Rationale: Obesity is a risk factor for type 2 diabetes (DM2), however not all obese people develop DM2. We explored differences in energy intake and expenditure between obese older adults with and without DM2. Methods: Baseline data from 2 lifestyle interventions with a total of 202 obese older adults were included in the analyses. Obesity was defined as BMI > 30.0, or >27.0 with waist circumference >88 (women) or >102 cm (men). DM2 was confirmed by use of diabetes medication. Subjects were between 55 and 85 years old and 45% was female. Energy intake (EI) was measured by 3-day food diary and physical activity level (PAL) by 3-day movement diary. Resting energy expenditure (REE) was measured using indirect calorimetry and total energy expenditure (TEE) was calculated as REE x PAL. Between group differences were analysed with independent samples T-tests. Results: The obese group with DM2 (n = 117) had more males (67.5% vs 37.6% p < 0.001) and similar BMI (33.3 vs 33.0 kg/m2) compared to the group without DM2 (n = 85). Analyses of males and females separately showed lower PAL in males with DM2 (vs without DM2; 1.37 vs 1.45, p = 0.015), without differences in EI (2055 vs 1953 kcal/d), REE (1970 vs 1929 kcal/d), and TEE (2699 vs 2830 kcal/d). In females with DM2, both PAL (1.38 vs 1.47, p = 0.014) and EI (1543 vs 1839 kcal/d, p = 0.008) were significantly lower, whereas REE (1592 vs 1598 kcal/d) and TEE (2220 vs 2318 kcal/d) did not differ significantly from obese females without DM2. Conclusion: In both males and females, obese older adults with type 2 diabetes showed similar resting and total energy expenditure but lower physical activity level compared to those without DM2. Females with DM2 showed lower energy intake. On average, subjects seem to have a negative energy balance, which is probably due to a combination of underreporting of intake and over-reporting of activity.
BACKGROUND: An early return to normal intake and early mobilization enhances postoperative recovery. However, one out of six surgical patients is undernourished during hospitalization and approximately half of the patients eat 50% or less of the food provided to them. We assessed the use of newly introduced breakfast buffets in two wards for gastrointestinal and oncological surgery and determined the impact on postoperative protein and energy intake.METHODS: A prospective pilot cohort study was conducted to assess the impact of the introduction of breakfast buffets in two surgical wards. Adult patients had the opportunity to choose between an attractive breakfast buffet and regular bedside breakfast service. Primary outcomes were protein and energy intake during breakfast. We asked patients to report the type of breakfast service and breakfast intake in a diary over a seven-day period. Prognostic factors were used during multivariable regression analysis.RESULTS: A total of 77 patients were included. The median percentage of buffet use per patient during the seven-day study period was 50% (IQR 0-83). Mean protein intake was 14.7 g (SD 8.4) and mean energy intake 332.3 kcal (SD 156.9). Predictors for higher protein intake included the use of the breakfast buffet (β = 0.06, p = 0.01) and patient weight (β = 0.13, p = 0.01). Both use of the breakfast buffet (β = 1.00, p = 0.02) and Delirium Observation Scale scores (β = -246.29, p = 0.02) were related to higher energy intake.CONCLUSION: Introduction of a breakfast buffet on a surgical ward was associated with higher protein and energy intake and it could be a promising approach to optimizing such intake in surgical patients. Large, prospective and preferably randomized studies should confirm these findings.
Environmental or ‘green' education is an important driving force behind the ‘greening' of society as it plays a critical role in raising environmental awareness and preparing students for green jobs. None of the existing environmental attitudes and behavior measures is focused on the evaluation of green education, especially in relation to consumption. To date, no longitudinal studies of children and students' attitudes towards consumption influenced by education exist. Also, little has been done to explore the socio-cultural context in which attitudes toward consumption are being formed and to explain the cross-cultural differences in environmental attitudes. This pilot study is designed to take the first step towards developing methods complementing existing quantitative measurements with qualitative strategies, such as consumption diaries, focus groups, and concept mapping. While this research is just a first attempt to tackle children's knowledge and attitudes consumption, preliminary results of the research on which this chapter is based and enthusiasm of the research participants encourage the author to stress the importance of consumption studies as part of green education for educational program developers. As a chapter of this volume, the author hopes that this study will add to the anthropological depository of research on the cultural variants in the perception of the environment in children. This chapter draws upon the consumption diaries collected from the upper-elementary school children in Amsterdam, The Netherlands, between September 2009 and May 2010. Consumption diaries are chronological documents recording purchase, use, and waste of materials, which can be used both as analytical tools and the means to stimulate environmental awareness. The four main methodological steps involved in this research were as follows. Children were asked to complete the consumption diary, paying specific attention to use and waste materials. Consequently, focus group meetings were held with parents and their children to discuss the diaries. Finally, interviews with the children were conducted in order to generate statements that supplement those generated by focus groups for carrying out the concept mapping analysis. The concept mapping analysis was then conducted to organize the order and analyze the ideas expressed in the focus group and interview sessions. This is an Accepted Manuscript of a book chapter published by Routledge/CRC Press in "Environmental Anthropology Today" on 8/5/11 available online: https://doi.org/10.4324/9780203806906 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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