ArticlePDF Available

Consequences of a Long-Term Raw Food Diet on Body Weight and Menstruation: Results of a Questionnaire Survey


Abstract and Figures

To examine the relationship between the strictness of long-term raw food diets and body weight loss, underweight and amenorrhea. In a cross-sectional study 216 men and 297 women consuming long-term raw food diets (3.7 years; SE 0.25) of different intensities completed a specially developed questionnaire. Participants were divided into 5 groups according to the amount of raw food in their diet (70-79, 80-89, 90-94, 95-99 and 100%). A multiple linear regression model (n = 513) was used to evaluate the relationship between body weight and the amount of raw food consumed. Odds of underweight were determined by a multinomial logit model. From the beginning of the dietary regimen an average weight loss of 9.9 kg (SE 0.4) for men and 12 kg (SE 0.6) for women was observed. Body mass index (BMI) was below the normal weight range (<18.5 kg/m(2)) in 14.7% of male and 25.0% of female subjects and was negatively related to the amount of raw food consumed and the duration of the raw food diet. About 30% of the women under 45 years of age had partial to complete amenorrhea; subjects eating high amounts of raw food (>90%) were affected more frequently than moderate raw food dieters. The consumption of a raw food diet is associated with a high loss of body weight. Since many raw food dieters exhibited underweight and amenorrhea, a very strict raw food diet cannot be recommended on a long-term basis.
Content may be subject to copyright.
Original Paper
Ann Nutr Metab 1999;43:69–79
Consequences of a Long-Term Raw Food
Diet on Body Weight and Menstruation:
Results of a Questionnaire Survey
C. Koebnick C. Strassner I. Hoffmann C. Leitzmann
Institute of Nutritional Science Justus Liebig University of Giessen, Germany
Received: April 17, 1998
Accepted: January 15, 1999
Dr. Corinna Koebnick
Institute of Nutritional Science, Justus Liebig University of Giessen
Wilhelmstrasse 20, D–35392 Giessen (Germany)
Tel. +49 641 99 39051, Fax +49 641 99 39049
Fax + 41 61 306 12 34
© 1999 S. Karger AG, Basel
Accessible online at: /karger
Key Words
Raw food diet W Nutritional deficiency W Body
mass index W Weight loss W Underweight W
Chronic energy deficiency W Amenorrhea
To examine the relationship be-
tween the strictness of long-term raw food
diets and body weight loss, underweight and
In a cross-sectional
study 216 men and 297 women consuming
long-term raw food diets (3.7 years; SE 0.25)
of different intensities completed a specially
developed questionnaire. Participants were
divided into 5 groups according to the
amount of raw food in their diet (70–79, 80–
89, 90–94, 95–99 and 100%). A multiple linear
regression model (n = 513) was used to eval-
uate the relationship between body weight
and the amount of raw food consumed. Odds
of underweight were determined by a multi-
nomial logit model.
From the begin-
ning of the dietary regimen an average
weight loss of 9.9 kg (SE 0.4) for men and
12 kg (SE 0.6) for women was observed. Body
mass index (BMI) was below the normal
weight range (! 18.5 kg/m
) in 14.7% of male
and 25.0% of female subjects and was nega-
tively related to the amount of raw food con-
sumed and the duration of the raw food diet.
About 30% of the women under 45 years of
age had partial to complete amenorrhea; sub-
jects eating high amounts of raw food
(1 90%) were affected more frequently than
moderate raw food dieters.
consumption of a raw food diet is associated
with a high loss of body weight. Since many
raw food dieters exhibited underweight and
amenorrhea, a very strict raw food diet can-
not be recommended on a long-term basis.
Raw food diets are mainly vegetarian diet
forms based on the experience of physicians
who were highly engaged in healthful nutrition,
such as Bircher-Benner, Waerland and Shel-
Ann Nutr Metab 1999;43:69–79
Table 1.
Definition of raw food diets
Raw food diets consist predominantly or exclusively of
unheated foods, mainly of plant origin (partly also
of animal origin).
Some foods are included that require a certain degree
of heating for their production (e.g. cold-pressed
honey and cold-pressed oils) as well as foods that
require a certain amount of heat during their pro-
cessing (e.g. dried fruits, dried meat and fish, cer-
tain nuts).
Furthermore, cold-smoked produce (e.g. meat and
fish) as well as pickled or fermented vegetables can
be included in the raw food diet [20, 36].
ton, whose writings constitute the origins of the
main raw food diet streams. Today raw food
diets are influenced mainly by the Diamonds
and are quite varied forms of nutrition, con-
sisting mostly of natural foods prepared in
unheated, non-mixed meals [1–6]. Staple foods
like meat, dairy products, cereals and cereal
products are largely avoided. Therefore, fruits
and vegetables make up a high percentage of
the food consumed and have to meet body
energy needs. A study of the literature shows
that raw food diets are subdivided into vegetar-
ian and non-vegetarian forms.
One of the extreme forms of raw food diets
is instinctotherapy. Its founder, Guy-Claude
Burger [3], recommends eating a.o. non-
heated meat. A few other authors suggest the
consumption of only small amounts of cooked
meat. Because of the large amounts of fruits,
the raw food diet according to Wandmaker [5]
is viewed as unbalanced and is therefore not
recommended by the German Nutrition Soci-
ety [7]. The definition of raw food diets ac-
cording to the Giessen Raw Food Working
Group is an attempt to develop a basis for
comparison of data reported in the literature
(table 1).
The main reasons for practising a raw food
diet as stated by its followers are to attain
health, to prevent illness and to live in a natu-
ral and healthy way for a long time [8, 9].
Some medical reports suggest a raw food diet
as therapy for diseases such as allergies, hy-
pertension and overweight [1, 10–12]. Raw
food diets are mostly considered to be a long-
term form of nutrition. However, the Dia-
monds suggest that their raw food diet can
additionally decrease body weight [2–5, 8].
Almost all persons experience drastic
changes in body weight after starting to con-
sume a raw food diet. The weight loss can be
substantial and often leads to a very low body
weight [8, 9, 13]. Underweight and nutritional
deficiencies in females are related to amenor-
rhea, low bone density and osteoporosis [14–
18]. The aim of the reported study was to
examine the association between the strict-
ness of a raw food diet and body weight loss,
underweight and amenorrhea.
Following announcements in several German
health magazines (October 1992 to January 1993),
1,328 persons classifying themselves as raw food diet-
ers were assessed using a short questionnaire sent by
mail. Of those, 865 persons estimated the amount of
raw food in their diet to be more than 70%. This
amount corresponds to the minimum amount of raw
food recommended by several authors [6]. A specially
developed questionnaire was sent to these selected per-
sons, of whom 88% responded. Individuals practising
a raw food diet for !4 months or being !16 years of
age or not living in Germany, and who had partici-
pated in the pre-test of the questionnaire were ex-
cluded from the study. After this selection 572 persons
remained in the study. Complete data sets were evalu-
ated of 513 persons (216 men and 297 women).
