Association of physical activity with body-composition indexes in children aged 6-8 y at varied risk of obesity.

BACKGROUND: Physical inactivity increases the risk of obesity, but the relations between reported levels of physical activity (PA) and measures of body fatness (BF) in children are remarkably inconsistent. OBJECTIVE: We examined the relation between objective measures of PA and body-composition indexes in nonobese children. DESIGN: A cross-sectional study was conducted in 100 children aged 6-8 y who were recruited according to their risk of future obesity: high-risk children had >/=1 obese parent [body mass index (BMI; in kg/m(2)): >30] and low-risk children had 2 nonobese biological parents (BMI: <30). Free-living activity energy expenditure (AEE) and PA level were calculated from 7-d doubly labeled water measurements, time spent in light-intensity activity was assessed by heart rate monitoring, and body composition was determined from isotopic dilution. To adjust for body size, fat mass and fat-free mass were normalized for height and expressed as fat mass index (FMI) and lean mass index (LMI), respectively. RESULTS: High-risk children had significantly higher BMI, LMI, and FMI than did low-risk children, but no group differences in PA were found. AEE and PA level were positively associated with LMI and, after adjustment for sex and fat-free mass, negatively associated with FMI but not with BMI. Boys who spent more than the median time in light-intensity activities had significantly higher FMI than did less sedentary boys. This difference was not observed in girls. CONCLUSIONS: AEE and PA level were negatively associated with BF in nonobese children. Accurate measures of body composition are essential to appropriate assessment of relations between PA and obesity risk.

The effect of normalization of ECW volume as a marker of hydration in peritoneal dialysis patients and controls.

OBJECTIVES: We measured extraceLlular water (ECW) and intracellular water (ICW) volumes in peritoneal dialysis (PD) patients and controls to determine the effect of ICW variation on ECW/ICW ratio and to compare alternative ratios of ECW to height, height2, weight, and body surface area (BSA). PATIENTS AND METHODS: We measured body water compartments by deuterium oxide and bromide dilution in 29 PD patients (14 M, 15 F) and 31 controls (15 M, 16 F). RESULTS: ECW was similar in PD patients (17.58 +/- 3.58 L) and controls (17.20 +/- 2.97 L), p = NS. ICW was nonsignificantly lowerin PD patients (17.58 +/- 4.88 L) than in controls (19.71 +/- 5.08 L), p = NS. ECW/ICW was greaterin PD patients (1.06 +/- 0.32) than in controls (0.92 +/- 0.25), p = 0.057, and was inversely correlated with ICW in PD patients (r = -0.733, p < 0.0001) and controls (r = -0.721, p < 0.0001). In contrast, ECW/height, ECW/height2, ECW/weight, and ECW/BSA were similar for the two groups. CONCLUSIONS: ECW/ICW is affected by changes in ICW as well as by ECW varying with hydration. ECW/ICW ratio leads to the spurious impression of overhydration in subjects with smaller ICW volumes. ECW/ICW does not reflect hydration alone and other methods of expressing ECW as a measure of hydration need further evaluation.

Specific immunoglobulin A antibodies in maternal milk and delayed Helicobacter pylori colonization in Gambian infants.

BACKGROUND: Immunoglobulin A (IgA) in maternal milk may protect Gambian infants from early Helicobacter pylori colonization. This study sought evidence that this protection could be due to specific IgA antibodies. METHODS: Sixty-five infants were screened from 12 weeks of age with [13C]-urea breath tests. Antibodies in maternal milk were measured to determine total IgA content and to detect specific IgA antibodies against crude whole-cell and recombinant H. pylori urease antigen preparations. RESULTS: Ten children (15%) had no evidence of early H. pylori colonization, 10 (15%) had early H. pylori colonization, and 43 (66%) had mixed results. Levels of maternal circulating specific immunoglobulin G, total milk IgA, and IgA directed against crude whole-cell H. pylori antigen preparation were not significantly associated with the rate of infant H. pylori colonization. However, mothers of infants with no evidence of early colonization produced significantly higher levels of anti-recombinant urease IgA antibodies in milk than did control mothers, particularly at 8, 16, and 20 weeks postpartum (P<.01). CONCLUSIONS: These observations support the hypothesis that antibodies in mother's milk directed against H. pylori urease can protect against colonization in human infancy.

Abnormalities of body composition in peritoneal dialysis patients.

