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Prentice RL, Aragaki AK, Zheng C, Manson JE, Tinker LF, Ravelli MN, Mossavar-Rahmani Y, Wallace RB, Tooze JA, Johnson KC, Lampe JW, Neuhouser ML, Schoeller DA. Biomarker-assessed total energy intake and its cohort study association with all-cause mortality in postmenopausal females. Am J Clin Nutr 2024; 119:1329-1337. [PMID: 38428741 DOI: 10.1016/j.ajcnut.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The association of total energy intake (EI) with all-cause mortality is uncertain as are the dependencies of this association on age and weight change history. OBJECTIVES To identify an EI biomarker suitable for use in epidemiologic association studies and to study EI associations with total mortality in a Women's Health Initiative (WHI) cohort of postmenopausal United States females (1993-present). METHODS EI biomarkers were developed based on doubly labeled water (DLW) total energy expenditure (TEE) and weight variation during the 2-wk DLW protocol period using the energy balance method in an embedded feeding study (n = 153). This along with 2 earlier WHI nutrition biomarker studies having TEE assessments (n = 1131 total), with 14.6 y (median) follow-up, constituted a prospective cohort for the study of EI and all-cause mortality. RESULTS An empirical biomarker for log(EI) was developed that had a correlation of 0.73 with log(feeding study-consumed EI). The overall association between EI and mortality was nonsignificant. The association, however, depended on age (P = 0.009), with lower EI associated with lower mortality at younger ages, and also on preceding weight change history (P = 0.03). Among participants with stable or increasing weight, mortality hazard ratios (95% confidence intervals [CIs]) for a 12% lower EI were 0.66 (95% CI: 0.51, 0.87) at age 60, 0.84 (95% CI: 0.72, 0.98) at age 70, and 1.06 (95% CI: 0.87, 1.29) at age 80. Corresponding values for participants having preceding weight loss were 0.83 (95% CI: 0.61, 1.12) at age 60, 1.05 (95% CI: 0.87, 1.26) at age 70, and 1.33 (95% CI: 1.08, 1.63) at age 80. A previously considered EI biomarker, using a theoretical model for variation in body fat and fat-free mass components over time, gave similar results following rescaling. CONCLUSIONS Lower EI is associated with lower all-cause mortality among younger postmenopausal females with stable or increasing weight and with higher mortality among older females with weight loss. This study was registered with clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States.
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Cheng Zheng
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Michele N Ravelli
- Biotech Center and Neurology, University of Wisconsin, Madison, WI, United States
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert B Wallace
- College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Center, Memphis TN, United States
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison WI, United States
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Jawara D, Ufearo DM, Murtha JA, Fayanju OM, Gannon BM, Ravelli MN, Funk LM. Racial disparities in selected micronutrient deficiencies after bariatric surgery: A systematic review. Surg Obes Relat Dis 2024; 20:283-290. [PMID: 37891101 PMCID: PMC10922431 DOI: 10.1016/j.soard.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/30/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Bariatric surgery has been associated with numerous micronutrient deficiencies. Several observational studies have found that these deficiencies are more common in racially/ethnically minoritized patients. OBJECTIVES To conduct a systematic review to investigate whether racially/ethnically minoritized patients experience worse nutritional outcomes after bariatric surgery. SETTING University of Wisconsin-Madison. METHODS PubMed, CINAHL, PsychINFO, and Cochrane databases were queried. We searched for manuscripts that reported micronutrient levels or conditions related to micronutrient deficiencies according to race/ethnicity (White, African American/Black, and Hispanic) after laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between 2002 and 2022. Eleven micronutrients (vitamins A, B1 [thiamine], B12, D, E, K, calcium, copper, folate, iron, and zinc), and four conditions (anemia, bone loss, fractures, and hyperparathyroidism) were assessed. RESULTS Abstracts from 953 manuscripts were screened; 18 full-text manuscripts were reviewed for eligibility, and ten met the inclusion criteria. Compared to White patients, African Americans had a higher prevalence of thiamine, vitamin D, and vitamin A deficiencies. There were no differences in calcium and vitamin B12 deficiencies. The other six micronutrients were not assessed according to race/ethnicity. Hyperparathyroidism was more prevalent in African Americans than White patients in the three studies that evaluated it. The prevalence of fractures was mixed. Anemia and bone loss were not evaluated according to race/ethnicity. CONCLUSIONS Although the literature on micronutrient outcomes following bariatric surgery according to race/ethnicity is limited, African Americans appear to experience a higher prevalence of vitamin deficiencies and associated conditions. Qualitative and quantitative research to explore these disparities is warranted.
