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Håglin, Lena
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Publications (10 of 31) Show all publications
Håglin, L., Bäckman, L., Linder, J., Forsgren, L. & Domellöf, M. (2018). Early Recognition of Cognitive Ability and Nutritional Markers for Dementia in Parkinson’s Disease. Journal of Aging Research & Clinical Practice, 7, 156-162
Open this publication in new window or tab >>Early Recognition of Cognitive Ability and Nutritional Markers for Dementia in Parkinson’s Disease
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2018 (English)In: Journal of Aging Research & Clinical Practice, ISSN 2258-8094, Vol. 7, p. 156-162Article in journal (Refereed) Published
Abstract [en]

Background: Cognitive decline and dementia are common non-motor problems in Parkinson’s disease (PD). The underlying aetiology is multifaceted and both chronic and reversible causes for cognitive decline are likely to be present. Malnutrition is frequent in the Parkinson population, both early and late in the disease, and nutritional deficiencies could play a role in some cognitive deficits. Objectives: The objective is to study the association between nutritional status with focus on iron intake and homeostasis, mild cognitive impairment (MCI), and PD dementia (PDD). Setting and Participants: This study included 73 out of 145 patients with PD participating in a population-based study in northern Sweden. Measurements: Registration of nutritional status by laboratory analyses of blood plasma and neuropsychological assessments at time of diagnosis were performed. MCI and PDD were assessed yearly up to ten years after diagnosis. Mini Nutritional Assessments (Full-MNA score) and plasma variables detecting iron homeostasis were compared between patients with MCI and patients with normal cognition (NC). Motor severity was measured using the Unified Parkinson´s disease rating scale III, (UPDRS III) and Hoehn and Yahr (H&Y) staging scale. Cox proportional Hazard model were performed to see if any variables that differed between MCI and NC could predict PDD at follow-up. Results: Patients with MCI at time of diagnosis had lower levels of plasma iron (P-Fe) and albumin (P-Albumin) as well as a lower score on Full-MNA score. Dietary intake of iron was higher in patients with MCI than in patients with NC (p = 0.012). In logistic regression models adjusted for age, sex, and UPDRS III, lower levels of P-Fe (p = 0.025) and P-Albumin (p = 0.011) and higher dietary iron intake (p = 0.019) were associated with MCI at baseline. A Cox regression model with dementia as endpoint revealed that lower levels of P-Fe increase the risk of dementia at follow-up with adjustments for age, sex, UPDRS III, and MCI at baseline (HR 95% CI = 0.87 (0.78-0.98), p = 0.021). Conclusions: Low P-Fe was associated with cognitive disturbance at baseline and predicted dementia up to ten years after diagnosis in patients with PD. Low P-Albumin and malnutrition assessed with Full-MNA score were associated with MCI at baseline but did not predict dementia at follow-up.

Place, publisher, year, edition, pages
Auzeville-Tolosane: SERDI, 2018
Keywords
Cognition, dementia, iron deficiency, Parkinson’s disease
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-159274 (URN)10.14283/jarcp.2018.26 (DOI)
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-05-24Bibliographically approved
Farooqi, N., Carlsson, M., Håglin, L., Sandström, T. & Slinde, F. (2018). Energy expenditure in women and men with COPD. Clinical Nutrition ESPEN, 28, 171-178
Open this publication in new window or tab >>Energy expenditure in women and men with COPD
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2018 (English)In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 28, p. 171-178Article in journal (Refereed) Published
Abstract [en]

Background: Many patients with chronic obstructive pulmonary disease (COPD) lose weight. Successful nutritional intervention is vital, thus assessment of energy requirement is required. The aim of this study was to present an improved possibility to assess energy requirement in patients with COPD.

Methods: Pub Med search was conducted for all the studies reporting total energy expenditure (TEE) measured by doubly labeled water (DLW) method in patients with COPD. Four studies were identified, whereof three were conducted in Sweden. The present analysis is based on these three studies of which the data was acquired.

