A remotely-delivered pilot and feasibility program to promote physical and food literacy in adolescents with intellectual disabilities.

BACKGROUND: Youth with intellectual disabilities experience disparities in physical activity and diet quality. Physical and food literacy are hypothesised to support adoption of healthy lifestyles; however, few such interventions have been developed for this population. METHOD: Participants with intellectual disabilities ages 12-16 years were recruited for a 12-week online sports skills and nutrition education intervention. Feasibility, acceptability, and preliminary efficacy were assessed by attendance, satisfaction, and pre-post measures of motor skills, perceived competence and motivation for physical activity, classifying foods, making healthy choices, and food consumption. RESULTS: Six teens participated in the program and attended 87.5% of the sessions. Satisfaction data suggested that the program was well-received by both teens and parents. Trends toward improvements on physical activity and nutrition outcome measures were observed. CONCLUSIONS: Preliminary data from this pilot study suggest that physical and food literacy in youth with intellectual disabilities can be improved, which in turn may contribute to the adoption of healthy lifestyles.

A venetoclax and azacitidine bridge-to-transplant strategy for NPM1-mutated acute myeloid leukaemia in molecular failure.

NPM1-mutated acute myeloid leukaemia (NPM1mut AML) represents a mostly favourable/intermediate risk disease that benefits from allogeneic haematopoietic stem cell transplantation (HSCT) in case of measurable residual disease (MRD) relapse or persistence after induction chemotherapy. Although the negative prognostic role of pre-HSCT MRD is established, no recommendations are available for the management of peri-transplant molecular failure (MF). Based on the efficacy data of venetoclax (VEN)-based treatment in NPM1mut AML older patients, we retrospectively analysed the off-label combination of VEN plus azacitidine (AZA) as bridge-to-transplant strategy in 11 NPM1mut MRD-positive fit AML patients. Patients were in MRD-positive complete remission (CRMRDpos ) at the time of treatment: nine in molecular relapse and two in molecular persistence. After a median number of two cycles (range 1-4) of VEN-AZA, 9/11 (81.8%) achieved CRMRD -negative (CRMRDneg ). All 11 patients proceeded to HSCT. With a median follow-up from treatment start of 26 months, and a median post-HSCT follow-up of 19 months, 10/11 patients are alive (1 died from non-relapse mortality), and 9/10 patients are in MRDneg status. This patient series highlights the efficacy and safety of VEN-AZA to prevent overt relapse, achieve deep responses and preserve patient fitness before HSCT, in patients with NPM1mut AML in MF.

Nutrient adequacy, dietary patterns and diet quality among children with and without intellectual disabilities.

BACKGROUND: Children with intellectual disabilities (ID) frequently have feeding problems, but there has been limited research on nutrient intake, dietary patterns and diet quality in this population. METHOD: Nutrient intakes, dietary patterns and the Healthy Eating Index were compared between 48 children with ID and 55 typically developing (TD) children aged 3-8 years who participated in the Children's Mealtime Study. Three-day food records that included two weekdays and one weekend day were used to assess dietary intake. Food intake was entered into the Nutrition Data System for Research for analysis of nutrient intake, dietary patterns and diet quality. Height and weight were measured to determine body mass index (BMI). The relation of dietary patterns to weight status was also assessed. RESULTS: Typically developing children and children with ID met the Estimated Average Requirement/Adequate Intake (EAR/AI) for most nutrients. However, a substantial number of children in both groups did not meet the EAR for vitamins E and D and calcium and the AI for vitamin K. Only one TD child met the AI for potassium. A small percentage of children in both groups did not meet the EAR for vitamin A and vitamin C, and in the ID group, a small percentage did not meet the EAR for vitamin B12 . Children in the ID group consumed, on average, fewer servings of vegetables than TD children (0.5 vs. 1.2, P < 0.001), but there was no significant difference in servings of fruit (0.8 vs. 1.1, respectively), fruit juice (less than a half serving in both groups), sugar-sweetened beverages (less than a half serving in both groups) or snacks (1.1 vs. 1.4, respectively) after adjusting for BMI z-score, parental education and race. We found a significant correlation between snack intake and BMI z-score among children with ID but not among TD children (r = 0.48, P < 0.0001 vs. r = 0.19, P = 0.16, respectively). The Healthy Eating Index indicated, on average, poor overall diet quality in both groups (58.2 in the ID group and 59.1 in the TD group). CONCLUSIONS: This study suggests that the diets of children with ID, as in TD children, need improvement. Targeting healthy eating in children with ID would improve diet quality and overall health.