For statistical analyses, participants were divided
into 5 groups according to the amount of raw food in
their diet. The cutoff points were 70, 80, 90, 95, and
100% of raw food. The diet groups were classified as
meat eaters (n = 253), vegetarians (n = 184) and vegans
(n = 135). Vegetarians omit meat and fish, and vegans
additionally avoid dairy products and eggs from their
BMI before a raw food diet
Consequences of a Long-Term Raw
Food Diet on Body Weight and
Ann Nutr Metab 1999;43:69–79
Table 2.
Determinants of BMI:
multiple linear regression
coefficients ordered according
to descending ß (p ! 0.0001,
adjusted R
= 0.572)
Independent determinants ßSignificance
0.723 0.000
Amount of raw food consumed, % –0.144 0.000
Duration of raw food diet 0.075 0.016
Vegan diet group –0.068 0.030
Gender 0.053 0.080
Age –0.019 0.566
Total food intake, g 0.006 0.834
A short questionnaire was developed as a selection
instrument. It contained a limited number of questions
concerning the amount of raw food consumed and the
duration of the raw food diet. To control the validity of
the self-estimated amounts of raw food consumed, the
results were compared to the computed amounts of a
food frequency questionnaire (FFQ) described below.
There was a high correspondence between the amounts
of raw food consumed [8].
The main questionnaire focused on the nutrition
behavior and the health situation of individuals con-
suming a raw food diet. Body weight data and weight
development were assessed retrospectively. The con-
cept was based on discussions with several authors of
books on raw food diets and interviews of raw food
dieters and their self-help groups. Comprehension of
the questionnaire was tested with a random sample of
16 raw food dieters drawn from the selected partici-
pants that were then excluded from further participa-
tion. Questions which were considered misleading or
unclear were not included in the final instrument.
The amounts of raw food consumed were assessed
by the FFQ developed by Aalderink et al. [19], Hoff-
mann [20] and Hoffmann et al. [21] and employed in
the Giessen Wholesome Nutrition Study. Its validity
as an instrument of selection was tested for bias by
Hoffmann [20]. The semiquantitative FFQ consisted
of 80 items modified for special demands of raw food
diets. The amount of raw food was calculated by the
raw/cooked weight ratio.
All statistical calculations were performed with the
statistical software package SPSS 8.0. The results are
presented as means with the standard error of mean
(B SE). Mean body mass index (BMI) values (weight
(kg)/height (m)
) were calculated separately for females
and males after adjusting for age at recruitment. The
BMI classification according to Ferro-Luzzi et al. [15]
was employed (table 2). A multiple linear regression
model for BMI as a dependent factor considers age,
gender, BMI before starting a raw food diet, duration
of the raw food diet, diet group and total food intake.
Odds ratios of underweight were computed by a multi-
nomial logit model considering gender and amount of
raw food consumed. Therefore, participants were di-
vided into 5 groups eating different amounts of raw
food: 70–79, 80–89, 90–94, 95–99 and 100%. In the
regression and the logit models of body weight data
only persons with complete data sets were included
(n = 513). Calculations on amenorrhea were carried
out with data from non-pregnant and non-menopausal
women !45 years of age (n = 145). Odds ratios of
amenorrhea were calculated by a multinomial logit
model considering the amount of raw food consumed.
To test the fit the loglinear models were compared to
different models including several factors and several
divisions of the amount of raw food consumed. Only
small differences in parameter estimates were ob-
served [22].
General Health Behavior and Diseases
Most of the raw food dieters investigated
in this study consumed high amounts of raw
food (1 90%; fig. 1). The mean percentage of
raw food eaten was 91 B 0.4%, and the aver-
age duration of a raw food diet was 3.7 B 0.25
years. There were only a few participants who
smoked (2.1%); the raw food dieters con-
sumed only small amounts of alcoholic bever-
ages (beer 13 B 2.6 ml/day; wine 9 B 2.0 ml/
Regular fasting (n = 282)
Ann Nutr Metab 1999;43:69–79
Fig. 1.
Cumulative frequency distribution of amount
of raw food consumed in male (n = 230) and female
(n = 342) raw food dieters.
Fig. 2.
Error bars of age-adjusted mean BMI B SE
divided into groups according to the amount of raw
food consumed.
n= 66
70–79 103
Amount of raw food consumed (%)
90–99 96
BMI (kg/m )
Table 3.
Fasting periods of investi-
gated raw food dieters
Fasting period, days
1 29.8
2–4 27.7
5–7 23.8
8–14 12.4
Several weeks 6.4
day; spirits 0.1 B 0.0 ml/day) and most of
them (89%) participated in various kinds of
physical activities.
Only a few participants (7%) used mineral
or vitamin supplements, 7.9% consumed al-
gae products, and 0.6% of the 342 female par-
ticipants took oral contraceptives. Enemas
were regularly applied by 16.1% of raw food
dieters, about 25% of them more than once a
week. About half of the participants (n = 282)
fasted at least once a year. Total fasting
(48.7%) and juice fasting (39.2%) were pre-
ferred. The main reason for fasting was purifi-
cation (58%). The fasting periods lasted from
1 day to several weeks (table 3).
Most of the participants changed to a raw
food diet for health reasons; other reasons did
not play an important role (!10%). About
55% changed to a raw food diet because of
their own disease, and 17% because of a dis-
ease of a family member. The most important
disorders were diseases of the gut, allergies,
asthma and rheumatism. About 94% of these
participants believed to be closer to recovery
from their disease since change of diet. Most
participants (98%) were very content with
their raw food diet.
Body Weight Reduction and Amount of
Raw Food Consumed
The age-adjusted mean BMI of male par-
ticipants was 20.7 B 0.2 kg/m
and of female
participants was 20.1 B 0.1 kg/m
. The BMI
range showed a tight distribution (95% CI
20.2–20.6 kg/m
). Most participants (73.8%)
Severe underweight (CED grade III)
Consequences of a Long-Term Raw
Food Diet on Body Weight and
Ann Nutr Metab 1999;43:69–79
Fig. 3.
Age-adjusted mean BMI be-
fore and during the consumption of
raw food diets.
18 70–79
Groups according to the amount of
raw food consumed (%)
80–89 100
raw food diet Lowest
level Highest level after
change to raw food diet Present
BMI (kg/m )
Table 4.
