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The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.

Introduction Effective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability. Materials and Methods This study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model. Results All GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60). Conclusion This study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.

OBJECTIVES: The aim was to determine the nutritional adequacy of calorie restricted (CR) diets during CR interventions up to 12 months. METHODS: The Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE™) phase 1 trial consisted of 3 single-site studies to test the feasibility and effectiveness of CR in adults without obesity. After baseline assessments, participants who were randomized to a CR intervention received education and training from registered dietitians on how to follow a healthful CR diet. Food diaries were completed at baseline and during the CR interventions (~6, 9, and 12 months) when participants were self-selecting CR diets. Diaries were analyzed for energy, macronutrients, fiber, 11 vitamins, and 9 minerals. Nutritional adequacy was defined by sex- and age-specific Estimated Average Requirement (EAR) or Adequate Intake (AI) criteria for each nutrient. Diet quality was evaluated using the PANDiet diet quality index. RESULTS: Eighty-eight CR participants (67% women, age 40 ± 9 y, BMI 27.7 ± 1.5 kg/m(2)) were included in the analysis. Dietary intake of fiber and most vitamins and minerals increased during CR. More than 90% of participants achieved 100% of EAR or AI during CR for 2 of 4 macronutrients (carbohydrate and protein), 6 of 11 vitamins (A, B1, B2, B3, B6, B12), and 6 of 9 minerals assessed (copper, iron, phosphorus, selenium, sodium, zinc). Nutrients for which

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression-and in some cases effectively treat-many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.

BACKGROUND Lifestyle interventions are the first-line treatment for obesity, but participant weight loss is typically low. OBJECTIVES We evaluated the efficacy of an alternative lifestyle intervention [Healthy Weight for Living (HWL)] compared with a modified Diabetes Prevention Program (m-DPP). HWL was based on a revised health behavior change model emphasizing hunger management and the development of healthy food preferences. m-DPP was a standard Diabetes Prevention Program implemented with counselor time matched to HWL. Participants were adult dependents of military personnel and had overweight or obesity. METHODS Participants were randomly assigned to HWL (n = 121) or m-DPP (n = 117), delivered primarily by group videoconference with additional midweek emails. The primary outcome was 12-mo weight change. Secondary outcomes included 6-mo changes in cardiometabolic risk factors and diet. Intention-to-treat (ITT) and complete case (CC) analyses were performed using linear mixed models. RESULTS Retention did not differ between groups (72% and 66% for HWL and m-DPP at 12 mo, respectively; P = 0.30). Mean ± SE adjusted 12-mo weight loss in the ITT cohort was 7.46 ± 0.85 kg for HWL and 7.32 ± 0.87 kg for m-DPP (P = 0.91); in the CC cohort, it was 7.83 ± 0.82 kg for HWL and 6.86 ± 0.88 kg for m-DPP (P = 0.43). Thirty-eight percent of HWL and 30% of m-DPP completers achieved ≥10% weight loss (P = 0.32). Improvements in systolic blood pressure, LDL cholesterol, triglycerides, fasting glucose, general health, sleep, and mood were similar across groups; improvements in diastolic blood pressure were greater in m-DPP. Adjusted group mean reductions in energy intake were not significantly different between groups, but HWL participants were more adherent to their dietary prescription for lower glycemic index and high fiber and protein (P = 0.05 to

OBJECTIVES: Self-monitoring daily dietary intake is recommended for weight loss and weight loss maintenance. However, current online platforms and applications are often burdensome, which may limit use. We conducted a pilot study to evaluate the accuracy of a new application designed to self-monitor dietary intake using natural spoken language (COCO; The Conversational Calorie Counter). METHODS: A total of 35 participants were enrolled in this pilot study. Participants were asked to record daily dietary intake using the COCO application for a period of at least five days. Two 24-hour dietary recalls were conducted during this time, between day three and day five, and served as the reference method for evaluating total energy intake (TEI; measured in kcal). Mean two-day energy intake was calculated for each assessment method for the days when the 24-hr recall and COCO data were collected. Self-reported TEI from COCO were compared to estimates obtained from the 24-hour dietary recalls by a paired samples t-test and a Pearson's correlation coefficient. RESULTS: On average, participants consumed three meals a day and recorded six days of food intake days with COCO (range: 4 to 10 days). The mean TEI was not significantly different between the two methods (1902 ± 621 kcal by 24-hour dietary recall and 1988 ± 1033 kcal by COCO, P = 0.59). There was a significant correlation between mean TEI measured with the two methods (r = 0.45; P = 0.006). In addition, a strong correlation was observed between the number of food items logged in COCO and those recalled in the 24-hour diet recalls (r = 0.82; P >0.0001). Completion of the exit survey by 28 participants indicated that 43% would definitely or probably use the application again. CONCLUSIONS: These results suggest that natural spoken language technology may have utility in applications to self-monitor food intake. Additional research is required to fully elucidate the validity of COCO in estimating dietary intake. FUNDING SOURCES: This research was supported by the NIH Grant # 1R21HL118347–01 (SBR and JG), Quanta Computing, Inc., and the National Defense Science and Engineering Graduate fellowship.

