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.

Comparison of isotope ratio mass spectrometry and cavity ring-down spectroscopy procedures and precision of the doubly labeled water method in different physiological specimens.

RATIONALE: This study determines if saliva collection procedures for the doubly labeled water (DLW) method, used for measuring total energy expenditure (TEE), are comparable to urine and plasma collection. Both the cavity ring-down spectroscopy (CRDS) and isotope ratio mass spectrometry (IRMS) analyses techniques are compared. METHODS: Saliva specimens were collected from participants for the DLW method. The specimens were collected under different conditions: after consumption of tap water, after chewing gum, and during exposure to conditions of high and low relative humidity. The isotopes in saliva were compared with simultaneous plasma and urine collection. TEE calculated from saliva and analyzed using CRDS was compared to that of plasma analyzed using IRMS. RESULTS: The within-individual variances were not significantly different between the saliva specimens (0.4‰) and plasma (0.3‰). After the oral dose of DLW, the saliva specimens displayed a shorter equilibration time to urine. When participants consumed 500 mL of tap water, the enrichment of saliva specimens reached a new plateau value faster than urine. Saliva collection exposed to high ambient humidity conditions was slightly less enriched as compared to low-humidity conditions while urine enrichment was unaffected. In contrast, whereas the within-individual effects of gum chewing during saliva collection on 18 O were unaffected, the abundance of 2 H in saliva was slightly lower after chewing the gum. The within-individual difference between TEE calculated from saliva and that calculated from plasma analyzed using IRMS did not differ from zero, and the standard deviation was not different from that predicted by a propagation of error analysis based on analytical error alone. CONCLUSIONS: Our findings support using saliva specimens for the DLW method. The analysis of plasma and urine, however, requires reducing the memory effect resulting from contaminants. Also, it should be performed in a manner that minimizes exposure to air where specimens may be exposed to evaporation or contamination from water vapor during sampling.

Alaska backcountry expeditionary hunting promotes rapid improvements in metabolic biomarkers in healthy males and females.

We have previously reported negative energy balance and health benefits during an Alaska backcountry expeditionary hunting (ABEH) immersion in two males. The purpose of our present study was to increase the number of participants, include females, and evaluate macronutrient intake and serum lipids. Four men (age: 46 ± 6 year, BMI: 26 ± 1 kg/m2 ) and three women (age: 46 ± 11 year, BMI: 25 ± 3 kg/m2 ) were recruited. Doubly labeled water methodology and dietary recall were utilized to assess energy expenditure and energy intake, respectively. Data were collected during pre- and post-ABEH visits. Body composition was measured using dual-energy x-ray absorptiometry and the cross-sectional area of skeletal muscle in the upper leg (XT), and intrahepatic lipid (IHL) was determined using magnetic resonance imaging and/or spectroscopy (MRI/MRS). Blood parameters were measured by LabCorp. Paired T-tests were used for statistical analysis. Data are reported as mean ± SD and considered significant at p < 0.05. Total energy intake was 7.7 ± 3.4 MJ/day and total energy expenditure was 17.4 ± 2.6 MJ/day, resulting in a negative energy balance of -9.7 ± 3.4 MJ/day. Protein intake(grams)/body weight(kilograms)/day was 1.0 ± 0.4. There were reductions in body weight (Δ-1.5 ± 0.7 kg), BMI (Δ-0.3 ± 0.2 kg/m2 ), fat mass (Δ-1.7 ± 0.9 kg), and IHL (Δ-0.3 ± 0.3% water peak). There were no changes in lean tissue mass (Δ0.6 ± 1.4 kg) or XT (Δ-1.3 ± 3.3 cm2 ). There were significant reductions in total cholesterol (Δ-44 ± 35 mg/dl), LDL-cholesterol (Δ-25 ± 14 mg/dl), VLDL-cholesterol (Δ-7 ± 7 mg/dl), and triglycerides (Δ-35 ± 33 mg/dl). The ABEH immersion resulted in considerable negative energy balance and provided comprehensive benefits in metabolic health without any reduction in skeletal muscle.

Systemic social and emotional learning: Promoting educational success for all preschool to high school students.

