Publications by authors named "Lauren T Ptomey"

36 Publications

A comparison of accelerometer cut-points for measuring physical activity and sedentary time in adolescents with Down syndrome.

Res Dev Disabil 2021 Nov 24;120:104126. Epub 2021 Nov 24.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

Background: No cut-points have been developed for youth with Down syndrome; there is concern that altered gait patterns, decreased energy expenditure and exercise capacity of individuals with Down syndrome may produce inaccurate physical activity data if accelerometer data are analyzed using cut-points from populations with typical development and other IDD diagnoses.

Aim: To compare physical activity and sedentary time across existing accelerometer cut-point methods in adolescents with Down syndrome.

Methods: In this cross-sectional analysis, participants diagnosed with Down syndrome (n = 37; 15.5 ± 1.9 years; 57 % female) wore an accelerometer on their non-dominant hip for seven-days. Data were analyzed and compared across four physical activity intensity cut-points: Evenson, Freedson 4-MET, McGarty, and Romanizi.

Outcomes & Results: Differences in time spent in each intensity across cut-point methods were evident for sedentary (448-615 min/day), light (72-303 min/day) and moderate-to-vigorous (12-77 min/day) activities. Between 0.0-67.6 % of the sample met the physical activity guidelines, depending on the cut-point method selected.

Conclusions & Implications: This study presents the wide variation of accumulated physical activity minutes when different cut-points are applied to individuals with Down syndrome. There is a critical need to establish Down syndrome-specific measures of physical activity assessment rather than applying methods developed for their peers with typical development.

What This Paper Adds: This paper highlights concerns over the application of objective measurements of physical activity in youth with Down syndrome from measurement methods derived from populations with typical development. This is the first manuscript to examine this issue in a sample comprised solely of youth with Down syndrome. Results demonstrate the large variation in time spent in each activity intensity that arise due to the application of different cut-point methods.
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http://dx.doi.org/10.1016/j.ridd.2021.104126DOI Listing
November 2021

A Randomized Trial Evaluating Exercise for the Prevention of Weight Regain.

Obesity (Silver Spring) 2021 01;29(1):62-70

Department of Internal Medicine, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA.

Objective: This study aimed to evaluate the effectiveness of three levels of exercise on weight regain subsequent to clinically meaningful weight loss (WL).

Methods: Adults with overweight or obesity (n = 298) initiated a 3-month behavioral WL intervention, which included reduced energy intake, increased exercise, and weekly behavioral counseling. Participants achieving ≥5% WL (n = 235) began a 12-month behavioral WL maintenance intervention and were randomized to 150 min/wk (n = 76), 225 min/wk (n = 80), or 300 min/wk (n = 79) of partially supervised moderate-to-vigorous-intensity exercise.

Results: Participants randomized to 150, 225, and 300 minutes of exercise completed 129 ± 30, 153 ± 49 and 179 ± 62 min/wk of exercise (supervised + unsupervised), respectively. Mean WL at 3 months (9.5 ± 3.1 kg) was similar across randomized groups (P = 0.68). Weight change across 12 months was 1.1 ± 6.5 kg, 3.2 ± 5.7 kg, and 2.8 ± 6.9 kg in the 150, 225, and 300 min/wk groups, respectively. Intent-to-treat analysis revealed no significant overall trend across the three treatment groups (P = 0.09), effects for group (P = 0.08), or sex (P = 0.21).

Conclusions: This study found no evidence for an association between the volume of moderate-to-vigorous-intensity exercise and weight regain across 12 months following clinically relevant WL. Further, results suggest that exercise volumes lower than those currently recommended for WL maintenance, when completed in conjunction with a behavioral weight-maintenance intervention, may minimize weight regain over 12 months.
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http://dx.doi.org/10.1002/oby.23022DOI Listing
January 2021

Weight Loss Interventions for Adolescents With Intellectual Disabilities: An RCT.

Pediatrics 2021 09 19;148(3). Epub 2021 Aug 19.

Departments of Internal Medicine.

Objectives: In this randomized trial, we compared the effectiveness of 2 diets (enhanced stop light diet [eSLD] versus conventional meal plan diet [CD]) and 2 delivery strategies (face-to-face [FTF] versus remote delivery [RD]) on weight loss across 6 months in adolescents with intellectual and developmental disabilities who were overweight or obese.

Methods: Participants were randomly assigned to 1 of 3 arms (FTF/CD, RD/CD, or RD/eSLD) and asked to attend one-on-one sessions with a health educator every 2 weeks to aid in maintaining compliance with recommendations for a reduced-energy diet and increased physical activity. The CD followed the US dietary guidelines. The eSLD used the stop light guide and was enhanced with portion-controlled meals. The FTF arm was delivered during in-person home visits. The RD arms were delivered by using video conferencing.

Results: A total of 110 adolescents with intellectual and developmental disabilities (aged ∼16 years, 53% female, BMI 33) were randomly assigned to the FTF/CD ( = 36), RD/CD ( = 39), or RD/eSLD ( = 35) group. Body weight at 6 months was obtained from 97%, 100%, and 86% of participants in the FTF/CD, RD/CD, and RD/eSLD arms, respectively. The eSLD elicited significantly greater weight loss than the CD: RD/eSLD (-5.0 ± 5.9 kg; -6.4%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) ( = .01). However, weight loss did not differ by delivery strategy: FTF/CD (-0.3 ± 5.0 kg; -0.2%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) ( = .20).

Conclusions: The eSLD elicited significantly greater 6-month weight loss compared with a CD when both interventions were delivered remotely. Minimal 6-month weight loss, which did not differ significantly between FTF delivery and RD, was observed with a CD.
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http://dx.doi.org/10.1542/peds.2021-050261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477713PMC
September 2021

Weekly Frequency of Meeting the Physical Activity Guidelines and Cardiometabolic Health in Children and Adolescents.

