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PubMedDate not supplied

The effect of nutritional status on morbidity after elective surgery for benign gastrointestinal disease.

The effect of nutritional status on the morbidity and mortality of major gastrointestinal surgery for benign disease was studied in 32 patients. Malnutrition was defined as a serum albumin less than 3.5 g/dl and a recent weight loss greater than 10%, in addition to any two of the following: weight for height, midarm circumference or triceps skin-fold thickness less than 10th percentile. The morbidity and mortality in the 17 malnourished patients was 59% and 29%, respectively, compared with 20% and 7% in 15 well-nourished patients matched for age and operative procedure (p less than 0.05). After operation, the mean duration of inadequate oral nutritional intake period (IONIP, defined as a caloric intake greater than 60% requirement) was 11.9 days +/- 2.9 (SEM) in well-nourished patients compared with 30.5 days +/- 3.7 in the malnourished group. The longer IONIP in malnourished patients was a consequence of the higher morbidity in this group, thus warranting the consideration of supportive (postoperative) parenteral nutrition in malnourished patients who undergo major gastrointestinal surgery for benign disease.

Adolescent↗
PubMed2004

Potential of essential fatty acid deficiency with extremely low fat diet in lipoprotein lipase deficiency during pregnancy: A case report.

BACKGROUND: Pregnancy in patients with lipoprotein lipase deficiency is associated with high risk of maternal pancreatitis and fetal death. A very low fat diet (< 10% of calories) is the primary treatment modality for the prevention of acute pancreatitis, a rare but potentially serious complication of severe hypertriglyceridemia. Since pregnancy can exacerbate hypertriglyceridemia in the genetic absence of lipoprotein lipase, a further reduction of dietary fat intake to < 1-2% of total caloric intake may be required during the pregnancy, along with the administration of a fibrate. It is uncertain if essential fatty acid deficiency will develop in the mother and fetus with this extremely low fat diet, or whether fibrates will cross the placenta and concentrate in the fetus. CASE PRESENTATION: A 23 year-old gravida 1 woman with primary lipoprotein lipase deficiency was seen at 7 weeks of gestation in the Lipid Clinic for management of severe hypertriglyceridemia that had worsened with pregnancy. While on her habitual fat intake of 10% of total calories, her pregnancy resulted in an exacerbation of the hypertriglyceridemia, which prompted further restriction of fat intake to < 2% of total calories, as well as administration of gemfibrozil at a lower than average dose. The level of gemfibrozil, as the active metabolite, in the venous and arterial fetal cord blood was within the expected therapeutic range for adults. The clinical signs and a biomarker of essential fatty acid deficiency, namely the ratio of 20:3 [n-9] to 20:4 [n-6] fatty acids, were closely monitored throughout her pregnancy. Despite her extremely low fat diet, the levels of essential fatty acids measured in the mother and in the fetal blood immediately postpartum were normal. Normal essential fatty acid levels may have been achieved by the topical application of sunflower oil. CONCLUSIONS: An extremely low fat diet in combination with topical sunflower oil and gemfibrozil administration was safely implemented in pregnancy associated with the severe hypertriglyceridemia of lipoprotein lipase deficiency.

Journal Article↗
PubMed2003

[Effects of intermittent nasogastric feeding with nonnutritive sucking on nutrient and gastrointestinal tract transit time in premature infants].