Background: Phylloquinone is the most abundant form of vitamin K in US diets. Green vegetables are considered the predominant dietary source of phylloquinone. As our food supply diversifies and expands, the food groups that contribute to phylloquinone intake are also changing, which may change absolute intakes. Thus, it is important to identify the contributors to dietary vitamin K estimates to guide recommendations on intakes and food sources. Objective: The purpose of this study was to estimate 1) the amount of phylloquinone consumed in the diet of US adults, 2) to estimate the contribution of different food groups to phylloquinone intake in individuals with a high or low vegetable intake (≥2 or Methods: Usual phylloquinone intake was determined from NHANES 2011–2012 (≥20 y old; 2092 men and 2214 women) and the National Cancer Institute Method by utilizing a complex, stratified, multistage probability-cluster sampling design. Results: On average, 43.0% of men and 62.5% of women met the adequate intake (120 and 90 μg/d, respectively) for phylloquinone, with the lowest self-reported intakes noted among men, especially in the older age groups (51–70 and ≥71 y). Vegetables were the highest contributor to phylloquinone intake, contributing 60.0% in the high-vegetable-intake group and 36.1% in the low-vegetable-intake group. Mixed dishes were the second-highest contributor to phylloquinone intake, contributing 16.0% in the high-vegetable-intake group and 28.0% in the low-vegetable-intake group. Conclusion: Self-reported phylloquinone intakes from updated food composition data applied to NHANES 2011–2012 reveal that fewer men than women are meeting the current adequate intake. Application of current food composition data confirms that vegetables continue to be the primary dietary source of phylloquinone in the US diet. However, mixed dishes and convenience foods have emerged as previously unrecognized but important contributors to phylloquinone intake in the United States, which challenges the assumption that phylloquinone intake is a marker of a healthy diet. These findings emphasize the need for the expansion of food composition databases that consider how mixed dishes are compiled and defined.

Background Nutrition clubs (NC) operate in community settings and provide members with nutrition education and meal replacements for weight management. NC are owned and operated by distributors of Herbalife products. There are over 6200 NC in the US, but there has been no independent assessment of the association of these NC with biomarkers of health. Methods We conducted a cross-sectional pilot study to compare the health status of 100 NC members to 100 community-matched controls (CC) in the greater Boston area. Each CC was matched to a NC member for community of residence (zip code), age category, gender, BMI category, race/ethnicity, education level (category), and readiness to make health changes. Measures obtained included cardio-metabolic risk factors, body composition, markers of nutritional status, reported health status, dietary intake, physical activity, sleep and depression. Results Participants were predominantly female (64%) and Hispanic (73%). NC members had significantly lower fasting insulin (P

Background Emerging research indicates that eating timing may influence dietary intake and metabolic health. However, studies to date have not examined the association of multiple measures of eating timing with both dietary intake and metabolic health in adults with overweight and obesity. Objective To examine the association of multiple measures of eating timing with dietary intake (ie, dietary composition, diet quality, and eating frequency) and metabolic health (ie, body composition and cardiometabolic risk). Design This is a cross-sectional analysis of baseline data from a weight loss and maintenance intervention collected from May 2015 to January 2018. Participants/setting Participants were women with overweight or obesity who were dependents of active duty and retired military personnel (N = 229; mean ± standard error, BMI = 34.7 ± 0.4 kg/m2, age = 40.9 ± 0.7 years). The study was conducted at military installations in Massachusetts, Connecticut, New York, Colorado, and Kentucky. Main outcome measures Eating timing variables examined included daily eating interval (time between first and last eating occasion), time-restricted eating (≤11 hours daily eating interval), early energy eaters (eating ≥60% of energy during the first half of time awake), and bedtime eaters (eating within 2 hours of bedtime). Statistical analysis The main analysis was limited to those reporting plausible energy intake (64% of total sample [n = 146]). Linear, quantile, or logistic regression models were used to determine the association of eating timing with measures of dietary intake and metabolic health. Results In individuals reporting plausible energy intake, each additional 1 hour in daily eating interval was associated with 53 kcal higher energy intake, higher glycemic load, eating frequency, and waist circumference (P Conclusions These findings lend support for the mechanistic targeting of eating timing in behavioral interventions aimed at improving dietary intake and body composition.

