Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition.

OBJECTIVE: To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD: An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS: A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION: There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.

Feeding the modern sow to sustain high productivity.

Selection for hyper-prolific sows has increased the litter size by more than 50% during the last three decades, and proper nutrition of the female pigs has concomitantly changed due to improved prolificacy and productivity of gilts and sows. This review summarizes the physiological characteristics and nutritional challenges associated with feeding modern hyper-prolific sows during the gilt rearing period and during gestation, transition, and lactation periods. The review presents up-to-date knowledge of the energy and lysine requirements of female pigs and focuses on how nutrition may increase fat gain and limit protein and weight gain in the gilt rearing period and in early and mid-gestation. In late gestation, fetal and mammary growth should be considered and during the transition, colostrum yield and farrowing performance need to be optimized. Finally, milk production should be optimized and body mobilization should be minimized in the lactation period to achieve high feed efficiency in hyper-prolific sows.

Energy cost of physical activities in growing broilers.

1. The time-energy budget method estimates the energy used for physical activity (PA) by integrating behaviour PA patterns with energy cost for specific PAs. Nevertheless, information about individual energy cost by type of PA are not available and so this study estimated the energy cost of PA for growing broilers.2. An indirect calorimetry system for single birds was constructed to measure the variation in the rate of O2 consumption (V˙O2, L/min) and rate of CO2 production (V˙CO2, L/min) produced by these PAs.3. A total of five birds were used in a replicated trial where their body weight (BW) ranged from 1.5 to 2.5 kg to measure the increase in heat production (HP) above resting levels as a result of PA. The procedure in the chamber was divided into five steps: (1) initial baselining, (2) resting metabolic rate, (3) PA such as feeding, drinking and other standing activities, (4) removal of gas exchange produced in step 3, and (5) final baselining. The PA was recorded using a video camera fixed at the chamber's top (and outside).4. The area under V˙CO2 and V˙O2 curves was used to calculate the CO2 production (vCO2, L) and O2 consumption (vO2, L). Then, the HP (cal/kg-0.75) was calculated according to the Brouwer equation. Two observers analysed the video records to estimate the time spent for each PA (seconds and frequency).5. To calculate the energetic coefficients, the HP was regressed with the function of time spent to perform each PA allowing to estimate the energy cost for eating, drinking and stand activities, which were 0.607, 0.352 and 0.938 cal/kg-0.75/s, respectively.

Estimation of energy expenditure using the oral 13 C-bicarbonate technique in privately owned adult and senior dogs of three different body sizes.

Knowledge about energy requirements (ER) of dogs is important in order to provide dogs with an appropriate energy supply. In this study, the oral 13 C-bicarbonate technique (o13 CBT) was used to estimate energy expenditure (EE) in 50 privately owned dogs of different body sizes (small: Danish-Swedish Farmdog (DSF, n = 16), medium: Beagle (n = 15), large: Labrador Retriever (n = 19)), of different ages (adult: 2-7 years (n = 33), senior: ≥8 years (n = 17)). The aim was to evaluate the feasibility of the method in the field and to get more information about ER of dogs. All dogs were measured twice, on two separate days under standardized, resting conditions. The dogs were fasted overnight prior to measurements, which were carried out in home environment. Only measurements of dogs resting calmly were included in the statistical analyses. No significant difference (p > 0.05) in EE was found between days of measurements. The EE measured in Labrador Retrievers (405 kJ (97 kcal)/kg BW0.75 /day) was significantly lower (p < 0.001) than of Beagles (530 kJ (127 kcal)/kg BW0.75 /day) and DSF (497 kJ (119 kcal)/kg BW0.75 /day), the difference between Beagles and DSF being non-significant. Senior dogs had significantly lower (p < 0.001) EE values than adult dogs with least square means (LSM) of 441 kJ (105 kcal)/kg BW0.75 /day and 513 kJ (123 kcal)/kg BW0.75 /day respectively. Analysed within breeds, EE of senior Labrador Retrievers (370 kJ (88 kcal)/kg BW0.75 /day)) was significantly lower (p < 0.01) than adults (439 kJ (105 kcal)/kg BW0.75 /day), as well as in DSF (453 kJ (108 kcal)/kg BW0.75 /day and 541 kJ (129 kcal)/kg BW0.75 /day for senior and adult dogs respectively). However, the EE was not significantly different (p > 0.05) between adult (548 kJ (131 kcal)/kg BW0.75 /day) and senior (499 kJ (119 kcal)/kg BW0.75 /day) Beagles. This study suggests that when measured under standardized resting conditions, the o13 CBT can provide reliable results of EE and be a helpful tool to get more knowledge about ER of dogs of different sizes, breeds and ages.