OBJECTIVES: Body composition changes occur in peritoneal dialysis (PD) due to abnormalities in nutrition and hydration. We investigated abnormalities of nutrition and hydration in PD patients compared with healthy controls by measurement of total body potassium (TBK) and body water compartments. DESIGN: Cross-sectional comparison study. METHODS: We measured TBK--an indicator of body cell mass--by whole body counting, total body water (TBW) by deuterium oxide dilution, and extracellular water (ECW) by bromide dilution in 29 PD patients and 32 controls. RESULTS: The absolute mean value of TBK for PD patients was not significantly lower than in controls. The ratios of observed TBK to predicted TBK from prediction formulas were compared. Equations used were those of Boddy, Bruce, Burkinshaw, and Ellis and our own equation derived from a local control database (Leeds). Observed/predicted ratios of TBK were significantly less in PD than in control subjects for all equations. Water volumes did not differ between PD and control groups. Observed/predicted ratios for TBK in PD patients correlated with serum potassium (Boddy r = 0.355, p = 0.06; Bruce r = 0.411, p < 0.05; Burkinshaw r = 0.457, p < 0.01; Leeds r = 0.412, p < or = 0.05; Ellis r = 0.356, p = 0.06) and tended to correlate with serum albumin (Bruce r = 0.343, p = 0.07; Burkinshaw r = 0.421, p < 0.05; Leeds r = 0.357, p = 0.06; Ellis r = 0.310, p = NS). There was no relationship with serum potassium in controls. Serum albumin in PD correlated with TBK (r = 0.445, p < 0.02), TBK/height (r = 0.419, p < 0.05), TBK/weight (r = 0.554, p = 0.002), and TBK/TBW (r = 0.586, p = 0.0001). Extracellular water/intracellular water (ECW/ICW) was inversely related to TBK (r = -0.455, p < 0.02 in PD; r = -0.387, p < 0.05 in controls) and to TBK/height (r = -0.446, p < 0.02 in PD; r = -0.411, p = 0.02 in controls). TBK/weight reduced with age in PD (r = -0.445, p < 0.02), as did TBK/TBW in PD (r = -0.463, p < 0.02). ECW/ICW tended to increase with age in PD (r = 0.351, p = 0.06). CONCLUSIONS: Observed/predicted ratio of TBK is reduced in PD patients relative to healthy controls, indicating reduced body cell mass. Serum albumin and potassium reflect TBK indices in PD. Body water volumes did not differ between PD and controls, implying no overall abnormality in hydration in the PD group. However, ECW is relatively increased compared to ICW with decreasing TBK indices, suggesting relative ECW expansion with reduction in body cell mass.

Validation of a quantitative magnetic resonance method for measuring human body composition.

OBJECTIVE: To evaluate a novel quantitative magnetic resonance (QMR) methodology (EchoMRI-AH, Echo Medical Systems) for measurement of whole-body fat and lean mass in humans. METHODS AND PROCEDURES: We have studied (i) the in vitro accuracy and precision by measuring 18 kg Canola oil with and without 9 kg water (ii) the accuracy and precision of measures of simulated fat mass changes in human subjects (n = 10) and (iii) QMR fat and lean mass measurements compared to those obtained using the established 4-compartment (4-C) model method (n = 30). RESULTS: (i) QMR represented 18 kg of oil at 40 degrees C as 17.1 kg fat and 1 kg lean while at 30 degrees C 15.8 kg fat and 4.7 kg lean were reported. The s.d. of repeated estimates was 0.13 kg for fat and 0.23 kg for lean mass. Adding 9 kg of water reduced the fat estimates, increased misrepresentation of fat as lean, and degraded the precision. (ii) the simulated change in the fat mass of human volunteers was accurately represented, independently of added water. (iii) compared to the 4-C model, QMR underestimated fat and over-estimated lean mass. The extent of difference increased with body mass. The s.d. of repeated measurements increased with adiposity, from 0.25 kg (fat) and 0.51 kg (lean) with BMI <25 kg/m(2) to 0.43 kg and 0.81 kg respectively with BMI >30 kg/m(2). DISCUSSION: EchoMRI-AH prototype showed shortcomings in absolute accuracy and specificity of fat mass measures, but detected simulated body composition change accurately and with precision roughly three times better than current best measures. This methodology should reduce the study duration and cohort number needed to evaluate anti-obesity interventions.

Socio-economic and environmental factors influence energy utilization in Brazilian breast-fed infants.