Med Sci Sports Exerc 2021 Jul 30. Epub 2021 Jul 30.

Ward Family Heart Center, Children's Mercy Hospital Kansas City, Kansas City, MO School of Medicine, University of Missouri Kansas City, Kansas City, MO Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NO Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.

The current physical activity (PA) guidelines for children and adolescents in the U.S. recommend ≥60 minutes of moderate-to-vigorous intensity PA (MVPA), 7 days per week for cardiometabolic health (CmH) benefits. Although the duration and intensity components of the PA guidelines have been rigorously studied, the frequency (7 days/week) component has not been thoroughly researched.

Purpose: To examine the association of the frequency component of the weekly PA guidelines on CmH in youth.

Methods: Cross-sectional accelerometer data from the 2003-06 National Health and Nutrition Examination Survey included youth aged 6-18 years with ≥4 days, ≥10 hours of wear time, and averaging ≥60 min/day of MVPA (n = 656). Participants were categorized into quartiles based on the proportion of days where they met the guidelines (≥60 min of MVPA). CmH variables were categorized as weight status/body anthropometrics, blood pressure, cholesterol, and fasting serum labs. Propensity score weighting was applied to quartiles and general linear modeling was used to compare associations of quartiles to CmH variables.

Results: Results are displayed as percent of days meeting guidelines (DMG) (95% CI); MVPA min/week: Q1 (n = 156; DMG = 45.8% (43.4-48.1); MVPA 467.5 min/week); Q2 (n = 165; DMG = 62.6% (61.6-63.7); MVPA 474.4 min/week); Q3 (n = 148; DMG = 75% (74.1-75.8); MVPA 446.5 min/week); Q4 (n = 187; DMG = 92.2% (87.7-96.6); MVPA 453.2 min/week). After adjusting for confounders and multiple comparisons, there were no clinically significant differences in weight status/body anthropometrics, blood pressure, cholesterol, or fasting serum labs between DMG quartiles.

Conclusion: We found no association between proportion of DMG and CmH in children and adolescents. Our study suggests that achieving an overall weekly average of 60 minutes/day of MVPA appears to be sufficient for CmH regardless of the 7 day/week frequency requirement of the PA guideline.
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http://dx.doi.org/10.1249/MSS.0000000000002767DOI Listing
July 2021

Calcium, fiber, iron, and sodium intake in adolescents with intellectual and developmental disabilities and overweight and obesity.

Disabil Health J 2021 10 17;14(4):101155. Epub 2021 Jun 17.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA.

Background: Adolescents with intellectual and developmental disabilities (IDD) and overweight or obesity (OW/OB) are a nutritionally vulnerable group with increased risk of nutritional deficiencies. However, there are limited data examining micronutrient intake in adolescents with IDD and OW/OB.

Objective: The purpose of this study was to assess the adequacy of calcium, iron, fiber, and sodium intake referenced against the United States Dietary Reference Intakes in adolescents with IDD and OW/OB.

Methods: Three-day image-assisted food records were used to assess dietary intake of 64 adolescents with IDD and OW/OB. A mean ± standard deviation was calculated for mean intake of calcium (mg), fiber (g/1000 kcals energy), iron (mg), and sodium (mg).

Results: A total of 157 nutrient intake observations were completed by 64 participants (56% female, 16.3 ± 2.3 years). Calcium intake for participants ages 14-18 years (n = 57) was 1027.4 ± 607.5 mg, which is below the EAR of 1050 mg. Calcium intake for participants ages ≥19 years (n = 7) was 921.1 ± 596.4 mg, which is greater than the EAR of 840 mg. Fiber intake was 8.4 ± 3.6 g/1000 kcals, which is below the AI of 14 g/1000 kcals. Iron intake for all participants exceeded their respective EARs. Sodium intake was 3180.9 ± 975.9 mg, which above the AI of 2300 mg.

Conclusion: Calcium intake was adequate for participants ≥19 years of age, but inadequate for participants 14-18 years. For all participants, iron and sodium intake exceeded the DRI while fiber intake was below the DRI.
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http://dx.doi.org/10.1016/j.dhjo.2021.101155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448970PMC
October 2021

A dyadic approach for a remote physical activity intervention in adults with Alzheimer's disease and their caregivers: Rationale and design for an 18-month randomized trial.

Contemp Clin Trials 2020 11 23;98:106158. Epub 2020 Sep 23.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. Electronic address:

Adults with Alzheimer's disease and related dementia (ADRD) and their caregivers represent a sizeable and underserved segment of the population with low levels of moderate physical activity (MPA). Options for increasing MPA in community dwelling adults with ADRD and their caregivers are limited. A home-based physical activity intervention delivered remotely via video conferencing to groups of adults with ADRD and their caregivers (RGV), represents a potentially effective approach for increasing MPA in this group. We will conduct an 18-month randomized trial (6 mos. Active intervention, 6 mos. Maintenance, 6 mos. no contact) to compare the effectiveness of the RGV approach with usual care, enhanced with caregiver support (EUC), for increasing MPA in 100 community dwelling adults with ADRD and their caregiver. The primary aim is to compare MPA (min/wk.), assessed by accelerometer, across the 6-mo. active intervention in adults with ADRD randomized to RGV or EUC. Secondarily, we will compare adults with ADRD and their caregivers randomized to RGV or ECU on the following outcomes across 18 mos.: MPA (min/wk.), sedentary time (min/wk.), percentage meeting 150 min/wk. MPA goal, functional fitness, activities of daily living, quality of life, residential transitions, cognitive function, and caregiver burden. Additionally, we will evaluate the influence of age, sex, BMI, attendance (exercise/support sessions), use of recorded sessions, self-monitoring, peer interactions during group sessions, caregiver support, type and quality of dyadic relationship, and number of caregivers on changes in MPA in adults with ADRD and their caregiver across 18 mos.
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http://dx.doi.org/10.1016/j.cct.2020.106158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686020PMC
November 2020

Weight management for adults with mobility related disabilities: Rationale and design for an 18-month randomized trial.

