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The present study is a first attempt to measure water balance and its components at altitude by using labeled water and bromide dilution and relating the results with acute mountain sickness (AMS). Water intake, total water output, and water output in urine and feces were measured over a 4-day interval before and a subsequent 4-day interval after transport to 4,350 m. Total body water and extracellular water were measured at the start and at the end of the two intervals. There was a close relationship between energy intake and water intake, and the relationship was unchanged by the altitude intervention. Subjects developing AMS reduced energy intake and water intake cor respondingly. The increase in total body water (TBW) in subjects developing AMS was accompanied by a reduction in total water loss. They did not show the increased urine output, compensating for the reduced evaporative water loss at altitude. Subjects showed a significant increase in TBW after 4 days at altitude. Subjects with AMS showed the biggest shifts in extracellular water relative to TBW. In conclusion, fluid retention in relation to AMS is independent of a change in water requirements due to altitude exposure. Subjects developing AMS were those showing a fluid shift of at least 1 liter from the intracellular to the extracellular compartment or from the extracellular to the intracellular compartment.

The prevalence of amenorrhea was studied among 113 professional and student ballet dancers in the Netherlands (mean age 23.3 yr, SD 4.8). Sixty-one dancers not on oral contraceptives were included in the subsequent analyses. Six cases (prevalence 9.8 percent, 95 percent confidence interval: 2.4-17.2) with secondary amenorrhea (< or = 4 cycles per year; previous menstruation > or = 3 months prior to the study; menarche > or = 1 yr prior to the study) were found. Two dancers had primary amenorrhea (no menarche at the age of > or = 16). There was a negative correlation between the age of menarche and the number of menstrual cycles during the 12 months preceding the study (r = -0.46, P = 0.001). Body composition (four-compartment model), amount of dancing (recorded), resting energy expenditure (ventilated hood), dietary intake (recorded), and indices of eating disorders (Eating Disorders Inventory, EDI) were studied in 15 of the dancers, 5 amenorrheic and 10 eumenorrheic. No significant differences were found between the amenorrheic and eumenorrheic dancers. An explanation for the lower prevalence of amenorrhea in ballet dancers in the Netherlands, compared with U.S. dancers, was not obvious. Relatively low EDI scores (25.8, SD 14.5) in a subsample of 24 dancers could indicate less rigid emphasis on leanness and dieting.

The aim of the study was to assess whether heart rate (HR) monitoring is suitable to estimate energy expenditure in spastic cerebral palsied (CP) children, who are known to have very low levels of daily physical activity. Total daily energy expenditure (TEE) predicted from HR recording (TEEHR, measured over 2 or 3 d) was therefore compared with TEE measured by doubly labeled water (TEEDLW, measured over 14 d) in nine children with spastic diplegia/tetraplegia (mean +/- SD age 10.7 +/- 1.6 yr). At group level, there was no difference in TEEDLW (7.4 +/- 2.1 MJ.d-1) and TEEHR (7.4 +/- 2.2 MJ.d-1). Spearman correlation between both methods was 0.88 (P < 0.001). Individual estimates of TEEHR ranged from -16.9% to +20.0%, with five TEEHR values within +/- 10% of TEEDLW. It was concluded that also in children with low levels of daily physical activity, HR monitoring (preferably 3 sampling days) can provide a close group estimate of energy expenditure. At the individual level, the method is not suitable.

A rapid and inexpensive method was developed to determine deuterium enrichment in body fluids. This is achieved by converting water into acetylene. To vacutainer tubes a small amount of calcium carbide is added. The tubes are evacuated and 25 microliters of sample are injected through the stopper. The reaction takes place spontaneously at room temperature in a few seconds. Enrichment at mass 27 compared with mass 26 can be determined by continuous flow isotope ratio mass spectrometry without any interference from the carrier gas helium. A series of D2O samples diluted with increasing amounts of H2O is prepared at the time of measurement of the biological samples and the measured ratios are used to calculate the isotope dilution of the unknown. The relative error of the method is 1.6% when a dose of 25 ml kg-1 is administered to the patient. The method was compared with two different methods in use in other laboratories, by a published method The means of the differences were -0.1 and 0.08 1, respectively, with standard deviations of 0.63 and 3.0.

In addition to factors such as fat free mass, hormonal status, genetics and energy balance, previous physical activity has been shown to influence energy turnover during resting (RMR = resting metabolic rate) or basal conditions (BMR = basal metabolic rate). This article presents data on BMR from elite endurance athletes (4 female and 4 male), at least 39 h after their last training session, in comparison with sedentary nonathletic controls matched for sex and fat free mass (FFM). Comparisons with theoretical calculations of BMR were also made. The athletes were shown to have a significantly higher BMR than was expected from calculations based on body mass (16%, P < 0.05) or body composition (12%, P < 0.05). There were no corresponding differences found in the nonathletic control group. The athletes had a 13% higher (P < 0.001) BMR than controls if related to FFM and 16% (P = 0.001) if related to both FFM and fat mass (FM). The athletes were also found to have 10% lower R-values (P < 0.01) indicating higher fat oxidation. The conformity of these findings with the present literature and the possible mechanisms behind them as well as its influence on theoretical calculations of energy turnover (ET) based on activity factors expressed as multiples of RMR are further discussed.

The main purpose of the present study was to examine factors that affect bone mineral density (BMD) in female ballet dancers. Training history, Ca intake, body composition, total body BMD (TBMD) and site-specific BMD, and bone mineral content were described in twenty-four female ballet dancers (mean age 22.6 (SD 4.5) years). Training history was determined by questionnaires, Ca intake by 7 d dietary record, BMD and bone mineral content by dual-energy X-ray absorptiometry (DXA), total body water by 2H dilution, extracellular water by bromide dilution, body fat by underwater weighing (UWW; two-component model), DXA, and the four-component (4C) model. Dancers had a significantly lower body mass index (BMI 18.9 (SD 1.0) kg/m2) than controls (21.3 (SD 1.9) kg/m2), with significantly lower percentage body fat (17.4 (SD 3.9) v. 24.4 (SD 5.1)) but comparable fat-free mass. Mean TBMD (1.147 (SD 0.069) g/cm2) was significantly higher (6%) compared with that of a reference population. These high values could be attributed to the high BMD of legs and pelvis, the weight-bearing sites of the dancer's body. No relationship was found between age, start of ballet classes, period (years) of dancing, Ca intake, and BMD (total and site-specific). However, TBMD was positively related to BMI, and negatively related to the age of menarche. BMD of the legs was significantly related to BMI, and negatively related to the age of menarche. BMD of the legs was significantly related to daily period (h) of training. Depending on the method used the percentage body fat ranged from 16.4 (by DXA) to 18.3 by the 4C model. These differences were significantly related to the TBMD. Percentage body fat by the different methods was not significantly different, except for DXA and 4C model. The present study showed that, despite the factors that have a negative effect on BMD, such as low body mass and late menarche, BMD in female ballet dancers was relatively high. These high values were probably caused by high levels of weight-bearing physical activity.

