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Nighat Farooqi,1 Frode Slinde,2 Maine Carlsson,3 Lena Håglin,4 Thomas Sandström1 1Department of Public Health and Clinical Medicine, Division of Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden; 2Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of Community Medicine and Rehabilitation, Division of Geriatric Medicine, Umeå University, Umeå, Sweden; 4Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden Background: In clinical practice, in the absence of objective measures, simple methods to predict energy requirement in patients with chronic obstructive pulmonary disease (COPD) needs to be evaluated. The aim of the present study was to evaluate predicted energy requirement in females with COPD using pedometer-determined physical activity level (PAL) multiplied by resting metabolic rate (RMR) equations. Methods: Energy requirement was predicted in 18 women with COPD using pedometer-determined PAL multiplied by six different RMR equations (Harris–Benedict; Schofield; World Health Organization; Moore; Nordic Nutrition Recommendations; Nordenson). Total energy expenditure (TEE) was measured by the criterion method: doubly labeled water. The predicted energy requirement was compared with measured TEE using intraclass correlation coefficient (ICC) and Bland–Altman analyses. Results: The energy requirement predicted by pedometer-determined PAL multiplied by six different RMR equations was within a reasonable accuracy (±10%) of the measured TEE for all equations except one (Nordenson equation). The ICC values between the criterion method (TEE) and predicted energy requirement were: Harris–Benedict, ICC =0.70, 95% confidence interval (CI) 0.23–0.89; Schofield, ICC =0.71, 95% CI 0.21–0.89; World Health Organization, ICC =0.74, 95% CI 0.33–0.90; Moore, ICC =0.69, 95% CI 0.21–0.88; Nordic Nutrition Recommendations, ICC =0.70, 95% CI 0.17–0.89; and Nordenson, ICC =0.40, 95% CI -0.19 to 0.77. Bland–Altman plots revealed no systematic bias for predicted energy requirement except for Nordenson estimates. Conclusion: For clinical purposes, in absence of objective methods such as doubly labeled water method and motion sensors, energy requirement can be predicted using pedometer-determined PAL and common RMR equations. However, for assessment of nutritional status and for the purpose of giving nutritional treatment, a clinical judgment is important regarding when to accept a predicted energy requirement both at individual and group levels. Keywords: pedometer-determined PAL, women with COPD, energy expenditure, DLW method

INTRODUCTION Chronic obstructive pulmonary disease (COPD) is characterised by a persistent airflow limitation that is associated with an enhanced chronic inflammatory response to noxious particles and gases in the airways [...], BACKGROUND/OBJECTIVES: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat-free mass depletion. SUBJECTS/METHODS: The results in this cross-sectional study are based on 169 COPD patients (62% female subjects). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires: the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ). RESULTS: Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared with men (P < 0.05). Thirty-six percent of the patients were depleted (fat-free mass index (FFMI) < 15 kg/[m.sup.2] for women and FFMI < 16 kg/[m.sup.2] for men). Depleted patients had more NIS (P < 0.05) and also rated appetite and taste of food as worse compared with non-depleted patients (P < 0.05). CONCLUSIONS: NIS are common in patients with COPD, and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and whether NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future. European Journal of Clinical Nutrition (2015) 69, 256-261;Doi:10.1038/ejcn.2014.76; published Online 7 May 2014

In studies of physical performance comprising muscle strength and power, a vertical jump is a test method that frequently is used. It is important to have access to accurate measuring tools providing data with high reproducibility. Studies have shown that body composition also may play an important part in physical performance. The purpose of this study was to determine test-retest reliability for 3 different kinds of vertical jumps and to correlate jump height with body composition. Thirty-four normally trained subjects (women n = 17) between 18 and 25 years participated. Test-retest, on 3 kinds of vertical jumps, was performed with a median of 7 days between jumps. Methods used were a countermovement jump (CMJ) on a contact mat, with and without arm swing, and an Abalakow jump (AJ) using measuring tape, with arm swing. Body