Is body mass index a useful measure of excess body fatness in adolescents and young adults with Down syndrome?

BACKGROUND: To determine the validity of body mass index (BMI) to identify excess fatness in youth with Down syndrome (DS). METHODS: Using the Centers for Disease Control and Prevention (CDC) growth reference, we defined overweight (≥ 85th percentile) and obesity (≥ 95th percentile) based on participants' age- and sex-specific BMI z-scores, calculated from measured height and weight. Percentage body fat was measured by dual-energy X-ray absorptiometry. We determined sensitivity, specificity, positive predictive value, negative predictive value and efficiency of BMI percentiles to identify excess adiposity relative to elevated percentage body fat cut-offs developed from the Pediatric Rosetta Body Composition project in 32 youth (20 boys/12 girls), ages 13-21 years with Down syndrome. RESULTS: For adolescents with Down syndrome using the cut-off points of 95th percentile for BMI (obesity), sensitivity and specificity were 71% and 96% respectively. Positive predictive value was 83% and negative predictive value was 92%. Overall efficiency was 91%. Sensitivity and specificity for BMI cut-offs above the 85th percentile (overweight) were 100% and 60% respectively. The positive predictive value was 41% and negative predictive value was 100%. Overall efficiency was 69%. CONCLUSION: On the whole, the obesity (≥ 95th percentile) cut-off performs better than the overweight cut-off (85th-94th percentile) in identifying elevated fatness in youth with DS.

Occupational exposure to blood and body fluids in a department of oral sciences: results of a thirteen-year surveillance study.

OBJECTIVES: Aim of this analysis was to identify trends that will aid in the prevention of injury. METHODS: Our data were collected from 1999 to 2011 during a surveillance program of occupational exposures to blood or other potentially infectious materials in a Dental School by using a standard coded protocol. RESULTS: 63 exposures were reported. 56/63 (89%) percutaneous and 7/63 (11%) mucosal, involving a splash to the eye of the dental care workers (DCW). 25/63 (40%) involved students, 23/63 (36%) DCW attending masters and doctorate, 13/63 (21%) DCW attending as tutors and 2/63 (3%) staff. 45/63 (71%) and 18/63 (29%) occurred respectively during and after the use of the device; of last ones, 1/18 (0.05%) were related to instrument clean-up and 1/18 (0.05%) to laboratory activity, 12/18 (67%) occurred when a DCW collided with a sharp object during the setting, and 4/18 (22%) during other activities. The instrument and the body part most likely involved were needle and finger respectively. The overall exposure rate was 4.78 per 10,000 patient visits. CONCLUSIONS: Our results may serve as benchmark that Dental Schools can employ to assess their frequency of injury.

Weight loss following a clinic-based weight loss program among adults with attention deficit/hyperactivity disorder symptoms.

OBJECTIVE: The purpose of the present study was to compare obese patients screening positive or negative for attention deficit/hyperactivity disorder (ADHD) on pretreatment body mass index (BMI), weight loss following a 16 week clinic-based behavioral weight loss program, weight loss attempts, dietary and physical activity habits, perceived difficulty of weight control skills, and eating self-efficacy. DESIGN: Patients who completed a behavioral weight loss program were approached to complete questionnaires on ADHD and eating habits. Medical charts were reviewed to obtain weight at pre- and post-treatment. RESULTS: Participants (N=63) were 75% female, mean age was 49 (SD=10.3), mean body mass index (BMI) was 41.4 kg/m² (SD=6.8) and 30% screened positive for ADHD on the Adult ADHD Symptom Rating Scale. Participants screening positive for ADHD did not have a higher BMI at baseline (p=0.41), but reported more previous weight loss attempts (p=0.01) and lost less weight (p=0.02) than participants who screened negative. Participants screening positive also reported consuming fast food meals more frequently (p=0.04), higher levels of emotional eating (p=0.002), greater difficulty with weight control skills (p=0.01), and lower eating self-efficacy (p=0.001). CONCLUSION: Attention-related problems appear to be common among weight treatment-seeking samples and represent a significant barrier to weight control that has not yet been addressed in the literature.

Modifiable risk factors in relation to changes in BMI and fatness: what have we learned from prospective studies of school-aged children?

