Comparison of energy expenditure by the doubly labeled water technique with energy intake, heart rate, and activity recording in man

Predicting resting energy expenditure: a critical appraisal

BACKGROUND

The most commonly used prediction models for resting energy expenditure (REE) are Harris-Benedict (1919), Schofield (1985), Owen (1986), and Mifflin-St Jeor (1990), based on height, weight, age and gender, and Cunningham (1991), based on body composition.

METHODS

Here, the five models are compared with reference data, consisting of individual REE measurements (n = 353) from 14 studies, covering a large range of participant characteristics.

RESULTS

For white adults, prediction of REE with the Harris-Benedict model approached measured REE most closely, with estimates within 10% for more than 70% of the reference population.

DISCUSSION

Sources of differences between measured and predicted REE include measurement validity and measurement conditions. Importantly, a 12- to 14-h overnight fast may not be sufficient to reach post-absorptive conditions and may explain differences between predicted REE and measured REE. In both cases complete fasting REE may not have been achieved, especially in participants with high energy intake.

CONCLUSION

In white adults, measured resting energy expenditure was closest to predicted values with the classic Harris-Benedict model. Suggestions for improving resting energy expenditure measurements, as well as prediction models, include the definition of post-absorptive conditions, representing complete fasting conditions with respiratory exchange ratio as indicator.

Energy Intake Evaluation by a Learning Approach Using the Number of Food Portions and Body Weight

An accurate quantification of energy intake is critical; however, under-reporting is frequent. The aim of this study was to develop an indirect statistical method of the total energy intake estimation based on gender, weight, and the number of portions. The energy intake prediction was developed and evaluated for validity using energy expenditure. Subjects with various BMIs were recruited and assigned either in the training or the test group. The mean energy provided by a portion was evaluated by linear regression models from the training group. The absolute values of the error between the energy intake estimation and the energy expenditure measurement were calculated for each subject, by subgroup and for the whole group. The performance of the models was determined using the test dataset. As the number of portions is the only variable used in the model, the error was 26.5%. After adding body weight in the model, the error decreased to 8.8% and 10.8% for the normal-weight women and men, respectively, and 11.7% and 12.8% for the overweight women and men, respectively. The results prove that a statistical approach and knowledge of the usual number of portions and body weight is effective and sufficient to obtain a precise evaluation of energy intake after a simple and brief enquiry.

Reindeer herders from subarctic Finland exhibit high total energy expenditure and low energy intake during the autumn herd roundup

OBJECTIVE

High levels of total energy expenditure (TEE, kcal/day) have been documented among numerous human populations such as tropical climate horticulturalists and high-altitude agriculturalists. However, less work has been conducted among highly physically active cold climate populations.

METHODS

In October 2018, TEE was measured using the doubly labeled water (TEE_DLW , N = 10) and flex-heart rate methods (TEE_HR , N = 24) for 6-14 days among reindeer herders (20-62 years) in northern Finland during an especially physically demanding, but not seasonally representative, period of the year for herders-the annual reindeer herd roundup. Self-reported dietary intake was also collected during TEE measurement periods. TEE was then compared to that of hunter gatherer, farming, and market economies.

RESULTS

During the herd roundup, herders expended a mean of 4183 ± 949 kcal/day as measured by the DLW method, which was not significantly different from TEE_HR . Mean caloric intake was 1718 ± 709 kcal/day, and was significantly lower than TEE_DLW and TEE_HR (p < .001). Herder TEE_DLW was significantly higher than that of hunter gatherer (p = .0014) and market (p < .0014) economy populations; however, herder TEE_DLW was not different from that of farming populations (p = .91).

CONCLUSION

High TEE and low caloric intake among herders reflect the extreme demands placed on herders during the annual herd round up. Although TEE_DLW was similar between cold climate herders and hot climate farming populations, there are likely differences in how that TEE is comprised, reflecting the local ecologies of these populations.

A nonlinear mixed model approach to predict energy expenditure from heart rate

Objective.Heart rate (HR) monitoring provides a convenient and inexpensive way to predict energy expenditure (EE) during physical activity. However, there is a lot of variation among individuals in the EE-HR relationship, which should be taken into account in predictions. The objective is to develop a model that allows the prediction of EE based on HR as accurately as possible and allows an improvement of the prediction using calibration measurements from the target individual.Approach.We propose a nonlinear (logistic) mixed model for EE and HR measurements and an approach to calibrate the model for a new person who does not belong to the dataset used to estimate the model. The calibration utilizes the estimated model parameters and calibration measurements of HR and EE from the person in question. We compare the results of the logistic mixed model with a simpler linear mixed model for which the calibration is easier to perform.Main results.We show that the calibration is beneficial already with only one pair of measurements on HR and EE. This is an important benefit over an individual-level model fitting, which requires a larger number of measurements. Moreover, we present an algorithm for calculating the confidence and prediction intervals of the calibrated predictions. The analysis was based on up to 11 pairs of EE and HR measurements from each of 54 individuals of a heterogeneous group of people, who performed a maximal treadmill test.Significance.The proposed method allows accurate energy expenditure predictions based on only a few calibration measurements from a new individual without access to the original dataset, thus making the approach viable for example on wearable computers.

A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study

The links between increased participation in Physical Activity (PA) and improvements in health are well established. As this body of evidence has grown, so too has the search for measures of PA with high levels of methodological effectiveness (i.e. validity, reliability and responsiveness to change). The aim of this “review of reviews” was to provide a comprehensive overview of the methodological effectiveness of currently employed measures of PA, to aid researchers in their selection of an appropriate tool. A total of 63 review articles were included in this review, and the original articles cited by these reviews were included in order to extract detailed information on methodological effectiveness.

Self-report measures of PA have been most frequently examined for methodological effectiveness, with highly variable findings identified across a broad range of behaviours. The evidence-base for the methodological effectiveness of objective monitors, particularly accelerometers/activity monitors, is increasing, with lower levels of variability observed for validity and reliability when compared to subjective measures. Unfortunately, responsiveness to change across all measures and behaviours remains under-researched, with limited information available.

Other criteria beyond methodological effectiveness often influence tool selection, including cost and feasibility. However, researchers must be aware of the methodological effectiveness of any measure selected for use when examining PA. Although no “perfect” tool for the examination of PA in adults exists, it is suggested that researchers aim to incorporate appropriate objective measures, specific to the behaviours of interests, when examining PA in free-living environments.

Design and Evaluation of a Computer-Based 24-Hour Physical Activity Recall (cpar24) Instrument

Background

Widespread access to the Internet and an increasing number of Internet users offers the opportunity of using Web-based recalls to collect detailed physical activity data in epidemiologic studies.

Objective

The aim of this investigation was to evaluate the validity and reliability of a computer-based 24-hour physical activity recall (cpar24) instrument with respect to the recalled 24-h period.

Methods

A random sample of 67 German residents aged 22 to 70 years was instructed to wear an ActiGraph GT3X+ accelerometer for 3 days. Accelerometer counts per min were used to classify activities as sedentary (<100 counts per min), light (100-1951 counts per min), and moderate to vigorous (≥1952 counts per min). On day 3, participants were also requested to specify the type, intensity, timing, and context of all activities performed during day 2 using the cpar24. Using metabolic equivalent of task (MET), the cpar24 activities were classified as sedentary (<1.5 MET), light (1.5-2.9 MET), and moderate to vigorous (≥3.0 MET). The cpar24 was administered twice at a 3-h interval. The Spearman correlation coefficient (r) was used as primary measure of concurrent validity and test-retest reliability.