Classification of BMI and distribution of relative body weight in relation to gender and amount of raw
food consumed (%)
Classification by Ferro-Luzzi [15] BMI
Raw food dieters
male female 70–79% 80–89% 90–99% 100%
!16 0.4 1.5 1.3 0.8 0.8 1.9
Moderate underweight (CED grade II) 16.0–16.9 2.2 4.1 2.5 0.8 3.4 6.8
Mild underweight (CED grade I) 17.0–18.4 12.1 19.3 11.4 11.9 17.8 22.3
Normal weight 18.5–24.9 78.3 69.6 69.6 79.4 73.5 67.0
Overweight 25.0–29.9 6.1 3.8 12.7 4.0 4.2 1.0
Obesity 30.0–39.9 0.0 1.2 2.5 0.8 0.4 0.0
Severe obesity 640.0 0.0 0.0 0.0 0.0 0.0 0.0
Missing data 0.9 0.6 0.0 2.4 0.0 1.0
n 230 342 79 126 264 103
had a normal body weight; 6.3% of the men
and 4.8% of the women were overweight;
1.2% of the women and none of the men were
obese. Unexpectedly 14.7% of the men and
25.0% of the women were underweight. Of
these, 2.6% of the men and 5.7% of the wom-
en suffered from chronic energy deficiency
(CED) grade II or III (table 4). Participants
eating a strict raw food diet showed a lower
BMI than persons consuming a moderate raw
food diet (fig. 2). Most raw food dieters expe-
rienced a dramatic loss of body weight after
changing to a raw food diet. Body weight sta-
bilized after some time and settled at a level
below the initial weight (fig. 3). The mean loss
of body weight from the time of changing to a
raw food diet to the time of evaluation was 9.9
B 0.4 kg (95% CI 4–20 kg) for male (n = 216)
and 12 B 0.6 kg (95% CI 3–26 kg) for female
(n = 297) participants. There were substantial
Ann Nutr Metab 1999;43:69–79
Fig. 4.
Classification of menstruation occurrence in
groups according to the amount of raw food consumed
(n = 145).
Fig. 5.
Error bars of mean BMI B SE in relation to
classification of menstruation occurrence (n = 145).
n= 86
Regular 14
Classification of menstruation occurrence
BMI (kg/m )
differences between groups according to the
amount of raw food consumed and loss of
body weight (fig. 3).
The multiple linear regression model (p !
0.0001, adjusted R
= 0.572) showed that low
body weight had a strong linear relation
(monotonic decrease) to the amount of raw
food eaten (table 2). The BMI was negatively
affected in the vegan group, but was unaf-
fected by the total food intake. The relations
to gender and duration of raw food diet con-
sumption were statistically significant. Fe-
males showed a lower BMI than males, and
the BMI increased slowly with the duration of
raw food diet consumption. Odds of becom-
ing underweight calculated by a multinomial
logit model (table 5) were 3 times higher for
strict raw food dieters (100% raw food) and 2
times higher for rather strict raw food dieters
(95–99% raw food) than for moderate raw
food dieters (!80% raw food). By including
the diet group in the logit model, no statisti-
cally significant effects were observed. Vegans
had no significantly higher odds of under-
weight than vegetarians or meat eaters.
Amenorrhea as a Functional Problem of
Female Raw Food Dieters
The mean age of non-pregnant and non-
menopausal women under 45 years of age was
32.9 B 0.63 years. Menstruation was stated as
being regular in about 60% of the valid an-
swers. The intensity of menstruation was esti-
mated as strong to very strong by 9.1%, as
medium by 53.3% and as weak to very weak
by 37.7% of the women. Approximately 10%
had irregular menstruation and 30% claimed
to have no or rare menstruation. About 70%
of female participants noticed a change in
menstruation since changing their diet. Of the
female raw food dieters of childbearing age,
23% suffered from a total absence of men-
struation. Female participants were divided
into 3 groups: periodical (n = 87) , irregular
(n = 14), and absence of menstruation (n =
44). The groups show statistically significant
differences in the amounts of raw food con-
sumed (p = 0.008) and in BMI (p = 0.000) but
not in age. Women with partial to total amen-
orrhea ate more raw food and had a lower
BMI than the other women (fig. 4, 5).
Consequences of a Long-Term Raw
Food Diet on Body Weight and
Ann Nutr Metab 1999;43:69–79
Table 5.
Parameter estimates of the multinomial logit model of becoming underweight, goodness-of-fit statistics
and measures of association (reference group: 70–79% amount of raw food)
Factor Odds
SE z value
Asymptotic 95% CI
lower upper
0.3670 –6.36 –3.05 1.61
Gender female 2.3
0.2331 3.64 0.39 1.31
Raw food consumed
100% 3.0
0.3872 2.82 0.33 1.85
95–99% 2.0
0.3632 1.96 –0.01 1.41
90–94% 1.2 0.1762 0.4413 0.40 –0.69 1.04
80–89% 0.8 –0.1832 0.4114 0.45 –0.99 0.62
Goodness-of-fit statistics (likelihood ratio) significance = 0.7686.
Measures of association: entropy = 0.0586, concentration = 0.0626.
Odds ratio = e
Values statistically significantly different from zero (· = 5%) are given in bold (z value 61.96).
Table 6.
Parameter estimates of the multinomial logit model of having amenorrhea, goodness-of-fit statistics and
measures of association (reference group: 70–79% amount of raw food)
Factor Odds
Estimate SE z value
Asymptotic 95% CI
lower upper
0.2 –1.8718 0.7596 2.46 –3.36 –0.38
Raw food consumed
100% 7.0
0.8456 2.30 0.28 3.60
95–99% 2.6 1.0833 0.8209 1.32 –0.53 2.69
90–94% 2.0 0.7087 0.9162 0.77 –1.09 2.50
80–89% 1.8 0.5988 0.8717 0.69 –1.11 2.31
Goodness-of-fit statistics were not calculated due to model saturation.
Measures of association: entropy = 0.0547, concentration = 0.0680.
Odds ratio = e
Values statistically significantly different from zero (· = 5%) are given in bold (z value 61.96).
Odds of having amenorrhea calculated by
a multinomial logit model (table 6) were 7
times higher for strict raw food dieters (100%
raw food) than for moderate raw food dieters
(!80% raw food). Inclusion of the diet group
in the logit model showed no statistically sig-
nificant relationship between odds of amenor-
rhea and diet group. There were no higher
odds for vegans than for vegetarians or meat
Ann Nutr Metab 1999;43:69–79
The consumers of raw food diets view their
eating behavior as part of a wholesome life-
style concept, including an overall healthy
way of life which means more than just an
alternative diet. Adherents of raw food diets
usually lead a healthy life, i.e. they are physi-
cally active, drink little alcohol and do not
smoke. This lifestyle shows a preventative
effect against diseases related to nutrition and
lifestyle [23, 24]. At present, little is known
about the consequences of a raw food diet on
long-term health.
