECTIVES: To maintain energy balance, reliable methods for assessing energy intake and expenditure should be used in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to validate the diet history and 7-day food diary methods of assessing energy intake (EI) using total energy expenditure (TEE) with the doubly labeled water (DLW) method (TEEDLW) as the criterion method in outpatient women with COPD. METHODS: EI was assessed by diet history (EIDH) and a 7-day food diary (EIFD) in 19 women with COPD, using TEEDLW as the criterion method. The three methods were compared using intra-class correlation coefficients (ICC) and Bland-Altman analyses. The participants were classified according to their reporting status (EI/TEE) as valid-reporters 0.79-1.21, under-reporters < 0.79 or over-reporters > 1.21. RESULTS: Diet history underestimated reported EI by 28%, and 7-day food diary underestimated EI by approximately 20% compared with TEEDLW. The ICC analysis showed weak agreement between TEEDLW and EIDH (ICC=-0.01; 95%CI-0.10 to 0.17) and between TEEDLW and EIFD (ICC=0.11; 95%CI -0.16 to 0.44). The Bland-Altman plots revealed a slight systematic bias for both methods. For diet history, six women (32%) were identified as valid-reporters, and for the 7-day food diary, twelve women (63%) were identified as valid-reporters. The accuracy of reported EI was only related to BMI. CONCLUSION: The diet history and 7-day food diary methods underestimated energy intake in women with COPD compared with the DLW method. Individuals with higher BMIs are prone to underreporting. Seven-day food diaries should be used with caution in assessing EI in women with COPD.

Nutrition impact symptoms and body composition in patients with COPD.

BACKGROUND/OBJECTIVES: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat-free mass depletion. SUBJECTS/METHODS: The results in this cross-sectional study are based on 169 COPD patients (62% female subjects). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires: the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ). RESULTS: Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared with men (P<0.05). Thirty-six percent of the patients were depleted (fat-free mass index (FFMI) <15 kg/m2 for women and FFMI<16 kg/m2 for men). Depleted patients had more NIS (P<0.05) and also rated appetite and taste of food as worse compared with non-depleted patients (P<0.05). CONCLUSIONS: NIS are common in patients with COPD, and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and whether NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future.

Stretch-shortening cycle muscle power in women and men aged 18-81 years: Influence of age and gender.

This study explored the age-related deterioration in stretch-shortening cycle (SSC) muscle power and concurrent force-velocity properties in women and men across the adult life span. A total of 315 participants (women: n = 188; men: n = 127) aged 18-81 years performed maximal countermovement jumps on an instrumented force plate. Maximal SSC leg extension power expressed per kg body mass (Ppeak) was greater in men than in women across the adult age span (P < 0.001); however, this gender difference was progressively reduced with increasing age, because men showed an ∼50% faster rate of decline in SSC power than women (P < 0.001). Velocity at peak power (VPpeak) was greater in men than in women (P < 0.001) but declined at a greater rate in men than in women (P = 0.002). Vertical ground reaction force at peak power (FPpeak) was higher in men than in women in younger adults only (P < 0.001) and the age-related decline was steeper in men than in women (P < 0.001). Men demonstrated a steeper rate of decline in Ppeak than women with progressive aging. This novel finding emerged as a result of greater age-related losses in men for both force and velocity. Consequently, maximal SSC power production was observed to converge between genders when approaching old age.

Energy expenditure by multisensor armband in overweight and obese lactating women validated by doubly labeled water.

OBJECTIVE: To validate total energy expenditure (TEE) and activity energy expenditure (AEE) from the portable SenseWear armband (SWA) Pro 2 (TEESWA and AEESWA ; InnerView software versions SWA 5.1 and SWA 6.1) against TEE from doubly labeled water (DLW) and AEE from DLW and indirect calorimetry (TEEDLW and AEEDLW ) in overweight/obese lactating women at 10 weeks postpartum. DESIGN AND METHODS: TEE was measured simultaneously with DLW (14 days) and SWA (first 7 days). Lactating women (n = 62), non-smoking, with a BMI > 25 kg/m(2) and wearing time SWA ≥ 90% were included. RESULTS: Mean TEESWA5.1 was overestimated with 85 kcal/day compared to TEEDLW (P = 0.040), while mean TEESWA6.1 was underestimated with 241 kcal/day compared to TEEDLW (P < 0.001). Mean AEESWA5.1 was similar to mean AEEDLW (P = 0.818), while mean AEESWA6.1 was underestimated with 581 kcal/day compared to AEEDLW (P < 0.001). TEESWA6.1 and AEESWA6.1 were systematically underestimated at higher levels of energy expenditure and BMI while only AEESWA5.1 was systematically overestimated at higher levels of energy expenditure. CONCLUSIONS: TEESWA5.1 and AEESWA5.1 were fairly estimated on a group level while TEESWA6.1 and AEESWA6.1 were significantly and systematically underestimated. Both SWA software versions showed large individual variation in agreement with TEEDLW and AEEDLW , limiting the validity on individual level.