OBJECTIVE: To evaluate the effects of nonnutritive sucking (NNS) on the nutrient intake, physical growth, feeding-related complications and whole gastrointestinal transit time (WGTT) in premature infants. METHODS: Thirty eight healthy appropriate for gestational age premature infants (birth weights ranged from 1 050 g to 1 790 g) accepting intermittent nasogastric feeding (INGF) were randomized into NNS group and N-NNS group according to INGF with and without NNS and fed with the same milk formula. The following data were collected and recorded, the physical growth parameters (e.g, body weight, length and head circumference) and the birth-weight regaining time, the fluid intake (including both intravenous and oral), caloric intake, time of reaching 418.4 kJ/(kg.d) by enteral feeding, time of putting nasogastric tube, stool frequency and characters, and relevant complications. WGTT were monitored. RESULTS: The birth-weight regaining time in NNS group was significantly shorter than that in N-NNS group [(8.8 +/- 3.7) d vs (11.1 +/- 3.0) d, P < 0.05]. Within two weeks after feeding, there was no significant difference in the increase of body weight, length and head circumference between the two groups (P > 0.05). The time of reaching 418.4 kJ/(kg.d) by enteral feeding in NNS group was significantly shorter than that in N-NNS group [(12.3 +/- 5.1) d vs (15.7 +/- 5.2) d, P < 0.05]; the times of putting nasogastric tube were respectively (13 +/- 10) d and (17 +/- 12) d, but the difference was not significant (P > 0.05). The morbidity of such complications as vomiting and abdominal distension was lower in NNS group than that in N-NNS group, but the difference was not statistically significant (P > 0.05). However, the morbidity of gastric residue in NNS was significantly lower than that in N-NNS (P < 0.05). WGTT of the second week in NNS group was significantly shorter than that in N-NNS [(33 +/- 13) h vs (45 +/- 20) h, P < 0.05]. Stool frequencies of the second week in NNS group were significantly more than those in N-NNS group [(2.26 +/- 0.17) times/d vs (1.79 +/- 0.58) times/d, P < 0.05]. However, there were no significantly differences in WGTT and stool frequencies of the first week between the two groups (P > 0.05). CONCLUSION: NNS was recommended as a beneficial intervention for premature infants during intermittent nasogastric tube feeding.

Enteral Nutrition↗
PubMed1989

The association between dietary intake and reported history of Candida vulvovaginitis.

The association between dietary intake and the history of Candida vulvovaginitis was evaluated in 166 women who had a history of Candida vulvovaginitis in the past 5 years (cases) and in 207 women without such a history (total population), as well as in 74 women with five or more episodes in the past 5 years and 125 women with no history of Candida vulvovaginitis. Women were interviewed about their demographic data, past medical and sexual history, and their history of vaginal or pelvic infections. An extensive dietary history was taken to determine each woman's usual adult dietary intake. Results indicate associations between total caloric intake, carbohydrates, and fiber and a history of Candida vulvovaginitis. The results were not altered by controlling for age, body mass index, smoking, use of oral contraceptives, and sexual activity variables. These results suggest several dietary constituents may influence susceptibility to Candida vulvovaginitis infections. A follow-up prospective study, using culture confirmation of Candida infection, is needed.

Adult↗
PubMed1989

Milk protein quantity and quality and protein requirements during development.

Most currently available infant formulas have a protein concentration that provides intakes of nutritionally available protein that markedly exceed the requirements and also the protein intakes from human milk in breast-fed infants. Exclusively breast-fed infants have protein intakes of about 2 gm/kg/day during the first month of life and thereafter the intake decreases to about 1 gm/kg/day between the fourth and the sixth month. The amino acid composition of the nutritionally available proteins from human milk also differ significantly from those found in formulas based on bovine milk proteins. If the purpose is to produce human milk substitutes with a protein amino acid pattern similar to that of human milk and to produce a plasma amino acid profile and other metabolic indices of protein metabolism similar to that found in breast-fed infants, then the quantity of protein in formulas must be decreased, and furthermore the quality of the milk proteins must be modified and/or the whey-to-casein ratio changed. Preterm infants with a birth weight less than 1,500 gm grow at intrauterine rates (approximately 30 gm/day) on human milk protein intakes of 3 gm/kg/day when the caloric intake is 120 kcal/kg/day and mineral intakes adequate. At this protein intake, indices of protein metabolism and plasma amino acid profiles are similar to those found in breast-fed term infants. If currently available formula proteins are administered at similar intakes, the plasma amino acid profile of the infants will differ from that found in human milk-fed infants although growth rates and other metabolic responses are similar. This suggests that protein quality must be modified in formulas for VLBW infants. Urine area and urine amino acid excretion correlates directly with protein intake greater than 3.0 gm/kg/day in VLBW infants. By monitoring these metabolites in the urine, it may be possible in the future to adjust protein intakes to meet individual differences in requirements in VLBW infants.

Animals↗
PubMed1997

[Diet therapy in non-insulin dependent diabetes mellitus (NIDDM)].

