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It is estimated that more than 170 million people are infected with hepatitis C virus (HCV) worldwide (1,2). Clinical trials have demonstrated that, for the first time in human history, [...]

The aim of this study is to determine what factors constitute a quality prosthesis and ascertain which factors affect prosthesis satisfaction. Sixty-four women who received full funding for their prosthesis and 38 women who received their hospital's usual funding were recruited. Women rated the information provided about breast prostheses very highly, with 85% reporting that it was "very good" or "excellent." Satisfaction was significantly associated with how well the prosthesis fit (1 week, p = .001; 3 months, p = .01), level of comfort (3 months, p = .005), and appearance of the prosthesis when worn (6 months, p = .001). Quality was significantly associated with how well it fit (1 week, p = .001; 3months, p = .001), how natural it felt (1 week, p = .001; 6 months, p = .01), the weight of the prosthesis (3 months, p = .003), and appearance when worn (6 months, p = .03). The results will be used to improve women's access to a quality prosthesis.

A survey was conducted of 100 graduates (ages 7-17) of an auditory/oral Australian preschool for children with hearing impairments (92 integrated with hearing peers and 8 segregated). Most children perceived their academic progress to be average or above; nearly all received audiological support; over one-third received speech therapy and integration assistance; two-thirds had mostly normal-hearing friends. (Author/JDD)

A survey was conducted of 100 graduates (ages 7-17) of an auditory/oral preschool in Australia for children with hearing impairments, with 92 being integrated with hearing peers and 8 segregated. The majority of students reported that they used hearing aids consistently; used speech as their major mode of communication; and perceived themselves as better listeners than speakers. (Author/JDD)

Calorie restriction (CR) enhances immune response and prolongs life span in animals. However, information on the applicability of these results to humans is limited. T-cell function declines with age. We examined effects of CR on T-cell function in humans. Forty-six overweight, nonobese participants aged 20-42 years were randomly assigned to 30% or 10% CR group for 6 months. Delayed-type hypersensitivity (DTH), T-cell proliferation (TP), and prostaglandin [E.sub.2] ([PGE.sub.2]) productions were determined before and after CR. DTH and TP to T-cell mitogens were increased in both groups over baseline (p [less than or equal to] .019). However, number of positive responses to DTH antigens (p = .016) and TP to anti-CD3 reached statistical significance only alter 30% CR (p = .001). Lipopolysaccharide-stimulated [PGE.sub.2] was reduced in both groups but reached statistical significance after 30% CR (p [less than or equal to] .029). These results, for the first time, show that 6-month CR in humans improves T-cell function. Key Words: Calorie restriction--T cell--Immune response--Aging--Obesity. doi: 10.1093/gerona/glp101

Exercise has well-recognized health benefits, including reduction in risk factors for cardiovascular disease and type 2 diabetes. However, the extent to which exercise influences energy regulation and facilitates a reduction in body fat is less clear. This review summarizes published studies on the effects of different amounts of exercise on body fatness, energy intake, and food preferences in humans. The results show consistent effects of exercise on body fatness in the absence of prescribed dietary change, with a progressive loss of body fat associated with higher exercise energy expenditures in both men and women. In part, these effects appear to be mediated by a spontaneous reduction in hunger associated with participation in exercise. Insufficient data are available on whether there are changes in food preferences and taste perception that influence energy balance through macronutrient selection, so further studies in this area are needed. doi: 10.1301/nr.2007.jan. 1-19 Key words: body composition, energy intake, exercise, food palatability, macronutrient

There is considerable uncertainty over whether any one dietary pattern broadly facilitates weight loss or maintenance of weight loss, and current dietary guidelines recommend a spectrum of dietary composition for the general population. However, emerging evidence suggests that specific dietary compositions may work better for identifiable groups of overweight/ obese individuals based on their individual metabolic status. In particular, characteristics of insulin dynamics, such as insulin sensitivity or insulin secretion status, may interact with diets that vary in macronutrient composition to influence the weight loss achieved with a hypocaloric diet. Key words: dietary composition, insulin secretion, insulin sensitivity, weight loss