Results

As compared with accelerometry, the cpar24 underestimated light activity by −123 min (median difference, P difference <.001) and overestimated moderate to vigorous activity by 89 min (P difference <.001). By comparison, time spent sedentary assessed by the 2 methods was similar (median difference=+7 min, P difference=.39). There was modest agreement between the cpar24 and accelerometry regarding sedentary (r=.54), light (r=.46), and moderate to vigorous (r=.50) activities. Reliability analyses revealed modest to high intraclass correlation coefficients for sedentary (r=.75), light (r=.65), and moderate to vigorous (r=.92) activities and no statistically significant differences between replicate cpar24 measurements (median difference for sedentary activities=+10 min, for light activities=−5 min, for moderate to vigorous activities=0 min, all P difference ≥.60).

Conclusion

These data show that the cpar24 is a valid and reproducible Web-based measure of physical activity in adults.

Classifying work rate from heart rate measurements using an adaptive neuro-fuzzy inference system

In a new approach based on adaptive neuro-fuzzy inference systems (ANFIS), field heart rate (HR) measurements were used to classify work rate into four categories: very light, light, moderate, and heavy. Inter-participant variability (physiological and physical differences) was considered. Twenty-eight participants performed Meyer and Flenghi's step-test and a maximal treadmill test, during which heart rate and oxygen consumption (VO2) were measured. Results indicated that heart rate monitoring (HR, HRmax, and HRrest) and body weight are significant variables for classifying work rate. The ANFIS classifier showed superior sensitivity, specificity, and accuracy compared to current practice using established work rate categories based on percent heart rate reserve (%HRR). The ANFIS classifier showed an overall 29.6% difference in classification accuracy and a good balance between sensitivity (90.7%) and specificity (95.2%) on average. With its ease of implementation and variable measurement, the ANFIS classifier shows potential for widespread use by practitioners for work rate assessment.

Adaptive neuro-fuzzy inference systems with k-fold cross-validation for energy expenditure predictions based on heart rate

This paper presents a new model based on adaptive neuro-fuzzy inference systems (ANFIS) to predict oxygen consumption (V˙O2) from easily measured variables. The ANFIS prediction model consists of three ANFIS modules for estimating the Flex-HR parameters. Each module was developed based on clustering a training set of data samples relevant to that module and then the ANFIS prediction model was tested against a validation data set. Fifty-eight participants performed the Meyer and Flenghi step-test, during which heart rate (HR) and V˙O2 were measured. Results indicated no significant difference between observed and estimated Flex-HR parameters and between measured and estimated V˙O2 in the overall HR range, and separately in different HR ranges. The ANFIS prediction model (MAE = 3 ml kg(-1) min(-1)) demonstrated better performance than Rennie et al.'s (MAE = 7 ml kg(-1) min(-1)) and Keytel et al.'s (MAE = 6 ml kg(-1) min(-1)) models, and comparable performance with the standard Flex-HR method (MAE = 2.3 ml kg(-1) min(-1)) throughout the HR range. The ANFIS model thus provides practitioners with a practical, cost- and time-efficient method for V˙O2 estimation without the need for individual calibration.

Estimating oxygen consumption from heart rate using adaptive neuro-fuzzy inference system and analytical approaches

In new approaches based on adaptive neuro-fuzzy systems (ANFIS) and analytical method, heart rate (HR) measurements were used to estimate oxygen consumption (VO2). Thirty-five participants performed Meyer and Flenghi's step-test (eight of which performed regeneration release work), during which heart rate and oxygen consumption were measured. Two individualized models and a General ANFIS model that does not require individual calibration were developed. Results indicated the superior precision achieved with individualized ANFIS modelling (RMSE = 1.0 and 2.8 ml/kg min in laboratory and field, respectively). The analytical model outperformed the traditional linear calibration and Flex-HR methods with field data. The General ANFIS model's estimates of VO2 were not significantly different from actual field VO2 measurements (RMSE = 3.5 ml/kg min). With its ease of use and low implementation cost, the General ANFIS model shows potential to replace any of the traditional individualized methods for VO2 estimation from HR data collected in the field.

Hunter-gatherer energetics and human obesity

Western lifestyles differ markedly from those of our hunter-gatherer ancestors, and these differences in diet and activity level are often implicated in the global obesity pandemic. However, few physiological data for hunter-gatherer populations are available to test these models of obesity. In this study, we used the doubly-labeled water method to measure total daily energy expenditure (kCal/day) in Hadza hunter-gatherers to test whether foragers expend more energy each day than their Western counterparts. As expected, physical activity level, PAL, was greater among Hadza foragers than among Westerners. Nonetheless, average daily energy expenditure of traditional Hadza foragers was no different than that of Westerners after controlling for body size. The metabolic cost of walking (kcal kg(-1) m(-1)) and resting (kcal kg(-1) s(-1)) were also similar among Hadza and Western groups. The similarity in metabolic rates across a broad range of cultures challenges current models of obesity suggesting that Western lifestyles lead to decreased energy expenditure. We hypothesize that human daily energy expenditure may be an evolved physiological trait largely independent of cultural differences.

Measurement of energy expenditure

Although investigators have been engaged in the study of human energy metabolism for over 100 years, there remain unanswered questions regarding the role that energy expenditure plays in human health and disease. A critical examination of available methods for measurement of the various components of daily energy expenditure is presented. Using a combination of the techniques available today, each component can be reliably studied, and the role that each of these plays in the human health can be examined. Several examples of the application of energy expenditure methods are presented. Finally, data are presented describing current knowledge regarding the relation between energy metabolism and cancer, including cancer risk, response to cancer, and in cancer survivors.

Pharmacokinetics and pharmacodynamics of MK-5046, a bombesin receptor subtype-3 (BRS-3) agonist, in healthy patients

MK-5046 is an orally active, potent, selective agonist of the orphan G protein-coupled receptor bombesin receptor subtype-3 (BRS-3) that is under evaluation for treatment of obesity. We report the safety, tolerability, pharmacokinetics, and pharmacodynamics of oral doses of MK-5046 (10-160 mg) in a double-blind, randomized, placebo-controlled study in healthy and obese male volunteers. MK-5046 exposure increased dose proportionally, and MK-5046 was eliminated with an apparent terminal half-life of 1.5 to 3.5 hours. Single doses transiently increased blood pressure. Patients reported adverse events (erections and feeling hot, cold, and/or jittery) that coincided with time of occurrence (T(max)) and increased with increasing dose. No changes were observed in body temperature, heart rate, plasma glucose levels, or feelings of hunger/satiety. The blood pressure and thermal experiences attenuated with a second dose 6 hours after the first. Additionally, the erections suggest a possible, unanticipated, role for BRS-3 in reproductive physiology. Oral administration of MK-5046 achieves plasma concentrations that are projected to activate BRS-3 and therefore should be suitable for exploring its biological role in humans.

Predicting energy expenditure in elders with the metabolic cost of activities

INTRODUCTION

Measuring free-living energy expenditure in aging human is a considerable challenge. The objective of this study was to predict total energy expenditure (TEE) in elders by combining the metabolic cost of activities and accelerometer outputs.

METHODS

Seventeen elders (7 women, 10 men) aged 60 to 78 yr were recruited. Body composition was measured by dual x-ray absorptiometry. Doubly labeled water was used as the criterion standard to measure TEE on a 7-d time frame. During the same period, participants wore a uniaxial accelerometer (Caltrac) to estimate TEE. Resting metabolic rate and metabolic costs of sitting, standing, and walking (1, 3, and 5 km·h(-1)) were measured by indirect calorimetry.

RESULTS

There was no correlation between Caltrac's outputs and doubly labeled water measurement of TEE. The best predictors of TEE were fat-free mass, the metabolic cost of standing, and the metabolic cost of walking at 3 km·h(-1) (r = 0.78, P < 0.01).