Food cravings are a desire for specific foods which, if uncontrolled may lead to excess energy intake and weight gain. However, information on the relation between food cravings, dietary intake, and indices of metabolic health is limited. This study used baseline data from females (n = 229; aged 40.9 ± 0.7 years; BMI 34.7 ± 6.4 kg/m2) who were dependents of active duty and retired military personnel, and enrolled in the Healthy Families Healthy Forces weight loss and maintenance study. Measures obtained included food cravings using the Food Craving Questionnaire-Trait (which provides a habitual and stable measure of food cravings), dietary composition and eating patterns from three 24-h dietary recalls and the Stanford 7-day Physical Activity Recall, body composition from anthropometric measures, cardiometabolic risk factors from blood measures, and demographic information from questionnaires. Linear, quantile, or logistic regression models were used to examine the association of total food craving scores on dietary intake, and indices of metabolic health. In individuals reporting plausible energy intake (n = 146; 2210 ± kcals/day) higher food craving scores were associated with a lower diet quality (P

OBJECTIVES: Self-monitoring daily dietary intake is recommended for weight loss, weight maintenance, and healthy eating. However, current tracking methods are often burdensome and result in short-term use. We conducted a pilot study to evaluate the accuracy of a new application designed to self-monitor dietary intake using natural spoken language (COCO; The Conversational Calorie Counter). METHODS: A total of 14 participants were recruited for the pilot study. They were instructed to record daily dietary intake using the COCO application for at least five consecutive days. Two unscheduled 24-hour dietary recalls were conducted between day 3 and day 5 as the reference method for evaluating total energy intake (TEI). The two-day energy estimates were averaged for each assessment method. Pearson's correlation coefficient was used to assess the validity of the COCO application. Estimates of TEI from COCO were compared to the 24-hour dietary recall by a paired samples t-test. RESULTS: Participants were primarily female (86%), with an average body mass index of 22.2 ± 1.8 kg/m(2) (mean ± standard deviation). On average, participants consumed three daily meals and recorded dietary intake for six days using the COCO application. The average TEI was 1782 ± 773 kcal for all recorded days (range: 4 to 10). The mean TEI measured by 24-hour dietary recall was 1791 ± 862 kcal, and mean TEI measured by COCO for the corresponding days was 1818 ± 916 kcal. We observed a significant correlation between the assessment methods (r = 0.58; P = 0.03), and there was no significant difference in TEI estimates from COCO compared to the 24-hour recall (P = 0.90). CONCLUSIONS: These results suggest that natural spoken language technology can be used in applications that facilitate self-monitoring of food intake to support weight management and the prevention of noncommunicable diseases. The significant correlation between estimates of TEI from COCO and the 24-hour dietary recall indicates the potential validity of this novel approach for capturing dietary data and assessing energy intake. FUNDING SOURCES: Sponsored by the National Institutes of Health (R21HL118347), the U.S. Department of Agriculture with Tufts University (58–1950-4–003), Quanta Computing, Inc., and the Department of Defense (National Defense Science Engineering Graduate Fellowship Program).

OBJECTIVES: To evaluate the nutrient adequacy of theoretical, modern-day Paleo meal plans relative to the U.S. Dietary Reference Intakes (DRIs). METHODS: This analysis used data from the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Study, which captured data on 9 726 self-reported, popular diet followers. Paleo respondents (N = 925) reported sources of recipes and diet guidance. Five days from each of the top six sources were used to generate 30 days of meal plans among a random sample of n = 200 Paleo respondents. Nutrition Data System for Research (NDSR) was used to estimate daily nutrient content of meal plans which was compared to DRIs and recommendations, as follows: recommended daily allowances (RDAs) for vitamins D, E, and folate, which do not vary by age (years, y)/sex; sex and age-specific RDAs for vitamins A, C, calcium (Ca), magnesium (Mg), and iron (Fe); adequate intakes (AIs) for potassium (K) and fiber; upper intake level (UL) for sodium (Na); and Dietary Guidelines for Americans (DGA) upper threshold to limit saturated fat and Na. RESULTS: Estimated daily nutrient intakes of theoretical Paleo meal plans met or exceeded RDAs for the following (Paleo vs. RDA): vitamin A for men or women (1481 RAE µg vs. 900 μg and 700 µg), vitamin D (56 µg vs. 15 μg), vitamin E (27 mg vs. 15 mg), folate (489 µg vs. 400 μg), vitamin C for men or women (225 mg vs. 90 mg and 75 mg), Mg for men and women 31–70 y (539 mg vs. 420 mg and 320 mg), and Fe for men (16 mg vs. 8 mg). Theoretical estimates did not meet the following: RDAs for carbohydrate (91 g vs. 130 g), Fe for women 19–50 y (16 g vs.18 mg), Ca for men and women 61–70 y (562 mg vs. 1000 mg and 1200 mg), and AI for K (4027 mg vs. 4700 mg) or dietary fiber (25 g vs. 28 g/2000 kcal). Estimated levels of Na exceeded the UL (2763 mg vs. 2300 mg), saturated fat exceeded the DGA (19% vs. 10% kcal), and added sugar levels fell within the recommendation (1% vs. 10%). CONCLUSIONS: While certain aspects of the Paleo diet offer improvements over typical reported intakes of US adults, saturated fat is high, and carbohydrate, fiber, Ca, and K levels of these theoretical diets do not meet DRIs. High levels of saturated fat present concern for cardiovascular health. Optimal nutrition may be challenging to sustain on a Paleo diet. FUNDING SOURCES: Supported by USDA Cooperative Agreements 58-8050-9-004 and 58-8050-9-003.

