Greater male variability in daily energy expenditure develops through puberty.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth.

Background: Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot. Methods: Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach. Results: All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences. Discussion: A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.

Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol.

Background: The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS. Methods: This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS. Discussion: The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.

The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study.

BACKGROUND: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. OBJECTIVE: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. METHODS: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. RESULTS: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (-58.8 min; P=.04) but not for the intervention group (-5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. CONCLUSIONS: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. TRIAL REGISTRATION: ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.

Total energy expenditure and body composition of children with developmental disabilities.

BACKGROUND: Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities. OBJECTIVE: Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome. METHODS/MEASURES: This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida were non-ambulatory. Doubly labeled water was used to measure energy expenditure and body composition. Descriptive statistics described the sample and MANOVA and ANOVA methods were used to evaluate differences between groups. RESULTS: Energy expenditure was significantly less for children with spina bifida who primarily used a wheelchair (p = .001) and children with Down syndrome (p = .041) when compared to children without a disability when adjusted for fat-free mass. However, no significant difference was detected in children with spina bifida who ambulated without assistance (p = .072). CONCLUSIONS: Children with spina bifida and Down syndrome have a significantly decreased energy expenditure which directly impacts recommended caloric intake. No significant difference was detected for children with spina bifida who ambulated, although the small sample size of this pilot study may have limited these findings. Validating these results in a larger study is integral to supporting successful weight management of these children.

Impact of a Smarter Lunchroom intervention on food selection and consumption among adolescents and young adults with intellectual and developmental disabilities in a residential school setting.

OBJECTIVE: To assess whether a Smarter Lunchroom intervention based on behavioural economics and adapted for students with intellectual and developmental disabilities would increase the selection and consumption of fruits, vegetables and whole grains, and reduce the selection and consumption of refined grains. DESIGN: The 3-month intervention took place at a residential school between March and June 2012. The evaluation employed a quasi-experimental, pre-post design comparing five matched days of dietary data. Selection and plate waste of foods at lunch were assessed using digital photography. Consumption was estimated from plate waste. SETTING: Massachusetts, USA. SUBJECTS: Students (n 43) aged 11-22 years with intellectual and developmental disabilities attending a residential school. RESULTS: Daily selection of whole grains increased by a mean of 0·44 servings (baseline 1·62 servings, P = 0·005) and refined grains decreased by a mean of 0·33 servings (baseline 0·82 servings, P = 0·005). The daily consumption of fruits increased by a mean of 0·18 servings (baseline 0·39 servings, P = 0·008), whole grains increased by 0·38 servings (baseline 1·44 servings, P = 0·008) and refined grains decreased by a mean of 0·31 servings (baseline 0·68 servings, P = 0·004). Total kilojoules and total gram weight of food selected and consumed were unchanged. Fruit (P = 0·04) and vegetable (P = 0·03) plate waste decreased. CONCLUSIONS: A Smarter Lunchroom intervention significantly increased whole grain selection and consumption, reduced refined grain selection and consumption, increased fruit consumption, and reduced fruit and vegetable plate waste. Nudge approaches may be effective for improving the food selection and consumption habits of adolescents and young adults with intellectual and developmental disabilities.

Meals in Our Household: reliability and initial validation of a questionnaire to assess child mealtime behaviors and family mealtime environments.

Mealtimes in families with young children are increasingly of interest to nutrition and public health researchers, yet assessment tools are limited. Meals in Our Household is a new parent-report questionnaire that measures six domains: 1) structure of family meals, 2) problematic child mealtime behaviors, 3) use of food as reward, 4) parental concern about child diet, 5) spousal stress related to child's mealtime behavior, and 6) influence of child's food preferences on what other family members eat. Reliability and initial face, construct, and discriminant validity of the questionnaire were evaluated between January 2007 and December 2009 in two cross-sectional studies comprising a total of 305 parents of 3- to 11-year-old children (including 53 children with autism spectrum disorders). Internal consistencies (Cronbach's α) for the six domains averaged .77 across both studies. Test-retest reliability, assessed among a subsample of 44 parents who repeated the questionnaire after between 10 and 30 days, was excellent (Spearman correlations for the domain scores between two administrations ranged from 0.80 to 0.95). Initial construct validity of the instrument was supported by observation of hypothesized inter-relationships between domain scores that were of the same direction and similar magnitude in both studies. Consistent with discriminant validity, children with autism spectrum disorders had statistically significantly (P<0.05) higher domain scores for problematic child mealtime behaviors, use of food as reward, parental concern about child diet, and spousal stress, as compared to typically developing children. Meals in Our Household may be a useful tool for researchers studying family mealtime environments and children's mealtime behaviors.