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Affiliation(s)
- Dawda Jawara
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | | | | | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bryan M Gannon
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Luke M Funk
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial VA, Madison, Wisconsin.
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Chu DY, Ravelli MN, Faltersack KM, Woods AL, Almane D, Li Z, Sampene E, Felton EA. Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet. Front Nutr 2024; 10:1304209. [PMID: 38249600 PMCID: PMC10796679 DOI: 10.3389/fnut.2023.1304209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Previous studies have demonstrated the safety and efficacy of the modified Atkins diet (MAD) in attenuating seizures in patients with intractable epilepsy. MAD works by achieving ketosis, which is heavily dependent on the metabolic compound, carnitine, to facilitate the transport of long-chain fatty acids across the mitochondria for beta-oxidation. The effect of carnitine on ketogenic diet therapy is not well-defined in the current literature. Thus, the purpose of our study is to investigate the effects of hypocarnitinemia on the efficacy of MAD. Methods A retrospective chart review was conducted, and 58 adults with epilepsy undergoing MAD were evaluated. Generalized linear mixed effects models were used to compare the low carnitine status with normal carnitine group in patient measures of body mass index, seizure frequency and severity, number of anti-seizure medications, beta-hydroxybutyrate, triglyceride, and carnitine levels across baseline, 3-9-month follow-up (timepoint 1), 1-2-year follow-up (timepoint 2), and 2+ year follow-up (timepoint 3). Results Our study revealed that 38.3% of adult patients with epilepsy following MAD experienced low free carnitine at some point through the course of diet therapy. Patients with hypocarnitinemia at timepoint 2 showed a significant percent seizure increase while seizures continued to decrease in the normal carnitine group. Fasting triglyceride levels at timepoint 1 were significantly increased in the low carnitine group compared to normal carnitine group. Change in BHB, BMI, seizure severity, and number of ASMs showcased no significant differences between the low and normal carnitine groups. Discussion It may be important for clinicians to monitor for hypocarnitinemia in adults on MAD and provide carnitine supplementation when low. Further investigations into carnitine and MAD may inform clinical decisions on carnitine supplementation to maximize the efficacy of MAD therapy.
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Affiliation(s)
- Daniel Y. Chu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Michele N. Ravelli
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Kelly M. Faltersack
- Department of Clinical Nutrition, University of Wisconsin Hospitals and Clinics, Madison, WI, United States
| | - Arron L. Woods
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Zhanhai Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Emmanuel Sampene
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Elizabeth A. Felton
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Leandro-Merhi VA, de Almeida Souza Tedrus GM, Jacober de Moraes GG, Ravelli MN. Interaction between vitamin D level, antiseizure medications (ASM) and seizure control in epilepsy adult patients. Rev Neurol (Paris) 2023; 179:1111-1117. [PMID: 37758540 DOI: 10.1016/j.neurol.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To investigate vitamin D levels and factors associated with seizure control in adult patients with epilepsy (APE). METHOD Cross-sectional study with APE in routine outpatient follow-up at a neurology clinic. Clinical variables, antiseizure medications (ASM) and vitamin D were investigated. Data were analyzed using the Chi2 or Fisher's exact tests, Mann-Whitney, Spearman's correlation coefficient, ROC curve and univariate and multiple logistic regression analysis. RESULTS Mean age was 46.5±15.1 years and disease duration was 27.5±17.0 years; 52.7% (n=49) of patients used one ASM and 47.3% (n=44) used≥2 ASM. There was a significant difference in the level of vitamin D according to the number of ASM and it was higher in patients who used a single ASM (26.02±10.22 versus 22.50±8.69; P=0.048). In the logistic regression, when vitamin D level was set at 20ng/mL, the chance of seizure control for patients using a single ASM was 6.99 times greater than for those using≥2 ASM. When vitamin D level was set at 40ng/mL, the number of ASM did not modify seizure control. There was no correlation between vitamin D and disease duration, patient age and age at the time of the first seizure. In the logistic regression, it was observed that satisfactory levels of vitamin D did not modify potential seizure control. CONCLUSION Thirty-three percent (33%) of patients presented with vitamin D deficiency (values below 20ng/mL) and 80% had vitamin D levels below what is recommended (30ng/mL). The use of ASM, when associated with different levels of vitamin D, modified the probability of seizure control in APE. Vitamin D levels and intrinsic epilepsy factors are associated with failure to effectively control seizures.