Energy intake recommendations for infants are based on data from industrialized countries. FAO/WHO/UNU expressed the need for studies on total energy expenditure (TEE) and basal metabolic rate from developing countries covering current and changing lifestyles. For this observational study, 65 infants of differing socioeconomic status (SES) (n = 32 middle SES, n = 33 low SES) were selected in Pelotas, southern Brazil, aiming to: 1) compare TEE, minimum observable energy expenditure (MOEE), activity energy expenditure (AEE) between breast-fed infants 8.7 mo of age from middle and low SES; and 2) investigate the effect of potential mediating factors on TEE and AEE. TEE and total body water were measured with doubly labeled water, MOEE with respiration calorimetry, breast milk intake using the dose-to-the-mother deuterium-oxide turnover method, food intake using 1-d food weighing, and prevalence of overweight using BMI Z-scores. TEE adjusted for ethnicity was 257 (95% CI 232-281) kJ/(kg . d) in middle SES infants vs. 318 (95%CI 294-342) kJ/(kg . d) in low SES infants (P = 0.001). MOEE did not differ between groups and the difference in TEE was therefore attributed to AEE (P = 0.008). The effect of SES on AEE was mediated by the number of persons per bedroom (crowding). Prevalence of overweight tended to be higher in middle SES infants (P = 0.054) than in low SES infants. The difference in TEE and AEE between SES groups emphasizes the importance of an accurate description of the SES of any population in which TEE is studied and questions the extent to which TEE data from middle-class infants in transitional countries should be considered normative.

Complementary feeding with cow's milk alters sleeping metabolic rate in breast-fed infants.

Although it is widely accepted that energy expenditure in infants is a function of feeding pattern, the mechanism behind this is not well understood. The objectives of this observational study were as follows: 1) to compare minimal observable energy expenditure (MOEE) between 2 subgroups of breast-fed infants, a BM group in which breast milk was the only source of milk and a BCM group given cow's milk in addition to breast milk; and 2) to identify potential mediators of a feeding pattern effect. For this purpose, infants were classified by feeding group on the basis of a mother's recall. Respiration calorimetry was used to measure MOEE in 62 infants (n = 35 BM, n = 27 BCM) aged 8.7 mo in Pelotas, southern Brazil. Breast-milk intake was measured using deuterium oxide, complementary food intake by 1-d food weighing, total energy expenditure and total body water using doubly labeled water; anthropometric indices were calculated. MOEE was 1672 +/- 175 kJ/d in BM compared with 1858 +/- 210 kJ/d in BCM infants (P < 0.001). Mass-specific MOEE was 201 +/- 24.6 and 216 +/- 31.9 kJ/(kg . d) in BM and BCM infants, respectively (P = 0.041). MOEE (kJ/d) was mediated by protein intake and fat-free mass (R(2) = 41.4%). We conclude that complementary feeding with cow's milk alters the sleeping metabolic rate in breast-fed infants. These findings deserve attention in relation to "metabolic programming" and the development of obesity later in life.

Measurement of insulin sensitivity indices using 13C-glucose and gas chromatography/combustion/isotope ratio mass spectrometry.

Important aspects of glucose metabolism can be quantified by using the minimal model of glucose kinetics to interpret the results of intravenous glucose tolerance tests. The power of this methodology can be greatly increased by the addition of stable isotopically labelled tracer to the glucose bolus dose. This allows the separation of glucose disposal from endogenous glucose production and also increases the precision of the estimates of the physiological parameters measured. Until now the tracer of choice has been deuteriated glucose and the analytical technique has been gas chromatography/mass spectrometry (GC/MS). The consequence of this choice is that nearly 2 g of labelled material are needed and this makes the test expensive. We have investigated the use of (13)C-labelled glucose as the tracer in combination with gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) as the analytical technique. This methodology offers superior analytical precision when compared with the conventional method and so the amount of tracer used, and hence the cost, can be reduced considerably. Healthy non-obese male volunteers were recruited for a standard intravenous glucose tolerance test (IVGTT) protocol but 6,6-(2)H-glucose and 1-(13)C-glucose were administered simultaneously. Tracer/tracee ratios were derived from isotope ratio measurements of plasma glucose using both GC/MS and GC/C/IRMS. The results of these determinations indicated that the two tracers behaved identically under the test protocol. The combination of these results with plasma glucose and insulin concentration data allowed determination of the minimal model parameters S*g and S*i. The parameter relating to insulin-assisted glucose disposal, S*i, was found to be the same in the two techniques, but this was not the case for the non-insulin-dependent parameter S*g.

