Increased resting metabolic rate in girls with Rett syndrome compared to girls with developmental disabilities.

The aim of this study was to determine the body composition and resting metabolic rate (RMR) of girls with Rett syndrome (RS) (n=15) and to compare them with an equally handicapped group of girls with developmental disabilities (DD) (n=13). Body composition was measured by bioelectrical impedance analysis and RMR - the amount of energy expended while at rest - by indirect calorimetry. Weight, height, body mass index (BMI), BMI percentiles and food intake were all measured and calculated by standardized procedures. Feeding time, ambulatory status and ability to self-feed were also assessed. Due to the sampling, there were no significant differences in age, height, weight, BMI, BMI percentiles and ambulatory status. Significant differences between groups were found for lower percentage lean body mass (LBM) (64.2±14.6 vs. 84.4±24.6) and higher absolute and relative fat mass (FM) in RS. RMR values adjusted for LBM were significantly higher in the group of girls with RS (approximately 160 kcal/day), indicating that higher energy expenditure is a component of increased risk of severely low body weight.

[Basal metabolic rate and energy expenditure in the elderly]. / Grundumsatz und Energieverbrauch im höheren Lebensalter.

The purpose of this study was to investigate energy requirements in healthy elderly subjects. Total daily energy expenditure (TEE) and resting metabolic rate (RMR) were measured by the doubly labeled water technique and indirect calorimetry in 36 healthy free living elderly men and women. Over a 15 day period additional measurements were made of dietary intake, physical activity and body composition. TEE did not differ between women and men (2941+/-439 vs 2965+/-543 kcal/d; p=ns), ranging from 2124 to 3968 kcal/d. Resting metabolic rate was significantly lower in women compared to men (1345+/-194 vs 1543+/-303 kcal/d; p=0.016). The TEE data were compared to the food diaries. Women and men underestimated their food intake significantly. TEE varies greatly within elderly subjects due to the variation in body weight and physical activity.

A study of linkage and association of body mass index in the Old Order Amish.

Obesity is thought to have a genetic component with the estimates of heritability ranging from 0.25-0.40. As part of an ongoing study of obesity in the Old Order Amish, seven two- and three-generation families (157 individuals) were assessed for 21 traits related to obesity, including body mass index (BMI) and BMI-percentile (a standardized distribution of BMI adjusted for age and sex). Genotyping was performed using a panel of 384 short-tandem repeat markers. In this sample, the estimates of heritability ranged from 0.16-0.31 for BMI and from 0.40-0.52 for BMI-percentile. Model-independent linkage analysis identified candidate regions on chromosomes 1, 5, 7, 8, and 11. Given that several markers on 7q were significant for both BMI and BMI-percentile (P < or = 0.001) and that the structural locus for leptin was located on 7q, this region was considered to be the primary candidate region. Subsequent typing of additional flanking markers on 7q corroborated the original findings. Tests of intrafamilial association for alleles at markers in this candidate region were significant at similar levels. Although there is some evidence for linkage and association in the region containing leptin, there appears to be stronger evidence for linkage (P < or = 0.001) and association (P < or = 0.00001) with BMI in a region 10-15 cM further downstream of leptin, flanked by markers D7S1804 and D7S3070 with peak values from D7S495-D7S1798. Evidence from linkage and association studies suggests that this region (D7S1804-D7S3070) may be responsible, at least in part, for variation in BMI and BMI-percentile in the Old Order Amish.

Body image in the old order Amish: a people separate from "the world".