CONCLUSIONS

Our results suggest that TEE may be estimated with good accuracy using fat-free mass, the cost of standing still, and the cost of walking at 3 km·h(-1). These predictors are easy to measure in older adults. Further work is needed to confirm our findings and develop prediction equation with these parameters.

Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies

BACKGROUND

There is an assumption that people in developing countries have a higher total energy expenditure (TEE) and physical activity level (PAL) than do people in developed nations, but few objective data for this assertion exist.

OBJECTIVE

We conducted a meta-analysis of TEE and PAL by using data from countries that have a low or middle human development index (HDI) compared with those with a high HDI to better understand how energy-expenditure variables are associated with development status and population differences in body size.

DESIGN

We performed a literature search for studies in which energy expenditure was measured by using doubly labeled water. Mean data on age, weight, body mass index (BMI; in kg/m(2)), TEE, and PAL were extracted, and HDI status was assessed. Pooled estimates of the mean effect by sex were obtained, and the extent to which age, weight, HDI status, and year of publication explained heterogeneity was assessed.

RESULTS

A total of 98 studies (14 studies from low- or middle-HDI countries) that represented 183 cohorts and 4972 individuals were included. Mean (±SE) BMI was lower in countries with a low or middle HDI than in those with a high HDI for both men and women (22.7 ± 1.0 compared with 26.0 ± 0.7, respectively, in men and 24.3 ± 0.7 compared with 26.6 ± 0.4, respectively, in women). In meta-regression models, there was an inverse association of age (P < 0.001) and a positive association of weight (P < 0.001) with TEE for both sexes; there was an association of age only in men with PAL (P < 0.001). There was no association of HDI status with either TEE or PAL.

CONCLUSION

TEE adjusted for weight and age or PAL did not differ significantly between developing and industrialized countries, which calls into question the role of energy expenditure in the cause of obesity at the population level.

[Determining factors of physical activity level in school children and adolescents: the OPACA study]

INTRODUCTION

Physical activity is a key factor for human health. This study attempts to measure the level of physical activity in children and to find out what are the factors that determine it.

METHOD

In a sample of the 11 and 14 year-old population of the centre-south area of Palencia, physical activity was measured using a three day diary, and anthropometric and socioeconomic variables were collected. Three variables were analysed: fat-free mass adjusted activity energy expenditure (AEE/FFM), physical activity level (PAL), and categorical physical activity (active/inactive).

RESULTS

A total of 179 children were included, of whom 71.5% were active or very active. Males were more active than females, and activity was also higher in summer. Physical activity declined between 11 and 14 years, and was lower during the weekends than in working days. There were no differences related to obesity, overweight or percent body fat. More active children had lower blood pressure. Physical activity was directly related to weekly hours spent in sport activities, and inversely related to time spent on sedentary activities. Multivariate analysis showed that children from families with low educational levels had a higher activity level not related to sport activities.

CONCLUSIONS

The level of physical activity in this population is acceptable, although there are sex differences and there is a declining trend through the adolescence.

A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review

BACKGROUND

Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults.

METHODS

Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.

RESULTS

Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.

CONCLUSION

The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report - direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.

Estimation of energy expenditure in a work environment: comparison of accelerometry and oxygen consumption/heart rate regression

The aim of this study was to compare estimation of energy expenditure (EE) in working environments, either from accelerometry or from an individual oxygen consumption/heart rate (VO(2)/HR) regression curve. The study participants were 46 volunteer workers aged 27+/-6 years old. A significant correlation between EE predicted by the VO(2)/HR curve and the accelerometer was observed (r=0.78, p <0.01). However, more disparities were observed between the two methods when the mean job intensity was not within 16% and 23% higher than resting HR. The accelerometer overestimated by a mean of 34.4% the prediction by VO(2)/HR regression if the intensity of the task was lower than a total of 1000 kcal/shift and underestimated the prediction by a mean of -24.9% if EE estimation of the work shift was higher than a total of 1500 kcal/shift. Despite a high correlation between both methods in the whole group, EE evaluated by accelerometry does not correspond to EE predicted by the VO(2)/HR regression curves when evaluated individually.

A new heart rate variability-based method for the estimation of oxygen consumption without individual laboratory calibration: application example on postal workers

Traditionally, the estimation of oxygen consumption (VO2) at work using heart rate (HR) has required the determination of individual HR/VO2 calibration curves in a separate exercise test in a laboratory (VO2-TRAD). Recently, a new neural network-, and heart rate variability-based method has been developed (Firstbeat PRO heartbeat analysis software) for the estimation of VO2 without individual calibration (VO2-HRV). In the present study, the VO2-values by the VO2-HRV were compared with the values by VO2-TRAD in 22 postal workers. Within individuals the correlation between the two methods was high (range 0.80-0.99). The VO2-TRAD gave higher values of VO2 compared to VO2-HRV (19%) especially during low physical activity work when non-metabolic factors may increase HR. When assessed in different HR categories, the smallest difference (11%), and highest correlations (range 0.83-0.99) in VO2 between the methods were observed at higher HR levels. The results indicate that the VO2-HRV is a potentially useful method to estimate VO2 in the field without laboratory calibration.

Activity levels in pregnant New Zealand women: relationship with socioeconomic factors, well-being, anthropometric measures, and birth outcome

Activity during pregnancy has health implications for mother and child. The aim of this prospective cohort study was to examine changes in activity levels during pregnancy; the influence of socioeconomic factors and well-being on activity, and the influence of activity on maternal anthropometric measures and birth outcome. Twenty-four hour activity diaries were collected for 3 d in months 4 and 7 of pregnancy in 197 volunteers. Anthropometric measures and questionnaires to determine personal details were collected at these times and 2 months post-partum. Health records were used to supply infant measures. The time spent on each activity category was calculated, and used to calculate overall daily metabolic equivalents (METs). Low socioeconomic (SES) group 24 h activity levels were significantly higher than for high SES or welfare groups (p = 0.013). Activity declined throughout pregnancy in all groups (p = 0.002). Women with children had higher 24 h activity, spending 41% more time walking and (or) on housework than nulliparous women (p = 0.013). Reduced well-being was associated with lower levels of activity. Sleep and lying down time influenced 2 month post-partum body mass (upper quartile gained 2.54 kg, lower quartile lost 0.24 kg, p < 0.001). Mean infant gestational age increased with increasing 24 h activity (p = 0.047). No infants were born prematurely to mothers who spent more than 190 min/d walking or doing housework activities in month 4. Probability of infant admission to the neonatal intensive care unit (NICU) declined with time spent walking or doing housework in month 4 (p = 0.007). Mean (SE) birth weight was 3883 (+/-165) g in the 10% of women spending less than 530 min sleeping or lying down per day, compared with 3413 (+/-104) g in the 10% of women spending 725 min or more sleeping or lying down. Socioeconomic factors were therefore important influences on activity levels during pregnancy. Inactivity, especially in early pregnancy, was associated with more maternal weight retention at 2 months post-partum and a greater probability of admission to NICU and premature delivery.