Objective: To assess the differences in daily physical activity between children with spastic diplegia and healthy schoolchildren, to determine whether special physical activity programs are needed in the population with cerebral palsy., Design: Cross-sectional design., Setting: Children's rehabilitation center Franciscusoord (day care center) and elementary schools., Subjects: Children with spastic diplegia (5 boys; mean (+/- SD) age 8.0 +/- 1.4 years; 9 ambulant, 1 wheelchair use) and healthy children (5 boys; mean (+/- SD) age 8.4 +/- 1.0 years)., Measurements: Total daily energy expenditure (TEE) and sleeping metabolic rate (SMR) were measured by the doubly labeled water technique and a respiration chamber. The TEE/SMR ratio was used as an index for the level of daily physical activity., Results: The TEE/SMR ratio under normal daily conditions in the children with cerebral palsy (mean +/- SD): 1.56 +/- 0.19) was significantly lower (p < 0.05) than in their healthy peers (mean +/- SD: 1.83 +/- 0.23) and was similar to the TEE/SMR ratio in a room-sized chamber., Conclusion: Children with spastic diplegia are considerably less active than their healthy peers. We recommend special physical activity programs for these children.

The effects of severe energy restriction alone (2.0 MJ/d for 4 wk and subsequently 3.5 MJ/d for 4 wk) or energy restriction plus moderate exercise on energy balance were studied in 20 healthy obese women. Subjects aged 25-50 y were matched on the basis of body mass index and percentage body fat and randomly assigned to diet alone (D) or diet and exercise (DE) for 8 wk. DE resulted in a significantly increased loss of fat mass compared with D (7.8 +/- 0.8 compared with 5.5 +/- 0.8 kg; P < 0.05). The average daily metabolic rate measured with doubly labeled water decreased with both treatments, with no differences between the treatments. Energy balance data show that the DE treatment resulted in a significantly greater energy deficit than the D treatment. The relative contribution of fat to energy expenditure during exercise was significantly enhanced by DE treatment whereas it did not change after D. The energy expended on physical activity was not changed at the end of both treatments, with no differences between the two groups. The unchanged energy expended on physical activity indicates that DE might be accompanied by partial compensation of daily physical activities outside the training for the energy expended during the training. The energy deficit due to energy restriction alone was not compensated by a decrease in free-living daily physical activities. Addition of moderate exercise to an energy-restriction program in obese women has advantages with respect to changes in body composition, energy expenditure, and substrate utilization.

Body composition data are important for adequate monitoring of growth and nutritional status in infants. 18O Isotope dilution techniques (ID18-O) are widely used to estimate total body water (TBW) and calculate fat-free mass (FFM). A problem of isotope dilution is an underestimation of TBW by the extrapolation to t = O approach and an overestimation of TBW by the plateau approach. Using total body electrical conductivity (TOBEC) as the reference technique we validated the extrapolation approach by 149 measurements (boys, n = 76; girls, n = 73) in 50 healthy infants aged 1-12 mo. TOBEC-derived FFM and fat mass were in excellent agreement with Fomon's reference data. Strictly linear relationships with slopes not significantly different from one were found between FFM estimated by TOBEC (FFMTOBEC) and FFM estimated by ID18-O (FFM18-O) (r = 0.98 and residual SD = 0.29 for boys, r = 0.98 and residual SD = 0.32 for girls). FFM18-O was slightly but significantly lower than FFMTOBEC, the difference being on average 0.18 (+/- 0.24) kg for girls and 0.08 (+/- 0.21) kg for boys (i.e. respectively 4 (+/- 4.5)% (p < 0.0001) and 1.5 (+/- 3.9)% (p = 0.004) of FFMTOBEC). We conclude that ID18-O using the extrapolation to t = O approach is suitable for TBW and FFM estimations in groups of infants. Due to the considerable measurement error of ID18-O (estimated at approximately 6%), individual TBW18-O and FFM18-O estimates should be considered with some caution.

Objective: Since little information is available on the capacity of the non-obese to adapt to a moderate decrease in energy intake, the effect of a 10-week moderately energy-restricted diet (ER) on energy expenditure and body composition was studied., Design: A controlled intervention study. After a weight-maintaining run-in period of 2 weeks, the ER group received a diet that contained 9.2 MJ/day on average, i.e. 80% of the energy of their habitual diet (estimated by means of a 7-day dietary record) for the next ten weeks while the control group received the weight-maintaining diet., Setting: Subjects continued daily life habits and came to the Institute every evening to have dinner and to receive food for the next 24 h., Subjects: 24 healthy non-obese, middle-aged men participated. Subjects were matched for age and body mass index and randomly assigned to a control group (n = 8) or an ER group (n = 16)., Results: Average daily metabolic rate (ADMR, i.e. total energy expenditure), measured with doubly labeled water in eight subjects of the ER group, appeared to be 82.5% of reported energy intake resulting in an actual level of energy restriction in these eight subjects of 33% on average (range 18-42%), rather than 20%. Subjects in the ER group lost 7.4 +/- 1.7 kg; 83% of this weight loss was fat mass, 17% was fat-free mass. Subjects in the control group lost some weight too (2.1 +/- 1.5 kg). Resting metabolic rate (RMR) (MJ/day) decreased in the ER group (P < 0.001). In this group the thyroid hormone triiodothyronine (T3) decreased (P < 0.001), while reverse T3 (rT3) increased (P < 0.05). ADMR decreased significantly., Conclusion: Under conditions of a controlled moderately energy-restricted diet in daily life a significant weight loss can be induced, similar to that observed after a balanced dietary deficit, providing 5 MJ/day. In addition, moderate energy restriction induces a decrease in fat-free mass and a fall in RMR.

Energy expenditure, and therefore energy requirement, generally decreases with advancing age because of a decrease in basal metabolic rate (BMR) and physical activity. The aim of the present study was to measure total energy expenditure (EE) and activity level in a group of healthy elderly (sixteen men aged 71.3 (SD 4.9) years; ten women aged 67.6 (SD 4.1) years) and young adults (nineteen men aged 30.4 (SD 5.0) years; ten women aged 27.2 (SD 3.9) years) by using the doubly-labelled water method in combination with measurements of BMR. Age-related differences in body composition and their relationship to BMR and activity level were studied. EE was lower in elderly compared with young adults, partly due to a significantly lower BMR. The lower BMR was not fully explained by the lower fat-free mass (FFM) in the elderly. Energy expended (MJ/d) on activity was higher for the younger subjects although there was no significant difference in the physical activity index (PAI = EE/BMR) between the two age groups. The effect of physical activity level is twofold: first it has a positive effect on the BMR, and second it has a positive effect on the FFM. Both effects involve an increase in the total EE with an increased level of physical activity. At energy balance this will lead to increased energy and nutrient intake, making especially the elderly less vulnerable to inadequate energy and nutrient intake.

The applicability of bioelectrical impedance analysis (BIA) to predict total body water (TBW) was assessed in 16 underweight [< 95% of ideal body weight (IBW)] and 25 normal-weight (> 95% of IBW) cancer patients. Although height2/resistance (ht2/R) proved to be a strong single predictor of TBW measured by deuterium dilution in both groups (normal-weight patients: r2 = 0.85, SEE 2.16 L; underweight patients: r2 = 0.86, SEE 2.24 L), TBW would be significantly overestimated in the underweight group if the prediction formula developed in the normal-weight group was used [bias 1.67 L (5%), 95% CI 0.20-3.15 L]. A systematic overestimation of TBW in the underweight patients was also found when TBW was predicted in our two patient groups by several previously published BIA formulas developed in normal-weight individuals. We conclude therefore, that although a similar relationship is found between ht2/R and TBW in normal-weight and underweight cancer patients, single-frequency BIA overestimates TBW in underweight patients when prediction formulas are used that have been developed in normal-weight subjects.