Considerable interest and resources are currently being directed to primary and secondary prevention of childhood obesity among school-aged children. Intervention studies in this age group have yielded mixed results, begging the question as to whether the correct targets for intervention have been identified. To evaluate the evidence base, we reviewed prospective observational studies published in English between 1990-2007 that reported weight or fatness changes in relation to diet, physical activity, and sedentary behavior. Sugar-sweetened beverage consumption emerged as the most consistent dietary factor in association with subsequent increases in weight status or fatness. Other foods and eating patterns showed less consistent associations and when associations were present, magnitudes were generally small. This may reflect the known limitations of standard dietary methodology to assess meal patterns and dietary intake. Findings for physical activity showed more consistent inverse associations with fatness outcomes than for weight status, and as was found for dietary factors, magnitudes of association were modest. Sedentary behavior effects on weight status differ by gender in many studies, with many, but not all, showing greater positive associations among girls. The lack of consistency observed in the studies of sedentary behaviors may reflect the range of variable definitions, measurement challenges, and the changing nature of electronic media. The intrinsic interplay among eating patterns, activity and sedentary behavior adds further complexity to the interpretation of the results of these studies. More sophisticated approaches to the analysis of these complex data in future studies may maximize what is learned. Although the classic obesity risk factors seem to play a role in the development of excess weight and fatness, some more recently identified potential factors, such as sleep, warrant further investigation in prospective studies before they are ready for evaluation using more controlled study designs.

High prevalence and abundant atypical genotypes of Toxoplasma gondii isolated from lambs destined for human consumption in the USA.

Little information is available on the presence of viable Toxoplasma gondii in tissues of lambs worldwide. The prevalence of T. gondii was determined in 383 lambs (<1 year old) from Maryland, Virginia and West Virginia, USA. Hearts of 383 lambs were obtained from a slaughter house on the day of killing. Blood removed from each heart was tested for antibodies to T. gondii by using the modified agglutination test (MAT). Sera were first screened using 1:25, 1:50, 1: 100 and 1:200 dilutions, and hearts were selected for bioassay for T. gondii. Antibodies (MAT, 1:25 or higher) to T. gondii were found in 104 (27.1%) of 383 lambs. Hearts of 68 seropositive lambs were used for isolation of viable T. gondii by bioassay in cats, mice or both. For bioassays in cats, the entire myocardium or 500g was chopped and fed to cats, one cat per heart and faeces of the recipient cats were examined for shedding of T. gondii oocysts. For bioassays in mice, 50g of the myocardium was digested in an acid pepsin solution and the digest inoculated into mice; the recipient mice were examined for T. gondii infection. In total, 53 isolates of T. gondii were obtained from 68 seropositive lambs. Genotyping of the 53 T. gondii isolates using 10 PCR-restriction fragment length polymorphism markers (SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico) revealed 57 strains with 15 genotypes. Four lambs had infections with two T. gondii genotypes. Twenty-six (45.6%) strains belong to the clonal Type II lineage (these strains can be further divided into two groups based on alleles at locus Apico). Eight (15.7%) strains belong to the Type III lineage. The remaining 22 strains were divided into 11 atypical genotypes. These results indicate high parasite prevalence and high genetic diversity of T. gondii in lambs, which has important implications in public health. We believe this is the first in-depth genetic analysis of T. gondii isolates from sheep in the USA.

Endemic toxoplasmosis in pigs on a farm in Maryland: isolation and genetic characterization of Toxoplasma gondii.

The prevalence of Toxoplasma gondii was investigated on a poorly managed pig farm in Maryland. Serum and tissue samples from 48 of the 100 pigs on the farm were available for T. gondii evaluation. Serological testing was performed using both ELISA and the modified agglutination test (MAT). Antibodies to T. gondii were detected by ELISA in 12 of 48 animals, while antibodies were detected in 34 of 48 pigs by MAT with titers of 1:10 in 1, 1:20 in 4, 1:40 in 7, 1:80 in 3, 1:160 in 8, 1:320 in 3, 1:640 in 4, and 1:1,280 in 4. Hearts of 16 pigs with MAT titers of 1:10 or higher were bioassayed for T. gondii in cats; 11 cats shed T. gondii oocysts. Hearts of 22 pigs were autolyzed and bioassayed only in mice; T. gondii was isolated from 3 of these 22 pigs. Genetic typing of the 14 T. gondii isolates using the SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico loci revealed 4 genotypes; 10 isolates belonged to type II lineage (genotypes 1 and 2), 3 belonged to genotype 3, and 1 belonged to genotype 4. Genotype 1 and 2 have type II alleles at all genetic loci, except the former has type II allele and the latter has a type I allele at locus Apico. Both genotypes 1 and 2 are considered to belong to the clonal type II lineages. Genotype 3 and 4 are nonclonal isolates. Results document high prevalence of T. gondii in pigs on a farm in Maryland.