BACKGROUND/OBJECTIVES Acid-producing diets have been associated with adverse health conditions. Dietary acid load can be estimated from dietary intake data, but the available methods require a full dietary assessment. We sought to identify a simpler means to estimate 24-h urinary net acid excretion (NAE), a robust measure of net endogenous acid production, using self-reported intakes of fruits, vegetables (acid-neutralizing foods), grain and/or protein (acid-producing foods) acquired by two different methods in community-dwelling older adults. Identifying food groups associated with NAE by using a method not requiring a full diet assessment could have a broad clinical application. SUBJECTS/METHODS Fruit, vegetable, protein and grain servings/day were estimated with a widely used food frequency questionnaire (study A, n=162, 63±8 years). Differences in their intakes across NAE categories (

Calorie restriction (CR) is a promising strategy to attenuate age-related disease risk. Higher protein diets enhance satiety but may also impair metabolic health and accelerate aging. The effect of higher protein intake on adherence to CR and cardiometabolic markers of healthspan remains unknown. We used the Geometric Framework for Nutrition to examine the association between diet composition and 1) CR adherence; and 2) cardiometabolic risk factors during a 2-year intervention. The CR group consumed higher percentage energy from protein and lower fat at 12 months compared to baseline (logit % protein=0.1; 95% CI=0.05, 0.15; logit % fat= -0.12; CI=-0.29, -0.18). Higher protein intake over the 2-year intervention was associated with higher adherence to CR. No effect of diet composition on cardiometabolic risk factors was observed. These findings suggest that dietary protein plays a critical role in adherence to CR with no adverse effects on cardiometabolic markers of healthspan. Part of a symposium sponsored by the Nutrition Interest Group.

Cancer diagnosis and treatment may influence dietary intake. The validity of using self-reported methods to quantify dietary intake has not been evaluated in childhood cancer survivors. We validated total energy intake (EI) reported from Food Frequency Questionnaire (FFQ) and repeated 24-hour diet recalls (24HRs) against total energy expenditure (TEE) measured using the doubly labeled water method in 16 childhood cancer survivors. Dietary underreporting, assessed by (EI-TEE)/TEE × 100%, was 22% for FFQ and 1% for repeated 24HRs. FFQ significantly underestimates dietary intake and should not be used to assess the absolute intake of foods and nutrients in childhood cancer survivors.

The acid load accompanying modern diets may have adverse effects on bone and muscle metabolism. Treatment with alkaline salts of potassium can neutralize the acid load, but the optimal amount of alkali is not established. Our objective was to determine the effectiveness of two doses of potassium bicarbonate (KHCO3) compared with placebo on biochemical markers of bone turnover, and calcium and nitrogen (N) excretion. In this double-blind, randomized, placebo-controlled study, 244 men and women age 50 years and older were randomized to placebo or 1 mmol/kg or 1.5 mmol/kg of KHCO3 daily for 3 months; 233 completed the study. The primary outcomes were changes in 24-hour urinary N-telopeptide (NTX) and N; changes in these measures were compared across the treatment groups. Exploratory outcomes included 24-hour urinary calcium excretion, serum amino-terminal propeptide of type I procollagen (P1NP), and muscle strength and function assessments. The median administered doses in the low-dose and high-dose groups were 81 mmol/day and 122 mmol/day, respectively. When compared with placebo, urinary NTX declined significantly in the low-dose group (p = 0.012, after adjustment for baseline NTX, gender, and change in urine creatinine) and serum P1NP declined significantly in the low-dose group (p = 0.004, adjusted for baseline P1NP and gender). Urinary calcium declined significantly in both KHCO3 groups versus placebo (p < 0.001, adjusted for baseline urinary calcium, gender, and changes in urine creatinine and calcium intake). There was no significant effect of either dose of KHCO3 on urinary N excretion or on the physical strength and function measures. KHCO3 has favorable effects on bone turnover and calcium excretion and the lower dose appears to be the more effective dose. Long-term trials to assess the effect of alkali on bone mass and fracture risk are needed. © 2015 American Society for Bone and Mineral Research.

Many specialty foods cannot be found in research-focused food databases. However, some nutrient data can be found for many of these foods through individual website searches using brand and store names. Some popular diet-tracking websites contain data for over 3 million foods, data often entered by consumers, based on non-systematic searches. The reliability of these data to guide dietary data entry decisions are unknown. Five popular diet tracking websites were used to compare availability and accuracy of data for food items from a specialty grocery store that are currently unavailable in research-focused food databases.

