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Energy balance and cancers.

Energy balance results from the exact equilibrium between caloric intake and caloric expenditure. A caloric intake larger than caloric expenditure results in overweight, even obesity, but other determinants, like hormonal dysfunction and/or genetic traits may play a part in obesity syndrome. Obesity, and even overweight, have been recognized as risk factors for the development of cancers. Human epidemiological studies, which have tended to establish the nature of the relationship between energy balance and cancer, are summarized first, with the influence of the various factors which act both on obesity and on cancer risk. Among these factors are the macronutrients responsible for the caloric intake, and some lifestyle factors (physical activity, drinking habits and tobacco use). Second, the animal studies help to distinguish between different relevant factors, and to understand some of the underlying mechanisms. However, the insulin-resistance syndrome, which appears to underlie the relationship between obesity and hormone-dependent cancers, and possibly colon cancer, is only relevant to human physiology because hormonal alterations are part of it. Prevention of hyperinsulinemia, insulin resistance and the accompanying visceral obesity appears to be a major public health task for the prevention of cancers.

Animals↗

[Food and nutrient consumption in Spain in 1940-1988 (and II). Comparative study of the main sources of information on food consumption].

BACKGROUND: This paper has two objectives. The first is to examine the consistency of the main nutritional studies carried out in Spain over the last fifty years. The second is to use these studies to describe the changes in the Spanish diet over this period and to characterize the present dietary pattern. MATERIAL AND METHODS: We have used three types of studies. First, food balance sheets elaborated by Barbancho, FAO, OECD and the Department of Agriculture. Second, surveys on the foods purchased by population groups, in particular the household budget surveys, and the "panel de consumo alimentario" from the Department of Agriculture. Third, food consumption surveys from Catalonia, Vasque Country, Murcia, Madrid, and Reus. RESULTS: Protein, lipid and total caloric intake have increased over the last fifty years. Carbohydrate intake has been stable. Caloric intake from lipids has increased, caloric intake from protein has been stable and that from carbohydrates has decreased. All studies are consistent in that, from 1980 onwards, caloric intake from protein has been 12.5-16.7%, caloric intake from carbohydrates has been 39.3-48.1%, and that from lipids has been 36.6-46.0%. The monounsaturated/saturated ratio has been 1.2-1.7 and the polyunsaturated/saturated ratio 0.4-0.7. All data sources show a high consumption of foods typical of the Mediterranean diet, in particular fruit, vegetables, fish and vegetable oil, rich in unsaturated fats. Consistency among data sources is higher when data are expressed as percentage of total caloric intake than when they are expelled in absolute quantities. CONCLUSIONS: All data sources suggest that the Spanish diet has changed with the economic development, but it still keeps most of the characteristics of the Mediterranean diet.

Cross-Sectional Studies↗

Total energy intake: implications for epidemiologic analyses.

Associations between intake of specific nutrients and disease cannot be considered primary effects of diet if they are simply the result of differences between cases and noncases in body size, physical activity, and metabolic efficiency. Epidemiologic studies of diet and disease should therefore be directed at the effect of nutrient intakes independent of total caloric intake in most instances. This is not accomplished with nutrient density measures of dietary intake but can be achieved by employing nutrient intakes adjusted for caloric intake by regression analysis. While pitfalls in the manipulation and interpretation of energy intake data in epidemiologic studies have been emphasized, these considerations also highlight the usefulness of obtaining a measurement of total caloric intake. For instance, if a questionnaire obtained information on only cholesterol intake in a study of coronary heart disease, it is possible that no association with disease would be found even if a real positive effect of a high cholesterol diet existed, since the caloric intake of cases is likely to be less than that of noncases. Such a finding could be appropriately interpreted if an estimate of total caloric intake were available. The relationships between dietary factors and disease are complex. Even with carefully collected measures of intake, consideration of the biologic implications of various analytic approaches is needed to avoid misleading conclusions.

Adult↗

Relation between serum insulinlike growth factor-1, insulinlike growth factor binding protein-2, and insulinlike growth factor binding protein-3 and nutritional intake in premature infants with bronchopulmonary dysplasia.