Results: There was a large variation in resting metabolic rate (RMR) and TEE. Body mass index decreased significantly with increase in disease severity (p < .001), and correlated significantly to forced expiratory volume in 1 s (FEV1) % predicted (r = .627, p < .001). FEV1% predicted had a significant correlation with RMR/kg body weight (BW)/day (r = -.503, p = .001), RMR/kg fat-free mass (FFM)/day (r = .338, p = .031), and TEE/kg FFM/day (r = .671, p < .001). Compared to men, women had a lower RMR and TEE/kg BW/day (p < .001 respectively p = .002), and higher RMR and TEE/kg FFM/day (p = .080 respectively p = .005). The correlates of: RMR/kg BW were gender and FEV1% predicted; of TEE/kg BW the correlates were age and gender, and of TEE/kg FFM the correlates were age and FEV1% predicted.

Conclusion: In this study, we have presented a possibility to assess energy requirement per kg BW/day and per kg FFM/day in patients with COPD in clinical settings. However, gender, age, and disease severity must be considered. 

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Energy expenditure in COPD, Doubly labeled water and COPD, FEV1 and energy expenditure
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-153541 (URN)10.1016/j.clnesp.2018.08.008 (DOI)000448887100025 ()30390877 (PubMedID)
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2019-08-21Bibliographically approved
Håglin, L., Johansson, I., Forsgren, L. & Bäckman, L. (2017). Intake of vitamin B before onset of Parkinson's disease and atypical parkinsonism and olfactory function at the time of diagnosis. European Journal of Clinical Nutrition, 71, 97-102
Open this publication in new window or tab >>Intake of vitamin B before onset of Parkinson's disease and atypical parkinsonism and olfactory function at the time of diagnosis
2017 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, p. 97-102Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/OBJECTIVES: To investigate whether vitamin-B density in the diet 2-8 years before diagnosis is associated with olfactory function at the time of diagnosis.

SUBJECTS/METHODS: This prospective nested case-control study included patients with Parkinson's disease (PD), multiple system atrophy and progressive supranuclear paralysis identified between 2004 and 2009 in the county of Västerbotten in northern Sweden. The case database (NYPUM study; Newly Diagnosed Parkinson in Umeå; n=147) was cross-linked to the Northern Sweden Health and Disease Study (NSHDS). Identified patients (n=96) and controls (n=375) were matched for sex, age, year of health survey, sub-cohort and geographical area. Dietary intake was assessed by a food frequency questionnaire, and the brief smell identification test (B-SIT) was used to measure olfactory function at the time of diagnosis.

RESULTS: There was no difference in vitamin-B or any other macro- or micro-nutrient densities, energy intake or body mass index (kg/m(2); BMI) between patients and controls at baseline at the time of the healthcare survey. A lower thiamin and folate density, amount per 1 megajoule, was reported in patients who scored below median on B-SIT (<7) when compared with that in patients who scored ⩾7 at the time of diagnosis. After adjusting for age, sex and BMI using linear and logistic regressions, an even stronger association was found between thiamin density and olfactory function.

CONCLUSIONS: A low thiamin and folate density in the reported diet, 2-8 years before PD diagnosis, was significantly associated with olfactory dysfunction at the time of PD diagnosis.European Journal of Clinical Nutrition advance online publication, 5 October 2016; doi:10.1038/ejcn.2016.181.

National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-129176 (URN)10.1038/ejcn.2016.181 (DOI)000394023900016 ()27703161 (PubMedID)
Available from: 2016-12-21 Created: 2016-12-21 Last updated: 2018-06-09Bibliographically approved
Håglin, L. & Bäckman, L. (2016). Covariation between plasma phosphate and daytime cortisol in early Parkinson's disease. Brain and Behavior, 6(12), Article ID e00556.
Open this publication in new window or tab >>Covariation between plasma phosphate and daytime cortisol in early Parkinson's disease
2016 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 6, no 12, article id e00556Article in journal (Refereed) Published
Abstract [en]

Background: Disturbed phosphate homeostasis in early Parkinson′s disease (PD) may originate from a stress-related condition and nutritional status among other risk factors, age, and gender.