Contemp Clin Trials 2020 09 6;96:106098. Epub 2020 Aug 6.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. Electronic address:

Adults with mobility related disabilities (MRDs) represent an underserved group with a high prevalence of overweight/obesity and limited options for weight management. We previously demonstrated clinically meaningful 12-month weight loss in adults with MRDs (-6.2%, 36% ≥5% of baseline weight) using an enhanced Stop Light Diet (eSLD) delivered using at home face-to-face behavioral sessions and optional physical activity. However, the costs/logistics associated with intervention delivery by individual home visits limits the potential for scaling and implementation of this approach. Thus, we will conduct a two-arm randomized trial in 128 overweight/obese adults with MRDs to compare weight loss (6 mos.) and maintenance (12 mos.) between interventions utilizing the eSLD, behavioral counseling, and increased physical activity delivered to individual participants in their homes or delivered to groups of participants in their homes remotely via video conferencing. The primary aim will compare weight loss between interventions arms across 6 months. Secondarily, we will compare weight loss (0-18 mos.), the proportion of participants who achieve clinically meaningful weight loss (≥5%) from 0 to 6 and 0 to18 months, and changes in quality of life from 0 to 6 and 0 to 18 months between interventions arms. We will also conduct cost, cost-effectiveness and contingent valuation comparisons and explore the influence of behavioral session attendance, compliance with the recommendations for diet and physical activity, self-monitoring of diet and physical activity, barriers to physical activity, sleep quality, and medications on weight change across 6 and 18 months. NCT REGISTRATION: NCT04046471.
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http://dx.doi.org/10.1016/j.cct.2020.106098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494524PMC
September 2020

The promotion of physical activity for the prevention of Alzheimer's disease in adults with Down Syndrome: Rationale and design for a 12 Month randomized trial.

Contemp Clin Trials Commun 2020 Sep 30;19:100607. Epub 2020 Jun 30.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.

Nearly all individuals with Down Syndrome (DS) display pathology associated with Alzheimer's disease (AD) beginning as early as age 30. Previous research in typically developed adults suggests that increased moderate-to-vigorous physical activity (MVPA) may improve cognitive function and protect against age-related structural and functional changes in the brain; however, the potential impact of increased MVPA on the development of AD in adults with DS has not been evaluated. Despite the potential positive impact of MVPA on cognition and AD risk, participation in MVPA among young adults with DS is low. The limited research evaluating strategies for increasing MVPA in adults with DS has been unsuccessful in increasing MVPA. Results from our preliminary investigation where we remotely delivered real-time MVPA, led by a trained health educator, to groups of adults with DS in their homes via video conferencing on a tablet computer demonstrated high attendance, increased MVPA during group sessions, and improvements in cognitive function. However, the sustainability, impact on total daily MVPA, optimal session frequency, and potential impacts on cognitive function and brain health of remotely delivered group MVPA sessions in adults with DS are unknown. Therefore, we will conduct a trial in 80 non-demented adults with DS to determine the feasibility and potential efficacy of remotely delivered group MVPA sessions to increase daily MVPA, relative to a usual care control. Secondarily we will assess the impact of MVPA on cardiovascular fitness, quality of life, cognitive function and brain parameters related to AD.

Nct Registration: NCT04048759.
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http://dx.doi.org/10.1016/j.conctc.2020.100607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334572PMC
September 2020

Weight Management in Primary Care for Children With Autism: Expert Recommendations.

Pediatrics 2020 04;145(Suppl 1):S126-S139

Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.

Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP's 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families.
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http://dx.doi.org/10.1542/peds.2019-1895PDOI Listing
April 2020

Do differences between individuals who are healthy weight or overweight on self-report measures of disinhibited eating and restrained eating reflect reality or item "bias"?

Psychol Assess 2020 Jun 19;32(6):553-567. Epub 2020 Mar 19.

Department of Internal Medicine.

In light of increasing rates of overweight and obesity worldwide, there is a critical need for accurate self-report measures of disinhibited and restrained eating behaviors across the weight spectrum. Item response theory was used to determine whether differences in disinhibited and restrained eating between healthy weight and overweight or obese individuals were due to item bias (i.e., differential item functioning). Study 1 participants were healthy weight ( = 510) or overweight or obese ( = 304) adults recruited from the community. Study 2 participants were healthy weight ( = 778) or overweight or obese ( = 320) college students. Study 1 participants completed the Eating Disorder Examination-Questionnaire (EDE-Q), Eating Disorder Inventory-3, Dutch Eating Behaviors Questionnaire, Restraint Scale, and Three-Factor Eating Questionnaire. Study 2 participants completed the Eating Pathology Symptoms Inventory (EPSI). Items on the Restraint Scale demonstrated the most evidence for bias (60% of items), whereas the majority of other scales demonstrated low to moderate levels of item bias (17-38% of items). However, EDE-Q Restraint and EPSI Binge Eating, Cognitive Restraint, Excessive Exercise, Muscle Building, and Negative Attitudes Toward Obesity scales did not show any evidence of differential item functioning among weight groups. Participants with the same level of disordered eating responded differently to certain eating disorder self-report items due to weight-bias, rather than true between-groups differences. Nevertheless, EDE-Q Restraint, EPSI Cognitive Restraint, and EPSI Binge Eating did not exhibit any evidence of bias and are ideal for assessing restrained and disinhibited eating across the weight spectrum in both research and clinical settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000810DOI Listing
June 2020

Physical activity across the curriculum (PAAC3): Testing the application of technology delivered classroom physical activity breaks.