Improved reporting of habitual food intake after confrontation with earlier results on food reporting

The aim of the present study was to improve the reporting of food intake by confronting subjects with their way of reporting food intake, e.g. under-recording and/or undereating. To minimize portion size errors, eighteen female dietitians were recruited as subjects. Energy- and water intake were measured for 1 week with a weighed dietary record. Resting metabolic rate was measured with an open-circuit ventilated-hood indirect calorimeter, and physical activity was measured with an accelerometer for movement registration. Water loss was estimated with 2H-labelled water. Energy balance was checked for by measuring empty body-weight 1 week before the start, at the start and at the end of the recording week. In the first part of the study, the change in body weight in the non-recording week was 0·14 kg and in the recording week -0·45 kg (P 0·02), indicating 12 % undereating. Total water intake closely matched measured water loss, indicating a high recording precision. There was under-reporting of habitual food intake that could be fully explained by undereating. In the second part of the study, subjects were confronted with these results and the protocol was repeated. This time there was no significant change in body weight in the recording week, indicating no undereating. The reporting of habitual food intake had been improved. In conclusion, in the studied group of highly motivated lean women, under-reporting of habitual food intake (here due to undereating) could be eliminated by confrontation with the results of this phenomenon.

Estimation of total daily energy expenditure and its components by monitoring the heart rate of Japanese endurance athletes

The estimation of total daily energy expenditure (TEE) or the energy needs of athletes is important for maintaining a proper energy balance during training. This study was conducted to measure the TEE of Japanese middle- and long-distance runners using a heart-rate monitoring method (the HR method), and to ascertain the impact of three key energy expenditure (EE) components occurring within the day: sleep, exercise (training) and inactivity (other daily habitual activities). Additionally, energy balance was evaluated by comparing TEE with energy intake (EI). The mean TEE of six male athletes aged 19-21 y was 4,514+/-739 kcal/d and their mean EI was 3,784+/-91 kcal/d during the training period of 11 d. This negative energy balance led to a significant decline in body weight (p<0.01), indicating that proper care should be taken to balance energy during training. The mean daily EEs during sleep, inactivity, and exercise were 536+/-46 (12.0% of TEE), 1,722+/-145 (38.7%), and 2,255+/-658 (49.3%) kcal/d, respectively. There was a significant correlation between TEE and exercise EE (p<0.01) in the athletes. The TEE of the endurance athletes was higher than expected and significantly affected by exercise EE, indicating that the TEE of athletes, in general, must be carefully evaluated before incorporating nutritional support for them.

Improving the specificity of the [13C]mixed triacylglycerol breath test by estimating carbon dioxide production from heart rate

BACKGROUND

The [13C]mixed triacylglycerol (MTG) breath test is a non-invasive measure of fat digestion and can be used to assess the need for enzyme replacement therapy in children with cystic fibrosis (CF). However, it lacks specificity. Quantitation of cumulative percent dose recovered (cPDR) requires knowledge of carbon dioxide production rate (VCO2). A resting value is assumed, but children are unlikely to remain at rest during the test.

OBJECTIVE

To improve the specificity and therefore the positive predictive value (PPV) of the MTG breath test using calibrated heart rate monitors to estimate non-resting VCO2.

DESIGN

Proof of concept study.

SUBJECTS

Six children with CF, 10 healthy children and eight healthy adults performed [13C]MTG breath tests.

METHODS

Heart rate monitors were worn throughout the test. Non-resting VCO2 was estimated continuously from heart rate. Percentage dose recovered was calculated using predicted resting VCO2, measured resting VCO2 and non-resting VCO2 estimated from heart rate. Physical activity level (PAL) was taken as cPDR calculated using non-resting VCO2 divided by cPDR calculated using measured resting VCO2. The cutoff point was determined using two graph-receiver operator characteristics.

RESULTS

Use of calibrated heart rate monitors to estimate non-resting VCO2 improved the specificity of the test. The PPV increased from 0.67 to 0.99. PAL was 1.3 in adults and children who performed the test in hospital, and 1.7 in children who performed the test at home.

CONCLUSION

Individually calibrated heart rate monitors are useful tools to estimate non-resting VCO2 during the [13C]MTG breath test.

A Novel Energy Expenditure Prediction Equation for Intermittent Physical Activity

PURPOSE

This study was designed to characterize the relative contributions of the current heart rate (HR) and HR in the previous minute to predict energy expenditure (EE) and to model these and other determinants to predict EE during intermittent activity.

METHODS

Regularly exercising subjects (N=65, 36+/-9 yr, body mass index (BMI), 23.9+/- 2.5 kg.m) were tested. Body composition and maximal oxygen uptake (& OV0312;O2) were measured. On a separate day, subjects completed 12 x 4-min workloads, separated by 4 x 1-min rest periods, during which HR and & OV0312;O2 were continuously monitored. Using the intermittent activity calibration data, an EE model was developed. For validation, the final model was used to predict EE in a separate sample (N=17), who completed a gym training exercise session. Using the HR data, EE data were estimated using (a) the new model and were compared with (b) a previous model developed using a continuous incremental calibration test.

RESULTS

The following variables contributed significantly to the estimation of EE during intermittent activity: age, gender, & OV0312;O2 max, current minute's HR, previous minute's HR, and an interaction variable consisting of previous minute's HR and & OV0312;O2 max. The final model yielded an R of 82% for the comparison of predicted and measured EE. When this model was applied to an independent sample for validation (N=17), improvements in EE prediction, when compared to the existing model (b), were most apparent during free-living non-continuous exercise.

CONCLUSION

It is possible to improve the accuracy of predicting EE from HR, by incorporating both & OV0312;O2 max and the previous minute's HR in the prediction model.

Comparison of accuracy and precision of heart rate calibration methods to estimate total carbon dioxide production during 13C-breath tests

BACKGROUND

13C-breath tests are noninvasive tools to measure gastrointestinal function and nutritional interventions. Calculation of percentage dose recovered of 13C in exhaled breath requires knowledge of CO2 production rate (VC02). A resting value is usually assumed, but this can underestimate VC02 because subjects are unlikely to remain at rest during tests that last for many hours. There is a need for a method to estimate nonresting VC02 during 13C-breath tests.

OBJECTIVE

To calibrate a heart rate monitor to continually estimate VC02 during 13C-breath tests.

DESIGN

Proof of concept study.

SUBJECTS

Eight healthy adults, 10 healthy children and six children with cystic fibrosis.

METHODS

Heart rate and VC02 were measured simultaneously at resting and nonresting levels. A new calibration method (smoothing heart rate and fitting a sigmoid function) was compared with published methods. A [ 3C]acetate breath test was used to demonstrate the range of physical activity during breath tests.

RESULTS

The new calibration method was more accurate than existing methods (mean bias -0.0002%, 95% confidence interval (CI) -0.0007, 0.0003% of the mean measured VC02). Smoothing heart rate gave a more precise estimate of VC02 and a more accurate estimate of resting energy expenditure (mean bias -0.09, 95% Cl -0.22, 0.05 mmol CO2 min-' m-2 body surface area) than using raw data (mean bias -0.21, 95% Cl -0.38, -0.04 mmol CO2 min' m-2 body surface area). Physical activity level ranged from 1.0 to 2.5 in children, and 1.0 to 1.5 in adults.

CONCLUSION

Use of smoothed HR with a sigmoid function provides an accurate method of estimating nonresting VC02 during 13C-breath tests.

Estimating relative physical workload using heart rate monitoring: a validation by whole-body indirect calorimetry

Measuring physical workload in occupational medicine is fundamental for risk prevention. An indirect measurement of total and relative energy expenditure (EE) from heart rate (HR) is widely used but it has never been validated. The aim of this study was to validate this HR-estimated energy expenditure (HREEE) method against whole-body indirect calorimetry. Twenty-four-hour HR and EE values were recorded continuously in a calorimetric chambers for 52 adult males and females (19-65 years). An 8-h working period was retained, comprising several exercise sessions on a cycloergometer at intensities up to 65% of the peak rate of oxygen uptake. HREEE was calculated with reference to cardiac reserve. A corrected HREEE (CHREEE) was also calculated with a modification to the lowest value of cardiac reserve. Both values were further compared to established methods: the flex-HR method, and the use of a 3rd order polynomial relationship to estimate total and relative EE. No significant difference was found in total EE when measured in a calorimetric chamber or estimated from CHREEE for the working period. A perfect linear and identity relationship was found between CHREEE and energy reserve values for intensities ranging from 15% to 65%. Relative physical workload can be accurately assessed from HR recordings when expressed in CHREEE between 15% to 65%, and EE can be accurately estimated using the CHREEE method.

