Comparison of Resting Energy Expenditure Prediction Methods With Measured Resting Energy Expenditure in Obese,Hospitalized Adults

Background: Several methods are available to estimate caloric needs in hospitalized, obese patients who require specialized nutrition support; however, it is unclear which of these strategies most accurately approximates the caloric needs of this patient population. The purpose of this study was to determine which strategy most accurately predicts resting energy expenditure in this subset of patients. Methods: Patients assessed at high nutrition risk who required specialized nutrition support and met inclusion and exclusion criteria were enrolled in this observational study. Adult patients were included if they were admitted to a medical or surgical service with a body mass index ≥ 30 kg/m². Criteria excluding patient enrollment were pregnancy and intolerance or contraindication to indirect calorimetry procedures. Investigators calculated estimations of resting energy expenditure for each patient using variations on the following equations: Harris‐Benedict, Mifflin–St. Jeor, Ireton‐Jones, 21 kcal/kg body weight, and 25 kcal/kg body weight. For nonventilated patients, the MedGem handheld indirect calorimeter was used. For ventilated patients, the metabolic cart was used. The primary endpoint was to identify which estimation strategy calculated energy expenditures to within 10% of measured energy expenditures. Results: The Harris‐Benedict equation, using adjusted body weight with a stress factor, most frequently estimated resting energy expenditure to within 10% measured resting energy expenditure at 50% of patients. Conclusion: Measured energy expenditure with indirect calorimetry should be employed when developing nutrition support regimens in obese, hospitalized patients, as estimation strategies are inconsistent and lead to inaccurate predictions of energy expenditure in this patient population.     

风心病瓣膜置换手术对能量代谢的影响

目的观察风湿性心脏病瓣膜置换手术患者围体外循环期静息能量消耗的改变。方法将接受体外循环手术的风心病患者20例分为男、女两组,A组为男性,B组为女性。采用间接能量监测仪测定手术前后的静息能量消耗,手术前后构成自身对照。结果男性患者在术后第1、3、5、7天的静息能量消耗与术前的静息能量消耗之比分别为(1.346±0.004雪、穴1.158±0.001雪、穴1.091±0.001雪和穴0.992±0.001雪;女性患者为穴1.285±0.002雪、穴1.130±0.001雪、穴1.052±0.001雪和穴1.008±0.0003雪;术后前5天明显高于术前穴P<0.01雪,术后第7天与术前无显著性差异。手术对男女性患者静息能量消耗的影响在术后第1天有显著性差异。结论风心病瓣膜置换手术后能量消耗有一定程度的增高。     

Resting Energy Expenditure in Older Inpatients: A Comparison of Prediction Equations and Measurements

Determining energy requirements are an important component of nutritional support for patients with malnutrition; however, the validity of prediction equations for resting energy expenditure (REE) is disputed in older hospitalized patients. We aimed to assess the validity of these equations in older hospitalized patients in Japan. This was a single-center, cross-sectional study of 100 patients aged ≥70 years, hospitalized between January 2020 and December 2021. REE was measured using an indirect calorimeter and was compared to the predicted values calculated from five REE prediction equations. The mean (95% confidence interval) measured REE was 968.1 (931.0, 1005.3) kcal/day, and the mean predicted REE was higher for the FAO/WHO/UNU (1014.3 [987.1, 1041.6] kcal/day, p = 0.164) and Schofield (1066.0 [1045.8, 1086.2] kcal/day, p < 0.001) equations and lower for the Harris-Benedict (898.6 [873.1, 924.1] kcal/day, p = 0.011), Ganpule (830.1 [790.3, 869.9] kcal/day, p < 0.001), and body weight (kg) × 20 (857.7 [821.9, 893.5] kcal/day, p < 0.001) equations. In the age group analysis, none of the predicted values were within a 10% error for more than 80% of patients aged 70–89 years and ≥90 years. The five REE prediction equations did not provide accurate estimates. Validated REE prediction equations need to be developed for older hospitalized patients.     

Estimation of Resting Energy Expenditure: Validation of Previous and New Predictive Equations in Obese Children and Adolescents

Objective: Accurate estimation of resting energy expenditure (REE) in childrenand adolescents is important to establish estimated energy requirements. The aim of the present study was to measure REE in obese children and adolescents by indirect calorimetry method, compare these values with REE values estimated by equations, and develop the most appropriate equation for this group.

Methods: One hundred and three obese children and adolescents (57 males, 46 females) between 7 and 17 years (10.6 ± 2.19 years) were recruited for the study. REE measurements of subjects were made with indirect calorimetry (COSMED, FitMatePro, Rome, Italy) and body compositions were analyzed.