Contemp Clin Trials 2020 03 29;90:105952. Epub 2020 Jan 29.

Weight Management, Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA. Electronic address:

Only 43% of children in the U.S., ages 6-11 yrs., meet current physical activity (PA) guidelines. To satisfy the MVPA requirement, schools have begun incorporating MVPA in the form of activity breaks or MVPA academic lessons. We completed two, 3 academic-yr. cluster randomized trials (DK61489, DK85317) called "Physical Activity Across the Curriculum" (PAAC) which involved increasing MVPA in the classroom. Across 3-yrs. teachers in PAAC schools delivered ~60 min/wk. (12 min/day) of MVPA. Although short of our MVPA goal (20 min/d), the PAAC approach substantially increased in-school MVPA. Teacher reluctance to devote additional time to develop and integrate PA lessons into their curriculum was the overwhelming barrier to meeting the MVPA goal. Therefore, to reduce barriers to delivery of classroom PA we developed a 3-academic yr. cluster randomized trial (2 yrs. active intervention, 1 yr. follow-up) to compare the effectiveness and sustainability of technology delivered (PAAC-R) and classroom teacher delivered (PAAC-T) activity breaks for increasing classroom MVPA in elementary school students in grades 2 and 3 at baseline who will progress to grades 4-5. NCT registration: NCT03493139.
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http://dx.doi.org/10.1016/j.cct.2020.105952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076720PMC
March 2020

Energy Expenditure and Intensity of Group-Based High-Intensity Functional Training: A Brief Report.

J Phys Act Health 2019 06 19;16(6):470-476. Epub 2019 May 19.

Background: High-intensity functional training (HIFT) may offer an attractive, time-efficient alternative to traditional aerobic exercise. However, limited information is available in the literature regarding HIFT meeting exercise guidelines for energy expenditure (improve health outcomes: ≥1000 kcal/wk; weight management: ≥2000 kcal/wk) and level of intensity (moderate: 3-6 metabolic equivalents [METs], vigorous: ≥6 METs) elicited by this approach. Thus, the primary aim was to objectively measure energy expenditure and intensity of HIFT sessions.

Methods: \Energy expenditure was assessed in 20 adults (18-50 y, 50% females). The HIFT session format included the following segments: warm-up (∼5 min), exercise (∼35 min), and cooldown (∼5 min). Participant oxygen consumption (COSMED, L/min and mL/kg/min), heart rate (Polar RS400), and physical activity (ActiGraph GT3X+) were collected in 15-second intervals. Average kcal per minute, METs, total kcal per session, and percent maximum heart rate (HR) were calculated.

Results: METs ranged from 5.5 to 11.6 for the complete session (including warm-up and cooldown). Participant's HR was ∼80% (range: 69%-100%). Average energy expenditure was ∼485 kcal per session (∼1400 kcal/wk). The vigorous-intensity exercise portion (∼35 min) contributed to 80% of total energy expenditure.

Conclusions: HIFT has the potential to meet the recommendations for exercise to improve health outcomes.
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http://dx.doi.org/10.1123/jpah.2017-0585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746154PMC
June 2019

The Feasibility of Remotely Delivered Exercise Session in Adults With Alzheimer's Disease and Their Caregivers.

J Aging Phys Act 2019 09 1;27(5):670–677. Epub 2019 Sep 1.

Adults with Alzheimer's disease (AD) and their caregivers represent a segment of the population with low levels of moderate-intensity physical activity (MPA) and limited options for increasing MPA. The purpose of this study was to evaluate the feasibility of a group video conference approach for increasing MPA in adults with AD and their caregivers. Adults with AD and their caregivers attended 30-min group exercise sessions three times per week for 12 weeks. Exercise sessions and support sessions were delivered in their homes on a tablet computer over video conferencing software. Nine adults with AD/caregiver dyads enrolled, and seven completed the 12-week intervention. Adults with AD attended 77.3% of the group exercise sessions, and caregivers attended 79.2% of group exercise sessions. Weekly MPA increased in both adults with AD (49%) and caregivers (30%). Exercise delivered by group video conferencing is a feasible and potentially effective approach for increasing MPA in adults with AD and their caregivers.
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http://dx.doi.org/10.1123/japa.2018-0298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891121PMC
September 2019

Dietary Intake and Physical Activity Assessment: Current Tools, Techniques, and Technologies for Use in Adult Populations.

Am J Prev Med 2018 10;55(4):e93-e104

Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.

Accurate assessment of dietary intake and physical activity is a vital component for quality research in public health, nutrition, and exercise science. However, accurate and consistent methodology for the assessment of these components remains a major challenge. Classic methods use self-report to capture dietary intake and physical activity in healthy adult populations. However, these tools, such as questionnaires or food and activity records and recalls, have been shown to underestimate energy intake and expenditure as compared with direct measures like doubly labeled water. This paper summarizes recent technological advancements, such as remote sensing devices, digital photography, and multisensor devices, which have the potential to improve the assessment of dietary intake and physical activity in free-living adults. This review will provide researchers with emerging evidence in support of these technologies, as well as a quick reference for selecting the "right-sized" assessment method based on study design, target population, outcome variables of interest, and economic and time considerations.

Theme Information: This article is part of a theme issue entitled Innovative Tools for Assessing Diet and Physical Activity for Health Promotion, which is sponsored by the North American branch of the International Life Sciences Institute.
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http://dx.doi.org/10.1016/j.amepre.2018.06.011DOI Listing
October 2018

Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial.