Estimating human energy expenditure: a review of techniques with particular reference to doubly labelled water

This review includes an historical overview of the techniques for measuring energy expenditure (EE). Following this overview, the "gold standard" method of measuring EE, the doubly labelled water (DLW) method, is emphasised. Other methods, such as direct calorimetry, indirect calorimetry systems, heart rate and EE relationships, questionnaires and activity recall, motion sensors, combined heart rate and motion sensors for the estimation of EE are then highlighted in relation to their validation against the DLW method. The major advantages and disadvantages for each method are then considered. The preferred method to determine EE is likely to depend principally on factors such as the number of study participants to be monitored, the time period of measurements and the finances available. Small study participant numbers over a short period may be measured accurately by means of indirect calorimetric methods (stationary and portable systems). For periods over 3-4 days, EE should ideally be measured using the DLW method. However, the use of motion sensors is very promising in the measurement of EE, and has a number of advantages over the DLW method. Furthermore, if used correctly, both heart rate and questionnaire methods may provide valuable estimates of EE. Additional studies are needed to examine the possibility of improving the accuracy of measurement by combining two or more techniques. Such information, if confirmed by scientific rigour, may lead to an improvement in the estimation of EE and population-based physical activity levels. The accurate measurement of physical activity and EE is critical from both a research and health prospective. A consideration of the relevant techniques used for the estimation of EE may also help improve the quality of these frequently reported measurements.

Markers of the validity of reported energy intake

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.

Predicting energy expenditure of physical activity using hip- and wrist-worn accelerometers

To investigate the association between physical activity and health, we need accurate and detailed free-living physical activity measurements. The determination of energy expenditure of activity (EEACT) may also be useful in the treatment and maintenance of nutritional diseases such as diabetes mellitus. Minute-to-minute energy expenditure during a 24-h period was measured in 60 sedentary normal female volunteers (35.4 +/- 9.0 years, body mass index 30.0 +/- 5.9 kg/m2), using a state-of-the-art whole-room indirect calorimeter. The activities ranged from sedentary deskwork to walking and stepping at different intensities. Body movements were simultaneously measured using a hip-worn triaxial accelerometer (Tritrac-R3D, Hemokentics, Inc., Madison, Wisconsin) and a wrist-worn uniaxial accelerometer (ActiWatch AW64, MiniMitter Co., Sunriver, Oregon) on the dominant arm. Movement data from the accelerometers were used to develop nonlinear prediction models (separately and combined) to estimate EEACT and compared for accuracy. In a subgroup (n=12), a second 24-h study period was repeated for cross-validation of the combined model. The combined model, using Tritrac-R3D and ActiWatch, accurately estimated total EEACT (97.7 +/- 3.2% of the measured values, p=0.781), as compared with using ActiWatch (86.0 +/- 4.7%, p<0.001) or Tritrac-R3D (90.0 +/- 4.6%, p<0.001) alone. This model was also accurate for all intensity categories during various physical activities. The subgroup cross-validation also showed accurate and reproducible predictions by the combination model. In this study, we demonstrated that movement measured using accelerometers at the hip and wrist could be used to accurately predict EEACT of various types and intensity of activities. This concept can be extended to develop valid models for the accurate measurement of free-living energy metabolism in clinical populations.

Food intake in the real world: implications for nutrition and aging

Nutrient intakes are affected by two classes of factors, physiological and environmental. In the real world, environmental variables such as social factors, palatability, and the time of eating appear to have large influences on amounts ingested in the short-term. Physiological control mechanisms also operate to regulate intake, and they induce compensatory responses to deviations from the norm. These physiological influences only appear to have weak influences on short-term intake unless there are large deviations from the normal state, but over the long-term they act patiently and persistently to rectify the excesses produced by environmental fluctuations and thereby tend to maintain a relative balance between energy intake and expenditure. As individuals age there is a progressive decline in physiological function including the mechanisms that act to control intake in the young. This should not produce a problem in a healthy individual in a stable environment: however, if that situation should change due to illness or an environmental change such as the death of a spouse, which produces decline in intake, elderly individuals would not have the physiological mechanisms present to compensate. Thus, the deficit in energy intake would not be replaced, and the lower level of intake would be maintained as long as the new health condition or environment remains stable. Hence, the decline in the effectiveness of the physiological systems with age makes the elderly particularly vulnerable and unable to rebound from deficits. Although the elderly have difficulty compensating for deficits automatically by physiologically-induced adjustments, the studies of real world intake reviewed in this article suggest that compensation can be produced by adjustments to the environment. The elderly appear to be as responsive to environmental factors as younger individuals. In particular, they appear to increase intake in response to social facilitation, diurnal rhythms, the eating environment, and palatability to the same extent as their juniors. These data suggest that alterations in the social, temporal, environmental, or hedonic conditions of eating could induce desired alterations in the nutrient intakes of the elderly. The study of real world eating behavior has produced evidence that suggests that this strategy can work. It remains for future applied investigations to ascertain whether or not this strategy is effective in treating undernutrition in the elderly.

Determinants of fat mass in prepubertal children

The aim of the present study was to compare variables of metabolism, physical activity and fitness to body composition in normal and overweight children in a cross-sectional study design. Body composition was assessed by anthropometric measurements and bioelectrical impedance analysis in forty-eight prepubertal children (age 5-11 years, thirteen normal-weight, thirty-five overweight). Total energy expenditure (EE) was measured by combination of indirect calorimetry (for measurement of resting EE) and individually calibrated 24 h heart-rate (HR) monitoring. Activity-related EE and physical activity level (PAL) were calculated. Time spent with min-by-min HR>FLEX HR was also used as a marker of moderate habitual and vigorous activities. Aerobic fitness (O2 pulse (O2 consumption:HR at submaximal steady-state heart rate), submaximal O2 consumption (VO2submaximal), RER at a HR of 170 beats per min) was determined by bicycle ergometry. Muscle strength of the legs (maximal isometric strength of musculus quadriceps and of musculus ischiocruralis (Fa max and Fb max respectively)) was measured by computer tensiometry. When compared with normal children, overweight children had higher skinfold thicknesses (sum of skinfold thicknesses at four sites +160 %), fat mass (+142 %), waist (+24 %) and hip circumferences (+14 %), resting EE (+13 %) and RER (+5 %). No significant group differences were found for fat-free mass, muscle mass, total EE, activity-related EE, PAL, HR>FLEX HR, VO2submaximal, O2 pulse, Fa max and Fb max as well as the fat-free mass- or muscle mass-adjusted values for resting EE, aerobic fitness and muscle strength. When compared with normal children, overweight children had a lower measured v. estimated resting EE (Delta resting EE) and spent more time watching television. There were positive relationships between fat-free mass(x) and resting EE(x), total EE(y), aerobic fitness(y) and muscle strength(y), but only Delta resting EE(x) and HR>FLEX HR(x) correlated with fat mass(y). In a stepwise multivariate regression analysis resting EE adjusted for fat-free mass and Delta resting EE were significant determinants of % fat mass and explained 29.7 % of its variance. Thus, in the present cross-sectional study, resting EE was the most important determinant of fat mass.

