The benefits of an active lifestyle are undisputed, yet our understanding of the contribution of physical activity (PA) to the daily energy budget is limited. The prevailing model of a linear relationship between PA and total energy expenditure (TEE) has been challenged by models that predict an upper limit of TEE (constrained) or a compensatory decrease elsewhere in the budget in response to increased PA (compensated). The purpose of this study was to determine the equation of best fit between PA and TEE using linear and non-linear modeling in the light of existing models. Secondarily, we sought to explore relationships between PA and postulated means of behavioral (time sedentary) and physiologic (i.e. Immune, reproductive) compensation. We measured TEE in 57 healthy weight stable adults (18 to 58 yrs., F = 28) who ranged from being sedentary to ultra-endurance trained runners (0 to 78 mi/wk.) using the doubly labeled water technique and PA and sedentary time using a waist mounted triaxial accelerometer during the same 14-day period. We obtained fasting serum (albumin, cortisol, TNFα, C-reactive protein, free testosterone, TSH and T3), plasma (leptin) and whole blood (WBC with differential) concentrations. Using linear and non-linear modeling, we observed a positive linear relationship between PA (Vector Magnitude Counts per Minute ) and TEE (R2=0.313, Y = 1.427*X + 1930 and adjusted for fat free mass (FFM) R2=0.363, Y = 1.151*X + 2155). We identified no association between PA and RMR ( R2=0.015 and adjusted for FFM R2=0.010). In addition, we observed an association between higher PA and lower % time sedentary (R2=0.723). Although inconsistent, there was a general trend for higher PA but not TEE or its components to be associated with lower immune and reproductive biomarkers. These findings support a conventional linear model though intervention studies will be needed to further address this issue. / Doctor of Philosophy / The health benefits of being physically active are well known. At the same time there is much that is not understood about the relationship between physical activity and how much energy we spend in a day (total energy expenditure). It has been assumed for a long time that the amount of energy we spend is a simple matter of adding the calories burned at rest, digesting food, and exercising and as we exercise more we continue to add an equal number of calories to the daily budget. We call this the linear or additive model – energy spent increases in a straight line as physical activity increases. Because we have techniques for measuring total energy expenditure in people going about their usual lives that were not widely available until recently due to cost, scientists have developed new ideas about how increases in physical activity affect total energy expenditure. The constrained model suggests that there is a cap on how many calories we can burn in a day and that our bodies will save energy in other parts of the budget if our physical activity remains high enough to reach or exceed that cap. The second idea is called the compensated model like the constrained model predicts that the rate we spend energy slows down as we exercise more because the body has saved energy in other parts of the budget (compensation). Researchers don't know for sure if either of these models are correct, so we conducted a study to determine how physical activity and total energy expenditure are related and if our findings agree with either of these models. We were also interested in determining how physical activity is related to energy spent at rest (resting metabolic rate ) and energy spent being active (physical activity energy expenditure). Finally, we wanted to determine ways that the body might compensate. One way is to spend more time sedentary. Another way is to save energy on less urgent needs like the immune and reproductive systems. Our main goal was to create an equation that explain how higher levels of physical activity are related to total energy expenditure and other parts of the energy budget (RMR and physical activity energy expenditure). We also created equations that explain how physical activity is related to sedentary behavior and immune and reproductive markers in the blood. We recruited 57 male and female volunteers that represent a wide range of physical activity levels – from sedentary to ultra-endurance trained runners who routinely run as much as 80 miles per week. We measured the energy they spent and physical activity over 2 weeks. In our sample, we found that physical activity was related to total energy expenditure and physical activity energy expenditure in a linear way. We did not find a cap on the amount of energy spent (constraint). We found that participants who exercised more spent less time sedentary not more meaning that we did not find behavioral compensation. It is possible that there was compensation from the immune system because some of the markers of immune function were lower in people who were more physically active, but it was not consistent in all of the blood markers. A larger study using an exercise intervention is needed to assign causation to the correlation we found.