Methods: Risk of malnutrition using Mini-nutritional assessment (MNA score) and plasma levels of protein markers and daytime cortisol at the time of diagnosis in PD (n = 75) were compared with a control group (n = 24). Cognition was assessed using the Mini-Mental State Examination (MMSE score) and motor function using Unified Parkinson′s Disease Rating Scale (UPDRS-part III scale).

Results: The patients with PD had significantly lower MNA score than controls which correlated with plasma phosphate levels. The logistic regression revealed that increasing MNA protected from low plasma phosphate, final score (OR = 0.399; 95% CI = 0.196–0.816; p = .012) and total score (OR = 0.656; 95% CI = 0.422–1.018; p = .060). Phosphate correlated with albumin (r = .315; p < .006), transferrin (r = .331; p < .004) and cortisol (r = −0.355; p < .002) confirmed by logistic regressions. Increasing albumin protects from low phosphate after adjusting in logistic regression (OR = 0.806; 95% CI = 0.682–0.952; p = .011) and after including variables from Table 1 in backwards elimination, final step (OR = 0.800; 95% CI = 0.660–0.969; p = .022). MNA total score and cortisol correlated inversely, confirmed in logistic regression for MNA total score (OR = 0.786; 95% CI = 0.627–0.985; p = .037) and for MNA initial score (OR = 0.650; 95% CI = 0.453–0.930; p = .020).

Conclusion: This study highlights the importance of phosphate for optimal nutritional status by association with MNA score and albumin in plasma. An inverse relationship between phosphate and cortisol indicate, in addition, that low phosphate levels may affect cognition and motor function in PD.

Keywords
albumin, cognition, cortisol, Mini-nutritional Assessment, Parkinson´s disease, phosphate, stress, transferrin
National Category
Neurosciences Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-129231 (URN)10.1002/brb3.556 (DOI)000392712000003 ()
Available from: 2016-12-21 Created: 2016-12-21 Last updated: 2018-06-09Bibliographically approved
Håglin, L. (2016). Using phosphate supplementation to reverse hypophosphatemia and phosphate depletion in neurological disease and disturbance. Nutritional neuroscience, 19(5), 213-223
Open this publication in new window or tab >>Using phosphate supplementation to reverse hypophosphatemia and phosphate depletion in neurological disease and disturbance
2016 (English)In: Nutritional neuroscience, ISSN 1028-415X, E-ISSN 1476-8305, Vol. 19, no 5, p. 213-223Article in journal (Refereed) Published
Abstract [en]

Hypophosphatemia (HP) with or without intracellular depletion of inorganic phosphate (Pi) and adenosine triphosphate has been associated with central and peripheral nervous system complications and can be observed in various diseases and conditions related to respiratory alkalosis, alcoholism (alcohol withdrawal), diabetic ketoacidosis, malnutrition, obesity, and parenteral and enteral nutrition. In addition, HP may explain serious muscular, neurological, and haematological disorders and may cause peripheral neuropathy with paresthesias and metabolic encephalopathy, resulting in confusion and seizures. The neuropathy may be improved quickly after proper phosphate replacement. Phosphate depletion has been corrected using potassium-phosphate infusion, a treatment that can restore consciousness. In severe ataxia and tetra paresis, complete recovery can occur after adequate replacement of phosphate. Patients with multiple risk factors, often with a chronic disease and severe HP that contribute to phosphate depletion, are at risk for neurologic alterations. To predict both risk and optimal phosphate replenishment requires assessing the nutritional status and risk for re-feeding hypophosphatemia. The strategy for correcting HP depends on the severity of the underlying disease and the goal for re-establishing a phosphate balance to limit the consequences of phosphate depletion.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Hypophosphatemia, Malnutrition, Refeeding syndrome, Nervous system
National Category
Neurosciences Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-129175 (URN)10.1179/1476830515Y.0000000024 (DOI)000378144900004 ()25909152 (PubMedID)
Available from: 2016-12-21 Created: 2016-12-21 Last updated: 2019-05-27Bibliographically approved
Farooqi, N., Slinde, F., Håglin, L. & Sandström, T. (2015). Assessment of energy intake in women with chronic obstructive pulmonary disease: A doubly labeled water method study. The Journal of Nutrition, Health & Aging, 19(5), 518-524
Open this publication in new window or tab >>Assessment of energy intake in women with chronic obstructive pulmonary disease: A doubly labeled water method study
2015 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 5, p. 518-524Article in journal (Refereed) Published
Abstract [en]