Endemic avian toxoplasmosis on a farm in Illinois: clinical disease, diagnosis, biologic and genetic characteristics of Toxoplasma gondii isolates from chickens (Gallus domesticus), and a goose (Anser anser).

Clinical toxoplasmosis in chickens (Gallus domesticus) has been rarely reported in literature. Here we report that three chickens on a farm in Illinois developed neurological signs. One of these chickens was examined postmortem and it had non-suppurative encephalitis with numerous Toxoplasma gondii tachyzoites and tissue cysts. The identity of the protozoa was confirmed immunohistochemically by staining with T. gondii specific antibodies, and by transmission electron microscopy. The owner of the 3 chickens donated all 11 remaining chickens and a goose on his property for the present study. All 11 chickens and a goose were euthanized, and blood, heart, brain, and 1 leg were obtained for T. gondii examination. Antibodies to T. gondii were found in sera of all chickens with titers of 1:40 in one, 1:320 in three, and 1:640 or higher in seven chickens tested by the modified agglutination test (MAT). The goose had a MAT titer of 1:320. For isolation of T. gondii, whole heart and brain and 50 g of leg muscles were digested in an acid-pepsin solution and bioassayed in four mice for each tissue. Viable T. gondii was isolated from tissues of all 11 chickens and the goose. Genotyping of these 12 T. gondii isolates using polymorphism at the genetic loci SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, a new SAG2 and Apico revealed that all isolates had Type II alleles at all loci, indicating these T. gondii isolates belong to the predominant clonal Type II lineages. This is the first report of isolation of viable T. gondii from a domestic goose (Anser anser).

Prevalence of Toxoplasma gondii in dogs from Colombia, South America and genetic characterization of T. gondii isolates.

The prevalence of Toxoplasma gondii in 309 unwanted dogs from Bogotá, Colombia, South America was determined. Antibodies to T. gondii were assayed by the modified agglutination test (MAT) and found in 52 (16.8%) of 309 dogs with titers of 1:20 in 20, 1:40 in six, 1:80 in 17, 1:160 in three, 1:320 in three, 1:1280 or higher in three. Some organs obtained after necropsy of dogs (hearts, tongues and brains, either separately or pooled) were used in bioassays carried out in mice (37 samples, of which 20 were assayed with separate organs and 17 were assayed with pooled organs), cats (pooled organs from six) and pooled organs of two dogs both in mice and cat. Mice receiving dog tissues were examined for T. gondii infection. Feces of cats that received dog tissues were examined for oocyst shedding. In total, T. gondii was isolated from tissues of 20 dogs (16 by bioassays in mice, 3 by bioassay in cats and 1 by bioassay in mice and cat). All infected mice from 7 of 17 isolates bioassayed in this host died of toxoplasmosis during primary infection. Only 10 of the 20 dogs whose tissues were bioassayed separately induced infections in mice. Interestingly, dog organs varied in their capacity to induce T. gondii infection in mice, hearts and tongues producing more positive results than the brain. The 20 T. gondii isolates obtained from seropositive dogs were PCR-RFLP genotyped using polymorphisms at 10 nuclear markers including SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, a new SAG2 and an apicoplast marker Apico. Ten genotypes were revealed. These genotypes are different from the three predominant Types I, II and III lineages that are widely spread in North America and Europe. A new allele denoted u-3 at PK1 locus was identified in three isolates. This result supports previous findings that T. gondii population is highly diverse in Colombia.

Characterization of Toxoplasma gondii from raccoons (Procyon lotor), coyotes (Canis latrans), and striped skunks (Mephitis mephitis) in Wisconsin identified several atypical genotypes.

