Accuracy of two Generic Prediction Equations and One Population-Specific Equation for Resting Energy Expenditure in Individuals with Spinal Cord Injury.

PURPOSE: The primary aim was to assess the accuracy of common prediction equations, the Harris-Benedict (HB) and the Mifflin St. Jeor (MSJ) equations, for estimating resting energy expenditure (REE) among people with spinal cord injury (SCI) against actual REE measurements. The secondary aim was to cross-validate the Buchholz et al. energy prediction equation created for people with SCI. METHODS: A metabolic cart with canopy was used to measure the actual REE. The HB, MSJ, and the Buchholz et al. equations were used for the prediction of REE. RESULTS: Thirty-nine participants (31 males and 8 females) were enrolled in this cross-sectional study. The REEs significantly differed from one another, F(1.52, 57.68) = 52.04, P < 0.001, where both the HB (M = 1703.06, SD = 265.1) and the MSJ (M = 1628.92, SD = 233.8) energy predictions were significantly higher (P < 0.001) than the measured REE (M = 1394.05, SD = 298.7). In contrast, the Buchholz et al. equation did not differ from the measured REE. CONCLUSIONS: Our data show that the HB and MSJ equations do not accurately predict the energy needs of this community. Using a SCI-specific equation would improve estimates of REE, such as the Buchholz et al. equation. More research into energy equations for this population may help health care professionals better tailor dietary requirements for weight management.

In vivo precision of the GE lunar iDXA for the assessment of lumbar spine, total hip, femoral neck, and total body bone mineral density in severely obese patients.

No study has evaluated the precision of the GE Lunar iDXATM (GE Healthcare) in measuring bone mineral density (BMD) among severely obese patients. The purpose of the study was to evaluate the precision of the GE Lunar iDXATM for assessing BMD, including the lumbar spine L1-L4, L2-L4, the total hip, femoral neck, and total body in a severely obese population (body mass index [BMI]>40 kg/m(2)). Sixty-four severely obese participants with a mean age of 46 ± 11 yr, BMI of 49 ± 6 kg/m(2), and a mean body mass of 136.8 ± 20.4 kg took part in this investigation. Two consecutive iDXA scans (with repositioning) of the total body (total body BMD [TBBMD]), lumbar spine (L1-L4 and L2-L4), total hip (total hip BMD [THBMD]), and femoral neck (femoral neck BMD [FNBMD]) were conducted for each participant. The coefficient of variation (CV), the root mean square (RMS) averages of standard deviations of repeated measurements, the corresponding 95% least significant change, and intraclass correlations (ICCs) were calculated. In addition, analysis of bias and coefficients of repeatability were calculated. The results showed a high level of precision for total body (TBBMD), lumbar spine (L1-L4), and total hip (THBMD) with values of RMS: 0.013, 0.014, and 0.011 g/cm(2); CV: 0.97%, 1.05%, and 0.99%, respectively. Precision error for the femoral neck was 2.34% (RMS: 0.025 g/cm(2)) but still represented high reproducibility. ICCs in all dual-energy X-ray absorptiometry measurements were 0.99 with FNBMD having the lowest at 0.98. Coefficients of repeatability for THBMD, FNBMD, L1-L4, L2-L4, and TBBMD were 0.0312, 0.0688, 0.0383, 0.0493, and 0.0312 g/cm(2), respectively. The Lunar iDXA demonstrated excellent precision for BMD measurements and is the first study to assess reproducibility of the GE Lunar iDXA with severely obese adults.

In vivo precision of the GE iDXA for the assessment of total body composition and fat distribution in severely obese patients.

