Misreporting of dietary energy intake obtained by 24 h recalls in older adults: a comparison of five previous methods using doubly labeled water.

BACKGROUND/OBJECTIVE: To test five different methods to detect misreporting in comparison to doubly labeled water in a sample of older adults. SUBJECTS/METHODS: A cross-sectional study with thirty-eight Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). Dietary data were collected by two 24 h recalls. Misreporting was compared with estimates obtained by the methods proposed by: Goldberg et al. [1, 2], Black [3], McCrory et al. [4], Huang et al [5], and Rennie et al [6]. Bland-Altman plots with 95% limits of agreement were constructed to assess the agreement between rEI and TEEDLW. Weighted kappa coefficients, sensitivity and specificity analyses, and area under the receiving operator characteristic curve (AUC) were used to test the performance of each method. RESULTS: The prevalence of under-reporters (UR) and over-reporters (OR) obtained by the reference (DLW) were 57.9% (n = 22) and 5.3% (n = 2), respectively. Black [3] presented the worst agreement and McCrory et al. [4] the best one to accurately classify individuals in the three categories of energy reporting. McCrory et al. [4] had the best performance in the sensitivity and specificity analyses detecting UR and plausible reporters. CONCLUSIONS: There was a high prevalence of misreporting, especially underreporting, in this sample of community-dwelling Brazilian older adults. The study showed a wide variation in the accuracy of predictive methods to handle misreporting, with none of the equations showing outstanding agreement with the reference. When DLW is not available, a valid method should be chosen to address energy intake reporting.

Estimating total daily energy requirements in community-dwelling older adults: validity of previous predictive equations and modeling of a new approach.

BACKGROUND/OBJECTIVES: Accurate estimation of energy requirements is crucial for health maintenance and prevention of malnutrition in older adults. This study aimed to assess the accuracy of predictive equations for estimating energy requirements in older adults and to test the validity of new predictive equations for this age group. SUBJECTS/METHODS: This is a cross-sectional study including 38 Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). The energy expenditure was compared to the Institute of Medicine (Dietary Reference Intake (DRI)) and Vinken et al. previous predictive equations and three predictive models developed in a modeling sample. The agreement was assessed using intra-class correlation coefficient, Bland-Altman plots, and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured energy expenditure. RESULTS: The mean (standard deviation) TEEDLW was 2656.7 (405.6) kcal/day for men and 2168.9 (376.9) for women. Vinken et al. and both DRI equations presented moderate to good degree of agreement, while the developed models vary from fair to very good agreement in comparison to DLW. The accuracy rate was the same for both DRI equations and Vinken et al. equation (60.53%). The new equations developed in this study had accuracy in predicting TEE for Brazilian older adults varying from 43.11% to 73.68%. CONCLUSIONS: The results corroborate the use of previous predictive equations for estimating energy requirements in Brazilian older adults. Further studies have the potential to explore the use of the developed models to assess energy needs in this population.

Correlations among vitamin K intake, body fat, lipid profile and glucose homeostasis in adults and the elderly.

Objective Recent research has investigated the possible inverse relationship between vitamin K intake and body fat. In addition, an increasing number of studies are supporting a key role for this vitamin in improving lipid profile and insulin sensitivity and reducing the risk of type 2 diabetes mellitus, but little is known about what mechanisms would be involved. Thus, the objective of this study was to investigate the relationship between vitamin K intake (in the form of phylloquinone - PK), body fat, lipid profile and markers of glucose homeostasis in adults and the elderly. Subjects and methods A cross-sectional study with 298 participants (46% men) in the São Paulo Health Survey 2014-2015. Spearman correlations were performed to evaluate the associations between vitamin K intake and the biochemical and body composition measures. Results Among normal-weight male adults (n = 15), PK intake presented a positive correlation with the quantitative insulin sensitivity check index (QUICKI) (r = 0.525; p = 0.045). Among men with high fat mass index (FMI) (n = 101), PK intake had a negative correlation with homeostasis model assessment estimate for ß-cell function (HOMA-ß) (r = -0.227; p = 0.022). In women with high FMI (n = 122), PK intake had a negative correlation with HOMA-ß (r = -0.199, p = 0.032) and insulin (r = -0.207, p = 0.026). No correlations were found between PK intake and lipid profile. Conclusions Our findings support a potential relationship among PK intake, body fat and markers of glucose homeostasis in adults and the elderly.