Fasting periods and regular enemas are
often recommended by proponents of raw
food diets as a method of body cleansing [6, 8,
9, 25]. About half of the participating raw
food dieters fasted at least once a year, some
of them for several weeks. It is reported that
very long fasting periods (1100 days) can
result in morphological changes in the cardiac
muscle with ECG changes caused by protein
deficiency [26]. Even though none of the par-
ticipants of the Giessen Raw Food Study
fasted for such a long period of time, fasting
for them could have been a risk because of
their low energy stores and low body weight,
particularly in association with their low ener-
gy diet.
Most proponents of raw food diets recom-
mend this dietary regimen as a long-term diet.
Only the Diamonds advocate their raw food
diet also as a therapy for weight loss [2–5, 8,
25]. The results of the Giessen Raw Food
Study show a substantial reduction in body
weight for participants during long-term con-
sumption of a raw food diet. The body weight
first decreases and then usually increases to a
level below the initial weight. The very conse-
quent raw food dieters show a greater loss of
body weight than the moderate raw food diet-
ers. Change in body weight usually indicates a
change in energy balance and reflects changes
in energy stores and in active body tissues
[27]. Decreasing body weight and concomi-
tant undernutrition result in a greater visceral
mass to muscle mass ratio [28].
The BMI reflects body energy stores and is
used as an indicator for CED [29–32] since it
shows a strong correlation with body fat [27,
33]. Most participants of the Giessen Raw
Food Study had BMI values within the nor-
mal range; however, 25% of the females and
14.7% of the males were below the normal
range – in some cases a BMI reflecting CED
was observed. Undernutrition affects only a
small group of the average German popula-
tion – 5.6% of the females and 3.8% of the
males, mostly under the age of 34 years, are
underweight [34]. The optimum range of BMI
which is compatible with good health is 20.1–
25.0 kg/m
for males and 18.7–23.8 kg/m
females [15, 27]. Low body weight is often
reported for vegetarians and vegans [35], but
a BMI reflecting CED is rarely observed in
contrast to raw food dieters. The main reason
for a low BMI for raw food dieters is the con-
sumption of a strict raw food diet. Further-
more, BMI is correlated with the duration of
the raw food diet and the vegan regimen.
Appleby et al. [36] observed a negative
association between BMI and carbohydrate
intake and the intake of dietary fiber in low
meat eaters. Raw food dieters eat mainly
fruits and vegetables. They mostly omit dairy
products, meat, cereals and cereal products
and therefore, their diet contains high
amounts of dietary fiber and carbohydrates.
Additionally, an insufficient energy supply in
43% of raw food dieters was reported [13, 37].
Very strict raw food dieters have higher odds
of becoming underweight than moderate raw
food dieters. Therefore, a very strict raw food
diet has to be considered as a risk to health if
practised for a long time.
A high percentage of the women (70%) par-
ticipating in the Giessen Raw Food Study had
Consequences of a Long-Term Raw
Food Diet on Body Weight and
Ann Nutr Metab 1999;43:69–79
irregularities in their menstruation after
changing to a raw food diet. A total absence of
menstruation was observed in 23% of female
raw food dieters of childbearing age. With
increasing amounts of raw food the BMI de-
creased and the odds of having amenorrhea
increased. The participants judged this as a
success of their diet, since proponents of raw
food diets view menstruation as a process of
cleansing. They claim that eating enough raw
food stops menstruation so that the cleansing
process is no longer required [3, 5, 38]. This
attitude concerning amenorrhea has no scien-
tific basis and ignores the possibility that
amenorrhea may lead to impaired health.
Nutritional deficiencies, low body fat
stores, CED and low body weight which is
related to changes in body composition are
associated with amenorrhea [14, 27, 39–41].
Amenorrhea is also observed with eating dis-
orders like bulimia and anorexia [17, 41–43].
Professional sportswomen often show disor-
dered eating habits, amenorrhea, and osteo-
porosis. This is collectively known as the
female athlete triad [44]. An imbalance be-
tween energy intake and energy expenditure
leads to an energy deficit which is associated
with menstrual irregularities and reproduc-
tive dysfunction in female long distance run-
ners [45].
A low BMI is indicative for CED and is
associated with amenorrhea. Amenorrhea can
result in impaired fertility [16, 27, 42]. When
estrogen levels are low, changes in mineral,
glucose and fat metabolism accompany amen-
orrhea. These metabolic changes affect bone
and cardiovascular health, increasing the risk
of osteoporosis and coronary heart disease in
later life [16, 42]. The maternal BMI is related
to the birth weight of a child [46]. Mothers
from China, India, Ethiopia and Zimbabwe
with a low BMI have babies with low birth
weights [23, 27]. In the female raw food diet-
ers of this study the odds of having amenor-
rhea increased with the strictness of the raw
food diet. For women of childbearing age
there may be further consequences for the
unborn child in case of pregnancy.
The absence of obesity in raw food dieters
should be seen positively, but their extremely
low body weight may be a problem. While an
energy restriction for many adults consuming
an average Western diet is recommended, a
strict raw food diet cannot guarantee an ade-
quate energy supply [20, 37]. A low BMI in
raw food dieters indicates low body energy
stores and CED. In a mostly vegan diet like
the raw food diets with low protein and energy
intake, protein metabolism can be affected to
the point of protein energy malnutrition. The
incidence of amenorrhea in female raw food
dieters is also a sign for functional problems
in the long-term consumption of a raw food
diet. As shown in this study the main determi-
nant for the BMI and the incidence of amen-
orrhea is the amount of raw food in the diet.
On the basis of the data obtained and the
reports in the literature, a strict raw food diet
with amounts of raw food over 90% cannot be
recommended. Studies yet to be published
with diets containing liberal amounts of raw
food indicate that about half the food eaten in
an uncooked form may be optimal for health
under normal conditions.
Ann Nutr Metab 1999;43:69–79
1 Bircher-Benner M: Ungeahnte Wir-
kungen falscher und richtiger Ernäh-
rung, ed 1. Zürich, Wendepunkt,
2 Diamond H, Diamond M: Fit fürs
Leben – Fit for Life, ed 2. München,
Goldmann, 1986.
3 Burger GC: Die Rohkost-Therapie,
ed 3. München, Heyne, 1985.
4 Shelton HM: Richtige Ernährung
mit natürlicher Nahrung, ed 2. Rit-
terhude, Waldthausen, 1991.
5 Wandmaker H: Willst Du gesund
sein? Vergiss den Kochtopf, ed 6.
Ritterhude, Waldthausen, 1991.
6 Koebnick C, Strassner C, Leitz-
mann C: Rohkost-Ernährung. Teil
1: Überblick und Bewertung der
theoretischen Grundlagen. aid-Ver-
braucherdienst 1997;42:244–250.
