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Incidence and type of malnutrition in homeless male veterans
TUESDAY, OCTOBER 26 POSTER SESSION: CLINICAL NUTRITION IIIlII I
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FAT UTILIZATION AND MOBILIZATION IN LEAN AND OBESE WOMEN FOLLOWING PROLONGED MODERATE INTENSITY WALKING. E.A. Meyer-Ball, M.S., R.D., L.F. Chitwood, Ph.D., N.R. Green, Ph.D., E.A. Haymes, Ph.D., R.J. Moffatt, Ph.D., Department of Nutrition, Food, and Movement Science, Florida State University, Tallahassee, FL. To examine the effect of prolonged moderate intensity walking on postexercise (POST-EX) fat utilization and mobilization in sedentary lean and obese women, nine lean (LE: body fat 23.2 + 4.1 %)and eight obese (OB: body fat 35.1 ± 2.3%) women completed an experimental test which included a 60 min pre-exercise rest (PRE-EX), a 90 min treadmill walk at 55% V0 2 ,,, and a 90 mminPOST-EX semi-reclining recovery. Each test followed a 12 hr overnight fast. Pre-test meal plans were based on nutrient distributions of 55% carbohydrate, 30% fat, 15% protein, and usual caloric intake determined by 3 day diet analysis. Respiratory exchange ratio (RER) was continuously monitored via open circuit spirometry throughout PRE-EX and POST-EX. Blood samples for the enzymatic determination of serum free fatty acids (FFA) and glycerol (GLY) were drawn from the antecubital vein at the completion of PRE-EX, 45 and 90 min POST-EX. A repeated measures ANOVA was used for data analysis with Newman Keuls' post hoc to locate significant differences between means. No significant differences were observed between the LE and OB for pre-test and 3 day diet analysis. Mean 45 and 90 min POST-EX RERs were .05) than PRE-EX with no significant differences significantly lower (p observed between the LE and OB. Mean percentage of calories expended as fat during PRE-EX, 45 and 90 main POST-EX were 68.0%, 88.4%, 85.0% respectively for the LE and 64.6%, 81.6%, 83.4% for the OB. POST-EX FFA levels at 45 and 90 min (LE: 0.952 ± 0.30, 0.963 ± 0.27 mmols; OB: 1.00 ± 0.35, 0.835 ± 0.07 mmols) were significantly elevated above PRE-EX (LE: 0.588 ± 0.15 mmols, OB: 0.514 ±0. I1 mmols). Differences between the groups were non-significant. Fat mobilization, determined by GLY levels, demonstrated a significant effect of time for glycerol levels from PRE-EX to POST-EX. However the data indicate that this significant effect was essentially due to the OB. Glycerol levels for the LE had returned to PRE-EX (0.100 ± 0.06 mmols) by 45 min POST-EX (0.086 ± 0.03 mmols). For the obese, GLY remained higher than PRE-EX (0.047 ± 0.02 mmols) throughout the 90 min of POST-EX (45 and 90 min POST-EX: 0.130 ± 0.07; 0.158 ± 0.09 mmols). Results indicate that 90 min of moderate intensity walking serves to significantly elevate fat utilization for at least 90 min POST-EX in both LE and OB women. However the differential GLY response between the two groups may be indicative of decreased clearance and/or continued fat mobilization among the obese.
COMPARISON OF MEASURED ENERGY EXPENDITURE TO RESTING ENERGY EXPENDITURE EQUATIONS IN PREADOLESCENT CHILDREN WITH CYSTIC FIBROSIS.