In adults, body mass (BM) and its components fat-free mass (FFM) and fat mass (FM) are normally regulated at a constant level. Changes in FM and FFM are dependent on energy intake (EI) and energy expenditure (EE). The body defends itself against an imbalance between EI and EE by adjusting, within limits, the one to the other. When, at a given EI or EE, energy balance cannot be reached, FM and FFM will change, eventually resulting in an energy balance at a new value. A model is described which simulates changes in FM and FFM using EI and physical activity (PA) as input variables. EI can be set at a chosen value or calculated from dietary intake with a database on the net energy of foods. PA can be set at a chosen multiple of basal metabolic rate (BMR) or calculated from the activity budget with a database on the energy cost of activities in multiples of BMR. BMR is calculated from FFM and FM and, if necessary, FFM is calculated from BM, height, sex and age, using empirical equations. The model uses existing knowledge on the adaptation of energy expenditure (EE) to an imbalance between EI and EE, and to resulting changes in FM and FFM. Mobilization and storage of energy as FM and FFM are functions of the relative size of the deficit (EI/EE) and of the body composition. The model was validated with three recent studies measuring EE at a fixed EI during an interval with energy restriction, overfeeding and exercise training respectively. Discrepancies between observed and simulated changes in energy stores were within the measurement precision of EI, EE and body composition. Thus the consequences of a change in dietary intake or a change in physical activity on body weight and body composition can be simulated.

An update of practical aspects of the use of labeled water for the measurement of total body water (TBW) and energy expenditure (EE) is presented as applied in Maastricht, The Netherlands. We use a 10-hour equilibration period. The isotopes for the measurement of TBW and EE are routinely administered, after collecting a background urine sample, as a last consumption before the night. Our data show an underestimate of TBW measured with isotope dilution after 4 hours (in the morning), a discrepancy which increases with the size of TBW. No such relation and no significant differences were found after 10-hour (overnight) equilibration. The ratio between the dilution space for deuterium and oxygen-18 is higher than the earlier figure of 1.03, especially in adult subjects with a high body fat content. For an observation period of EE over two weeks, samples from the second and the last voiding on the first, mid, and last day of the observation period are collected. Differences in EE calculated from morning and evening samples within the first and second week allow detection of sampling errors and if so, samples are excluded from the final calculation. Differences of EE between weeks 1 and 2 allow a check for the consistency of the subjects' physical activity level and usually fall within 10% of the average EE over the total observation interval.

This study was performed to investigate the effect of weight-training (12 wk; 21 male subjects) on energy expenditure and substrate utilization during sleep. Sleeping metabolic rate (SMR) as measured in a respiration chamber was calculated according to three procedures: the lowest mean energy expenditure of a shiftable 3-h interval between 0:00 and 6:00 (SMR3) and SMR over predetermined intervals from 3:00 to 6:00 (SMR3-6) and from 0:00 to 6:00 (SMR0-6). In analogy with SMR the corresponding respiratory quotients were expressed as RQ3, RQ3-6, and RQ0-6. Changes in body composition were assessed from changes in body weight, body volume (densitometry), and total body water (deuterium dilution). Weight-training induced an increase in fat-free mass (+1.1 +/- 1.3 kg; P < 0.001) and a decrease in fat mass (-2.3 +/- 1.5 kg; P < 0.001) and body weight (-1.1 +/- 2.1 kg; P < 0.05). There was no significant change in SMR, irrespective of the way SMR was expressed. Only RQ3 decreased significantly (from 0.82 +/- 0.04 to 0.79 +/- 0.02; P < 0.05). Remarkably RQ3, RQ3-6, and RQ0-6 were highly negative correlated with the pre-training RQ (r = -0.93, -0.91, and -0.90, respectively: P < 0.001) resulting in a diminished variation in post-training RQ (P < 0.001). These results suggest that weight-training has no effect on SMR but increases relative fat utilization in low fat oxidizers and vice versa for individuals displaying high pre-training lipid oxidation.

Patients with liver cirrhosis are often undernourished. In healthy subjects, the pattern of food intake is one of the variables that can influence energy balance and substrate metabolism. The short term (two day) effect of the pattern of food intake in patients with cirrhosis and controls was compared. In a respiration chamber, eight patients with cirrhosis of the liver and 23 controls were fed to estimated energy balance in two meals daily ('gorging' pattern) and four to seven meals daily ('nibbling' pattern). Twenty four hour energy expenditure, expressed as a multiple of the sleeping metabolic rate, was reduced in patients with cirrhosis (1.31 (0.03) v 1.44 (0.02) for controls; p < 0.01) because of an increased sleeping metabolic rate per kg fat free mass in these patients. In both patients and controls, the respiratory quotient was significantly lower during the morning preprandial period (9.00-12.00) on the gorging pattern, reflecting a higher oxidation ratio of fat to carbohydrate compatible with a more catabolic state. For patients with cirrhosis, a nibbling pattern of food intake, including a good breakfast and a late evening meal, would be preferable, in order to have shorter episodes of catabolism during the day.

The effect of the amount of protein intake (12% and 21% of total energy intake, diet A and diet B, respectively) on nitrogen balance and whole-body protein turnover (PT) was measured in 19 young men and 10 young women (aged 30 +/- 5 and 27 +/- 4 y, respectively). In young adults, mean nitrogen balance was approximately zero during diet A whereas it was positive during diet B. In young adults, PT was significantly higher during diet B in comparison with diet A. This was also seen in elderly subjects, as described before. From a comparison of the current data with the data previously obtained in elderly subjects it can be concluded that during diet A young adults had PT rates higher than those of elderly subjects. During diet B, PT of young men was comparable with the PT of elderly men whereas young women still had higher PT rates than elderly women (even when corrections were made for differences in body composition).

Objective: The effect of age on energy expenditure was studied., Design: Case-control study., Setting: Respiration chamber at the University of Maastricht., Subjects: Thirteen young men (27 +/- 4 years) and ten elderly men (74 +/- 5 years), were recruited with advertisements in local media., Methods: In a 36 h experiment, 24 h energy expenditure (EE), sleeping metabolic rate (SMR), diet-induced thermogenesis (DIT) and energy expenditure of physical activity (EEact) were measured while subjects performed an activity protocol in a respiration chamber under strictly controlled conditions., Results: SMR as a function of fat-free mass (FFM) was not different between both age groups. 24 h EE during a standardized activity protocol was significantly higher for the young men (young men: 12.85 +/- 1.53 MJ/d; elderly men: 10.90 +/- 1.12 MJ/d; P = 0.011). The DIT expressed as MJ/d was significantly higher for the young subjects but similar when expressed as percentage of energy intake (young men: 13.10 +/- 5.44%; elderly men: 9.88 +/- 3.86%). The resulting figure for EEact (24 h EE--SME--DIT) was the same for young and elderly men (young men: 3.11 +/- 0.71 MJ/d; elderly men: 3.05 +/- 0.64 MJ/d)., Conclusion: The results indicate that mean energy costs for low intensity daily activities (some daily household activities and a bench stepping exercise) were the same for young and elderly men.

In this study the effect of protein intake (12% and 21% of total energy intake, diets A and B, respectively) on nitrogen balance and on whole-body protein turnover (PT) was measured in 17 elderly men and 11 elderly women (mean +/- SD: 74 +/- 12 y and 68 +/- 9 y, respectively) with different levels of physical activity. Mean (+/- SD) nitrogen balance (diet A: -0.004 +/- 0.027 g.kg-1.d-1, diet B: 0.011 +/- 0.064 g.kg-1.d-1) did not differ significantly from zero during either diet. PT increased significantly when the protein content of the diet increased from 12% to 21% of total energy (P < 0.0001). There was a positive correlation between protein intake and PT (diet A: synthesis and breakdown, P < 0.01; diet B: synthesis, P < 0.001; breakdown, P < 0.0001). PT rates were significantly higher for men when compared with women, even when corrections were made for differences in body composition (P < 0.05).