To maintain energy balance, reliable methods for assessing energy intake and expenditure should be used in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to validate the diet history and 7-day food diary methods of assessing energy intake (EI) using total energy expenditure (TEE) with the doubly labeled water (DLW) method (TEEDLW) as the criterion method in outpatient women with COPD. EI was assessed by diet history (EIDH) and a 7-day food diary (EIFD) in 19 women with COPD, using TEEDLW as the criterion method. The three methods were compared using intra-class correlation coefficients (ICC) and Bland-Altman analyses. The participants were classified according to their reporting status (EI/TEE) as valid-reporters 0.79-1.21, under-reporters < 0.79 or over-reporters > 1.21. Diet history underestimated reported EI by 28%, and 7-day food diary underestimated EI by approximately 20% compared with TEEDLW. The ICC analysis showed weak agreement between TEEDLW and EIDH (ICC=-0.01; 95%CI-0.10 to 0.17) and between TEEDLW and EIFD (ICC=0.11; 95%CI -0.16 to 0.44). The Bland-Altman plots revealed a slight systematic bias for both methods. For diet history, six women (32%) were identified as valid-reporters, and for the 7-day food diary, twelve women (63%) were identified as valid-reporters. The accuracy of reported EI was only related to BMI. The diet history and 7-day food diary methods underestimated energy intake in women with COPD compared with the DLW method. Individuals with higher BMIs are prone to underreporting. Seven-day food diaries should be used with caution in assessing EI in women with COPD.

Keywords
Energy intake, COPD in women, validity of diet history, validity of 7-day food diary
National Category
Geriatrics Gerontology, specialising in Medical and Health Sciences Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-106281 (URN)10.1007/s12603-014-0575-4 (DOI)000354199200005 ()25923480 (PubMedID)
Available from: 2015-07-10 Created: 2015-07-09 Last updated: 2018-06-07Bibliographically approved
Vikdahl, M., Backman, L., Johansson, I., Forsgren, L. & Håglin, L. (2015). Cardiovascular risk factors and the risk of Parkinson's disease. European Journal of Clinical Nutrition, 69(6), 729-733
Open this publication in new window or tab >>Cardiovascular risk factors and the risk of Parkinson's disease
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2015 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 6, p. 729-733Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/OBJECTIVES: The objective of this study was to investigate whether serum triglycerides (S-TG), cholesterol, blood pressure and waist/height ratio are risk factors for Parkinson's disease (PD).

SUBJECTS AND METHODS: A population-based sample within the Northern Sweden Health and Disease Study (NSHDS) was used in this study (n = 101 790 subjects). Cases with PD were identified prospectively in a community-based study of idiopathic Parkinsonism in the period 2004-2009 in the county of Vasterbotten in northern Sweden. The case database obtained was crosslinked to the NSHDS. Eighty-four of 147 patients with PD had visited the primary health care 2-8 years before diagnosis for participation in the NSHDS. For each case, four referents from the NSHDS population were selected, matched for sex, age, year of health survey, subcohort and geographic area.

RESULTS: Cases had lower mean S-TG levels (P = 0.007). After stratification for sex, the lower S-TG remained significant for men (P = 0.006) but not for women (P = 0.450), and these were confirmed by the conditional logistic regression for all cases, none adjusted (hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.42, 0.99) and after adjusting for age, body mass index (BMI) and physical activity (HR: 0.61; 95% CI: 0.39, 0.96). Systolic blood pressure (SBP) was negatively associated with PD risk after adjustments for age, BMI and physical activity (HR: 0.98; 95% CI: 0.97-0.99). Smoking and former smoking were associated with a reduced risk for PD.

