Medical record versus researcher measures of height and weight

This study examined the extent of agreement between medical record and researcher measures of height and weight in adults and assessed the clinical significance of any resulting differences in body mass index (BMI) (kg/m(2)) according to the categorizations of underweight, normal weight, and overweight. Medical record and researcher measurements for height (n = 85), preoperative weight (n = 84), and postoperative weight (n = 65) in older patients undergoing elective coronary artery bypass grafting were used for analysis. Researcher measurements of height and weight were obtained by the same person and were compared to height and weight measurements extracted from the medical record. Bland and Altman's limits of agreement method was used to determine the extent of measurement error between medical record and researcher values. Cohen's kappa was used to assess for clinical significance of the differences in BMI categories based on medical record and researcher measurements. For height, 7% of the values were outside the 95% limits of agreement. For preoperative and postoperative weight, less than 5% of the values were outside the 95% limits of agreement. There were no significant differences in BMI categorization using Cohen's kappa between medical record and researcher measurements. Although there may be some measurement error for height in the medical record, weight measurements may have less error and the amount of measurement error may not be clinically relevant. Height and weight measurements extracted from the medical record are reliable and accurate in patients admitted for elective surgery, as are weight measurements obtained in stable postoperative patients.     

Assessment of a food frequency questionnaire as a screening tool for low fat intakes

This study tested the ability of a self-administered food frequency questionnaire (FFQ) to identify women with low fat intakes. FFQs were completed by 95 control participants of a dietary trial at a mean of 2.9 ± 0.8 years post-randomization. Subjects were selected in approximately equal numbers from women who were low-fat eaters (⩽30% of energy from fat) and high-fat eaters (>30% of energy from fat). Percentage energy from fat derived from food records and FFQ were similar in both the low- and high-fat eaters. Percentage of energy from carbohydrate and total grams of carbohydrate (low-fat eaters only) were slightly higher measured by FFQ than by food records, and percentage of energy from protein was slightly lower. The correlation between nutrient intake measured by FFQ and food records for the whole group was 0.74 for percentage of energy from fat, 0.50 for total fat, 0.59 for percentage of energy from carbohydrate, 0.43 for total carbohydrate, 0.53 for percentage of energy from protein, 0.27 for total protein, and 0.32 for energy intake. Correlations were slightly lower when the low-and high-fat eaters were examined separately. The area under the receiver operating characteristic (ROC) curve, 0.83, was significantly above 0.5 (p < < 0.001), indicating that the FFQ discriminated between low- and high-fat eaters significantly better than chance. The FFQ cutoff point of 30% of energy from fat had a true positive rate of 0.63 and false positive rate of 0.24. The use of this cutoff point for screening would result in the loss of 36% of potential subjects and an estimated increase in baseline percentage of energy from fat intake of 2.3 percentage points.     

Development of a food-frequency questionnaire to measure the dietary calcium intake of adult Japanese women

Assessing calcium intake is necessary for epidemiological studies on osteoporosis. This study was aimed at developing a valid food frequency questionnaire (FFQ) to estimate the dietary calcium intake of Japanese people. The FFQ contains 26 items, representing common sources of calcium. The respondents, 74 women aged 15 - 79 years living in Fukui city, whose dietary calcium intake was estimated at 638 +/- 306 (S.D.) mg based on a one-day weighted food record kept during the National Nutrition Survey of 1996, were asked to indicate their consumption frequency and usual portion size (large, medium, small) for each food item. Trained dieticians interviewed the subjects to confirm their answers to the FFQs. The mean calcium intake per day according to the FFQ (655 +/- 222 mg) did not differ significantly from that according to the one-day food record. The coefficient of correlation between these methods was 0.512, a statistically significant value. The calcium intake from dairy products showed a good correlation, r = 0.717. The coefficient of correlation between the values estimated based on two FFQ filled out three days apart was 0.900, showing good test-retest reliability. Therefore, this FFQ is valid and reliable in estimating dietary calcium intake for epidemiological studies.     

Malnutrition in geriatric patients: a neglected problem?