Results: In females, the percentage of accurate prediction varied from 32.6 (World Health Organization [WHO]) to 43.5 (Molnar and Lazzer). The bias for equations was ?0.2% (Kim), 3.7% (Molnar), and 22.6% (Derumeaux-Burel). Kim's (266 kcal/d), Schmelzle's (267 kcal/d), and Henry's equations (268 kcal/d) had the lowest root mean square error (RMSE; respectively 266, 267, 268 kcal/d). The equation that has the highest RMSE values among female subjects was the Derumeaux-Burel equation (394 kcal/d). In males, when the Institute of Medicine (IOM) had the lowest accurate prediction value (12.3%), the highest values were found using Schmelzle's (42.1%), Henry's (43.9%), and Müller's equations (fat-free mass, FFM; 45.6%). When Kim and Müller had the smallest bias (?0.6%, 9.9%), Schmelzle's equation had the smallest RMSE (331 kcal/d). The new specific equation based on FFM was generated as follows: REE = 451.722 + (23.202 * FFM). According to Bland-Altman plots, it has been found out that the new equations are distributed randomly in both males and females.

Conclusion: Previously developed predictive equations mostly provided unaccurate and biased estimates of REE. However, the new predictive equations allow clinicians to estimate REE in an obese children and adolescents with sufficient and acceptable accuracy.     

Energy Expenditure,Protein Oxidation and Body Composition in a Cohort of Very Low Birth Weight Infants

The nutritional management of preterm infants is a critical point of care, especially because of the increased risk of developing extrauterine growth restriction (EUGR), which is associated with worsened health outcomes. Energy requirements in preterm infants are simply estimated, so the measurement of resting energy expenditure (REE) should be a key point in the nutritional evaluation of preterm infants. Although predictive formulae are available, it is well known that they are imprecise. The aim of our study was the evaluation of REE and protein oxidation (Ox) in very low birth weight infants (VLBWI) and the association with the mode of feeding and with body composition at term corrected age. Methods: Indirect calorimetry and body composition were performed at term corrected age in stable very low birth weight infants. Urinary nitrogen was measured in spot urine samples to calculate Ox. Infants were categorized as prevalent human milk (HMF) or prevalent formula diet (PFF). Results: Fifty VLBWI (HMF: 23, PFF: 27) were evaluated at 36.48 ± 0.85 post-conceptional weeks. No significant differences were found in basic characteristics or nutritional intake in the groups at birth and at the assessment. No differences were found in the REE of HMF vs. PFF (59.69 ± 9.8 kcal/kg/day vs. 59.27 ± 13.15 kcal/kg/day, respectively). We found statistical differences in the protein-Ox of HMF vs. PFF (1.7 ± 0.92 g/kg/day vs. 2.8 ± 1.65 g/kg/day, respectively, p < 0.01), and HMF infants had a higher fat-free mass (kg) than PFF infants (2.05 ± 0.26 kg vs. 1.82 ± 0.35 kg, respectively, p < 0.01), measured with air displacement plethysmography. Conclusion: REE is similar in infants with a prevalent human milk diet and in infants fed with formula. The HMF infants showed a lower oxidation rate of proteins for energy purposes and a better quality of growth. A greater amount of protein in HMF is probably used for anabolism and fat-free mass deposition. Further studies are needed to confirm our hypothesis.     

Impact of Disease Activity on Resting Energy Expenditure and Body Composition in Adult Crohn's Disease

Background: There is controversy about nutrition status and calorie needs during phases of active versus inactive adult Crohn's disease (CD). Results have been reported in cross‐sectional studies, but longitudinal data are unavailable. Our aim was to explore whether disease activity had an impact on resting energy expenditure (REE) and body composition in adult patients with CD. Materials and Methods: Adult patients were studied on 2 occasions with active and inactive CD. REE was measured by indirect calorimetry. Body composition was estimated from bioelectrical impedance analysis. Disease activity was measured using the Crohn's Disease Activity Index (CDAI). Regression analyses of REE with CDAI score, C‐reactive protein, and erythrocyte sedimentation rate were also performed. Results: Seventy‐five patients were included. Patients with active CD had increased REE/body weight compared with patients with inactive disease (28.8 ± 5.4 vs 25.9 ± 4.3 kcal/kg, P < .001). Disease behavior and location, but not sex, had an impact on REE/body weight. Body mass index was lower in active disease than in remission (17.4 ± 3.0 vs 18.1 ± 2.6 kg/m², P = .010). Body composition was not affected by disease behavior or location. Conclusion: Patients with remission had a better nutrition status and decreased REE compared with those with active CD. REE could also be affected by disease location and behavior.     

