Deficits in episodic memory are related to uncontrolled eating in a sample of healthy adults.

Despite a substantial amount of animal data linking deficits in memory inhibition to the development of overeating and obesity, few studies have investigated the relevance of memory inhibition to uncontrolled eating in humans. Further, although memory for recent eating has been implicated as an important contributor to satiety and energy intake, the possibility that variations in episodic memory relate to individual differences in food intake control has been largely neglected. To examine these relationships, we recruited ninety-three adult subjects to attend a single lab session where we assessed body composition, dietary intake, memory performance, and eating behaviors (Three Factor Eating Questionnaire). Episodic recall and memory inhibition were assessed using a well-established measure of memory interference (Retrieval Practice Paradigm). Hierarchical regression analyses indicated that memory inhibition was largely unrelated to participants' eating behaviors; however, episodic recall was reliably predicted by restrained vs. uncontrolled eating: recall was positively associated with strategic dieting (ß = 2.45, p = 0.02), avoidance of fatty foods (ß = 3.41, p = 0.004), and cognitive restraint (ß = 1.55, p = 0.04). In contrast, recall was negatively associated with uncontrolled eating (ß = -1.15, p = 0.03) and emotional eating (ß = -2.46, p = 0.04). These findings suggest that episodic memory processing is related to uncontrolled eating in humans. The possibility that deficits in episodic memory may contribute to uncontrolled eating by disrupting memory for recent eating is discussed.

The impact of two workplace-based health risk appraisal interventions on employee lifestyle parameters, mental health and work ability: results of a randomized controlled trial.

Health risk appraisals (HRA) are a common type of workplace health promotion programme offered by American employers. In the United Kingdom, evidence of their effectiveness for promoting health behaviour change remains inconclusive. This randomized controlled trial examined the effects of two HRA interventions on lifestyle parameters, mental health and work ability in a UK context. A total of 180 employees were randomized into one of three groups: Group A (HRA augmented with health promotion and education activities), Group B (HRA only) and Group C (control, no intervention). After 12 months, changes in mean scoring in 10 lifestyle, mental health and work ability indices were compared, Groups A and B demonstrated non-significant improvements in 70% and 80%, respectively, compared with controls (40%). Odds ratios revealed that, compared with the control group, Group A was 29.2 (95% CI: 9.22-92.27) times more likely to report a perceived change in lifestyle behaviour; Group B 4.4 times (95% CI: 1.65-11.44). In conclusion, participation in the HRA was associated with a higher likelihood of perceived lifestyle behaviour change which was further increased in the augmented HRA group, thereby providing preliminary evidence that HRA and augmented HRA in particular may help UK employees make positive healthy lifestyle changes.

Single-nucleotide polymorphisms in the C-reactive protein (CRP) gene promoter that affect transcription factor binding, alter transcriptional activity, and associate with differences in baseline serum CRP level.

To investigate whether functional polymorphisms exist in the C-reactive protein (CRP) gene, i.e., ones that contribute directly to differences in baseline CRP among individuals, we sequenced a 1,156-nucleotide-long stretch of the CRP gene promoter in 287 ostensibly healthy people. We identified two single-nucleotide polymorphisms (SNPs), a bi-allelic one at nucleotide -409 (G-->A), and a tri-allelic one at -390 (C-->T-->A), both resident within the hexameric core of transcription factor binding E-box elements. Electrophoretic mobility shift assays confirmed that the SNP within the sequence (-412)CACGTG(-407) (E-box 1) modulates transcription factor binding, and that the one within (-394)CACTTG(-389) (E-box 2) supports transcription factor binding only when the -390 T allele is present. The commonest of four E-box 1/E-box 2 haplotypes (-409G/-390T) identified in the population supported highest promoter activity in luciferase reporter assays, and the rarest one (-409A/-390T) supported the least. Importantly, serum CRP in people with these haplotypes reproduced this rank order, i.e., people with the -409G/-390T haplotype had the highest baseline serum CRP (mean +/- SEM 10.9 +/- 2.25 microg/ml) and people with the -409A/-390T haplotype had the lowest (5.01 +/- 1.56 microg/ml). Furthermore, haplotype-associated differences in baseline CRP were not due to differences in age, sex, or race, and were still apparent in people with no history of smoking. At least two other SNPs in the CRP promoter lie within E-box elements (-198 C-->T, E-box 4, and -861 T-->C, E-box 3), indicating that not only is the quality of E-box sites in CRP a major determinant of baseline CRP level, but also that the number of E-boxes may be important. These data confirm that the CRP promoter does encode functional polymorphisms, which should be considered when baseline CRP is being used as an indicator of clinical outcome. Ultimately, development of genetic tests to screen for CRP expression variants could allow categorization of healthy people into groups at high versus low future risk of inflammatory disease.