The main approach in NIDDM therapy is diet. Most patients present insulin resistance characterized by overweight, VLDL increase, minimal increase of LDL, decrease of HDL cholesterol, and hypertension. The overall goals of nutrition therapy are the maintenance of near normal glucose levels, and the achievement of optimal serum lipid levels with adequate calories for maintaining or attaining a reasonable body weight. In presence of obesity and hypertension even a slightly weight loss could achieve an improvement in metabolic control and in hypertension with a better life expectance. General-ly carbohydrate intake would represent the 50-60% of total caloric amount (with preference to those with low glycemic index), and lipids no more than 35% (less than 10% of these 10-15% from monounsaturated fats with less than 300 mg/day of cholesterol). If elevated very low density lipoproteins level is the primary problem, a beneficial approach is 10% of total caloric intake from saturated fats, 10% from polyunsaturated, and 15-20% from monounsaturated fats with less than 200 mg/day of cholesterol and 40% of carbohydrates. A large amount of fructose (20% of calories) may increase LDL levels but sweeteners as saccarine or aspartame are approved and determine a better diet compliance. Daily consumpion of 20-35 g of dietary fibres from food sources is recommended for metabolic control. Protein intake would be of about 10% of total caloric amount especially in presence of diabetic nepropathy. Alcohol would not exceed 30 g/day for men and 20 g/day for women keeping in mild that alcohol may worsen metabolic control, diet compliance, and may be dangerous itself. For people with hypertension a decrease of dietary sodium intake is recommended. Nutritional recommendations are developed to meet treatment goals and desired outcomes. Monitoring metabolic parameters, blood pressure, and body weight is very important to ensure successful outcomes.

English Abstract↗
PubMed1983

The effect of rises in food costs on food intake of three year olds in Jerusalem.

The food intake of two samples of children born five years apart were determined in 1975 and 1980 at three years of age in a low and middle class neighbourhood of Jerusalem. The 24-hour recall method was used. No deficiency in caloric intake was noted. The protein intake was twice the recommended dietary allowance (RDA), 3.7 gr/kg in the study group interviewed in 1975 and 3.3 gr/kg in those interviewed in 1980. The mean daily iron intake was only 40% of the RDA. The main sources for protein were milk and milk products, poultry and eggs. Significantly higher mean caloric and protein intakes were noted for the upper as compared to middle and low social class in 1980. Children from Asian origin had the lowest caloric and protein intake in 1975 and 1980 whereas those of European-American origin had the highest. Severe inflation and the resulting tenfold increase in food prices in Israel were not reflected in marked changes in dietary intake. The percentage expenditure on food was 25% of total income during both periods. The possible factors influencing the stability in dietary intake are governmental subsidy for the essential foods, correction of wages and increase in social security payments thus maintaining the buying power, as well as the educational effect of the preventive services--the Mother and Child Health Stations on feeding practices.

Child, Preschool↗
PubMed1985

The effect of intravenous hyperalimentation on the dietary intake of patients with small cell lung cancer. A randomized trial.

In a randomized trial of 119 patients with small cell cancer of the lung, the effects of a 30-day course of central intravenous hyperalimentation (IVH) on dietary intake were evaluated. All patients underwent the same aggressive chemotherapy and radiation therapy; 57 patients received IVH and 62 served as controls. Median caloric intake prior to antineoplastic therapy was less than 1.2 times basal energy expenditure, below the maximum necessary to maintain weight. While receiving IVH, patients had increased caloric and protein intake. Once the IVH was stopped, oral intake was transiently depressed and thereafter similar to control patients. Baseline nutritional parameters, age, sex, and immediate toxicity from chemotherapy did not predict subsequent caloric insufficiency. Direct estimation of dietary intake is likely the most valuable measure in selecting patients who will need adjunctive nutritional support.

Adult↗
PubMed2001

Sucrose ingestion normalizes central expression of corticotropin-releasing-factor messenger ribonucleic acid and energy balance in adrenalectomized rats: a glucocorticoid-metabolic-brain axis?