Selection effect for growth traits on energy requirements in beef Nelore steers.

Growth data of 77,372 Nelore steers were used to estimate the selection effect on energy requirements considering two beef production systems: cow-calf and slaughter cycles. All the animals had measures from 120 days to 7 years old. The parameters necessary to evaluate the selection effect on energy requirements were obtained by random regression analysis using Legendre polynomials. The models included additive direct and maternal effects, and animal and maternal permanent environmental effects as random terms. Contemporary group and dam age at calving (linear and quadratic effect) were included as fixed effects, and orthogonal Legendre polynomials of animal age (cubic regression) were considered random covariables. The coefficients from the model M3353_5 were used to calculate the genetic gains necessary to predict the increase in phenotypes. The selection was simulated for body weight (BW) and weight gain (WG) at different ages and energy requirements were calculated using NRC equations. The cost of feed was calculated for a cow-calf and slaughter cycle of production considering a system of Brachiaria decumbens pasture without supplementation. In slaughter system, the selection for weight of 365 days of age is the best option. In cow-calf systems, the selection W120 is the best choice.

Meeting Paris agreement objectives will temper seabird winter distribution shifts in the North Atlantic Ocean.

We explored the implications of reaching the Paris Agreement Objective of limiting global warming to <2°C for the future winter distribution of the North Atlantic seabird community. We predicted and quantified current and future winter habitats of five North Atlantic Ocean seabird species (Alle alle, Fratercula arctica, Uria aalge, Uria lomvia and Rissa tridactyla) using tracking data for ~1500 individuals through resource selection functions based on mechanistic modeling of seabird energy requirements, and a dynamic bioclimate envelope model of seabird prey. Future winter distributions were predicted to shift with climate change, especially when global warming exceed 2°C under a "no mitigation" scenario, modifying seabird wintering hotspots in the North Atlantic Ocean. Our findings suggest that meeting Paris agreement objectives will limit changes in seabird selected habitat location and size in the North Atlantic Ocean during the 21st century. We thereby provide key information for the design of adaptive marine-protected areas in a changing ocean.

Energy Requirement Is Higher During Weight-Loss Maintenance in Adults Consuming a Low- Compared with High-Carbohydrate Diet.

BACKGROUND: Longer-term feeding studies suggest that a low-carbohydrate diet increases energy expenditure, consistent with the carbohydrate-insulin model of obesity. However, the validity of methodology utilized in these studies, involving doubly labeled water (DLW), has been questioned. OBJECTIVE: The aim of this study was to determine whether dietary energy requirement for weight-loss maintenance is higher on a low- compared with high-carbohydrate diet. METHODS: The study reports secondary outcomes from a feeding study in which the primary outcome was total energy expenditure (TEE). After attaining a mean Run-in weight loss of 10.5%, 164 adults (BMI ≥25 kg/m2; 70.1% women) were randomly assigned to Low-Carbohydrate (percentage of total energy from carbohydrate, fat, protein: 20/60/20), Moderate-Carbohydrate (40/40/20), or High-Carbohydrate (60/20/20) Test diets for 20 wk. Calorie content was adjusted to maintain individual body weight within ± 2 kg of the postweight-loss value. In analyses by intention-to-treat (ITT, completers, n = 148) and per protocol (PP, completers also achieving weight-loss maintenance, n = 110), we compared the estimated energy requirement (EER) from 10 to 20 wk of the Test diets using ANCOVA. RESULTS: Mean EER was higher in the Low- versus High-Carbohydrate group in models of varying covariate structure involving ITT [ranging from 181 (95% CI: 8-353) to 246 (64-427) kcal/d; P ≤0.04] and PP [ranging from 245 (43-446) to 323 (122-525) kcal/d; P ≤0.02]. This difference remained significant in sensitivity analyses accounting for change in adiposity and possible nonadherence. CONCLUSIONS: Energy requirement was higher on a low- versus high-carbohydrate diet during weight-loss maintenance in adults, commensurate with TEE. These data are consistent with the carbohydrate-insulin model and lend qualified support for the validity of the DLW method with diets varying in macronutrient composition. This trial was registered at clinicaltrials.gov as NCT02068885.