O gasto energético total (GET) pode ser usado como medida da ingestão energética (IE). Existe um constante sub-relato da IE obtida por métodos de avaliação do consumo alimentar, mas poucos estudos o investigaram em nações em desenvolvimento. Objetivos: a) comparar a validade das estimativas de IE de um questionário de freqüência alimentar, três recordatórios alimentares e um diário alimentar de três dias, segundo a água duplamente marcada; b) determinar a influência da prática de atividade física, do índice de massa corporal e de fatores psicossociais no sub-relato e; c) comparar as taxas de sub-relato entre agrupamentos de padrões alimentares. Métodos: Sessenta e cinco mulheres responderam aos métodos de inquérito supracitados, a partir dos quais foi estimada a IE. O GET foi medido pela água duplamente marcada. A prática de atividade física, índice de massa corporal, escolaridade, renda, idade, conhecimento nutricional, insatisfação corporal, restrição dietética, compulsão alimentar e o desejo de aceitação social foram correlacionados ao sub-relato. Os padrões alimentares foram obtidos pela análise de cluster. Resultados: O GET foi de 2.622 ± 490 kcal, enquanto que a IE, mensurada respectivamente pelo recordatório, diário e questionário, foi de 2.078 ± 430 kcal; 2.044 ± 479 kcal e 1.984 ± 832 kcal. A proporção de sub-relatores foi de 24,6% para o recordatório, 29,2% para o diário e 53,8% para o questionário (p < 0,005). Os sub-relatores apresentaram menores médias de renda e escolaridade e maiores valores de idade, insatisfação corporal e desejo de aceitação social. O sub-relato foi mais comum no padrão alimentar mais frugal. Conclusão: Os três métodos de avaliação do consumo alimentar apresentaram erros sistemáticos, embora o questionário de freqüência alimentar tenha tido o pior desempenho. O sub-relato foi influenciado por diversos fatores psicossociais e variou conforme o padrão alimentar relatado, o que pode comprometer a avaliação do consumo / Total energy expenditure (TEE) may be used as a measure of energy intake (EI). There is a constant underreporting of EI obtained by dietary assessment methods, but few studies have investigated it in developing nations. Objectives: a) to compare the validity of EI estimates obtained by a food-frequency questionnaire, three diet recalls and a three-day food record; b) to determine the influence of physical activity, body mass index and psychosocial factors on underreporting and; c) to compare underreporting rates between dietary pattern\'s clusters. Methods: Sixty-five women completed the dietary assessment methods, which were used to estimate EI. TEE was measured by doubly labeled water. Physical activity practice, body mass index, education, income, age, nutritional knowledge, body dissatisfaction, dietary restraint, binge eating and social desirability were correlated to underreporting. Dietary patterns were obtained by cluster analysis. Results: TEE was 2,622 ± 490 kcal, while EI, measured respectively by the diet recall, food record and food-frequency questionnaire, was 2,078 ± 430 kcal; 2,044 ± 479 kcal and 1,984 ± 832 kcal. Proportion of underreporters was 24.6% (recall), 29.2% (record) and 53.8% (questionnaire) (p < 0.005). Underreporters had smaller income and education and greater age, body dissatisfaction and social desirability. Underreporting was more common in the \'frugal foods\' pattern. Conclusions: The three dietary assessment methods presented systematic errors, although the foodfrequency questionnaire had the worst performance. Underreporting was influenced by psychosocial factors and varied according the reported dietary pattern, which may compromise dietary assessment

O gasto energético total (GET) pode ser usado como medida da ingestão energética (IE). Existe um constante sub-relato da IE obtida por métodos de avaliação do consumo alimentar, mas poucos estudos o investigaram em nações em desenvolvimento. Objetivos: a) comparar a validade das estimativas de IE de um questionário de freqüência alimentar, três recordatórios alimentares e um diário alimentar de três dias, segundo a água duplamente marcada; b) determinar a influência da prática de atividade física, do índice de massa corporal e de fatores psicossociais no sub-relato e; c) comparar as taxas de sub-relato entre agrupamentos de padrões alimentares. Métodos: Sessenta e cinco mulheres responderam aos métodos de inquérito supracitados, a partir dos quais foi estimada a IE. O GET foi medido pela água duplamente marcada. A prática de atividade física, índice de massa corporal, escolaridade, renda, idade, conhecimento nutricional, insatisfação corporal, restrição dietética, compulsão alimentar e o desejo de aceitação social foram correlacionados ao sub-relato. Os padrões alimentares foram obtidos pela análise de cluster. Resultados: O GET foi de 2.622 ± 490 kcal, enquanto que a IE, mensurada respectivamente pelo recordatório, diário e questionário, foi de 2.078 ± 430 kcal; 2.044 ± 479 kcal e 1.984 ± 832 kcal. A proporção de sub-relatores foi de 24,6% para o recordatório, 29,2% para o diário e 53,8% para o questionário (p < 0,005). Os sub-relatores apresentaram menores médias de renda e escolaridade e maiores valores de idade, insatisfação corporal e desejo de aceitação social. O sub-relato foi mais comum no padrão alimentar mais frugal. Conclusão: Os três métodos de avaliação do consumo alimentar apresentaram erros sistemáticos, embora o questionário de freqüência alimentar tenha tido o pior desempenho. O sub-relato foi influenciado por diversos fatores psicossociais e variou conforme o padrão alimentar relatado, o que pode comprometer a avaliação do consumo / Total energy expenditure (TEE) may be used as a measure of energy intake (EI). There is a constant underreporting of EI obtained by dietary assessment methods, but few studies have investigated it in developing nations. Objectives: a) to compare the validity of EI estimates obtained by a food-frequency questionnaire, three diet recalls and a three-day food record; b) to determine the influence of physical