Use of isotopically labelled octanoic acid to assess the effect of meal size on gastric emptying.

It has been proposed that the (13)C-octanoic acid breath test (OBT) provides a safe, non-radioactive means of measuring gastric emptying. However, deuterated octanoic acid provides a better marker when compared with scintigraphy, as the kinetics are less complex than those of the (13)C label. The appearance of (2)H in saliva is modelled as a two-compartment body water system, using an asymmetric triangular gastric emptying function. This study compared the (2)H-octanoic acid saliva test (OST) with the OBT in measuring altered states of gastric emptying in the nutritional context of diet manipulation. Gastric emptying was measured using the OST and OBT in a three-way crossover study involving 12 healthy male and female subjects (mean BMI = 23.4 kg/m(2), aged 24-57 years). Following an overnight fast, subjects were given an egg meal, labelled with 10 microL/kg body weight (2)H-octanoic acid and 100 microL (13)C-octanoic acid. The meal was nutritionally manipulated to provide a 1 MJ, 2 MJ or 3 MJ meal. Breath and saliva samples were collected at regular intervals for 6 h, with further saliva samples being collected over four subsequent days. (2)H isotopic enrichment in saliva and (13)C isotopic enrichment in breath were analysed using isotope ratio mass spectrometry and the data fitted to the respective gastric emptying models. The half excretion time (T(1/2) (D)), time to maximum emptying rate (T(1) (D)) and time when emptying is complete (T(2) (D)) were calculated from the (2)H saliva test data, and the lag time (T(lag) (C)), half excretion time (T(1/2) (C)), latency phase (T(lat) (C)) and ascension time (T(asc) (C)) were calculated from the (13)C breath test data. Overall, the OBT correlated well with the OST, with a significant relationship between T(1/2) (C) and T(1/2) (D), a significant relationship between T(lat) (C) and T(1) (D) and finally a significant relationship between T(asc) (C) and T(2) (D). Gastric emptying measured using the OST was significantly faster with the 1 MJ meal (DeltaT(1/2) (D) = -0.77 h vs. 2 MJ, p = 0.004). Increases were also seen when the meal size was increased from 2 MJ to 3 MJ (DeltaT(1/2) (D) = +0.44 h vs. 2 MJ), but these were not significant. These trends were mirrored in the OBT data, with significant differences between 1 MJ and 2 MJ (DeltaT(1/2) (C) = -0.63 h vs. 2 MJ, p = 0.013) and non-significant increases with the larger 3 MJ meal (DeltaT(1/2) (C) = +0.10 h vs. 2 MJ). Total meal calorie content was shown to have an effect on gastric emptying using both the OBT and the OST. The deuterium method allows the direct calculation of the gastric emptying function and could be used as an alternative to gamma scintigraphy, allowing further validation of the (13)C-octanoic acid breath test.

Measurement of gastric emptying in man using deuterated octanoic acid.

Gamma scintigraphy is considered the gold standard for the measurement of gastric emptying in humans. Recently, it has been proposed that a [(13)C]octanoate breath test can be used as an alternative technique for measuring gastric emptying of the solid phase, but the results from the two methods are not directly equivalent since in the breath test the label is subject to post-absorptive processing and consequently the emptying functions cannot be observed directly. This work investigates an alternative stable isotope method using deuterated octanoate where the kinetics of redistribution between and elimination from the various body pools are much more easily modelled. Gastric emptying was studied in healthy human volunteers by simultaneous measurement using both [(13)C]octanoate and [(2)H]octanoate as well as gamma scintigraphy. Comparison of the gastric emptying functions from the deuterium method and scintigraphy indicated that the two methods gave equivalent results. The new method can therefore be used in populations considered too vulnerable to ionising radiation to allow gamma scintigraphy to be performed, or as a proxy gold standard in laboratories where scintigraphic methods are unavailable, allowing further comparisons with the breath test method to be made to validate the latter in different population groups.

Placental acquisition of maternal specific IgG and Helicobacter pylori colonization in infancy.