Background. The association of psychological eating behavior constructs with overweight and obesity during early adult life and middle age has been documented ill several studies. However, the association of eating behavior with unexplained weight change in old age is relatively unexplored. Methods. Body weight, eating behavior (dietary restraint, disinhibition, and hunger as assessed by the Eating inventory), reported dietary intake, and physical activity level were assessed at baseline in 36 nonobese postmenopausal women aged 61.3 [+ or -] 3.1 years (mean + standard deviation). Measurements were repeated 4.4 [+ or -] 0.9 years later, and changes in body weight were examined in relation to baseline and follow-up eating behavior scores, reported dietary intake, and physical activity level. Results. Participants had no major changes in health or lifestyle characteristics over the study interval. Weight change ranged from -7.5 to + 5.8 kg (mean-0.3 [+ or -] 3.5 kg), and there were no significant changes in reported dietary intake. Mean hunger score (calculated as the mean of baseline and follow-up hunger score) predicted weight change per year over the study period (bivariate r = 0.386, p = .020), even in statistical models adjusted for mean dietary intake variables (partial r = 0.658, p = .003). Restraint, disinhibition, and physical activity level did not predict weight change. Conclusions. Reported hunger assessed by the Eating Inventory was associated with unintentional weight change in healthy postmenopausal women. The Eating Inventory questionnaire may provide a clinically useful tool for identifying older individuals at risk of undesirable weight change, and particularly unintentional weight loss, a factor strongly associated with increased morbidity and premature death in this population.

I. Introduction II. Changes in the Regulation of Energy Intake A. Comparisons of young and elderly adults B. Reduced hunger and increased satiation as mediators of impaired defense against energy [...]

Objective To examine relative associations of dietary composition variables with body mass index (BMI; calculated as kg/[m.sup.2]) among young and middle-aged US adults. We hypothesized that in subjects with physiologically plausible reported energy intakes, fiber intake would be inversely associated with BMI, independent of other dietary composition and sociodemographic variables. Subjects and design Data from adults age 20 to 59 years in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996 were used. Exclusions were pregnancy or lactation, food insecurity, missing weight or height data, or having only one dietary recall. Based on our previously published methods, a physiologically plausible reported energy intake was calculated as being within [+ or -]22% of predicted energy requirements for the mean of two 24-hour recalls. Results Reporting plausibility ([reported energy intake / predicted energy requirements] X 100) averaged 83% in the total sample (N = 4,539) and increased to 96% in the plausible sample (n = 1,932). Only approximately 5% of the plausible sample consumed the Adequate Intake for fiber. In plausibly reporting women, fiber, its interaction with percentage energy from fat, and energy density were independently associated with BMI. Only percentage energy from fat was associated with BMI in men reporting plausibly. Compared with the total sample, stronger relationships between diet and BMI were observed among the plausible reporters. In women, a low-fiber (<1.5 g/MJ*), high-fat ([greater than or equal to]35% energy) diet was associated with the greatest increase in risk of overweight or obesity compared with a high-fiber, low-fat diet. Conclusions Weight control advice for US women should place greater emphasis on consumption of fiber. J Am Diet Assoc. 2005;105:1365-1372.

Background. Low body mass index (BMI) and micronutrient deficiencies are associated with increased morbidity and mortality rates in old age. Whether adverse patterns of dietary variety predict both low BMI and low micronutrient intakes in older adults was investigated. Methods. A cross-sectional analysis of national survey data was conducted in 1174 healthy adult men and women (ages 21 to 90 years) who provided physiologically plausible dietary data in the 1994-1996 Continuing Survey of Food Intakes by Individuals. Measurements included reported energy intake, protein intake (percentage meeting Recommended Dietary Allowance), micronutrient intakes (percentage meeting Estimated Average Requirements for 14 micronutrients), and BMI. Results. Adults who were 61 years or older consumed a greater total variety of foods, chose foods from a wider range of food groups, had a greater variety of micronutrient-dense foods and energy-weak foods, and had a lower variety of micronutrient-weak foods compared with adults ages 21 to 60 years (p < .05 to .001). However, older adults with low BMIs ( Conclusions. In contrast to previous suggestions that older persons consume a monotonous diet, this study showed that adults who were 61 years or older consumed a greater total food variety, and a greater variety of micronutrient-dense and energy-weak foods, compared with adults who were 60 years or younger. Although consumption of a low variety of energy-dense foods may contribute to reduced energy intake and body weight at any age, the variety of micronutrient-dense foods consumed needs to increase in old age to prevent micronutrient deficiencies. These findings suggest that all adults need advice on the changing needs for dietary variety with aging to maintain health, and that older persons with low BMI are particularly vulnerable to dietary shortfalls.

