OBJECTIVE: To investigate the long-term effects of changes in dietary carbohydrateafat ratio and simple vs complex carbohydrates. DESIGN: Randomized controlled multicentre trial (CARMEN), in which subjects were allocated for 6 months either to a seasonal control group (no intervention) or to one of three experimental groups: a control diet group (dietary intervention typical of the average national intake); a low-fat high simple carbohydrate group; or a low-fat high complex carbohydrate group. SUBJECTS: Three hundred and ninety eight moderately obese adults. MEASUREMENTS: The change in body weight was the primary outcome; changes in body composition and blood lipids were secondary outcomes. RESULTS: Body weight loss in the low-fat high simple carbohydrate and low-fat high complex carbohydrate groups was 0.9 kg (P`0.05) and 1.8 kg (P`0.001), while the control diet and seasonal control groups gained weight (0.8 and 0.1 kg, NS). Fat mass changed by 7 1.3 kg (P`0.01), 7 1.8 kg (P`0.001) and 0.6 kg (NS) in the low-fat high simple carbohydrate, low-fat high complex carbohydrate and control diet groups, respectively. Changes in blood lipids did not differ signi®cantly between the dietary treatment groups. CONCLUSION: Our ®ndings suggest that reduction of fat intake results in a modest but signi®cant reduction in body weight and body fatness. The concomitant increase in either simple or complex carbohydrates did not indicate signi®cant differences in weight change. No adverse effects on blood lipids were observed. These ®ndings underline the importance of this dietary change and its potential impact on the public health implications of obesity.

The use of movement registration for daily physical activity assessment was evaluated during a 7-day period in 30 free-living subjects. Body movement was registered with a Tracmor motion sensor consisting of a triaxial accelerometer and a data unit for on-line processing of accelerometer output over 1-min intervals. Average Tracmor output was correlated against four different energy estimates: 1) average daily metabolic rate (ADMR), determined with doubly labeled water; 2) ADMR-sleeping metabolic rate (SMR; determined in a respiration chamber); 3) (ADMR-SMR) per kilogram of body mass; and 4) the overall physical activity level (PAL = ADMR/SMR). The highest correlation was found for the relationship between Tracmor output and PAL (r = 0.58). After correction for Tracmor values arising from vibrations produced by transportation means, this correlation was improved to 0.73. There was no difference between Tracmor output and PAL in discriminating between overall activity levels with "low" (PAL < 1.60), "moderate" (1.60 < or = PAL < or = 1.85), and "high" (PAL > 1.85) intensity. It is concluded that the Tracmor can be used in free-living subjects to distinguish among interindividual as well as intraindividual levels of daily physical activity.

MALPUECH-BRUGÈ RE, CORINNE, WILHELMINE

Patients with liver cirrhosis are often undernourished. In healthy subjects, the pattern offood intake is one ofthe variables that can influence energy balance and substrate metabolism. The short term (two day) effect of the pattern of food intake in patients with cirrhosis and controls was compared. In a respiration chamber, eight patients with cirrhosis of the liver and 23 controls were fed to estimated energy balance in two meals daily ('gorging' pattern) and four to seven meals daily ('nibbling' pattern expenditure and substrate metabolism in a large group of patients with cirrhosis (n= 123), reported that 18% were considered hypermetabolic, whereas 52% were normometabolic, and 31% were hypometabolic. They concluded that the resting metabolic rate is not a clear cut phenomenon in cirrhotic patients. Owen et al5 reported that after an overnight fast the energy requirements of patients with alcoholic cirrhosis were normal, but the nature of fuels oxidised was more similar to that in healthy controls after two to three days of total starvation, that is, a relatively high contribution of fat to energy metabolism.The pattern of food intake is often cited as one of the variables that can influence energy balance and substrate metabolism. When the daily energy intake is consumed in a small number of large meals ('gorging' pattern) relatively more energy has to be stored than with a feeding pattern of a large number of small meals ('nibbling' pattern). A gorging pattern has been shown to enhance lipogenesis,10 11 to increase body weight,12 to increase the blood serum cholesterol concentration,'3 14 and to reduce glucose tolerance.14-16 In a previous study in which we investigated the short term (two day) effect of feeding frequency on nutrient utilisation in healthy young subjects, we observed a stronger diurnal periodicity of lipogenesis and lipolysis on a gorging pattern than on a nibbling pattern of food intake. 17 In patients with cirrhosis of the liver, a late evening meal seemed to improve the efficiency of nitrogen metabolism. '8 This study was conducted to assess the 24 hour energy expenditure and sleeping metabolic rate of patients with liver cirrhosis and compare the results with those from healthy adult controls. A second aim was to determine whether the pattern of food intake has an effect on the oxidation rate of protein, fat, and carbohydrate in cirrhotic patients. The results of substrate metabolism were partially compared with a similar study on healthy young adults. Methods SUBJECTSEight patients with biopsy-proved cirrhosis of the liver were studied. All were in a stable clinical condition at the time of the study. Their median age was 53 (range 39-62) years and their median body mass index was 23.7 110 on 10 May 2018 by guest. Protected by copyright.

The pattern of food intake can affect the regulation of body weight and lipogenesis. We studied the effect of meal frequency on human energy expenditure (EE) and its components. During 1 week ten male adults (age 25-61 years, body mass index 20.7-30.4 kg/m2) were fed to energy balance a t two mealsld (gorging pattern) and during another week at seven meals/d (nibbling pattern). For the first 6 d of each week the food was provided at home, followed by a 36 h stay in a respiration chamber. 0, consumption and CO, production (and hence EE) were calculated over 24 h. EE in free-living conditions was measured over the 2 weeks with doubly-labelled water (average daily metabolic rate, ADMR). The three major components of ADMR are basal metabolic rate (BMR), diet-induced thermogenesis (DIT) and EE for physical activity (ACT). There was no significant effect of meal frequency on 24 h EE or ADMR. Furthermore, BMR and ACT did not differ between the two patterns. DIT was significantly elevated in the gorging pattern, but this effect was neutralized by correction for the relevant time interval. With the method used for determination of DIT no significant effect of meal frequency on the contribution of DIT to ADMR could be demonstrated.