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Assessment of energy intake in women with chronic obstructive pulmonary disease: A doubly labeled water method study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine. Umea Univ Hosp, Dept Resp Med & Allergy, SE-90185 Umea, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
2015 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 5, 518-524 p.Article 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.

Place, publisher, year, edition, pages
2015. Vol. 19, no 5, 518-524 p.
Keyword [en]
Energy intake, COPD in women, validity of diet history, validity of 7-day food diary
National Category
Geriatrics Gerontology, specializing in Medical and Health Sciences Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:umu:diva-106281DOI: 10.1007/s12603-014-0575-4ISI: 000354199200005PubMedID: 25923480OAI: oai:DiVA.org:umu-106281DiVA: diva2:841031
Available from: 2015-07-10 Created: 2015-07-09 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Nutrition and energy expenditure in women with chronic obstructive pulmonary disease
Open this publication in new window or tab >>Nutrition and energy expenditure in women with chronic obstructive pulmonary disease
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim

The overall objective of this thesis was to increase the knowledge and validate methods for assessment of total daily energy expenditure (TEE), energy requirement and energy intake (EI) in women with COPD. We also investigated the relationship of BMI with clinical characteristics of COPD in a population-based study. Due to the substantial and increasing morbidity in women with COPD, special attention was given to this group.

Methods

Resting metabolic rate (RMR) was measured by indirect calorimetry (IC). TEE was measured by criterion method, doubly labeled water (DLW) (Paper I-III) during a 14-day period. TEE was simultaneously assessed by SenseWear Armband, software version 5.1 and 6.1 (SWA5 respectively SWA6), and ActiHeart (paper I). EI was assessed by diet history interview and 7-day food diary (paper II), and energy requirement was predicted using pedometer-determined physical activity level (paper III). Energy requirement data was also acquired from studies concerning TEE measured by DLW in patients with COPD (paper IV). BMI and other characteristics in subjects with COPD were compared with non-COPD subjects in a population-based study, Obstructive Lung disease in Norrbotten study (OLIN) (paper V).

Results

There was a large variation in RMR and TEE measured by DLW in this group of women with COPD. The results of energy expenditure study showed that the SWA5 assessed TEE with good accuracy over a 14-day period in free-living women with COPD. However, the SWA6 and ActiHeart methods tend to underestimate TEE. A higher proportion of women were within ± 5% of the TEE individually measured with the DLW method using SWA5 than SWA6 and AH (63%, 47%, 37% respectively). The agreement between the TEE measured by DLW and SWA5 was strong, and with SWA6 and ActiHeart it was lesser. Bland-Altman plots revealed no systematic bias for TEE. The reported EI was underestimated by 28% respectively 20 % when assessed by diet, and the 7-day food diary compared with the criterion method, DLW. More women were identified as valid-reporters based on their 7- day food diaries than on their diet histories (63% vs 32%). The accuracy of reported EI was only related to BMI. The agreement between the DLW and the EI methods was weak. The Bland-Altman plots revealed a slight systematic bias for both methods. 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. The agreement between the DLW and four of six predicted TEE methods was strong. The Bland– Altman plots revealed no systematic bias for predicted energy requirement except for one. Estimated PAL from the pedometer was lower by 14 % than the measured criterion PAL. The energy requirement calculation based on available TEE data measured by DLW varied by BW and FFM. Compared to men, women had a lower RMR and TEE/kg BW/day, and higher RMR and TEE/kg FFM/day. The correlates of RMR/kg BW were gender and forced expiratory volume in 1st second (FEV1) % of predicted value, of TEE/ kg BW the correlates were age and gender, and of TEE/kg FFM were age and FEV1 % predicted. BMI decreased significantly with increase in disease severity and correlated significantly to forced expiratory volume in 1st second % predicted. In the population-based study (OLIN), subjects with COPD had lower BMI and a higher prevalence of underweight than in non-COPD, and its sub-groups namely, normal lung function and restrictive spirometry pattern subjects. There was an independent association between COPD and low BMI. Fewer COPD subjects were obese than in the non-COPD, normal lung function and restrictive spirometry pattern groups. Among the subjects with COPD, women had a lower mean BMI and a higher proportion were under-weight than men. In COPD women with under-weight, FEV1 % predicted values increased with an increase in BMI.

Conclusion

Compared with the gold standard DLW method, the total daily energy expenditure can be assessed reliably by SenseWear Armband 5 in women with COPD, while other devices underestimated TEE. The energy intake was underestimated by diet history and 7-day food diary methods, and energy requirement was predicted with reasonable accuracy using pedometer-determined PAL and common RMR equations, compared with DLW. Furthermore, the energy requirement was determined per kg BW/day and per kg FFM/day, using DLW based TEE data in patients with COPD. In the population-based study (OLIN), subjects with COPD had lower BMI and higher prevalence of under-weight than subjects without COPD. There was a gender difference, which was particularly significant in COPD, for women to have lower mean BMI and a higher prevalence of under-weight. The present findings indicate that low BMI is common in COPD and needs to be intervened. For a successful nutritional treatment, it is imperative to assess the patient’s ener