The relative contribution of circulating glucose to meal-to-meal variability in energy intake is not known. In 8 free-living young (median age 26.5 y) women with healthy body weight (median BMI 22.2 kg/[m.sup.2]), we measured glucose in the interstitial space by an automated monitoring procedure (continuous glucose monitoring system, CGMS[TM]) for up to 3 consecutive days (mean 706 glucose readings per subject). We examined the association between interstitial glucose (which lags blood glucose by ~10 min), self-reported hunger, satiety, desire for a meal, and nutrient intakes. Participants reported consuming a typical Western diet (59% carbohydrate, 27% fat, 14% protein). Median (interquartile range) interstitial glucose was 5.2 mmol/L (4.7-5.8). Using repeated-measures techniques in univariate analyses, desire for a meal (r = 0.45, P < 0.0001), hunger (r = 0.37, P = 0.0002), satiety (r = -0.40, P < 0.0001), low interstitial absolute mean glucose up to 25 min before eating (r = -0.23, P = 0.02), and a large decline in glucose between 40 and 5 min before eating (r = -0.17, P = 0.08) were all associated with meal energy intake. In multivariate regression analyses, desire for a meal (P < 0.0001) and hunger (P = 0.02) were the strongest independent contributors to meal energy intake, whereas absolute mean glucose measured in the period 15 to 0 min before eating was marginally significant (P = 0.08). In conclusion, absolute glucose level is a significant predictor of energy intake in nonobese women. However, desire for a meal and hunger are quantitatively more important, emphasizing the importance of both glucose signals and nonglucose (internal or environmental) factors in within-subject variability in energy intake. In addition, the CGMS may have utility in understanding the role of circulating glucose in energy regulation in free-living subjects under a wide range of different nutritional conditions. KEY WORDS: * glucose * energy * hunger * satiety * free-living

To test the hypothesis that total energy expenditure (TEE) and resting energy expenditure (REE) are low in extremely obese individuals, factors that could contribute to maintenance of excess weight, a cross-sectional study was conducted in 30 weight stable, extremely obese women [BMI (mean [+ or -] SEM) 48.9 [+ or -] 1.7 kg/[m.sup.2]]. TEE was measured over 14 d using the doubly labeled water method, REE and the thermic effect of feeding (IEF) were measured using indirect calorimetry, and activity energy expenditure (AEE) was calculated as TEE--(REE + TEF). Body composition was determined using a 3-compartment model. Subjects were divided into tertiles of BMI (37.5-45.0; 45.1-52.0; and 52.1-77.0 kg/[m.sup.2]) for data analysis. TEE and REE increased with increasing BMI tertile: TEE, 12.80 [+ or -] 0.5, 14.67 [+ or -] 0.5, and 16.10 [+ or -] 0.9 MJ/d (P < 0.01); REE, 7.87 [+ or -] 0.2, 8.78 [+ or -] 0.3, and 9.94 [+ or -] 0.6 MJ/d (P < 0.001), and these values were 29-38% higher than published means of measured TEE in nonobese individuals. No significant differences were observed among BMI tertiles for AEE, TEF, or physical activity level (PAL = TEE/REE, overall mean 1.64 [+ or -] 0.16). The Harris-Benedict and WHO equations provided the closest estimates of REE (within 3%), whereas the obese-specific equations of Ireton-Jones overpredicted (40%) and Bernstein underpredicted (21%) REE. Extremely obese individuals have high absolute values for TEE and REE, indicating that excess energy intake contributes to the maintenance of excess weight. Standard equations developed for nonobese populations provided the most accurate estimates of REE for the obese individuals studied here. REE was not accurately predicted by equations developed in obese populations. J. Nutr. 134: 1412-1416, 2004. KEY WORDS: * extreme obesity * energy expenditure * fat-free mass * prediction equations

To identify existing dietary patterns and examine associations between these patterns and plasma homocysteine and B vitamin concentrations in an urban Chinese population living in Beijing (n = 119), dietary information was collected with a food frequency questionnaire designed for this population. Plasma homocysteine and B vitamin concentrations were examined. Food group variables, expressed as percentages of total energy intake, were entered into cluster analysis to define three distinct dietary pattern groups. The prevalence of high homocysteine (>11 [micro]mol/L for women and 12 [micro]mol/L for men), was 31.9%; of low folate ( KEY WORDS: * dietary patterns * homocysteine * B vitamin * cluster analysis * Chinese

