Insufficient energy intake to meet energy expenditure demands of physical activity can result in systemic neuroendocrine and metabolic abnormalities in activity-dependent anorexia and relative energy deficiency in sport (REDs). REDs affects >40% of athletes, yet the lack of underlying molecular changes has been a hurdle to have a better understanding of REDs and its treatment. To assess the molecular changes in response to energy deficiency, we implemented the \"exercise-for-food\" paradigm, in which food reward size is determined by wheel-running activity. By using this paradigm, we replicated several aspects of REDs in female and male mice with high physical activity and gradually reduced food intake, which results in weight loss, compromised bone health, organ-specific mass changes, and altered rest-activity patterns. By integrating transcriptomics of 19 different organs, we provide a comprehensive dataset that will guide future understanding of REDs and may provide important implications for metabolic health and (athletic) performance.

OBJECTIVE: To compare the pre-competition nutrition practices of Lithuanian elite international-level (IL) and national-level (NL) bodybuilders.
METHODS: Sixteen male bodybuilders (n=8 per group) were enrolled. The IL group comprised individuals achieving 1st to 4th place in the World and European Championships organized by the IFBB, whereas the NL group ranked between 1st and 6th place in the national championships. Body mass and diet data were obtained via a questionnaire. A repeated-measures ANOVA was performed using time as a within factor and group as a between factor.
RESULTS: Both groups experienced a reduction in body mass during the pre-competition phase (p<0.001), which was slower in the IL than in the NL group (p=0.048). Both groups exhibited a reduction in caloric (p<0.001), carbohydrate (p<0.001), and fat (p=0.006) intake relative to body mass, but not in protein intake. Nevertheless, the IL group had a higher intake of calories (p=0.015), protein (p<0.001), but not carbohydrates relative to body mass vs. the NL group.
CONCLUSIONS: The Lithuanian IL and NL bodybuilders both reduced calories by cutting fat and carbohydrates during pre-competition. The IL group maintained higher calorie and protein intake, resulting in similar body mass loss but at a slower rate than the NL group.

Recent studies about refeeding in anorexia nervosa (AN) suggest starting with a high calorie diet. This narrative review aims to understand the initial refeeding management in hospitalized children and adolescents with AN and to develop a practical protocol.
We performed a comprehensive database search in June 2023 for abstracts published between January 2010 and May 2023 in different databases: Pubmed, The Cochrane Library and Embase with the terms refeeding syndrome, energy intake, diet therapy, weight restoration, hypophosphatemia, nutritional rehabilitation, anorexia nervosa, restrictive eating disorders, child, adolescent and young adult.
Fifteen papers were included in this review. Twelve studies were retrospective or observational. Only 3 randomized controlled trials were found. Initial energy intake varies within a wide range between 500 and 2800 kcal per day but generally begins with higher calories than current recommendations. Only hypophosphatemia was often described without clinical refeeding syndrome. Initial weight restoration was better with high calorie refeeding (HCR). Length of stay was shorter with HCR in some studies. Long term outcomes were unknown. Only two studied severely malnourished patients (< 70 % mBMI).
In adolescents with AN and with a low risk of RS, high calorie refeeding is possible under close medical monitoring and with prompt electrolyte correction. Robust studies with a unified protocol are needed to confirm the safety of high calorie refeeding especially in severely malnourished adolescents with AN.

OBJECTIVE: The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns.
METHODS: Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded.
RESULTS: The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively).
CONCLUSIONS: The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target.

BACKGROUND: Energy requirement assessment is a cornerstone for nutrition practice. The extent to which total energy expenditure (TEE; indicator of energy requirements) has been measured in adults with chronic diseases has not been explored.
OBJECTIVE: This systematic review aimed to: 1) Characterize evidence on TEE among individuals with chronic diseases, and 2) Describe TEE across chronic diseases and compared to controls without a chronic disease.
METHODS: A literature search using terms related to doubly labeled water and TEE was conducted in PubMed, MEDLINE, Web of Science, and Embase. Eligible articles included those that measured TEE using doubly labeled water in adults with a major chronic disease. Methodological quality was determined using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Sample size-weighted TEE was calculated in each chronic disease subgroup.
RESULTS: Fifty studies were included, of which 15 had a control group. Median sample size was 20 participants, and approximately half of studies were published over 10 years ago. Thirty-five (70%) studies reported resting energy expenditure, and about half (k=26) reported physical activity level. Methodological quality was \'neutral\' (k=25) or \'positive\' (k=23) for most studies. TEE among individual studies ranged from 934 to 3274 kcal/day. Mean weighted TEE was lowest among gastrointestinal (1786 kcal/day) and neurological (2104 kcal/day) subgroups and highest among cancer (2903 kcal/day), endocrine (2661 kcal/day), and autoimmune (2625 kcal/day) subgroups. Excluding one article in cancer survivors resulted in a low TEE in the cancer subgroup (2112 kcal/day). Most studies with a control group reported no differences in TEE between controls and patients; however, only one study was powered for between-group comparisons.
CONCLUSIONS: Energy requirements vary across chronic diseases, although there is insufficient evidence to suggest that TEE is different than controls. Further research is needed to inform energy requirement recommendations that consider chronic disease.