CONCLUSIONS: We found lower S-TG and SBP 2-8 years before a diagnosis of PD. Smoking was confirmed to be negatively associated with PD, whereas recreational activity indicates a risk for women.

National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-106498 (URN)10.1038/ejcn.2014.259 (DOI)000355607300014 ()25514902 (PubMedID)
Available from: 2015-07-16 Created: 2015-07-14 Last updated: 2018-06-07Bibliographically approved
Håglin, L. (2015). High serum phosphate concentration as the result of smoking might underlie the lower risk of Parkinson's disease. Medical Hypotheses, 85(3), 287-290
Open this publication in new window or tab >>High serum phosphate concentration as the result of smoking might underlie the lower risk of Parkinson's disease
2015 (English)In: Medical Hypotheses, ISSN 0306-9877, E-ISSN 1532-2777, Vol. 85, no 3, p. 287-290Article in journal (Refereed) Published
Abstract [en]

Epidemiological studies have found a negative association between cigarette smoking and Parkinson's disease (PD): PD patients are approximately 50% less likely to have smoked cigarettes than age- and sex-matched controls. In both women and men, the PD protection effect of smoking may be explained by higher levels of phosphate in serum (S-P) and triglycerides (S-TG) in smokers compared to non-smokers. That is, the protecting effect from smoking could be mediated by either a high S-P or high S-TG levels. I suggest that higher S-P as the result of smoking may be associated with intracellular depletion of Pi in skeletal muscle and that this depletion of Pi is associated with increased availability of phosphate for the brain. This increased phosphate availability would protect against PD, as oxidative phosphorylation in the mitochondria is a central and persistent phenomenon in the pathogenesis cascade of PD. Phosphate is necessary for energy production in the form of creatine phosphate (CP) and adenosine-tri-phosphate (ATP) in the brain and skeletal muscle. As such, hypophosphatemia increases risk of cell death. In some clinical instances, this energy depletion may pre-dispose to dopamine neuron death. Mitochondrial dysfunction is associated with the generation of oxidative stress and mediates the induction of apoptosis. Studies with NMR spectroscopy reveal that an energy deficit in brain cells is a strong mark for PD although this differed for men and women. Compared to women, men had lower serum phosphate and ATP levels in the brain (about 15% lower). In addition to sex differences, age, stress, and malnutrition may cause low serum phosphate levels, a situation that could contribute to the lack of energy available to the brain and the risk of PD. As hypophosphatemia is present in overnutrition and has an inverse relation with a high BMI, both obesity and malnutrition are considered to be presumptive risk factor for PD.

Keywords
cigarette-smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-109810 (URN)10.1016/j.mehy.2015.05.017 (DOI)000360868100010 ()26206759 (PubMedID)
Available from: 2015-10-07 Created: 2015-10-06 Last updated: 2018-06-07Bibliographically approved
Vikdahl, M., Domellöf, M. E., Forsgren, L. & Håglin, L. (2015). Olfactory function, eating ability, and visceral obesity associated with MMSE three years after Parkinson's disease diagnosis. The Journal of Nutrition, Health & Aging, 19(9), 894-900
Open this publication in new window or tab >>Olfactory function, eating ability, and visceral obesity associated with MMSE three years after Parkinson's disease diagnosis
2015 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 9, p. 894-900Article in journal (Refereed) Published
Abstract [en]

