Unintended Weight Loss in Older Adults

UWL: Activity Level Factors (2007)


Ozeki T, Ebisawa H, Ichikawa M, Nagasawa N, Sato F, Fujita Y.  Physical activities and energy expenditures of institutionalized Japanese elderly women.  J Nutr Sci Vitaminol 2000;46:188-192.

PubMed ID: 11185656
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To clarify the actual situation of daily physical activities and the energy expenditure of institutionalized Japanese elderly people.

Inclusion Criteria:
  • Elderly female volunteers living in institutions for the elderly with meal services
Exclusion Criteria:
  • No abnormalities in preliminary urinary tests for sugar, protein, ketone body and urobilinogen
  • Not taking any special dietary therapy
Description of Study Protocol:


Japanese elderly women who live in institutions for the elderly and receive meal services participated voluntarily.

Design:  Cross-Sectional study

Blinding used (if applicable):  not applicable 

Intervention (if applicable):  not applicable 

Statistical Analysis

Relations between variables were analyzed by calculating Pearson correlation coefficients.

Data Collection Summary:

Timing of Measurements

Dietary survey, energy metabolic study, and time study were carried out over 3 consecutive days.

Dependent Variables

  • BMR measured by indirect calorimetry using standard protocol
  • Energy expenditure by physical activity
  • Intensity of daily physical activity was based on the physical activity index (total/basal energy expenditure)

  • Estimated skeletal muscle mass through 24-hour urinary creatinine excretion

  • Weighed food records for 3 consecutive days

Independent Variables

  • Age

Control Variables


Description of Actual Data Sample:

Initial N: 113 Japanese women

Attrition (final N):  113

Age:  aged 79.5 +/- 7.0 years

Ethnicity: not mentioned

Other relevant demographics: 27 were living in nursing homes, 51 living in homes for the elderly, and 35 living in homes for the elderly with moderate fees


Location:  Japan


Summary of Results:



Dietary intake

Basal metabolism Total expenditures


Kcal/day - RDA


1,010 1,300


Kcal/day - Subjects

1,412 +/- 310 (717 - 2,322)

881 +/- 145 (568 - 1,360)

1,112 +/- 231 (578 - 1,755)

+300 +/- 254 (-369 - +1,082)

Kcal/kg body weight - RDA





Kcal/kg body weight - subjects 33.4 +/- 7.6 (17.9 - 55.6) 20.9 +/- 3.8 (14.8 - 34.7) 26.2 +/- 5.2 (15.1 - 46.7) +7.2 +/- 6.0 (-7.5 - +26.1)

Other Findings

Mean BMR was 881 +/- 145 kcal/day (20.9 +/- 3.8 kcal/kg body weight).

The physical activity index in individuals ranged from 1.01 - 1.57, the mean value was 1.26 +/- 0.14, and 64% of the subjects examined showed a lower value than 1.3.

From these values, the mean total energy expenditure was calculated as 1,112 +/- 231 kcal/day (26.2 +/- 5.2 kcal/kg body weight).

Author Conclusion:

The present study showed that 64% of institutionalized Japanese elderly women, almost all residents in the nursing home, have a lower physical activity index than the "low level" in the current RDAs in Japan.  This is important to consider for adequate meal services in institutions for the elderly from the viewpoint of preventing malnutrition caused by an increase in remaining foods through an excess supply in dietary energy.

Funding Source:
University/Hospital: Tokyo Metropolitan Institute of Gerontology, Nagoya Women's College, Jumonji Women's, Kawasaki University
Reviewer Comments:

Authors note that subjects were representative of elderly Japanese.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? Yes
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? N/A
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes