Romieu I, Dossus L, Barquera S, Blottière HM, Franks PW, Gunter M, et al. Energy balance and obesity: what are the main drivers? Cancer Causes Control. Article PubMed PubMed Central Google Scholar.

Savarino G, Corsello A, Corsello G. Macronutrient balance and micronutrient amounts through growth and development. Ital J Pediatr. Article CAS PubMed PubMed Central Google Scholar.

Dietary reference values for nutrients Summary report. EFSA Support Publ. Google Scholar. Hutchinson C. A review of iron studies in overweight and obese children and adolescents: a double burden in the young? Eur J Nutr. Pereira-Santos M, Costa PRF, Assis AMO, Santos CAST, Santos DB.

Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. Article CAS PubMed Google Scholar.

Gu K, Xiang W, Zhang Y, Sun K, Jiang X. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. Article CAS Google Scholar. Kang NR, Kwack YS. An update on mental health problems and cognitive behavioral therapy in pediatric obesity.

Pediatr Gastroenterol Hepatol Nutr. Weihe P, Spielmann J, Kielstein H, Henning-Klusmann J, Weihrauch-Blüher S.

Childhood obesity and cancer risk in adulthood. Curr Obes Rep. Weihrauch-Blüher S, Schwarz P, Klusmann JH. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood.

Das JK, Salam RA, Thornburg KL, Prentice AM, Campisi S, Lassi ZS, et al. Nutrition in adolescents: physiology, metabolism, and nutritional needs.

Ann N Y Acad Sci. De Vet E, Stok FM, De Wit JBF, De Ridder DTD. The habitual nature of unhealthy snacking: how powerful are habits in adolescence? Overweight and obese teenagers: why is adolescence a critical period? CAS Google Scholar. Hayes G, Dowd KP, MacDonncha C, Donnelly AE.

Tracking of physical activity and sedentary behavior from adolescence to young adulthood: a systematic literature review. J Adolesc Health. Chaput J-P, Dutil C. Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors. Int J Behav Nutr Phys Act. Golden NH, Schneider M, Wood C et al.

Nutrition co, Adolescence co, Obesity so,. Preventing obesity and eating disorders in adolescents. Petrie HJ, Stover EA, Horswill CA. Nutritional concerns for the child and adolescent competitor. Peklaj E, Reščič N, Koroušic Seljak B, Rotovnik Kozjek N. Is RED-S in athletes just another face of malnutrition?

Clin Nutr ESPEN. Mountjoy M, Kaiander Sundgot-Borgen J, Burke M. International Olympic Committee IOC Consensus Statement on relative Energy Deficiency in Sport RED-S : update.

Starc GK, Kovač M, Strel J, et al. Anthropol Noteb. Inštitut za varovanje zdravja. Republike Slovenije Institute of Health Protection of Republic of Slovenia.

Slikovno gradivo s prikazom velikosti porcij. Ljubljana, Slovenia. pdf Accessed January 15, OPEN Platform for Clinical Nutrition. Referenčne vrednosti za vnos hranil. Tabelarična priporočila za otroke od 1. Leta starosti naprej , mladostnike, odrasle, starejše, nosečnice ter doječe matere.

Ljubljana, Slovenija: Nacionalni inštitut za javno zdravje. National Institute of Public Health ; Leatherdale ST, Manske S, Wong SL, Cameron R. Integrating research, policy, and practice in school-based physical activity prevention programming: the School Health Action, Planning, and evaluation system SHAPES physical activity module.

Health Promot Pract. Wong SL, Leatherdale ST. Association between sedentary behavior, physical activity, and obesity: inactivity among active kids.

Prev Chronic Dis. PubMed Google Scholar. Lohman TG, Roche AF, Martorell RA, editors. Anthropometric standardization reference manual. Champaign, Illinois: Human Kinetics Book; Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey.

Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. Kobe H, Štimec M, Ribič CH, Fidler Mis N. Food intake in slovenian adolescents and adherence to the optimized mixed Diet: a nationally representative study.

Public Health Nutr. Barić IC, Cvjetić S, Satalić Z. Dietary intakes among croatian schoolchildren and adolescents. Nutr Health. Havel DH, Calloway DH, Gussow JD, Mertz W, Nesheim MC, editors. National Research Council US Subcommittee on the tenth Edition of the recommended Dietary allowances.

Recommended Dietary Allowances: 10th Edition. Washington DC, US: National Academies Press; Adamo KB, Prince SA, Tricco AC, Connor-Gorber S, Tremblay M.

A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. Int J Pediatr Obes IJPO Off J Int Assoc Study Obes.

Ottevaere C, Huybrechts I, Béghin L, Cuenca-Garcia M, De Bourdeaudhuij I, Gottrand F, et al. Relationship between self-reported dietary intake and physical activity levels among adolescents: the HELENA study. Gregorič M, Blaznik U, Fajdiga Turk V, Delfar N et al.

Različni vidiki prehranjevanja prebivalcev Slovenije v starosti od 3 mesecev do 74 let. Accessed January 31, Fidler Mis N, Kobe H, Štimec M. Dietary dietary intake of macro- and micronutrients in slovenian adolescents: comparison with reference values.