The nutrient intake in geriatric long-stay patients and the mortality risk associated with low energy intake were studied in 61 patients, 43 women and 18 men, with a mean age of 87 years, at a geriatric long-stay care hospital during a 6-month follow-up. Dietary intake was assessed with a 9-day dietary record. Energy expenditure was calculated assuming a physical activity level of 1.33 × basal metabolic rate (BMR), predicted from equations given by FAO/WHO. Mean energy intakes were 1557 kcal in men and 1280 kcal in women; 84% of the patients had an intake below estimated energy expenditure and 30% were below estimated BMR. Only 5% received dietary supplement. Eleven out of the 61 patients died during the follow-up and the deceased had lower energy intake than the others (1185 kcal vs 1401 kcal, P <0.05). An energy intake below median (1378 kcal) was associated with an age adjusted increased 6-month mortality risk, odds ratio 12.5. A high proportion of geriatric long-stay patients report dietary intake far below present recommendations and are thereby at risk for having/developing malnutrition. Improved surveillance of geriatric long-stay patients'dietary habits seems justified.     

慢阻肺缓解期患者营养不良及其相关因素分析

观察７６例慢阻肺缓解期患者的肺功能，饮食摄入情况与营养状况的关系，并探讨了ＣＯＰＤ患者营养不良发生的机理。结果显示５４．０％的ＣＯＰＤ患者体重低于理想体重的９０％。８４．２％的患者膳食中热能摄入量低于正常人标准供给量。ＦＥＶ１占预计值百分比，ＦＥＶ１／ＦＶＣ％与饱含中总热能摄入量占正常人标准供给量的百分比呈正相关，ＦＶＣ占预计值百分比与Ｅ％ＲＤＡ相关无显著性。     

Influence of glycemic index/load on glycemic response, appetite, and food intake in healthy humans

OBJECTIVE: High glycemic index (GI)/load (GL) diets reportedly enhance appetite and promote positive energy balance. Support for this hypothesis stems largely from acute feeding trials and longer-term studies lacking control over the macronutrient composition and palatability of test foods. This study evaluated the effects of consuming high- and low-GI/GL meals, matched on macronutrient composition and palatability, plasma glucose and insulin, appetite, and food intake. RESEARCH DESIGN AND METHODS: Thirty-nine healthy adults consumed only low- or only high-GI foods ad libitum in the laboratory for 8 days in either high (three foods per meal)- or low (one food per meal)-variety conditions. Glucose and insulin concentrations as well as appetitive sensations were determined before and for 2 h following breakfast and lunch on days 1 and 8. Energy intake was monitored daily. RESULTS: There were no significant differences in plasma glucose or insulin responses, appetitive ratings, or food intake between treatments. CONCLUSIONS: These data indicate that the differential glycemic response of foods tested in isolation under fixed time are not preserved under conditions of chronic ad libitum consumption of mixed meals.     

Regulation of serum paraoxonase activity by genetic,nutritional, and lifestyle factors in the general population

BACKGROUND: Paraoxonase may protect lipoproteins and cell membranes from peroxidation, and alterations in the activity of this enzyme have been associated with some chronic diseases. Serum paraoxonase appears to be mainly under genetic control, but some studies suggest that environmental factors may also modulate its activity. The aim of the present study was to investigate whether diet and lifestyle affect serum paraoxonase activity. METHODS: We studied a population-based sample of 388 individuals (194 women and 194 men; age range, 18-75 years) and assessed their daily dietary intake using a 3-day estimated food record. The variables studied included serum paraoxonase activity, paraoxonase polymorphisms at positions 55 and 192, age, gender, smoking status, physical exercise, body mass index, energy consumption, nutrient intake (total lipids, saturated fatty acids, beta-carotenes, vitamins C and E), and serum lipid concentrations. RESULTS: Multiple linear regression analysis showed that only genetic polymorphisms, serum cholesterol, HDL-cholesterol concentrations, and cigarette smoking were significant predictors of serum paraoxonase activity. HDL-cholesterol concentrations were also related to body mass index, daily energy consumption, and saturated fatty acid intake. CONCLUSIONS: The between-individual variability of serum paraoxonase activity is regulated mainly by genetic determinants. Although HDL-cholesterol and tobacco smoking may contribute to the modulation of this enzyme, the other nutritional and lifestyle factors do not seem to play a significant role.     

