Association of dietary intake underreporting with body image perception

Feasibility of a Structured Calorie-Restricted Dietary Intervention in Korean Adults with Early Type 2 Diabetes and Obesity: A Pilot Study

Background: Calorie restriction is increasingly recognized as a strategy for glycemic management in type 2 diabetes mellitus (DM) by promoting weight loss and potentially achieving diabetes remission. This study evaluated the feasibility of a 12-week structured calorie-restricted dietary intervention based on healthy Korean dietary patterns for adults with early type 2 DM. Methods: Adults aged 18-60 years with a body mass index (BMI) greater than 25 kg/m2 and a short duration of diabetes were recruited. The intervention comprised two phases: a 6-week weight loss phase, targeting a 3% reduction every two weeks, starting with an 800 kcal/day diet and increasing by 200 kcal per phase, with all meals provided via home delivery, followed by a 6-week self-managed weight maintenance period, preceded by a one-week reintroduction phase with meals provided. Results: Among 27 participants, 24 completed the intervention (89% retention). Mean weight reduction at 6 weeks was 6.4 kg (7.6%), primarily achieved during Phase 1 (5.1%). By 12 weeks, the average weight reduction further improved to 7.4 kg (8.7%). Dietary adherence ranged from 80% to 90%, with energy intake closely aligning with the prescribed targets. Non-achievers exhibited a smaller initial reduction (2.5 kg vs. 3.9 kg), with the gap persisting throughout the study. Postprandial glycemic response to a mixed meal (65% carbohydrate) significantly improved from baseline to week 5. Conclusions: This structured dietary intervention demonstrated substantial weight reduction and improved glycemic response in adults with type 2 DM, highlighting its feasibility and effectiveness as a guided strategy for weight management.

Does physical activity level and total energy expenditure relate to food intake, appetite, and body composition in healthy older adults? A cross-sectional study

PURPOSE

With ageing, older adults (≥ 65 years) may experience decreased appetite, contributing to declines in body weight and muscle mass, potentially affecting physical capabilities. Physical activity (PA) has been suggested as a potential strategy to enhance appetite in older adults, but evidence supporting this is insufficient. This study aimed to investigate the relationship between PA levels, total energy expenditure (TEE), body composition, energy intake (EI) and appetite in older adults.

METHODS

One hundred and eight healthy older adults (age 70 ± 4 years; BMI 24.3 ± 2.6 kg/m2) were categorised into three groups (low, medium, high) based on accelerometer-measured PA level (AMPA) and TEE from 7-day PA diaries. Body composition was measured using bioelectrical impedance. Energy and nutrient intakes were assessed using 3-day weighed food diaries. Appetite was assessed using the visual analogue scales at 30-min intervals throughout 1 day.

RESULTS

TEE was positively correlated with EI and % muscle mass (p < 0.05), with higher % muscle mass and TEE associated with higher EI. Energy and protein intake were significantly higher in the high TEE group than the low group (p = 0.03, p = 0.01; respectively). No significant differences in energy and macronutrient intake were observed across AMPA groups, and appetite components (hunger, fullness, desire to eat, prospective consumption) did not differ significantly in either the AMPA or TEE groups.

CONCLUSIONS

Higher TEE is associated with higher energy and protein intake, with body composition playing a crucial role. These findings highlight the importance of considering PA, TEE, and body composition in interventions aimed at improving EI in older adults.

CLINICAL TRAIL REGISTRATION

clinicaltrials.gov as NCT05067036. Registered 2 October 2021, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05067036.

Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countries

Background

Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label reflecting the nutrient profile of foods. It has been implemented in several European countries on a voluntary basis, pending the revision of the European labeling regulation. Hence, scientific evidence is needed regarding the ability of the nutrient profile underlying the Nutri-Score (uNS-NPS, 2023-updated version) to characterize healthier foods. Our objective was therefore to study the prospective association between the nutritional quality of diet characterized by the uNS-NPS and the risk of cardiovascular diseases in a large European population.