Ann Nutr Metab. Zdešar Kotnik KJ, Gregorič G, Koroušić M, Seljak B, Golja P, editors, editors. Evaluation of nutrition among adolescents in Slovenia. Health of children and adolescents; 3rd scientific and professional international conference; ; Portorož: University of Primorska Press.

Sanchez A, Norman GJ, Sallis JF, Calfas KJ, Cella J, Patrick K. Patterns and Correlates of Physical Activity and Nutrition Behaviors in adolescents.

Am J Prev Med. Dietary intake and food sources of fatty acids in australian adolescents. Article Google Scholar. Rippin HL, Hutchinson J, Jewell J, Breda JJ, Cade JE.

Child and adolescent nutrient intakes from current national dietary surveys of european populations. Nutr Res Rev. Wong SL, Leatherdale ST, Manske SR.

Reliability and validity of a school-based physical activity questionnaire. Med Sci Sports Exerc. Butte NF, Watson KB, Ridley K, Zakeri IF, McMurray RG, Pfeiffer KA, et al.

A youth compendium of physical activities: activity codes and metabolic intensities. Melzer K, Heydenreich J, Schutz Y, Renaud A, Kayser B, Mäder U. Metabolic equivalent in adolescents, active adults and pregnant women.

European Food Information Resource EuroFIR. Download references. The authors are grateful to all the volunteers for their participation and all school employees for their assistance in organizing and conducting this study.

We thank professor Gregor Jurak for organization and realization of the ACD. Si study design. We thank the professors Marjeta Kovač, Maja Bučar Pajek, and Janko Strel and all the students, who assisted in performing the questionnaires.

Limited non-specific funding has been provided by the Slovenian Research Agency within the research programme P Bio-pscho-social context of kinesiology. This reevaluation is best done in advance of performing new DRI reviews of dietary macronutrients. Other significant variables for consideration include energy for growth and maturation and to support pregnancy, energy needs postpartum, energy intake amounts to achieve and maintain weight loss or weight gain, energy requirements to support recovery from disease and treatments or interventions such as surgery, and the health consequences of chronic overnutrition or undernutrition across the life span.

Biographical sketches of the committee members are provided in Appendix B. The committee began by gathering evidence from several sources, which involved conducting an umbrella review of systematic reviews and gathering information during open meetings that it convened with subject-matter experts see Chapter 3 and Appendix C.

The committee also engaged expert consultants and requested data analyses from CDC and Statistics Canada. The committee also participated in open-session discussions held by the Standing Committee for the Review of the Dietary Reference Intakes Framework the standing committee to discuss questions about defining the DRI population.

In a subsequent open session, the standing committee reported its guidance on this question to the federal working group and the Committee to Review the DRIs for Energy i. In a letter report to the federal working group, the standing committee noted that the report, Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease NASEM, stated that the general U.

and Canadian populations included individuals with obesity and other chronic conditions such as hypertension or diabetes, as well as individuals at risk of chronic disease who do not meet DRI exclusion criteria where they exist.

NASEM, , p. Based on the totality of evidence gathered, open-session discussions with subject-matter experts, guidance from the standing committee, and its deliberations, the committee formulated an approach to address its work and derive the findings, conclusions, and recommendations that are presented in this report.

This report is organized into nine chapters. This first chapter describes the background for the study, the statement of task, and the study approach.

Chapter 2 provides an overview of the DRI process. Chapter 4 reviews metabolic factors that affect energy expenditure and requirements. Chapter 5 presents the prediction equations for estimated energy requirements that the committee developed.

Chapter 6 describes dietary intake assessment and body composition from national surveys and compares them between U. and Canadian populations.

Chapter 7 illustrates applications of the DRIs to assess and plan energy intakes for individuals and groups. Chapter 8 characterizes relative risk and discusses public health implications of inadequate and excessive energy intakes and expenditure.

Chapter 9 presents research gaps and recommendations. CDC Centers for Disease Control and Prevention. html accessed November 23, Fryar, C.

Carroll, and J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2—19 years: United States, — through — NCHS Health E-Stats. Gonzalez, M. Correia, and S. A requiem for BMI in the clinical setting. Current Opinion in Clinical Nutrition and Metabolic Care 20 5 Hervik, A.

The role of fiber in energy balance. Journal of Nutrition and Metabolism IOM Institute of Medicine. Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: The National Academies Press.

The development of DRIs Lessons learned and new challenges: Workshop summary. Livesey, G. A perspective on food energy standards for nutrition labelling. British Journal of Nutrition 85 3 NASEM National Academies of Sciences, Engineering, and Medicine.

Guiding principles for developing Dietary Reference Intakes based on chronic disease. Defining populations for Dietary Reference Intake recommendations: A letter report.

NIH National Institutes of Health. Pasco, J. Nicholson, S. Brennan, and M. Prevalence of obesity and the relationship between the body mass index and body fat: Cross-sectional, population-based data. PloS One 7 1 :e Speakman, J. Pontzer, J.