Field evaluation of energy expenditure in women using Tritrac accelerometers

PURPOSE

To investigate the use of Tritrac accelerometers to measure energy expenditure (EE) of various activities for women in the field setting, as compared with portable indirect calorimetry.

METHODS

Twenty women (age 20-29) performed a choreographed routine of six activities (walking, jogging, stair climbing, walking on an incline, stationary cycling, and arm ergometry) while wearing a Tritrac-R3D accelerometer (Hemokinetics Inc., Madison WI) and the Cosmed K4b(2) portable metabolic cart (Cosmed, Rome, Italy).

RESULTS

Comparing the mean error scores (K4b(2) - Tritrac), the Tritrac overestimated the EE (kcal x min(-1)) of walking (-1.45) and jogging (-1.75), whereas underestimating the EE of stair climbing (2.76), stationary cycling (2.75), and arm ergometry (1.20). Walking on an incline showed the lowest mean error score (-0.11). Intraclass correlations were moderate for walking (r = 0.568, < 0.05), jogging (r = 0.666, < 0.05), and stairs (r = 0.503, < 0.05) but for the other activities ranged from r = 0.290 ( > 0.05) to r = 0.480 ( < 0.05). The raw data from the Tritrac was applied to a previously developed nonlinear model to adjust the Tritrac scores to the standard of whole-room indirect calorimetry. This resulted in statistically significant improvements in the agreement between the adjusted Tritrac value and the K4b for walking, jogging, and walking on an incline ( < 0.05).

CONCLUSION

When compared with portable indirect calorimetry, the Tritrac overestimates the EE of walking and jogging, whereas underestimating that of stair climbing, stationary cycling, and arm ergometry. This limits the use of such a technique to measure EE in the field. The main issues appear to be the type and intensity of the activity and the need for movement in order for the Tritrac to register EE. Activity specific linear regression equations are proposed as a tool to improve the measurement of EE using the Tritrac in the field.

Predicting total energy expenditure from self-reported dietary records and physical characteristics in adult and elderly men and women

BACKGROUND

Energy requirements and nutrient intakes are commonly estimated from self-reported dietary records, but such estimation has proven to be unreliable. When energy intakes determined from dietary records are compared with energy expenditures measured with the use of doubly labeled water, the former consistently underestimate energy requirements and have a high degree of variability.

OBJECTIVE

The objective of this study was to reduce the bias and variability of self-reported dietary records through the use of stepwise multiple regression analysis to develop models that relate energy expenditure measured with the use of doubly labeled water to energy intake from dietary records, sex, and fat-free mass (or weight and height).

DESIGN

Data from 54 healthy adult men and women were used to develop these models.

RESULTS

Fat-free mass, energy intake, and sex accounted for 86% of the variability in energy expenditure, whereas energy intake, sex, height, and weight accounted for 83%. When the model relating fat-free mass, energy intake, and sex to energy expenditure was tested on published data, it reduced the bias and variability of self-reported dietary records from -17 +/- 27% to 3 +/- 16%. When the model relating energy intake, sex, weight, and height to energy expenditure was tested on published data, it reduced the bias and variability of self-reported dietary records from -19 +/- 25% to -0.3 +/- 19%.

CONCLUSION

Results from this study indicate that a simple relation can be used to correct self-reported dietary records to estimated energy requirements.

Diary days needed to estimate activity among older African-American and Hispanic women

PURPOSE

The purpose of this study was to estimate variation in energy expenditure among older African-American and Hispanic female workers and nonworkers, and identify the number of days of diary self-report necessary to reliably estimate activity.

METHODS

227 women (111 African-American, 116 Hispanic) from the Women On The Move study completed a 7-d diary and were used in the analysis for this study (mean age 49.3 yr, SD = 7.0; mean weight 77.0 kg, SD = 17.6 kg; mean BMI 30, SD = 6.5). Kcal per day for total activity and specific types of activity were calculated for each subject and used in generalizability analyses.

RESULTS

Results indicated that 11 d of activity are needed to reliably estimate total activity for African-American nonworkers and 8 d for Hispanic nonworkers. For workers, 12 d of activity are needed to reliably estimate total activity for African-Americans and 14 d are required for Hispanics. Days of diary self-report required by activity type for African-Americans range from 6 to 48 for nonworkers and from 6 to 30 for workers. For Hispanics, days of diary self-report required by activity type range from 8 to 111 for nonworkers and 7 to 42 for workers.

CONCLUSIONS

The results of this study indicate the need for more than 7 d of diary self-report to achieve reliable estimates of total activity in older African-American and Hispanic women. The study also found that certain types of activity could be reliably estimated in less than 7 d. However, when there is less variability in the measure/behavior, the reliability is expected to be less and more measurement days are needed to achieve a desired level of reliability.

Type A behavior and daily living activity among older minority women

INTRODUCTION

The association between type A behavior pattern (TABP) and physical activity is unclear, with studies reporting both positive and negative results and some reporting no association. Because previous studies have looked primarily at the relationship between TABP and exercise, the purpose of this study was to assess the association between TABP and (1) total activity, (2) activity at work, (3) exercise, (4) household chores, (5) leisure activity, and (6) inactivity.

METHODS

Two hundred twenty-seven women (111 African American, 116 Hispanic) from a larger study (Women on the Move) were used in the analysis for this study. The mean age was 49.3 years (SD 7 years), mean weight 77 kg (SD 17.6 kg), and mean body mass index (BMI) 30 (SD 6.5). As part of the Women on the Move Study, participants completed a 7-day diary and a 10-item Activity Temperament Scale. Multiple regression analysis was conducted to test the relationship between TABP and daily activity. Significant findings were observed for total activity and leisure activity with the Activity Temperament Scale summary score. Both had positive associations, indicating that those who had a higher score on the Activity Temperament Scale also had higher total activity kilocalories (kcal) and leisure activity kilocalories. Significant positive findings were also observed for total activity, leisure activity, and exercise with individual items on the Activity Temperament Scale. Household chores, work, and inactivity had significant negative associations with one or more of the individual items on the Activity Temperament Scale.

CONCLUSIONS

Although previous studies have reported on TABP and physical activity (primarily exercise), these findings provide new information specific to daily living activity by dimension in an older minority population. Results suggest a positive association between TABP and daily living activity with a general pattern of higher scores associated with higher activity and lower scores associated with higher inactivity. However, even though some significant findings were observed, the overall models did not reveal meaningful associations.

Comparison of energy expenditure estimates from doubly labeled water, a physical activity questionnaire, and physical activity records

BACKGROUND

Various methods are used by epidemiologists to estimate the energy cost of physical activity; these include physical activity records and recalls. However, there is limited validation of these methods against the doubly labeled water technique for determining energy expenditure (EE).

OBJECTIVE

We compared EE as estimated by indirect methods (physical activity records and recall questionnaires) used in epidemiologic studies with EE obtained from doubly labeled water (EE(DLW)) in free-living men.

DESIGN

We determined EE(DLW), energy intake at weight maintenance, and EE from 7-d physical activity records (EE(Record)) and a 7-d physical activity recall questionnaire (EE(Recall)) in 24 men aged 41 plus minus 2.0 y ( plus minus SEM) with a body mass index (in kg/m(2)) of 25.1 plus minus 0.5.

RESULTS

There was excellent agreement between EE(DLW) (13.27 plus minus 0.35 MJ/d) and energy intake (13.19 plus minus 0.36 MJ/d), with a difference of 0.5 plus minus 1.0% ( plus minus SE). The indirect measures of physical activity and EE were 14.17 plus minus 0.37 MJ/d for EE(Record) (difference from EE(DLW): 7.9 plus minus 3.2%) and 17.40 plus minus 1.45 MJ/d for EE(Recall) (difference from EE(DLW): 30.6 plus minus 9.9%).