OBJECTIVE: Body image measures were assessed among the Old Order Amish, a Protestant religious community living separate from Western industrialized society. METHOD: One hundred six Old Order Amish men (n = 50) and women (n = 56), aged 14-67 years, were studied by two measures of body image: (1) body dissatisfaction as assessed by the difference between subjects' body mass index (BMI, kg/m(2)) and the BMI that they chose as their ideal and (2) the relative accuracy of perception of body size assessed by comparing subjects' choice of body size on a Figure Rating Scale with the choice of a relative. RESULTS: Young persons and persons of normal weight of both genders showed no body dissatisfaction or inaccuracy in their perception of their body size. Older persons of both genders, on the other hand, manifested body dissatisfaction (actual BMI greater than ideal BMI). Older women also overestimated their body size. Obese persons of both genders manifested body dissatisfaction (actual BMI greater than ideal BMI) and obese men overestimated their body size. DISCUSSION: Young Amish people do not show the body image problems characteristic of young persons in Western industrial society. Their elders and obese persons may have some such problems. 2000 by John Wiley & Sons, Inc.

Reduced resting metabolic rate in athletes with menstrual disorders.

PURPOSE: This study investigated metabolic and nutritional determinants in association with menstrual disorders in athletes. Athletes with normal menstrual function (AN; N = 21) and athletes with menstrual disorders (AD: N = 12) participated in this study. METHODS: The quality of the menstrual cycle was judged according to salivary progesterone concentrations. Resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) were measured by indirect calorimetry. Body composition, energy intake and restrained eating scores were obtained. RESULTS: When adjusted for body composition by ANCOVA, RMR was significantly (approximately 460 kJ, P < 0.02) lower in athletes with menstrual disorders than in athletes without menstrual disorders. The DIT and the daily energy intake of the groups did not differ. Athletes with menstrual disturbances scored significantly higher on the Restraint Eating Scale (TFEQ). Thyroid hormones (fT3 and fT4), analyzed by a competitive chemiluminescent immunoassay, were in the normal range and not different between groups. CONCLUSIONS: The results provide evidence that restrained eating and low RMR are associated with menstrual cycle disturbances in athletes.

The Eating Inventory in obese women: clinical correlates and relationship to weight loss.

OBJECTIVES: Describe the physical and psychological correlates of the Eating Inventory (EI) (also known as the Three-Factor Eating Questionnaire) factors in an obese sample, and determine the relationship between the three EI factors and weight loss. DESIGN: Consecutive series of obese women enrolled between 1987 and 1996 in clinical trials of weight loss treatments. PARTICIPANTS: 223 obese women with a weight of 100.7 +/- 15.5 kg, an age of 41.4 +/- 8.8 y and a body mass index (BMI) of 37.2 +/- 5.6 kg/m2. MEASURES: The EI and a variety of physical (weight, body composition and resting energy expenditure) and psychological (mood and binge eating) measures were assessed before and after 5-6 months of treatment. RESULTS: Before treatment, higher restraint scores were associated with lower body weights (P = 0.02), while higher disinhibition scores were associated with greater binge eating severity (P<0.0001). Weight loss treatment was associated with significant increases in restraint and decreases in disinhibition and hunger (all Ps<0.0001). Greater increases in restraint during treatment were associated with larger weight losses (P<0.0001). CONCLUSIONS: The three factors of the EI showed clinical utility in a sample of women receiving treatment for obesity.

[Psychosomatic aspects of obesity]. / Psychosomatische Aspekte der Adipositas.

Obesity is characterised by an imbalance of caloric intake and energy expenditure. Increased caloric uptake and reduced physical activity are important. No specific psychopathology exists in obesity. Obese people view their body weight and form significantly more negative than lean controls and often experience depression and anxiety. Quality of life is often impaired. Obesity causes many disadvantages in interpersonal and social aspects. 30% of the obese subjects report binge eating. Whether binge eating should be considered as an independent syndrome is currently under discussion. The treatment of obesity is not satisfactory. Pharmacological approaches have so far failed. Behavioral therapy including dieting of different forms is not successful in long terms. 95% of the patients regain body weight within five years. Surgical therapy are very successful but should be only applied in severe obesity.

Biological and psychological correlates of intermittent dieting behavior in young women. A model for bulimia nervosa.