BACKGROUND: The usefulness of serum insulinlike growth factor (IGF)-system-peptide measurement to assess the adequacy of nutritional intake in premature infants with chronic lung disease bronchopulmonary dysplasia (BPD) was assessed. METHODS: Twenty-nine premature infants had serial measurements taken of their serum IGF-1, insulinlike growth factor binding protein (IGFBP)-2, and IGFBP-3 concentrations between 2 and 6 weeks of age. Regression analyses were used to examine the relation between nutritional parameters and IGF-1, IGFBP-2, and IGFBP-3 concentrations in premature infants with and without BPD. RESULTS: The group of infants with BPD (n = 12) did not differ from infants without BPD (n = 17) in gestational age or weight at entry, but gained less weight during the study period. In infants without BPD, IGF-1 correlated positively with protein intake (r = 0.50) and caloric intake (r = 0.41) over the 3 days before sample collection and with weight change over the previous week (r = 0.46). In contrast, infants with BPD showed a significant correlation between IGF-1 and weight change (r = 0.54) only. There was a significant negative correlation between IGFBP-2 and protein intake in infants without BPD (r = -0.50) and in infants with BPD (r = -0.41). Negative correlations between IGFBP-2 and both weight change (r = -0.64) and caloric intake (r = -0.43) over the previous week were found only in the group of infants without BPD. IGFBP-3 correlated positively with weight changes and protein intake in both groups but correlated with caloric intake only in the group without BPD. Multiple regression analyses were used to determine significant independent variables associated with IGF-1, IGFBP-2, and IGFBP-3. In infants without BPD, significant independent predictors of IGFBP-2 were 7-day weight change and 2-day protein intake; 3-day caloric intake was the only significant independent predictor for IGFBP-3. For infants with BPD, 3-day weight gain was the only independent variable associated with serum IGF-1. Protein intake in the week before sample collection was an independent predictor of IGFBP-2 and 3-day weight change and 2-day protein intake were independent predictors of IGFBP-3. CONCLUSIONS: These results confirm that changes in serum IGF-1, IGFBP-2, and IGFBP-3 reflect the nutritional status of premature infants and demonstrate that the relation between these proteins and nutritional intake differs in premature infants with and without BPD. Refinement of these observations by future studies may permit a more accurate determination of the protein and caloric intake sufficient for growth and repair after injury in premature infants with lung disease.

Biomarkers↗

Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease.

BACKGROUND: Low serum albumin is a strong risk factor for mortality, but its association with low serum bicarbonate and inflammation in the setting of mild to moderately decreased kidney function is uncertain. METHODS: We analyzed data from 15594 subjects over the age of 20 who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Glomerular filtration rate (GFR) in mL/min/1.73 m2 was estimated by the abbreviated Modification of Diet in Renal Disease (MDRD) equation using appropriately calibrated serum creatinine. RESULTS: The age-adjusted prevalence of hypoalbuminemia (serum albumin <3.8 g/dL) at a GFR of 90, 60, 30, and 15 mL/min/1.73 m2 was 19%, 21%, 38%, and 59%, respectively, while the age-adjusted prevalence of C-reactive protein (CRP) >or= 0.22 mg/dL was 36%, 44%, 69%, and 81%, respectively, both P trend <0.001. Age, female gender, non-Hispanic black compared with non-Hispanic white race, diabetes, hypertension, hepatitis C, urine albumin: creatinine ratio >1 g/g, dietary protein intake, dietary caloric intake, serum bicarbonate, CRP, and GFR category were all significant predictors of hypoalbuminemia on univariate analysis. On simultaneously adjusting for the above variables, hypertension, diabetes, GFR, and dietary protein and caloric intake were no longer significant independent predictors of hypoalbuminemia. The adjusted odds ratio (OR) of serum bicarbonate (by quartile) for hypoalbuminemia was 1.0 for serum bicarbonate >28 mEq/L (reference), 1.25 for 26-28 mEq/L, 1.51 for 23-25 mEq/L, and 1.54 for 1.0 mg/dL. CONCLUSION: Elevated CRP and low serum bicarbonate are independently associated with hypoalbuminemia, explaining much of the high prevalence of hypoalbuminemia in chronic kidney disease.