Contemp Clin Trials 2018 10 24;73:16-26. Epub 2018 Aug 24.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA. Electronic address:

Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0-6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.
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http://dx.doi.org/10.1016/j.cct.2018.08.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176482PMC
October 2018

Remote Exercise for Adults with Down Syndrome.

Transl J Am Coll Sports Med 2018 Apr;3(8):60-65

Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS.

Purpose: Adults with Down syndrome are less physically active than their typically developed peers. The purpose of this study was to assess the feasibility of delivering moderate-to- vigorous exercise sessions, led by a trained health educator using real-time video conferencing, to groups of young adults with Down syndrome in their homes.

Methods: Participants were randomized to 30-minute group exercise sessions either 1 or 2 times a week delivered on an iPad mini tablet computer using the Zoom video conferencing application, and were asked to attend individual support/education sessions once a week using FaceTime on the iPad, for 12 weeks. Minutes of MVPA during all group sessions were assessed using a Fitbit Charge HR activity/heart rate monitor. Participants were also asked to complete weekly homework assignments involving MVPA.

Results: Twenty-seven participants (n = 14,1 session·wk, n =13, 2 sessions·wk), mean age 27.9 ± 7.1 yrs., ~ 41% female, enrolled in and completed the 12-wk. intervention. Attendance at group exercise and individual support/education sessions did not differ significantly between those randomized to 1 (exercise sessions =89.9 ± 8.8%, support/education sessions = 81.2 ±18.7%) or 2 sessions·wk (exercise sessions = 88.8 ± 7.7%; =0.79, support/education sessions= 86.0 ± 20.9%; =0.87). Participants averaged 27.7 ± 5.7 mins·session of MVPA with no significant difference between the 1 (26.6 ± 3.0 mins·session) and 2 session·wk groups (28.8 ± 7.7 mins·session, =0.16). The completion rate for homework assignments did not differ significantly between the 1 (21.4 ± 26.3%) and 2 session·wk groups (37.7 ± 21.7%, =0.28).

Conclusion: Exercise delivered by group video conferencing may be a feasible and potentially effective approach for increasing MVPA in adults with Down syndrome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005664PMC
April 2018

Changes in cognitive function after a 12-week exercise intervention in adults with Down syndrome.

Disabil Health J 2018 07 26;11(3):486-490. Epub 2018 Feb 26.

Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, 66160, USA. Electronic address:

Background: Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cognition, including memory.

Objective: The purpose of this study was to evaluate changes in cognitive function after completion of a 12-week exercise intervention in adults with DS.

Methods: Participants were randomized to attend 30-minute group exercise sessions 1 or 2 times a week for 12 weeks. The exercise sessions were delivered via video conferencing on a tablet computer to groups of 5-8 participants. Sessions consisted of aerobic based exercises such as walking and jogging to music, dancing, as well as strength based exercises such as vertical jumps, bicep curls, and squats. Cognitive function was measured at baseline and end of study using the Cantab Dementia Battery for iPads, which assessed the cognitive domains of memory, attention, and reaction time.

Results: Twenty-seven participants (27.9 ± 7.1 years of age, 40.7% female) enrolled and completed the 12-week intervention. Participants randomized to 1 session/week averaged 26.6 ± 3.0 min/week of PA from the group exercise session. Participants randomized to 2 sessions/week averaged 57.7 ± 15.3 min/week of PA from the group exercise sessions. Participants improved their performance on the two memory variables (p = 0.048 and p = 0.069).

Conclusion: Increased exercise may have positive changes on memory and other cognitive functions.
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http://dx.doi.org/10.1016/j.dhjo.2018.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005720PMC
July 2018

Changes in Energy Intake and Diet Quality during an 18-Month Weight-Management Randomized Controlled Trial in Adults with Intellectual and Developmental Disabilities.

J Acad Nutr Diet 2018 06 6;118(6):1087-1096. Epub 2018 Jan 6.

Background: Previous research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality.

Objective: The purpose of this secondary analysis was to determine whether two different weight-loss diets affect energy intake, macronutrient intake, and diet quality as measured by the Healthy Eating Index-2010 (HEI-2010) during a 6-month weight-loss period and 12-month weight-management period, and to examine differences in energy intake, macronutrient intake, and HEI-2010 between groups.

Design: Overweight/obese adults with IDDs took part in an 18-month randomized controlled trial and were assigned to either an enhanced Stop Light Diet utilizing portion-controlled meals or a conventional diet consisting of reducing energy intake and following the 2010 Dietary Guidelines for Americans. Proxy-assisted 3-day food records were collected at baseline, 6 months, and 18 months, and were analyzed using Nutrition Data System for Research software. HEI-2010 was calculated using the data from Nutrition Data System for Research.

Participants/setting: The study took place from June 2011 through May 2014 in the greater Kansas City metropolitan area.

Main Outcome Measures: This was a secondary analysis of a weight-management intervention for adults with IDDs randomized to an enhanced Stop Light Diet or conventional diet, to examine differences in energy intake, macronutrient intake, and HEI-2010 across time and between groups.

Statistical Analyses Performed: Independent- and paired-samples t tests and general mixed modeling for repeated measures were performed to examine group differences and changes at baseline, 6 months, and 18 months between the enhanced Stop Light Diet and conventional diet groups.