Little is known about the relative effects of fermentable fiber (FF) vs. nonfermentable fiber (NFF) on energy regulation in humans. We compared 27 [+ or -] 0.6 g/d supplements of FF (pectin,/[beta]-glucan) and NFF (methylcellulose) for their ability to decrease ad libitum energy intake (El) and hunger, increase satiety and cause spontaneous body weight and fat losses. Men and women (n = 11) aged 23-46 y, BMI 20.0-34.4 kg/[m.sup.2], consumed first NFF and then FF for 3 wk each, with a 4-wk washout period between phases. Daily satiety assessed with analog scales was higher with NFF than FF (60.7 [+ or -] 1.0 vs. 57.7 [+ or -] 0.8 mm, P = 0.01). However, there were no differences in reported El (NFF < FF by 7%, P = 0.31, NFF < baseline by 9.5%, P = 0.11), body weight (NFF 0.13 kg, P = 0.73; FF 0.13 kg, P = 0.60) or fat percentage (NFF -0.3%, P = 0.56; FF -0.1%, P = 0.66) within either phase. In contrast to findings in animals, NFF was more, rather than less satiating than FF, and use of neither NFF nor FF preparations was associated with body weight or fat loss. These pilot results suggest no role for short-term use of FF and NFF supplements in promoting weight loss in humans consuming a diet ad libitum. J. Nutr. 133: 3141-3144, 2003. KEY WORDS: * fiber * fermentable * nonfermentable * satiety * weight loss

Body composition methods were examined in 20 women [body mass index (BMI) 48.7 [+ or -] 8.8 kg/[m.sup.2]] before and after weight loss [-44.8 [+ or -] 14.6 (SD) kg] after gastric bypass (GBP) surgery. The reference method, a three-compartment (3C) model using body density by air displacement plethysmography and total body water (TBW) by [H.sub.2][sup.18]O dilution (3C-[H.sub.2][sup.18]O), showed a decrease in percent body fat (%BF) from 51.4 to 34.6%. Fat-free mass hydration was significantly higher than the reference value (0.738) in extreme obesity (0.756; P < 0.001) but not after weight reduction (0.747; P = 0.16). %BF by [H.sub.2][sup.18]O dilution and air displacement plethysmography differed significantly from %BF by 3C-[H.sub.2][sup.18]O in extreme obesity (P < 0.05) and 3C models using [sup.2][H.sub.2]O or bioelectrical impedance analysis (BIA) to determine TBW improved mean %BF estimates over most other methods at both time points. BIA results varied with the equation used, but BIA better predicted %BF than did BMI at both time points. All methods except BIA using the Segal equation were comparable to the reference method for determining changes over time. A simple 3C model utilizing air displacement plethysmography and BIA is useful for clinical evaluation in this population. three-compartment models

Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with undernourished children. This review summarizes data from Brazil--a developing country undergoing the nutrition transition--suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include long-term effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment. Key Words: undernutrition, stunting, obesity, diabetes, hypertension

U.S. adults are now gaining more weight and becoming obese at an earlier age than in previous years. The specific causes of adult weight gain are unknown, but may be attributed to a combination of factors leading to positive energy balance. U.S. food supply data indicate that Americans have had a gradual increase in energy intake since 1970, and that per capita energy intake was 1.42 MJ/d (340 kcal/d) higher in 1994 than that in 1984. In contrast, self-reported physical activity remained constant between 1990 and 1998. Taken together, these data indicate that the increasing trend in U.S. adult weight gain is primarily attributable to overconsumption of energy. Epidemiological and experimental studies in animals and humans provide strong evidence that biobehavioral factors such as dietary variety, liquid (vs. solid) energy, portion size, palatability (taste), snacking patterns, restaurant and other away-from-home food, and dietary restraint and disinhibition influence hunger, satiety and/or voluntary energy intake. When these eating behaviors are consistently experienced either separately or in combination over the long term, they are likely to facilitate overeating. We provide a brief overview of the evidence to date for the role of these biobehavioral factors in contributing to excess energy intake and increases in body weight over time. J. Nutr. 132: 3830S-3834S, 2002. KEY WORDS: * obesity * weight gain * energy intake * energy balance * biobehavioral factors