Acidosis↗

Overweight, obesity and weight control.

Evidence is cited showing that overweight is a health hazard, but that this is primarily true only when the excess weight is due to an excess accumulation of adipose tissue. Diagnosis of frank obesity should be established by a careful interpretation of height-weight tables and of all other pertinent data. Although many factors play an etiologic role, obesity can occur only when caloric intake exceeds caloric output, and can be obviated only when this imbalance is reversed. Therefore prevention of weight gain, which should receive increasing attention, and also satisfactory weight loss, both require that caloric output be increased through added physical activity and that caloric intake be decreased through diminished consumption. Success depends on recognizing the fallacy of all misleading misinformation, and on establishing permanent habits of regular exercise and of moderation in eating and drinking. Suggestions are made that can be effective guidelines to a commonsense program of weight control.

Adolescent↗

Metabolic changes associated with malnutrition in the patients with multiple organ failure.

To clarify the metabolic changes associated with malnutrition in the patients with multiple organ failure (MOF), we measured energy expenditure, nitrogen excretion, nonprotein respiratory quotient (NPRQ), caloric intake, and cumulative caloric balance (CCB) in 20 MOF patients (12 survivors and 8 non-survivors). The non-survivors exhibited significantly greater cumulative caloric deficit than the survivors. Metabolic activity tended to decline to normal in the survivors as organ failures were overcome. In the non-survivors, on the contrary, regardless of large caloric deficit hypermetabolism persisted and characteristically followed by the sudden decrease in metabolic activity at the time immediately prior to death. Compared to the survivors, the non-survivors generally exhibited poorer response in metabolic activity and greater NPRQ change to the altered amount of caloric intake. It seemed that protein sparing effect by increased caloric intake was preserved in both the survivors and the non-survivors only with CCB above -5 times basal energy expenditure. These results suggest that persistent hypermetabolism and poor metabolic response to nutritional support are partly responsible for existing organ failures and poor outcome in MOF patients.

Journal Article↗

Energy utilization by the broiler chicken as affected by various fats and fat levels.

Two experiments were designed to investigate the effects of fat supplementation at different levels on energy utilization by the broiler chicken. In one experiment, finisher diets containing 2.5, 5.0, or 10.0% of added corn oil (CO), poultry oil (PO), tallow (T), or a commercial hydrolyzed animal-vegetable fat blend (HB) were fed. In the second experiment, starter diets containing 0, 2.5, or 7.5% added CO, PO or HB were fed. Metabolizable energy (ME) values were not controlled through formulation but were determined experimentally. Energy retention was measured by a slaughter technique, and metabolic energy losses were calculated as the difference between metabolizable energy intake and energy deposition in the carcass. Broilers that were fed PO, T, and HB failed to adjust feed intake to control caloric intake. They ate significantly more ME calories per day when these fat sources were fed, gained more, were fatter, and had a lower feed:gain ratio than broilers fed no added fat or lower levels of fat. Failure to regulate caloric intake when fats are added to diets may be a component of the "extra caloric" effect of fat. Broilers which were fed CO tended to regulate their caloric intake better than those which are fed PO, T, and HB. It was not determined if CO is less palatable than the other fat sources or if the unsaturated fatty acids metabolically regulate appetite. When CO was fed, broilers tended to have lower feed:gain ratios than when the other fats were fed. There was an indication that daily heat production was less when CO was fed, which would suggest a lower heat increment. Fatty acid analysis verified the efficient use of dietary fats for adipose deposition and suggested a disproportionately greater use of the unsaturated fatty acids for carcass lipids.

Animal Feed↗

Reliability and validity of a macronutrient self-selection paradigm and a food preference questionnaire.