Results: One hundred and forty six participants (57% female, mean±standard deviation age=36.2±12.0 years) were randomized to either the enhanced Stop Light Diet or conventional diet group (77 enhanced Stop Light Diet, 69 conventional diet) and provided data for analysis at baseline, 124 completed the 6-month weight-loss period, and 101 completed the 18-month study. Participants on the enhanced Stop Light Diet diet significantly reduced energy intake at 6 and 18 months (both P<0.001), but those on the conventional diet did not (both P=0.13). However, when accounting for age, sex, race, education level, and support level (mild vs moderate IDD), there was a significant decrease during the 18-month intervention in energy intake for the enhanced Stop Light Diet and conventional diet groups combined (P<0.01 for time effect), but no significant group difference in this change (P=0.39 for group-by-time interaction). There was no significant change in total HEI-2010 score at 6 and 18 months (P=0.05 and P=0.38 for the enhanced Stop Light Diet group; P=0.22 and P=0.17 for the conventional diet group), and no significant group difference at 6 and 18 months (P=0.08 and P=0.42). However, when participants' age, sex, race, education level, and support level were accounted for, mixed modeling indicated a significant increase in total HEI-2010 scores for the enhanced Stop Light Diet and conventional diet groups combined during the 18-month intervention (P=0.01 for time effect).

Conclusions: The results of this study found that after controlling for demographic factors, individuals with IDDs can decrease their energy intake and increase their diet quality, with no significant differences between the enhanced Stop Light Diet and conventional diet groups.
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http://dx.doi.org/10.1016/j.jand.2017.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971127PMC
June 2018

The Feasibility of Group Video Conferencing for Promotion of Physical Activity in Adolescents With Intellectual and Developmental Disabilities.

Am J Intellect Dev Disabil 2017 11;122(6):525-538

Richard A. Washburn and Joseph E. Donnelly, Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center.

Physical activity (PA) rates of adolescents with intellectual and developmental disabilities (IDD) are low and effective strategies for increasing PA are limited. The purpose of this study was to assess the feasibility of a group-based PA intervention that was delivered remotely to adolescents with IDD. Participants attended 30-min group PA sessions 3 times a week. PA sessions were delivered in their homes by video conferencing on a tablet computer. Thirty-one participants enrolled and 29 completed the 12-week intervention. Participants attended 77.2% ± 20.8% of scheduled sessions and averaged 26.7 ± 2.8 min of PA/session, with 11.8 ± 4.8 min at moderate- to vigorous intensity. Group-based PA delivered remotely may be a feasible approach for the promotion of PA in adolescents with IDD.
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http://dx.doi.org/10.1352/1944-7558-122.6.525DOI Listing
November 2017

Distance learning strategies for weight management utilizing online social networks versus group phone conference call.

Obes Sci Pract 2017 06 5;3(2):134-142. Epub 2017 May 5.

Cardiovascular Research Institute, Department of Internal Medicine University of Kansas Medical Center Kansas City KS USA.

Objective: The increase in technology and online social networks (OSNs) may present healthcare providers with an innovative modality for delivering weight management programmes that could have an impact on health care at the population level. The objective of this study was to evaluate the feasibility and efficacy of using an OSN to deliver a weight loss programme to inform future, large-scale trials.

Methods: Seventy individuals (age = 47 ± 12.4, minority = 24.3%) with obesity (BMI = 36.2 ± 4.0) completed a 6-month weight loss intervention and were randomized to either a conference call or OSN delivery group. Weight loss was achieved by reducing energy intake by 500-700 kcal·d below estimated total daily energy expenditure and progressing physical activity to 300 min/week. Behavioural weight loss strategies were delivered weekly throughout the intervention.

Results: Conference call and OSN groups produced clinically meaningful weight loss of ≥5% from baseline to 6 months (phone = -6.3 ± 6.4%, OSN = -5.8 ± 6.7%). There was no significant difference in weight change between groups ( = 0.765).

Conclusion: The phone and OSN groups met the American Heart Association/American College of Cardiology/The Obesity Society's Guidelines by reducing baseline weight by 5-10% within 6 months. OSNs appear to be a viable delivery platform for weight loss interventions; however, larger scale adequately powered trials are needed.
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http://dx.doi.org/10.1002/osp4.96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478801PMC
June 2017

Weight management in adults with intellectual and developmental disabilities: A randomized controlled trial of two dietary approaches.

J Appl Res Intellect Disabil 2018 Jan 23;31 Suppl 1:82-96. Epub 2017 Mar 23.

Cardiovascular Research Institute, Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.

Background: The prevalence of obesity among individuals with intellectual and developmental disabilities (IDD) is equal to or greater than the general population.

Methods: Overweight/obese adults (BMI ≥25 kg/m ) with mild-to-moderate intellectual and developmental disabilities were randomized to an enhanced stop light diet (eSLD = SLD + portion-controlled meals, n = 78) or a conventional diet (CD, n = 72) for an 18 months trial (6 months weight loss, 12 months maintenance). Participants were asked to increase physical activity (150 min/week), self-monitor diet and physical activity and attend counselling/educational sessions during monthly home visits.

Results: Weight loss (6 months) was significantly greater in the eSLD (-7.0% ± 5.0%) compared with the CD group (-3.8% ± 5.1%, p < .001). However, at 18 months, weight loss between groups did not differ significantly (eSLD = -6.7% ± 8.3%; CD = 6.4% ± 8.6%; p = .82).

Conclusion: The eSLD and CD provided clinically meaningful weight loss over 18 months in adults with intellectual and developmental disabilities.
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http://dx.doi.org/10.1111/jar.12348DOI Listing
January 2018

Response to Letter to the Editor.

J Nutr Educ Behav 2016 09;48(8):598

Cardiovascular Research Institute, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.

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http://dx.doi.org/10.1016/j.jneb.2016.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215045PMC
September 2016

Assessing the Nutrition Literacy of Parents and Its Relationship With Child Diet Quality.

J Nutr Educ Behav 2016 Jul-Aug;48(7):505-509.e1. Epub 2016 May 20.

Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS.

Objective: To estimate the reliability and validity of the Nutrition Literacy Assessment Instrument for Parents (NLit-P) and to investigate relationships among parental nutrition literacy, parental and child body mass index, and child diet quality (Healthy Eating Index).