Effects of dieting and physical activity on pregnancy and lactation.

Concerns regarding weight control and fitness during the reproductive years have prompted questions about dieting and physical activity among pregnant and lactating women. Dieting to lose weight is never recommended during pregnancy, even among obese women. Once lactation is established, moderate energy restriction to achieve a weight loss of < or = 2 kg/mo is probably safe for women who are overweight initially. There are several potential risks and benefits of exercise during pregnancy and lactation. The data available indicate that moderate aerobic exercise is safe and beneficial for most women, if appropriate guidelines are followed.

Between-day and within-day variability in the relation between heart rate and oxygen consumption: effect on the estimation of energy expenditure by heart-rate monitoring.

Estimation of energy expenditure (EE) by heart-rate (HR) monitoring (HRM) assumes that the relation between HR and oxygen consumption (VO2) is stable between days and within a day. To evaluate this assumption, 12 healthy subjects underwent an HR-VO2 calibration session on two mornings and two afternoons, with one morning and one afternoon session on the same day. Measurements were made while subjects were supine, sitting, standing while shifting body weight side-to-side, and walking at four intensities. Subjects wore an HR monitor during waking hours on another day (15.1 +/- 1.5 h). Regression analysis was used to determine the relation between HR and VO2 in the sedentary and active HR ranges, and four EE values (HRM-EE) based on the four calibration sessions were calculated for each subject. The four group mean HRM-EE values were nearly identical (CV: 1.1%). The regression equations generated from the four calibration sessions did not differ significantly for the group as a whole, but for some subjects there were significant differences among sessions in the slope of the active regression equation (P = 0.005). Intraindividual CVs for HRM-EE were generally < 10%, but ranged from 0.1% to 24.7%. In general, within an individual, HR was more variable than was VO2, and intraindividual variability in EE was associated with intraindividual variability in the flex HR and sedentary HR range. HRM is appropriate for assessment of EE for a group; however, caution is recommended when HRM is used for individual determinations of EE.

Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance.

BACKGROUND: Limiting postpartum weight retention is important for preventing adult obesity, but the effect of weight loss on lactation has not been studied adequately. OBJECTIVE: We evaluated whether weight loss by dieting, with or without aerobic exercise, adversely affects lactation performance. DESIGN: At 12+/-4 wk postpartum, exclusively breast-feeding women were randomly assigned for 11 d to a diet group (35% energy deficit; n = 22), a diet plus exercise group (35% net energy deficit; n = 22), or a control group (n = 23). Milk volume, composition, and energy output; maternal weight, body composition, and plasma prolactin concentration; and infant weight were measured before and after the intervention. RESULTS: Weight loss averaged 1.9, 1.6, and 0.2 kg in the diet, diet + exercise, and control groups, respectively (P < 0.0001) and was composed of 67% fat in the diet group and nearly 100% fat in the diet + exercise group. Change in milk volume, composition, and energy output and infant weight did not differ significantly among groups. However, there was a significant interaction between group and baseline percentage body fat: in the diet group only, milk energy output increased in fatter women and decreased in leaner women. The plasma prolactin concentration was higher in the diet and diet + exercise groups than in the control group. CONCLUSIONS: Short-term weight loss (approximately 1 kg/wk) through a combination of dieting and aerobic exercise appears safe for breast-feeding mothers and is preferable to weight loss achieved primarily by dieting because the latter reduces maternal lean body mass. Longer-term studies are needed to confirm these findings.