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Affiliation(s)
| | | | | | - M N Ravelli
- Department of Neurology (SMPH), University of Wisconsin, Madison, USA.
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Polfuss M, Bandini LG, Ravelli MN, Huang Z, Moosreiner A, Schoeller DA, Huang CC, Ding D, Berry C, Marston E, Hussain A, Shriver TC, Sawin KJ. Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol. Front Pediatr 2023; 11:1151797. [PMID: 37547107 PMCID: PMC10397728 DOI: 10.3389/fped.2023.1151797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS. Methods This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS. Discussion The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.
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Affiliation(s)
- Michele Polfuss
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, United States
| | - Linda G. Bandini
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Michele N. Ravelli
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Zijian Huang
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Moosreiner
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Dale A. Schoeller
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Chiang-Ching Huang
- Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, United States
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cristen Berry
- Pediatric Translational Research Unit, Children’s Wisconsin, Milwaukee, WI, United States
| | - Emma Marston
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Azeem Hussain
- Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, United States
| | - Timothy C. Shriver
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Kathleen J. Sawin
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, United States
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Ravelli MN, Schoeller DA. Traditional Self-Reported Dietary Instruments Are Prone to Inaccuracies and New Approaches Are Needed. Front Nutr 2020; 7:90. [PMID: 32719809 PMCID: PMC7350526 DOI: 10.3389/fnut.2020.00090] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Diet is a modifiable behavior that influences an individual's health. Because of this, diet assessment is an important component of public health surveillance, evaluating response to community health interventions, and monitoring individual compliance to medical interventions. Diet assessments are usually performed using one of three basic methods: diet recall, diet diaries, or food frequency questionnaires. Although these three assessment instruments have displayed a strong agreement between themselves, when reported intake is compared with intake measured using quantitative nutrient biomarkers, investigators have identified systematic misreporting errors for all three of these self-reported dietary instruments. Aims: This work aims to summarize the state of knowledge regarding misreporting and why it impedes diet–health research and to introduce advances in the collection and the treatment of dietary data. Methods: This work reviews and summarizes published data on misreporting and the recent efforts to reduce such errors. Results: The evidence demonstrates a strong and consistent systematic underreporting of energy intake (EIn) across adults and children studies. Underreporting of EIn has been found to increase with body mass index (BMI), and the differences between macronutrient reports indicate that not all foods are underreported equally. Protein is least underreported, but which specific foods are commonly underreported are not known. Conclusions: Because energy underreporting varies as a function of BMI, self-reported EIn should not be used for the study of energy balance in the study of obesity. The between-individual variability in the underreporting of self-reported intake of energy and other nutrients attenuates diet–disease relationships. Recent efforts to correct for underreporting have reduced misreporting of diet outcomes, but improvements have been incremental in nature and more research is needed to validate and extend these efforts.
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Affiliation(s)
- Michele N Ravelli
- Department of Neurology, University of Wisconsin, Madison, WI, United States
| | - Dale A Schoeller
- Nutritional Sciences and Biotechnology Center, University of Wisconsin, Madison, WI, United States
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