Obesidade associada às reduzidas massa magra e massa óssea: uma emergente e complexa relação envolvendo alterações bioquímicas, metabólicas e funcionais / Obesity associated with reduced lean mass and bone mass an emerging and complex relationship involving biochemical, metabolic and functional changes

Introdução - O envelhecimento traz consigo alterações da composição corporal que podem ser desencadeadas ou agravadas pelo estilo de vida. A presença simultânea da reduzida massa magra, da osteopenia (reduzida densidade óssea) e da obesidade emerge como possível fator de risco para morbimortalidade de forma mais proeminente do que quando tais parâmetros são considerados separadamente. Objetivo - Investigar a prevalência da presença concomitante da obesidade, da osteopenia e da reduzida massa magra em amostra de indivíduos a partir dos 50 anos; e avaliar se a presença simultânea dessas alterações está associada a menores concentrações de 25- hidroxivitamina D [25(OH)D], a pior perfil glicêmico e lipídico, ao reduzido gasto energético e nível de atividades físicas e à pior aptidão cardiorrespiratória. Métodos - Trata-se de estudo transversal com 218 indivíduos (52% do sexo feminino), de 63 (59 - 69) anos, participantes do ISA-Capital 2015 e ISA Nutrição 2015. A composição corporal foi obtida por DXA. Ajustou-se a massa gorda (kg) pela altura ao quadrado e a obesidade foi estabelecida quando >9kg/m2 para homens e >13kg/m2 para mulheres. A reduzida massa magra (MM) foi definida como MM apendicular/IMC

Introduction - Aging is related to changes in body composition that can be driven or worsen according to the lifestyle. Given the impact of obesity, osteopenia (low bone density), and reduced lean mass, it is suggested that their concomitant presence would even increase the risk for morbimortality. Objective - To investigate the prevalence of the concomitant obesity, low lean mass and osteopenia in a sample of adults aged from 50 years and evaluate if simultaneous disturbances on body composition are associated with lower 25-hidroxyvitamin D [25(OH)D], worse lipid and glycemic profile, lower total energy expenditure and physical activity level, and poorer cardiorespiratory fitness. Methods: This is a cross-sectional study with 218 individuals (52% female), aged 63 (59 - 69) years recruited from the ISA-Capital 2015 and ISA Nutrição 2015. Appendicular lean mass (ALM), fat mass and bone mineral density (BMD) were measured by DXA. Obesity was defined as fat mass (kg) divided by height squared >9 kg/m2 and >13kg/m2 for men and women, respectively. Low lean mass (LM) was defined as ALM/BMI

High C-reactive protein instead of metabolic syndrome is associated with lower bioimpedance phase angle in individuals clinically screened for a lifestyle modification program

BACKGROUND: Phase angle (PhA) value is a useful tool for identifying cell membrane integrity dysfunction. It is known that metabolic syndrome (MetS) increases oxidative stress and inflammation; and consequently can promote cellular damage. We hypothesized that MetS and inflammatory blood markers could be associated with lower PhA values. Therefore, the aim of this study was to identify the association of PhA values with MetS and blood markers in individuals clinically screened for a lifestyle modification program. METHODS: In a cross-sectional study, 417 selected subjects (76 men and 341 women, 53.9 ± 9.4 years old) were evaluated. Assessments included clinics, anthropometric measures, body composition by bioimpedance, and laboratory blood markers, including plasma lipids, glucose, and C-reactive protein concentrations. According to the PhA median values, subjects were classified in low (≤6.3°) and high (>6.3°) PhA groups. RESULTS: Subjects with lower PhA values were older and showed lower body mass index, waist circumference, muscle mass index, creatinine, and uric acid; and higher gamma-GT and HDL cholesterol. Neither the presence of MetS nor the presence of the increasing number of MetS components was associated with PhA values. The logistic regression analysis adjusted for age, gender, body mass index, and muscle mass index showed that higherC-reactive protein concentrations (>3.0 mg/L) increased the odds of low PhA values (OR = 1.62; CI = 1.01­2.60).CONCLUSION: Higher C-reactive protein concentrations increased the odds of low PhA independently of the presence of MetS. Additionally, contrary to our hypothesis, MetS was not associated with PhA values.

Modifiable factors of vitamin D status among a Brazilian osteoporotic population attended a public outpatient clinic.

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population.

Modifiable factors of vitamin D status among a Brazilian osteoporotic population attended a public outpatient clinic / Fatores modificáveis do status de vitamina D em uma população brasileira de osteoporóticos assistidos em um ambulatório público

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population. .

Objetivos Avaliar a concentração sérica de 25-hidroxivitamina D [25(OH)D] em pacientes osteoporóticos brasileiros e os fatores modificáveis do status de vitamina D nesta população. Sujeitos e métodos Em um estudo transversal, 363 pacientes, residentes na comunidade, que procuravam atendimento médico especializado, foram avaliados entre o outono e a primavera, em São Paulo, Brasil. Níveis séricos de 25(OH)D e paratormônio (PTH), avaliações bioquímicas e antropométricas e exames de densitometria óssea foram obtidos. O grupo foi avaliado por meio de dois questionários: um questionário abordou estilo de vida e hábitos alimentares, fototipo de pele, exposição solar, problemas médicos e os níveis de suplementação de vitamina D (colecalciferol); o outro questionário avaliou a qualidade de vida relacionada à saúde. Regressão logística e árvore de decisão foram utilizadas para avaliar a associação entre as variáveis e a adequação do status de vitamina D. Resultados A idade média da amostra foi de 67,9 ± 8,6 anos e a concentração média de 25(OH)D foi de 24,8 ng/mL. A prevalência de um status de vitamina D inadequado foi elevada (73,3%), apesar de 81,5% dos indivíduos receberem colecalciferol (dose média de 8.169 UI/semana). 25(OH)D correlacionou-se positivamente com a densidade mineral óssea do colo de fêmur e negativamente com PTH. Nas análises multivariadas, a dose de colecalciferol, a prática de exercícios físicos e o mês do ano (setembro) foram associados com a melhora do status de vitamina D. Conclusões Nesta população osteoporótica, a suplementação de 7.000 UI/semana não é suficiente para atingir a concentração desejada ...