Energy expenditure in lactating women: a comparison of doubly labeled water and heart-rate-monitoring methods.

Estimates of total daily energy expenditure (TDEE) by heart-rate (HR) monitoring were compared with those made by the doubly labeled water (DLW) method in nine exclusively breast-feeding women. Subjects recorded HR and dietary intake daily during the 8-d, isotope-measurement period. Milk energy output was determined by 3-d test weighing and analysis of 24-h milk samples. Total energy output (milk energy and TDEE) averaged 12.36 +/- 1.03 MJ/d with DLW compared with 11.74 +/- 1.3 MJ/d with HR monitoring, a 5.8% difference (NS). Individual differences ranged from -27.1% to +17.6%. The high water turnover and relatively low level of activity during lactation made the slopes of deuterium and 18O disappearance more similar, resulting in increased error in estimates of TDEE by DLW. Therefore, the DLW method may not be appropriate for use in lactating women. There are considerable individual deviations in estimating TDEE by HR monitoring, but it is satisfactory for estimating TDEE of groups.

Psychological measures of eating behavior and the accuracy of 3 common dietary assessment methods in healthy postmenopausal women.

BACKGROUND: Factors affecting the accuracy of reported energy intake (rEI) need to be identified. OBJECTIVE: Our objective was to investigate the association of psychological measures of eating behavior with the accuracy of rEI assessed by 7-d weighed intakes, a 24-h recall, and a food-frequency questionnaire. DESIGN: Subjects were 26 restrained eaters aged 60.3 +/- 0.6 y (mean +/- SEM) and weighing 63.8 +/- 1.7 kg and 34 unrestrained eaters aged 59.4 +/- 0.6 y and weighing 64.0 kg. rEI was assessed by using 3 dietary assessment methods and total energy expenditure (TEE) was determined by using doubly labeled water. Calculated EI (cEI) was determined as TEE corrected for the estimated change in body energy. Subjects completed the Eating Inventory. RESULTS: rEI values were significantly lower than TEE values for all 3 dietary assessment methods (P < 0.05); there was no significant relation between rEI and TEE by any method. There was no significant difference in 100 x rEI:TEE between restrained and unrestrained eaters by any of the dietary assessment methods. When combined data from the 3 methods were used, 100 x rEI:cEI was not significantly different from 100% in unrestrained eaters (99 +/- 6.8%) but was lower in restrained eaters (89.1 +/- 5.3%; P < 0.05). There was a positive relation between hunger and 100 x rEI:TEE (P < 0.05). CONCLUSIONS: Low hunger is associated with undereating relative to normal eating during measurement of dietary intake; high dietary restraint may be associated with a reduction in reporting of consumed foods. Dietary hunger and restraint assessed with use of the Eating Inventory may help to identify subjects likely to underreport dietary intake.

Dietary variety within food groups: association with energy intake and body fatness in men and women.

BACKGROUND: Short-term experimental studies suggest that dietary variety may influence body fatness but no long-term human studies have been reported. OBJECTIVE: The purpose of this study was to determine whether dietary variety within food groups influences energy intake and body fatness. DESIGN: Seventy-one healthy men and women (aged 20-80 y), who provided accurate reports of dietary intake and completed a body-composition assessment, were studied. RESULTS: Dietary variety was positively associated with energy intake within each of 10 food groups (r = 0.27-0.56, P < 0.05). In multiple regression analysis with age and sex controlled for, dietary variety of sweets, snacks, condiments, entrées, and carbohydrates (as a group) was positively associated with body fatness (partial r = 0.38, P = 0.001) whereas variety from vegetables was negatively associated (partial r = -0.31, P = 0.01) (R2 = 0.46, P < 0.0001). In separate models, both a variety ratio (variety of vegetables/variety of sweets, snacks, condiments, entrées, and carbohydrates) and percentage dietary fat were significant predictors of body fatness (controlled for age and sex, partial r = -0.39 and 0.31, respectively, P < 0.01). However, dietary fat was no longer significantly associated with body fatness when the variety ratio and dietary fat were included in the same model. CONCLUSIONS: Our data, coupled with those of previous short-term studies, suggest that a high variety of sweets, snacks, condiments, entrées, and carbohydrates coupled with a low variety of vegetables promotes long-term increases in energy intake and body fatness. These findings may help explain the rising prevalence of obesity.