The eating disorder bulimia nervosa is characterized by alternating periods of strict dieting and overeating. Patients also report mood fluctuations, frequent eating related thoughts, fear of loss of control over eating, impairment of cognitive abilities such as concentration, and somatic complaints. The present study attempted to clarify to what extent these symptoms are consequences of the dieting behavior. Nine healthy young women, classified as unrestrained eaters, were set on a intermittent dieting schedule over 4 weeks. Four days each week (Tue, Wed, Thu, Fri) they had to reduce their intake below 600 kcal/day, the other 3 days they could eat without restrictions. Psychological variables were assessed by means of a standardized diary. Biological indices of starvation were also measured repeatedly. There was no substantial weight loss after the 4 weeks, although subjects had significantly increased levels of beta-hydroxybutyric acid during the dieting periods, and decreased levels of t3 after 2 weeks. The reported tendency to overeat and the actual calorie intake during the days of unlimited access to food showed a significant increase over the 4-week period. Eating-related thoughts, feelings of hunger, and fear of loss of control were significantly more frequent during periods of dieting, compared to days of normal eating. Subjects also reported worse mood, heightened irritability, difficulties concentrating, and increased fatigue. These results suggest that a substantial part of symptoms of bulimic patients might be associated with the frequent periods of an extremely restrained eating behavior.

Resting metabolic rate and diet-induced thermogenesis in restrained and unrestrained eaters.

OBJECTIVE: The hypothesis was studied whether restrained eaters had reduced resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) and whether the effect was caused by weight cycling. METHOD: 12 restrained and 12 unrestrained eaters (classified by the Three Factor Eating Questionnaire) were studied with regard to RMR an DIT by direct calorimetry using a ventilated hood system. In a second study 12 weight cycling restrained eaters and 12 weight stable restrained eaters were compared. RESULTS: Restrained eaters had significantly lower RMR than unrestrained eaters. No difference in DIT was found. Weight cycling and no weight cycling restrained eaters did not differ with regard to RMR and DIT. DISCUSSION: These data indicate that restrained eating but not weight cycling significantly reduces RMR.

Physical activity, total energy expenditure, and food intake in grossly obese and normal weight women.

The doubly labeled water method was used to measure average daily total energy expenditure (TEE) in 10 healthy normal weight women classified as unrestrained eaters and in 10 grossly obese women. The body mass index was 20.0 +/- 1.3 kg/m2 in the control group and 37.4 +/- 8.1 kg/m2 for the obese group. TEE was measured over a 2-week period. TEE was 2,357 +/- 504 kcal/day for the controls and 3,708 +/- 367 kcal/day for the obese group during a cognitive-behavioral treatment.

Resting metabolic rate and total energy expenditure in acute and weight recovered patients with anorexia nervosa and in healthy young women.

Because little is known about energy requirements in anorectic patients before and after weight gain we measured resting metabolic rate (RMR) by indirect calorimetry and total energy expenditure (TEE) by the doubly labeled water method in 6 patients with anorexia nervosa (body mass index [BMI] = 15.1 +/- 1.3 kg/m2), in 6 weight-recovered anorectics (BMI = 21.2 +/- 2.1 kg/m2), and in 12 healthy age-matched women (BMI = 20.5 +/- 1.9 kg/m2). No significant differences were found between the weight-recovered anorectic women and the healthy controls in RMR (1,330 +/- 131 kcal/day [weight-recovered]; 1,419 +/- 197 [controls]) and in TEE (2,602 +/- 637 kcal/day [weight-recovered]; 2,596 +/- 493 kcal/day [controls]). The RMR was significantly lower in the acutely ill anorectic patients (1,171 +/- 113 kcal/24 hr) than in weight-recovered anorectics and in healthy controls. The TEE was significantly lower in the anorectic group (1,946 +/- 192 kcal/day) than in the healthy controls.

Everyday eating behavior and menstrual function in young women.