Objective: We studied the effect of varying only protein intake on energy balance, protein balance and estimated weight gain composition in premature infants fed either a formula with a protein content of 2.0 g/100 ml (F2) or a protein content of 1.5 g/100 ml (F1.5)., Design: Premature infants were randomly allocated to receive F1.5 or F2. Weight gain composition was estimated from protein and energy balances. Energy expenditure was measured with doubly labelled water., Patients: F1.5, n = 8; gestational age 32 +/- 3 weeks, birth weight 1716 +/- 560 g. F2, n = 8; gestational age 32 +/- 3 weeks, birth weight 1544 +/- 488 g., Results: Infants fed F2 showed a significantly higher protein accretion (P = 0.003) and weight gain (P = 0.011) when compared to the infants fed F1.5. There were no differences in the energy balance. The estimated weight gain composition was different between both groups., Conclusion: The F2 fed infants had an estimated weight gain composition comparable to the reported intrauterine values, while the F1.5 fed infants showed a weight gain composition more comparable to the reported values of the full term infant. The impact of nutrient composition in premature infant formulas on body composition and growth is discussed.

A triaxial accelerometer was used to evaluate the relationship between energy expenditure due to physical activity (EEact) and body acceleration during different types of activity. In a laboratory experiment, 11 male subjects performed sedentary activities and walked on a motor driven treadmill (3-7 km.h-1). EEact was calculated from total energy expenditure (EEtot), as measured by indirect calorimetry, and sleeping metabolic rate (SMR): EEact = EEtot--SMR. Body accelerations were measured with a triaxial accelerometer at the low back. Special attention was paid to the analysis of unidirectional and three-directional accelerometer output. During sedentary activities a linear relationship between EEact and the sum of the integrals of the absolute value of accelerometer output from all three measurement directions (IAAtot) was found (r = 0.82, P < 0.001, Sy,x = 0.22 W.kg-1). During walking EEact was highly correlated with the integral of absolute accelerometer output in antero-posterior direction (IAAx; r = 0.96, P < 0.001, Sy,x = 0.53 W.kg-1). When all examined activities were included in a regression analysis, a strong linear relationship between EEact and IAAtot was found (r = 0.95, P < 0.001, Sy,x = 0.70 W.kg-1). Using this relationship, EEact during sedentary activities as well as EEact during walking could be estimated with an accuracy of about 15%. Although sedentary activities and walking represent a large part of normal daily physical activity, the validity and usefulness of the triaxial accelerometer--measuring IAAtot--to predict EEact in daily life must be studied under free-living conditions.

Intestinal absorption and its relationship to increased total body water was studied in seven infants with congenital heart disease receiving regular diuretics due to congestive heart failure. All infants and six age-matched healthy controls were studied for a 3-d period during which time all food intake was recorded, stools were collected, and total body water content (TBW) and extracellular water were measured. All the anthropometric measurements were lower in the infants with congenital heart disease compared with healthy controls. Energy and fat excretion in the stools were significantly increased in the group of patients, but when expressed as a percentage of daily caloric intake or as a percentage of the specific intake (e.g. fat excretion/fat intake x 100), no statistical differences were found. TBW as a percentage of body weight was increased in our patients compared with our controls (84.95 +/- 5.82% versus 68.65 +/- 4.60%; p = 0.01) and so was extracellular water as a percentage of predicted (200.0 +/- 18.6% versus 100.9 +/- 7.2%; p = 0.001). A positive correlation was found between energy and fat excretion as a percentage of the intake and TBW as a percentage of predicted; energy and fat malabsorption did not exceed 8% in the patients with the highest body water content (120% of predicted). It is concluded that malabsorption is not a significant factor in failure to thrive of patients with congenital heart disease who are receiving regular diuretics. Based on the significant negative correlation between excess body water and fat and calorie absorption, however, it is suggested to monitor TBW in patients who fail to gain weight.

Deuterium dilution for the measurement of total body water (TBW) has been conducted using varying protocols for equilibration. We measured TBW from deuterium dilution in urine samples in twenty-eight subjects using three protocols: (1) early morning dosage without breakfast, measuring deuterium in a second voiding at 4 h and 6 h; (2) early morning dosage with breakfast with the same measurement times; (3) dosage as last consumption before overnight sleep, measuring deuterium in a second voiding at 10 h. Results were compared with TBW estimates from underwater weighing (UWW). Because UWW is an indirect measure of TBW, it is used as an independent reference method in order to compare only relative discrepancies between the two methods. TBW values in the fasted state were not significantly different from those obtained in the fed state. The urinary deuterium enrichment was higher at 4 h than at 6 h (resulting TBW differences: 0.6 (SD 0.4) l). At 4 h and 6 h, differences in TBW measurements from deuterium and densitometry were positively related to the amount of TBW, indicating incomplete equilibration in larger water compartments. At 10 h no such relationship existed, indicating complete mixing of deuterium. It is concluded that 10 h equilibration is preferable to the shorter 4 h and 6 h, for the determination of TBW.

Vitamin B-6 metabolism was studied as a function of dietary protein intake. Subjects were 29 young adults (29 +/- 1 y old) and 26 elderly adults (70 +/- 1 y old) who consumed standardized diets containing 12% (Diet A) and 21% (Diet B) of total energy as protein for 3 wk each, according to a randomized crossover design. Vitamin B-6 intake for young and elderly subjects was 1.52 +/- 0.08 mg/d (21.74 +/- 0.45 micrograms/g protein) and 1.47 +/- 0.05 mg/d (23.81 +/- 0.08 micrograms/g protein), respectively, during consumption of Diet A and 1.79 +/- 0.07 mg/d (14.49 +/- 0.11 micrograms/g protein) and 1.73 +/- 0.05 mg/d (16.24 +/- 0.06 micrograms/g protein) during consumption of Diet B. Plasma pyridoxal phosphate (PLP), pyridoxal and total vitamin B-6 concentrations were significantly lower in the elderly subjects compared with the young adult subjects during both diet periods. In the elderly subjects, PLP was significantly higher during Diet B consumption (Diet A: 27 +/- 3 nmol/L; Diet B: 32 +/- 3 nmol/L), whereas the level of protein intake had no significant effect on plasma PLP in the young adults (Diet A: 47 +/- 6 nmol/L; Diet B: 45 +/- 5 nmol/L). Plasma pyridoxal and plasma total vitamin B-6 concentrations were not influenced by the amount of protein intake in young and elderly subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Weight loss due to malnutrition and possibly intestinal malabsorption is a well-known phenomenon in high-altitude climbers. Up to approximately 5,000 m, energy balance may be attained and intestinal energy digestibility remains normal. To see whether 1) energy balance may also be attained at 6,542 m and, if not, 2) whether decreased energy digestibility would play a significant role in the energy deficit, energy intake (EI), energy expenditure, body composition, and energy digestibility of 10 subjects (4 women, 6 men; 27-44 yr) were assessed during a 21-day sojourn on the summit of Mt. Sajama, Bolivia (6,542 m). EI was measured during two 3-day intervals: EI1 (days 7-9) and EI2 (days 17-19). Total fecal energy loss during EI1 was calculated from fecal energy measured by bomb calorimetry. Average daily metabolic rate (ADMR) at altitude was measured in six subjects (2 women, 4 men) using doubly labeled water over a 10-day interval (days 9-19). Basal metabolic rate was measured before and after the expedition by respiratory gas analysis. Body composition was estimated from skinfolds and body mass before and during the altitude sojourn. Subjects were in negative energy balance throughout the observation period (EI1-ADMR = -2.9 +/- 1.8 MJ/day and EI2-ADMR = -2.3 +/- 1.8 MJ/day based on a gross energy digestibility of 95%). The activity level, expressed as ADMR to basal metabolic rate, was 1.56-2.39. The loss of fat mass (3.7 +/- 1.5 kg) represented 74 +/- 15% of the loss of body mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Single-frequency bioelectrical-impedance analyses (BIA) and bioelectrical spectroscopy (modeling multifrequency measurements; BIS) were validated as methods to predict body water (BW) compartments in 29 healthy adults. Total body water (TBW) and extracellular water (ECW) were determined by deuterium- and bromide-dilution techniques. Contribution of BIA to anthropometry and influence of the position of electrodes were examined. Stepwise-regression analysis revealed that inclusion of BIA to anthropometric data greatly improved the fit with BW compartments. Highly significant correlations were observed between BIS and BW compartments (TBW: r2 = 0.98, SEE = 1.2; ECW: r2 = 0.95, SEE = 0.6). Cross-correlation (14 males, and 15 females) indicated predictive potential of the method. Results from BIS and BIA were comparable, but it is argued that BIS has the potential of improved standardization of the method.

