A Low-Fat Intake and Greater Activity Level are Associated With Lower Weight Regain 3 Years After Completing a Very–Low-Calorie Diet

Objective To examine the roles of diet, exercise, and lifestyle factors in determining long-term weight regain after weight loss with a very–low-calorie diet (VLCD).Subjects Twenty-seven of 38 women who lost weight with a VLCD.Design Graduates of a weight loss intervention study returned for follow-up 3 years after program completion. Percentage of initial weight loss that was regained was correlated with subjects’ fat intake (assessed via 7-day food records and a Diet Habit Survey), energy intake (assessed via 7-day food records), activity level and lifestyle factors (assessed via questionnaires) that are supportive of weight loss maintenance.Statistical analyses performed Regression analysis was used to assess the relationship of weight regain with fat intake, activity level, and energy intake. Contingency table analysis was used to assess the association between weight regain and lifestyle factors.Results Subjects followed experienced a −20.7 kg±9.2 kg (−19.2%±7%) (mean±standard deviation) weight change during the original VLCD program and a 13.9 kg±11.3 kg (76.6%±52.1%) weight change 3 years post-VLCD. Fat intake, assessed by a 7-day food diary, was positively correlated with weight regain at 3 years (r=0.66, P=.0004). Less weight regain was also seen with a lower percent fat intake as reflected by a higher Diet Habit Survey score (r=−0.55, P=.004). Women with the lowest tertile of reported fat intake (<25% of energy) from the Diet Habit Survey regained the least amount of weight (P=.05). Activity level was negatively correlated with weight regain (r=−0.53, P=.005). After correction for multiple comparisons, there was no association between total energy intake and weight regain. Lifestyle factors were also not associated with weight regain.Applications/conclusions Identifying strategies to maintain weight loss is crucial because of the negative health effects and increasing prevalence of obesity. For women who have lost weight on a VLCD, limiting dietary fat intake and maintaining physical activity are both important factors for the prevention of weight regain. To promote better weight loss outcomes, registered dietitians should help clients who have lost weight limit their fat intake to less than 30% of energy and encourage high activity levels. J Am Diet Assoc. 2002;102:1252–1256.     

Dietary Intake and Counseling, Weight Maintenance, and the Course of HIV Infection

Objective To define relationships among dietary intake and counseling, weight maintenance, and the clinical course of patients infected with the human immunodeficiency virus(HIV).Design A prospective cohort study in an HIV clinic in a county hospital.Subjects HIV-infected patients (68 with and 40 without acquired immunodeficiency syndrome [AIDS]) who had a good performance status and no chronic diarrhea were assessed at entry to the study and after 6 months. The following assessments were made: energy and nutrient intake based on 7-day food records, anthropometric measurements, immunologic function as lymphocyte T-cell subpopulations (ratio of CD4 to CD8), and serum cholesterol level. Patients were monitored to determine clinical outcome.Intervention All patients received standardized dietary counseling designed to address identified intake deficiencies and maintain body weight.Main outcome measures Changes in energy and nutrient intake, body weight, and clinical outcome (ie, time to AIDS-defining illness and overall survival time).Statistical analyses performed Group differences (HIV group vs AIDS group) were sought using χ² analyses and Student's t test. A multivariate regression model was used to determined the best predictors of clinical outcome.Results At baseline, total energy intake (based on 30 kcal/kg usual body weight) was adequate in both HIV and AIDS patients (101±4% and 103±5% [mean±standard deviation] of need, respectively). Despite dietary counseling and continued maintenance of energy intake, body weight, serum cholesterol level, and CD4 level progressively decreased. Consequently, saturated fat intake was found to be inversely related (P<.01) to serum cholesterol level. Clinical outcome (after 3.5 years) was associated with baseline ratio of CD4 to CD8 (P<.0001), weight (P<.01), and serum cholesterol level (P<.001). Multivariate analysis related ratio of CD4 to CD8 (P<.001) and weight maintenance (P<.001) to favorable outcome in the final model.Applications Weight loss in patients with HIV infection is independently prognostic of clinical outcome, and development of hypocholesterolemia is not favorable for clinical outcome. Because weight loss progresses despite conventional dietary counseling to identify energy need, interventions earlier in the disease course should be considered along with increased target levels for energy intake. J Am Diet Assoc. 1995; 95:428–432, 435.     