Agreement between percentage pain reductions calculated from numeric rating scores of pain intensity and those reported by patients with acute or cancer pain

The use of percentage pain reduction is increasingly used to evaluate the effectiveness of pain treatments, but the degree of agreement between calculated percentage pain reduction (CPPR) as calculated from pre- and post-treatment levels of pain intensity and those reported directly by patients is unknown. Lack of agreement between these two measures could lead to errors in the determination of treatment effectiveness. We aimed to determine the agreement between CPPR and patient-reported percentage pain reduction (PRPPR). Patients with acute or cancer pain were asked to rate their pain intensity on a 0-10 verbal numerical rating scale (NRS) and to estimate the percent pain reduction from baseline pain after analgesic administration. They then received analgesics every 10 min until pain intensity declined to 4/10 or less. To evaluate agreement between CPPR and PRPPR, we computed the concordance correlation coefficient (CCC), which measures both accuracy and precision, and estimated the 95% limits of agreement for the differences between these two measures. 761 adult patients were enrolled. Female, healthy patients with acute pain of severe intensity and high levels of education predominated in the sample. The mean difference between CPPR and PRPPR was -2.6% (95% limits of agreement -12 to 17%). The CCC was 0.56 (accuracy was 0.9 and precision was 0.6). Although CPPR appeared to underestimate PRPPR in the higher range, this trend was not clinically important. The agreement between percentage pain reductions calculated from NRS scores and those estimated by patients did not vary according to gender or age. The good overall agreement between percentage pain reductions calculated from NRS scores and those estimated by patients suggests that these indices may be used interchangeably. The findings of this study extend existing patient-centered pain research and may be applied for the evaluation and comparison of pain treatments.     

Postoperative Energy Intake in Patients after Colorectal Cancer Surgery

In a prospective noninterventional study of 75 consecutive patients (mean age 71 ± 12 years) undergoing surgery for colorectal cancer, standard postoperative energy intake was evaluated. Seventeen patients expended 40%–60% of estimated basal energy during hospitalization, 33 patients 60%–80%, 22 patients 80%–100% and three patients 100%–125%. Weight loss was observed in 67 patients (mean loss 4.7 ± 4.4%) during hospitalization. Men had a significantly higher mean total calorie deficit (p < 0.001), and mean weight loss percentage (p < 0.01), compared to women. Preoperative nutritional status, nutrition-associated complications and length of hospital stay did not change the nutritional support and intake. Correlation analyses resulted in significant associations between gender and total calorie deficit (r_s = 0.41, p < 0.01), postoperative weight loss and total calorie deficit (r_s = ?0.32, p<0.01), and between postoperative weight loss and length of stay (r_s = 0.27, p < 0.05). We concluded that the patients' energy intake was insufficient compared to estimated basal energy expenditure. These results suggest a need for individualized nutritional care, based on each patient's energy needs and on registration of daily calorie intake, all with the aim of increasing energy intake postoperatively in standard hospital care.     

Use of electronic self-monitoring for food and fluid intake: A pilot study.

In this small pilot study, the authors examined the use of a personal digital assistant (PDA) to electronically self-monitor the dietary and fluid intake of individuals receiving hemodialysis. The purpose of this study was to describe intake patterns of fluid, sodium, potassium, phosphorus, protein, and calories over a 3-month period as recorded using a PDA. Mean weekly intake values were plotted on line graphs to examine trends of intake. The patients' mean weekly intakes of sodium, potassium, phosphorus, and fluid were dynamic and fluctuating. Protein and caloric intakes were significantly below the recommendations of the K/DOQI guidelines. Standard methods to assess intake may not adequately capture intake patterns on a daily basis.     

Diet, growth, and the risk for type 1 diabetes in childhood: a matched case-referent study

OBJECTIVE: To study the association between type 1 diabetes risk and previous intake of energy, accounting for body size and previous intake of nutrients and foods, accounting for the energy intake. RESEARCH DESIGN AND METHODS: We conducted an incident population-based case-referent study in Stockholm, Sweden, including 99 of 100 eligible 7- to 14-year-old diabetic children and 180 of 200 age-, sex-, and area-matched referent children identified through the Swedish population register. Average daily energy and nutrient intake 1 year before diabetes diagnosis/interview was estimated using the food frequency questionnaire with assessment of consumed food amounts. Mean SD scores of growth measurements taken during the last 4 years before the diagnosis were used. Odds ratios (ORs) were calculated by conditional logistic regression. RESULTS: Average intake of energy, carbohydrate, fat, and protein was significantly higher among the case subjects as well as mean weight-for-age SD score. Higher energy intake and weight-for-age were both associated with increased diabetes risk after adjustment for each other: OR (95% CI) for medium and high levels of energy intake were 1.33 (0.52-3.42) and 5.23 (1.67-16.38), respectively, and for weight-for-age were 3.20 (1.30-7.88) and 3.09 (1.16-8.22), respectively. High intake of carbohydrates, especially disaccharides and sucrose, increased diabetes risk. CONCLUSIONS: Higher energy intake and larger body size were independently associated with increased diabetes risk. Of the different nutrients, higher intake of carbohydrates, particularly disaccharides and sucrose, increased the risk. Lifestyle habits leading to higher energy intake and more rapid growth in childhood may contribute to the increase of childhood-onset type 1 diabetes by different mechanisms.     