INCIDENCE AND TYPE OF MALNUTRITION IN RD, LD, HOMELESS MALE VETERANS. E.M. Notz, and P. H. Byers, PhD, RN, VA Medical Center, Bay Pines, FL to to comprise 18 Veterans are estimated 48% of the 3 million homeless people in the nutritional examined the study US. This consecutively 33 men who were status of admitted to a domiciliary homeless program in The majority of subjects were a VA hospital. educated, and had middle-aged, high-school None year. for more than one been homeless were married and all but one was an alcohol abuser. Nutritional status was assessed indices, using anthropometrics, biochemical and extensive nutrient intake information derived from the administration of the Institute 's "Health Habits National Cancer and History Questionnaire" (HHHQ). According the Tridimensional Cartesian Classifito cation of protein-calorie malnutrition, 52% 21% of the subjects were malnourished, with classified as having marasmus with muscle of daily deficit. The average percentage calories consumed in alcohol was 30%, which was significantly correlated with duration homelessness. Nutrient intake was of riboflavin, folic lower for significantly acid and calcium when the intake from alcohol Elevated serum lipids, MCV, was excluded. as were MCH and SGOT values were prevalent; albumin, magnesium, hematocrit, depressed The HHHQ classified and WBC. beta-carotene more subjects as abnormal on the micronutrients than the lab values, but did not as misclassify any abnormal lab values the need for normal. The findings indicate early nutritional assessment and intervennutritional status of tion, and that the these subjects reflects the joint effects of homelessness and alcohol consumption.
THE EFFECT OF LIBERALIZING DIETARY CHOLESTEROL AND FAT INTAKE ON NUTRITIONAL STATUS AND DIETARY INTAKE OF INSTITUTIONALIZED ELDERLY.D.J.Parrington,MS,RD,CNSD, P. Rousseau MD, and A.Fuentevilla-Clifton MD, Carl T. Hayden VA Medical Center, Phoenix, AZ Hypocholesterolemia (cholesterol (Chol) < 160mg/dL) is a well established prognostic indicator for mortality risk in institutionalized elders. The prudence of following the American Heart Association (AHA)
M.D. Murphy, MS, RD, LD, C.S. Ireton-Jones, PhD, RD, LD, B.C. Hilman, MD, M.A. Gorman, PhD, RD, LD, and G.U. Liepa, PhD, Texas Woman's University, Denton, TX. Two commonly-used equations for estimating energy expenditures in patients with cystic fibrosis (CF) are the Harris Benedict equations (HBE) and the Cystic Fibrosis Consensus Committee equations (CFCCE). The HBE were not designed for use
with children, as only healthy adults participated in the development of these equations. The CFCCE were developed using the World Health Organization equations for the prediction of the resting energy expenditures (REEs) of children. The applicability of such formulae to patients with CF is questionable. A recent advancement in the nutritional care of pediatric patients has been the clinical application of indirect calorimetry for measuring energy expenditures. Limited documentation exists which compares indirect calorimetry with the HBE and the CFCCE. The purpose of this study was to compare the measured energy expenditures (MEEs) to the energy expenditures calculated from both the HBE and the CFCCE, in order to assess the REEs in children with CF. Thirty one preadolescent (3.25 - 12.75 years of age) male and female CF children who were afebrile a not in pulmonary distress were studied. In every patient, the MEE was above the predicted REE value as derived from the HBE (p = .0001) and the CFCCE (p = .01). Both the HBE and the CFCCE underestimated the energy expenditures of this population by 13 percent, and 8 percent respectively. These data support the usefulness of the measurement of energy expenditure in determining the energy needs of preadolescent patients with CF. In clinical practice, the REEs would be multiplied by activity coefficients in order to determine the total daily energy expenditures of this population.
guidelines (5 300 mg chol, <30% fat) for institutionalized elders who are at risk of increased mortality secondary to hypocholesterolemia was at question. Fifteen residents with a mean age of 81.5 years, with no known diagnosis of malignancy and without medications which alter cholesterol levels, participated. Residents had been receiving diets following the AHA guidelines for at least
three months at the onset. A liberal fat (38%) and Chol (>700mg Chol) diet was served for the next three months. Lipid panels were analyzed prior to the onset of the liberalized fat diet, and at six week intervals during the higher fat intake. Nutrient intake was determined by measured plate waste. Nutrient analysis was determined using Handbook 8. Dietary fat and Chol intake increased significantly (p<.05 and p<.01 ). Total Chol and High density lipoproteins (HDL) decreased significantly with the liberalized diet (p<.05 and p<.01). Low density lipoproteins and Triglycerides had no significant change.The Chol/HDL ratio also decreased significantly (p.05). We conclude for some is indicated that the AHA diet elders. Elders receiving institutionalized rehabilitation with plans to return to the
community may benefit most.