Beyond Meatless,the Health Effects of Vegan Diets: Findings from the Adventist Cohorts

Vegetarians, those who avoid meat, and vegans, additionally avoiding dairy and eggs, represent 5% and 2%, respectively, of the US population. The aim of this review is to assess the effects of vegetarian diets, particularly strict vegetarian diets (i.e., vegans) on health and disease outcomes. We summarized available evidence from three prospective cohorts of Adventists in North America: Adventist Mortality Study, Adventist Health Study, and Adventist Health Study-2. Non-vegetarian diets were compared to vegetarian dietary patterns (i.e., vegan and lacto-ovo-vegetarian) on selected health outcomes. Vegetarian diets confer protection against cardiovascular diseases, cardiometabolic risk factors, some cancers and total mortality. Compared to lacto-ovo-vegetarian diets, vegan diets seem to offer additional protection for obesity, hypertension, type-2 diabetes, and cardiovascular mortality. Males experience greater health benefits than females. Limited prospective data is available on vegetarian diets and body weight change. Large randomized intervention trials on the effects of vegetarian diet patterns on neurological and cognitive functions, obesity, diabetes, and other cardiovascular outcomes are warranted to make meaningful recommendations.     

Behavioral and body size correlates of energy intake underreporting by obese and normal-weight women

Objective To examine behavioral and body size influences on the underreporting of energy intake by obese and normal-weight women.Design Seven-day estimated food records were kept by subjects before they participated in a 49-day residential study. Self-reported energy intake was compared with energy intake required to maintain a stable body weight during the residential study (reference standard). Energy intake bias and its relationship to various body size and behavioral measures were examined.Subjects Twenty-two, healthy, normal-weight (mean body mass index [BMI]=21.3) and obese (mean BMI=34.2) women aged 22 to 42 years were studied.Statistical analyses Analysis of variance, paired t test, simple linear regression, and Pearson correlation analyses were conducted.Results Mean energy intake from self-reported food records was underreported by normal-weight (−9.7%) and obese (−19.4%) women. BMI correlated inversely with the energy intake difference for normal-weight women (r=−.67, P=.02), whereas the Beck Depression Inventory correlated positively with the energy intake difference for obese women (r=.73, P<.01).Conclusion/applications Results suggest that body size and behavioral traits play a role in the ability of women to accurately self-report energy intake. BMI appears to be predictive of underreporting of energy intake by normal-weight women, whereas emotional factors related to depression appear to be more determinant of underreporting for obese women. Understanding causative factors of the underreporting phenomenon will help practicing dietitians to devise appropriate and realistic diet intervention plans that clients can follow to achieve meaningful change. J Am Diet Assoc. 1999;99:300-306.     

Cross-Validation of Prediction Equations for Resting Energy Expenditure in Young, Healthy Children

Objective To examine the accuracy of several prediction equations for resting energy expenditure (REE) in children.Design REE was measured in 113 prepubertal children (60 girls and 53 boys aged 3.9 to 7.8 years old, weighing 14.7 to 30.0 kg) using indirect calorimetry and compared with values estimated from the prediction equations of Altman and Dittmer, The Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), Maffeis et al, and Harris and Benedict.Statistical analysis Measured REE (MREE) was compared with predicted REE (FREE) by means of regression analysis. Prediction equations were considered accurate if the regression of MREE vs FREE was not significantly different from the line of identity (slope=l.0; INTERCEPT=0). Precision was assessed by the multiple correlation coefficient of the regression of MREE vs FREE.Results MREE was 938±119 kcal/day, and FREE was 1,057+224 kcal/day for the Altman and Dittmer equations, 956±84 kcal/day for the FAO/WHO/UNU equations, 948±64 kcal/day for the equations of Maffeis et al, and 954+102 kcal/day for the Harris-Benedict equations. The regression of MREE vs FREE was significantly different from the line of identity for all prediction equations except the FAO/WHO/UNU equations (slope=0.96, P=.735; INTERCEPT=–15 kcal/day, P=.885 for girls and SLOPE=1.08, P=.635; INTERCEPT=-62 kcal/day, P=.635 for boys). None of the equations was precise for MREE vs FREE (for all, R²<.6). For the FAO/WHO/UNU equations, less than half of the predictions were within ±50 kcal/day but 99% were within 200 kcal/day.Conclusion Most prediction equations for REE in children do not accurately or precisely estimate REEs. The exception is the FAO/WHO/UNU equations, which are reasonably accurate and precise for practical purposes. J Am Diet Assoc. 1997;97: 140–145.     