OBJECTIVE: To evaluate the precision of the iDXA for total body composition and fat distribution measurements in severely obese patients. DESIGN AND METHODS: Sixty-five severely obese participants with a mean age of 46 ± 11 years, BMI of 49 ± 6 kg/m(2) , and a mean body mass of 137.3 ± 20.9 kg took part in this investigation. Two consecutive iDXA scans with repositioning of the total body were conducted for each participant. The coefficient of variation (CV), the root-mean-square (RMS) averages of standard deviations of repeated measurements, the corresponding 95% least significant change, and Intraclass Correlations (ICC) were calculated. RESULTS: Precision expressed as % CV, for total body bone mineral content, fat free mass, total body fat, total body lean, and % total body fat were 1.08%, 0.94%, 0.90%, 1.00%, 0.79%, respectively. Precision was 1.44% for gynoid fat distribution and 1.64% for android fat (AF) distribution. The ICCs in all DXA measurements were 0.99 with % AF having the lowest at 0.96. CONCLUSIONS: The GE Lunar iDXA™ demonstrated excellent precision for total body composition assessments and is the first study to assess reproducibility in severely obese individuals.

Differences in demographic, behavioral, and biological variables between those with valid and invalid accelerometry data: implications for generalizability.

BACKGROUND: The exclusion of participants with invalid accelerometry data (IAD) may lead to biased results and/or lack of generalizability in large population studies. The purpose of this study was to investigate whether demographic, behavioral, and biological differences occur between those with IAD and valid accelerometry data (VAD) among adults using a representative sample of the civilian noninstitutionalized U.S. population. METHODS: Ambulatory participants from NHANES (2003-2004) who were 20-85 years of age were included in the current study and wore an ActiGraph 7164 accelerometer for 7 days. A "valid person" was defined as those with 4 or more days of at least 10+ hrs of monitoring per day. Among adults (20-85 yrs), 3088 participants provided VAD and 987 provided IAD. Demographic, behavioral, and biological information were obtained from the household interview or from data obtained in a mobile examination center. RESULTS: Differences were observed in age, BMI, ethnicity, education, smoking status, marital status, use of street drugs, current health status, HDL-cholesterol, C-reactive protein, self-reported vigorous physical activity, and plasma glucose levels between those with VAD and IAD. CONCLUSIONS: Investigators should take into consideration the potential cut-off bias in interpreting results based on data that excludes IAD participants.

Effects of a culturally sensitive sign on the use of stairs in African American commuters.

OBJECTIVES: To examine the effectiveness of a culturally sensitive sign to encourage stair use among African American commuters. METHODS: 16,035 commuters were observed in their using either stairs or an adjacent escalator in a subway station. After baseline observation, a culturally sensitive sign to promote stair use was displayed beside the escalator/stairs. Demographic information and use of escalators/stairs were recorded. RESULTS: Stair use increased from 15.8% to 21.5% with the sign. Caucasian commuters used the stairs 23.1% of the time at baseline, and increased to 28.3% with the sign. Among African Americans, stair use increased from 10.3% to 16.4% with the sign. African American women showed the greatest increases in stair use. Stair use remained elevated the week after the sign was removed in all commuters. Among African Americans, stair use returned to baseline within three weeks. Stair use increased significantly among both overweight and non-overweight Caucasians and African Americans. CONCLUSION: Culturally sensitive interventions can promote physical activity among African Americans in an urban setting.

Arg64 beta3-adrenoceptor variant and the components of energy expenditure.

OBJECTIVE: To determine Trp64Arg beta(3)-adrenoceptor genotype-specific differences in the components of energy expenditure. HYPOTHESIS: We hypothesized that resting metabolic rate (RMR) and physical activity levels would be lower and that thermic effect of feeding (TEF) would be higher in those with the Arg64 allele. RESEARCH METHODS AND PROCEDURES: RMR and TEF were measured by indirect calorimetry, physical activity by questionnaire, and total energy expenditure by the doubly labeled water method. Genotype-specific measures were compared using ANOVA and analysis of covariance (ANCOVA). RESULTS: RMR in Arg64 homozygotes was significantly lower than in Trp64 homozygotes [Arg64, 1373 +/- 259 kcal/d (n = 15) vs. Trp64Arg, 1538 +/- 238 kcal/d (n = 25) vs. Trp64, 1607 +/- 290 kcal/d (n = 22); p < 0.01]. TEF was significantly higher in Arg64 homozygotes compared with Trp64 homozygotes (Arg64, 359 +/- 28 kcal/d; Trp64Arg, 322 +/- 22 kcal/d; and Trp64, 279 +/- 23 kcal/d; p < 0.05). No differences were identified between genotypes in physical activity or in total energy expenditure. DISCUSSION: Our results suggest that the Arg64 beta(3)-adrenoceptor allele contributes significantly to the genetic variability in both RMR and TEF.