CONCLUSIONS

Seven-day physical activity records provide an acceptable estimate of EE in free-living adults compared with EE(DLW), but 7-d physical activity recalls have limited application to estimate daily EE. For optimal validity, the 7-d physical activity records require good subject compliance and the provision of careful instructions for their use.

Is TV viewing an index of physical activity and fitness in overweight and normal weight children?

OBJECTIVE

To assess relationships between TV viewing and body composition, energy expenditure, physical activity, fitness and nutrition habits in prepubertal children.

DESIGN

Cross-sectional study.

SUBJECTS

Sixty prepubertal children (mean body mass index: 20.8 kg m(-2), age: 5-11 years, overweight: n = 52, normal weight: n = 8).

METHODS

TV consumption, socio-economic status (SES) and nutrition habits were estimated by questionnaires. Fat mass and fat-free mass were assessed by anthropometrics and bioelectrical impedance analysis, and resting energy expenditure by indirect calorimetry. Total energy expenditure was measured by a combination of indirect calorimetry and individually calibrated 24-hour heart rate (HR) monitoring. Activity-related energy expenditure and physical activity level were calculated. Aerobic fitness (VO2 submax) was determined by ergometry, muscle strength (musculus quadriceps, musculus ischiocruralis) was measured by computer tensiometry. Children were stratified according to their daily TV consumption: <or=1 h of TV per day (group I) and >1 h of TV per day (group II).

RESULTS

When compared with children of group I, children of group II had increased body weight, body mass index, skinfolds, fat mass and prevalence of overweight (P < 0.05 and <0.01, respectively). By contrast, fat-free mass, energy expenditure, measures of physical activity and muscle strength were similar. Children of group II had normal absolute VO2 submax but reduced adjusted VO2 submax (P < 0.05). They also had parents with a lower educational level (P < 0.05). Similar nutritional habits were observed in both groups. There were no significant differences in the observed parameters between children with high (1-3 h day(-1)) and very high (>3 h day(-1)) TV viewing.

CONCLUSIONS

There is a positive relationship between TV viewing and fatness. Increased TV viewing does not reflect reduced 24-hour energy expenditure as assessed by 24-hour HR monitoring, submaximal VO2, muscle strength or poor dietary intake. Increased TV consumption is associated with a low SES.

The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees

PURPOSE

To evaluate the effect of social desirability trait, the tendency to respond in a manner consistent with societal expectations, on self-reported fruit, vegetable, and macronutrient intake.

METHODS

A 61-item food frequency questionnaire (FFQ), 7-item fruit and vegetable screener, and a single question on combined fruit and vegetable intake were completed by 132 female employees at five health centers in eastern Massachusetts. Intake of fruit and vegetables derived from all three methods and macronutrients from the FFQ were fit as dependent variables in multiple linear regression models (overall and by race/ethnicity and education); independent variables included 3-day mean intakes derived from 24-hour recalls (24HR) and score on the 33-point Marlowe-Crowne Social Desirability scale (the regression coefficient for which reflects its effect on estimates of dietary intake based on the comparison method relative to 24HR).

RESULTS

Results are based on the 93 women with complete data and FFQ-derived caloric intake between 450 and 4500 kcal/day. In women with college education, FFQ-derived estimates of total caloric were associated with under-reporting by social desirability trait (e.g., the regression coefficient for total caloric intake was -23.6 kcal/day/point in that group versus 36.1 kcal/day/point in women with education less than college) (difference = 59.7 kcal/day/point, 95% confidence interval (CI) = 13.2, 106.2). Except for the single question on which women with college education tended to under-report (difference =.103 servings/day/point, 95% CI = 0.003, 0.203), there was no association of social desirability trait with self-reported fruit and vegetable intake.

CONCLUSIONS

The effect of social desirability trait on FFQ reports of macronutrient intake appeared to differ by education, but not by ethnicity or race. The results of this study may have important implications for epidemiologic studies of diet and health in women.

Total energy expenditure in stable patients with cystic fibrosis

BACKGROUND AND AIMS

Undernutrition is a common problem in patients with cystic fibrosis and is associated with a poor prognosis. The two aims of this study were to assess and compare the two main field techniques in the measurement of total energy expenditure and, secondly, to assess total energy expenditure in stable patients and compare with healthy controls.

METHODS

Resting energy expenditure was measured using indirect calorimetry and total energy expenditure was measured using 24-h heart rate (HR) methodology and doubly isotopically labelled water.

RESULTS

Seventeen patients, mean age 23 years and FEV(1)52% predicted and thirteen controls were recruited. Resting energy expenditure was higher in patients 0.24 (0.03) MJ/kg Fat-Free Mass (FFM) compared to controls 0.22 (0.02) MJ/kg FFM, P=0.02. Twenty-four hour heart rate underestimated total energy expenditure, 9.49 (1.85) MJ/day in patients compared to 11.69 (2.79) MJ/day using doubly labelled water. There was no difference in total energy expenditure in patients and controls using both methods, 11.69 (2.79) MJ/day compared to 11.38 (2.71) MJ/day using doubly isotopically labelled water.

CONCLUSIONS

In clinically stable young adult patients with moderately severe respiratory disease total energy expenditure is comparable to that an a control population despite in increase in resting energy expenditure and both 24-h HR and doubly isotopically labelled water are suitable for use in patients with cystic fibrosis.

The validity of self-reported energy intake as determined using the doubly labelled water technique

In the 1980s the development of the doubly labelled water (DLW) technique made it possible to determine the validity of dietary assessment methods using external, independent markers of intake in free-living populations. Since then, the accuracy of self-reported energy intake (EI) has been questioned on a number of occasions as under-reporting has been found to be prevalent in many different populations. This paper is a review of investigations using the DLW technique in conjunction with self-reported EI measures in groups including adults, children and adolescents, obese persons, athletes, military personnel and trekking explorers. In studies where a person other than the subject is responsible for recording dietary intake, such as parents of young children, EI generally corresponds to DLW determined energy expenditure. However, in instances where the subjects themselves report their intake, EI is generally under-reported when compared with energy expenditure. It was originally believed that this phenomenon of under-reporting was linked to increased adiposity and body size, however, it is now apparent that other factors, such as dietary restraint and socio-economic status, are also involved. This paper therefore aims to present a more comprehensive picture of under-reporting by tying in the findings of many DLW studies with other studies focusing particularly on the characteristics and mechanisms for under-reporting. Awareness of these characteristics and mechanisms will enable researchers to obtain more accurate self-reports of EI using all dietary recording techniques.

Eating behavior: lessons from the real world of humans

Food intake by normal humans has been investigated both in the laboratory and under free-living conditions in the natural environment. For measurement of real-world intake, the diet-diary technique is imperfect and tends to underestimate actual intakes but it appears to be sensitive, can detect subtle influences on eating behavior, and produces reliable and valid measures. Research studies in the real world show the multivariate richness of the natural environment, which allows investigation of the complexities of intake regulation, and even causation can be investigated. Real-world research can overcome some of the weaknesses of laboratory studies, where constraints on eating are often removed or missing, facilitatory influences on eating are often controlled or eliminated, the importance of variables can be overestimated, and important influences can be missed because of the short durations of the studies. Real-world studies have shown a wide array of physiologic, psychological, and social variables that can have potent and immediate effects on intake. Compensatory mechanisms, including some that operate with a 2- to 3-d delay, adjust for prior excesses. Heredity affects all aspect of food-intake regulation, from the determination of body size to the subtleties of the individual preferences and social proclivities and the extent to which environmental factors affect the individual. Hence, real-world research teaches valuable lessons, and much more is needed to complement laboratory studies.