OBJECTIVE: To examine the association of different types of everyday eating behavior with disturbances of menstrual function. DESIGN: Prospective cohort study with two groups, low dietary restraint (n = 13) and high dietary restraint (n = 9), identified with the Three-Factor Eating Questionnaire by Stunkard and Messick. SETTING: Research clinic. PARTICIPANTS: Normal volunteers (students and young professionals). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Frequent serum and urine samples for determination of estradiol (E2), progesterone (P), and metabolites. Food and behavioral diaries. RESULTS: Eleven of the 13 women with low dietary restraint had menstrual cycles that fulfilled the following standard criteria: Serum E2 maximum of 440 pmol/L or more, P maximum of 19 nmol/L or more, and luteal phase length of 9 days or more. Only 2 of the 9 women with high dietary restraint had cycles that satisfied these criteria. Of the remaining 7, 1 had an anovulatory cycle and 6 had decreased P concentrations (P less than 0.05) and/or a shortened luteal phase (P less than 0.02). CONCLUSIONS: High cognitive restraint in everyday eating behavior may be a risk factor for the development of menstrual disturbance in young women.

Cholecystokinin, gastrin and stress hormone responses in marathon runners.

The purpose of this investigation was to determine the influence of long-distance running on the secretion of the gastrointestinal peptide hormones cholecystokinin (CCK) and gastrin. Several known stress hormones, ACTH, cortisol and norepinephrine, were also measured. The hormones were estimated before and after a competitive marathon run of 46.5 km and under control conditions a few weeks later. Except gastrin, all hormones were significantly higher under prerun conditions than under control conditions and were highest after the run. The most marked prerun elevation was in CCK. Therefore, CCK seems to be an important regulation factor in response to anticipatory stress.

Average total energy expenditure in anorexia nervosa, bulimia nervosa, and healthy young women.

The double-labeled water method was used to measure average daily total energy expenditure (EE) in 11 healthy normal-weight women classified as unrestrained eaters, in 8 patients with anorexia nervosa, and in 8 patients with bulimia nervosa. The body mass index was 20.0 +/- 1.3 kg/m2 in the control group, 15.2 +/- 5.6 kg/m2 in the anorectic groups, and 19.7 +/- 1.9 kg/m2 in the bulimic group. EE was measured over a 2-week period during which weight remained constant in all groups and was 2357 +/- 504 kcal/day for the controls, 2510 +/- 920 kcal/day for the bulimics, and 2899 +/- 656 kcal/day for the anorectics. Differences were not significant among groups. Physical activity was recorded in diaries by all subjects. Anorectic patients showed significantly more activity than all other groups. The data suggest that EE is high in anorectic patients as a consequence of physical activity.

Energy expenditure and everyday eating behavior in healthy young women.

The doubly labeled water method was used to measure average daily total energy expenditure (EE) in 23 healthy normal-weight women classified as restrained or unrestrained eaters. Although the relative weight of restrained eaters was found to be higher (BMI 21.1 +/- 1.3 vs 20.0 +/- 1.3 kg/m2, p less than 0.03), the self-reported energy consumption of the restrained eaters, when adjusted for body composition and height, totaled approximately 410 kcal/d less energy than that of the unrestrained group (p less than 0.002). Correspondingly, the adjusted EE was found to be lower by 620 kcal/d in restrained eaters (p less than 0.005). In both groups metabolic indices of starvation (beta-hydroxybutyric acid and triiodothyronine) were in the normal range. Neither these nor weight changed from the beginning to the end of the 14-d observation period. Thus, the lower EE of the restrained group reflects diminished caloric requirements and is not an adaptive response to a temporary decrease in food intake.

Differences in food-choice frequencies between restrained and unrestrained eaters.

Reported frequency of consumption for certain food items was studied in young normal-weight women, classified into 19 unrestrained and 20 restrained eaters by the Three-Factor Eating Questionnaire of Stunkard & Messick (1985). Neither group differed in the consumption of basic foods and snacks but restrained eaters showed a strong tendency to avoid fat. A large percentage of this group was used to consuming artificial sweeteners and other calorie-reduced foodstuffs. These qualitative alterations in the everyday eating behavior of restrained eaters may be one of the links between dietary restraint and binge eating.