Our laboratory has developed a macronutrient self-selection paradigm (MSSP) designed to vary fat content significantly and systematically with sugar, complex carbohydrates, and protein content in a battery of foods in which fat is commonly consumed in the American diet. We have also developed a food preference questionnaire (FPQ) according to an identical design but using a list of foods mutually exclusive of those presented for selection and intake in the MSSP. Men were tested twice on both instruments, with a 4-week interval between tests. It was determined that the MSSP has strong test-retest reliability for overall fat (r = 0.91) and other macronutrient intake and total caloric intake. In addition, hunger and fullness ratings were reproducible, and fat preferences (r = 0.99) and hedonic responses to foods listed on the FPQ were highly consistent across trials. This study also demonstrated that the MSSP is a valid instrument with respect to the men's reports of habitual intake of fat (r = 0.80) and total carbohydrates on the Block food questionnaire (FQ). In addition, men's fat preferences on the FPQ were validated with respect to overall fat (r = 0.86) and total caloric intake in the MSSP and fat intake (r = 0.83) reported on the Block FQ. The MSSP also has the capability to detect a wide range of fat intake (3.06-50.35% among the present subjects), indicating that this instrument can identify individuals who differ markedly in fat intake or could detect changes in fat preference within subjects. In addition, this paradigm detected a large range of sugar and total caloric intake. It is anticipated that the use of these laboratory tools can enhance our understanding of the relationship between dietary fat intake and obesity.

Adult↗

Mechanisms of loss of lean body mass in patients on chronic dialysis.

Patients on chronic dialysis treatment often have reduced lean body mass. Certain aspects of bio-incompatibility in dialysis can be viewed as leading to a chronic inflammatory state. In most chronic inflammatory diseases, loss of mean body mass is independent of reduced caloric intake. However, reduced caloric intake accounts for most of the weight loss in these patients and also dialysis patients. Refeeding is associated with increased fat deposition more than restoration of muscle mass. In addition to reduced caloric intake, patients with rheumatoid arthritis, a classic example of a chronic inflammatory disease, have an elevated resting energy expenditure associated with decreased lean body mass. Elevated cellular tumor necrosis factor (TNF) and IL-1 beta production can be demonstrated in these patients. However, in many dialysis patients, increased cytokine production can be 'normal' or reduced. This takes place as the level of malnutrition increases. Thus, cytokines such as IL-1 and TNF play a decreasing role in the pathogenesis of loss of body mass as malnutrition increases and curtails the synthesis of cytokines. Similar to patients with AIDS, progressive disease in patients on chronic dialysis may exhibit subclinical malnutrition which leads to decreased cytokine production. Reduction in cytokine production can be viewed as a protective mechanism.

Biological Factors↗

Nutritional effects of KT/V in children on peritoneal dialysis: are there benefits from larger dialysis doses?

Dialysis adequacy is monitored by urea kinetic modeling (UKM), in particular by calculation of KT/V (normalized whole body urea clearance) and PCRN (normalized protein catabolic rate). All children on peritoneal dialysis from our unit (7 children; mean age 7 years, 8 months) participated in our study (dialysis research program of the French Registry of Peritoneal Dialysis). Every month analysis of dialysate and urine collections and blood samples were compared to a 3-day diet survey to analyze the relations between doses of dialysis (KT/V) and nutrition [dietary protein intake (DPI) and caloric intake]. Calculated protein intake and DPI were also compared. Spearman correlation coefficients were used to assess the association between variables. KT/V values were spread over a wide range (0.8-2.8, mean 1.9). KT/V was positively (weakly) correlated to PCRN (p = 0.07, y = 0.24x + 1.08, r = 0.2), but not to DPI. No correlation could be found between PCRN and DPI, but doses of dialysis (KT/V) were positively correlated to caloric intake (p = 0.001, y = 28.97x + 13.66, r = 0.424). We assume that the correlation between KT/V and PCRN is not necessarily the reason, but only a calculation effect. On the contrary, the positive correlation between KT/V and caloric intake allows us to speculate that more efficient dialysis enhances appetite.

Child↗

Effects of protein intake on pulmonary gas exchange and ventilatory drive in postoperative patients.