During 2005-2006, sera and tissues from raccoons (Procyon lotor), coyotes (Canis latrans), and skunks (Mephitis mephitis) from the state of Wisconsin were tested for Toxoplasma gondii infection. Antibodies to T. gondii were found in 32 of 54 (59.2%) raccoons, 18 of 35 (51.4%) coyotes, and 5 of 7 (71.4%) skunks using the modified agglutination test and a cut-off titer of 1:20. Pooled tissues (brains, hearts, and tongues) from 30 raccoons, 15 coyotes, and 1 skunk were bioassayed for T. gondii infection in mice or cats. Viable T. gondii was isolated from 5 of 30 (16.7%) raccoons, 6 of 15 (40.0%) coyotes, and the skunk. Genetic characterization of the 12 parasite isolates by multilocus PCR-RFLP markers revealed 6 different genotypes including 5 atypical and I archetypal II lineages. The results indicate the prevalence of T. gondii in wildlife mammals is high and that these animals may serve as an important reservoir for transmission of T. gondii.

Diverse and atypical genotypes identified in Toxoplasma gondii from dogs in São Paulo, Brazil.

The prevalence of Toxoplasma gondii in 118 unwanted dogs from São Paulo City, São Paulo State, Brazil, was determined. Antibodies to T. gondii were assayed by the modified agglutination test and found in 42 (35.8%) dogs, with titers of 1:20 in 10, 1:40 in 6, 1:80 in 5, 1:160 in 5, 1:320 in 6, 1:640 in 7, and 1:1,280 or higher in 3. Hearts and brains of 36 seropositive dogs were bioassayed in mice, or cats, or both. Tissues from 20 seropositive dogs were fed to 20 T. gondii-free cats. Feces of cats were examined for oocysts. Toxoplasma gondii was isolated from 15 dogs by a bioassay in mice, from the brain alone of 1, from the heart alone of 4, and from both brains and hearts of 10. All infected mice from 5 of 15 isolates died of toxoplasmosis during primary infection. Four additional isolates were obtained by bioassay in cats. Genotyping of these 19 T. gondii isolates using polymorphisms at 10 nuclear markers including SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and a new SAG2 (an apicoplast marker Apico) revealed 12 genotypes. One isolate had Type III alleles at all 11 loci, and the remaining 18 isolates contained a combination of different alleles and were divided into 11 genotypes. The absence of Type II in Brazil was confirmed. The result supports previous findings that T. gondii population genetics is highly diverse in Brazil.

Neospora caninum and Toxoplasma gondii antibodies in dogs from Durango City, Mexico.

Toxoplasma gondii and Neospora caninum are structurally similar parasites, with many hosts in common. The prevalence of antibodies to T. gondii and N. caninum was determined in sera from dogs from Durango City, Mexico. Using a modified agglutination test, antibodies to T. gondii were found in 52 (51.5%) of the 101 dogs with titers of 1:25 in 27, 1:50 in 11, 1:100 in 5, 1:200 in 4, 1:400 in 2, 1:800 in 2, and 1:3,200 or higher in 1. Antibodies to N. caninum were determined by the indirect immunofluorescent antibody test (IFAT) and the Neospora sp. agglutination test (NAT). Two of the 101 dogs had N. caninum antibodies; these dogs did not have T. gondii antibodies, supporting the specificity of the tests used. The N. caninum antibody titers of the 2 dogs were: 1:400 by IFAT and 1:200 by NAT in 1, and 1:25 by NAT and IFAT in the other. Results indicate that these 2 structurally similar protozoans are antigenically different.

The healthy weight research network: a research agenda to promote healthy weight among youth with autism spectrum disorder and other developmental disabilities.

The Healthy Weight Research Network (HWRN) for children with autism and developmental disabilities is an interdisciplinary network with national representation. This paper discusses the modified Delphi procedure that was used to develop the HWRN's research agenda to address the problem of obesity in children with autism and developmental disabilities. The five research areas identified for priority included: (i) family practices around food/mealtimes; (ii) physical activity and sedentary behaviours in relation to weight; (iii) relationship between food patterns, behaviour and weight gain; (iv) programme-adaption and delivery; and (v) influence of school and community-based organizations on food intake and physical activity. The goals and agenda of the HWRN hold promise for making progress toward the prevention and successful treatment of obesity in this population.

Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder.

Mealtime behavior problems and family stress occur frequently among families of children with autism spectrum disorder (ASD). However, it is unknown whether food selectivity is an associated factor. The associations of high food selectivity with mealtime behavior problems, spousal stress, and influence on family members were assessed among 53 children with ASD and 58 typically developing (TD) children ages 3-11 years. Compared to TD children, children with ASD were more likely to have high food selectivity, and their parents reported more mealtime behavior problems, higher spousal stress, and influence on what other family members ate. High food selectivity was associated with mealtime behavior problems in both groups. Interventions to reduce food selectivity may lead to decreases in mealtime behavior problems.

