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The purpose of this study was to investigate whether weight-stable chronically energy-deficient subjects exhibit evidence of metabolic adaptation and to establish whether international predictive equations overestimate the basal metabolic rate (BMR) of tropical populations. BMR, body weight, height, and fat-free mass (FFM) by underwater weighing were measured in healthy, physically active urban dwellers of low socioeconomic status (178 men and women aged 22-38 y) in Bangalore, Southern India. Subjects were selected on the basis of body mass index (BMI; in kg/[m.sup.2]) and classified in three groups: severely undernourished (BMI [is less than] 17.0; n = 30 men, n = 25 women), marginally undernourished (BMI = 17.0-18.5; n = 31 men, n = 30 women), and well nourished (BMI [is greater than] 18.5; n = 27 men, n = 35 women). The BMR of the well-nourished group, expressed in absolute terms (6.20 and 5.18 MJ/d for men and women, respectively), was significantly higher (P [is less than] 0.000) than that of the severely undernourished group (5.72 and 4.64 MJ/d for men and women, respectively). Normalizing BMR for either body weight or FFM by analysis of covariance abolished all differences. The mean BMR of the low-BMI study group was substantially higher (11-14%) than reported previously for undernourished Indian adults. The BMR of both men and women, regardless of their nutritional status, was accurately estimated by age- and sex-specific FAO/WHO/UNU equations. These findings suggest the absence of an enhanced metabolic response in weight-stable chronically undernourished adults. This is in contrast with earlier reports, and supports more recent views. The study also provides evidence of the absence of ethnic-specific energy turnover in Indians. Am J Clin Nutr 1997;66:1086 93.

We present a food pyramid that reflects Mediterranean dietary traditions, which historically have been associated with good health. This Mediterranean diet pyramid is based on food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s, where adult life expectancy was among the highest in the world and rates of coronary heart disease, certain cancers, and other diet-related chronic diseases were among the lowest. Work in the field or kitchen resulted in a lifestyle that included regular physical activity and was associated with low rates of obesity. The diet is characterized by abundant plant foods (fruit, vegetables, breads, other forms of cereals, potatoes, beans, nuts, and seeds), fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts, normally with meals. This diet is low in saturated fat ([less than or equal to] 7-8% of energy), with total fat ranging from 35% of energy throughout the region. The pyramid describes a dietary pattern that is attractive for its famous palatability as well as for its health benefits.

Since Keys' first observations in the 1960s, the Mediterranean diet has been under scrutiny by researchers and public health specialists for its health-promoting qualities. Detailed analyses of food surveys carried out in Italy at that time permitted a definition of an Italian-style Mediterranean diet, characterized by low total fat (

Nutrition scientists have theorized that people who do not obtain enough energy from the diet may adapt to the reduced calorie intake. In situations of marginal energy intake, metabolism may slow down and the individual may become less active; decreased metabolic rate and decreased activity conserve energy. Throughout the Third World, food supplies are often inadequate and unreliable, particularly in agricultural societies which have a season of harvest and a season of scarcity. A review of the literature concludes that the most effective means of adapting to low energy intake is by reducing physical activity. But this can have deleterious consequences; when the individual becomes less active, food deprivation may worsen. In farming communities, intense physical labor is necessary to generate the food supply, and in urban areas, inactivity may lead to reduced income from employment. Food deprivation causes weight loss and a reduction in the metabolic rate, the rate at which the body burns calories. The latter outcome may be beneficial in that it conserves energy and protects the individual against further weight loss. A critical issue is whether this process represents adaptation, the successful adjustment to less than ideal nutrition, or malnutrition. Adaptation is viewed as having no adverse effect on the individual whereas malnutrition is linked to fatigue, illness and other negative consequences. The policy implications are extensive; if it is concluded that people in developing countries adapt to marginal energy intake, then less economic and food aid can be justified. One expert panel calculated the energy requirement of people in developing countries in two ways, one by the standard method and the other for the adapted state, which made a lower intake acceptable. This is similar to lowering the poverty line, because it shifts large numbers of people out of a risk category and into the mainstream. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: Leptin is thought to represent a peripheral signal involved in the regulation of energy balance. Its action has been studied in animals and obese subjects. Little is known about leptin's role during negative energy balance. Objective: The objective was to evaluate the relation between energy turnover, body composition, and plasma leptin concentrations in anorexia nervosa (AN). Design: Sixteen weight-stable women with AN were compared with 22 control subjects and 14 rehabilitated AN patients (R-AN). Basal metabolic rate (BMR) was measured by indirect calorimetry; fat-free mass (FFM) and fat mass (FM) were calculated according to a 4-compartment model. Plasma leptin was determined by radioimmunoassay. Results: The BMR of AN patients (2.73 [+ or -] 0.37 kJ/min) was significantly lower than that of control subjects (3.45 [+ or -] 0.34 kJ/min) (P [is less than] 0.001), even after adjustment for FFM (2.92 [+ or -] 0.33 kJ/min in AN patients and 3.30 [+ or -] 0.26 kJ/min in control subjects; P [is less than] 0.004). Plasma leptin concentrations in AN patients were 76% lower than in control subjects, even after body fat was controlled for. In R-AN patients, BMR was not significantly different from that of control subjects and leptin concentrations were generally close to normal. Plasma leptin concentrations correlated significantly with FM ([r.sup.2] = 0.53, P [is less than] 0.0000) and BMR, even after adjustment for FFM ([r.sup.2] = 0.21, P [is less than] 0.0003). Conclusions: BMR and plasma leptin concentrations are depressed in patients with AN; this is not explained by body composition changes. The relation between leptin and BMR suggests that leptin plays a role in the energy sparing response to exposure to chronic energy deficiency. The return of BMR to normal and the significant increase in leptin concentrations in R-AN patients suggests a full reversibility of this adaptation mechanism. Am J Clin Nutr 2000;71:1495-502. KEY WORDS Basal metabolic rate, leptin, body composition, fat-free mass, anorexia nervosa, Italy, women