activity, body mass index and psychosocial factors on underreporting and; c) to compare underreporting rates between dietary pattern\'s clusters. Methods: Sixty-five women completed the dietary assessment methods, which were used to estimate EI. TEE was measured by doubly labeled water. Physical activity practice, body mass index, education, income, age, nutritional knowledge, body dissatisfaction, dietary restraint, binge eating and social desirability were correlated to underreporting. Dietary patterns were obtained by cluster analysis. Results: TEE was 2,622 ± 490 kcal, while EI, measured respectively by the diet recall, food record and food-frequency questionnaire, was 2,078 ± 430 kcal; 2,044 ± 479 kcal and 1,984 ± 832 kcal. Proportion of underreporters was 24.6% (recall), 29.2% (record) and 53.8% (questionnaire) (p < 0.005). Underreporters had smaller income and education and greater age, body dissatisfaction and social desirability. Underreporting was more common in the \'frugal foods\' pattern. Conclusions: The three dietary assessment methods presented systematic errors, although the foodfrequency questionnaire had the worst performance. Underreporting was influenced by psychosocial factors and varied according the reported dietary pattern, which may compromise dietary assessment

Background: The level of activity in an individual can be the difference between health and illness. Physical inactivity can cause diseases such as osteoporosis and type-2 diabetes. It has been reported that children live an increasingly inactive life, with less than the recommended a total of 60 minutes daily for children and adolescents of 6-17 years of age. Objective: The objective was to compare two activity diaries and how the results correspond to measurements by an activity meter. Material and methods: This study included 12 children who each carried an activity meter for four days to measure Total Energy Expenditure. In parallel, they filled in two different activity diaries. In the diaries two different calculation methods were used, with a Physical Activity Ratio value or a Metabolic Equivalent of Task value which then was inserted into equations to calculate Total Energy Expenditure. Anthropometric measurements were obtained by use of a stadiometer, a caliper and a bioimpedance scale. Results: The results from the Physical Activity Ratio diary indicated a better match with the results from the activity meter. Conclusions: Between the two diaries significant difference in how the activities were estimated were found, where an overestimation could be seen in the diary that used the Metabolic Equivalent of Task. Differences could also be seen between the activity meter and both diaries, also here the difference were bigger with the Metabolic Equivalent of Task diary. The Physical Activity Ratio diary was better matched with the activity meter.

Uma sessão de exercício aeróbio provoca queda da pressão arterial (PA) e aumento da freqüência cardíaca (FC) pós-exercício. Diversos fatores, como a massa muscular, a intensidade e o gasto energético total do exercício podem influenciar esta resposta. Este estudo verificou as respostas pós-exercício da PA, da FC e de seus mecanismos, avaliando a influência dos fatores citados. Vinte e quatro jovens submeteram-se a quatro sessões: controle(C); exercício com um membro inferior (mmii) em 50% do VO2pico(E1); exercício com dois mmii em 50% do VO2pico (E2); e exercício com dois mmii com a mesma potência de E1(E2/1). As PA sistólica (PAS), média (PAM) e diastólica (PAD), o débito cardíaco (DC), a resistência vascular periférica (RVP), o volume sistólico (VS), a FC e a modulação autonômica cardíaca foram medidos. Após o exercício, a PAS e o DC diminuíram e a RVP aumentou em E2. A PAD e PAM não se alteraram. A FC aumentou e o VS e o componente de alta freqüência da variabilidade da FC diminuíram em E1 e E2 (maior em E2). Concluindo: o exercício aeróbio promove hipotensão pós-exercício, devido à queda do DC pela redução do VS. O gasto energético total do exercício é o principal determinante desta resposta. A FC permanece elevada pós-exercício devido ao retardo da reativação vagal. A intensidade e o gasto energético do exercício são os principais determinantes desta resposta / A single bout of aerobic exercise reduces blood pressure (BP) and increases heart rate (HR) during the recovery period. Many factors, such as exercise intensity, muscle mass and total energy expenditure might influence this response. This study verified post-exercise responses of BP, HR and their mechanisms, evaluating the influence of previous factors. Twenty-four subjects underwent four sessions: control (C); exercise with one leg at 50% of VO2peak (E1); exercise with two legs at 50% of VO2peak (E2); and exercise with two legs and the same workload employed in E1 (E2/1). Systolic, mean, and diastolic BPs (SBP, MBP, DBP), systemic vascular resistance (SVR), cardiac output (CO), stroke volume (SV), HR, and cardiac autonomic modulations were measured before and after interventions. After exercise, SBP and CO decreased, while SVR increased in E2. DBP and MBP did not change. HR increased, while SV and the high frequency band of HR variability decreased in E1 and E2 (more in E2). In conclusion: aerobic exercise produced post-exercise hypotension by a decrease in CO, via a decrease in SV. This response is determined by the exercise total energy expenditure. HR is elevated after exercise due to a delay in the restoration of vagal activity to the heart. Exercise intensity and total energy expenditure influence this response. Key-words: aerobic exercise, muscle mass, total energy expenditure, relative intensity, blood pressure, heart rate, autonomic modulation