Energy intake covering energy expenditure is essential for performance as well as for health aspects in endurance athletes. This study was performed to determine the energy needs for elite cross country skiers during a week of training and to demonstrate whether energy balance could be maintained. Energy intake was calculated from weighed dietary records and doubly labeled water was used to simultaneously measure energy turnover. Average daily energy intake ranged from 15.7 to 20.4 MJ.d-1 in the females and from 25.7 to 36.0 MJ.d-1 in the males. This correlated well with the data for average daily energy turnover (r = 0.96; P = 0.0001) that ranged from 15.1 to 20.2 MJ.d-1 and from 25.4 to 34.9 MJ.d-1, in females and males, respectively. The mean difference being 0.1 (+/- 1.9) MJ.d-1. The close match between energy intake and energy expenditure has not previously been shown in athletes at these high levels of energy turnover. However, if energy intake over separate 24-h periods was compared with corresponding data for training, no significant relationship was found. This indicates that the athletes were not in energy balance during shorter periods. Furthermore, the validity of theoretical calculations of energy turnover, in highly trained subjects, derived from multiples of estimated BMR, is questioned.

The aim of the present study was to investigate whether weight-training-induced adaptations in body composition and isokinetic strength differ as a function of body build. Body build of a subject was characterized as the extent to which a person's fat-free mass index (FFMI = fat-free mass.height-2;kg.m-2) differs from the regression of FFMI over fat mass index (FMI = fat mass.height-2;kg.m-2) as derived from a sedentary male population (N = 77). From this population two groups with either a slender (N = 10) or a solid (N = 11) body build were selected. For 12 wk the subjects performed a weight-training program twice a week. Training induced a significant (P < 0.05) increase in fat-free mass (FFM) in the solid group (1.6 kg, 2.3%) in contrast with the slender group, which showed no significant change in FFM. Both groups showed comparable decreases in fat mass (FM; slender: -1.7 kg, -10.8% versus solid: -2.4 kg, -11.3%) and increases in strength (on average 13.8%). In conclusion, the increase in FFM due to a weight-training program is modified by body build. This modification, however, is restricted to a larger increase in the solidly built group.

Body composition was measured in nine healthy, normal-weight, weight-stable subjects in three different research centres. In each centre the usual procedures for the measurements were followed. It revealed that the measurement procedures in the three centres were comparable. Body composition was measured in each centre between 09.00 and 13.00 hours after a light breakfast by densitometry (underwater weighing) and bio-electrical impedance. A single, total-body-water determination by D2O dilution was used as a reference value. Body fat determined by densitometry was significantly lower in one centre, which, however, could be completely explained by a lower body weight, probably due to water loss (the subjects refrained for a longer time from food and drinks before the measurements in that centre) and, thus, by violation of the assumptions of Siri's (1961) formula. Also, body impedance was slightly higher in that centre, indicating a lower amount of body water. Mean body fat from densitometry was also slightly lower in that centre compared with body fat determined by D2O dilution. Individual differences between body fat from densitometry and from total body water were relatively large, up to 7% body fat. The relationship between fat-free mass from densitometry and bio-electrical impedance was not different between the centres. It is concluded that differences in the relationship between body composition and bio-electrical impedance, as reported in the literature, may be due to differences in standardization procedures and/or differences in reference population.

In man there is evidence that the ability to adjust fat oxidation to fat intake is less effective than the ability to adjust carbohydrate and protein oxidation to carbohydrate and protein intake. The short-term (3-day) effects of a low-fat (LF), mixed (M), and high-fat (HF) diet on human substrate balances were studied using a respiration chamber. Subjects were 14 young female students classified by means of their scores on psychometric questionnaires as "restrained" or "unrestrained" eaters. Subjects were in energy balance, ie, the mean difference between energy intake (EI) and energy expenditure (EE) was 86 +/- 85 kJ/d. The fat content of the food significantly influence the 24-hour respiratory quotient (RQ) and nonprotein respiratory quotient (NPRQ). For both the LF and M diets, the 24-hour RQ was significantly lower than the food quotient (FQ), whereas the RQ on the HF diet was not different from the FQ. Oxidation of fat and carbohydrate significantly increased with, respectively, an increasing fat and carbohydrate content of the diet for both restrained- and unrestrained-eating subjects. Restrained-eating subjects showed a decreased fat oxidation compared with unrestrained eaters in response to a HF diet, resulting in a positive fat balance for restrained-eating subjects. On a LF diet, fat balance was negative for both groups of subjects, indicating net endogenous fat oxidation. In conclusion, restrained-eating subjects have more difficulty in the handling of a HF diet, possibly explaining their higher susceptibility to becoming obese.

Metabolic rate, more specifically resting metabolic rate (RMR) or sleeping metabolic rate (SMR), of an adult subject is usually expressed as a function of the fat-free mass (FFM). Chronic exercise is thought to increase FFM and thus to increase RMR and SMR. We determined body mass (BM), body composition, and SMR before, during, and after an endurance training programme without interfering with energy intake. The subjects were 11 women and 12 men, aged 37 (SD 3) years and body mass index 22.3 (SD 1.5) kg.m-2. The endurance training prepared subjects to run a half marathon competition after 44 weeks. The SMR was measured overnight in a respiration chamber. Body composition was measured by hydrostatic weighing. Measurements were performed at 0, 8, 20, 40, and 90 weeks after the start of the training. The BM had decreased from a mean value of 66.6 (SD 6.9) to 65.6 (SD 6.7) kg (P < 0.01), fat mass (FM) had decreased from 17.1 (SD 3.9) to 13.5 (SD 3.6) kg (P < 0.001), and FFM had increased from 49.5 (SD 7.3) to 52.2 (SD 7.6) kg (P < 0.001) at 40 weeks. Mean SMR before and after 40 weeks training was 6.5 (SD 0.7) and 6.2 (SD 0.6) MJ.day-1 (P < 0.05). The decrease in SMR was related to the decrease in BM (r = 0.62, P = 0.001). At 90 weeks, when most subjects had not trained for nearly a year, BM and SMR were not significantly different from the initial value while FM and FFM had not changed since week 40 of training.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients with liver disease are frequently undernourished. We determined the habitual pattern of energy intake and intake of protein, fat, carbohydrate and alcohol in patients with liver disease. 20 Patients differing with respect to cause, duration and severity of liver disease reported their habitual food intake using a 7-day food record. Control subjects formed a representative sample of the Dutch population. The results showed that patients with liver disease, had a significantly decreased daily energy intake (both expressed in absolute values and per kg body mass), compared with control subjects. Total fat intake was reduced in patients, whereas total intake of protein, carbohydrate and alcohol was similar to the control group. In the first 4 hours after rising, energy and protein intake were significantly increased in the patient group. During the evening the consumption of protein was lower in patients with liver disease than in control subjects. These findings are probably functional in order to minimize episodes of catabolism.