Decreased Fat and Nitrogen Losses in Patients with AIDS Receiving Medium-Chain-Triglyceride-Enriched Formula Vs Those Receiving Long-Chain-Triglyceride-Containing Formula

Objective The purpose of this study was to compare two enteral formulas, differing only in fat source, for product acceptance, tolerance, and effect on fat malabsorption and nutritional status in subjects with acquired immune deficiency syndrome (AIDS).Design The double-blind, randomized 15-day trial was divided into a 3-day period in which solid food was consumed followed by a 12-day experimental period in which liquid formulas were consumed.Setting/subjects Twenty-three men and one woman with AIDS and fat malabsorption completed the study. The study was conducted in the General Clinical Research Center, University of Alabama Hospital, University of Alabama at Birmingham. Laboratory assays were performed in the Department of Nutrition Sciences.Interventions After 3 days of consuming a controlled, solid food diet containing 100 g fat per day from mixed sources to document fat malabsorption, subjects were randomly assigned to one of two groups. Each group received a liquid formula containing 35% of energy as fat for 12 days. One group received a formula containing 85% medium-chain triglycerides (MCTs) and the control group received a formula containing 100% long-chain triglycerides.Main outcome measures Determinations included stool number, consistency, weight, and fat and nitrogen content; urine nitrogen and creatinine levels; and body weight.Statistical analysis performed Subject demographic and other baseline characteristics were compared using two-sample t tests; stool and urine assessments were compared between groups at the initial experimental period using two-sample t tests; changes from initial to final experimental periods were assessed by means of analysis of covariance; changes in pooled intake, body weight, and the number and consistency of bowel movements were also assessed using analysis of covariance. All statistical tests were two-tailed and considered significant at P<.05.Results Within-group comparisons indicated that subjects fed the MCT formula showed significantly decreased stool fat and stool nitrogen content (P=.01 and P=.03, respectively) and increased fat absorption (P=.03), whereas those fed the control formula did not. Differences in stool fat between the groups were not statistically significant. However, the difference in fat absorption from the initial to final formula period was significant (P=.04). Subjects consuming the MCT formula also tended to have a decreased number of bowel movements and abdominal symptoms, whereas subjects fed the control formula showed no improvement. All subjects maintained their body weights.Applications There may be advantages to using an MCT-based formula in the treatment of AIDS-associated malabsorption.     

Knowledge on the Complementary Feeding of Infants Older than Six Months among Mothers Following Vegetarian and Traditional Diets

Solid foods should be introduced not later than the age of six months, regardless of whether the family adheres to a traditional, vegetarian, or vegan diet. The aim of this study was to compare the knowledge on the complementary feeding of infants older than six months among mothers who adhere to traditional and vegetarian diets and to identify problems that require the assistance of a dietician. A total of 251 mothers of children aged 10–12 months participated in the study. Only 10% of vegetarian mothers declared that they had placed their children on a vegetarian diet, whereas 36 mothers adhered to a lacto-ovo-vegetarian diet during complementary feeding in the first year of life. Mothers adhering to a traditional diet were characterized by lower levels of knowledge (4.1 ± 2.3 points) than vegetarian mothers (5.3 ± 2.1 points). Mothers following a traditional diet were more likely to indicate a higher than recommended number of daily meals (OR = 1.76; Cl: 1.31–1.97, p < 0.001). Significant differences were noted in the respondents’ adherence to the BLW method, which was more readily implemented by vegan (p < 0.05) and lacto-vegetarian (p < 0.05) mothers and was least popular among mothers following a traditional diet (OR = 0.81; CI: 0.66–1.23, p < 0.04). Vegetarian mothers unnecessarily delayed the introduction of gluten and potentially allergizing foods to the children’s diets, sometimes even past the age of 12 months.     