Validity of reported energy intake in preadolescent girls.

Energy intake and energy expenditure were assessed in 109 girls aged 8-12 y. Intake was estimated from a 7-d dietary record based on household measures. Expenditure was measured with the doubly labeled water technique during 2-wk period. Overall, the mean (+/-SD) energy intake was 7.0 +/- 1.67 MJ/d and the mean energy expenditure was 8.03 +/- 1.28 MJ/d. The mean difference between intake and expenditure was 1.03 +/- 1.77 MJ/d (P < 0.0001). The mean proportion of actual intake reported was 88.3 +/- 21.0%. Multivariate-regression analysis showed that age and total daily energy expenditure were significantly and independently related to the reporting error. Coefficients for age and total daily energy expenditure were both positive, indicating that as age and daily energy expenditure increased, the magnitude of the error of reporting increased. Income, ethnicity, parental obesity, and body fat were not significantly related to accuracy of reporting. The use of food records to determine energy intake appears to provide more accurate results in younger than in older girls, and the accuracy of the method apparently decreases as energy expenditure increases.

Accuracy of standardized equations for predicting metabolic rate in premenarcheal girls.

Several different equations based on height, weight, sex, and age are available to predict metabolic rate in children and adolescents. The purpose of this study was to determine which of the published standardized equations most accurately predicts metabolic rate in premenarcheal girls. Resting metabolic rate (RMR) was measured in 186 premenarcheal girls by using open-circuit indirect calorimetry with a ventilated hood. Measured RMR was compared with equations provided by the FAO/WHO/UNU, the Mayo Clinic, and Robertson and Reid for girls of the same age. The accuracy of each equation differed for each Tanner stage. The Mayo Clinic standards significantly differed from measured RMR among girls in Tanner stages 1 and 2. The Robertson and Reid standards differed from measured RMR for girls in Tanner stage 1. Only the FAO/WHO/UNU equation predictions did not differ from measured RMR for all Tanner stages studied. These results indicate that the FAO/WHO/UNU equation is the best predictor of RMR in premenarcheal girls at different stages of development. Furthermore, because RMR measured under inpatient and outpatient conditions did not differ significantly, an overnight measurement is not necessary for a reliable determination of RMR.

Validity of reported energy intake in obese and nonobese adolescents.

Daily metabolizable energy intake (ME) and total daily energy expenditure (TEE) were measured in 28 nonobese and 27 obese adolescents over a 2-wk period. Reported ME was significantly (p less than 0.001) lower than measured TEE in both the nonobese and the obese groups (2193 +/- 618 vs 2755 +/- 600 kcal/d and 1935 +/- 722 vs 3390 +/- 612 kcal/d, respectively). Reported ME as a percentage of TEE was significantly lower in the obese than the nonobese group (58.7 +/- 23.6% vs 80.6 +/- 18.7%, respectively). When reported ME was adjusted to account for changes in body energy stores, reported ME still remained significantly lower than TEE in both groups. ME was highly reproducible over the 2-wk period. Intraclass correlation coefficients among days for subjects with complete 14-d diaries were 0.87 and 0.89 for nonobese and obese groups, respectively. In both groups, interindividual variability in ME was significantly greater than intraindividual variability. Our data suggest that reported ME in nonobese and obese adolescents is not representative of TEE or energy requirements.

Effect of sedentary activities on resting metabolic rate.

We examined the effect of television viewing on resting metabolic rate (RMR) in a cohort of 9 obese and 18 nonobese girls aged 10.4 +/- 1.1 y. RMR was measured while girls watched television, read, or sat quietly for 15 min. Movement was assessed by using activity monitors and a manual count of movements observed on a videotape. Absolute RMR was greater for the obese girls, but no significant treatment effect existed for absolute RMR within either group. Although measured activity did not differ, observed movements were greater when the girls were sitting quietly. Total observed and measured movements were significantly correlated with the CV of the minute-by-minute RMR. These results suggest that television viewing does not alter RMR. Although children appear to fidget more when sitting quietly than when they read or watch television, fidgeting appears to affect the minute-to-minute variation of RMR rather than the level of resting energy expenditure.