Energy expenditure in chronic obstructive pulmonary disease-evaluation of simple measures.

BACKGROUND/OBJECTIVES: Almost 50% of all chronic obstructive pulmonary disease (COPD) patients become underweight. One possible reason for nutritional treatment to fail could be miscalculation of patients' energy requirements. The aim of this study was, therefore, to evaluate simple measures that may be used to assess the energy requirement of COPD patients. SUBJECTS/METHODS: This cross-sectional evaluation study includes 68 COPD patients (42 women). Resting metabolic rate (RMR) was assessed by indirect calorimetry, while total energy expenditure (TEE) was assessed by a 7-day monitoring using the ActiReg. Simple measures to evaluate was body weight (kg) multiplied by 125 kJ (30 kcal), predicted RMR multiplied by 1.7 and two simple questionnaires. RESULTS: Mean physical activity level (PAL) from the ActiReg was 1.46. Calculation of energy expenditure multiplying body weight with 125 kJ resulted in a TEE of 8614 kJ compared with ActiReg 8317 kJ (P=0.10). To multiply predicted RMR by 1.7 resulted in a statistically significant overestimation of 1335 kJ (P<0.01). Both questionnaires showed a clear 'dose-response' regarding PAL from ActiReg in the different activity categories. CONCLUSIONS: This study shows that simple measures of energy expenditure could, on group level, assess COPD patient's energy needs. However, for individual assessment of energy need, more thorough procedures are necessary.

Physical activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects.

AIM: To investigate physical activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects. SUBJECTS AND METHODS: Children who had undergone surgery for congenital heart defects and healthy controls in the Gothenburg area were invited to participate in the study. All participants were aged 9-11 or 14-16 years. The activity monitor ActiReg was used to assess physical activity. Participants were interviewed about their participation in sports and performed a maximal exercise test on a bicycle with measured oxygen uptake. RESULTS: A total of 32 and 25 patients, and 61 and 45 controls, in the two age-groups were included, respectively. The patients had a wide range of severity of congenital heart defects. The physical activity level was similar in the patients and the controls. The rate of sports participation was high for both patients and controls; 80-94% of all participants took part in sports at least once a week. The majority of the patients were considered to have at least a moderate level of aerobic fitness. CONCLUSIONS: Although children who have undergone surgery for congenital heart defects have a similar level of physical activity compared with that of healthy children, some of them may require support to participate in exercise and vigorous physical activity.

Energy expenditure in underweight chronic obstructive pulmonary disease patients before and during a physiotherapy programme.

OBJECTIVE: To investigate how total daily energy expenditure (TEE) changes when underweight patients with chronic obstructive pulmonary disease (COPD) enters a physiotherapy programme. DESIGN: Prospective intervention study. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. SUBJECTS: Fifteen patients with severe COPD and BMI<21 kg/m(2) were recruited consecutively at the outpatient COPD unit at the Department of Respiratory Medicine. Fourteen patients completed the whole study. INTERVENTION: TEE was assessed by the doubly labelled water method in a 2-week control period and during 2 weeks of physiotherapy. Energy intake was assessed using 7-day dietary record during control and physiotherapy period. RESULTS: Mean TEE during physiotherapy period was 500 kJ (6%) lower than during control period but the difference was not statistically significant. Ten of the 14 patients had lower and four had higher TEE. Mean energy intake during the physiotherapy period did not change from the control period (7700 vs 7600 kJ/day). CONCLUSIONS: Since underweight patients with COPD may show variable TEE during physiotherapy compared to a control period, an assessment of individual energy requirements is recommended.

Dietary problems in patients with severe chronic obstructive pulmonary disease.

BACKGROUND AND AIMS: Low body weight and low fat-free mass-index (FFMI) are common in patients with severe chronic obstructive pulmonary disease (COPD). Several factors seem to contribute. The aims of the present observational study were to investigate dietary problems in patients with severe COPD and to compare dietary problems to nutritional status, energy intake and smoking habits. METHODS: Nutritional status was assessed in 73 stable outpatients using body mass index and FFMI by single-frequency bioelectrical impedance. Lung function, smoking habits, energy intake and dietary problems were also assessed. RESULTS: The most frequently reported dietary problems were 'anorexia', 'dyspeptic symptoms other than diarrhoea', 'slimming', 'fear of gaining weight', 'dyspnoea', 'diarrhoea', 'depression, anxiety, solitude'. Smoking habits and gender had impact on the kind of dietary problems reported. Reporting two dietary problems correlated to low FFMI, whereas reporting one or more dietary problems correlated to decreased energy intake. CONCLUSION: Dietary problems are common in the group studied and related to smoking habits and gender. Dietary problems affect energy intake and FFMI negatively. It is important to recognize dietary problems and to offer intervention of the dietary problems as a part of the dietary intervention.