Social and emotional learning (SEL) has become more central to education because of demand from educators, parents, students, and business leaders alongside rigorous research showing broad, positive impacts for students and adults. However, all approaches to SEL are not equal. Systemic SEL is an approach to create equitable learning conditions that actively involve all Pre-K to Grade 12 students in learning and practicing social, emotional, and academic competencies. These conditions require aligned policies, resources, and actions at state and district levels that encourage local schools and communities to build the personal and professional capacities of adults to: implement and continuously improve evidence-based programs and practices; create an inclusive culture that fosters caring relationships and youth voice, agency, and character; and support coordinated school-family-community partnerships to enhance student development. Promoting social and emotional competencies-including the abilities to understand and manage emotions, achieve positive goals, show caring and concern for others, establish and maintain positive relationships, and make responsible decisions-are important for success at school and in life. In this article, we summarize key concepts and evidence for systemic SEL. Next, we explain interrelated Theories of Action and resources developed by the Collaborative for Academic, Social, and Emotional Learning (CASEL) to implement and continuously improve systemic SEL in schools, districts, and states. We discuss research on nested, interacting settings and processes involved in systemic SEL at proximal (classrooms, schools, families, and communities) and distal (districts, states, national, and international) ecological levels. We conclude with recommendations for future SEL research, practice, and policy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating the potential of Special Olympics fitness models as a health intervention for adults with intellectual disabilities.

BACKGROUND: People with intellectual disabilities (ID) have high prevalence of cardiovascular disease (CVD) risk factors; yet, few behavioral health interventions are designed and implemented for people with ID. OBJECTIVE: This study examined Special Olympics Inc. (SOI) fitness models as a potential intervention to reduce CVD risk in people with ID. METHODS: Data from SOI fitness models implemented in 2016-2018 were assessed. Special Olympics Programs received funding, resources, and technical assistance from SOI to conduct fitness models centered on inclusive physical activity and goal setting. Weight, body mass index, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at baseline and 4-12 weeks into the model. Multi-level multivariable quintile linear regression assessed change. RESULTS: 383 participants with ID (athletes) and 281 partners without ID met inclusion criteria. Mean weight loss among athletes was 0.67 kg and 132 (31.9%) lost ≥ 1 kg. Blood pressure decreased in SBP quintile 4 (-7.52 mm Hg, 95% confidence interval [CI]: 11.8, -4.0), SBP quintile 5 (-9.52 mm Hg, 95% CI: 13.5, -5.6), and DBP quintile 5 (-7.49 mm Hg, 95% CI: 13.1, -1.9). Partners had similar results. Strongest effects were in a 'high-risk' group that was in the quintile 4 or 5 in all baseline measures. CONCLUSION: In fitness models developed to improve fitness for people with ID, there was a reduction in weight and blood pressure. SOI fitness models show promise and potential as a health intervention. This work enables further examination of indicators for successful implementation and evaluation of health.

Influence of Energy Balance on the Rate of Weight Loss Throughout One Year of Roux-en-Y Gastric Bypass: a Doubly Labeled Water Study.

OBJECTIVE: To investigate the influence of changes in energy balance and body composition on the rate of weight loss throughout 1 year of Roux-en-Y gastric bypass. METHODS: Variables were collected pre-, 6, and 12 months (M) post-surgery from 18 women (BMI ≥ 40 and ≤ 50 kg m-2, 20 to 45 years). Total energy expenditure (TEEm), fat-free mass (FFM), and fat mass (FM) were measured by doubly labeled water. Self-reported energy intake (EIsr) was obtained from three non-consecutive food diaries. Metabolic adaptation was assessed via deviations from TEE predictive equation, and the calculated energy intake (EIc) via the sum of TEE and change in body stores. RESULTS: BMI significantly decreased (mean ± SD) from 45 ± 2 kg m-2 to 32 ± 3 kg m-2 at 6 M, and to 30 ± 3 kg m-2 at 12 M after surgery. The TEEm reduced significantly at both time points when compared with pre-surgery (6 M: - 612 ± 317 kcal day-1; 12 M: - 447 ± 516 kcal day-1). At 6 M, a metabolic adaptation was observed and the energy balance was - 1151 ± 195 kcal day-1, while at 12 M it was - 332 ± 158 kcal day-1. Changes in the values of TEEm were associated with changes in body weight at 12 M post-surgery. A significant underreporting was observed for EIsr (1057 ± 385 kcal day-1) vs. EIc (2083 ± 309 kcal day-1) at 12 M post-operative. CONCLUSION: The higher rate of weight loss at 6 M post-surgery was a response to energy imbalance, which was caused by high restriction in energy intake even with the presence of metabolic adaptation at this time. The EIsr was not sufficiently accurate to assess the energy consumption of this population. REGISTRATION OF CLINICAL TRIALS (OBSERVATIONAL STUDY): Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.