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()URNAL OF TI
AMERICAN lE D)IETETIC ASSOCIATION / A-31
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I
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I
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l
Im
i
I
I
I11111! I
III ,
FAT UTILIZATION AND MOBILIZATION IN LEAN AND OBESE WOMEN FOLLOWING PROLONGED MODERATE INTENSITY WALKING. E.A. Meyer-Ball, M.S., R.D., L.F. Chitwood, Ph.D., N.R. Green, Ph.D., E.A. Haymes, Ph.D., R.J. Moffatt, Ph.D., Department of Nutrition, Food, and Movement Science, Florida State University, Tallahassee, FL. To examine the effect of prolonged moderate intensity walking on postexercise (POST-EX) fat utilization and mobilization in sedentary lean and obese women, nine lean (LE: body fat 23.2 + 4.1 %)and eight obese (OB: body fat 35.1 ± 2.3%) women completed an experimental test which included a 60 min pre-exercise rest (PRE-EX), a 90 min treadmill walk at 55% V0 2 ,,, and a 90 mminPOST-EX semi-reclining recovery. Each test followed a 12 hr overnight fast. Pre-test meal plans were based on nutrient distributions of 55% carbohydrate, 30% fat, 15% protein, and usual caloric intake determined by 3 day diet analysis. Respiratory exchange ratio (RER) was continuously monitored via open circuit spirometry throughout PRE-EX and POST-EX. Blood samples for the enzymatic determination of serum free fatty acids (FFA) and glycerol (GLY) were drawn from the antecubital vein at the completion of PRE-EX, 45 and 90 min POST-EX. A repeated measures ANOVA was used for data analysis with Newman Keuls' post hoc to locate significant differences between means. No significant differences were observed between the LE and OB for pre-test and 3 day diet analysis. Mean 45 and 90 min POST-EX RERs were .05) than PRE-EX with no significant differences significantly lower (p observed between the LE and OB. Mean percentage of calories expended as fat during PRE-EX, 45 and 90 main POST-EX were 68.0%, 88.4%, 85.0% respectively for the LE and 64.6%, 81.6%, 83.4% for the OB. POST-EX FFA levels at 45 and 90 min (LE: 0.952 ± 0.30, 0.963 ± 0.27 mmols; OB: 1.00 ± 0.35, 0.835 ± 0.07 mmols) were significantly elevated above PRE-EX (LE: 0.588 ± 0.15 mmols, OB: 0.514 ±0. I1 mmols). Differences between the groups were non-significant. Fat mobilization, determined by GLY levels, demonstrated a significant effect of time for glycerol levels from PRE-EX to POST-EX. However the data indicate that this significant effect was essentially due to the OB. Glycerol levels for the LE had returned to PRE-EX (0.100 ± 0.06 mmols) by 45 min POST-EX (0.086 ± 0.03 mmols). For the obese, GLY remained higher than PRE-EX (0.047 ± 0.02 mmols) throughout the 90 min of POST-EX (45 and 90 min POST-EX: 0.130 ± 0.07; 0.158 ± 0.09 mmols). Results indicate that 90 min of moderate intensity walking serves to significantly elevate fat utilization for at least 90 min POST-EX in both LE and OB women. However the differential GLY response between the two groups may be indicative of decreased clearance and/or continued fat mobilization among the obese.
COMPARISON OF MEASURED ENERGY EXPENDITURE TO RESTING ENERGY EXPENDITURE EQUATIONS IN PREADOLESCENT CHILDREN WITH CYSTIC FIBROSIS.