Energy expenditure, physical activity, and body composition of ambulatory adults with hereditary neuromuscular disease.

Persons with neuromuscular disease (NMD) have progressive weakness and wasting of skeletal muscle, reduced fat-free mass, and increased fat mass relative to healthy control subjects. To test the hypothesis that resting energy expenditure (REE), estimated total daily energy expenditure (TEE), and physical activity patterns are altered in ambulatory adults with NMD, 26 adult men and women with slowly progressive NMD and 19 able-bodied control subjects similar in age and weight were evaluated. REE was measured after an overnight fast by indirect calorimetry, TEE by heart rate monitoring, and body composition by air-displacement plethysmography. REE was not significantly different between NMD and control subjects; however, TEE was significantly reduced in NMD subjects compared with control subjects, respectively (women: 7.8 +/- 1.5 compared with 10.5 +/- 2.8; men: 10.2 +/- 3.6 compared with 12.7 +/- 2.6 MJ/d; P < or = 0.01), indicating that NMD subjects expended less energy in physical activity than did control subjects. NMD subjects also tended toward an increased energy cost of physical activity, particularly at higher activity levels (P = 0.06). Multiple regression analysis indicated that for all subjects combined, adiposity was positively associated with age and TEE and negatively associated with time spent in the active heart rate range and fat-free mass (P < or = 0.0001). This relation did not differ between NMD and control subjects, nor did it differ between men and women. We hypothesize that because of their reduced physical activity and increased adiposity, persons with NMD may be at risk for developing secondary conditions such as cardiovascular disease, hypertension, and diabetes.

Does dieting during lactation put infant growth at risk?

For some women, postpartum retention of weight gained during pregnancy may contribute to obesity. A recent 10-week randomized intervention showed that infants of initially overweight, lactating mothers who exercised and dieted to lose an average of 0.5 kg/week grew normally. The findings of this study support the Institute of Medicine guidelines for weight loss in overweight women who are exclusively breast-feeding their child.

Effects of a 6-week hypocaloric diet on changes in body composition, hunger, and subsequent weight regain in healthy young and older adults.

Recent studies have suggested a short-term impairment in the regulation of food intake in older adults, but further studies are needed to determine if a longer-term impairment exists and to identify underlying causes. Changes in body weight and composition were measured over a 6-week underfeeding study and a 6-month follow-up period in healthy young (n = 23) and older (OLD, n = 18) men and women. The young adults were either normal weight (YNW, n = 12) or overweight (YOW, n = 11). Energy intakes during underfeeding were 896 +/- 18 (SEM) kcal less than weight-maintenance energy requirements determined prior to underfeeding. In addition, changes in perceived hunger during underfeeding were monitored in a subgroup (n = 19). OLD and YOW subjects lost significantly more weight during underfeeding than did YNW subjects (p = .025 and .000, respectively), and they did not gain back significant weight in the 6-month follow-up. In addition, OLD subjects reported a significantly lower frequency of hunger during underfeeding (p = .05). There was no significant difference among groups in the relationship between weight lost and fat-free mass lost. Healthy OLD adults have an impaired ability to regulate food intake over at least 6 months following underfeeding compared with YNW adults, and a reduction in their perceived frequency of hunger may be a contributing factor.

Body composition by air-displacement plethysmography by using predicted and measured thoracic gas volumes.