The relationship of race/ethnicity and social class to hormone replacement therapy: results from the Third National Health and Nutrition Examination Survey 1988-1994.

OBJECTIVE: To use a nationally representative sample to examine the prevalence of hormone replacement therapy (HRT) use and its relationship to different markers of social class in American women 60 years of age and older. DESIGN: Nationally representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 3,479 women aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans, non-Hispanic blacks and much older women were oversampled to produce reliable estimates for these groups. RESULTS: Overall, the number of women who reported ever having used HRT was 37% [confidence interval (CI), 33%-40%] of all women older than 60 years of age; 40% (CI, 37%-41%) of older, non-Hispanic white women; 20% (CI, 14%-25%) of non-Hispanic black women; and 24% (CI, 20%-29%) of Mexican American women. HRT was used by 43% (CI, 38%-47%) of women 60 to 70 years old, 37% (CI, 32%-41%) of those 71 to 80 years old, and 20% (CI, 13%-26%) of women older than 80. HRT use was lowest among women who did not complete high school or among those in the lowest family income categories. Among women more than 60 years old who reported having a hysterectomy, 51% (CI, 47%-55%) reported using HRT, whereas only 20% (CI, 17%-23%) of those who had a natural menopause reported using HRT. CONCLUSIONS: Although many women can benefit from HRT, the number of American women who report they have ever used it remains low. More research is needed to examine the implications of racial differences in compliance, patient and physician attitudes toward HRT, and possible environmental barriers that may prevent use.

Impact of physician telephone management of nursing home residents before the initial assessment: a pilot study.

OBJECTIVE: To describe physician telephone management of newly admitted nursing home residents before direct evaluation by the physician, and the effect on resident outcomes. DESIGN: Retrospective chart review of 111 consecutive discharge records from two proprietary community nursing homes in Baltimore, Maryland in 1999. MEASUREMENTS: Data regarding the admission process were collected, with an emphasis on physician telephone orders at admission and all subsequent telephone orders before the first physician visit. Physicians were categorized as attending physicians or on-call physicians. Unexpected outcomes defined as an unplanned admission to an acute hospital or an unanticipated death within 14 days of admission to the nursing home were identified. The relationships among resident, physician, and admission characteristics and unexpected outcomes were analyzed. RESULTS: Most residents (97 of 111 (87%)) were admitted from an acute hospital, and the remaining 13% were admitted from home or another nursing home. An attending physician confirmed admission orders for 87 of 111 (78%) residents, and an on-call physician confirmed admission orders for the remainder. Physicians changed medications at the time of admission, as compared with preadmission medications, in 58 of 111 (52%) residents and ordered laboratory studies or radiographs in 59 of 111 (53%). On-call physicians were just as likely to make both types of changes as attending physicians. In the time interval after the initial telephone contact but before the first physician visit, medication changes were made in 35 of 111 (32%) residents and testing was ordered in 16 of 111 (14%). Nineteen of 111 (17%) residents were either readmitted to the hospital or died within 14 days of admission to the nursing home. These unexpected outcomes were statistically less likely to occur in the group of residents for whom physicians made medication changes at the time of admission as compared to the group for whom no medication changes were made [6 of 58 (10%) versus 13 of 53 (25%), P = 0.04, respectively], and in the group for whom tests were ordered at the time of admission as compared to not ordered [4 of 59 (7%) versus 15 of 51 (29%), P = 0.002, respectively]. There were no differences in the likelihood of unexpected outcomes when physicians made medication changes or ordered tests after the time of admission but before the first physician visit. CONCLUSIONS: In this study, physicians made adjustments in medications and ordered tests for newly admitted nursing home patients before seeing the resident in the majority of cases. Unexpected outcomes including readmission to the hospital or death within 14 days of admission were less common among those residents when such changes were made at the time of admission. Further studies are needed to identify those changes as well as those resident and physician characteristics that might lead to improved outcomes.