composition was assessed with the use of bioelectric impedance analysis. The results showed that high intraclass correlation coefficients (ICCs) were observed between testing occasions for all 3 vertical jumps (ICC between 0.48 and 0.88). The AJ in women presented the lowest ICC. Also the correlation between CMJ and AJ was high (rs = 0.88). Moderate-to-high correlations could be shown between body composition and CMJ in women (rs = -0.57-0.76). In conclusion, very high test-retest reliability for CMJ on a contact mat was found. For the AJ using a measuring tape, ICC were overall high, but a moderate nonsignificant ICC were found in women, indicating poor reproducibility. The data from the CMJ and AJ may be compared if approximately 25% of the AJ value is subtracted. In practice, this means that vertical jump tests have high reproducibility and can be used as measures of power development. [ABSTRACT FROM AUTHOR]

PURPOSES: To validate the energy expenditure estimated from The Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) with total energy expenditure (TEE) measured by doubly labeled water (DLW), and to present and examine the validity of an extended version of the MLTPAQ with additional questions about inactivity during leisure time (eMLTPAQ), in a sample of Swedish 15-yr-old adolescents. METHODS: Thirty-five 15-yr-old adolescents were interviewed using the eMLTPAQ. In addition to anthropometry, indirect calorimetry was measured to assess basal metabolic rate, and TEE was assessed by the DLW method over a 14-d period. RESULTS: Energy expenditure calculated from MLTPAQ correlated well with TEEDLW (r=0.49, P<0.01), and the correlation increased when including questions about inactivity (r=0.73, P<0.01). However, eMLTPAQ underestimated TEE in 34 of the 35 students, with a mean difference between the methods of 2.8 MJ.d(-1) (95% limits of agreement: -0.1 to 5.6 MJ.d(-1)), which mainly was explained by a relative high intensity in the time which remained unreported. CONCLUSION: eMLTPAQ is valid in ranking adolescents energy expenditure and in describing patterns of leisure time physical activities. [ABSTRACT FROM AUTHOR]

Introduction: The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component., Aim: To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA., Methods: In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference., Results: The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94)., Conclusion: The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG-SGA is essential before implementing the professional component into clinical practice or research., (© 2024 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

[Purpose] To examine the effects of age and gender in an ageing population with respect to functional decline and the relationship between muscle power and functional capacity. [Participants and Methods] The cohort (N=154) was subdivided into youngest-old (65-70 years.; n=62), middle-old (71-75 years.; n=46), and oldest-old (76-81 years.; n=46). Measures of mechanical muscle function included countermovement jump height, muscle power, leg strength and grip strength. Functional performance-based measures included heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old performed significantly worse than the middle-old, whereas the youngest-old did not outperform the middle-old to the same extent. Increased contribution of muscle power was observed with increasing age. Males had consistently higher scores in measures of mechanical muscle function, whereas no gender differences were observed for functional capacity. [Conclusion] The age-related decline in functional capacity appears to accelerate when approaching 80 years of age and lower limb muscle power seems to contribute to a greater extent to the preservation of functional balance and gait capacity at that stage. Males outperform females in measures of mechanical muscle function independent of age, while the findings give no support for the existence of gender differences in functional capacity., Competing Interests: None., (2021©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Objective: There is no consensus on how to estimate energy requirements after liver transplantation (LT). The aim of this study was to compare measured resting energy expenditure (REE) with predictive equations and fixed factors, and evaluate whether clinical variables were associated with REE., Methods: During the period of 2011 through 2018, REE measured with indirect calorimetry and predicted by the Harris and Benedict (HB) equation was compared in patients during the first 30 postoperative days after LT. The