Both CRF and norepinephrine (NE) inhibit food intake and stimulate ACTH secretion and sympathetic outflow. CRF also increases anxiety; NE increases attention and cortical arousal. Adrenalectomy (ADX) changes CRF and NE activity in brain, increases ACTH secretion and sympathetic outflow and reduces food intake and weight gain; all of these effects are corrected by administration of adrenal steroids. Unexpectedly, we recently found that ADX rats drinking sucrose, but not saccharin, also have normal caloric intake, metabolism, and ACTH. Here, we show that ADX (but not sham-ADX) rats prefer to consume significantly more sucrose than saccharin. Voluntary ingestion of sucrose restores CRF and dopamine-beta-hydroxylase messenger RNA expression in brain, food intake, and caloric efficiency and fat deposition, circulating triglyceride, leptin, and insulin to normal. Our results suggest that the brains of ADX rats, cued by sucrose energy (but not by nonnutritive saccharin) maintain normal activity in systems that regulate neuroendocrine (hypothalamic-pituitary-adrenal), behavioral (feeding), and metabolic functions (fat deposition). We conclude that because sucrose ingestion, like glucocorticoid replacement, normalizes energetic and neuromodulatory effects of ADX, many of the actions of the steroids on the central nervous system under basal conditions may be indirect and mediated by signals that result from the metabolic effects of adrenal steroids.

Administration, Oral↗
PubMed1995

Comparison of effects of adrenalectomy and RU-486 in rats given a choice of maintenance diet and fat supplement.

The effects of adrenalectomy (ADX) and the blockade of glucocorticoid receptors by RU-486 on Sprague-Dawley rats given a choice of a maintenance diet and a fat supplement were studied. Adult male rats were given free access to AIN-76A diet only (CON) or AIN-76A diet and a separate dietary fat option for 4 wk (FAT). They were then assigned to one of the following treatments: ADX, sham operation, ADX with corticosterone (CORT) replacement, RU-486 injections, or vehicle injections. Food intake and body weight were monitored daily for an additional 3 wk. ADX decreased caloric intake and weight gain in the FAT group more than in the CON group. RU-486 also decreased caloric and fat option intakes as well as weight gain. ADX, but not RU-486, reduced body fat content, lowered plasma insulin and triglyceride levels, and decreased glucose intolerance. CORT replacement partially prevented the effects of ADX on weight gain and body fat content. The results of this study indicate that ADX has greater effects on weight gain and body fat accumulation than does RU-486.

Adrenalectomy↗
PubMed2005

Food intake of children with short stature born small for gestational age before and during a randomized GH trial.

Parents of short children born SGA often report that their children have a serious lack of appetite and a low food intake. In this study we investigated food intake, by using a standardized 7-day food questionnaire, in 88 short SGA children before start of GH treatment. The intake was compared with the recommended daily intake (RDI) of age-matched children. We also compared the food intake of GH-treated children (n=62) with randomized controls (n=26) after 1 year of GH treatment. In addition, we evaluated the effect of food intake and GH treatment on body composition and serum levels of IGF-I, IGFBP-3 and leptin. Our study shows that caloric intake, fat and carbohydrate intake of short SGA children aged 5.9 (1.6) years was significantly lower compared to the RDI for age-matched children. One year of GH treatment resulted in a significant increase of caloric, fat, carbohydrate and protein intake compared to baseline. Compared to randomized controls, caloric, carbohydrate and protein intake increased significantly after 1 year of GH treatment. Short SGA children had significantly lower SDS scores for LBM, fat mass, skinfold (SF) and BMI compared to age-matched references. They also had significantly lower serum IGF-I, IGFBP-3 and leptin levels. GH treatment resulted in a significant increase of height, LBM, BMI, IGF-I and IGFBP-3 SDS and a significant decrease of SF SDS and leptin SDS. In conclusion, our study shows that short SGA children have indeed a lower food intake than age-matched controls. During GH treatment the food intake increased significantly compared to baseline in contrast to the randomized control group.

Body Composition↗
PubMed1995

Effects of supplemental nutrition on lead-induced depression of growth and food consumption in weanling rats.

The objective of this study was to determine whether growth-depressant effects of lead (Pb) could be prevented by preventing the accompanying depression of caloric intake from ad libitum food consumption by caloric supplementation. The animal used was the female weanling rat. Three experiments were performed in which progressively increasing levels of caloric supplementation were provided in order to attain a level of nutrition which would totally prevent growth depression from Pb exposure. Nutritional supplementation of Pb-exposed animals almost completely eliminated the Pb-induced depression of weight gains. We conclude that the deficit in growth due to Pb can be adequately explained on the basis of a primary effect on appetite, rather than being secondary to depression of proliferative responses of cells to growth factors, e.g., insulin-like growth factor I.

Animal Nutritional Physiological Phenomena↗
PubMed2001

Dietary caloric restriction prevents the age-related decline in plasma melatonin levels of rhesus monkeys.