Relative Weight,Weight Loss Efforts and Nutrient Intakes among Health-Conscious Vegetarian,Past Vegetarian and Nonvegetarian Women Ages 18 to 50.

Objective: To compare relative weight, weight loss efforts and nutrient intakes among similarly health-conscious vegetarian, past vegetarian and nonvegetarian premenopausal women.

Methods: Demographic data, lifestyle practices and weight loss efforts (by questionnaire), body mass index (BMI;kg/m²) and dietary intake (via multiple-pass 24-hour diet recall) were compared in a convenience sample of 90 current vegetarians, 35 past vegetarians and 68 nonvegetarians.

Results: Age (31.9 ± 8.8), educational attainment, smoking status, alcohol use, physical activity and perceived health status were similar among the three groups of women. BMI did not differ by dietary pattern and averaged 23.7 ± 4.7 for all women combined. Participants had intentionally lost ≥ 10 pounds a mean of 2.1 times, and 39% of women perceived themselves to be overweight; again, no differences were observed among dietary groups. Dietary intakes of vegetarians and current nonvegetarians were consistent with current recommendations for macronutrient composition (<30% fat, <10% saturates). Compared to current nonvegetarians, current vegetarians had lower intakes of protein, saturated fat, cholesterol, niacin, vitamins B₁₂ and D, and higher fiber and magnesium intakes. Vegetarians’ mean vitamin B₁₂ and D intakes were well below recommendations.

Conclusions: Relative weight and weight loss efforts do not differ by dietary pattern among similarly health-conscious vegetarian and nonvegetarian women. The only differences in nutrient intake with potential health implications were vitamins D and B₁₂.     

The Gustaf Study: Repeated, Telephone-Administered 24-hour Dietary Recalls of Obese and Normal-Weight Men — Energy and Macronutrient Intake and Distribution Over the Days of The Week

Objective A dietary survey of obese and control men was conducted through 24-hour dietary recalls administered by telephone at 12 times selected randomly over a period of 3 months. Energy and macronutrient intake and distribution were studied for all days of the week.Subjects Eighty-six obese men, 20 to 60 years old, body mass index (BMI)= 37.7±4.4 (mean±standard deviation) from the waiting list of the outpatient clinic and 61 normal-weight (BMI= 23.0±1.9), age-matched men selected randomly from the Stockholm County Census Bureau.Main outcome measures Energy and macronutrient intake, intakes by energy tertiles, and distribution over the days of the week.Statistical analyses Nonparametric tests were used because of skewed distribution of most food data.Results A median daily energy intake of 2,700 kcal was found in both groups. The obese men reported a higher protein (P<.001) and a lower alcohol (P<.001) intake than the control subjects. Both groups reported a maximum intake of energy and macronutrients on Saturdays. When separated into tertiles according to reported energy intake, the obese men in tertile 3 reported a higher intake from fat (% energy, P<.001) and a lower intake from protein (P<.01) compared with men in tertile 1. Normal-weight men in tertile 3 reported a higher intake from fat (% energy, P<.01) compared with men in tertile 1.Conclusions When reported energy intake was compared with calculated total daily energy expenditure, there was a greater discrepancy in the obese group than in the control group. The normal-weight men may have had a special interest in food and health, and this group may not reflect the population at large. J Am Diet Assoc. 1996; 96:686–692.     