The effects of different protein regimens on pulmonary gas exchange and ventilatory drive were examined in eight postoperative patients receiving inspiratory pressure support ventilation. They were studied during 60 consecutive hours, which included two 12-h periods of high protein intake (33%) of total caloric intake provided as protein), each of them being preceded and followed by a 12-h period of standard protein intake (14% of total caloric intake provided as protein). Throughout the study, total caloric intake was 1.5 times the predicted resting energy expenditure. Nitrogen was provided as a 24% branched chain amino acid (BCAA) solution during the period of standard protein intake. During the periods of high protein intake, it was provided as a 24% and a 41% BCAA solution. Pulmonary gas exchange was continuously measured during the second half of each period, with the use of a mass spectrometer system. Measurements of the ventilatory response to CO2 (FICO2 0, 1.5, and 3%) were achieved at the end of each dietary regimen. O2 consumption, CO2 production, respiratory quotient, minute ventilation, and PaCO2 were the same for the three protein regimens. Changing protein intake failed to affect the ventilatory response to CO2. The authors conclude that, in postoperative patients having inspiratory pressure support ventilation, the administration of a high protein intake does not affect the ventilatory drive and the pulmonary gas exchange.

Carbon Dioxide↗

Dietary patterns and metabolic control in diabetic diets: a prospective study of 51 outpatient men on unmeasured and exchange diets.

In a prospective, single blind study, 51 adult diabetic, male outpatients at or below ideal body weight (IBW), all but four of whom were insulin-treated, were randomly assigned to a calorically defined exchange diet (EXCH) or an unmeasured diet avoiding refined sugars (UNMEAS). Fasting chemistries, weights and 48-hr dietary recalls were obtained every 3 months for 3 years. There was no difference between groups in mean body weight, mean caloric intake, percentages of carbohydrate or fat intake, day to day consistency of caloric intake, or fasting chemistries. The patients whose actual weight tended to be less than IBW consumed more calories than their theoretical calculated needs (p = 0.002) without effect on glycemic control or stability of weight. Patients with low carbohydrate intake (less than 30%) had significantly higher triglyceride levels (p = 0.015). Otherwise, variations in dietary patterns were not reflected in fasting clinical chemistries. Individual fasting serum glucose levels were not related to consistency of carbohydrate intake, caloric distribution throughout the day or composition of diets. These results suggest that actual dietary patterns of subjects following exchange diabetic diets with precise caloric prescriptions are similar to those resulting from unmeasured diets with restriction of simple sugars. Other than correlation between carbohydrate intake and triglycerides, there was no detectable effect of variations in dietary patterns upon conventional chemical metabolic levels.

Adult↗

Evidence for genetic influences on human energy intake: results from a twin study using measured observations.

Human obesity is associated with greater-than-average energy intake, although relatively few studies have tested the heritability of food intake. The present study examined the genetic architecture of measured caloric intake during laboratory test meals in 36 monozygotic and 18 dizygotic twin pairs. A series of analyses tested the hypotheses that (1) there would be a genetic influence on total caloric intake, (2) there would be genes influencing total caloric intake above and beyond those influencing body composition, (3) there would be a phenotypic association between total caloric intake and fat mass above and beyond any genetic influences, and (4) there would be genetic influences on macronutrient intake (i.e., fat, carbohydrate, and protein intake) above and beyond total caloric intake. Results suggested genetic influences on age- and sex-adjusted total caloric intake (24-33% of the variance), although 95% confidence intervals were wide and suggested that "true" heritability estimates might be considerably lower or higher. Caloric intake was influenced by both common and unique environmental factors. Greater-than-average caloric intake was associated with increased adiposity, despite probable genetic influences on both phenotypes. Finally, there was evidence for macronutrient-specific familial influences, although the extent to which they were genetic or environmental in origin could not be teased apart. Results suggest that human obesity may be influenced by behaviors that are themselves genetically regulated. However, further studies are needed to obtain more precise heritability estimates and a better understanding of the conditions under which genetic influences on energy intake emerge.

Adult↗

The effect of exercise on food intake in men and women.