Determining energy requirement and evaluating energy expenditure in neurological diseases.

Objectives: It has been reported that in most neurological patients, resting energy expenditure due to hypermetabolism is increased. Physical activity, which is another component of energy expenditure, varies depending on the course of the disease. Different mechanisms are used to explain changes in energy expenditure in this population. Pathological problems of centers that regulate energy balance in the brain, endocrine and metabolic dysfunction, mitochondrial damage, autonomic dysfunction and inflammatory anomalies are thought to be at the root of this situation. In this review study, studies about energy expenditure and energy requirement in neurological diseases have been examined and suggested practices in this field have been presented. Methods: We reviewed articles regarding selected from PubMed, Science Direct, EBSCO, and databases about energy expenditure and neurological diseases. Results: Based on the type of neurological diseases; factors such as stage of the disease, disease complications, metabolic status, mechanical ventilation, body composition, movement restrictions or hyperactivity change energy expenditure and, as a result, nutrition requirement. Determination of the energy requirement is the basic variable for adjusting medical nutrition therapy. Despite an increase in resting energy expenditure as a result of metabolic processes in most neurological disorders, the daily energy expenditure is reported to change based on the restriction of physical activity due to the disorder. Discussion: Determining patient's energy expenditure and energy requirements is regarded as the right approach in terms of improving the patient's quality of life, regulating appropriate medical nutrition treatment and increasing the effectiveness of other treatments.

Estimated basal metabolic rate and maintenance fluid volume in children: A proposal for a new equation.

The basal metabolic rate (BMR) of children aged <2 years is proportional to their body weight (W; kg). However, no simple mathematical model for the estimation of BMR in children aged ≥2 years has been established. Based on Japanese studies on childhood BMR, conducted until the 1960s, we noted that childhood BMR (after infancy) is proportional to body weight to the power of 1/2 (W1/2 ). Moreover, we confirmed that the two previously reported equations for calculating BMR (Schofield's equation and Oxford University's equations) are proportional to W1/2 . Based on these facts, we propose a new equation for the maintenance fluid volume for hospitalized children. Our equation (300 × W1/2  mL/day) gives values almost equal to the maintenance fluid volume calculated by the most commonly used equation of Holliday and Segar in children aged 2-18 years. Our equation will be useful for pediatricians to calculate the maintenance fluid volume for children in daily clinical settings.

Evaluating human basal metabolism: the erroneous and misleading use of so-called "prediction equations".

Prediction (regression) equations are widely used, but their reliability as predictive tools is questionable as they provide contradicting results. The key point is that values calculated by regression equations are not precisely defined numbers but lie within a range of possible values in the standard deviation interval, none of which can be considered as the most probable. Ignoring this point leads to illicit/improper calculations, generating wrong results, which may have adverse consequences for human health. To demonstrate this, we applied the equations of Harris and Benedict in a reverse method, i.e. calculating (predicting) the daily energy expenditure in the same subjects used to obtain the equations and comparing values with the original measured data. We used the Bland-Altman and frequency distribution analyses. We found large differences in both individual data and population characteristics, showing that prediction equations are not predictive tools.