Longitudinal changes in energy expenditure in girls from late childhood through midadolescence.

BACKGROUND: Longitudinal data on energy expenditure in children and adolescents are scarce. OBJECTIVE: The purpose of this study was to examine changes in energy expenditure and physical activity in girls from late childhood through midadolescence. DESIGN: We measured total energy expenditure (TEE) by doubly labeled water, resting metabolic rate (RMR) by indirect calorimetry, body composition by 18O dilution, and time spent in activity by an activity diary in 28 initially nonobese girls at approximately 10, approximately 12, and approximately 15 y of age. Changes with age in TEE, RMR, and activity energy expenditure (AEE), both in absolute terms and in adjusted analyses, and in physical activity level (PAL) and time spent sleeping, being sedentary, and in moderate and vigorous activity were evaluated by mixed-model repeated-measures analyses. RESULTS: Absolute TEE and AEE increased significantly from age 10 to age 15 y (P < 0.0001 for both). Absolute RMR at ages 12 and 15 y did not differ significantly, despite significant increases in fat-free mass and fat mass between the visits. PAL was significantly higher (P < 0.0001) at age 15 y than at age 10 or 12 y, whereas time spent being sedentary increased significantly from age 10 to age 15 y (P < 0.001), and AEE adjusted for fat-free mass appeared to decrease over the same interval. CONCLUSION: Conclusions drawn regarding changes with age in physical activity depend on the measure of physical activity assessed.

Relation of body mass index and body fatness to energy expenditure: longitudinal changes from preadolescence through adolescence.

BACKGROUND: Although it is widely accepted that weight gain results when energy intake exceeds energy expenditure (EE), how reduced EE contributes to the development of obesity remains unclear. OBJECTIVE: We tested the hypothesis that reduced EE in the premenarcheal period in girls constitutes a risk factor for an increase in relative weight [body mass index (BMI) z score] and percentage of body fat (%BF) during adolescence. DESIGN: We measured EE at study entry in 196 premenarcheal nonobese girls. Resting metabolic rate (RMR) was measured by indirect calorimetry. Total energy expenditure (TEE) was measured by the doubly labeled water method. Activity energy expenditure (AEE) was calculated from RMR and TEE. After the baseline study, girls were followed annually until 4 y after menarche (x+/- SD: 7.1 +/- 2.6 y). At each visit, height, weight, and %BF by bioelectrical impedance were measured. Girls also completed annual food-frequency and activity questionnaires. Linear mixed effects modeling was used to evaluate the longitudinal relation between BMI z score and %BF and measures of baseline EE. RESULTS: We found no significant relation in change in %BF with RMR, AEE, or TEE. We observed a small positive relation between BMI z score and AEE and TEE (P < 0.05) but no significant relation with RMR. When we stratified by parental overweight, the findings were unchanged for RMR. TEE and AEE were positively related to BMI z score in girls of overweight parents. CONCLUSIONS: Our findings suggest that EE in the premenarcheal period is not a risk factor for increases in %BF or BMI z score in girls during adolescence.

Relation of body composition, parental overweight, pubertal stage, and race-ethnicity to energy expenditure among premenarcheal girls.

BACKGROUND: Previous studies assessed the influence of parental weight status, sexual maturation, race-ethnicity, and energy expenditure among children, but few examined these issues comprehensively. OBJECTIVE: The objective was to determine whether differences in energy expenditure among premenarcheal girls are related to the pubertal stage and the race-ethnicity of the girls or to the weight status of their parents. DESIGN: We measured the body composition and the energy expenditure of 196 nonobese girls enrolled in a longitudinal study. Total body water was measured by the isotopic dilution of (18)O water. We measured resting metabolic rate with the use of indirect calorimetry and daily energy expenditure by the doubly labeled water method. We used established criteria to determine sexual maturation. Parental weight status was based on body mass index. RESULTS: Resting metabolic rate was higher among girls with >or=1 overweight parent than among girls with 2 normal-weight parents. Total energy expenditure was also higher among girls with >or=1 overweight parent, but these results were of borderline significance. We found no effect of pubertal stage on resting metabolic rate. Nonresting energy expenditure was significantly lower among pubertal girls than among prepubertal girls. After adjustments for age and body composition, we noted that resting metabolic rate, nonresting energy expenditure, and total energy expenditure were all significantly lower among black girls than among white girls. CONCLUSIONS: Differences in resting metabolic rate and total energy expenditure among premenarcheal girls were associated with parental weight status and the girls' race-ethnicity, whereas differences in nonresting energy expenditure were associated with pubertal stage and race-ethnicity. Whether the observed differences in energy expenditure persist after puberty and predict weight gain during puberty awaits the results of longitudinal analyses.