This study examines whether risk factors for poor nutrition are associated with global cognitive function three years after confirmed Parkinson's disease (PD) diagnosis. The follow-up investigations for this prospective community-based study were conducted three years after PD diagnosis. The study participants lived in Vasterbotten County, a region in northern Sweden with 142,000 inhabitants. This study population consisted of 118 PD outpatients from the study of Newly Diagnosed PD in UmeAyen (NYPUM). Global cognition was assessed with the Mini Mental State Examination (MMSE) at baseline and at follow-up. Anthropometry, nutrition (Mini Nutritional Assessment, MNA, 3-day food registration, 3-FDR), olfactory function (Brief Smell Identification Test, B-SIT), and swallowing, cutting food, and salivation (single questions from the Unified Parkinson's Disease Rating Scale, UPDRS) were used as markers for nutritional status. The MMSE score decreased over three years (-1.06 +/- 3.38, p=0.001). Olfactory function at baseline was associated to MMSE at three years (B=0.365, p=0.004). Changes in waist/hip ratio (B=113.29, p=0.017), swallowing (B=1.18, P=0.033), and cutting food (B=-1.80, p=0.000) were associated with MMSE at follow-up. This study indicates that olfactory function, cutting food, swallowing, and visceral obesity are associated with MMSE three years after PD diagnosis.

Keywords
Cognition, MMSE, olfactory function, Parkinson's disease, UPDRS
National Category
Geriatrics Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-112262 (URN)10.1007/s12603-015-0573-1 (DOI)000364577300004 ()26482690 (PubMedID)
Available from: 2015-12-07 Created: 2015-12-04 Last updated: 2018-06-07Bibliographically approved
Farooqi, N., Slinde, F., Carlsson, M., Håglin, L. & Sandström, T. (2015). Predicting energy requirement with pedometer-determined physical-activity level in women with chronic obstructive pulmonary disease. The International Journal of Chronic Obstructive Pulmonary Disease, 10, 1129-1137
Open this publication in new window or tab >>Predicting energy requirement with pedometer-determined physical-activity level in women with chronic obstructive pulmonary disease
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2015 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 10, p. 1129-1137Article in journal (Refereed) Published
Abstract [en]

Background: In clinical practice, in the absence of objective measures, simple methods to predict energy requirement in patients with chronic obstructive pulmonary disease (COPD) needs to be evaluated. The aim of the present study was to evaluate predicted energy requirement in females with COPD using pedometer-determined physical activity level (PAL) multiplied by resting metabolic rate (RMR) equations. Methods: Energy requirement was predicted in 18 women with COPD using pedometer-determined PAL multiplied by six different RMR equations (Harris-Benedict; Schofield; World Health Organization; Moore; Nordic Nutrition Recommendations; Nordenson). Total energy expenditure (TEE) was measured by the criterion method: doubly labeled water. The predicted energy requirement was compared with measured TEE using intraclass correlation coefficient (ICC) and Bland-Altman analyses. Results: The energy requirement predicted by pedometer-determined PAL multiplied by six different RMR equations was within a reasonable accuracy (+/- 10%) of the measured TEE for all equations except one (Nordenson equation). The ICC values between the criterion method (TEE) and predicted energy requirement were: Harris-Benedict, ICC =0.70, 95% confidence interval (CI) 0.23-0.89; Schofield, ICC =0.71, 95% CI 0.21-0.89; World Health Organization, ICC =0.74, 95% CI 0.33-0.90; Moore, ICC =0.69, 95% CI 0.21-0.88; Nordic Nutrition Recommendations, ICC =0.70, 95% CI 0.17-0.89; and Nordenson, ICC =0.40, 95% CI -0.19 to 0.77. Bland-Altman plots revealed no systematic bias for predicted energy requirement except for Nordenson estimates. Conclusion: For clinical purposes, in absence of objective methods such as doubly labeled water method and motion sensors, energy requirement can be predicted using pedometer-determined PAL and common RMR equations. However, for assessment of nutritional status and for the purpose of giving nutritional treatment, a clinical judgment is important regarding when to accept a predicted energy requirement both at individual and group levels.

Keywords
pedometer-determined PAL, women with COPD, energy expenditure, DLW method
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-106033 (URN)10.2147/COPD.S80616 (DOI)000356192100002 ()
Available from: 2015-07-03 Created: 2015-07-03 Last updated: 2018-06-07Bibliographically approved
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