fixed factors 25 kcal/kg, 30 kcal/kg, or 35 kcal/kg were used to calculate energy requirements. The accuracy of HB and fixed factors were evaluated with a Bland-Altman analysis and Lin's concordance correlation coefficient. The associations of pre- and postoperative clinical variables with REE were evaluated in a multivariate regression analysis., Results: A total of 143 patients were evaluated and had indirect calorimetry performed on postoperative day 6 (interquartile range: 3) in median. The mean measured REE was 1950 ± 461 kcal (range, 720-3309 kcal) or 24.5 ± 6.1 kcal/kg body weight. Large limits of agreements were observed in the Bland-Altman analyses for both HB and fixed factors. HB was closer than fixed factors with a positive concordance (concordance correlation: 0.350; 95% confidence interval, 0.248-0.445) and Pearsons r 2 = 0.261. Measured REE was significantly associated (P < 0.05) with age, sex, Model for End-Stage Liver Disease score before LT, surgery time, and graft cold ischemia time according to the multiple regression analysis., Conclusions: The low accuracy of HB and fixed factors suggests risks of both under- and overfeeding of individual patients if energy requirement is only based on calculation. REE measurement is recommended after LT to secure accurate and safe nutritional therapy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and Aims: Patients with chronic liver disease often experience symptoms that affect their ability to eat. These symptoms can contribute to weight loss and malnutrition. We aimed to examine the prevalence of nutrition impact symptoms (NIS) in patients with chronic liver disease, and to investigate the relationships between NIS, malnutrition and health-related quality of life., Methods: In a cross-sectional study on adult patients with chronic liver disease under evaluation for liver transplantation, we studied NIS with two questionnaires: the Eating Symptoms Questionnaire and the Disease-Related Appetite Questionnaire. Malnutrition was primarily assessed with the Global Leadership Initiative on Malnutrition (GLIM) criteria. Health-related quality of life (HRQOL) was assessed with the Chronic Liver Disease Questionnaire., Results: Among the 133 included patients, 90% reported one or more NIS and 51% reported four or more NIS. The most common symptoms were dry mouth (61%), abdominal pain (58%), diarrhoea (45%) and nausea (41%). Malnutrition was present in 32% according to GLIM criteria. Malnourished patients reported more NIS (p = 0.004) and had lower HRQOL (p < 0.001). Certain NIS, such as pain, poor appetite, changes in taste and early satiety, were predictors for malnutrition., Conclusions: NIS are common in patients with chronic liver disease and are associated with malnutrition and worse HRQOL. NIS should therefore be systematically assessed in patients with chronic liver disease. Whether identification and proper management of NIS can prevent malnutrition and improve quality of life deserves further exploration., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Patients with chronic obstructive pulmonary disease (COPD) might suffer from severe dyspnea, which importantly impacts on the performance of activities of daily living (ADL). Patient training of energy conservation techniques (ECTs) might be useful to improve the tolerance and execution of these ADL, but objective studies evaluating the effect of teaching ECTs on the metabolic equivalent of task (MET) in patients with COPD are sparse., Objectives: The aim of this study was to test the hypothesis that practicing ECTs after a 2-week ECT teaching period would reduce the energy expenditure (MET) in performing an activity in patients with severe COPD., Methods: Energy expenditure was assessed with a gas exchange system (OxyconTM Mobile) during one out of five standardized ADL before and after a 2-week intervention period in which ECTs were taught. These ECTs comprised a good breathing technique, an ergonomic way of performing the activity, and the use of assistive devices., Results: Thirty-two patients with COPD (mean FEV1: 39 ± 14%; female: n = 18; age: 68 ± 7 years) were included. A significantly lower MET (2.3 ± 0.6 to 2.1 ± 0.5; p < 0.05) and less desaturation (89.7 ± 5.2 vs. 91.1 ± 5.5% HbO2; p < 0.05) were seen while performing the same activity after the intervention. However, there was no significant difference in the time spent on the task performed (6.0 ± 3.9 vs. 6.7 ± 4.0 min; p > 0.05)., Conclusions: A 2-week educative program on ECTs successfully reduces the energy spent for performing ADL relevant to the patient without any significant increase in the time spent