A study was intended to estimate energy intake (EI) for a nutrition intervention study. Subjects were 17 elderly men (age: 72 +/- 5 years) and 11 elderly women (age: 67 +/- 4 years). Two methods were used to measure EI: a 4-day dietary record (DR group; n = 12) or a dietary questionnaire (DQ group; n = 16). Subjects were fed for 3 weeks according to this intake during an intervention period, and energy expenditure (EE) was measured with doubly labelled water to verify the resulting figure for EI. Body weight and body composition were measured at the beginning of the second week and at the end of the third week, and metabolizable energy (ME) was calculated as gross energy intake (GEI) minus energy in faeces and urine. GEI, ME and EE did not differ between the DR and DQ groups (mean +/- SD for GEI: 10.09 +/- 1.21 and 9.29 +/- 1.36; ME: 9.09 +/- 1.28 and 8.34 +/- 1.31; EE: 10.13 +/- 1.57 and 9.25 +/- 0.35 MJ/d). In both groups ME was significantly lower than EE (DR group P < 0.05; DQ group P < 0.01). Body weight decreased significantly during the intervention period (mean +/- SD for DR group: -0.64 +/- 0.50 kg, P < 0.001; DQ group: -0.86 +/- 0.90 kg, P < 0.01). The change in body weight was significantly correlated with energy balance (ME - EE; P < 0.05). As shown from the results of the body composition measurements, body weight loss was a decrease of fat mass.(ABSTRACT TRUNCATED AT 250 WORDS)

The pattern of food intake can affect the regulation of body weight and lipogenesis. We studied the effect of meal frequency on human energy expenditure (EE) and its components. During 1 week ten male adults (age 25-61 years, body mass index 20.7-30.4 kg/m2) were fed to energy balance at two meals/d (gorging pattern) and during another week at seven meals/d (nibbling pattern). For the first 6 d of each week the food was provided at home, followed by a 36 h stay in a respiration chamber. O2 consumption and CO2 production (and hence EE) were calculated over 24 h. EE in free-living conditions was measured over the 2 weeks with doubly-labelled water (average daily metabolic rate, ADMR). The three major components of ADMR are basal metabolic rate (BMR), diet-induced thermogenesis (DIT) and EE for physical activity (ACT). There was no significant effect of meal frequency on 24 h EE or ADMR. Furthermore, BMR and ACT did not differ between the two patterns. DIT was significantly elevated in the gorging pattern, but this effect was neutralized by correction for the relevant time interval. With the method used for determination of DIT no significant effect of meal frequency on the contribution of DIT to ADMR could be demonstrated.

This paper reviews evidence that the macro-nutrient composition of the diet and the maintenance of energy balance are correlated. Intervention studies show that subjects lose weight on low-fat diets and gain weight on high-fat diets. Descriptive studies show that overweight subjects eat relatively more fat but have the same total energy intake as nonoverweight subjects. The body has a limited ability to oxidize fat compared with its ability to oxidize carbohydrate and protein. The conclusion is that becoming overweight can be prevented by reducing the fat content of the diet. Studies on nutrient utilization show a ready increase in carbohydrate oxidation whereas fat oxidation does not change after meals enriched with, respectively, carbohydrate or fat. However, in the long term, the respiratory quotient (RQ) is closer to the food quotient (FQ) for subjects eating high-fat diets than it is for subjects eating high-carbohydrate diets. For high-carbohydrate diets, the RQ is lower than is the FQ, indicating that subjects must mobilize body fat. This is supported by data on body weight loss in subjects changing from a standard maintenance diet to a low-fat diet, even while energy intake was increased with nearly 20%. Direct evidence for a higher energy expenditure for low-fat diets is not yet available.

A study was conducted to investigate the effect of feeding frequency on the rate and composition of weight loss and 24 h energy metabolism in moderately obese women on a 1000 kcal/day diet. During four consecutive weeks fourteen female adults (age 20-58 years, BMI 25.4-34.9 kg/m2) restricted their food intake to 1000 kcal/day. Seven subjects consumed the diet in two meals daily (gorging pattern), the others consumed the diet in three to five meals (nibbling pattern). Body mass and body composition, obtained by deuterium dilution, were measured at the start of the experiment and after two and four weeks of dieting. Sleeping metabolic rate (SMR) was measured at the same time intervals using a respiration chamber. At the end of the experiment 24 h energy expenditure (24 h EE) and diet-induced thermogenesis (DIT) were assessed by a 36 h stay in the respiration chamber. There was no significant effect of the feeding frequency on the rate of weight loss, fat mass loss or fat-free mass loss. Furthermore, fat mass and fat-free mass contributed equally to weight loss in subjects on both gorging and nibbling diet. Feeding frequency had no significant effect on SMR after two or four weeks of dieting. The decrease in SMR after four weeks was significantly greater in subjects on the nibbling diet. 24 h EE and DIT were not significantly different between the two feeding regimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Weight loss is a well-known phenomenon at high altitude. It is not clear whether the negative energy balance is due to anorexia only or an increased energy expenditure as well. The objective of this study was to gain insight into this matter by measuring simultaneously energy intake, energy expenditure, and body composition during an expedition to Mt. Everest. Subjects were two women and three men between 31 and 42 yr of age. Two subjects were observed during preparation at high altitude, including a 4-day stay in the Alps (4,260 m), and subsequently during four daytime stays in a hypobaric chamber (5,600-7,000 m). Observations at high altitude on Mt. Everest covered a 7- to 10-day interval just before the summit was reached in three subjects and included the summit (8,872 m) in a fourth. Energy intake (EI) was measured with a dietary record, average daily metabolic rate (ADMR) with doubly labeled water, and resting metabolic rate (RMR) with respiratory gas analysis. Body composition was measured before and after the interval from body mass, skinfold thickness, and total body water. Subjects were in negative energy balance (-5.7 +/- 1.9 MJ/day) in both situations, during the preparation in the Alps and on Mt. Everest. The loss of fat mass over the observation intervals was 1.4 +/- 0.7 kg, on average two-thirds of the weight loss (2.2 +/- 1.5 kg), and was significantly correlated with the energy deficit (r = 0.84, P < 0.05). EI on Mt. Everest was 9-13% lower than during the preparation in the Alps.(ABSTRACT TRUNCATED AT 250 WORDS)

Estimates of body composition by densitometry were made in 84 apparently healthy subjects (42 men, 42 women) with a mean age of 40 +/- 6 years (mean +/- s.d.), before and after weight loss. The initial body mass index (BMI) was 30.7 +/- 2.3 kg/m2 and the achieved weight loss on a 4.2 MJ/day energy deficit diet for 13 weeks was 12.2 +/- 3.7 kg. The results by densitometry were compared with estimates obtained by four other techniques: deuterium oxide dilution, skinfold thickness, bioelectrical impedance (three equations) and BMI (two equations). The fat-free mass (FFM) loss estimated by densitometry in men and women was 2.8 +/- 1.8 kg and 1.3 +/- 1.3 kg respectively. The dilution technique gave comparable results with densitometry. The losses of FFM assessed by skinfold thicknesses, BMI and impedance equations were almost similar, but significantly larger than the reduction in FFM measured by densitometry. These deviations were mainly the result of significantly larger differences from densitometry before compared to after weight loss. No correlation was found between change in FFM by densitometry and change in resistance measured by the bioelectrical impedance method in both sexes. It is concluded that application of published prediction formulae in weight loss studies are less appropriate and will lead to changes in FFM that are significantly different from the changes estimated by densitometry or deuterium oxide dilution.