OBJECTIVES: This study presents the design and implementation of Coco: The Conversational Calorie Counter, a spoken food logging application for iOS. The aim of this work is to reduce the burden on individuals wanting to monitor their food to support healthy eating, as well as individuals with obesity tracking food intake to manage their weight. METHODS: We built a server to predict the best matching foods in the most recent USDA database, given a user's natural language meal description. For each logged food, the user selects the correct USDA food and portion sizes from a list of ranked options provided by our server. We constructed convolutional neural network models to predict matching USDA foods automatically. We launched an iOS prototype of our system for 14 participants in a pilot study to log their meals for five days. RESULTS: Participants were an average of 23.2 ± 2.60 years, 92.3% female, and 14.3% actively trying to lose weight. The results of the patient satisfaction survey administered at the end of study indicated that, on a scale from 1–5 (1 is best, and 5 worst), Coco was rated 1.86 ± 0.53 for perceived accuracy of nutrition facts, 1.79 ± 0.70 for personalization, and 1.43 ± 0.65 for appealing interface design. Compared to existing food logging applications, on a scale of 1–3 (1 is better, 2 the same, and 3 worse), Coco was rated better or the same as existing methods on 8 out of 9 questions, with a score of 1.67 ± 1.16 for difficulty of food logging, 1.33 ± 0.58 for personalization, and 1.67 ± 0.58 for how fun it was. 14.3% of participants said they would definitely continue using Coco, and 28.6% said they would probably continue using the app. CONCLUSIONS: This study demonstrates the acceptability of logging food intake with spoken natural language, with the potential to benefit individuals who find existing methods of tracking dietary intake too tedious and/or time-consuming for sustainable use. FUNDING SOURCES: This research was sponsored by the NIH (grant # R21HL118347), the USDA under agreement no. 58-1950-4-003 with Tufts University, a grant from Quanta Computing, Inc., and by the DoD through the National Defense Science Engineering Graduate Fellowship (NDSEG) Program.

Calorie restriction (CR) increases longevity in many species and reduces risk factors for chronic diseases. In humans, CR may improve health span, yet concerns remain about potential negative effects of CR.To test the effect of CR on mood, quality of life (QOL), sleep, and sexual function in healthy nonobese adults.A multisite randomized clinical trial (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 [CALERIE 2]) was conducted at 3 academic research institutions. Adult men and women (N = 220) with body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 22.0 to 28.0 were randomized to 2 years of 25% CR or an ad libitum (AL) control group in a 2:1 ratio favoring CR. Data were collected at baseline, 12 months, and 24 months and examined using intent-to-treat analysis. The study was conducted from January 22, 2007, to March 6, 2012. Data analysis was performed from July 18, 2012, to October 27, 2015.Two years of 25% CR or AL.Self-report questionnaires were administered to measure mood (Beck Depression Inventory-II [BDI-II], score range 0-63, higher scores indicating worse mood, and Profile of Mood States [POMS], with a total mood disturbance score range of -32 to 200 and higher scores indicating higher levels of the constructs measured), QOL (Rand 36-Item Short Form, score range 0-100, higher scores reflecting better QOL, and Perceived Stress Scale, score range 0-40, higher scores indicating higher levels of stress), sleep (Pittsburgh Sleep Quality Index [PSQI], total score range 0-21, higher scores reflecting worse sleep quality), and sexual function (Derogatis Interview for Sexual Function-Self-report, total score range 24-188, higher scores indicating better sexual functioning).In all, 218 participants (152 women [69.7%]; mean [SD] age, 37.9 (7.2) years; mean [SD] BMI, 25.1 [1.6]) were included in the analyses. The CR and AL groups lost a mean (SE) of 7.6 (0.3) kg and 0.4 (0.5) kg, respectively, at month 24 (P .001). Compared with the AL group, the CR group had significantly improved mood (BDI-II: between-group difference [BGD], -0.76; 95% CI, -1.41 to -0.11; effect size [ES], -0.35), reduced tension (POMS: BGD, -0.79; 95% CI, -1.38 to -0.19; ES, -0.39), and improved general health (BGD, 6.45; 95% CI, 3.93 to 8.98; ES, 0.75) and sexual drive and relationship (BGD, 1.06; 95% CI, 0.11 to 2.01; ES, 0.35) at month 24 as well as improved sleep duration at month 12 (BGD, -0.26; 95% CI, -0.49 to -0.02; ES, -0.32) (all P .05). Greater percent weight loss in the CR group at month 24 was associated with increased vigor (Spearman correlation coefficient, ρ = -0.30) and less mood disturbance (ρ = 0.27) measured with the POMS, improved general health (ρ = -0.27) measured with the SF-36, and better sleep quality per the PSQI total score (ρ = 0.28) (all P .01).In nonobese adults, CR had some positive effects and no negative effects on health-related QOL.clinicaltrials.gov Identifier: NCT00427193.