Aeration requirement and energy consumption of reactor-composting of rose pomace influenced by C/N ratio.

As the composting industry develops rapidly in the world, the compost producers have focused on the efficiency of energy utilization in production without restricting the quality of compost in the forced ventilation systems. Therefore, this experimental study quantified the impacts of initial C/N ratio on aeration requirement and energy consumption due to aeration for reactor composting of rose pomace through kinetics of the process using fifteen 100-l composting reactors. The results of the study showed that initial C/N ratio significantly affected decomposition rate, compost maturity, and dry matter losses and organic matter losses (P < 0.05). The maximum decomposition rate (0.072 day-1) and the highest degree of progression of the composting process existed at the mixture with initial C/N ratio of 24.26. The results underlined the importance of the initial C/N of composting of rose pomace in terms of energy consumption due to aeration. In particular, more mature compost within a short time can be obtained when composting was operated with a C/N ratio of 23.7-25.8 in the expense of requiring more airflow rate, fan power, and energy consumption by aeration fan per composting material.

Energy needs in the treatment of uncomplicated severe acute malnutrition: Secondary analysis to optimize delivery of ready-to-use therapeutic foods.

Outpatient therapeutic feeding protocols for the treatment of uncomplicated severe acute malnutrition in children were initially based on weight gain data from inpatient settings and expert knowledge of the physiological requirements during recovery. However, weight gain and energy requirements from historic inpatient settings may differ from modern outpatient settings and therefore may not be appropriate to guide current therapeutic feeding protocols. We calculated the weight gain and average estimated total daily energy requirement of children successfully treated for uncomplicated severe acute malnutrition as outpatients in Niger (n = 790). Mean energy provided by six therapeutic feeding protocols was calculated and compared with average estimated energy requirements in the study population. Overall weight gain was 5.5 g·kg-1 ·day-1 among recovered children. Average energy requirements ranged from 92 to 110 kcal·kg-1 ·day-1 depending on the estimation approach. Two current therapeutic feeding protocols were found to provide an excess of energy after the first week of treatment in our study population, whereas four research protocols tended to provide less energy than the estimated requirement after the first week of treatment. Alternative feeding protocols have the potential to simplify and lead to important savings for programmes but should be evaluated to show adequacy to meet the energy needs of children under treatment, as well as feasibility and cost efficiency. Our findings rely on theoretical calculations based on several assumptions and should be confirmed in field studies.

Modeling net energy requirements of 2 to 3-week-old Cherry Valley ducks.

OBJECTIVE: A total of three hundred unsexed ducks were utilized to estimate net energy requirements of maintenance (NEm) and weight gain (NEg) for 2 to 3-week-old Cherry Valley ducks and to establish a model equation to predict NE requirements using the factorial method. METHODS: To determine the apparent metabolizable energy (AME) of the diet, fifty 7-day-old ducks at approximately equal body weights (BWs) were randomly assigned into five groups that were fed at different levels (ad libitum, 85%, 75%, 65%, and 55% of ad libitum intake), and the endogenous acid-insoluble ash as indigestible marker. The two hundred and fifty 7-day-old ducks were used for a comparative slaughter experiment. At the beginning of the experiment, ten ducks were sacrificed to determine the initial body composition and energy content. The remaining ducks were randomly assigned into five groups (same as metabolic experiment). Ducks of the ad libitum group were slaughtered at 14 and 21-dayold. At the end of the experiment, two ducks were selected from each replicate and slaughtered to determine the body composition and energy content. RESULTS: The results of the metabolizable experiment showed AME values of 13.43 to 13.77 MJ/kg for ducks at different feed intakes. The results of the comparative slaughter experiment showed the NEm value for 2 to 3-week-old Cherry Valley ducks was 549.54 kJ/kg of BW0.75/d, and the NEg value was 10.41 kJ/g. The deposition efficiency values of fat (Kf) and crude protein (Kp) were 0.96 and 0.60, respectively, and the values of efficiency of energy utilization (Kg) and maintenance efficiency (Km) were 0.75 and 0.88, respectively. CONCLUSION: The equation for the prediction of NE requirements for 2 to 3-week-old Cherry Valley ducks was the following: NE = 549.54 BW0.75+10.41 ΔW, where ΔW is the weight gain (g).