Rood, H. Sagayama, D. Schoeller, K. Westerterp, W. Wong, Y. Yamada, C. Loechl, and A. The International Atomic Energy Agency international doubly labelled water database: Aims, scope and procedures.

Annals of Nutrition and Metabolism 75 2 Statistics Canada. Health fact sheets: Overweight and obese adults, htm accessed September 30, Stierman, B. Afful, M. Carroll, T. Chen, O. Davy, S. Fink, C. Fryar, Q. Gu, C. NEAT is the energy expenditure for unstructured and unplanned activities.

This includes daily-living activities like cleaning the house, yard work, shopping, and occupational activities. NEAT also includes the energy required to maintain posture and spontaneous movements such as fidgeting and pacing. NEAT can vary by up to 2, calories a day for two people of similar size, according to Dr.

James Levine, the Mayo Clinic researcher who first coined the term. NEAT may be an important component of obesity, and is currently an area of research. The brain specifically the hypothalamus is the main control center for hunger and satiety. There is a constant dialogue between our brains and gastrointestinal tracts through hormonal and neural signals, which determine if we feel hungry or full.

Nutrients themselves also play a role in influencing food intake, because the hypothalamus senses nutrient levels in the blood. When nutrient levels are low, the hunger center is stimulated. Conversely, when nutrient levels are high, the satiety center is stimulated.

The hypothalamus, shown in blue, is about the size of an almond and serves as the hunger center of the brain, receiving signals from the gastrointestinal tract, adipose tissue, and blood and signaling hunger and satiety. Hunger is the physiological need to eat.

When the stomach is empty, it contracts and starts to grumble and growl. Ghrelin levels are high before a meal and fall quickly once nutrients are absorbed.

Appetite is the psychological desire to eat. Satiety is the sensation of feeling full. After you eat a meal, the stomach stretches and sends a neural signal to the brain stimulating the sensation of satiety and relaying the message to stop eating.

There are many hormones that are associated with satiety, and various organs secrete these hormones, including the gastrointestinal tract, pancreas, and adipose tissue. Cholecystokinin CCK is an example of one of these satiety hormones and is secreted in response to nutrients in the gut, especially fat and protein.

In addition to inhibiting food intake, CCK stimulates pancreatic secretions, gall bladder contractions, and intestinal motility—all of which aid in the digestion of nutrients. Fat tissue also plays a role in regulating food intake. Fat tissue is the primary organ that produces the hormone leptin , and as fat stores increase, more leptin is produced.

Higher levels of leptin communicate to the satiety center in the hypothalamus that the body is in positive energy balance. Leptin acts on the brain to suppress hunger and increase energy expenditure. In several clinical trials, it was found that people who are overweight or obese are actually resistant to the hormone, meaning their brain does not respond as well to it.

Therefore, when you administer leptin to an overweight or obese person, there is generally no sustained effect on food intake. The structure of the hormone leptin left , which is primarily produced by adipose tissue. The obese mouse in the photo has a gene mutation that makes it unable to produce leptin, resulting in constant hunger, lethargy, and severe obesity.

For comparison, a mouse with normal leptin production is also shown. Such gene mutations are rare, but they serve as a dramatic illustration of the importance of the hormone in signaling energy balance. Energy balance seems like it should be a simple math problem, and in fact, it is based on a fundamental truth in physics—the first law of thermodynamics.

What makes energy balance challenging is the reality that both energy intake and energy expenditure are dynamic variables that are constantly changing, including in response to each other. This means that if you start to exercise more—increasing your energy expenditure—you will also feel hungrier, because your body needs more fuel to support the increase in physical activity.

If you eat fewer calories, perhaps in an effort to lose weight, your stomach will produce more ghrelin, and your adipose tissue will produce less leptin.

These shifting hormone levels work together to increase hunger and make you focus on obtaining more calories. People who try to gain weight run into the opposite problem. Their leptin levels increase, suppressing hunger. Even measuring how much energy is consumed is not as simple as you might think.

We can measure the caloric content of food from a chemical standpoint, but we can only estimate how much energy a person will absorb from that food. This will depend on how well the food is digested and how well the macronutrients are absorbed—factors which vary depending on the food itself, the digestion efficiency of the person eating it, and even the microbes living in their gut.

Two people may eat the exact same meal, yet not absorb the same number of calories. Energy expenditure is also dynamic and changes under different conditions, including increased or decreased caloric intake.

Decreased caloric intake and going into negative energy balance cause a drop in BMR to conserve energy. Muscles also become more efficient, requiring less energy to work, and without realizing it, people in negative energy balance often decrease their NEAT activity level. These adaptations help to conserve body weight and make it more difficult to stay in negative energy balance.

People may still be able to lose weight despite their bodies working to prevent it, but maintaining a new, lower weight requires constant vigilance, and weight regain is common. Research has also shown that people respond differently to positive energy balance.

When a group of people are overfed, the amount of weight gained amongst study participants varies widely. In a study of identical twins who were given an extra 1, calories per day for days, weight gain varied between 10 and 30 pounds among participants.

Weight gain between twins was more similar though not exactly the same , which may be attributed to genetic factors. But this is also an oversimplified answer, because of all the complexities underlying energy intake and energy expenditure.