The BOD POD, a new air-displacement plethysmograph for measuring human body composition, utilizes the inverse relationship between pressure and volume (Boyle's law) to measure body volume directly. The quantity of air in the lungs during tidal breathing, the average thoracic gas volume (Vtg), is also measured by the BOD POD by using a standard plethysmographic technique. Alternatively, the BOD POD provides the use of a predicted Vtg (Vtgpred). The validity of using Vtgpred in place of measured Vtg (Vtgmeas) to determine the percentage of body fat (%BF) was evaluated in 50 subjects (36 women, 14 men; ages 18-56 yr). There was no significant difference between Vtgmeas and Vtgpred (mean difference +/- SE, 53.5 +/- 63.3 ml) nor in %BF by using Vtgmeas vs. Vtgpred (0.2 +/- 0.2 %BF). On an individual basis, %BF measured by using Vtgmeas vs. Vtgpred differed within +/-2.0% BF for 82% of the subjects; maximum differences were -2.9 to +3.0% BF. For comparison, data from 24 subjects who had undergone hydrostatic weighing were evaluated for the validity of using predicted vs. measured residual lung volume (VRpred vs. VRmeas, respectively). Differences between VRmeas and VRpred and in %BF calculated by using VRmeas vs. VRpred were significant (187 +/- 46 ml and 1.4 +/- 0.3% BF, respectively; P < 0.001). On an individual basis, %BF determined by using VRmeas vs. VRpred differed within +/-2.0% BF for 46% of the subjects; maximum differences were -2.9 to +3.8% BF. With respect to %BF measured by air displacement, our findings support the use of Vtgpred for group mean comparisons and for purposes such as screening in young to middle-aged individuals. This contrasts with the use of VRpred in hydrostatic weighing, which leads to significant errors in the estimation of %BF. Furthermore, although the use of Vtgpred has some application, determining Vtgmeas is relatively simple in most cases. Therefore, we recommend that the use of Vtgmeas remain as standard experimental and clinical practice.

Meal palatability, substrate oxidation and blood glucose in young and older men.

We investigated the effects of food palatability on the thermic effect of feeding (TEF), substrate oxidation and circulating glucose and insulin. Healthy young men (23.4+/-1.0, SD, years, n=10) and older men (69.4+/-1.3, years, n=9) were resident in a metabolic unit for two 2-day study periods. On the second day of each period, they consumed in random order either a palatable test meal containing 2.93 MJ or a nonpalatable control meal containing the same foods in identical amounts but blended and freeze-dried into biscuit form. TEF and respiratory quotient (RQ) were measured over 6 h and blood samples were taken for measurement of glucose and insulin. Age group had no effect on TEF, RQ or circulating glucose other than to delay the time of peak TEF (P<0.002 for both meals). There was no significant effect of meal type on TEF, but RQ and circulating glucose were higher following consumption of the palatable meal (P<0.001 for both parameters). These results suggest that over 6 h postprandial, consumption of palatable foods does not increase TEF, but is instead associated with increased glycemic response and increased carbohydrate oxidation. These changes, combined with previous work on the glycemic index, predict an accelerated return of hunger and increased energy intake at subsequent meals following consumption of palatable vs. control foods. Further studies are needed to examine the possible mechanism for this previously suggested "second meal" effect of diet palatability on energy intake.

Effects of exercise on plasma lipids and metabolism of lactating women.

To examine the effects of exercise on plasma lipids and metabolism during lactation, sedentary, exclusively breast-feeding women were randomly assigned to an exercise (E) or control (C) group at 6-8 wk postpartum. E subjects performed aerobic exercise 45 min.d-1, 5 d.wk-1, for 12 wk. Resting metabolic rate (RMR), energy expenditure, body composition, and dietary intake were measured at 6-8, 12-14, and 18-20 wk postpartum. Maximum oxygen uptake (VO2max), postprandial insulin, glucose, and thermic response, and plasma lipid levels were measured at 6-8 and 18-20 wk. VO2max increased by 25% vs 5% in the E vs the C group, respectively (P < 0.0001). RMR was similar between groups and did not change over time. Weight and percent body fat declined (P < 0.01) during the study, but there was no difference between E and C groups. Exercise marginally increased high-density lipoprotein cholesterol levels (P < 0.08), but did not affect other lipid concentrations. Insulin response decreased as VO2max increased (P = 0.05). There was no effect of time or group on glucose or thermic response. Exercise improves cardiovascular fitness during lactation, but does not increase the rate of postpartum weight loss.