7 Deutsche Gesellschaft für Ernäh-
rung: Stellungnahme zur Rohkost
nach Helmut Wandmaker; in: DGE-
Info, Forschung, Klinik und Praxis.
1993, pp 77–78.
8 Koebnick C, Strassner C, Leitz-
mann C: Bewertung der Rohkost-
Ernährung in der Ernährungsbera-
tung. Ern Umschau 1997;44:444–
9 Koebnick C, Strassner C, Dörries S,
Kwanbunjan K, Leitzmann C: Er-
nährungs- und Gesundheitsverhal-
ten von Personen mit überwiegen-
der Rohkost-Ernährung. Z Ernäh-
rungswiss 1995;34:53.
10 Bircher R: Leben und Lebenswerk
Bircher-Benner. Zürich, Bircher-
Benner, 1950.
11 Douglass JM, Rasgon IM, Fleiss
PM: Effects of a raw food diet on
hypertension and obesity. South
Med J 1985;78:841–844.
12 Waerland A: Health is Your Birth-
right, ed 1. Bern, Blume.
13 Strassner C, Koebnick C, Leitz-
mann C: Rohkost-Ernährung. Teil
2: Die Giessener Rohkost-Studie.
aid-Verbraucherdienst 1997;42:
14 Crosignani PG, Vegetti W: A practi-
cal guide to the diagnosis and man-
agement of amenorrhoea. Drugs
15 World Health Organisation (WHO):
Energy and protein requirements:
Report of a joint FAO/WHO/UNU
expert consultation. WHO Tech
Rep Ser 1985;724.
16 Fruth SJ, Worrell TW: Factors asso-
ciated with menstrual irregularities
and decreased bone mineral density
in female athletes. J Orthop Sports
Phys Ther 1995;22:26–38.
17 Kopp W, Blum WF, von Prittwitz S,
Ziegler A, Lubbert H, Emons G,
Herzog W, Herpertz S, Deter HC,
Remschmidt H, Hebebrand J: Low
leptin levels predict amenorrhoea in
underweight and eating disorders of
females. Mol Psychiatry 1997;2:
18 Mazess RB, Barden HS, Ohlrich ES:
Skeletal and body composition ef-
fects of anorexia nervosa. Am J Clin
Nutr 1990;52:438–441.
19 Aalderink J, Hoffmann I, Groene-
veld M, Leitzmann C: Results of the
Giessen Wholesome Nutrition
Study. Food consumption and nu-
trient intake by women adhering to
Wholesome Nutrition and women
adhering to a mixed diet. Ernäh-
rungsumschau 1994;41:328–335.
20 Hoffmann I: Giessener Vollwert-Er-
nährungsstudie: Untersuchung auf
Bias am Beispiel von Fettstoffwech-
sel-Parametern. Giessen, Wissen-
schaftlicher Fachverlag, 1994.
21 Hoffmann I, Kohl M, Groeneveld
M, Leitzmann C: Development and
validation of a new instrument to
measure food intake. Am J Clin
Nutr 1994;59(suppl):284.
22 Ananth CV, Kleinbaum DG: Re-
gression models for ordinal re-
sponses: A review of methods and
applications. Am J Epidemiol 1997;
23 Lindsted K, Tonstad S, Kuzma JW:
Body mass index and patterns of
mortality among Seventh-Day Ad-
ventist men. Int J Obes 1991;15:
24 Chang-Claude J, Frentzel-Beyme R:
Dietary and lifestyle determinants
of mortality among German vege-
tarians. Int J Epidemiol 1993;22:
25 Walker NW: Auch Sie können wie-
der jünger werden, ed 3. Ritterhude,
Waldhausen, 1993.
26 Kasper H: Ernährungsmedizin und
Diätetik, ed 8. München, Urban &
Schwarzenberg, 1996.
27 Shetty PS, James WPT: Body Mass
Index. A Measure of Chronic Energy
Deficiency in Adults. FAO Food
and Nutrition Paper 56. Aberdeen,
Rower Research Institute, 1994.
28 Soares MJ, Shetty P: Basal metabol-
ic rates and metabolic economy in
chronic undernutrition. Eur J Clin
Nutr 1991;45:363–373.
29 Ferro-Luzzi A, Sette S, Franklin M,
James WPT: A simplified approach
of assessing adult chronic energy de-
ficiency. Eur J Clin Nutr 1992;46:
30 James WP: Introduction: The chal-
lenge of adult chronic deficiency.
Eur J Clin Nutr 1994;48(suppl 3):1–
31 Norgan NG, Ferro-Luzzi A: Weight-
height indices as estimators of fat-
ness in men. Hum Nutr Clin Nutr
32 Khosla T, Lowe CR: Indices of obe-
sity derived from body weight and
height. Br J Prev Soc Med 1967;21:
33 Naidu AN, Rao NP: Body mass in-
dex: A measure of the nutritional
status in Indian populations. Eur J
Clin Nutr 1994;48(suppl 3):131–
34 Kübler W, Anders HJ, Heeschen W,
Kohlmeier M (eds): Vera-Schriften-
reihe Band II. Niederkleen, Wissen-
schaftlicher Fachverlag Fleck, 1992.
35 Hahn A, Leitzmann C: Vegetarische
Ernährung. Stuttgart, Ulmer, 1996.
36 Appleby PN, Thorogood M, Mann
JI, Key TJ: Low body mass index in
non-meat eaters: The possible roles
of animal fat, dietary fibre and alco-
hol. Int J Obes 1998;22:454–460.
37 Strassner C: Die Giessener Rohkost-
Studie: Ernährungs- und Gesund-
heitsstatus von Rohköstlern unter
besonderer Berücksichtigung von
Protein und Energie. Heidelberg,
Verlag für Medizin und Gesundheit,
Consequences of a Long-Term Raw
Food Diet on Body Weight and
Ann Nutr Metab 1999;43:69–79
38 Rudolph S: So erlebte ich meine
erste Urzeitgeburt. Natürlich Leben
39 Benson JE, Engelbert-Fenton KA,
Eisenman PA: Nutritional aspects of
amenorrhoea in the female athlete
triad. Int J Sport Nutr 1996;6:134–
40 Copeland PM, Sacks NR, Herzog
DB: Longitudinal follow-up of ame-
norrhoea in eating disorders. Psy-
chosom Med 1995;57:121–126.