Introdução: A síndrome do intestino curto (SIC) representa um estado clínico de má absorção grave, e a gestão dietética de pacientes com SIC é extremamente desafiadora. Uma vez que o grau de desnutrição é frequentemente considerável, a intervenção dietética bem sucedida depende da estimativa mais exata possível das necessidades energéticas para prever as metas da terapia nutricional. Objetivo: Quantificar o gasto energético total (GET) em pacientes com SIC pelo método da água duplamente marcada (ADM). Materiais e Métodos: Neste estudo observacional, o GET foi mensurado pelo método da água duplamente marcada em 22 voluntários, 11 com SIC e 11 controles pareados por sexo, idade e IMC (grupo Controle). O GET foi estimado pela equação de Escott-Stump e a partir de acelerômetro, e foi comparado com o GET determinado pela ADM. O gasto energético em repouso (GER) foi mensurado por calorimetria indireta (CI) e comparado com o GER estimado pela equação de Harris e Benedict. O acelerômetro também foi utilizado para estabelecer o nível de atividade física. Resultados: Os participantes tinham idade (média ± DP) de 53 ± 8 anos. O GET medido por ADM foi significativamente menor no grupo SIC comparado ao grupo Controle (p < 0,01); no entanto, o GET estimado não diferiu significativamente entre os grupos. O GET medido foi significativamente maior do que o GET estimado por fórmula no grupo SIC, (respectivamente 1875 ± 276 e 1517 ± 175 kcal/dia, p < 0,01), assim como para o grupo Controle (2393 ± 445 e 1532 ± 178 kcal/dia, p < 0,01). No entanto, o GET medido foi significativamente menor do que o GET predito a partir do acelerômetro no grupo SIC (2075 ± 298 kcal/dia, p = 0,02), e não diferiu significativamente no grupo Controle (2207 ± 355 kcal/dia, p = 0,21). Não foram verificadas diferenças significantes entre o GER medido e predito para ambos, e entre os grupos. Conclusão: O GET medido em pacientes com SIC foi significativamente maior do que o GET estimado por fórmula, e foi menor quando comparado com os valores dos sujeitos controles. No entanto, o GET estimado a partir do acelerômetro, superestima o GET medido por ADM. As fórmulas atualmente utilizadas na prática clínica parecem subestimar as necessidades de energia de pacientes com SIC. Desta forma, adaptações da estimativa atual, aumentando as prescrições de ingestão energética nestes pacientes parecem ser adequadas para apoiar as necessidades diárias de energia e evitar a subnutrição. / Background: Short bowel syndrome (SBS) is a serious malabsorption disorder, and dietetic management of SBS patients is extremely challenging. Once the degree of undernutrition has been assessed, successful dietary intervention depends on the most accurate estimation and provision of energy needs to provide nutritional therapy goals. Objective: To quantify total energy expenditure (TEE) in SBS patients using the doubly labeled water (DLW) method. Design: In this observational study, TEE was measured by the DLW method in 22 participants, 11 with SBS and 11 gender-age-and BMI-matched controls (Control group). Predicted energy requirements were determined using the Escott-Stump equation and by using and accelerometer, and they were compared with TEE determined with DLW. Resting energy expenditure (REE) was measured using indirect calorimetry and compared with predict REE using the Harris and Benedict equation. The accelerometer was also used to determine physical activity level. Results: Participants were aged (mean ± SD) 53 ± 8 years. Measured TEE was significantly lower in the SBS group compared to the Control group (p < 0.01); however, predicted TEE did not differ significantly between the groups. Measured TEE was significantly higher than predicted TEE for the SBS group, (1875 ± 276 and 1517 ± 175 kcal/d, p < 0.01) and also for the Control group (2393 ± 445 and 1532 ± 178 kcal/d, p < 0.01) when determined by formula. However, measured TEE was significantly lower than predicted TEE (2075 ± 298 kcal/d, p = 0.02) for the SBS group, and did not differ for the Control group (2207 ± 355 kcal/d, p = 0.21) when determined by accelerometer. No significant differences were seen between measured and predicted REE both within and between groups. Conclusion: Measured TEE in SBS patients was significantly higher than predicted using standard equations, but also lower than values for age, BMI and gender-matched non-SBS controls. However, predicted TEE using accelerometer overestimated the measured TEE. Currently-used formulas in clinical practice appear to underestimate energy requirements of SBS patients. Therefore, adjustments to the current estimation, increasing the energy intake requirements in these patients appear to be adequate to support the daily energy requirements and avoid undernutrition.

Introduction Optimal nutrition is vital in the management of infants born preterm. Dietary fat in infancy is fundamental for the provision of energy for growth and development. Essential fatty acids, specifically Long Chain Polyunsaturated Fatty Acids (LC-PUFAs) such as docosahexaenoic acid (DHA), have been under investigation by several international research groups in the past decade. Essential fatty acids are critical in neurodevelopment as DHA is found in high proportions in structural lipids of cell membranes, particularly in the central nervous system (CNS). The accumulation of essential fatty acids and particularly DHA in the brain and retina occurs most rapidly during the perinatal period, therefore preterm infants are of particular concern (Singer, 2001). Current scientific consensus is that the optimum growth rate for preterm infants is equal to the in utero growth rate throughout the last trimester, however, failure to achieve the optimum intrauterine growth rate is common in preterm infants (Olhager and Forsum, 2003). Preterm infants require large amounts of energy and nutrients with which many infants are not provided or are not able to absorb, due to immature gastrointestinal and metabolic systems and other medical complications (Olhager and Forsum, 2003). There are a number of unresolved issues regarding optimal growth rate and total energy requirements (ER) for preterm infants. Hypotheses/Objectives This study is a “side study” to a double blind randomised controlled trial (RCT) of DHA supplementation in preterm infants. The hypothesis of this “side study” is that increased DHA during the neonatal period