Diet Composition Related to Body Fat in a Multivariate Study of 203 Men

Objective To assess whether usual diet (especially intake of dietary fat, carbohydrate, and fiber) was related to body fat percentage in healthy men.Design A written questionnaire provided data on demographic and lifestyle characteristics. Dietary fat, carbohydrate, protein, and fiber intakes were analyzed using the National Cancer Institute food frequency questionnaire. Percentage of body fat was determined using three-site skinfold measurements, and a submaximal treadmill test was used to estimate aerobic fitness.Subjects Subjects were 203 healthy men (14.0±5.3% mean body fat) aged 21 to 71 years. The subjects were chosen from randomly selected districts within Utah County and volunteered for free diet and fitness evaluations.Statistical analysis Multiple regression analysis determined the extent to which the individual diet components predicted body composition before and after controlling for energy intake, fitness level, body weight, and age. Multivariate analysis of variance was used to compare relative body fat groups in regard to dietary variables.Results Reported intakes of carbohydrate (P=.0085, R²=.022), complex carbohydrate (P=.0127,R²=.024), and fiber (P=.002, R²=.03) were inversely associated with body fat after controlling for age, energy intake, and fitness level. Energy intake was positively related to body fat after controlling for age, fitness level, and body weight. When subjects were separated into low-, moderate-, and high-body-fat groups, the fattest subjects reported eating significantly more dietary fat (P=.05) and less carbohydrate (P=.01), complex carbohydrate (P=.01), and fiber (P=.005) than the leanest subjects. No significant difference in reported energy intake was noted across body fat groups.Applications Composition of the diet may play a role in obesity beyond energy intake in men over the long-term. Lifestyle changes for men should probably include modifications in diet composition, especially increased consumption of foods high in complex carbohydrate and fiber. J Am Diet Assoc. 1996; 96:771–777.     

A Longitudinal Study of Children’s Juice Intake and Growth: The Juice Controversy Revisited

Objectives To determine associations between children’s longitudinal juice intake and growth parameters at age 72 months and to determine children’s beverage intake patterns over time.Subjects/setting White children (n=72) residing in the vicinity of a Southern US city participated in a longitudinal study.Methods Seven in-home interviews were conducted per child when each child was between 24 and 72 months of age. The 7 sets of 3-day dietary data were analyzed for beverage intake, categorized as juice (100% juice only), milk, carbonated beverages, and other drinks (eg, lemonade, tea, juice drinks). The following growth parameters were determined for each child at age 72 months: height, weight, body mass index (measured as kg/m²), and ponderal index (measured as kg/m³); the 3 latter are measures of overweight.Statistical analyses Associations between longitudinal juice intake and each growth parameter were tested with general linear models. Repeated measures analysis of variance tested changes in beverage intakes over time.Results There were no statistically significant associations between juice and children’s height, weight, or body mass index, as tested by general linear models. Children’s longitudinal juice intake was negatively related to ponderal index (β=0.065, P=.050). Children’s juice intake decreased significantly between ages 2 and 6 years, from 6.8 to 3.6 oz/day (P=.0001); intakes of carbonated beverages and other drinks increased from 1.7 to 3.8 oz/day (P=.0016) and from 2.7 to 6.2 oz/day (P=.0001), respectively.Applications/conclusions Children’s longitudinal juice intake was not associated with either short stature or overweight. As juice consumption decreased, intakes of less nutritious beverages increased. Consumption of 100% juices should be encouraged by health professionals and parents/caregivers. J Am Diet Assoc. 2001; 101:432-437.     

Integrated nutritional, hormonal, and metabolic effects of recombinant human growth hormone (rhGH) supplementation in trauma patients