Physical activity questionnaire for adolescents validated against doubly labelled water.

OBJECTIVE: To validate a physical activity questionnaire for adolescents (PAQA) adapted from the International Physical Activity Questionnaire (IPAQ). DESIGN: Energy expenditure was measured during a 14-day period with doubly labelled water (DLW). PAQA was administered as an interview at the end of the period, asking for physical activity in school, during transportation and leisure-time, during a habitual week. Energy expenditure (EE(PAQA)) was calculated as the product of total physical activity + sleep and predicted resting metabolic rate, and was compared to energy expenditure from DLW (EE(DLW)), thermic effect of feeding excluded. SETTING: Participants were recruited from grade 9 in a compulsory school in Göteborg, Sweden. All data were collected at school, and distribution of DLW and measuring of resting metabolic rate were performed at Sahlgrenska University Hospital. SUBJECTS: A total of 33 adolescents (16 girls, 17 boys) 15.7 (0.4) y performed all measurements. RESULTS: : For the whole group, PAQA underestimated energy expenditure by 3.8 (1.7) MJ (P<0.001). There was a strong correlation (r = 0.62, P<0.001) between EE(PAQA) and EE(DLW), but not for boys (r = 0.42, P = 0.090) and girls (r = 0.33, P = 0.22) separately. CONCLUSIONS: PAQA is not able to predict energy expenditure in Swedish adolescents, largely explained by the amount of unreported time. The ability to rank adolescents energy expenditure is questioned because of the gender effect, although we found a strong correlation for the whole group.

Energy intake in Swedish adolescents: validation of diet history with doubly labelled water.

OBJECTIVE: To compare habitual energy intake (EI) estimated from diet history (DH) with total energy expenditure (TEE) measured with doubly labelled water (DLW) in adolescents. DESIGN: DH included a detailed questionnaire and an interview. TEE was measured during a 14-day period. Adequate (AR), under- (UR) and over-reporters (OR) were defined from the ratio EI/TEE: AR 0.84-1.16, UR <0.84 and OR >1.16. SETTING: Participants were recruited from grade 9 in a compulsory school in Göteborg, Sweden. All data were collected at school and DLW dosages were distributed at Sahlgrenska University Hospital. SUBJECTS: A total of 35 adolescents (18 boys, 17 girls), 15.7 (0.4) y. RESULTS: EI was 11.0 (3.6) MJ and TEE was 11.4 (2.1) MJ (P=0.42). DH was able to rank EI compared to TEE (Spearman's r=0.59, P< or =0.001). For girls, EI was 18% lower (P=0.0067) and for boys, EI was 7% higher (P=0.26) compared to TEE. The 95% limits of agreement for difference between TEE and EI were -5.6 to 6.5 MJ. In total, 20 subjects were defined as AR (57%), nine as UR (26%) and six as OR (17%). Energy from in-between meals was 33% lower (P=0.0043) in UR girls and 57% higher (P=0.026) in OR boys, compared to adequate reporting girls and boys, respectively. In UR girls, energy-adjusted intake (10 MJ) of specific foods did not differ significantly, fat was lower and carbohydrate and vitamin C were higher compared to AR girls (all P<0.05). OR boys had no significant differences in food and nutrient intake in 10 MJ compared to AR boys. CONCLUSION: The diet history was able to capture EI for the group and to rank subjects. There was a wide individual range in reporting-accuracy related to gender. SPONSORSHIP: The Ingabritt and Arne Lundberg Foundation, The Wilhelm and Martina Lundgren Foundation.

Total energy expenditure in underweight patients with severe chronic obstructive pulmonary disease living at home.