UNASSIGNED: This study aimed to investigate the effects of energy intake on activities of daily living (ADL) in patients with acute stroke, with a focus on the differences between obese and non-obese patients.
UNASSIGNED: This retrospective observational study was conducted in a neurological hospital and included patients hospitalized for acute stroke. During the acute phase (1 week after admission), energy intake was assessed, and the main outcome was defined as the Functional Independence Measure in the motor domain (FIM-M) at discharge. All subjects were divided into two groups based on their body mass index (BMI) at admission, with BMI ≥ 25 defining the obese stroke group and BMI < 25 defining the non-obese stroke group. Linear regression analysis was performed to examine the relationship between energy intake and FIM-M in each group.
UNASSIGNED: A total of 307 patients with acute stroke (median age: 79 years) were included in this study, with 118 patients (39%) in the obese stroke group. In the non-obese stroke group, a significant and independent relationship was observed between FIM-M and energy intake (β = 0.103, p = 0.031, adjusted R2 = 0.687). However, in the obese stroke group, no significant relationship was found between FIM-M and energy intake (β = 0.076, p = 0.302).
UNASSIGNED: In patients with acute stroke, energy intake positively affects functional outcomes in non-obese patients but not in obese patients. This study highlights the importance of considering obesity as a potential factor in determining energy intake in patients with acute stroke.

Cancer cachexia is a complex systemic wasting syndrome. Nutritional mechanisms that span energy intake, nutrient metabolism, body composition, and energy balance may be impacted by, and may contribute to, the development of cachexia. To date, clinical management of cachexia remains elusive. Leaning on discoveries and novel methodologies from other fields of research may bolster new breakthroughs that improve nutritional management and clinical outcomes. Characteristics that compare and contrast cachexia and obesity may reveal opportunities for cachexia research to adopt methodology from the well-established field of obesity research. This review outlines the known nutritional mechanisms and gaps in the knowledge surrounding cancer cachexia. In parallel, we present how obesity may be a different side of the same coin and how obesity research has tackled similar research questions. We present insights into how cachexia research may utilize nutritional methodology to expand our understanding of cachexia to improve definitions and clinical care in future directions for the field.

The prevalence of obesity has been increasing in the US. Among the multifactorial contributors to obesity, dietary factors stand out as primary drivers. Using data from NHANES, we investigated the trends and disparities in diet quality and nutrient intake among US adults with different bodyweight statuses. Participants were divided into normal weight, overweight, and obese groups based on BMI. Diet quality was examined using HEI-2020. Nutrient intake was estimated based on the USDA Food and Nutrient Database for Dietary Studies. From 1999 to 2020, Despite an overall improvement in diet quality among overweight and obese US adults, disparities persisted for most HEI-2020 components, and worsened for whole grains, seafood and plant proteins, and fatty acids between normal weight and obese participants. Overweight and obese participants tended to consume less energy from total carbohydrates and more from total fat. The estimated total energy intake increased among obese participants over the past two decades, while no significant changes were observed among normal weight and overweight participants. In the 2017-2020 period, obese participants had lower HEI-2020 scores than both normal weight and overweight participants. However, no significant differences in total energy intake were observed among normal weight, overweight, and obese populations.

Nutrition affects both body composition and, consequently, athletic performance. Only a few studies have assessed the nutritional behavior and knowledge of elite players. The present study aimed to assess the dietary intake, body composition, and nutritional knowledge of elite handball players. Thirty-nine handball players (age: 23.2 ± 2.7 years, weight: 88.2 ± 10.1 kg, height: 1.87 ± 0.07 m, and years of training: 13 ± 2) participated in the study. The athletes completed a set of anthropometric measurements, a 24 h food recall, and a translated edition of Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ). The average body fat percentage was 16.7 ± 3.8%, while the average fat free mass was 73.9 ± 8.5 kg. The athletes\' average daily energy intake was 2606.6 ± 756 kcal, while the average daily intake for carbohydrates, proteins, and fats was 243.85 ± 107.79 g [2.8 ± 1.3 g/kg BW/d-37.2 ± 10.5% of Total Energy Intake (TEI)], 131.59 ± 53.28 g (1.51 ± 0.7 g/kg BW/d-20.3 ± 6.9% of TEI), and 117.65 ± 40.52 g (40.9 ± 9.9% of TEI), respectively. For iron, calcium, and vitamin D, the average daily intakes were 19.33 ± 10.22 mg, 1287.7 ± 676.42 mg, and 3.22 ± 3.57 mcg respectively. The average success rate on the A-NSKQ was only 38.5 ± 10.7% out of 100. Elite handball players exhibit inadequate dietary intake and sports nutrition knowledge. Nutritional education should be a primary concern towards the amelioration of their athletic performance.

OBJECTIVE: This paper aims to examine the association between meal duration and obesity indicators among Spanish adolescents.
METHODS: We conducted a cross-sectional analysis using data from the Eating Healthy and Daily Life Activities (EHDLA) project involving 755 adolescents aged 12 to 17 years (54.8% girls) from three secondary schools in the Valle de Ricote Region of Murcia, Spain. To evaluate overall meal duration, participants were asked how long (on average) breakfast, morning snacks, lunch, afternoon snacks, and dinner typically last. Subsequently, global meal duration was measured, and the participants were categorized into tertiles. Obesity-related indicators, including body mass index (BMI) z score, waist circumference (WC), and skinfold thickness, were assessed. The analyses were adjusted for potential confounders such as sex, age, socioeconomic status, physical activity, sedentary behavior, diet quality, and energy intake.
RESULTS: Concerning meal duration status, adolescents with long meal durations had the lowest estimated marginal means of BMI z score, WC, and body fat percentage (using the sum of triceps and calf skinfolds). However, significant differences between adolescents with a long meal duration and those with a short meal duration were observed only for BMI z score (p = 0.008), and WC (p = 0.020). Furthermore, significant differences in BMI z score (p = 0.017) between adolescents with a long meal duration and those with a moderate meal duration were identified.
CONCLUSIONS: These findings underscore the importance of promoting slower eating habits as part of obesity prevention strategies. Future studies should explore the causality of this association and its potential for behavioral interventions.