The energy requirements and metabolic benefits of wilderness hunting in Alaska.

The purported healthy aspects of subsistence foods have led to the popularity of the Paleo diet. There has been very little focus, surprisingly, on health benefits derived from the nomadic nature of humans during the Paleolithic era. The purpose of our study was to examine total energy expenditure (TEE), total energy intake (TEI), body composition, blood lipids, and intrahepatic lipid in humans during a 12-day Alaskan backcountry expeditionary hunting (ABEH) immersion. Four healthy men (age: 42 ± 3 year, BMI: 27 ± 1 kg/m2 ) were recruited for the study. TEE was measured using the doubly labeled water method and a food diary was utilized to assess TEI. Body composition was measured using dual energy X-ray absorptiometry (DXA); cross-sectional area of the thigh (XT) and intrahepatic lipid (IHL) were measured using molecular imaging. Blood samples were collected for the measurement of blood lipids. DXA, XT, IHL, and blood data were collected pre- and immediately post-ABEH. Results were analyzed using paired t-tests and considered significant at P < 0.05. TEE and TEI averaged 18.1 ± 1.2 and 9.1 ± 2.5 MJ/day, respectively, indicating substantial negative energy balance (-9.0 ± 1.3 MJ/day). There was a reduction in percent body fat (∆-3.3 ± 0.2%), total fat mass (∆-3.3 ± 0.4 kg), and visceral fat volume (Δ-261 ± 188 cm3 ). Lean tissue mass and XT was unchanged. There was a decrease in IHL (Δ-0.5 ± 0.1% water peak), and a trend (P = 0.055) toward reduction in LDL-cholesterol. We conclude that constancy of physical activity during negative energy balance may provide metabolic benefits above and beyond variations in diet that exist with the hunter-gatherer lifestyle.

Dilution space ratio of 2H and 18O of doubly labeled water method in humans.

Variation of the dilution space ratio (Nd/No) between deuterium ((2)H) and oxygen-18 ((18)O) impacts the calculation of total energy expenditure (TEE) by doubly labeled water (DLW). Our aim was to examine the physiological and methodological sources of variation of Nd/No in humans. We analyzed data from 2,297 humans (0.25-89 yr old). This included the variables Nd/No, total body water, TEE, body mass index (BMI), and percent body fat (%fat). To differentiate between physiologic and methodologic sources of variation, the urine samples from 54 subjects were divided and blinded and analyzed separately, and repeated DLW dosing was performed in an additional 55 participants after 6 mo. Sex, BMI, and %fat did not significantly affect Nd/No, for which the interindividual SD was 0.017. The measurement error from the duplicate urine sample sets was 0.010, and intraindividual SD of Nd/No in repeats experiments was 0.013. An additional SD of 0.008 was contributed by calibration of the DLW dose water. The variation of measured Nd/No in humans was distributed within a small range and measurement error accounted for 68% of this variation. There was no evidence that Nd/No differed with respect to sex, BMI, and age between 1 and 80 yr, and thus use of a constant value is suggested to minimize the effect of stable isotope analysis error on calculation of TEE in the DLW studies in humans. Based on a review of 103 publications, the average dilution space ratio is 1.036 for individuals between 1 and 80 yr of age.

Doubly labeled water analysis using cavity ring-down spectroscopy.

The doubly labeled water method provides an objective and accurate measure of total energy expenditure in free-living subjects and is considered the gold-standard method for this measurement. Its use, however, is limited by the need to employ isotope ratio mass spectrometry (IRMS) to obtain the high-precision isotopic abundance analyses needed to optimize the dose of expensive (18) O-labeled water. Recently, cavity-ring down spectroscopy (CRDS) instruments have become commercially available and may serve as a less expensive alternative to IRMS. We compared the precision and accuracy of CRDS with those of IRMS for the measurement of total energy expenditure from urine specimens in 14 human subjects. The relative accuracy and precision (SD) for total body water was 0.5 ± 1% and for total energy expenditure was 0.5 ± 6%. The CRDS instrument displayed a memory between successive specimens of 5% for (18) O and 9% for (2) H. The memory necessitated carefully ordering of specimens to reduce isotopic disparity, performance of several injections of each specimen to condition the analyzer, and use of a mathematical memory correction on subsequent injections. These limited the specimen throughput to about one urine specimen per hour. CRDS provided accuracy and precision for isotope abundance measurements of urine that were comparable with those of IRMS. The memory problems were easily recognized by our experienced laboratory staff, but future efforts should be aimed at reducing the memory of the CRDS so that it would be less likely to result in poor reproducibility in laboratories using doubly labeled water for the first time.