Abstract [sv]

Bakgrund/Syfte

Kroniskt obstruktiv lungsjukdom (KOL) är en av de stora folksjukdomarna där dödligheten ökar mest globalt sett. I Sverige är ökningen av KOL mest uttalad för kvinnor. Viktminskning är vanligt vid KOL. Låg kroppsvikt, låg andel fettfrimassa och lågt kroppsmasseindex (BMI) är dessutom riskfaktorer för ökad sjuklighet och dödlighet. Det finns därför behov av att ge anpassad kostbehandling for att motverka viktnedgång eller för att uppnå viktuppgång. För framgångsrik kostbehandlingen behövs metoder som på ett tillförlitligt sätt kan bedöma den totala energiförbrukningen, energiintag, och energibehov., Dessa metoder har ännu inte utvärderats väl hos KOL patienter. Det övergripande syftet därför med denna avhandling var att validera och öka kunskaperna om metoder som är tillförlitliga för att kunna bedöma energiförbrukning, energiintag och energibehov hos patienter med KOL. Vidare, jämfördes BMI och kliniska egenskaper mellan personer med och utan KOL in en populations-baserad studie.

Metoder

Viloenergiförbrukning mättes med indirekt kalorimeter hos kvinnor med KOL. Den totala energiförbrukningen mättes hos dessa kvinnor med dubbelmärktvatten metoden (DLW) (Arbete 1-3) under en 14-dagars period. Samtidigt bedömdes energiförbrukningen med två aktivitetesmätare, SenseWear Armband, mjukvaruversion 5.1 och 6.1 (SWA5 respektive SWA6), och ActiHeart (arbete 1). Energiintaget bedömdes med kostanamnes och 7-dagars matdagbok (arbete 2); energibehovet beräknades med olika viloenergiförbruknings formler och fysisk aktivitetsnivå uppskattad med en stegräknare (arbete 3). En sammanställning och en analys genomfördes av energibehovet baserad på data från flera studier som har mätt TEE med DLW hos KOL patienter (Arbete 4). BMI och kliniska egenskaper jämfördes mellan personer med och utan KOL i ett stort populationsbaserat material från Obstruktiv Lungsjukdom i Norrbotten (OLIN) studien (Arbete 5).

Resultat

Det fanns en stor variation in viloenergiförbrukningen och energiförbrukning mätt med DLW hos kvinnor med KOL. Energiförbrukningen mätt med aktivitetsmätare SWA5 visade hög tillförlitlighet både på grupp- och individnivå, medan SWA6 och ActiHeart metoderna underskattade energiförbrukningen. Energiintaget bedömd med kostanamnes och 7-dagars matdagbok visade en underskattning med 28% respektive 20% jämfört med DLW metoden. Det rapporterade energiintaget stämde för flertalet kvinnor bättre mot DLW metoden när energiintaget bedömdes med 7-dagars matdagbok jämfört med kostanamnes (63% mot 32%). Det beräknade energibehovet från stegräknare och från fem av sex olika RMR ekvationer låg inom en rimlig marginal (± 10%) jämfört med den uppmätta energiförbrukningen med DLW. Beräkning av energibehov baserat på tillgänglig data om energiförbrukning mätt med DLW varierade utifrån kroppsvikt och fettfrimassa hos patienter med KOL. Kvinnor hade en lägre viloenergiförbrukning och energiförbrukning per kg kroppsvikt och dag, och högre daglig viloenergiförbrukning och energiförbrukning per kg fettfrimassa och dag jämfört med män. I den populationsbaserade studien hade personer med KOL signifikant lägre BMI och högre prevalens av undervikt än personer utan KOL. Det fanns ett oberoende samband mellan KOL och lågt BMI. Färre personer med KOL var överviktiga än personer som inte hade KOL. Kvinnor med KOL hade både lägre BMI och högre andel med undervikt än män med KOL.

Slutsats

SenseWear Armband med programvaran 5.1 visar sig kunna beräkna den totala energiförbrukningen på ett tillförlitligt sätt hos kvinnor med KOL. Energiintaget beräknat utifrån kostanamnes och 7-dagars matdagbok underskattades. Energibehovet kan beräknas med en rimlig precision med hjälp av stegräknare och viloenergiförbrukningsformler hos dessa kvinnor. De sammanställda data om energiförbrukning mätt med DLW kan användas för att beräkna energibehov per kg- kroppsvikt och fettfri massa hos patienter med KOL i kliniskt syfte. I det populationsbaserade materialet från OLIN-studien noterades ett lägre BMI och högre prevalens av undervikt hos personer med KOL, och detsamma resultat förekom hos kvinnor med KOL jämfört med män med KOL.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 99 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1851
Keyword
Energy expenditure and women, Women and COPD, Nutrition and women
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-128680 (URN)978-91-7601-614-5 (ISBN)
Public defence
2017-01-27, Sal E04, målpunkt R-1 (by 6E), Biomedicin, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-12-16 Created: 2016-12-12 Last updated: 2016-12-15Bibliographically approved

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