41 Golden NH, Shenker IR: Amenor-
rhea in anorexia nervosa. Neuroen-
docrine control of hypothalmic dys-
function. Int J Eat Disord 1994;16:
42 Mcliver B, Romanski SA, Nippoldt
TB: Evaluation and management of
amenorrhoea. Mayo Clin Proc 1997;
43 Selzer R, Caust J, Hibbert M, Bowes
G, Patton G: The association be-
tween secondary amenorrhoea and
common eating disordered weight
control practices in an adolescent
population. J Adolesc Health 1996;
44 Grooms AM: The female athlete
triad. J Fla Med Assoc 1996;83:
45 Zanker CL, Swaine IL: The relation-
ship between serum oestradiol con-
centration and energy balance in
young women distance runners. Int
J Sports Med 1998;19:104–108.
46 Giay T, Khoi HH: Use of body mass
index in the assessment of adult nu-
tritional status in Vietnam. Eur J
Clin Nutr 1994;48(suppl 3):124–
... There are also problems with the cooking hypothesis that claims, amongst other things, that early Homo sapiens was unable to survive on a diet of raw wild foods (Wrangham 2017: S303). As highlighted by Lombard and van Aardt (2023), one snag is that the hypothesis relies heavily on a single study of 531 urban-dwelling German participants, forms (a, b), and edible plant parts (d, e), as well as the percentage increases in foodplant resources that can be expected when moving from the Cradle to Wonderboom (c) finding that their shop-bought, fruit-and-vegetable raw diet resulted in 'low energy levels' in only five (1%) of the individuals and that the menstruation cycles of up to 40% (n = 118) of the women may not be normal (Koebnick et al. 1999). The study never reported on general patterns in menstrual irregularity, why their participants chose a raw diet nor on the potential underlying causes for the reported energy deficit and/or menstrual disruptions. ...
... Manore 2002;Vyver et al. 2008), regardless of whether food is cooked or not. Yet, based on the WEIRD (western, educated, industrialised, rich, and democratic) study by Koebnick et al. (1999), and Brace et al.'s (1987) suggestion that the adoption of earth-oven cooking allowed the use of frozen food in the northern hemisphere, Wrangham and Conklin-Britain (2003) concluded that most plant foods are either not sufficiently digestible or are toxic unless cooked and that 'frozen meat cooking' is obligatory for all humans. ...
Full-text available
With this contribution, we provide a species and edible part list for the foodplant population of the Wonderboom landscape at the eastern end of the Magaliesberg range in Gauteng, South Africa, as a current proxy to hypothesise about past foraging behaviours. The greater Magaliesberg region is an ancient, relatively stable ecotone between the Grassland and Savanna Biomes, with its roots in the plateau uplift at ~ 4 Ma. We present the foraging landscape (foraging-scape) in a three-tier model at intervals of ~ 12.5 km, ~ 35 km, and ~ 70 km to assess proportional increases in foodplant species and edible parts when the foraging range is increased. We demonstrate that foraging within a ~ 12.5 km radius from the site provides an exceptionally rich foodplant landscape today. Thus, if the foodplant fitness potential during the Middle Pleistocene was roughly similar, it is reasonable to hypothesise that the Wonderboom foragers may have had little reason—apart from perhaps famine or drought—to go beyond a daily range for collecting plant foods. The Wonderboom ~ 12.5 km radius surface area is broadly similar to the footprint of the Cradle of Humankind ~ 40–70 km to its southwest. Directly comparing their foodplant species inventories shows that currently, 185 more foodplants grow around Wonderboom than in the Cradle. Our results suggest that the ecotone locality of Wonderboom, between the Grassland Biome to the south and the Savanna Biome to the north, may have had adaptive advantages in terms of its foodplant foraging potential.
... This indicates that women of reproductive age have gynecological organic disorders or dysfunctional ovaries. However, an improper diet can cause amenorrhea in young women and can also lead to ovarian insufficiency in upcoming years of their fertility or in old age may cause osteoporosis (19)(20)(21)(22). About one third to a half of women addresses symptoms of moderate or severe dysmenorrhea. ...
Full-text available
Background: Dysmenorrhea can be defined as painful uterine cramps that occur along with menses that affects about a fraction of menstruating women worldwide. Dysmenorrhea usually starts during or right after menarche. Dysmenorrhea can be divided into either; Primary (pain without cause/reason) or Secondary dysmenorrhea (pelvic pain with a cause/disease), both of them are involved in painful menstrual cramps. In addition to this, symptoms such as nausea, headache, irritability and absenteeism from work and education are often reported. Objectives: This research was conducted with an aim to determine the prevalence of dysmenorrhea and to find a relation between BMI and Primary Dysmenorrhea among girls. Methodology: An observational, cross-sectional study with 351 female participants in total was performed through convenience sampling in Islamabad/Rawalpindi with a specifically designed questionnaire with slight modifications from November 2022 to January 2023. Statistics were applied using the IBM SPSS version 26.0. Results: Our research revealed a significant (p = 0.039) association between BMI and the occurrence of Primary Dysmenorrhea. Through statistical comparisons, it was found that mild and severe dysmenorrhea symptoms were more prevalent among study participants who were underweight and those who were obese. The p-values for these comparisons were 0.000 and 0.028, respectively, indicating that underweight subjects are more likely to experience dysmenorrhea. Conclusion: Results show that the incidence of dysmenorrhea is higher in girls of age 18-25 years because of the abnormal Body Mass Index (BMI), which indicates that greater number of population have poor nutritional status and inadequate dietary habits.
... However, the relation between atherosclerosis progression and hematologic parameters is not well defined [8,9]. CHD is coronary heart disease that caused by more than 250 different factors such as age, sex, blood pressure, diabetes, glucose disorders and fat disorders such as LDL disorders [10][11][12]. Other study indicated that change in concentration of LDL_C and HDL has most effect in arthrosclerosis and LDL_C is first factor for prediction of arthrosclerosis. ...
Full-text available
The influence of lipids on blood and plasma viscosity has not been fully elucidated An excess of weight including obesity have reached epidemic rates in all age groups, both in developed and developing countries. Biochemical Parameters maybe has relation with each other. This research aimed to study of relation between LDL with other biochemical parameters. For this study 1000 data about these experiments was collected from private laboratory in Ilam city. The data classified by disease, age, sex and season. The data analyzed with SPSS software version 19 and used of various test such as. This study indicated that LDL has significant relationship with season, TG, cholesterol and HDL. And also we find this study shown that LDL has significant and direct relationship with season. For better result about relationship of biochemical parameter with each other we suggest that this study done in different area and analysis all of result and find the relationship.
... Increased starch digestion would have provided our ancestors with more glucose, the principal energy source for the brain and some other tissues, and the inferred accelerated brain size increases over the last 500,000 years may have been a consequence of cooking starch-rich foods such as plant underground storage organs (USOs) (Dunbar, 2006(Dunbar, , 2020 (see further AMY discussion in this chapter). Indeed, some studies have shown that humans cannot extract su cient energy and nutrients from uncooked foods (Koebnick et al., 1999), suggesting that we are biologically committed to cooking. The pervasive cultural and biological adaptations associated with cooking may have made humans 'obligate chefs ' (Boback et al., 2007;Carmody et al., 2019;Carmody et al., 2016;Wrangham & Conklin-Brittain, 2003). ...