would increase total energy expenditure (TEE) and improve neurodevelopmental outcome. Specifically, at term postconceptual age (PCA) it was hypothesised that preterm infants receiving higher intake of DHA would have higher TEE’s due to the acceleration in brain maturation. Also, it was hypothesised that preterm infants receiving high levels of DHA would have TEE’s equivalent to term born infants due to their same brain maturation status. Other hypothesised effects of DHA supplementation include an accelerated maturation of the visual cortical pathways, and accelerated white matter (WM) tract development aiding in brain maturation. The first objective of this study was to measure TEE and ER in very preterm infants when they reached an age of 31-33 weeks post conceptional age (PCA). The effects of DHA supplementation on TEE, at simulated in utero levels, in very preterm infants (born < 33 weeks PCA), when assessed at term equivalent (40 weeks PCA) were studied. Another objective was to compare WM brain tissue volume at term PCA between two preterm groups and then with the term born infants. Visual latency was also compared between the two preterm infant groups and then with the term born infants. Methods TEE was measured using the doubly labelled water (DLW) method which is based on the differential elimination of 2H (deuterium) and 18O from the body subsequent to a loading dose of these isotopes. TEE was measured at the preterm age between 31-33 weeks PCA and again at term PCA. TEE measurements are made at term PCA in a term born control group. Brain assessment was by Magnetic Resonance Imaging and (MRI) and Visual Evoked Potential (VEP). Magnetic resonance imaging quantitatively measured brain volumes and WM. Visual evoked potential would provide information on visual latency and amplitude. Results The cohort consisted of 38 infants. The TEE of the very preterm infant group was measured at 31-33 weeks PCA. The mean (±standard deviation) (SD) TEE was calculated at 80(±27) kcal/kg/d, and using data in the literature for foetal energy accretion of 28kcal/kg/d, the mean ER was calculated to be 108(±27) kcal/kg/d. At term PCA TEE was calculated for the preterm DHA supplemented group to be 56(±19) kcal/kg/d and for the non-DHA supplemented group 70(±39) kcal/kg/d. These measurements were not statistically different. Flash VEP conducted on preterm given different amounts of DHA tested at term PCA found no statistically different measurements. When combining these results and comparing them to measurements of term born infants at term PCA, the right eye measurements showed that preterm infants had statistically greater latencies than term infants. When combining the left and right eye measurements the latencies no statistical significance was found. Amplitude was also not statistically significant between the groups. MRI measures at term PCA were not statistically different DHA supplemented and the non-DHA supplemented preterm infant group. When the preterm infant cohort was combined and compared to the term born infant group, the results showed that preterm infants imaged at term PCA had reduced WM development in a number of frontal lobe projections, and anterior and posterior commissarial pathways of the corpus callosum and corona radiata. Discussion The TEE and ER measurements in this study represent the largest preterm infant cohort to date. The ER values reported here are of value in allowing the calculation of appropriate feeding and nutritional strategies for preterm infants. Although no differences in TEE between the DHA and non DHA supplemented groups were found this may have been due to the small sample size. With regard to the latency outcomes, it can be speculated that if measurements were conducted at a later PCA the correlations may have been stronger and significant. Several other factors may have also affected the results, including alertness of the infant at the time of testing, thickness of the cranium, and other health factors could not be controlled for. This study contains the youngest cohort to be compared via Flash VEP. The MRI data did not find significant differences in brain volume and WM between the DHA supplemented and the non-DHA supplemented groups. The infant CNS is rapidly developing and there are multiple environmental factors which may have affected outcomes. The data did however find differences in WM development between the preterm and term infants. The reduced WM development found in the preterm infants compared to term born infants may provide some explanation for the correlation between preterm birth and poorer cognitive and functional outcomes. Larger studies which extend beyond the first months of life are recommended in order to investigate the long-term relationships between DHA supplementation, TEE and brain maturation.

Introdução: A síndrome do intestino curto (SIC) representa um estado clínico de má absorção grave, e a gestão dietética de pacientes com SIC é extremamente desafiadora. Uma vez que o grau de desnutrição é frequentemente considerável, a intervenção dietética bem sucedida depende da estimativa mais exata possível das necessidades energéticas para prever as metas da terapia nutricional. Objetivo: Quantificar o gasto energético total (GET) em pacientes com SIC pelo método da água duplamente marcada (ADM). Materiais e Métodos: Neste estudo observacional, o GET foi mensurado pelo método da água duplamente marcada em 22 voluntários, 11 com SIC e 11 controles pareados por sexo, idade e IMC (grupo Controle). O GET foi estimado pela equação de Escott-Stump e a partir de acelerômetro, e foi comparado com o GET determinado pela ADM. O gasto energético em repouso (GER) foi mensurado por calorimetria indireta (CI) e comparado com o GER estimado pela equação de Harris e Benedict. O acelerômetro também foi utilizado para estabelecer o nível de atividade física. Resultados: Os participantes tinham idade (média ± DP) de 53 ± 8 anos. O GET medido por ADM foi significativamente menor no grupo SIC comparado ao grupo Controle (p < 0,01); no entanto, o GET estimado não diferiu significativamente entre os grupos. O GET medido foi significativamente maior do que o GET estimado por fórmula no grupo SIC, (respectivamente 1875 ± 276 e 1517 ± 175 kcal/dia, p < 0,01), assim como para o grupo Controle (2393 ± 445 e 1532 ± 178 kcal/dia, p < 0,01). No entanto, o GET medido foi significativamente menor do que o GET predito a partir do acelerômetro no grupo SIC (2075 ± 298 kcal/dia, p = 0,02), e não diferiu significativamente no grupo Controle (2207 ± 355 kcal/dia, p = 0,21). Não foram verificadas diferenças significantes entre o GER medido e predito para ambos, e entre os grupos. Conclusão: O GET medido em pacientes com SIC foi significativamente maior do que o GET estimado por fórmula, e foi menor quando comparado com os valores dos sujeitos controles. No entanto, o GET estimado a partir do acelerômetro, superestima o GET medido por ADM. As fórmulas atualmente utilizadas na prática clínica parecem subestimar as necessidades de energia de pacientes com SIC. Desta forma, adaptações da estimativa atual, aumentando as prescrições de ingestão energética nestes pacientes parecem ser adequadas para apoiar as necessidades diárias de energia e evitar a subnutrição. / Background: Short bowel syndrome (SBS) is a serious malabsorption disorder, and dietetic management of SBS patients is extremely challenging. Once the degree of undernutrition has been assessed, successful dietary intervention depends on the most accurate estimation and provision of energy needs to provide nutritional therapy goals. Objective: To quantify total energy expenditure (TEE) in SBS patients using the doubly labeled water (DLW) method. Design: In this observational study, TEE was measured by the DLW method in 22 participants, 11 with SBS and 11 gender-age-and BMI-matched controls (Control group). Predicted energy requirements were determined using the Escott-Stump equation and by using and accelerometer, and they were compared with TEE determined with DLW. Resting energy expenditure (REE) was measured using indirect calorimetry and compared with predict REE using the Harris and Benedict equation. The accelerometer was also used to determine physical activity level. Results: Participants were aged (mean ± SD) 53 ± 8 years. Measured TEE was significantly lower in the SBS group compared to the Control group (p < 0.01); however, predicted TEE did not differ significantly between the groups. Measured TEE was significantly higher than predicted TEE for the SBS group, (1875 ± 276 and 1517 ± 175 kcal/d, p < 0.01) and also for the Control group (2393 ± 445 and 1532 ± 178 kcal/d, p < 0.01) when determined by formula. However, measured TEE was significantly lower than predicted TEE (2075 ± 298 kcal/d, p = 0.02) for the SBS group, and did not differ for the Control group (2207 ± 355 kcal/d, p = 0.21) when determined by accelerometer. No significant differences were seen between measured and predicted REE both within and between groups. Conclusion: Measured TEE in SBS patients was significantly higher than predicted using standard equations, but also lower than values for age, BMI and gender-matched non-SBS controls. However, predicted TEE using accelerometer overestimated the measured TEE. Currently-used formulas in clinical practice appear to underestimate energy requirements of SBS patients. Therefore, adjustments to the current estimation, increasing the energy intake requirements in these patients appear to be adequate to support the daily energy requirements and avoid undernutrition.

Uma sessão de exercício aeróbio provoca queda da pressão arterial (PA) e aumento da freqüência cardíaca (FC) pós-exercício. Diversos fatores, como a massa muscular, a intensidade e o gasto energético total do exercício podem influenciar esta resposta. Este estudo verificou as respostas pós-exercício da PA, da FC e de seus mecanismos, avaliando a influência dos fatores citados. Vinte e quatro jovens submeteram-se a quatro sessões: controle(C); exercício com um membro inferior (mmii) em 50% do VO2pico(E1); exercício com dois mmii em 50% do VO2pico (E2); e exercício com dois mmii com a mesma potência de E1(E2/1). As PA sistólica (PAS), média (PAM) e diastólica (PAD), o débito cardíaco (DC), a resistência vascular periférica (RVP), o volume sistólico (VS), a FC e a modulação autonômica cardíaca foram medidos. Após o exercício, a PAS e o DC diminuíram e a RVP aumentou em E2. A PAD e PAM não se alteraram. A FC aumentou e o VS e o componente de alta freqüência da variabilidade da FC diminuíram em E1 e E2 (maior em E2). Concluindo: o exercício aeróbio promove hipotensão pós-exercício, devido à queda do DC pela redução do VS. O gasto energético total do exercício é o principal determinante desta resposta. A FC permanece elevada pós-exercício devido ao retardo da reativação vagal. A intensidade e o gasto energético do exercício são os principais determinantes desta resposta / A single bout of aerobic exercise reduces blood pressure (BP) and increases heart rate (HR) during the recovery period. Many factors, such as exercise intensity, muscle mass and total energy expenditure might influence this response. This study verified post-exercise responses of BP, HR and their mechanisms, evaluating the influence of previous factors. Twenty-four subjects underwent four sessions: control (C); exercise with one leg at 50% of VO2peak (E1); exercise with two legs at 50% of VO2peak (E2); and exercise with two legs and the same workload employed in E1 (E2/1). Systolic, mean, and diastolic BPs (SBP, MBP, DBP), systemic vascular resistance (SVR), cardiac output (CO), stroke volume (SV), HR, and cardiac autonomic modulations were measured before and after interventions. After exercise, SBP and CO decreased, while SVR increased in E2. DBP and MBP did not change. HR increased, while SV and the high frequency band of HR variability decreased in E1 and E2 (more in E2). In conclusion: aerobic exercise produced post-exercise hypotension by a decrease in CO, via a decrease in SV. This response is determined by the exercise total energy expenditure. HR is elevated after exercise due to a delay in the restoration of vagal activity to the heart. Exercise intensity and total energy expenditure influence this response. Key-words: aerobic exercise, muscle mass, total energy expenditure, relative intensity, blood pressure, heart rate, autonomic modulation

Consistently, reports in the literature have identified that a sedentary lifestyle contributes to the progression of a range of chronic degenerative diseases. The measurement of energy expenditure and physical activity pattern in children is a challenge for all professionals interested in paediatric health and from a broader perspective, the public health fraternity charged with considering longer term health consequences of physical inactivity. The primary objective of this thesis was to identify a suitable indirect and objective measurement technique for the assessment of energy expenditure and physical activity pattern in children. The ideal characteristics of such a technique are that it should be reproducible and have been validated against a criterion reference method. To achieve this goal, a series of methodological studies were undertaken (Chapters II and III). This work was essential to increase accuracy during the individualised laboratory calibration process and further minimise prediction errors when analysing data from 7 days of monitoring under free-living conditions in the second part of the study (Chapters IV and V). In the first study to verify the combined effect of body position, apparatus and distraction on children's resting metabolic rate (RMR), experiments were carried out on 14 children aged 8-12 (mean age = 10.1 years ± 1.4). Each participant underwent 2 test sessions, one week apart under three different situations: a) using mouthpiece and nose-clip (MN) or facemask (FM); b) sitting (SEAT) or lying (LY) and c) TV viewing (TV) or no TV viewing. In the first session, following 20 min rest and watching TV, the following protocol was used: LY: 20 min - stabilisation; 10 min using MN and 10 min using FM. Body position was then changed to seated: 20 min stabilisation; 10 min using FM; 10 min using MN. In the second session, FM and MN order was changed and participants did not watch TV. Data were analysed according to the eight combinations among the three studied parameters. Repeated measures ANOVA indicated statistically significant differences for &VO2 (p=0.01) and RMR (p=0.02), with TVMNSEAT showing higher values than TVFMLY. Bland-Altman analysis showed a bias for &VO2, &VCO2, RQ and RMR between TVFMLY and TVMNSEAT of -17.8±14.5 ml.min-1, -8.8±14.5 ml. min-1, 0.03±0.05 and -115.2±101.9 kcal.d-1, respectively. There were no differences in RMR measurements due to body position and apparatus when each variable was isolated. Analyses of distraction in three of four combinations indicated no difference between TV and no TV. In summary, different parameter combinations can result in increased bias and variability and thereby reported differences among children's RMR measurement. The second study dealt with treadmill adaptation and determination of self-selected (SS) walking speed. Assessment of individual and group differences in metabolic energy expenditure using oxygen uptake requires that individuals are comfortable with, and can accommodate to, the equipment being utilised. In this study, a detailed proposal for an adaptation protocol based on the SS was developed. Experiments were carried out on 27 children aged 8-12 (mean age = 10.3±1.2 yr). Results from three treadmill tests following the adaptation protocol showed similar results for step length with no significant differences among tests and lower and no statistically significant variability within- and between-days. Additionally, no statistically significant differences between SS determined over-ground and on a treadmill were verified. These results suggest that SS speed determined over-ground is reproducible on a treadmill and the 10 min familiarisation protocol based on this speed provided sufficient exposure to achieve accommodation to the treadmill. The purpose of the third study was to verify within- and between-day repeatability and variability in children's oxygen uptake ( &VO2), gross economy (GE) [ &VO2 divided by speed] and heart rate (HR) during treadmill walking based on SS. 14 children (mean age = 10.2±1.4 yr) undertook 3 testing sessions over 2 days in which four walking speeds, including SS, were tested. Within- and between-day repeatability was assessed using the Bland and Altman method and coefficients of variability (CV) were determined for each child across exercise bouts and averaged to obtain a mean group CV value for &VO2, GE and HR per speed. Repeated measures ANOVA showed no statistically significant differences in within- or between-day CV for &VO2, GE or HR at any speed. Repeatability within and between-day for &VO2, GE and HR for all speeds was verified. These results suggest that submaximal &V O2 during treadmill walking is stable and reproducible at a range of speeds based on children's SS. In the fourth study, the objective was to establish the effect of walking speed on substrate oxidation during a treadmill protocol based on SS. Experiments were carried out on 12 girls aged 8-12 (mean age = 9.9±1.4 yr). Each participant underwent 2 test sessions, one week apart. Workloads on the treadmill included 2 speeds slower than SS (1.6 [V1] and 0.8 km.h-1 [V2] slower than SS), SS (V3), and a speed 0.8 km.h-1 faster than SS (V4). Indirect calorimetry from respired gas measurements enabled total fat (FO) and carbohydrate (CHO) oxidation rates to be calculated according to the non-protein respiratory quotient (Peronnet and Massicote, 1991) and percentage of CHO and FO calculations using equations from McGilvery and Goldstein (1983). Repeated measures ANOVA followed by a Tukey Post Hoc test (p< 0.05) was used to verify differences in CHO and FO rates among speeds. Paired T-test was used to verify differences in CHO and FO rates between tests per velocity. The reliability between-day was assessed using intraclass correlation coefficient (ICC). Results showed significant differences for CHO among all speeds, as well as significant differences for FO between V1 and V2 against V3 and V4 in both tests. Analyses between trials per velocity showed no significant substrate use differences as well as acceptable reliability. At the self-selected speed (V3) there was an accentuation in FO reduction as well as an increase in CHO oxidation. The purpose of the fifth study was to determine whether there were differences in substrate oxidation between girls (G) and women (W) during a treadmill protocol based on SS. Experiments were carried out on 12 G aged 8-12 (mean age = 9.9±1.4 yr) and 12 W aged 25-38 (mean age = 32.3±3.8 yr). The treadmill protocol included 6 min workloads followed by 5 min rest periods. Workloads included 2 speeds slower than SS (1.6 (V1) and 0.8 km.h-1 (V2) slower than SS), SS (V3), and a speed 0.8 km.h-1 faster than SS (V4). Total fat and carbohydrate (CHO) oxidation rates were calculated from indirect calorimetry according to the non-protein respiratory quotient. Repeated measures ANOVA followed by a Tukey Post Hoc test was used to verify intra-test differences in CHO and fat oxidation rates among speeds. Intergroup differences were analysed using paired T-test. Fat utilisation in W achieved a plateau at a relative velocity 0.8 km.h-1 slower than SS, but for G, fat utilisation increased until SS, and then stabilised upon reaching the higher velocity. CHO oxidation curves rose abruptly above V2 for W, while for G the acute increase occurred after SS (V3). Collectively, these results indicate that as walking intensity increases G are able to meet the energy demands of the work by increasing fat oxidation together with the increased CHO oxidation up to SS. In contrast for W, increasing CHO oxidation is associated with an early decrease in fat utilisation at a velocity slower than the self-selected speed. The sixth study dealt with validation of indirect techniques for the measurement of energy expenditure in free-living conditions against the DLW technique. Experiments were carried out on 19 children aged 8-12 (mean age = 10.3±1.0 yr). To indirectly predict energy expenditure 12 different procedures were used. Only one procedure, combining activity and heart rate (AHbranched), was based on a group equation, the others were based on individualised regression. Three of the individually-based techniques were able to accurately predict energy expenditure in free-living conditions. These tecniques were HRPAnetRMR using HRnet [HR exercise minus sleep HR (SHR)] against PAnet (measured PA exercise minus measured RMR) and upper and lower body equations corrected by RMR; HRPAnet4act using the same procedure but corrected by the mean resting &VO2 for 4 resting activities [(4act) = supine watching TV, sitting watching TV, sitting playing computer games and standing], and HRPALBnet4act using only lower body activities and corrected by 4act. HRPAnetRMR was only slightly more accurate than HRPAnet4act and HRPALBnet4act, but this technique is only adjusted by RMR whereas the other two are heavily dependent on more complex laboratory calibration. Bland and Altman (1986) analyses showed no significant differences between AHbranched predicted and measured TEE using the DLW technique. A SEE of 79 kcal.d-1 and a mean difference of 72 kcal.d-1, with a 95% CI ranging from -238 to 93.9 kcal.d-1 was found. In addition, no significant differences between predicted HRPAnetRMR and measured TEE using DLW were found, showing an SEE of 99 kcal.d-1 and a mean difference of -67 kcal.d-1, and a 95% CI ranging from -276.6 to 141.9 kcal.d-1. AHbranched and HRPAnetRMR were both valid and similarly suitable for the prediction of energy expenditure in children under free-living conditions. Significant associations between DLWAEE and the after-school time window indicated that this time window as an important discretionary period representative of children physical activity. However, the duration of the after-school time windows should be more carefully considered. Accelerometer data showed a better association between the largest after-school time window (3.5 hr) and measured TEE. The final study, completed with 19 children aged 8-12 (10.3±1.0 yr) highlighted, under laboratory conditions across a range of walking and running speeds, the inadequacy of the use of the standard MET in children. This traditional approach overestimates energy expenditure with an increased difference linearly related to speed increments. Minute-by-minute analyses of 7 days of free-living monitoring showed an average overestimation of 64 minutes per day for moderate-to-vigorousphysical- activity (MVPA) using the standard MET compared with the individually measured MET. For all intensities, these differences were statistically significant (p< 0.001). The second part of this study showed a variability of 20% in the average time spent at MVPA when comparing HR I 140 bpm and HR > 50%P &VO2 (P &VO2 = the highest &VO2 observed during an exercise test to exhaustion). Results of the current study compared to observations in the literature showed that HR I 140 bpm consistently estimates lower MVPA time than HR > 50%P &VO2. When these two PA indices were compared with individual and standard MET measured minute-byminute, statistically significant differences were verified among all of them at MPA, but no differences were verified at VPA, except between individual and standard METs. However, whether each one of the PA indices used are under- or overestimating time at MVPA is still debatable due to the lack of a gold standard. Finally, each index used in this study classified different numbers of participants as achieving the PA target of 60 min.d-1. The wide variability between indices when attempting to classify children who are achieving the recommended target is cause for great concern because habitually these indices are utilised as screening tools in paediatric and public health settings and used to guide behavioural interventions.