Total energy expenditure (TEE) was estimated in healthy Swedish women by the doubly labeled water method in a longitudinal study during pregnancy and lactation. Measurements were made before pregnancy (A); in gestational weeks 16-18 (B), 30 (C), and 36 (D); as well as 2 (F) and 6 (G) mo after delivery. When the results were interpreted, earlier published data regarding resting metabolic rate (RMR), energy intake, and energy in breast milk were also considered. TEE (MJ/d) and TEE/RMR were 10.5 +/- 2.2 (mean +/- SD) and 1.87 +/- 0.42 (n = 28), 9.6 +/- 2.8 and 1.65 +/- 0.67 (n = 22), 12.5 +/- 3.4 and 1.82 +/- 0.45 (n = 22), 12.2 +/- 4.1 and 1.66 +/- 0.52 (n = 19), 10.6 +/- 2.0 and 1.82 +/- 0.41 (n = 23), and 10.8 +/- 2.7 and 1.79 +/- 0.42 (n = 23) at A, B, C, D, F, and G, respectively. The results indicated that physical activity tended to be decreased during early pregnancy. Taking changes in body energy stores into consideration, it was estimated that subjects recorded 86% and 77% of their energy intakes at A and F respectively.

We studied the effect of an increase in physical activity on energy balance and body composition without interfering with energy intake (EI). Sixteen women and sixteen men, aged 28-41 years, body mass index 19.4-26.4 kg/m2, not participating in any sport before the start of the experiment, prepared to run a half-marathon competition after 44 weeks. Measurements of body composition, EI and energy expenditure (EE) were performed before (0 weeks), and 8, 20, and 40 weeks after the start of training. Body composition was measured with hydrodensitometry and isotope dilution, and EI with a 7 d dietary record. EE was measured overnight in a respiration chamber (sleeping metabolic rate (SMR)) and in a number of subjects over 2-week intervals with doubly-labelled water (average daily metabolic rate (ADMR)). ADMR showed an average increase of 30% in both sexes from the start of training onwards while SMR tended to decrease. EI showed a tendency to drop from week 20 to week 40 in the men and a tendency to increase from week 20 to week 40 in the women. Body mass (BM) did not change in both sexes until the observation at 40 weeks when the median value of the change in men was -1.0 kg (P < 0.01; Wilcoxon signed-rank) while the corresponding change of -0.9 kg in the women was not statistically significant. Body composition changes were most pronounced in men as well. Based on changes in BM, body volume and total body water, men lost 3.8 kg fat mass (FM) (P < 0.001; Wilcoxon signed-rank) and gained 1.6 kg protein mass (P < 0.01; Wilcoxon signed-rank) while the corresponding changes in women were 2.0 kg (P < 0.05; Wilcoxon signed-rank) and 1.2 kg (P < 0.05; Wilcoxon signed-rank). In men the loss of FM was positively correlated with the initial percentage body fat (Pearson r 0.92, P < 0.001). In conclusion, body fat can be reduced by physical activity although women tend to compensate for the increased EE with an increased EI, resulting in a smaller effect on BM and FM compared with men.

Obese boys [n = 10, aged 10-11 y, average percent body fat (%BF) 32.4] were given a regimented training program (4 wk, 5 1-h sessions, 45 min cycling/wk at 50-60% of predetermined VO2max) to investigate whether they modify their energy expenditure by reducing or augmenting their spontaneous physical activities. No change was observed in mean weight (52.7 vs 52.9 kg), %BF based on 2H- and 18O-dilution and densitometry (32.4 vs 31.7), sleeping metabolic rate (5.83 vs 5.68 MJ/24 h), and spontaneous activity by heart rate recording (percent time of light intensity: 85.3 vs 83.6; medium: 11.2 vs 12.4; and heavy: 3.5 vs 3.9) and activity questionnaires (861 vs 821 min physical activity/wk). There was a 12% increase in average daily metabolic rate by doubly labeled water, half of which can be explained by the energy cost of training and the rest by an increase in energy expenditure outside the training hour. In conclusion, training leads to an appreciable augmentation in the overall energy expenditure of obese children, even with a lack of change in spontaneous physical activity.

The relationship between sleeping metabolic rate (SMR) measured from 0300 to 0600 h in a respiration chamber and body composition was studied in 47 healthy adult subjects (23 men and 24 women). The effect of the menstrual cycle on SMR was examined in 16 of the 24 women. SMR increased in the postovulation phase of the menstrual cycle (estimated as days 18-29 after last menstruation) 7.7% on average (P less than 0.001). A stepwise regression showed that both fat-free mass (FFM), fat mass (FM), and the phase of the menstrual cycle contributed significantly to SMR. After adjustment for FFM and FM, no sex differences in SMR (men vs preovulation women) remained. The inclusion of FM in this model is an improvement that eliminates the sex difference in SMR/FFM that is usually found. A prediction equation is given that explains 85% of the variance in SMR among individuals.

The best predictor of energy expenditure in man is the fat-free mass of the body. Fat-free mass explains most of the variation in resting metabolic rate and even in total metabolic rate under sedentary conditions. We studied possible determinants of fat-free mass as routes to influence energy metabolism. Existing data sets were analysed with observations on height, fat mass (FM), fat-free mass (FFM), and habitual level of physical activity (PA). PA was calculated from average daily metabolic rate (ADMR) as measured over 1-4-week intervals with 2H2(18)O and basal metabolic rate (BMR): PA = ADMR/BMR. Ninety-six subjects, 66 females and 30 males, from 7 different studies were included. FFM and FM were adjusted for height by taking its ratio to the square of height, in analogy with the body mass index. Subsequently, all analyses were corrected for origin of the data. In a regression analysis FM explained 53 and 40% of the variation in FFM in females and males, respectively. Adding PA to the model raised the explained variation in FFM in females to 62%. In contrast with females (r = 0.10, n.s.), there was an independent relationship between PA and FM in males (r = -0.41, p less than or equal to 0.05), such that a higher PA was related to a lower FM. In conclusion, FFM is a function of FM and PA. The absence of an effect of exercise training on FFM, i.e. additional exercise in weight-reduction programmes, is discussed.