The rapid increase in the prevalence of obesity is a priority for investigators from across numerous disciplines, including biology, nutritional science, and public health and policy. In this paper, we systematically examine the premise that common dietary obesity is an addictive disorder, based on the criteria for addiction described in the Diagnostic and Statistical Manual (DSM) of Mental Disorders of the American Psychiatric Association, version IV, and consider the consequences of such a reclassification of obesity for public policy. Specifically, we discuss evidence from both human and animal studies investigating the effects of various types and amounts of food and the food environment in obese individuals. Neurobiological studies have shown that the hedonic brain pathways activated by palatable food overlap considerably with those activated by drugs of abuse and suffer significant deficits after chronic exposure to high-energy diets. Furthermore, food as a stimulus can induce the sensitization, compulsion and relapse patterns observed in individuals who are addicted to illicit drugs. The current food environment encourages these addictive-like behaviors where increased exposure through advertisements, proximity and increased portion sizes are routine. Taking lessons from the tobacco experience, it is clear that reclassifying common dietary obesity as an addictive disorder would necessitate policy changes (e.g., regulatory efforts, economic strategies, and educational approaches). These policies could be instrumental in addressing the obesity epidemic, by encouraging the food industry and the political leadership to collaborate with the scientific and medical community in establishing new and more effective therapeutic approaches.

Animal studies have shown that life span is extended by caloric restriction (CR). This manuscript describes the design and methodology of an innovative CR intervention, which is the treatment arm of the CALERIE Study. This study is a multi-center, randomized controlled trial examining the effects of 2 years of CR on biomarkers of longevity among non-obese (BMI ≥ 22 kg/m(2) and

A randomized controlled trial of high glycemic load (HG) and low glycemic load (LG) diets with food provided for 6 months and self-administered for 6 additional months at 30% caloric restriction (CR) was performed in 29 overweight adults (mean+/-SD, age 35+/-5y; BMI 27.5+/-1.5 kg/m(2)). Total energy expenditure (TEE), resting metabolic rate (RMR), fat and fat free mass (FFM), were measured at 3, 6 and 12 months. Changes in TEE, but not changes in RMR, were greater than accounted for by the loss of FFM and fat mass (P=0.001-0.013) suggesting an adaptive response to long-term CR. There was no significant effect of diet group on change in RMR or TEE. However, in subjects who lost >5% body weight (n=26), the LG diet group had a higher percentage of weight loss as fat than the HG group (p

Background:Thereremainsnoconsensusabouttheoptimaldietary composition for sustained weight loss. Objective: The objective was to examine the effects of 2 dietary macronutrient patterns with different glycemic loads on adherence to a prescribed regimen of calorie restriction (CR), weight and fat loss, and related variables. Design: A randomized controlled trial (RCT) of diets with a high glycemic load (HG) or a low glycemic load (LG) at 30% CR was conducted in 34 healthy overweight adults with a mean (! SD) age of35! 6yandbodymassindex(kg/m 2 )of27.6! 1.4.Allfoodwas providedfor6moindietscontrolledforconfoundingvariables,and subjectsself-administeredtheplansfor6additionalmonths.Primary andsecondaryoutcomesincludedenergyintakemeasuredbydoubly labeled water, body weight and fatness, hunger, satiety, and resting metabolic rate. Results: All groups consumed significantly less energy during CR than at baseline (P " 0.01), but changes in energy intake, body weight, body fat, and resting metabolic rate did not differ significantly between groups. Both groups ate more energy than provided (eg,21%and28%CRat3moand16%and17%CRat6mowithHG and LG, respectively). Percentage weight change at 12 mo was # 8.04! 4.1%intheHGgroupand# 7.81! 5.0%intheLGgroup. There was no effect of dietary composition on changes in hunger, satiety, or satisfaction with the amount and type of provided food during CR. Conclusions: These findings provide more detailed evidence to suggest that diets differing substantially in glycemic load induce comparable long-term weight loss. Am J Clin Nutr 2007;85: 1023‐30.

Cancer treatment can impact the hypothalamic-pituitary region of the developing brain, impairing appetite regulation and causing food craving in children who have survived cancer. We assessed food craving using a modified Food Craving Inventory in 22 survivors of pediatric acute lymphoblastic leukemia (ALL) and lymphoma (median age = 11.7 years) and evaluated its association with treatment exposure and changes in weight status over a one-year period. Mean total craving score was 2.1 (SD = 0.7). Survivors reported significantly higher mean craving score for fast-foods [2.6 (SD = 0.9)] than for sweets [2.1 (SD = 0.8)], carbohydrates [2.0 (SD = 0.6)], and fats [1.8 (SD = 0.7)] (all P values