An anabolic stimulus is needed in addition to conventional nutritional support in the catabolic “flow” phase of severe trauma. One promising therapy appears to be rhGH infusion which has direct as well as hormonal mediated substrate effects. We investigated on a whole-body level, the basic metabolic effects of trauma within 48–60 h after injury in 20 severely injured (injury severity score [ISS] = 31 ± 2), highly catabolic (N LOSS = 19 ± 2 g/d), hypermetabolic (resting energy expenditure [REE] = 141 ± 5% basal energy expenditure [BEE]), adult (age 46 ± 5 y) multiple-trauma victims, before starting nutrition therapy and its modification after 1 wk of rhGH supplementation with TPN (1.1 × REE calories, 250 mg N·kg⁻¹·d⁻¹). Group H (n = 10) randomly received at 8:00 a.m. on a daily basis rhGH (0.15 mg·kg⁻¹·d⁻¹) and Group C (n = 10) received the vehicle of infusion. Protein metabolism (turnover, synthesis and breakdown rates, and N balance); glucose kinetics (production, oxidation, and recycling); lipid metabolism, (lipolysis and fat oxidation rates), daily metabolic and fuel substrate oxidation rate (indirect calorimetry); and plasma levels of hormones, substrates, and amino acids were quantified. In group H compared to group C: N balance is less negative (−41 ± 18 vs −121 ± 19 mg N·kg⁻¹·d⁻¹, P = 0.001); whole body protein synthesis rate is 28 ± 2% (P = 0.05) higher; protein synthesis efficiency is higher (62 ± 2% vs 48 ± 3%, P = 0.010); plasma glucose level is significantly elevated (256 ± 25 vs 202 ± 17 mg/dL, P = 0.05) without affecting hepatic glucose output (1.51 ± 0.20 vs 1.56 ± 0.6 mg N·kg⁻¹·min⁻¹), glucose oxidation and recycling rates; significantly enhanced rate of lipolysis (P = 0.006) and free fatty acid reesterification (P = 0.05); significantly elevated plasma levels of anabolic GH, IGF-1, IGFBP-3, and insulin; trauma induced counter-regulatory hormone (cortisol, glucagon, catecholamines) levels are not altered; trauma induced hypoaminoacidemia is normalized (P < 0.05) and 3-methylhistidine excretion is significantly low (P < 0.001). Improved plasma IGF-1 levels in Group H compared with Group C account for protein anabolic effects of adjuvant rhGH and may be helpful in promoting tissue repair and early recovery. Skeletal muscle protein is spared by rhGH resulting in the stimulation of visceral protein breakdown. The hyperglycemic, hyperinsulinemia observed during rhGH supplementation may be due to defective nonoxidative glucose disposal, as well as inhibition of glucose transport activity into tissue cells. The simultaneous operation of increased lipolytic and reesterification processes may allow the adipocyte to respond rapidly to changes in peripheral metabolic fuel requirements during injury. This integral approach helps us to better understand the mechanism of the metabolic effects of rhGH.     

Using Cluster Analysis to Examine Dietary Patterns: Nutrient Intakes, Gender, and Weight Status Differ Across Food Pattern Clusters

Objective This study explored the usefulness of cluster analysis in identifying food choice patterns of three groups of adults in relation to their energy intake.Design Food frequency data were converted to percentage of total energy from 38 food groups and entered into a cluster analysis procedure. Subjects in the emerging food group patterns were compared in terms of weight status, demographics, and the nutrition composition of their usual diet.Setting Data were collected as part of three studies in two US metropolitan areas using identical protocols. Participants were university employees (103 women and 99 men) who volunteered for a reliability study of health behavior questionnaires and moderately obese volunteers (223 women and 101 men) to two weight-loss studies who were recruited by newspaper advertisements.Statistical analysis performed Subjects were clustered according to food energy sources using the FASTCLUS procedure in the Statistical Analysis System. One-way analysis of variance and χ² analysis were then performed to compare the weight status, nutrient intakes, and demographics of the food patterns.Results Six food pattern clusters were identified. Subjects in the two clusters associated with high consumption of pastry and meat had significantly higher fat intakes (P=.0001). Subjects in two other clusters, those associated with high intake of skim milk and a broad distribution of energy sources had significantly higher micronutrient levels (P=.0001). Body mass index and the distribution of gender were also significantly different across clusters.Conclusions The success of cluster analysis in identifying dietary exposure categories with unique demographic and nutritional correlates suggests that the approach may be useful in epidemiologic studies that examine conditions such as obesity, and in the design of nutrition interventions. J Am Diet Assoc. 1997:97:272–279.     