This study was designed to examine aspects of digestive function that may limit assimilation of water and oxidation of orally ingested carbohydrate (CHO) during exercise. Eight males completed a crossover study in which each cycled on four occasions for 80 min at 70% maximal O2 consumption. Beverage was consumed at 0, 20, 40, and 60 min. Beverages were water, 4.5% glucose (4.5G), 17% glucose (17G), and 17% maltodextrin (17MD). CHO beverages contained 20 meq/l NaCl and were 13C enriched to measure exogenous CHO oxidation. Gastric (beverage) volume was measured at 80 min. Water uptake was estimated by including 2H2O in the beverage and measuring 2H accumulation in blood. Jejunal perfusion tests were conducted at rest with the same subjects and beverages. In 60 min, 1,294 +/- 31 (SE) ml were ingested; at 80 min, volumes emptied with H2O (1,257 +/- 32 ml) and 4.5G (1,223 +/- 32 ml) were greater than with 17G (781 +/- 56 ml) and 17MD (864 +/- 71 ml; P less than 0.05). Total CHO oxidized was similar with all beverages, but there was a greater increase in exogenous CHO oxidation over time with 17G and 17MD than with 4.5G; 54, 19, and 18% of the CHO ingested with 4.5G, 17G, and 17MD, respectively, was oxidized. This represents 57, 32, and 27%, respectively, of the CHO emptied from the stomach. 2H accumulation in the blood was more rapid with H2O and 4.5G than with 17G or 17MD. Net jejunal water absorption was greater from 4.5G than from water. Net water absorption was also observed from 17MD, whereas net secretion was observed with 17G.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the present study was to compare data on 24-h energy expenditure (EE24h) in nine boys and ten girls (mean age 9.3 and 8.1 years, respectively) by heart rates (fc) combined with energy expenditure obtained from a 1-day stay in an indirect calorimeter (EEcal) and a 2-week period of normal living using the doubly labelled water method (EEdlw). Individual calibration curves were derived from fc and oxygen uptake measured during sleep (in the calorimeter), standing and walking on a treadmill. An estimation of energy expenditure based on 24-h fc monitoring (EEfc) was made during the stay in the calorimeter and on a normal school-day. Mean results showed an overestimation in EEfc compared to EEcal and EEdlw of 10.4% and 12.3% respectively, varying from 6.3% to 16.2%. These results confirmed earlier observations in adults that for a group the fc method overestimates EE24h by about 10%.

We compared the physical activity of 11 lean and 11 obese men and women over a 7-day period. There were no significant differences in either the amount of movement recorded with an accelerometer (9.5 (SD 3.9) vs 9.9 (SD 2.6) kcounts.day-1), or in the energy expenditure due to physical activity reflected by the difference between the average daily metabolic rate measured by the doubly labelled water technique and the sleeping metabolic rate measured in a respiration chamber and adjusted for fat-free mass: 112 (SD 33) vs 118 (SD 22) kJ.kg-1.day-1. The obese showed a non-significant loss of body mass of 0.5 (SD 1.1) kg, probably due to reduced intake during the 7-day intake recording period.

Resting energy expenditure (REE) was measured in 68 patients with stable chronic obstructive pulmonary disease (COPD) and in 34 weight-stable, age-matched (65 +/- 8 y; means +/- SD) healthy control subjects. Fat-free mass (FFM) determined by bioelectrical resistance explained 84% of the variation in REE in the control group but only 34% in the COPD patients. REE could not reliably be predicted from regression equations either developed in healthy subjects or in COPD patients. REE adjusted for FFM was significantly higher (P less than 0.05) in weight-losing (n = 34) than in weight-stable (n = 34) patients (6851 +/- 781 and 6495 +/- 650 kJ/d, respectively). Pulmonary function was more compromised in weight-losing patients. Adjusted REE in weight-stable patients was significantly higher (P less than 0.01) than in the healthy control group (6131 +/- 405 kJ/d). In patients with COPD, factors in addition to FFM are important determinants of REE. A disease-related increase in REE develops, which may contribute to weight loss in COPD in combination with a lack of an adaptive response to undernutrition in weight-losing patients.

Weight loss after gastric partition is highly variable even when the operation itself has been successful. We studied changes in body composition in relation to energy expenditure before and one year after surgery in one woman and five men, age 20-38 years, and BMI 42-62 kg/m2. Observations were performed shortly before, and 6, 12, 27 and 54 weeks after surgery. Body composition was measured with hydrostatic weighing and isotope dilution, and energy expenditure over 24 h (24EE) and during complete rest (sleeping metabolic rate (SMR)) with a respiration chamber and in five of the six subjects under daily living conditions over two-week intervals with doubly labeled water (average daily metabolic rate (ADMR). Weight loss and fat loss over the full observation period until 54 weeks after surgery was 54 +/- 8 and 43 +/- 9 kg (mean +/- s.e.m.), respectively. There was a more than three-fold difference in fat loss between the subject losing most, i.e. 70 kg, and the subject losing least, i.e. 20 kg. Fat loss was not related to initial fat mass in this group of six subjects but there was a significant negative relation with the loss of protein mass. There was a strong negative relation between fat loss and activity level of the subjects expressed as the quotient ADMR/SMR. These results show the contrary from what would be expected. Reduction of fat mass after successful gastric partition is highest in those subjects having the lowest physical activity level (before and) after surgery; these subjects lose less fat-free mass.

Limits of energy turnover in relation to physical performance were addressed in terms of upper and lower limit, changes during a training programme and how to regulate energy balance at a changing energy turnover. At the lower limit we stress the risk of energy restriction to reach a desired body size or body composition for reduced performance, early osteoporosis and weight cycling. The upper limit of energy turnover can be increased by the consumption of energy dense carbohydrate-rich foods. Training induces an increase in energy turnover which can initially be more then twice the calculated energy costs from laboratory measurements of physical activity. In the long term, training can induce a reduction in resting energy expenditure even while the active cell mass (muscle mass) of the body has increased. The regulation of energy balance on a day to day basis seems to be better at high levels of energy turnover either as a consequence of the physiological need or as a consequence of the fact that athletes performing at a high level of energy expenditure have learned to ingest as much food as possible.

A study was conducted to investigate whether there is a diurnal pattern of nutrient utilization in man and how this is affected by meal frequency to explain possible consequences of meal frequency for body weight regulation. When the daily energy intake is consumed in a small number of large meals, there is an increased chance to become overweight, possibly by an elevated lipogenesis (fat synthesis and accumulation) or storage of energy after the meal. Thirteen subjects, two males and eleven females, were fed to energy balance in two meals per day (gorging pattern) and seven meals per day (nibbling pattern) over 2-day intervals. On the second day on each feeding regimen, the diurnal pattern of nutrient utilization was calculated from simultaneous measurements of oxygen consumption, carbon dioxide production and urinary nitrogen excretion over 3 h intervals in a respiration chamber. A gorging pattern of energy intake resulted in a stronger diurnal periodicity of nutrient utilization, compared to a nibbling pattern. However, there were no consequences for the total 24 h energy expenditure (24 h EE) of the two feeding patterns (5.57 +/- 0.16 kJ/min for the gorging pattern; 5.44 +/- 0.18 kJ/min for the nibbling pattern). Concerning the periodicity of nutrient utilization, protein oxidation during the day did not change between the two feeding patterns. In the gorging pattern, carbohydrate oxidation was significantly elevated during the interval following the first meal (ie from 1200 h to 1500 h, P less than 0.01) and the second meal (ie from 1800 h to 2100 h, P less than 0.05). The decreased rate of carbohydrate oxidation observed during the fasting period (from rising in the morning until the first meal at 1200 h), was compensated by an increased fat oxidation from 0900 to 1200 h to cover energy needs. In the nibbling pattern, carbohydrate and fat oxidation remained relatively constant during the active hours of the day.(ABSTRACT TRUNCATED AT 250 WORDS)