on the activity., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Background:: Frailty is considered highly prevalent among the aging population. Fruit and vegetable intake is associated with positive health outcomes across the life-span; however, the relationship with health benefits among older adults has received little attention., Aim:: The aim was to examine if a relationship exists between meal frequency or frequency of vegetable intake and the development of frailty in a population of older adults., Methods:: A total of 371 individuals, 80 years or older, from the study 'Elderly Persons in the Risk Zone' were included. Data was collected in the participants' home by face-to-face interviews up to 24 months after the intervention. Baseline data were calculated using Chi 2 -test; statistical significance was accepted at the 5% level. Binary logistic regression was used for the relationship between meal frequency or vegetable intake and frailty., Results:: Mean meal frequency was 4.2 ± 0.9 meals per day; women seem to have a somewhat higher meal frequency than men (p=0.02); 57% of the participants had vegetables with at least one meal per day. No significant relationship was found between meal frequency or vegetable intake and frailty at 12 or 24 months follow-ups., Conclusions:: Among this group of older adults (80+), meal frequency was slightly higher among women than men, and just over half of the participants had vegetables with at least one meal a day. The risk of developing frailty was not associated with meal frequency or vegetable intake. The questions in this study were meant as indicators for healthy food habits.

Background: Many patients with chronic obstructive pulmonary disease (COPD) lose weight. Successful nutritional intervention is vital, thus assessment of energy requirement is required. The aim of this study was to present an improved possibility to assess energy requirement in patients with COPD., Methods: Pub Med search was conducted for all the studies reporting total energy expenditure (TEE) measured by doubly labeled water (DLW) method in patients with COPD. Four studies were identified, whereof three were conducted in Sweden. The present analysis is based on these three studies of which the data was acquired., Results: There was a large variation in resting metabolic rate (RMR) and TEE. Body mass index decreased significantly with increase in disease severity (p < .001), and correlated significantly to forced expiratory volume in 1 s (FEV 1 ) % predicted (r = .627, p < .001). FEV 1 % predicted had a significant correlation with RMR/kg body weight (BW)/day (r = -.503, p = .001), RMR/kg fat-free mass (FFM)/day (r = .338, p = .031), and TEE/kg FFM/day (r = .671, p < .001). Compared to men, women had a lower RMR and TEE/kg BW/day (p < .001 respectively p = .002), and higher RMR and TEE/kg FFM/day (p = .080 respectively p = .005). The correlates of: RMR/kg BW were gender and FEV1% predicted; of TEE/kg BW the correlates were age and gender, and of TEE/kg FFM the correlates were age and FEV1% predicted., Conclusion: In this study, we have presented a possibility to assess energy requirement per kg BW/day and per kg FFM/day in patients with COPD in clinical settings. However, gender, age, and disease severity must be considered., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background & Aims: Clinical signs of malnutrition, starvation, cachexia and sarcopenia overlap, as they all imply muscle wasting to a various extent. However, the underlying mechanisms differ fundamentally and therefore distinction between these phenomena has therapeutic and prognostic implications. We aimed to determine whether dietitians in selected European countries have 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia, and use these terms in their daily clinical work., Methods: An anonymous online survey was performed among dietitians in Belgium, the Netherlands, Norway and Sweden. 'Sufficient knowledge' was defined as having mentioned at least two of the three common domains of malnutrition according to ESPEN definition of malnutrition (2011): 'nutritional balance', 'body composition' and 'functionality and clinical outcome', and a correct answer to three cases on starvation, cachexia and sarcopenia. Chi-square test was used to analyse differences in experience, work place and number of malnourished patients treated between dietitians with 'sufficient knowledge' vs. 