Evaluation of a new air displacement plethysmograph for measuring human body composition.

A new air displacement plethysmograph, the BOD POD (BP), was evaluated in comparison to hydrostatic weighing (HW). Sixty-eight adult subjects (26 F, 42 M) varying widely in age (range 20-56 yr), ethnicity, and fatness participated in this study. Same-day test-retest reliability was assessed in a subsample of 16 subjects (9 F, 7 M) and validity was assessed in all subjects (N = 68). The test-retest coefficients of variation (CV) for %FAT measured by BP (%FATBP) and HW (%FATHW) were not significantly different (1.7% +/- 1.1% and 2.3% +/- 1.9% for BP and HW, respectively (mean +/- SD)), indicating excellent reliability for both methods. Validity of percent fat measured by the BP (%FATBP) was also excellent. The mean difference in %FAT (BP - HW) was -0.3 +/- 0.2 (SEM), with a 95% confidence interval of -0.6 to 0 %FAT. The regression equation (%FATHW = 1.86 + 0.94 %FATBP; r2 = 0.93, SEE = 1.81) was not significantly different from the line of identity (%FATHW = %FATBP), and did not differ by gender. These findings indicate that the BOD POD is a highly reliable and valid method for determining %FAT in adult humans in comparison to HW. This new method has several advantages over HW in that it is quick, relatively simple to operate and may be able to accommodate special populations such as the obese, elderly, and disabled.

Energy requirements of urban Chinese adults with manual or sedentary occupations, determined using the doubly labeled water method.

OBJECTIVE: To examine total energy expenditure (TEE) in relation to occupation and reported leisure time activities in free-living Chinese adults, and to determine whether measured TEE values differ from current international dietary energy recommendations. SETTING AND SUBJECTS: Seventy three weight-maintaining adults aged 35-49 y, leading unrestricted lives in urban Beijing, with a wide variety of occupations. DESIGN AND METHODS: A cross-sectional study in which TEE was determined by doubly labeled water, body composition by deuterium oxide ((2)H(2)O) dilution, resting energy expenditure (pREE) by prediction equations, and occupational and leisure time activities by questionnaire. RESULTS: For men and women respectively, TEE averaged 12.10+/-0.32 and 9.53+/-0.23 MJ/day (P<0.001), and physical activity level (PAL=TEE/pREE) was 1.77+/-0.04 and 1.66+/-0.02 (P<0.05). Fat-free mass (FFM) was the single best predictor of TEE (adjusted r(2)=0.71, P<0.001). Occupational category (light, moderate and heavy) further predicted TEE, independent of FFM (adjusted multiple r(2)=0.82, P<0.001). Both TEE adjusted for weight and PAL increased with occupational category. Measured TEE was slightly but significantly higher than the 1985 FAO/WHO/UNU estimates for women with light occupations, but did not differ from estimates for men with light occupations, or for adults with moderate or heavy occupations. CONCLUSION: Level of occupational activity, but not duration or type of leisure activity, significantly predicted TEE in free-living urban Chinese adults. Current energy requirement recommendations slightly underestimated the energy needs of women with light occupations but were accurate for men and women with moderate and heavy occupations. SPONSORSHIP: NIH grants DK53404 and F32-DK09747.

The energy expenditure of postmenopausal women classified as restrained or unrestrained eaters.