Modulation of food intake by glucose in patients with type 2 diabetes

OBJECTIVE: A gain in body weight is a common adverse effect of glucose-lowering therapies in patients with type 2 diabetes, the mechanisms of which are not completely understood. Blood glucose is considered to play a crucial role in the regulation of food intake. On this background, we hypothesized that a short-term reduction of blood glucose concentration to normal values acutely increases food intake in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: To test this hypothesis, 12 patients with type 2 diabetes were examined twice, once during a euglycemic (5.0 mmol/l) clamp experiment and another time during a hyperglycemic (10.5 mmol/l) clamp. The experiments were performed in a single-blind fashion with the order of conditions balanced across patients. On both clamp conditions, insulin was infused at a constant rate of 2.5 mU/kg per min for 125 min. Simultaneously, a glucose solution was infused at a variable rate to achieve target glycemic levels. During the final 30 min of the clamps, the patients were allowed to eat as much as they liked from a standard breakfast buffet. RESULTS: Compared with the hyperglycemic condition, the patients ingested on average 25 +/- 10% more energy during euglycemia (645 +/- 75 vs. 483 +/- 37 kcal; P = 0.029). The increased energy intake during euglycemia was equally distributed across macronutrient components, i.e., during euglycemia the patients ate more carbohydrates (+27.1 +/- 11.4%; P = 0.037), fat (+22.5 +/- 10.0%; P = 0.046), and proteins (+25.2 +/- 11.2%; P = 0.046) than during hyperglycemia. Circulating levels of insulin, amylin, leptin, ghrelin, and glucagon-like peptide-1 did not differ between the euglycemic and hyperglycemia clamp, excluding a major contribution of these hormones to the difference in food intake. Summing up the glucose administered intravenously and the food ingested yielded a remarkably similar total energy influx in both conditions (794 +/- 64 vs. 790 +/- 53 kcal; P = 0.961). CONCLUSIONS: Together our data suggest that total energy supply to the organism is tightly regulated on a short-term basis independent of the route of influx. Alternatively, it can be hypothesized that euglycemia stimulated or that hyperglycemia suppressed food intake at the subsequent buffet meal in our type 2 diabetic patients. Regardless of these different interpretations, our data indicate an important regulatory role of glucose for food intake in type 2 diabetic patients that is of considerable clinical relevance.     

Comparison of the protein composition of breast milk and the nutrient intake between Thai and Japanese mothers

This study compared the protein composition of breast milk and the nutrient intake between Thai and Japanese lactating mothers. The breast milk was collected from 15 Thai and 14 Japanese mothers at the fifth day post-partum. Twenty-four-hour dietary records were performed from the second-to-the-fourth day post-partum. The nutrient intake was calculated by using the nutrient content of a food table. The protein composition of the whey was separated by gel electrophoresis and was identified by mass spectrometry and two-dimensional electrophoresis. The results showed that the concentrations of the major protein types in the breast milk were not significantly different between the two groups. The concentrations of the minor protein types varied markedly with the individuals, with higher concentrations in the breast milk of the Thai mothers. There were no significant differences in terms of the energy and protein intake; however, the sources of energy were different. The results indicate that the total protein and lactoferrin concentrations in the breast milk could be predicted by the maternal daily energy and fat intake.     

Effects of a raw food diet on hypertension and obesity

We examined responses to cooked and uncooked food in 32 outpatients with essential hypertension; 28 were also overweight. By varying cooked and uncooked food percentages and salt intake, patients acted as their own control subjects in this unblinded study. After a mean duration of 6.7 months, average intake of uncooked food comprised 62% of calories ingested. Mean weight loss was 3.8 kg and mean diastolic pressure reduction 17.8 mm Hg, both statistically significant (P less than .00001). Eighty percent of those who smoked or drank alcohol abstained spontaneously.     