Effect of physical inactivity on the oxidation of saturated and monounsaturated dietary Fatty acids: results of a randomized trial.

OBJECTIVES: Changes in the way dietary fat is metabolized can be considered causative in obesity. The role of sedentary behavior in this defect has not been determined. We hypothesized that physical inactivity partitions dietary fats toward storage and that a resistance exercise training program mitigates storage. DESIGN: We used bed rest, with randomization to resistance training, as a model of physical inactivity. SETTING: The trial took place at the Space Clinic (Toulouse, France). PARTICIPANTS: A total of 18 healthy male volunteers, of mean age +/- standard deviation 32.6 +/- 4.0 y and body mass index 23.6 +/- 0.7 kg/m(2), were enrolled. INTERVENTIONS: An initial 15 d of baseline data collection were followed by 3 mo of strict bed-rest alone (control group, n = 9) or with the addition of supine resistance exercise training every 3 d (exercise group, n = 9). OUTCOME MEASURES: Oxidation of labeled [d(31)]palmitate (the main saturated fatty acid of human diet) and [1-(13)C]oleate (the main monounsaturated fatty acid), body composition, net substrate use, and plasma hormones and metabolites were measured. RESULTS: Between-group comparisons showed that exercise training did not affect oxidation of both oleate (mean difference 5.6%; 95% confidence interval [95% CI], -3.3% to 14.5%; p = 0.20) and palmitate (mean difference -0.2%; 95% CI, -4.1% to 3.6%; p = 0.89). Within-group comparisons, however, showed that inactivity changed oxidation of palmitate in the control group by -11.0% (95% CI, -19.0% to -2.9%; p = 0.01) and in the exercise group by -11.3% (95% CI, -18.4% to -4.2%; p = 0.008). In contrast, bed rest did not significantly affect oleate oxidation within groups. In the control group, the mean difference in oleate oxidation was 3.2% (95% CI, -4.2% to 10.5%; p = 0.34) and 6.8% (95% CI, -1.2% to 14.7%; p = 0.08) in the exercise group. CONCLUSIONS: Independent of changes in energy balance (intake and/or output), physical inactivity decreased the oxidation of saturated but not monounsaturated dietary fat. The effect is apparently not compensated by resistance exercise training. These results suggest that Mediterranean diets should be recommended in sedentary subjects and recumbent patients.

Decreased energy expenditure is caused by abnormal body composition in infants with Prader-Willi Syndrome.

OBJECTIVE: Infants with Prader-Willi syndrome (PWS) are hypotonic and underweight before the onset of childhood obesity. This study evaluates body composition in the PWS infant and its relationship to energy expenditure. STUDY DESIGN: Sixteen infants and toddlers with PWS (mean age, 12.4+/-6 months; eight female subjects) underwent analysis of body composition with dual-energy x-ray absorptiometry and deuterium dilution, and energy expenditure with both doubly labeled water and indirect calorimetry. RESULTS: Percent body fat was significantly increased (male subjects, P<.001; female subjects, P<.001) and fat-free mass (FFM) was significantly decreased (male subjects, P<.001; female subjects, P=.04) in infants with PWS when compared with age-matched published data for normal infants. Meanwhile, total energy expenditure was significantly decreased (male subjects, P=.025; female subjects, P<.001) in infants with PWS when compared with published normative data. There was a normal relationship between FFM and total energy expenditure in infants with PWS. CONCLUSION: Compared with published data for infants without PWS, infants with PWS demonstrate increased percent body fat, decreased FFM, and decreased energy expenditure. Importantly, total energy expenditure per kilogram of FFM appears similar in infants with and without PWS. We conclude that lower energy expenditure in infants with PWS is caused by decreased FFM.