Full-text available
This handbook is currently in development, with individual articles publishing online in advance of print publication. At this time, we cannot add information about unpublished articles in this handbook, however the table of contents will continue to grow as additional articles pass through the review process and are added to the site. Please note that the online publication date for this handbook is the date that the first article in the title was published online. For more information, please read the site FAQs.
... Eating is central to human behavior. Some evolutionary accounts suggest humans are evolutionarily optimized to eat cooked food (e.g., Carmody & Wrangham, 2009;Wrangham & Conklin-Brittain, 2003), as indicated by the reduction of tooth and jaw size observed approximately 100,000 years ago (Brace et al., 1991), and by the fact that people cannot survive on a raw-food diet, except under unusual circumstances (e.g., extremely sedentary lifestyle; Koebnick et al., 1999). All human populations cook (Harris, 1992). ...
Full-text available
While eating is universally salient, food habits vary greatly even across similar western cultural groups. Italians, for example, are renowned pasta consumers whereas this habit is less pervasive in other western cultures. This variability might shape the conceptualization of food of different cultural groups. Against this backdrop, it has been proposed the semantic representation of food is universally organized along two main axes, with natural food (e.g., vegetables, fruit ) relying more on sensory properties and manufactured food (e.g., pasta ) relying more on functional properties. In this exploratory study, we compared the semantic representation of pasta, vegetables, and fruit across Italian and English-speaking participants with a free-listing task. We find the representation of pasta is not restricted to functional properties. Moreover, Italian and English speakers differed both quantitatively and qualitatively in their representation of pasta. Italians produced more exemplars of pasta than English-speaking participants, and their conceptual organization of pasta also included fine-grained distinctions (e.g., egg-based vs. flour-and-water pasta), whereas English-speaking participants mostly focused on perceptual components (e.g., long) – even when accounting for differential consumption, cooking, and preparation experience of pasta. Our results suggest that culture-specific experiences can shape the conceptualization of food.
... Third, the question "do you eat too many calories" did not capture the type of food consumed. A study found that excess consumption of raw plant foods, for example, is associated with a risk of being underweight and is not a risk factor for obesity-related disease (Koebnick et al., 1999). However, it should be noted that although the participants in this study were medical students they were from the general population where eating traditional Chinese food is the norm and typically includes lightly steamed or stir-fried plant-based foods, accompanied by starches, fish, and meat in bite-size portions to flavor the meal. ...
Full-text available
The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.
... These medical conditions increase the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure, and certain cancers. Raw food diets are good methods for controlling body weight [2] since they are low in fat and contain protein and fiber, which help to keep the body in good shape. Raw food diets are also associated with favorable plasma β-carotene [3] and lower plasma, cholesterol, and triglyceride concentrations [4]. ...
Full-text available
The raw eating quality of sweet potato is complex. As consumers start paying more attention to the raw eating quality of tuberous roots in sweet potato, the evaluation of the raw eating quality of sweet potato is becoming an important issue. Therefore, we measured 16 quality indicators in 81 varieties of sweet potato. It was found that these 16 quality traits had different coefficients of variation (C.V.). Among them, the C.V. of fructose, glucose, and adhesiveness were the largest: 87.95%, 87.43% and 55.09%, respectively. The cluster analysis method was used to define six categories of the different tuberous roots of sweet potato. Group I, III, and IV had a stronger hardness and higher starch and cellulose content. Groups II, V, and VI were softer, with a high moisture and soluble sugar content. The principal component analysis method was used to comprehensively evaluate 16 quality indicators of 81 sweet potato varieties. It was found that Futian1, Taishu14, and Nanshu022 are good varieties in terms of raw eating quality. These varieties have low hardness, high adhesiveness in texture, high soluble sugar content, and low starch and cellulose. Future research should focus on improving the raw eating quality of sweet potato by reducing hardness, starch, and cellulose, while increasing adhesiveness, soluble sugar, and moisture content.
Full-text available
Thus far, most researchers have focused on the cognition of fire use, but few have explored the cognition of firemaking. With this contribution we analyse aspects of the two main hunter-gatherer firemaking techniques—the strike-a-light and the manual fire-drill—in terms of causal, social and prospective reasoning. Based on geographic distribution, archaeological and ethnographic information, as well as our cognitive interpretation of strike-a-light firemaking, we suggest that this technique may well have been invented by Neanderthal populations in Eurasia. Fire-drills, on the other hand, represent a rudimentary form of a symbiotic technology, which requires more elaborate prospective and causal reasoning skills. This firemaking technology may have been invented by different Homo sapiens groups roaming the African savanna before populating the rest of the globe, where fire-drills remain the most-used hunter-gatherer firemaking technique.
Conference Paper
Full-text available
With the discovery of fire by mankind, new transformations have taken place in our dietary styles. Over the centuries, industrialization and rapidly developing technology have led to the introduction of many new food products, culinary techniques and various gastronomy concepts into our lives. The frequent change of our lifestyles has allowed the foods we consume and the things we are interested in to differentiate in a short time. All these changes are affected in the food sector. The concepts of gastronomy that come into our lives with French cuisine are developing and changing with new
Vegetarianism is defined as a dietary pattern that is based on abstaining from the consumption of animal products. According to this dietary pattern processed foods have been considered unhealthy, and the consumption of raw plant-based diets and un-processed foods has been encouraged, however, these effects have not been fully proven and there are contradictions. The aim of the current study was to conduct a systematic literature review of the available evidence to assess and investigate the effects of a raw vegetarian diet with a review of clinical trial studies. The literature search to find related studies were performed through three scientific databases, including PubMed, SCOPUS, and Google Scholar with related keywords. Based on our findings from the literature, a raw vegan diet with more than 90% raw food cannot be recommended for a long time due to micronutrient deficiencies as well as related complications. In order to investigate possible advantages and disadvantages, it seems well-designed clinical trials are necessary to clarify these effects.
All women who enter menopause experience amenorrhea unless they receive hormone replacement therapy. In younger women, amenorrhea unrelated to pregnancy and lactation can be a distressing symptom. In addition to its psychologic morbidity, amenorrhea may be the manifesting feature of a wide array of anatomic and endocrine abnormalities. Amenorrhea results in impaired fertility. When estrogen levels are low, changes in mineral, glucose, and fat metabolism accompany amenorrhea. These metabolic changes affect bone and cardiovascular health, increasing the risk of osteoporosis and coronary heart disease in later life. Amenorrhea with hyperandrogenism, most commonly caused by the polycystic ovarian syndrome, may cause endometrial hyperplasia and increases the risk of endometrial adenocarcinoma. Because of the broad differential diagnosis of amenorrhea, establishing an accurate diagnosis can prove challenging. In this article, we outline one approach to the assessment of patients with amenorrhea and to the management of its common causes and consequences.