Gastrointestinal regulation of food intake

Despite substantial fluctuations in daily food intake, animals maintain a remarkably stable body weight, because overall caloric ingestion and expenditure are exquisitely matched over long periods of time, through the process of energy homeostasis. The brain receives hormonal, neural, and metabolic signals pertaining to body-energy status and, in response to these inputs, coordinates adaptive alterations of energy intake and expenditure. To regulate food consumption, the brain must modulate appetite, and the core of appetite regulation lies in the gut-brain axis. This Review summarizes current knowledge regarding the neuroendocrine regulation of food intake by the gastrointestinal system, focusing on gastric distention, intestinal and pancreatic satiation peptides, and the orexigenic gastric hormone ghrelin. We highlight mechanisms governing nutrient sensing and peptide secretion by enteroendocrine cells, including novel taste-like pathways. The increasingly nuanced understanding of the mechanisms mediating gut-peptide regulation and action provides promising targets for new strategies to combat obesity and diabetes.     

Nutritional behaviour and quality of life during oncological polychemotherapy: Results of a prospective study on the efficacy of oral nutrition therapy in patients with acute leukaemia

A total of 29 patients with acute leukaemia were prospectively randomized before starting cytostatic treatment to be nourished either with intensified oral nutrition (intervention group) or ad libitum nutritional intake during the whole tumour therapy (median 22 weeks). All received menus of free choice (daily offer of 1.0-2.0 g protein, 30-50 kcal kg-1 body weight (BW)). Beyond this, intervention patients received nutrition education, daily visits by the dietician and record of food intake, as well as a weekly assessment of subjective well-being (linear analogue self assessment 'LASA'). From the LASA items, the factors: 'malaise', 'psychological distress', 'therapy side-effects' were extracted by principal component analysis, and correlated to nutrient intake and nutritional status. At the end of antineoplastic induction therapy, after continuous hospitalization of 10 weeks (median), 31.3% of the controls had regained their initial nutritional status, and 68.8% of the intervention group. Mean daily energy intake was 23.2 kcal kg-1 BW during weeks with weight loss (constant weight: 30.9, weight gain: 39.3 kcal kg-1 BW). Nutritional behaviour correlated with subjective well-being, low intake with complaints of tumour treatment side effects and weight loss with malaise.     

Agreement of measures obtained radiographically and by the OSI CA-6000 Spine Motion Analyzer for cervical spinal motion

The purpose of this study was to determine the agreement between angular measures of cervical spinal motion obtained from radiographs and from measures recorded by the OSI CA 6000 Spine Motion Analyzer (OSI SMA) in asymptomatic subjects. Fourteen subjects performed each of the following motions two times while wearing the OSI SMA: cervical flexion, extension, side bending to the right and left. Each motion was performed once for the cervical radiograph. The difference between the values obtained by the two methods was plotted against the average of those values for each subject to illustrate the level of agreement of the two methods. The plotted points were widely scattered, with a large range between the limits of agreement. Range of motion values taken from the OSI SMA were not similar to those obtained from radiographs for the motions of the cervical spine.     

Food composition table-based estimation of energy and major nutrient intake in comparison with chemical analysis: a validation study in Korea

This study was initiated to examine the accuracy of conventional food composition table-based estimation of intakes of energy, protein, lipid and carbohydrate, in comparison with chemical analysis. For this purpose, 66 women (at the ages of 29 to 54 years) in three locations in Jeju Island, Republic of Korea, volunteered to offer 24-hour food duplicate samples. A half of them were house-wives, and the remaining half were farmers or fishers. The duplicate samples were subjected 1) to the chemical analysis for daily intake of energy, protein, lipid and carbohydrate after official methods in Korea (measured values), and 2) to the estimation of intakes of the same items taking advantage of Korean Food Composition Tables (estimated values). The two sets of the results, i.e., the measured and estimated values, were compared by paired and unpaired t-test, and linear regression analysis. The estimated values correlated closely with the measured values, irrespective of energy or the three major nutrients. A close agreement was observed for energy intake (the estimated/measured ratio of > 98%), and it was also the case for protein intake (101%). Under- and over-estimation was observed, however, in regard to carbohydrate (by - 8%) and lipid intake (by + 24%), respectively. It was concluded that the Korean Food Composition Tables are sufficiently accurate when applied for estimation of total energy intake as well as protein intake. Cares should be taken, however, in applying the tables for estimation of lipid and carbohydrate intake, because there may be the risk of over- and under-estimation for the former and the latter, respectively.