To study the effect of acute exercise on caloric intake in normal-weight young people, food intake was monitored in 10 men and 10 women during consecutive 5-d periods, one with and one without exercise. Food intake during the exercise period was compared with that during the control period. Caloric intake during the control period was 2467 +/- 165 kcal/d (means +/- SEM) for men and 1831 +/- 103 kcal/d for women. During the exercise period the men increased their caloric intake to 2658 +/- 188 kcal/d and the women's caloric intake remained unchanged, 1830 +/- 91 kcal/d. Caloric intake was not affected by sequence of treatment or duration of protocol. Men responded to 5 d of acute exercise with increased caloric intake (208 +/- 64 kcal/d), which was insufficient to compensate for the caloric cost of exercise (596 kcal/d above resting metabolic rate). Women did not change their caloric intake despite expending 382 kcals/d during exercise. Consequently, both normal-weight men and women were in negative caloric balance during the exercise period.

Analysis of Variance↗

Measuring human age by estimating lifetime caloric consumption.

BACKGROUND: This study was prompted by a desire to measure human age by a means other than chronological or biological age. The purpose of the study was to use the total lifetime caloric intake in men as an index of aging. METHOD: The study was carried out by developing an algorithm to approximate the lifetime caloric intake. The total caloric intake is expressed such that one calorie-age year is defined as the total calories expended by an individual during his/her 20th year. RESULTS: The results indicated that (1) the caloric intake of men progressively decreases with advancing age, that (2) the caloric-age is usually less than chronological age, and that (3) the caloric-age algorithm is a simple although crude method to assess lifetime caloric intake. CONCLUSION: The most important conclusion is that a person can get a better appreciation of the importance of avoiding excess caloric intake if human age is measured in terms of lifetime caloric intake.

Age Determination by Teeth↗

Urban nutritional problems of Korea.

Rapid economic development resulted in urbanization of Korea, since 1960s. Seoul is the center of politics, finance, education and culture of Korea. Mostly young people have migrated to large cities, such as Seoul and Pusan. For instance, the population in Seoul city was 2.5 million in 1960 but increased to 10 million in 1990. Presently, total population of Seoul and Pusan, second largest city, composed of approximately 50% of whole national population. The economic distribution among urban people became extremely uneven creating a large gap between low and high income group. As a consequence, both under and over nutritional problems coexist. According to the national nutrition survey data, animal food, such as meat, fish and dairy products have been consumed about 6 times more, and cereal consumption was far less in higher income group. In terms of nutrients intake, 28% of total caloric intake comes from lipids and 15-17% of total caloric intake from protein. This was found in higher income group, while low income group consumed more than 80% of total caloric intake from carbohydrate. The trends of major causes of death in Korea have changed. The degenerative diseases, cerebral disorder, high blood pressure became leading cause of death in recent years. Malignant neoplasm and diabetes followed second leading cause of death in Korea. Undernutrition and nutritional insufficiencies, anemia and low growth rate continue to exist among low income group. According to the annual death rate by age group, the age between 34-54 was the highest in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Influence of fat intake and caloric restriction on bone in aging male rats.

Caloric and fat intake may have important skeletal consequences. To evaluate this possibility, skeletal effects of adult-onset caloric restriction (CR) at differing fat intakes were assessed in male Lobund-Wistar rats. At age 17 months, two groups of animals received an anti-obesity diet, restricted approximately 35% from individual ad libitum baseline calorie consumption, and two groups received a diet approximately 50% restricted. Dietary fat concentrations were 5, 15, 15, and 25% by weight, respectively. At ages 20, 24, 28, 30, and 32 months, ex vivo femoral bone densitometry and serum biochemical analyses were performed. Body weight (BW) decreased with time on CR in each group (p < .005), declining faster at the more severe restriction (p = .001). Femoral bone mineral contents (BMC) were also reduced. After adjusting for bone area and BW differences among groups, the only significant difference was a reduction in distal femur BMC in the 25% fat group subjected to more severe CR (p = .02). No differences were observed in serum parathyroid hormone, calcium, phosphorus, or creatinine. Femoral bone loss occurred with CR. This was entirely accounted for by reduction in BW. Higher dietary fat content did not affect BW in CR animals, but did result in lower distal femur BMC.

Aging↗