Body Composition, Dietary Intake, and Energy Expenditure in Nonobese, Prepubertal Children of Obese and Nonobese Biological Mothers

Objective To determine differences in dietary intake, resting energy expenditure, activity level, fat-free mass, and percentage body and abdominal fat in nonobese children of obese mothers compared with nonobese children of nonobese mothers.Design Cross-sectional comparison study. Children's food diaries were analyzed to determine average energy and nutrient content. Resting energy expenditure of children was measured by means of indirect calorimetry. Children's activity levels were estimated through questionnaires administered during interviews. Dual-energy x-ray absorptiometry was used to estimate body composition of children.Subjects Mothers of subjects responded to advertisements and were recruited as nonobese (body mass INDEX=20 to 25) or obese (body mass index ≥30). Offspring included in the study were prepubertal and nonobese (10th to 90th percentile of weight for height by gender). Twelve pairs of children could be matched for weight, gender, and age.Statistical analysis performed Wilcoxon signed rank tests were used to determine differences between the 2 groups of children.Results Percentage abdominal fat was greater (median DIFFERENCE=3.15, P=.001) and fat-free mass was lower (median DIFFERENCE=1.19, P=.04) in children of obese mothers compared with children of nonobese mothers. No statistically significant differences between the 2 groups of children were found for dietary intake, resting energy expenditure, activity level, or percentage body fat.Applications/conclusions The significantly higher percentage of abdominal fat and lower fat-free mass in children of obese mothers may contribute to obesity onset. Use of dual-energy x-ray absorptiometry as a screening tool for nonobese, prepubertal children with an obese parent will help to identify those at risk. Education and lifestyle changes can then be implemented to help prevent the onset of obesity. J Am Diet Assoc. 1999;99:58-65.     

A Worksite Program for Overweight Middle-Aged Men Achieves Lesser Weight Loss With Exercise Than With Dietary Change

Objective To compare changes in total and regional body composition using dual energy X-ray absorptiometry (DEXA) after subjects lost weight through change in diet or exercise.Design A 12-month, randomized, controlled study of two weight-loss interventions — low-fat diet ad libitum or moderate, unsupervised exercise — in free-living, middle-aged men. Compliance was determined at monthly measurement sessions through food records and activity logs; DEXA scans were performed every 3 months.Subjects/setting Fifty-eight overweight men (mean body mass INDEX=29.0±2.6; mean AGE=43.4±5.7 years) recruited from a national corporation were assigned randomly to diet, exercise, or control groups.Interventions One group reduced dietary fat to 26.4% of energy intake but kept activity unchanged; another group self-selected aerobic exercise (three sessions per week at 65% to 75% maximum heart rate) but kept diet unchanged. A control group maintained weight.Main outcome measures At 12 months, measurements of weight, total and regional fat mass and lean mass, energy intake, and percentage dietary fat; physical activity indexes. Statistical analyses Results were analyzed using paired t tests and analysis of variance.Results Mean weight loss was 6.4±3.3 kg in dieters and 2.6+3.0 kg in exercisers; control subjects maintained weight. DEXA scans revealed that 40% of dieters’ weight loss was lean tissue; more than 80% of weight lost by exercisers was fat. Exercisers maintained limb lean tissue and lost fat mass.Conclusions Greater total weight and lean tissue loss occurred when subjects lost weight through a low-fat diet consumed ad libitum than when subjects participated in unsupervised aerobic exercise. Use of DEXA enabled identification of progressive total and regional changes in fat and lean tissue. J Am Diet Assoc. 1997; 97:37–42.     