Methods: Cross-sectional study of 101 parent-child dyads that collected measures of socioeconomic status, nutrition literacy, 2 24-hour child diet recalls, and body mass index. Reliability of NLit-P was assessed by confirmatory factor analysis. Pearson correlation and multiple linear regression were used.

Results: Fair to substantial reliability was seen across 5 NLit-P domains, whereas Pearson correlations support concurrent validity for the NLit-P related to child diet quality and parental income, age, and educational attainment (P < .001). For every 1% increase in NLit-P, there was a 0.51 increase in child Healthy Eating Index (multivariate coefficient, 0.174; P < .001).

Conclusions And Implications: The NLit-P demonstrates potential for measuring parental nutrition literacy, which may be an important educational target for improving child diet quality.
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http://dx.doi.org/10.1016/j.jneb.2016.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931947PMC
November 2017

Distance learning strategies for weight management utilizing social media: A comparison of phone conference call versus social media platform. Rationale and design for a randomized study.

Contemp Clin Trials 2016 Mar 12;47:282-8. Epub 2016 Feb 12.

University of Kansas Medical Center, Cardiovascular Research Institute, Division of Internal Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA. Electronic address:

Management of obesity in the context of the primary care physician visit is of limited efficacy in part because of limited ability to engage participants in sustained behavior change between physician visits. Therefore, healthcare systems must find methods to address obesity that reach beyond the walls of clinics and hospitals and address the issues of lifestyle modification in a cost-conscious way. The dramatic increase in technology and online social networks may present healthcare providers with innovative ways to deliver weight management programs that could have an impact on health care at the population level. A randomized study will be conducted on 70 obese adults (BMI 30.0-45.0 kg/m(2)) to determine if weight loss (6 months) is equivalent between weight management interventions utilizing behavioral strategies by either a conference call or social media approach. The primary outcome, body weight, will be assessed at baseline and 6 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity will be assessed on the same schedule. In addition, a cost analysis and process evaluation will be completed.
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http://dx.doi.org/10.1016/j.cct.2016.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4889333PMC
March 2016

Do weight management interventions delivered by online social networks effectively improve body weight, body composition, and chronic disease risk factors? A systematic review.

J Telemed Telecare 2017 Feb 9;23(2):263-272. Epub 2016 Jul 9.

Cardiovascular Research Institute, Division of Internal Medicine, Kansas City, USA.

Introduction Currently, no systematic review/meta-analysis has examined studies that used online social networks (OSN) as a primary intervention platform. Therefore, the purpose of this review was to evaluate the effectiveness of weight management interventions delivered through OSN. Methods PubMed, EMBASE, PsycINFO, Web of Science, and Scopus were searched (January 1990-November 2015) for studies with data on the effect of OSNs on weight loss. Only primary source articles that utilized OSN as the main platform for delivery of weight management/healthy lifestyle interventions, were published in English language peer-reviewed journals, and reported outcome data on weight were eligible for inclusion in this systematic review. Five articles were included in this review. Results One-hundred percent of the studies ( n = 5) reported a reduction in baseline weight. Three of the five studies (60%) reported significant decreases in body weight when OSN was paired with health educator support. Only one study reported a clinical significant weight loss of ≥5%. Conclusion Using OSN for weight management is in its early stages of development and, while these few studies show promise, more research is needed to acquire information about optimizing these interventions to increase their efficacy.
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http://dx.doi.org/10.1177/1357633X16630846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985486PMC
February 2017

Breakfast Intake and Composition Is Associated with Superior Academic Achievement in Elementary Schoolchildren.

J Am Coll Nutr 2016 May-Jun;35(4):326-33. Epub 2015 Dec 23.

a Cardiovascular Research Institute, Division of Internal Medicine.

Objective: To determine whether breakfast consumption or content affects academic achievement measured by standardized tests.

Methods: Baseline data were collected in fall of 2011 from 698 students (50.5% female, age = 7.5 ± 0.6 years) living in the state of Kansas. Academic achievement was assessed using 3 components from the Wechsler Individual Achievement Test (WIAT-III). Prior to taking the WIAT-III, participants completed a breakfast recall of all foods and drinks consumed that morning, which was analyzed using Nutrition Data System for Research (NDS-R). WIAT-III scores were compared between breakfast and non-breakfast consumers in a sample (n = 162) matched for age, sex, race, education level of both parents, household income, body mass index (BMI), and cardiovascular fitness, and Pearson correlations were calculated from all breakfast eaters (n = 617) between test performance and components of the breakfast.

Results: When compared to non-breakfast consumers, the breakfast consumers had significantly higher scores in all 3 WIAT-III components (all p < 0.05). In breakfast consumers, servings of fruit juice were negatively correlated with reading comprehension and fluency standard score and mathematics standard score (both p < 0.0001), and greater servings of whole grains were significantly related to higher scores in reading comprehension and fluency and mathematics (both p < 0.05).

Conclusion: Both breakfast consumption and the content may be associated with improved standardized test performance in elementary school students.
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http://dx.doi.org/10.1080/07315724.2015.1048381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896496PMC
February 2017

Parents' perspective on weight management interventions for adolescents with intellectual and developmental disabilities.

Disabil Health J 2016 Jan 23;9(1):162-6. Epub 2015 Jul 23.

Cardiovascular Research Institute, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.

Background: Adolescents with intellectual and developmental disabilities (IDD) have high rates of obesity. However, little research has been conducted demonstrating effective strategies and barriers for weight loss or weight management in adolescents with IDD. Furthermore, parents play a large role in terms of weight management in children and adolescents with IDD, and their views should be taken into consideration when designing a diet and PA intervention for weight management.