Methods

Our analyses included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study (EPIC, 1992-2010, 7 European countries). Food intakes were assessed at baseline using country-specific dietary questionnaires. The uNS-NPS was calculated as a continuous scale for each food, based on its 100 g content of energy, sugars, saturated fatty acids, salt, fibre, and protein and percentage content of fruit, vegetables, and pulses. A dietary index was derived at the individual level (uNS-NPS DI: energy-weighted mean of uNS-NPS scores of all foods consumed by a participant). Cardiovascular events during follow-up were retrieved using country-specific methods (self-report, registry data). Multi-adjusted Cox models were computed.

Findings

Overall, 16,214 first cardiovascular events were reported (median follow-up: 12.3 years; 4,103,133 person-years). The consumption of foods with a higher uNS-NPS score (reflecting a lower overall nutritional quality of diet) was associated with higher risks of total cardiovascular events (Hazards Ratio (HR) for an increment of 1 standard deviation: 1.03 (95% Confidence Interval 1.01-1.05)), especially myocardial infarction (HR = 1.03 (1.01-1.07)), and stroke (HR = 1.04 (1.01-1.07)).

Interpretation

In this large prospective study among European adults, a higher risk of cardiovascular diseases (total and several subtypes) was observed in individuals consuming a diet with a lower nutritional value, as graded by the uNS-NPS score. This brings new evidence on the relevance of the updated nutrient profile underlying the Nutri-Score to characterize foods with a healthier nutrient profile.

Funding

EPIC-CVD was supported by EU FP7, ERC, UK MRC, British Heart Foundation, and UK NIHR.

Social desirability bias is related to children's energy intake in a laboratory test meal paradigm

Dietary intake is notoriously difficult to measure in children. Laboratory test meals address some of the methodological concerns of self-report methods, but may also be susceptible to social desirability bias, referring to the tendency for individuals to adjust their behaviors in order to be perceived more positively. The aim of the current study was to evaluate whether social desirability bias was associated with children's energy intake during a laboratory test meal, and whether this association varied by food type (total caloric intake, snack food intake, fruit/vegetable intake) and sex. A total of 82 children (M age = 9.45 ± 0.85; 50 % girls; 84.1 % rural; 85.4 % White) completed several surveys, including the Children's Social Desirability Scale and had their body composition measured. At lunchtime, they were granted access to a multi-array test meal (>5000 kcal). After adjusting for lean mass, fat mass, depressive symptoms, and parental food restriction, children who reported higher social desirability bias consumed fewer calories from snack foods (B = -11.58, p = .009, semi-partial correlation = -0.28). Boys with higher social desirability bias consumed less calories from fruits and vegetables (B = -6.47, p = .010, semi-partial correlation = -0.411); this association was not significant in girls. The desire to be perceived in a positive manner may influence children's eating behaviors in experimental paradigms. Replication studies with larger, more diverse pediatric samples are needed, as are strategies to reduce the effects of social desirability bias on test meal intake in order to enhance the validity of this dietary assessment approach.

The Impact of Weight Bias and Stigma on the 24 h Dietary Recall Process in Adults with Overweight and Obesity: A Pilot Study

People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.

Food Addiction and Binge Eating Disorder in Relation to Dietary Patterns and Anthropometric Measurements: A Descriptive-Analytic Cross-Sectional Study in Iranian Adults with Obesity

Obesity is associated with maladaptive eating behaviors, including food addiction (FA) and binge eating disorder (BED). However, the key factors influencing the development of maladaptive eating behaviors remain unknown. Adherence to specified dietary patterns has been suspected of making indirect impacts. This study investigates the association of FA and BED with dietary patterns and anthropometric measurements among 400 Iranian adults (aged 18-60; 66.25% women) living with obesity (body mass index [BMI] ≥ 30 kg/m2). The Binge Eating Scale and Yale Food Addiction Scale were used to measure BED and FA. A validated 147-item semi-quantitative food frequency questionnaire underwent principal component analysis and identified three major dietary patterns: mixed, unhealthy, and healthy dietary pattern. After adjusting for confounders, higher adherence to unhealthy dietary patterns was associated with an increased risk of FA, while higher adherence to healthy dietary patterns was associated with a lower risk of FA. Also, those within obesity class III had a significantly higher risk of FA and BED than those in obesity class I. This study suggests that adherence to an unhealthy dietary pattern may be associated with a higher risk of FA. It also highlights the link between higher BMI and maladaptive eating behaviors.