Body mass index (BMI) in conjunction with indices of energy turnover, e.g. physical activity levels (PAL), was recently proposed for classifying adult chronic energy deficiency (CED). Three deprived populations in Africa and Asia were chosen to assess the classification system. Repeated monitoring showed that the combined indicator was affected by instability in PALs and produced implausible discontinuities in the prevalence of different grades of CED. The use of BMI alone produced coherent data with changing BMI distributions, and only 5% of the population would have been wrongly classified as being malnourished, because of being thin but active. The risk of misclassification would be even smaller for populations with BMI distribution shifted towards the right. The prevalence of CED was consistently related within each country to indices of socio-economic status. Yet in Zimbabwe 18% of women and 6% of men had Grade I obesity compared with 11% and 14%, respectively, with CED. Less than 1% Indian and Ethiopian adults were obese but 61% of women and 70% of men were classified as CED in India and 57% and 50%, respectively, in Ethiopia. We propose that adult BMI alone is sufficient to provide important new insights into the problems of food availability and its control in less developed countries.
This study examines the relationship between body mass index (BMI) and 26-year mortality among 8828 nonsmoking, nondrinking Seventh-day Adventist men, including 439 who were very lean (BMI less than 20 kg/m2). The adjusted relative risk comparing the lowest BMI quintile (less than 22.3) to the highest (greater than 27.5 kg/m2) was 0.70 (95 percent CI 0.63-0.78) for all cause mortality, 0.60 (95 percent CI 0.43-0.85) for cerebrovascular mortality, and 0.80 (95 percent CI 0.61-1.04) for cancer mortality. Very lean men did not show increased mortality. To assess whether the protective effect associated with low BMI is modified by increasing age, the product term between BMI and attained age (age at the end of follow-up or at death) was included as a time-dependent covariate. For ischemic heart disease mortality, age-specific estimates of the relative risk for the lowest quintile relative to the highest ranged from 0.32 (95 percent CI, 0.19-0.52) at age 50 to 0.71 (95 percent CI, 0.56-0.89) at age 90. Interaction was also seen for the next lowest quintile (22.4-24.2). There was a significant trend of increasing mortality with increasing BMI for all endpoints studied. For cancer and cerebrovascular mortality the P-values for trend were 0.0001 and 0.001 respectively. For the other endpoints the P-values were less than 0.0001. Thus, there was no evidence for a J-shaped relationship between BMI and mortality in males. While the protective effect associated with the lowest BMI quintile decreased with increasing age for ischemic heart disease mortality, it remained greater than one at all ages. The relatively large number of subjects who were lean by choice, rather than as a result of preclinical disease or smoking, may explain these findings.
Basal metabolic rates (BMR) and body composition were measured in 130 adult Indian males, selected from three socio-economic groups. Results show a significantly lower BMR in the chronically undernourished, with a greater dependence on carbohydrate as fuel in the fasted state. When expressed as per kg body weight or kg fat-free mass (FFM), the BMRs are significantly higher in these individuals. The latter observations suggest variations in the contribution of viscera and skeletal muscle to the FFM, with a relatively greater visceral to muscle mass ratio. However, on adjustment for differences in weight and FFM by means of an analysis of covariance, the chronically undernourished (both urban and rural) have significantly lower BMRs. This indicates a 'metabolic economy' in these individuals, which could be attributable in part to their significantly lower serum T3 levels. When the subjects are classified on the basis of grades of chronic energy deficiency (CED), individuals with low body mass index (BMI) (less than 17 and below) are not similar in their basal metabolism. Those individuals from good socio-economic backgrounds with access to ad libitum energy and protein intake but with low BMI have comparable BMRs to the well nourished. It may therefore be unwise to classify all individuals with low BMI 'across the board' as suffering from CED. Socio-economic scaling may be a useful addition to the present classification of CED.
Eleven female patients (aged 18-46 y) with anorexia nervosa were measured by use of dual-photon absorptiometry for 1) bone mineral content (BMC, in g) and bone mineral density (BMD, in g/cm2) of the total skeleton and its regions, 2) BMD of the lumbar spine and the proximal femur, and 3) total body soft-tissue composition. The patients weighed 44.4 kg, approximately 15 kg less than normal peers (n = 22). The fat mass (3.35 kg) and content of soft tissue (7.8%) were four and three times lower (p less than 0.001) respectively, than those in normal women (15.1 kg and 26%, respectively). The total skeleton mineral (1921 g) was approximately 25% less than that of young normal women. The BMC as a fraction of the lean tissue mass was approximately 4.9% in the patients and 5.9% in normal women. Total body and femoral BMD averaged only 10% and 13% lower than those of normal women, respectively; however, spinal BMD was particularly reduced (approximately 25%, p less than 0.001).
We examined responses to cooked and uncooked food in 32 outpatients with essential hypertension; 28 were also overweight. By varying cooked and uncooked food percentages and salt intake, patients acted as their own control subjects in this unblinded study. After a mean duration of 6.7 months, average intake of uncooked food comprised 62% of calories ingested. Mean weight loss was 3.8 kg and mean diastolic pressure reduction 17.8 mm Hg, both statistically significant (P less than .00001). Eighty percent of those who smoked or drank alcohol abstained spontaneously.
Weight-height (W-H) indices continue to be popular methods of assessing fatness in both clinical practice and population studies, even though skinfold thicknesses provide simple valid estimates. Different grades of obesity have been defined in terms of W/H2 values but these have not been related to fatness. So far, no allowance has been made for the changing body composition with age which alters the relationships between fatness and W/H2 or the other W-H indices. These relationships were calculated in an industrial sample of 138 adult men and 22-55 yr. W/H2 and relative weight (weight/desirable weight) were the best of the W-H indices of fatness, having the lowest correlations with height (r = 0.07), the highest correlation with percentage of body weight as fat (%F) (r = 0.75), and with fat mass (r = 0.88), and the lowest standard error of estimate (SEE) (4.1%F). However, W/H and W/H3 had very similar r and SEE with %F. Adding age to W/H2 improved the accuracy of the estimation of %F, (R2=0.66 SEE = 3.6%), and reduced the overestimation of %F in the young and underestimation in the middle-aged that occur with W/H2 alone. Validated equations for estimating %F and fat mass in men from W/H2 and age are presented. However, W-H indices should be used cautiously as they cannot distinguish between overweight due to muscle, bone, water or fat.