BACKGROUND Caloric restriction (CR), energy intake reduced below ad libitum (AL) intake, increases life span in many species. The implications for humans can be clarified by randomized controlled trials of CR. METHODS To determine CR's feasibility, safety, and effects on predictors of longevity, disease risk factors, and quality of life in nonobese humans aged 21-51 years, 218 persons were randomized to a 2-year intervention designed to achieve 25% CR or to AL diet. Outcomes were change from baseline resting metabolic rate adjusted for weight change ("RMR residual") and core temperature (primary); plasma triiodothyronine (T3) and tumor necrosis factor-α (secondary); and exploratory physiological and psychological measures. RESULTS Body mass index averaged 25.1 (range: 21.9-28.0 kg/m(2)). Eighty-two percent of CR and 95% of AL participants completed the protocol. The CR group achieved 11.7±0.7 %CR (mean ± standard error) and maintained 10.4±0.4% weight loss. Weight change in AL was negligible. RMR residual decreased significantly more in CR than AL at 12 months (p = .04) but not 24 months (M24). Core temperature change differed little between groups. T3 decreased more in CR at M12 and M24 (p < .001), while tumor necrosis factor-α decreased significantly more only at M24 (p = .02). CR had larger decreases in cardiometabolic risk factors and in daily energy expenditure adjusted for weight change, without adverse effects on quality of life. CONCLUSIONS Sustained CR is feasible in nonobese humans. The effects of the achieved CR on correlates of human survival and disease risk factors suggest potential benefits for aging-related outcomes that could be elucidated by further human studies.

PITTAS, ANASTASSIOS G., SUSAN B. ROBERTS, SAI KRUPA DAS, CHERYL H. GILHOOLY, EDWARD SALTZMAN, JULIE GOLDEN, PAUL C. STARK, AND ANDREW S. GREENBERG. The effects of the dietary glycemic load on type 2 diabetes risk factors during weight loss. Obesity. 2006;14:2200–2209. Objective: To compare the effects of two calorie-restricted diets that differ in glycemic load (GL) on glucose tolerance and inflammation. Research Methods and Procedures: Thirty-four healthy overweight adults, ages 24 to 42 years, were randomized to 30% provided calorie-restricted diets with high (HG) or low (LG) glycemic load for 6 months. Outcomes were changes in glucose-insulin dynamics and C-reactive protein (CRP) levels. Results: Compared with baseline, levels of fasting insulin, homeostasis model assessment of insulin resistance, postload insulin at 30 minutes, and incremental area-under-thecurve-insulin during the oral glucose tolerance test were significantly lower in both groups at 6 months (p range, 0.01 to 0.05), but after adjustment for baseline values and weight change, there were no differences between the two groups with regard to changes over time in any parameter. The mean percentage change in insulin sensitivity by a frequently sampled intravenous glucose tolerance test was 26% in the HG group and 24% in the LG group (p 0.83); first-phase acute insulin release was 20% in the HG group and 21% in the LG group (p 0.77). More participants on the LG diet (14 of 16 subjects) had a decline in serum CRP, compared with those on the HG diet (7 of 16 subjects) (p 0.05). Discussion: In healthy overweight adults provided with food for 6 months, the dietary GL did not seem to influence chronic adaptations in glucose-insulin dynamics above that associated with weight loss. This finding highlights the importance of absolute weight loss over the dietary macronutrient composition used to achieve weight loss. The finding of greater declines in CRP concentration after consumption of a low-GL diet warrants further investigation.

High eating behavior self-efficacy may contribute to successful weight loss. Diet interventions that maximize eating behavior self-efficacy may therefore improve weight loss outcomes. However, data on the effect of diet composition on eating behavior self-efficacy are sparse. To determine the effects of dietary glycemic load (GL) on eating behavior self-efficacy during weight loss, body weight and eating behavior self-efficacy were measured every six months in overweight adults participating in a 12-mo randomized trial testing energy-restricted diets differing in GL. All food was provided during the first six months and self-selected thereafter. Total mean weight loss did not differ between groups, and GL-level had no significant effect on eating behavior self-efficacy. In the combined cohort, individuals losing the most weight reported improvements in eating behavior self-efficacy, whereas those achieving less weight loss reported decrements in eating behavior self-efficacy. Decrements in eating behavior self-efficacy were associated with subsequent weight regain when diets were self-selected. While GL does not appear to influence eating behavior self-efficacy, lesser amounts of weight loss on provided-food energy restricted diets may deter successful maintenance of weight loss by attenuating improvements in eating behavior self-efficacy.

Energy-restricted low glycemic load diets are being used increasingly for weight loss. However, the long-term effects of such regimens on mood and cognitive performance are not known. We assessed the effects of low glycemic load (LG) and high glycemic load (HG) energy-restricted diets on mood and cognitive performance during 6 months of a randomized controlled trial when all food was provided. Subjects were 42 healthy overweight adults (age 35+/-5 years; BMI 27.8+/-1.6 kg/m(2)) with a mean weight loss of 8.7+/-5.0% that did not differ significantly by diet randomization. Mood was assessed by using the Profile of Mood States (POMS) questionnaire. Cognitive performance was assessed by using computerized tests of simple reaction time, vigilance, learning, short-term memory and attention, and language-based logical reasoning. Worsening mood outcome over time was observed in the HG diet group compared to the LG for the depression subscale of POMS (p=0.009 after including hunger as a covariate). There was no significant change over time in any cognitive performance values. These findings suggest a negative effect of an HG weight loss diet on sub-clinical depression but, in contrast to a previous suggestion, provide no support for differential effects of LG versus HD diets on cognitive performance.