AIM: The aim of the study was to assess total daily energy expenditure (TDE), as measured by doubly labelled water (DLW), and describe its components in home-living underweight patients with severe chronic obstructive pulmonary disease (COPD). METHODS: Basal metabolic rate (BMR) was measured prior to the study. Ten patients received DLW, followed by urine analysis by isotope ratio mass spectrometry from 10 standardised occasions during 15 days. Dietary intake was registered by each patient the first 7 days of the study. The patients were also interviewed about their physical activity pattern. RESULTS: Measured BMR was higher than predicted in five of the 10 patients using equations from WHO. Using disease-specific equations, estimated BMR was higher for male, but not for female COPD patients. The best estimation of BMR resulted from prediction including fat-free mass. TDE varied considerably between 5200 and 11,100 kJ. Physical activity level (PAL) ranged from 1.15 to 1.80. Energy intake varied between 4500 and 9100 kJ. In underweight patients with severe COPD, TDE is highly variable, ranging from 110 to 200 kJ/kg body weight. CONCLUSIONS: This is the first study assessing and describing total energy expenditure in underweight patients with severe COPD living at home. Energy requirement in the patient group cannot solely be calculated from prediction equations. BMR should be measured and physical activity level assessed.

Bioelectrical impedance variation in healthy subjects during 12 h in the supine position.

BACKGROUND AND AIM: Bioelectrical impedance analysis is used to assess human body composition. Studies have shown that meal ingestion and change of body posture affects bioelectrical impedance, but none has studied bioelectrical impedance variation in supine subjects. The aim was to examine the bioelectrical impedance variation in healthy subjects during 12 h in the supine position. METHODS: Bioelectrical impedance was measured 16 times during 12 h in 18 healthy subjects. An identical meal was given at breakfast, lunch, and dinner. RESULTS: Mean (standard deviation) impedance at 50 kHz increased from 558 (87) omega at study start to 584 (95) Omega at study end (P<0.05). Bioelectrical impedance is reduced after ingestion of the first meal, but not following the meals at 1230 and 1730. Calculated body fat content increased from a baseline mean (SD) of 21.7 (6.1) % body fat to 23.9 (6.7) % body fat at study end (P<0.05). CONCLUSIONS: Bioelectrical impedance increased during 12 h in supine subjects. The increase is probably explained by a shift in body fluids from the extremities to thorax during the day and the importance of strict measurement standardisation both in epidemiological studies and clinical practice is underlined.

Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation.

UNLABELLED: Dietary intervention studies in COPD patients often are short-term inpatient studies where a certain amount of extra energy is guaranteed. The aim of this study was to evaluate the effect of an 1 year individual multifaceted dietary intervention during multidisciplinary rehabilitation. Eighty-seven patients with severe COPD, not demanding oxygen therapy were included, 24 of them served as controls. A dietary history interview was performed at baseline and at study end. Dietary advice given were based on results from the dietary history and socio-economic status. The intervention group was divided into three parts; NW: normal weight (dietary advice given aiming to weight maintenance), OW: overweight (weight-reducing advice) and UW: underweight (dietary advise based on an energy- and protein-rich diet). RESULTS: UW-group: Eighty-one per cent of the patients gained weight or kept a stable weight. OW-group: Fifty-seven per cent lost more than 2 kg NW-group: Seventy-six per cent kept a stable weight or gained weight. Increased dietary intake from baseline was seen for energy protein, carbohydrates and certain micronutrients (P < 0.05) in the UW group. Six minutes walking distance increased by approximately 20 m in both NW (P < 0.05) and UW patients. To conclude, slight, but uniform, indications of positive effects of dietary intervention during multidisciplinary rehabilitation was seen. Dietary intervention in underweight COPD patients might be a prerequisite for physical training.

Bioelectrical impedance: effect of 3 identical meals on diurnal impedance variation and calculation of body composition.

BACKGROUND: Bioelectrical impedance analysis (BIA) can be used for estimating body composition. Earlier studies showed that the ingestion of meals lowers bioelectrical impedance, but none studied the effect of repeated ingestion of an identical meal in narrow intervals on impedance measurements during 24 h. OBJECTIVES: The objectives were to study the effect on bioelectrical impedance of 3 identical meals and to compare the results from single-frequency BIA measurements with those from multiple-frequency BIA measurements. DESIGN: Bioelectrical impedance was measured 18 times during 24 h in 18 healthy subjects [10 women and 8 men; x +/- SD age: 31.5 +/- 11.7 y; body mass index (in kg/m(2)): 22.2 +/- 2.7]. An identical meal was given at breakfast, lunch, and dinner. RESULTS: Bioelectrical impedance decreased after ingestion of a standard meal (P < 0.05). The decrease in impedance lasted 2-4 h after each meal. The decrease was additive during the day, although it was more pronounced after the first meal because of the combined effect of rising from the supine position and meal ingestion. This is an important consideration when calculating body composition: percentage of body fat varied by 8.8% from the highest to the lowest measurement in women and by 9.9% from the highest to the lowest measurement in men. The bioelectrical impedance at 50 kHz was identical when measured with multiple frequencies or a single frequency. CONCLUSION: The ingestion of meals leads to an additive decrease in bioelectrical impedance and thus to a decrease in the calculated percentage of body fat.