Objective: The aims of this study are to better understand the parents' perspectives on the strategies and barriers for helping children and adolescents with IDD be successful in a weight management program and to identify how this information to guide future approaches.

Methods: Semi-structured interviews were conducted in 18 parents whose children had just finished a diet and PA intervention. Interviews were transcribed verbatim, and thematic analysis was performed.

Results: Parents reported a positive attitude toward the program, liked the convenience of the program, and felt that they learned beneficial strategies to encourage healthy habits in the home. Parents found time to be a major barrier to supporting their child with a diet and PA intervention. Parents were willing to change their own dietary behaviors to help their children successfully follow a weight loss intervention; however, no parent reported changing their own PA levels.

Conclusion: Future diet and PA studies should aim to reduce parental time commitment and increase importance of PA.
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http://dx.doi.org/10.1016/j.dhjo.2015.07.003DOI Listing
January 2016

Predicting resting energy expenditure in young adults.

Obes Res Clin Pract 2016 May-Jun;10(3):304-14. Epub 2015 Jul 22.

University of Kansas Medical Center, Kansas City, KS, USA.

Purpose: To develop and validate a REE prediction equation for young adults.

Methods: Baseline data from two studies were pooled (N=318; women=52%) and randomly divided into development (n=159) and validation samples (n=159). REE was measured by indirect calorimetry. Stepwise regression was used to develop an equation to predict REE (University of Kansas (KU) equation). The KU equation and 5 additional REE prediction equations used in clinical practice (Mifflin-St. Jeor, Harris-Benedict, Owens, Frankenfield (2 equations)) were evaluated in the validation sample.

Results: There were no significant differences between predicted and measured REE using the KU equation for either men or women. The Mifflin-St. Jeor equation showed a non-significant mean bias in men; however, mean bias was statistically significant in women. The Harris-Benedict equation significantly over-predicted REE in both men and women. The Owens equation showed a significant mean bias in both men and women. Frankenfield equations #1 and #2 both significantly over-predicted REE in non-obese men and women. We found no significant differences between measured REE and REE predicted by the Frankenfield #2 equations in obese men and women.

Conclusion: The KU equation, which uses easily assessed characteristics (age, sex, weight) may offer better estimates of REE in young adults compared with the 5 other equations. The KU equation demonstrated adequate prediction accuracy, with approximately equal rates of over and under-prediction. However, enthusiasm for recommending any REE prediction equations evaluated for use in clinical weight management is damped by the highly variable individual prediction error evident with all these equations.
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http://dx.doi.org/10.1016/j.orcp.2015.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867535PMC
November 2017

Validity of energy intake estimated by digital photography plus recall in overweight and obese young adults.

J Acad Nutr Diet 2015 Sep 26;115(9):1392-9. Epub 2015 Jun 26.

Background: Recent reports have questioned the adequacy of self-report measures of dietary intake as the basis for scientific conclusions regarding the associations of dietary intake and health, and reports have recommended the development and evaluation of better methods for the assessment of dietary intake in free-living individuals. We developed a procedure that used pre- and post-meal digital photographs in combination with dietary recalls (DP+R) to assess energy intake during ad libitum eating in a cafeteria setting.

Objective: To compare mean daily energy intake of overweight and obese young adults assessed by a DP+R method with mean total daily energy expenditure assessed by doubly labeled water (TDEE(DLW)).

Methods: Energy intake was assessed using the DP+R method in 91 overweight and obese young adults (age = 22.9±3.2 years, body mass index [BMI; calculated as kg/m(2)]=31.2±5.6, female=49%) over 7 days of ad libitum eating in a university cafeteria. Foods consumed outside the cafeteria (ie, snacks, non-cafeteria meals) were assessed using multiple-pass recall procedures, using food models and standardized, neutral probing questions. TDEE(DLW) was assessed in all participants over the 14-day period.

Results: The mean energy intakes estimated by DP+R and TDEE(DLW) were not significantly different (DP+R=2912±661 kcal/d; TDEE(DLW)=2849±748 kcal/d, P=0.42). The DP+R method overestimated TDEE(DLW) by 63±750 kcal/d (6.8±28%).

Conclusion: Results suggest that the DP+R method provides estimates of energy intake comparable to those obtained by TDEE(DLW).
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http://dx.doi.org/10.1016/j.jand.2015.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555004PMC
September 2015

Position of the Academy of Nutrition and Dietetics: nutrition services for individuals with intellectual and developmental disabilities and special health care needs.

J Acad Nutr Diet 2015 Apr;115(4):593-608

Texas Scottish Rite Hospital for Children, Dallas, TX.

It is the position of the Academy of Nutrition and Dietetics that nutrition services provided by registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs), who work under RDN supervision, are essential components of comprehensive care for adults with intellectual and developmental disabilities (IDD) and children and youth with special health care needs (CYSHCN). Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community based, and culturally competent. Individuals with IDD and CYSHCN have many risk factors requiring nutrition interventions, including growth alterations (eg, failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, drug-nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Furthermore, these individuals are also more likely to develop comorbid conditions, such as obesity or endocrine disorders that require nutrition interventions. Poor nutrition-related health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Timely and cost-effective nutrition interventions can promote health maintenance and reduce risk and cost of comorbidities and complications. Public policy for individuals with IDD and CYSHCN has evolved, resulting in a transition from institutional facilities and programs to community and independent living. The expansion of public access to technology and health information on the Internet challenges RDNs and NDTRs to provide accurate scientific information to this rapidly growing and evolving population. RDNs and NDTRs with expertise in this area are best prepared to provide appropriate nutrition information to promote wellness and improve quality of life.
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http://dx.doi.org/10.1016/j.jand.2015.02.002DOI Listing
April 2015
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