Rhesus monkeys exhibit an age-associated decrease in peak plasma melatonin levels analogous to that reported for humans. This decrease is essentially abolished in monkeys subjected to a 30% reduction in caloric intake over a 12-yr period. The caloric restriction (CR) effect does not seem to be a reversal, but rather a long-term prevention, of the age-related decline in hormone concentrations. The age effect does not seem to be due to a phase shift in the peak of melatonin secretions, as has been observed in some populations of aged humans. It is also extremely unlikely that the CR effect simply reflects a phase shift, since old monkeys on the diet have nocturnal melatonin levels equal to or greater than adult fully fed controls. Thus, if peak times (approximately 0200 h) were actually shifted, maximal levels in old CR monkeys would be even higher. These findings, coupled with previous observations in humans, suggest that peak plasma melatonin levels may represent a possible candidate "biomarker of aging" in primates. Moreover, this index of age-associated physiological decrement seems to be inhibited by dietary CR.

Aging↗
PubMed2002

Weight-cycling decreases incidence and increases latency of mammary tumors to a greater extent than does chronic caloric restriction in mouse mammary tumor virus-transforming growth factor-alpha female mice.

Multiple periods of caloric restriction (or fasting)/refeeding in rodents have had inconsistent effects on mammary tumor (MT) development. In the present study, the consequence of intermittent caloric restriction/refeeding resulting in weight-cycling was evaluated using an oncogene-induced MT mouse model. Hybrid mouse MT virus-transforming growth factor alpha (MMTV-TGF-alpha)/Lep(+)Lep(ob) female mice were used. Ad libitum-fed mice (n = 30) were fed American Institute of Nutrition (AIN)-93M diet. Beginning at 10 weeks of age, weight-cycled mice (n = 30) were fed an AIN-93 modified diet (2-fold increase in protein, fat, vitamin, and mineral contents) at 50% of ad libitum for 3-week intervals followed by 3-week intervals of ad libitum feeding using AIN-93M diet. Pair-fed mice (n = 33), were fed a 2:1 mixture of AIN-93M:AIN-93 modified diets to match the caloric intake of weight-cycled mice for each 6-week age-matched caloric restriction/refeeding interval. Food intakes were determined daily and body weights weekly. Mice were euthanized when MTs exceeded 20 mm in length or at 80 weeks of age. Final body weights were similar, but cumulative food intake of ad libitum-fed mice was 21% greater than that of the other groups. Ad libitum-fed mice had a 77% MT incidence versus 3% for weight-cycled and 44% for pair-fed mice. MTs were detected earlier for ad libitum-fed mice, 64.1 weeks versus 73.5 weeks for pair-fed mice. The only MT in one weight-cycled mouse was excised at necropsy (80 weeks of age) and weighed only 0.063 g. Average MT weight for ad libitum-fed mice was 1.034 g and for pair-fed mice was 0.667 g. Intervals of caloric restriction/refeeding resulting in weight-cycling were protective against MT development in this mouse model. Future studies should address the application of this intervention to additional transgenic mice as well as other MT models.

Animals↗
PubMed1995

Source of dietary carbohydrate affects life span of Fischer 344 rats independent of caloric restriction.

Previous investigations suggest that increased life span of calorie-restricted rodents is a function of caloric intake rather than the macro- or micronutrient composition of the diet. However, the dietary source of carbohydrate has not been widely investigated. We hypothesized that the dietary carbohydrate source may affect the life span of rats independent of caloric restriction. This hypothesis was tested in male Fischer 344 rats fed ad libitum or restricted to 60% of ad libitum, an isocaloric diet containing 14% protein, 10% fat, and 66% sucrose or cornstarch. Body weights of the ad libitum- and restricted-fed sucrose rats were consistently greater throughout the experimental period compared to diet-matched animals. Food intake did not differ significantly. The survival curves of ad libitum starch- vs sucrose-fed rats were significantly different. That is, the mean, median and upper 10th percentile survival were significantly greater in the ad libitum starch- vs sucrose-fed rats (mean life span: cornstarch-fed, 720 +/- 23 days; sucrose-fed, 659 +/- 19 days). Calorie-restricted starch-fed rats had poorer early life survival, and no significant increase in mean life span compared to ad libitum cornstarch-fed animals (726 vs 720 days). These animals did, however, have the greatest upper 10th percentile survival of all four experimental groups. Mean life span of calorie-restricted sucrose-fed rats was significantly greater than that of all other groups (890 +/- 18 days). The differences in survival rates between sucrose- and cornstarch-fed animals could not be attributed to the effects of carbohydrate source on body weight, energy absorption, or on the timing and severity of the pathological lesions normally associated with aging and/or caloric restriction in this species. These data support the hypothesis that the dietary source of carbohydrate, i.e., sucrose vs cornstarch, can significantly affect life span independently of caloric intake.