INCIDENCE AND TYPE OF MALNUTRITION IN RD, LD, HOMELESS MALE VETERANS. E.M. Notz, and P. H. Byers, PhD, RN, VA Medical Center, Bay Pines, FL to to comprise 18 Veterans are estimated 48% of the 3 million homeless people in the nutritional examined the study US. This consecutively 33 men who were status of admitted to a domiciliary homeless program in The majority of subjects were a VA hospital. educated, and had middle-aged, high-school None year. for more than one been homeless were married and all but one was an alcohol abuser. Nutritional status was assessed indices, using anthropometrics, biochemical and extensive nutrient intake information derived from the administration of the Institute 's "Health Habits National Cancer and History Questionnaire" (HHHQ). According the Tridimensional Cartesian Classifito cation of protein-calorie malnutrition, 52% 21% of the subjects were malnourished, with classified as having marasmus with muscle of daily deficit. The average percentage calories consumed in alcohol was 30%, which was significantly correlated with duration homelessness. Nutrient intake was of riboflavin, folic lower for significantly acid and calcium when the intake from alcohol Elevated serum lipids, MCV, was excluded. as were MCH and SGOT values were prevalent; albumin, magnesium, hematocrit, depressed The HHHQ classified and WBC. beta-carotene more subjects as abnormal on the micronutrients than the lab values, but did not as misclassify any abnormal lab values the need for normal. The findings indicate early nutritional assessment and intervennutritional status of tion, and that the these subjects reflects the joint effects of homelessness and alcohol consumption.
THE EFFECT OF LIBERALIZING DIETARY CHOLESTEROL AND FAT INTAKE ON NUTRITIONAL STATUS AND DIETARY INTAKE OF INSTITUTIONALIZED ELDERLY.D.J.Parrington,MS,RD,CNSD, P. Rousseau MD, and A.Fuentevilla-Clifton MD, Carl T. Hayden VA Medical Center, Phoenix, AZ Hypocholesterolemia (cholesterol (Chol) < 160mg/dL) is a well established prognostic indicator for mortality risk in institutionalized elders. The prudence of following the American Heart Association (AHA)
M.D. Murphy, MS, RD, LD, C.S. Ireton-Jones, PhD, RD, LD, B.C. Hilman, MD, M.A. Gorman, PhD, RD, LD, and G.U. Liepa, PhD, Texas Woman's University, Denton, TX. Two commonly-used equations for estimating energy expenditures in patients with cystic fibrosis (CF) are the Harris Benedict equations (HBE) and the Cystic Fibrosis Consensus Committee equations (CFCCE). The HBE were not designed for use
with children, as only healthy adults participated in the development of these equations. The CFCCE were developed using the World Health Organization equations for the prediction of the resting energy expenditures (REEs) of children. The applicability of such formulae to patients with CF is questionable. A recent advancement in the nutritional care of pediatric patients has been the clinical application of indirect calorimetry for measuring energy expenditures. Limited documentation exists which compares indirect calorimetry with the HBE and the CFCCE. The purpose of this study was to compare the measured energy expenditures (MEEs) to the energy expenditures calculated from both the HBE and the CFCCE, in order to assess the REEs in children with CF. Thirty one preadolescent (3.25 - 12.75 years of age) male and female CF children who were afebrile a not in pulmonary distress were studied. In every patient, the MEE was above the predicted REE value as derived from the HBE (p = .0001) and the CFCCE (p = .01). Both the HBE and the CFCCE underestimated the energy expenditures of this population by 13 percent, and 8 percent respectively. These data support the usefulness of the measurement of energy expenditure in determining the energy needs of preadolescent patients with CF. In clinical practice, the REEs would be multiplied by activity coefficients in order to determine the total daily energy expenditures of this population.
guidelines (5 300 mg chol, <30% fat) for institutionalized elders who are at risk of increased mortality secondary to hypocholesterolemia was at question. Fifteen residents with a mean age of 81.5 years, with no known diagnosis of malignancy and without medications which alter cholesterol levels, participated. Residents had been receiving diets following the AHA guidelines for at least
three months at the onset. A liberal fat (38%) and Chol (>700mg Chol) diet was served for the next three months. Lipid panels were analyzed prior to the onset of the liberalized fat diet, and at six week intervals during the higher fat intake. Nutrient intake was determined by measured plate waste. Nutrient analysis was determined using Handbook 8. Dietary fat and Chol intake increased significantly (p<.05 and p<.01 ). Total Chol and High density lipoproteins (HDL) decreased significantly with the liberalized diet (p<.05 and p<.01). Low density lipoproteins and Triglycerides had no significant change.The Chol/HDL ratio also decreased significantly (p.05). We conclude for some is indicated that the AHA diet elders. Elders receiving institutionalized rehabilitation with plans to return to the
community may benefit most.
,I
()URNAL OF TI
AMERICAN lE D)IETETIC ASSOCIATION / A-31