Nutrition for Ultramarathon Running: Trail, Track, and Road.

Ultramarathon running events and participation numbers have increased progressively over the past three decades. Besides the exertion of prolonged running with or without a loaded pack, such events are often associated with challenging topography, environmental conditions, acute transient lifestyle discomforts, and/or event-related health complications. These factors create a scenario for greater nutritional needs, while predisposing ultramarathon runners to multiple nutritional intake barriers. The current review aims to explore the physiological and nutritional demands of ultramarathon running and provide general guidance on nutritional requirements for ultramarathon training and competition, including aspects of race nutrition logistics. Research outcomes suggest that daily dietary carbohydrates (up to 12 g·kg-1·day-1) and multiple-transportable carbohydrate intake (∼90 g·hr-1 for running distances ≥3 hr) during exercise support endurance training adaptations and enhance real-time endurance performance. Whether these intake rates are tolerable during ultramarathon competition is questionable from a practical and gastrointestinal perspective. Dietary protocols, such as glycogen manipulation or low-carbohydrate high-fat diets, are currently popular among ultramarathon runners. Despite the latter dietary manipulation showing increased total fat oxidation rates during submaximal exercise, the role in enhancing ultramarathon running performance is currently not supported. Ultramarathon runners may develop varying degrees of both hypohydration and hyperhydration (with accompanying exercise-associated hyponatremia), dependent on event duration, and environmental conditions. To avoid these two extremes, euhydration can generally be maintained through "drinking to thirst." A well practiced and individualized nutrition strategy is required to optimize training and competition performance in ultramarathon running events, whether they are single stage or multistage.

Metabolisable energy intake and growth of privately owned growing dogs in comparison with official recommendations on the growth curve and energy supply.

The correct assumption of metabolisable energy (ME) requirement is essential for the nutrition consultation and diet formulation. In young dogs, too high energy supply can accelerate growth and thus lead to developmental orthopaedic diseases. The aim of the present study was to collect the data on ME intake and body weight (BW) development in privately owned growing dogs in order to compare these data with the current recommendations. Our hypothesis was that the actual ME intake of healthy young dogs would be lower than the actual recommendation. The data of 493 privately owned puppies (median age at first consultation 21 weeks, the median expected mature BW 30 kg) on ME intake, actual and expected mature BW were collected and compared with recommendations of the Society of Nutrition Physiology (GfE, Meyer and Zentek and NRC). In 243 dogs, there was a follow-up. The actual BW did not deviate systematically from the calculated expected BW (R2  = .929). The ME intake significantly decreased with age (p < .05) and significantly increased with expected mature BW (p < .05). There was no significant interaction between these two parameters (p > .05). Sex had no effect on the ME intake (p > .05). The ME intake of young dogs with a history of skeletal problems or of food allergy did not differ systematically from healthy dogs of similar age and expected mature BW. The ME intake was considerably below NRC recommendations, especially in younger puppies (>8-17 weeks: 78%, >17-26 weeks: 83% of NRC recommendation). A predictive linear equation for ME intake was developed: ME intake (MJ) = (1.063 - 0.565 × [actual BW/expected mature BW]) × actual BW0.75 .