Pica Practices of Pregnant Women are Associated with Lower Maternal Hemoglobin Level at Delivery

Objective To determine the prevalence of pica during pregnancy, maternal hemoglobin levels at delivery, and the association of pica with 2 adverse pregnancy outcomes: low birth weight and preterm birth.Design A retrospective cohort study was conducted using eligible subjects (n=281) from a cross-sectional survey (n=366).Subjects/setting Mothers aged 16 to 30 years with infants younger than 1 year of age who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interviewed at 4 WIC clinics in Houston and Prairie View, Tex. Medical records from 31 hospitals were abstracted.Main outcome measures Maternal hemoglobin levels at delivery, mean birth weight, and mean gestational age were compared for women who reported pica and women who did not.Statistical analyses χ² Tests, orthogonal t tests, analysis of variance, and regression analysis were used to test the relationships among study variables.Results Pica prevalence categorized by substance was as follows: ice, 53.7%; ice and freezer frost, 14.6%; other substances such as baking soda, baking powder, cornstarch, laundry starch, baby powder, clay, or dirt, 8.2%; and no pica, 23.5%. Women in all 3 pica groups had lower hemoglobin levels (mean±standard deviation, 114±12 g/L, 110±13 g/L, and 113±12 g/L, respectively) at delivery than women who did not report pica (118±11 g/L) (P<.01 for all pica groups vs no pica). There were no differences in mean birth weight or mean gestational age of infants born to women from the 3 pica groups and the No Pica group.Applications The findings suggest that pica practices are associated with significantly lower maternal hemoglobin levels at delivery but are not associated with pregnancy outcomes. Dietitians should ask pregnant women with anemia about pica and should counsel women who report pica regarding the health risks associated with it. J Am Diet Assoc. 1998; 98:293-296.     

Evaluation of Predicted and Measured Energy Requirements in Burned Children

Objective The energy predictions of nine calculations for pediatric patients were compared with measured resting energy expenditure (MREE) by means of indirect calorimetry to determine the optimal means of energy projection in the burn population younger than 3 years of age.Methodology Nutritional sufficiency and maintenance of preburn weight were factors in the confirmation of energy needs. Demographic factors were also studied: preburn weight, percent burn, percent third-degree burn, and age. Group 1 consisted of 24 patients younger than 3 years of age (range=7 months to 2.6 years) with a percent burn of 30.6±2.0 and percent third-degree burn of 21.9±2.6. Group 2, consisting of 24 patients 5 to 10 years old matched by percent burn and percent third-degree burn, was included to determine whether differences between actual and projected needs were evident in older, prepubescent patients.Statistical analysis Analysis of variance was used to ascertain the most reliable multiplier for MREE needed to maintain at least 95% of preburn weight at discharge while ensuring adequate nutrition. Multiple regression analysis was used to determine the relationship between energy requirement and body weight, percent burn, and age. Results An additional 30% of MREE provided a consistent ratio of actual energy intake to required intake. MREE × 1.3 was used as a guide to study the existing calculations. For both groups, the four equations that predicted energy in healthy children most often underestimated MREE × 1.3, whereas the five formulas for children with burns tended to overpredict energy. Regression analysis yielded two new sets of equations using age, preburn weight, and percent burn (<3 YEARS=Mayes 1 [r².71], 5 to 10 YEARS=Mayes 3 [r²=.70] or percent third-degree burn (<.3 YEARS=Mayes 2 [r²=.68], 5 to 10 YEARS=Mayes 4 [r²=.67]).Conclusions The application of a 30% factor to MREE is supported in burn patients younger than 10 years of age. Standard energy projections do not provide an accurate assessment of energy needs in the pediatric burn population; thus, two sets of equations that more closely predict energy needs are proposed. J Am Diet Assoc. 1996; 96:24-29.     

A new food guide for North American vegetarians

In summary, this vegetarian food guide has a number of advantages over previous guides designed for this population:

• It is based on current nutritional science. This guide aims to provide sufficient nutrient intake based on the most recent dietary reference intakes and addresses concerns such as balance of fats in diets.

• It provides information about how to meet calcium needs that is appropriate to a wide range of individuals, including those who follow lacto-ovo-vegetarian diets and vegan diets.

• It promotes the concepts of variety and moderation. Many other guides for both vegetarians and nonvegetarians direct consumers only to dairy foods to meet calcium needs, whereas this guide emphasizes the wide variety of foods that can meet calcium requirements.

• It focuses on foods that are commonly consumed by vegetarians.