Plausible self-reported dietary intakes in a residential facility are not necessarily reliable

Background/Objectives: Comparing reported energy intakes with estimated energy requirements as multiples of basal metabolic rate (Ein:BMR) is an established method of identifying implausible food intake records. The present study aimed to examine the validity of self-reported food intakes believed to be plausible. Subjects/Methods: One hundred and eighty men and women were provided with all food and beverages for two consecutive days in a residential laboratory setting. Subjects self-reported their food and beverage intakes using the weighed food diary method (WDR). Investigators covertly measured subjects’ actual consumption over the same period. Subjects also reported intakes over four consecutive days at home. BMR was measured by indirect calorimetry. Results: Average reported energy intakes were significantly lower than actual intakes (11.2 and 11.8 MJ/d, respectively, P<0.001). Two-thirds (121) of the WDR were under-reported to varying degrees. Only five of these were considered as implausible using an Ein:BMR cut-off value of 1.03*BMR. Under-reporting of food and beverage intakes, as measured by the difference between reported and actual intake, was evident at all levels of Ein;BMR. Reported energy intakes were lower still (10.2 MJ/d) while subjects were at home. Conclusions: Under-recording of self-reported food intake records was extensive but very few under-reported food intake records were identified as implausible using energy intake to BMR ratios. Under-recording was evident at all levels of energy intake

Hormonal responses among normal-weight adolescents and obese teenagers undergoing laparoscopic adjustable gastric banding

Background: Bariatric procedures such as laparoscopic adjustable gastric banding (LAGB) can markedly decrease body adiposity in severely obese adolescents, but relatively little is known about the short-term effects of such procedures on meal-related hormonal response. Methods: Participants completed a fixed size breakfast meal and fasting concentrations of appetitive hormones (leptin, insulin/glucose, ghrelin, PYY) were measured. PYY, ghrelin, and visual analog scale (VAS) ratings of fullness, hunger, nausea, and desire to eat were assessed immediately before the meal and 15, 30, 60, and 90 minutes afterwards. Results: A total of 10 normal-weight controls (age: 15.4&#x00B1;2.0 years, BMI: 21.3&#x00B1;1.7 kg/m2; n=5 female) and 21 severely obese (age: 16.1&#x00B1;1.0 years, BMI: 46.4&#x00B1;6.6 kg/m2; n=18 females) adolescents were studied pre-LAGB. Eleven of the obese adolescents were studied again 122.6&#x00B1;17.8 days post-LAGB (BMI 40.9&#x00B1;7.8 kg/m2, mean change in BMI: &#x2212;3.5&#x00B1;2.5 kg/m2). In comparison to normal-weight controls, surgical candidates had significantly higher fasting insulin and leptin and lower fasting ghrelin. Fasting PYY decreased significantly post-surgery. Meal-related suppression of ghrelin, as measured by area under the curve (AUC), was significantly less in absolute value among pre-operative candidates than among normal weight controls [t(9.65)&#x200A;=&#x200A;2.90, p&#x200A;=&#x200A;0.017, d&#x200A;=&#x200A;1.29], with a trend for a decrease in AUC for candidates pre- to post-LAGB [t(10)&#x200A;=&#x200A;2.07, p&#x200A;=&#x200A;0.065, d&#x200A;=&#x200A;0.811]. No significant differences for AUC for PYY were found between normal-weight controls and surgical candidates, or surgical candidates pre- to post-LAGB. Normal-weight controls and surgical candidates did not differ by AUC for any VAS rating; however, post-LAGB, adolescents reported a significantly greater AUC for nausea [t(10)&#x200A;=&#x200A;&#x2212;&#x200A;2.58, p=0.03]. Conclusions: Despite short-term decreases in body mass index post-LAGB, few changes were observed in appetitive hormones prior to or following a standardized breakfast. In addition, subjective ratings of fullness, hunger, nausea, and desire to eat did not differ between surgical candidates and normal-weight controls, but following LAGB, adolescents reported significantly more nausea. Future studies should examine longer-term effects of LAGB on appetitive hormones

Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten‐free diet: a cross‐sectional, mixed‐methods study

Background: Certain approaches to managing a strict gluten-free diet (GFD) for coeliac disease (CD) may lead to impaired psychosocial well-being, a diminished quality of life (QOL) and disordered eating. The present study aimed to understand adolescents’ approaches to managing a GFD and the association with QOL. Methods: Thirty adolescents with CD (13–17 years old) following the GFD for at least 1 year completed the Celiac Dietary Adherence Test (CDAT) and QOL survey. Their approaches to GFD management were explored using a semi-structured interview, where key themes were developed using an iterative process, and further analysed using a psychosocial rubric to classify management strategies and QOL. CDAT ratings were compared across groups. Results: Gluten-free diet management strategies were classified on a four-point scale. Adaptive eating behaviours were characterised by greater flexibility (versus rigidity), trust (versus avoidance), confidence (versus controlling behaviour) and awareness (versus preoccupation) with respect to maintaining a GFD. Approximately half the sample (53.3%) expressed more maladaptive approaches to maintaining a GFD and those who did so were older with lower CD-Specific Pediatric Quality of Life (CDPQOL) scores, mean subscale differences ranging from 15.0 points for Isolation (t = 2.4, P = 0.03, d.f. = 28) to 23.4 points for Limitations (t = 3.0, P = 0.01, d.f. = 28). Conclusions: Adolescents with CD who manage a GFD with maladaptive eating behaviours similar to known risk factors for feeding and eating disorders experience diminished QOL. In accordance with CD management recommendations, we recommend ongoing follow-up with gastroenterologists and dietitians and psychosocial support referrals, as needed.</p