'less sufficient knowledge'., Results: 712/7186 responded to the questionnaire, of which data of 369 dietitians were included in the analysis (5%). The term 'malnutrition' is being used in clinical practice by 88% of the respondents. Starvation, cachexia and sarcopenia is being used by 3%, 30% and 12% respectively. The cases on starvation, cachexia and sarcopenia were correctly identified by 58%, 43% and 74% respectively. 13% of the respondents had 'sufficient knowledge'. 31% of the respondents identified all cases correctly. The proportion of respondents with 'sufficient knowledge' was significantly higher in those working in a hospital or in municipality (16%, P < 0.041), as compared to those working in other settings (7%)., Conclusions: The results of our survey among dietitians in four European countries show that the percentage of dietitians with 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia is unsatisfactory (13%). The terms starvation, cachexia and sarcopenia are not often used by dietitians in daily clinical work. As only one-third (31%) of dietitians identified all cases correctly, the results of this study seem to indicate that nutrition-related disorders are suboptimally recognized in clinical practice, which might have a negative impact on nutritional treatment. The results of our study require confirmation in a larger sample of dietitians., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: Malnutrition is common among patients with diseases of the liver and gastrointestinal tract. Nutritional intake may be negatively affected by nutrition impact symptoms (NIS). Therefore, the aims were to assess: 1) the prevalence of NIS in this group of patients and 2) the relationship between NIS and nutritional status as well as nutritional risk., Material and Methods: We performed a cross-sectional study among patients with liver disease, inflammatory bowel disease, cancer or pancreatitis. Nutritional risk was assessed by the NRS-2002. Nutritional status was assessed by body mass index (BMI) and handgrip strength (HGS), which were both measured within 5 days after admission. NIS were assessed by the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ)., Results: In total, 126 patients were included (women 39%) with a mean BMI of 24 ± 5 kg/m(2). The prevalence of low HGS was 38%, and the prevalence of those at nutritional risk was 58%. The number of NIS reported by 50% of the patients were 4 or more in the ESQ and 5 or more in the DRAQ. Patients who were both at nutritional risk and had a low HGS more frequently reported difficulties swallowing, poor appetite, feeling full after having one-fourth of the meal and food tasting bad., Conclusions: NIS that preclude food intake are very frequent among patients with diseases of the liver and gastrointestinal tract. Specific NIS are associated with low HGS, weight loss and being at nutritional risk.

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk., (©ERS 2014.)

Introduction: Emerging evidence indicates that patients with chronic obstructive pulmonary disease (COPD) have a poorer vitamin D status than the general population, possibly affecting several comorbidities. In northern latitudes, these problems could be even more accentuated in wintertime because of the low ultraviolet B radiation., Objectives: To examine the dietary intake of vitamin D and the levels of 25-hydroxyvitamin D (25-OH-D) in a COPD population compared with a reference group in Swedish settings., Methods: Ninety-eight COPD patients (forced expiratory volume in 1 s/vital capacity ratio < 0.65) recruited from the outpatient clinics at the university hospitals in Gothenburg and Uppsala, Sweden were included in this cross-sectional study. The reference group (149 individuals) was randomly selected from the Swedish National Registry. The serum concentrations of 25-OH-D, intact parathyroid hormone, creatinine and calcium were measured. A trained dietitian conducted a dietary history interview to evaluate food intake of vitamin D, prescribed drugs and supplements containing vitamin D., Results and Conclusions: The mean serum concentration of 25-OH-D was significantly higher in the reference group (57.6 ± 23 nmol/L) compared with the COPD group (51.5 ± 22 nmol/L) (P = 0.039). The dietary intake was predominantly below the recommendations in both groups. Mean total daily intake of vitamin D and mean daily supplementation of vitamin D was significantly higher in the COPD group (P = 0.012 and P = 0.030, respectively). Low intake of vitamin D and low serum levels of 25-OH-D are common in both COPD patients and an elderly Swedish population. Monitoring vitamin D status and possibly routinely treating COPD patients with vitamin D and calcium should be considered to minimise the risk of severe vitamin D deficiency among COPD patients., (© 2013 John Wiley & Sons Ltd.)