OBJECTIVE: Restrained eating is a common dietary practice among individuals who are attempting to prevent weight gain, but little is known about differences in energy physiology and regulation between restrained and unrestrained eaters. We investigated this issue in non-obese free-living postmenopausal women classified as long-term restrained (n=26) or unrestrained (n=34) eaters group matched for body mass index (BMI). MEASUREMENTS: Measurements were made of total energy expenditure (TEE), resting energy expenditure (REE), body composition, reported leisure time activity, maximal aerobic capacity (VO2max) and weight change during the study period. In addition, physical activity level (PAL) and nonexercise activity thermogenesis (NEAT) were calculated from measured variables. RESULTS: There were no significant differences between the groups in body composition, weight change, aerobic capacity or total leisure time activity. Relationships between fat-free mass (FFM) and both REE and TEE, and the relationship between work load and energy expenditure in the test of maximal oxygen consumption, were also not different between groups. However, restrained eaters had a significantly lower PAL (equal to TEE/REE, 1.72+/-0.04 vs 1.84+/-0.04, P<0.05). In addition, in multiple regression models predicting NEAT, NEAT was significantly lower in restrained eaters than unrestrained eaters and there was a positive relationship between NEAT and weight change in unrestrained eaters but no relationship in restrained eaters (P<0.05). CONCLUSIONS: In contrast to a previous report, we found no significant difference in TEE between restrained and unrestrained eaters. PAL was slightly lower in restrained eaters, apparently due to reduced NEAT, and restrained eaters also lacked the positive association between NEAT and body weight change seen in unrestrained eaters. This latter finding, if confirmed in future studies, could help explain an increased susceptibility of restrained eaters to weight gain. SPONSORSHIP: NIH grants AG12829, DK46124 and T32AG00209, and US Cooperative Agreement number 58-1950-9-001.

Weight change during lactation does not alter the concentrations of chlorinated organic contaminants in breast milk of women with low exposure.

The purpose of this longitudinal study was to evaluate whether a loss of body fat during lactation between 4 and 20 wk postpartum increases the concentration of environmental contaminants in breast milk. We examined this relationship in two different cohorts of exclusively breastfeeding women: (1) California women with low exposure to contaminants (n = 10 whose weight was stable [mean change, 0.0 +/- 0.2 kg] and n = 11 who lost weight [mean loss, -4.1 +/- 0.4 kg]) and (2) Hispanic women (n = 30) who had recently immigrated to North Carolina, primarily from Mexico, and were presumed to have a higher prior exposure to contaminants. Breast milk samples were analyzed for hexachlorobenzene (HCB) and DDT and its related products. There was no significant relationship between change in body composition and change in milk contaminant concentrations in either California or North Carolina women. Concentrations of HCB were similar between the California and North Carolina women, but those of DDT and related products were higher in the North Carolina subjects. Results suggest that moderate weight loss in lactating women with low exposure to environmental contaminants does not increase contaminant concentration in breast milk.

Nutritional aspects of neuromuscular diseases.

Evidence suggests that individuals with DMD have reduced skeletal development, including decreased linear growth and bone mineral density, compared to normal subjects. Despite their reduced muscle mass, a high percentage of DMD patients are overweight. Body composition measurements can assist with monitoring changes in fat mass and skeletal muscle mass as the disease progresses. Weight management in overweight DMD patients is indicated because excess adiposity burdens mobility and breathing, but only one study in two DMD patients has documented that weight reduction can be done safely. In the latter stages of the disease most DMD subjects become underweight because of an acceleration in skeletal muscle protein degradation relative to its synthesis. Studies of energy, protein and branched chain amino acid supplementation in DMD have yielded promising but inconclusive results, and more well-designed studies are needed in this area. Although there is currently no cure for DMD, studies on the role of nutritional therapy in increasing the quality of life in these patients are urgently needed. Studies in adults with various SP-NMDs indicate a reduction in fat-free mass and an increase in fat mass relative to controls. The newly developed method of air displacement plethysmography for measuring body composition is ideally suited for SP-NMD subjects because it requires very little effort and the measurement procedure is relatively fast. Dual energy x-ray absorptiometry technology has been proposed for distinguishing myogenic from neurogenic SP-NMDs from calculation of the fat-to-lean soft tissue ratio, which is higher in patients with myogenic muscular atrophy. Studies on the energy metabolism of ambulatory SP-NMD subjects indicate that their basal metabolic rate is either similar to or slightly lower than controls, but 24-hour energy expenditure is about 25% lower than controls. This reduction in 24-hour energy expenditure is due to a reduction in physical activity in SP-NMD. Studies examining the roles of energy expenditure, physical activity, and diet in the development of adiposity and risk for secondary chronic diseases in SP-NMD subjects are currently underway.