Animals↗
PubMed2003

Environmental, life-style, and physical precursors of clinical Parkinson's disease: recent findings from the Honolulu-Asia Aging Study.

BACKGROUND: Increased westernization with Japanese migration to the U. S. in the early 20(th) century is thought to have altered the risk of cardiovascular disease. Whether similar effects include changes in the risk of Parkinson's disease (PD) is not clear. This report describes the relations between environmental, life-style, and physical attributes and the incidence of PD that have been observed in the Honolulu-Asia Aging Study. METHODS: Beginning in 1965, environmental, life-style, and physical attributes were recorded at selected examinations in a cohort of 8,006 Japanese-American men. Subjects were followed for clinical PD. FINDINGS: During 30 years of follow- up, PD was observed in 137 men. Overall incidence (7.1/10,000 person-years) was generally higher than in Asia and similar to rates observed in Europe and the U. S. Precursors of PD included constipation, adiposity, years worked on a sugar or pineapple plantation, years of exposure to pesticides, and exposure to sugar cane processing. Factors showing an inverse association with PD included coffee intake and cigarette smoking. Among dietary factors, carbohydrates increased the risk of PD while the intake of polyunsaturated fats appeared protective. Total caloric intake, saturated and monounsaturated fats, protein, niacin, riboflavin, beta-carotene, vitamins A, B, and C, dietary cholesterol, cobalamin, alpha-tocopherol, and pantothenic acid showed no clear relation with clinical PD. INTERPRETATION: Findings suggest that several environmental, life-style, and physical attributes appear to be precursors of PD. Whether patterns of precursors can be used to identify individuals at high risk of future PD or can broaden the scope of early interventions or recruitment into neuroprotective trials warrants further study.

Aged↗
PubMed1986

Effects of exercise-training on the thermic effect of food and body fatness of adult women.

Resting metabolic rate (RMR), thermic effect of food (TEF), aerobic capacity (VO2max), body fat, and food intake were measured in 10 healthy women before and after a 10 week graded exercise program of jogging. Pretraining TEF was a linear function of VO2max. Following exercise training, the women showed a significant increase (20%) in VO2max and loss (10.4%) of body fat; body weight did not change. Fat loss was directly related to changes in VO2max and RMR. The women showed a wide variation of changes in RMR (-21 to +2%) and TEF (-32 to +66%) from their pretraining levels. The changes in RMR and TEF were significantly positively correlated with improvements in VO2max. Analyses using multiple regression techniques, indicated that the changes in RMR and TEF accounted for 96.2% of the total variation in the changes of VO2max. Analyses of food intake indicated that diet composition (but not caloric intake) was highly related to the changes in VO2max, RMR, TEF and body fatness. Present results support further our hypothesis, that VO2max is an important physiological index of dietary thermogenesis and fat loss of individuals of normal body weight and fatness. Possible nutritional and physiological factors that may explain the wide variation in RMR and TEF of the women are discussed.

Adipose Tissue↗
PubMed1991

Weekly rhythms of spontaneous nutrient intake and meal pattern of humans.

Weekly variations in the nutrient intakes and the meal patterns of humans were investigated by paying 323 adult humans to maintain a 7-day diary of everything they ate, when they ate it, and their subjective states of hunger, depression, and anxiety. A marked weekly rhythm of nutrient intake was observed, with a greater total caloric intake and larger meal sizes on weekends associated with an increase in the duration of the meals and the number of other people present. The number of other people present had both significantly larger univariate correlations with meal size and multivariate Beta coefficients predicting meal size on weekends than on weekdays. The results support a hypothesis that the heightened intake on weekends results from increased social facilitation of intake resultant from a greater number of other people present at weekend meals and a greater flexibility to extend the duration of the meals on weekends.

Adult↗