Metabolizable energy requirement for maintenance estimated by regression analysis of body weight gain or metabolizable energy intake in growing pigs

Objective: Feed energy required for pigs is first prioritized to meet maintenance costs. Additional energy intake in excess of the energy requirement for maintenance is retained as protein and fat in the body, leading to weight gain. The objective of this study was to estimate the ME requirements for maintenance (MEm) by regressing body weight gain against ME intake (MEI) in growing pigs. Methods: Thirty-six growing pigs (26.3 ± 1.7 kg) were allotted to 1 of 6 treatments with 6 replicates per treatment in a randomized complete block design. Treatments were 6 feeding levels which were calculated as 50, 60, 70, 80, 90 or 100% of the estimated ad libitum MEI (2,400 kJ/kg BW0.60·d). All pigs were individually housed in metabolism crates for 30 d and weighed every 5 d. Moreover, each pig from each treatment was placed in the open-circuit respiration chambers to measure heat production (HP) and energy retained as protein (REp) and fat (REf) every 5 d. Serum biochemical parameters of pigs were analyzed at the end of the experiment. Results: The ADG and HP as well as the REp and REf linearly increased with increasing feed intake (p < 0.010). ß-hydroxybutyrate (BHBA) concentration of serum tended to increase with increasing feed intake (p = 0.080). The regression equations of MEI on ADG were MEI, kJ/kg BW0.60·d = 1.88 × ADG, g/d + 782 (R2=0.86) and MEm was estimated at 782 kJ/kg BW0.60·d. Protein retention of growing pigs would be positive while REf would be negative at this feeding level via regression equations of REp and REf on MEI. Conclusion: The MEm was estimated at 782 kJ/kg BW0.60·d in current experiment. Furthermore, growing pigs will deposit protein and oxidize fat if provided feed at the estimated maintenance level.

Impact of dietary macronutrient profile on feline body weight is not consistent with the protein leverage hypothesis.

The protein leverage hypothesis proposes that the need to prioritise protein intake drives excess energy intake (EI) when the dietary ratio of protein to fat and carbohydrate is reduced. We hypothesised that cats may become prone to overconsuming energy content when moderate protein diets were offered, and considered the potential influence of fat and carbohydrate on intake. To determine the effect of dietary protein and macronutrient profile (MNP) on EI, weight and body composition, cats (1-4 years) were offered food in excess of energy requirements (ER). A total of six diets were formulated, containing moderate (approximately 7 % w/w; approximately 22 % metabolisable energy (ME)) or high (approximately 10 % w/w; approximately 46 % ME) protein and varying levels of carbohydrate and fat. For 4 weeks, 120 cats were offered 100 % of their individual ER of a diet at the MNP selected by adult cats (50:40:10 protein energy ratio:fat energy ratio:carbohydrate energy ratio). EI, body weight (BW), body composition, activity and palatability were measured. Subsequently, cats were offered one of the six diets at 200 % of their individual ER for 4 weeks when measurements were repeated. Cats offered excess high protein diets had higher EI (kJ/kg) throughout, but at 4 weeks BW was not significantly different to baseline. Cats offered excess moderate protein diets reduced EI and gradually lost weight (average loss of 0·358 (99 % CI 0·388, 0·328) kg), irrespective of fat:carbohydrate and initial palatability. The data do not support the protein leverage hypothesis. Furthermore, cats were able to adapt intake of a wet diet with high protein in an overfeeding environment within 28 d.

Total energy expenditure in adults aged 65 years and over measured using doubly-labelled water: international data availability and opportunities for data sharing.

BACKGROUND: Increasing population lifespan necessitates a greater understanding of nutritional needs in older adults (65 year and over). A synthesis of total energy expenditure in the older population has not been undertaken and is needed to inform nutritional requirements. We aimed to establish the extent of the international evidence for total energy expenditure (TEE) using doubly-labelled water (DLW) in older adults (65 years and over), report challenges in obtaining primary data, and make recommendations for future data sharing. METHODS: Four databases were searched to identify eligible studies; original research of any study design where participant level TEE was measured using DLW in participants aged ≥65 years. Once studies were identified for inclusion, authors were contacted where data were not publicly available. RESULTS: Screening was undertaken of 1223 records; the review of 317 full text papers excluded 170 records. Corresponding or first authors of 147 eligible studies were contacted electronically. Participant level data were publicly available or provided by authors for 45 publications (890 participants aged ≥65 years, with 248 aged ≥80 years). Sixty-seven percent of the DLW data in this population were unavailable due to authors unable to be contacted or declining to participate, or data being irretrievable. CONCLUSIONS: The lack of data access limits the value of the original research and its contribution to nutrition science. Openly accessible DLW data available through publications or a new international data repository would facilitate greater integration of current research with previous findings and ensure evidence is available to support the needs of the ageing population. TRIAL REGISTRATION: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42016047549 .