Recommendations for increased consumption of protein are among the most common approaches of popular or fad diets. This review summarizes the effects of dietary protein on satiety, energy intake, thermogenesis, and weight loss, as well as its effect on a variety of health outcomes in adults. In short-term studies, dietary protein modulates energy intake via the sensation of satiety and increases total energy expenditure by increasing the thermic effect of feeding. Whereas these effects did not contribute to weight and fat loss in those studies in which energy intake was fixed, one ad libitum study does suggest that a high-protein diet results in a greater decrease in energy intake, and therefore greater weight and fat loss. In terms of safety, there is little long-term information on the health effects of high-protein diets. From the available data, however, it is evident that the consumption of protein greater than two to three times the U.S. Recommended Daily Allowance contributes to urinary calcium loss and may, in the long term, predispose to bone loss. Caution with these diets is recommended in those individuals who may be predisposed to nephrolithiasis or kidney disease, and particularly in those with diabetes mellitus. Key Words: dietary protein, energy intake, thermogenesis, weight loss, high-protein diet, urinary calcium loss, bone loss

Background. Although an influence of eating behavior on dietary intake and physiology has been documented in several studies, the extent to which eating behavior influences long-term health is uncertain. Methods. Current dietary restraint, disinhibition, and hunger were assessed using the Eating Inventory in 1252 nonsmoking women aged 55 to 65 years. In addition, subjects reported the presence or absence of 22 specific morbidities, along with general demographic information. Logistic regression was used to examine associations between eating behavior scores and morbidity, adjusting for age, prior smoking status, hormone replacement therapy, education level, and body mass index (BMI). Results. In adjusted models excluding BMI, higher disinhibition scores were associated with small increased risks for hypercholesterolemia (odds ratio [OR] 1.04, p = .045), leg cramps (OR 1.05, p = .044), indigestion (OR 1.06, p = .020), and cataract (OR 1.09, p = .036), and a decreased risk of eczema (OR 0.91, p = .008). In addition, higher hunger scores were associated with increased risk of eczema (OR 1.09, p = .026). However, after adjusting for confounding variables plus BMI, higher disinhibition scores were associated with increased risks for low back pain (OR 1.06, p = .031) and constipation (OR 1.10, p = .004), and associations of disinhibition and hunger with eczema were unchanged (OR 0.90, p = .008 and OR 1.09, p = .024, respectively). Dietary restraint was not associated with morbidity in any model. Conclusions. Higher disinhibition and hunger scores were associated with small alterations in reported morbidity risk in a large population of nonsmoking older women. Although our cross-sectional study design makes the directionality of these relationships unclear, our results suggest at most a relatively minor independent influence of eating behavior constructs on long-term health.

There is little information on the accuracy of simple body composition methods in non-Western populations. We determined the percentage of body fat (%BF) by isotope dilution [oxygen-18 ([H.sub.2][sup.18]O) and deuterium oxide ([sup.2][H.sub.2]O)] and anthropometry in 71 healthy, urban Chinese adults aged 35-49 y [body mass index (BMI) 18-35 kg/[m.sup.2]]. The accuracy of several prediction equations for assessment of %BF from skinfold measurements was evaluated against %BF determined by [H.sub.2][sup.18]O dilution. We also assessed the relationship between BMI and %BF, and the fat-free mass (FFM) hydration coefficient for our population. All skinfold equations yielded means within ~2%BF of [H.sub.2][sup.18]O-derived %BF. However, on the basis of residual plot analysis and the 95% confidence interval (Cl) for the mean difference between methods, the equations of Durnin and Womersley (for assessment of body density from skinfolds) coupled with that of Brozek et al. (for assessment of %BF from body density) provided the most valid assessment for individuals. In addition, the FFM hydration coefficient averaged 0.734 [+ or -] 0.002 (SEM), indicating that the usually assumed value of 0.732 is appropriate for this population. Finally, although BMI had high specificity (90%) for classifying individuals as having body fat within the normal range (30%BF. J. Nutr. 132: 310-317, 2002. KEY WORDS: * isotope dilution * anthropometry * body mass index * percentage of body fat * fat-free mass hydration coefficient