Associação entre o padrão alimentar e a densidade mineral óssea de mulheres menopausadas com osteoporose / The association between dietary patterns and bone mineral density in postmenopausal women with osteoporosis

Introdução: A osteoporose requer estratégias para prevenir sua progressão, garantindo melhores condições de vida aos pacientes. Padrões alimentares fornecem informações sobre a influência da dieta global, contribuindo para o cuidado desses indivíduos. Objetivo: Investigar a associação entre o padrão alimentar e a densidade mineral óssea de mulheres menopausadas com osteoporose. Métodos: Trata-se de estudo transversal com 156 mulheres (> 45 anos), atendidas em ambulatório da cidade de São Paulo, Brasil. Densidade Mineral Óssea (DMO; g/cm2) da coluna (CL), fêmur total (FT), colo do fêmur (CF) e corpo total (CT) foram obtidas por absorciometria de feixe duplo. Peso (kg), estatura (m), Índice de Massa Corporal (IMC; kg/m2), gordura corporal (g), massa magra (g) e informações sobre os hábitos de vida também foram obtidos. A dieta foi avaliada por registro alimentar de 3 dias. Os padrões alimentares (PA) foram derivados via análise fatorial por componentes principais a partir de 13 grupos de alimentos. Utilizou-se regressão linear múltipla ajustada para ingestão energética e de cálcio, idade, tempo de menopausa e massa magra. Também foi conduzida ANOVA Two-way para avaliar a associação integrada dos PA com o IMC sobre a DMO, seguida de regressão linear estratificada pelas categorias de IMC. Adotou-se significância de 5 por cento . Resultados: Obteve-se 5 PA: 1) Saudável (frutas, hortaliças, tubérculos e raízes); 2) Carne vermelha e cereais refinados; 3) Laticínios magros; 4) Doces, café e chás; e 5) Ocidental (sucos artificiais, refrigerantes, snacks, pizzas, tortas e gorduras).

Introduction: Osteoporosis claims for strategies to preventing disease progression, ensuring a better quality of life to patients. Dietary patterns could provide information about the influence of overall diet on osteoporosis treatment, contributing to osteoporotic care. Objective: To investigate the association between dietary patterns and bone mineral density in postmenopausal women with osteoporosis. Methods: This cross-sectional study included 156 postmenopausal osteoporotic women, over 45 y, attended in an outpatient clinic in Sao Paulo, Brazil. Bone Mineral Density (BMD; g/cm2) of Lumbar Spine (LS), Total Femur (TF), Femoral Neck (FN), and Total Body (TB) were obtained by dual-energy X-ray absorptiometry. Weight (kg), height (m), Body Mass Index (BMI; kg/m2), body fat (g), lean mass (g) and lifestyle information were also assessed. Dietary intake was evaluated using a 3-day food diary. Dietary patterns were obtained by principal component factor in the 13 previously formed food groups. Adjusted linear regression analysis was applied in order to evaluate the predict effect of dietary patterns on BMD. Two-way ANOVA was used to investigate the association between dietary patterns and BMI with BMD, followed by a linear regression model stratified by BMI categories. Significance level was set as 5 per cent . Results: Five patterns were retained: 1) Healthy (vegetables, fruits, tubers, and tuberous roots); 2) Red meat and refined cereals; 3) Low-fat dairy; 4) Sweets, coffee and tea; and 5) Western (fats, snacks, pizzas, pies, soft drinks, and fruit drinks).

Antioxidant intake and bone status in a cross-sectional study of Brazilian women with osteoporosis.

This study aimed to investigate the association between antioxidant intake and bone mineral density (BMD) in postmenopausal women with osteoporosis. We conducted a cross-sectional study with 150 women, mean age 68.7 (SD 9.1) years. BMD and body composition were obtained using dual-energy X-ray absorptiometry (DXA). We assessed anthropometric measures and dietary intake and applied an adapted Dietary Antioxidant Quality Score (a-DAQS) to evaluate the antioxidant consumption. 65.3% of women had higher scores on the a-DAQS. We found no relationship between the a-DAQS and BMD; however, we observed an inverse correlation between vitamin A and lumbar spine (LS) BMD in g/cm(2) (r = - 0.201; p = 0.013). An analysis of variance (ANOVA) test also showed that vitamin A was negatively associated with the LS BMD (F = 6.143; p = 0.013, but without significance when a multivariate analysis was applied. The a-DAQS did not have an association with BMD; however, Vitamin A showed a negative correlation with BMD, but such an association disappeared when the other antioxidants were taken together. Our findings encourage an antioxidant-based dietary approach to osteoporosis prevention and treatment, since the negative effect of vitamin A was neutralized by the intake of such nutrients.