Vitamin D Status and Resting Metabolic Rate May Modify through Expression of Vitamin D Receptor and Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1 Alpha Gene in Overweight and Obese Adults.

BACKGROUND: Resting metabolic rate (RMR) used to prognosticate and measure the amount of energy required. Vitamin D is known as a new predictor of RMR. The aim of this study is to investigate the relationship between vitamin D effects on RMR in connection with the vitamin D receptor (VDR) and peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) gene expression. METHODS: We enrolled 298 overweight and obese adults in this cross-sectional study. Body mass index (BMI), fat mass, fat-free mass, insulin level, visceral fat, and vitamin D status were assessed. RMR was measured by means of indirect calorimetry. The real-time polymerase chain reaction using specific primer pairs for VDR and PGC-1α was performed. RESULTS: There were significant differences in terms of fat free mass, fat percentage, insulin levels, RMR/kg body weight, and RMR/BMI, VDR, and PGC-1α among participants were categorized based on the vitamin D status. But after using general linear model for adjusting, all significant results missed their effectiveness except RMR/kg body weight and VDR. Linear regression analysis used to show the mediatory role of VDR and PGC-1α on the RMR/kg body weight and vitamin D status relationship. Our results showed that VDR had a mediatory effect on the relationship between RMR/kg body weight and vitamin D status (ß = 0.38, 95% CI -0.48 to 1.60; ß = -1.24, 95% CI -5.36 to 1.70). However, PGC-1α did not affect the relationship between RMR/kg body weight and vitamin D status (ß = 0.50, 95% CI = -0.02 to 3.42; ß = 0.59, 95% CI 0.14-3.90). CONCLUSION: Our study showed the mediatory effect of VDR gene expression in the association of 25(OH)2D plasma levels and resting metabolic rate among obese individuals.

Validity of a triaxial accelerometer and simplified physical activity record in older adults aged 64-96 years: a doubly labeled water study.

BACKGROUND: The aim was to examine the validity of a triaxial accelerometer (ACCTRI) and a simplified physical activity record (sPAR) in estimating total energy expenditure (TEE) and physical activity level (PAL) in older adults with the doubly labeled water (DLW) method. METHODS: A total of 44 Japanese elderly individuals (64-96 years), of which 28 were community-dwelling healthy adults with or without sporting habits (S or NS group) and 16 were care home residents with frailty (F group), were included in the study. Basal metabolic rate (BMR) was measured by indirect calorimetry, TEE was obtained by the DLW method, and PAL was calculated as TEE/BMR. Daily step count was monitored by a pedometer (Lifecorder). The 24-h average metabolic equivalent was assessed by ACCTRI and sPAR. RESULTS: The TEEDLW in men was 2704 ± 353, 2308 ± 442, and 1795 ± 338 kcal d-1, and that in women was 2260 ± 208, 1922 ± 285, and 1421 ± 274 kcal d-1 for the S, NS, and F groups, respectively. ACCTRI and sPAR systematically underestimated actual TEE (- 14.2 ± 11.6 and - 15.3 ± 12.3% for ACCTRI and sPAR, respectively). After diet-induced thermogenesis was taken into account for ACCTRI and sPAR, TEEDLW was significantly correlated with TEEACCTRI (R2 = 0.714) and TEEsPAR (R2 = 0.668). PALDLW was also significantly correlated with PALACCTRI (R2 = 0.438) and PALsPAR (R2 = 0.402). CONCLUSIONS: Age, living conditions, frailty, and sporting habits contribute to TEE and PAL in the elderly population. ACCTRI and sPAR underestimated TEE and PAL, and adequate corrections are required. The corrected ACCTRI and sPAR are both useful tools to estimate TEE and PAL.