Field evaluation of the Computer Science and Applications, Inc. physical activity monitor

PURPOSE

The purpose of this study was to evaluate the Computer Science and Applications, Inc. (CSA) activity monitor to quantify physical activity in free living subjects using an activity diary as the criterion measure.

METHODS

Subjects also completed a 7-d physical activity recall at the end of the monitoring period. Nine male and 10 female subjects (mean, SD) (25.0, 3.6 yr) wore the CSA monitor for 7 consecutive days. On 3 of those days, subjects completed an activity diary (2 weekdays and 1 weekend day). Total kcal per day (Dkcal(tot)) was calculated from the self-reported diary classifications of the subject's activities. For the 3 days that coincided with the diary, total number of counts accumulated per day (cnt(tot)) was obtained from the monitor.

RESULTS

The amount of activity per day recorded by the CSA monitor followed the same pattern of change as the activity diary. The cnt(tot) and Dkcal(tot) were significantly (P < or = 0.05) correlated on day 1 (r = 0.65), day 2 (r = 0.49), day 3 (r = 0.55), and for the 3 days pooled (r = 0.51). Subjects were classified as low, moderate, or highly active based on tertiles of kcal from the diary and counts from the CSA monitor. The percentage agreement between the CSA and the activity diary was 68.4% (Kappa = 0.53, P < 0.01). The number of minutes spent in the various activity categories were compared between instruments using an ANOVA model. The results of these analyses suggest that the CSA overestimated light activity and underestimated vigorous activity compared with the diary.

CONCLUSION

In conclusion, the CSA monitor may be useful in a field situation where total physical activity and patterns of physical activity are the desired outcomes.

No effect of gender on different components of daily energy expenditure in free living prepubertal children

BACKGROUND

There are limited and controversial data on the influence of gender on metabolic rate in prepubertal children.

OBJECTIVE

To assess the effect of gender on resting energy expenditure (REE), activity-related energy expenditure (AEE), total energy expenditure (TEE) and physical activity level (PAL) in free-living prepubertal children.

DESIGN

Cross-sectional study.

SUBJECTS

40 prepubertal children (24 boys, 16 girls, 4-11 y old (mean age: 7.0 +/- 1.2 y), BMI 13.1-32.0 kg/m2).

MEASUREMENTS

Energy expenditure was measured by the combination of indirect calorimetry and individually calibrated 24 h heart rate monitoring. Body composition was assessed by anthropometrics and bioelectrical impedance analysis. Socio-cultural and socio-economic factors, as well as activities of daily living, were estimated by questionnaire for the parents. Boys and girls were matched for fat-free mass (FFM, boys: 25.9 +/- 8.5 kg; and girls: 24.4 +/- 4.5 kg, n.s.) and fat mass (FM, boys: 11.6-5.9 kg; and girls: 10.8 +/- 3.3 kg, n.s.).

RESULTS

We found no sex difference in REE, AEE and TEE. PAL was 1.4 +/- 0.3 for boys and 1.2 +/- 0.4 for girls. REE and TEE were significantly related to FFM (r=0.62, r=0.81, r=0.60). FFM was found to be the most significant determinant of REE (r2=0.70). REE accounted for the largest part of the variance in TEE (r2=0.46). Gender had no significant effect.

CONCLUSIONS

There is no effect of gender on energy expenditure in prepubertal children.

Assessment of physical activity level in relation to obesity: current evidence and research issues

PURPOSE

Validations of methods for the assessment of physical activity and studies on the relation between energy expenditure of activity and obesity were reviewed, with suggestions for further research.

DESIGN

Validation studies of field methods for the assessment of physical activity against doubly labeled water were evaluated, studies on the relation between doubly labeled water assessed energy expenditure of activity and obesity are discussed.

METHODS

Three field methods for the assessment of physical activity, validated with doubly labeled water as a criterion method, were included: activity questionnaires, heart rate monitoring, and motion sensors.

RESULTS

The triaxial accelerometer came out as the best field method for the assessment of physical activity, followed by the Baecke activity questionnaire. The majority of obese subjects are moderately active, and an increase in the activity level of obese subjects is limited by the ability to perform exercise of higher intensity.

CONCLUSIONS

Accelerometers are an objective tool for the assessment of physical activity in large populations over periods long enough to be representative for normal daily life and with minimal discomfort to the subjects. The accelerometer can be used to distinguish differences in activity levels between individuals and to assess the effect of interventions on physical activity within individuals.

Heart rate indicators for assessing physical activity level in the field

The reliability and validity of heart rate (HR) indicators for assessing physical activity level (PAL) was examined in 16 male and female farmers in northeast Thailand. For each subject, daytime HRs were monitored for 12 days, 4 days each in three agricultural seasons in a year. At the group level, the percentage of time when HR exceeded flex-HR (%Flex) had the highest reliability as an indicator of PAL even in the season of lowest activity (r > 0.91 in males and r > 0.89 in females). Regarding the reliability of each subject's %Flex for assessing PAL, regression analyses revealed coefficients of determination of 0.73-0.97 in males and 0.62-0.97 in all females except one. Analyses of covariance (ANCOVA), with %Flex as a covariate, showed that the difference among the slopes of PAL of different subjects was not significant in females, but was in males (P = 0.003). Comparison of measured PAL values and corresponding PAL values estimated by a regression equation for all subjects showed that 75% were within +/-0.2; further, PAL values tended to be underestimated in cases when they exceeded 2.0 for males. The results for these Thai-Lao subjects are consistent with previous studies on other populations; thus, it may be concluded that %Flex is reliable and valid for assessing PAL for a group of subjects and for assessing intraindividual variability of PAL. Am. J. Hum. Biol. 11:647-657, 1999. Copyright 1999 Wiley-Liss, Inc.

Impact of a single exercise bout on energy expenditure and spontaneous physical activity of obese boys

The main objective of the present study was to determine whether a structured, laboratory-based exercise task would modify the energy expenditure (EE) and the pattern of spontaneous physical activity (PA) of obese boys on the day of an exercise laboratory visit and on the following day. Fourteen 10- to 15-y-old moderately obese (36.6+/-3.3% fat) boys volunteered. They each had three laboratory visits, I wk apart. In one visit, they performed a strenuous 50-min cycling task; in another, a 30-min medium-intensity cycling task; and in another (which served as placebo), they did not exercise. PA was monitored the day before (d 1), during (d 2), and after (d 3) each laboratory visit by use of a heart rate monitor and a 12-h recall interview. EE was calculated from minute-by-minute heart rate and each child's predetermined relationship between oxygen uptake and heart rate. EE and PA were analyzed from 1300 to 1900 h each day using 15-min intervals. EE tended to decrease (p < 0.087) in the afternoon of all d 2 compared with d 1, and it increased on d 3 after the medium-intensity exercise (p < 0.0005). EE during d 2 and 3 combined, compared with d 1, decreased after the high-intensity exercise (534.2 versus 564.3 kJ/h, p < 0.05). It increased after the medium-intensity exercise (561.8 versus 526.7 kJ/h, p = 0.052) and was not affected after the placebo visit (589.4 versus 574.3 kJ/h). Time spent outdoors was consistently reduced on the day of laboratory visit compared with the day before and after the visit, regardless of the contents of intervention. In conclusion, a single laboratory visit is followed by a reduction in EE and PA on the day of intervention. However, its effect on EE the following day may be dose dependent: medium-intensity exercise induces an increase in EE, but high-intensity exercise causes a decrease in EE. One implication is that intervention by physical training should employ medium-intensity exercise to enhance the EE of obese boys.