BACKGROUND: Colonization with Helicobacter pylori generally occurs in infancy, and the microorganism is often acquired from close family members. Rate of infant colonization may be affected by maternal immune status. METHODS: To investigate the potential protective effect of anti-H. pylori immunoglobulin G (IgG) acquired via the placenta, 65 mothers and their infants were studied from the infant's birth for 1 year. Circulating IgG antibodies were measured by enzyme-linked immunosorbent assay (ELISA) in cord blood and every 8 weeks. Immunoblotting was performed on sera from infants with significant increases in IgG levels. Rate of infant H. pylori colonization was measured by 13C urea breath tests every 4 weeks from the age of 12 weeks. RESULTS: Maternal and infant cord blood specific IgG levels were correlated (R2 =.747, p <.001). Infant H. pylori specific IgG fell 5-fold compared to maternal levels over the first 6 months of life, and rose subsequently in many cases, with the development of novel immunoblot patterns. There were no significant associations between the age at first positive urea breath test and maternal or infant cord specific H. pylori IgG levels. CONCLUSIONS: Transplacentally acquired specific IgG antibody does not protect infants from colonization by H. pylori.

Quantitative analysis using gas chromatography/combustion/isotope ratio mass spectrometry and standard addition of intrinsically labelled standards (SAIL)--application to isoflavones in foods.

We have investigated a novel application of gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) for the quantitative analysis of the isoflavones in food matrices. Previous methods have been hampered by the lack of analytical standards to introduce early enough in the extraction procedure to allow compensations for losses at all stages of the procedure. In this work we have produced standard materials that can be added at the initial extraction, by intrinsically labelling soya plants by growing them in an atmosphere enriched in the stable isotope of carbon in CO(2). On analysis these plants were shown to contain phytoestrogens at a high (up to 20%) level of enrichment. The dried plant material has been used to estimate the isoflavone concentrations of a set of spiked flours. For daidzein the methodology was shown to produce results comparable to those achieved by GC/MS techniques. The method was less successful for genistein, possibly due to the greater fragility of this compound under the conditions required for the analysis.

Comparison of anthropometric equations for estimation of total body water in peritoneal dialysis patients.

BACKGROUND: Several formulae exist for estimating total body water (TBW). We aimed to assess their validity in peritoneal dialysis patients by comparison with TBW estimated by deuterium oxide dilution (TBW(D)). METHODS: We compared the equations of Chertow (TBW(Cher)), Chumlea (TBW(Chum)), Hume and Weyers (TBW(HW)), Johansson (TBW(J)), Lee (TBW(L)), Watson (TBW(W)) and TBW as 58% of body weight (TBW(0.58Wt)) with TBW(D) in 31 peritoneal dialysis (PD) patients and 32 controls. Estimates were compared with TBW(D) using Bland and Altman comparison. Extracellular water (ECW) was also estimated by sodium bromide dilution. RESULTS: In PD patients, mean TBW(D) was 35.04 (SD 7.84) l. Estimates were greater for TBW(Cher), TBW(Chum), TBW(HW), TBW(J) and TBW(0.58Wt). Mean TBW(L) and TBW(W) did not differ from TBW(D). Ninety-five percent limits of agreement (LOA) compared with TBW(D) (as a percentage of the mean) were similar for all of the different equations in PD patients (between +/-15.4 and +/-17.3%) except TBW(0.58Wt), which was far greater (+/-26.4%). In controls, mean TBW(D) was 37.03 (SD 6.63) l. Estimates were greater for TBW(Cher), TBW(Chum), TBW(HW), TBW(J) and TBW(0.58Wt). Mean TBW(L) and TBW(W) did not differ from TBW(D). Ninety-five percent LOA compared with TBW(D) (as a percentage of the mean) were similar for all equations in the controls, and closer than in PD patients (between +/-9.1 and +/-11.5%) except TBW(0.58Wt), which was again far greater than the other equations (+/-28.1%). TBW(HW) - TBW(D) correlated with mean TBW (r=-0.412, P<0.05 in PD and r=-0.383, P<0.05 in controls). TBW(W) - TBW(D) (r=-0.539, P<0.005) correlated with mean TBW in PD. TBW(0.58Wt) - TBW(D) correlated with body mass index (BMI) (r=0.624, P<0.0001 in PD and r=0.829, P<0.0001 in controls) and ECW/TBW (r=0.406, P<0.05 in PD and r=0.411, P<0.02 in controls). CONCLUSIONS: Predictive equations were less accurate in PD than controls. TBW(0.58Wt) was most inaccurate, with systematic overestimation of TBW with increasing BMI and ECW/TBW. There were no differences in LOA with TBW(D) for the other equations within each group.