Theoretical calculations suggest that small daily reductions in energy intake can cumulatively lead to substantial weight loss, but experimental data to support these calculations are lacking. We conducted a 1-year randomized controlled pilot study of low (10%) or moderate (30%) energy restriction (ER) with diets differing in glycemic load in 38 overweight adults (mean +/- s.d., age 35 +/- 6 years; BMI 27.6 +/- 1.4 kg/m(2)). Food was provided for 6 months and self-selected for 6 additional months. Measurements included body weight, resting metabolic rate (RMR), adherence to the ER prescription assessed using (2)H(2)(18)O, satiety, and eating behavior variables. The 10%ER group consumed significantly less energy (by (2)H(2)(18)O) than prescribed over 12 months (18.1 +/- 9.8%ER, P = 0.04), while the 30%ER group consumed significantly more (23.1 +/- 8.7%ER, P0.001). Changes in body weight, satiety, and other variables were not significantly different between groups. However, during self-selected eating (6-12 months) variability in % weight change was significantly greater in the 10%ER group (P0.001) and poorer weight outcome on 10%ER was predicted by higher baseline BMI and greater disinhibition (P0.0001; adj R(2) = 0.71). Weight loss at 12 months was not significantly different between groups prescribed 10 or 30%ER, supporting the efficacy of low ER recommendations. However, long-term weight change was more variable on 10%ER and weight change in this group was predicted by body size and eating behavior. These preliminary results indicate beneficial effects of low-level ER for some but not all individuals in a weight control program, and suggest testable approaches for optimizing dieting success based on individualizing prescribed level of ER.

Background and aims: Caloric restriction (CR) attenuates biological aging in animal models but there is little information on the feasibility and efficacy of CR regimens in humans. We examined the effects of consuming an insoluble cereal fiber supplement on ability to sustain CR over 1 year in healthy overweight adults. Methods: In 34 healthy overweight women and men (BMI 25–30 kg/m2, age 20–42 yr), a 30% CR regimen meeting national recommendations for dietary fiber was provided for 24 weeks, and for an additional 24 weeks subjects were counseled to prepare the same regimen at home. During 5–10 weeks of CR, subjects were randomized to consume an extra 20 g/day of dietary fiber from a high fiber cereal (+F) or to not consume additional fiber (−F). After this time, all subjects were encouraged to consume the extra fiber. Outcomes included adherence to the provided and self-prepared CR regimens (energy intake determined using doubly labeled water), changes in body weight, and self-reported satisfaction with the amount of consumed food. Results: During 5–10 weeks of CR when all food was provided, both +F and −F groups were highly adherent to the CR regimen and there was no significant difference between groups in energy intake (p=0.51), weight change (p=0.96), or satisfaction with amount of provided food (p=0.08). During self-prepared CR from 25 to 48 weeks, mean adherence was lower than during the food-provided phase and there was a significant association between fiber intake and % CR (r=0.69, p

To examine characteristics of craved foods in relation to dietary energy restriction (ER) with high (HG) and low glycemic load (LG) diets.Assessments of food cravings before and during a randomized controlled trial of HG and LG diets provided for 6 months.Thirty-two healthy, overweight women aged 20-42 years.Self-reported food cravings and dietary intake, body weight, weight history and measures of eating behaviors.Foods craved at baseline were more than twice as high in energy density as the habitual diet (3.7+/-1.5 vs 1.7+/-0.3 kcal/g; P0.001), and on average were lower in protein (P0.001) and fiber (P0.001) and higher in fat (P=0.002). There were no statistically significant changes in nutritional characteristics of craved foods after 6 months of ER. There was a significant relationship between reported portion size of craved food consumed at baseline and lifetime high body mass index (r=0.49, P=0.005). Additionally, there was a significant association between susceptibility to hunger and craving frequency at baseline, and there were significant relationships between hunger score, craving frequency, strength and percentage of time that cravings are given in to after 6 months of ER. In multiple regression models, subjects who lost a greater percentage of weight craved higher energy-dense foods at month 6 of ER, but also reported giving in to food cravings less frequently (adjusted R (2)=0.31, P=0.009).High energy density and fat content, and low protein and fiber contents were identifying characteristics of craved foods. The relationships between craving variables and hunger score suggest that the relative influence of hunger susceptibility on cravings may be important before and especially after ER. Portion size of craved foods and frequency of giving in to food cravings appear to be important areas for focus in lifestyle modification programs for long-term weight loss.