Measurement of Resting Energy Expenditure in Healthy Children

Background: The role that the components of energy expenditure play in the etiology of childhood obesity has highlighted the need for greater accuracy and standardized protocols for the measurement of resting energy expenditure (REE). However, protocols used to assess REE in children are varied, and consensus on a suitable method for measuring REE in children has not been reached. This study was undertaken to determine the effect of measurement time and measurement device (mask or mouthpiece) on REE in healthy children. Design: Following a 12‐hour fast and abstinence from exercise, 23 children (age, 7–12 years) completed two 35‐minute protocols: one with a face mask and the other with a mouthpiece/noseclip. Energy expenditure was measured continuously via indirect calorimetry, while device acceptability was assessed using a 6‐point comfort rating scale. Results: Repeated measures ANOVA indicated that there was no significant difference in REE when measured after 10, 15, 20, or 25 minutes of rest compared to 30 minutes for either the mask or mouthpiece/noseclip (REE range, 1371–1460 kcal/d). Examination of the percentage coefficient of variation (CV) in energy expenditure for each time period by device showed that the least variation existed after 20 minutes of measurement using the mask (CV 6%). Paired t test analysis indicated significantly less discomfort when wearing the mask compared to the mouthpiece/noseclip. Conclusion: It would appear that a 20‐minute protocol using a mask may increase compliance and prove to be a more practical protocol for measuring REE in children.     

Resting Energy Expenditure Is Not Altered in Children and Adolescents with Obesity. Effect of Age and Gender and Association with Serum Leptin Levels

In children and adolescents, obesity does not seem to depend on a reduction of resting energy expenditure (REE). Moreover, in this young population, the interactions between either age and obesity or between age and gender, or the role of leptin on REE are not clearly understood. To compare the levels of REE in children and adolescents we studied 181 Caucasian individuals (62% girls) classified on the basis of age- and sex-specific body mass index (BMI) percentile as healthy weight (n = 50), with overweight (n = 34), or with obesity (n = 97) and in different age groups: 8–10 (n = 38), 11–13 (n = 50), and 14–17 years (n = 93). REE was measured by indirect calorimetry and body composition by air displacement plethysmography. Statistically significant differences in REE/fat-free mass (FFM) regarding obesity or gender were not observed. Absolute REE increases with age (p < 0.001), but REE/FFM decreases (p < 0.001) and there is an interaction between gender and age (p < 0.001) on absolute REE showing that the age-related increase is more marked in boys than in girls, in line with a higher FFM. Interestingly, the effect of obesity on absolute REE is not observed in the 8–10 year-old group, in which serum leptin concentrations correlate with the REE/FFM (r = 0.48; p = 0.011). In conclusion, REE/FFM is not affected by obesity or gender, while the effect of age on absolute REE is gender-dependent and leptin may influence the REE/FFM in 8–10 year-olds.     

TG/HDL Ratio Is an Independent Predictor for Estimating Resting Energy Expenditure in Adults with Normal Weight,Overweight, and Obesity

Factors that determine resting energy expenditure (REE) remain under investigation, particularly in persons with a high body mass index (BMI). The accurate estimation of energy expenditure is essential for conducting comprehensive nutrition assessments, planning menus and meals, prescribing weight and chronic disease interventions, and the prevention of malnutrition. This study aimed to: (a) determine the contribution of cardiometabolic biomarkers to the inter-individual variation in REE in persons categorized by BMI; and (b) assess the contribution of these biomarkers in the prediction of REE when persons of varying BMI status were categorized by their glycemic and metabolic syndrome status. Baseline data from 645 adults enrolled in diet intervention trials included REE measured by indirect calorimetry, body composition by dual energy X-ray absorptiometry, anthropometrics, and cardiometabolic biomarkers. Multivariate linear regression modeling was conducted to determine the most parsimonious model that significantly predicted REE by BMI category, metabolic syndrome status, and glycemic status. Modeling with the traditional predictors (age, sex, height, weight) accounted for 58–63% of the inter-individual variance in REE. When including age, sex, height, weight and fat-free mass as covariates, adding TG/HDL to regression modeling accounted for 71–87% of the variance in REE. The finding that TG/HDL is an independent predictor in estimating REE was further confirmed when participants were categorized by metabolic syndrome status and by glycemic status. The clinical utility of calculating the TG/HDL ratio not only aids health care providers in identifying patients with impaired lipid metabolism but can optimize the estimation of REE to better meet therapeutic goals for weight and disease management.     

The thermic effect of food and obesity: discrepant results and methodological variations

Studies have yielded discrepant results concerning whether the thermic effect of food (TEF) is reduced in obesity. Methodological variations among published studies make understanding the discrepant results very difficult. Although methodological differences are often noted as contributing to the discrepant results, little work has been done to address these differences and standardize experimental protocols. This paper reviews 50 studies that have investigated TEF in obesity and focuses on factors related to experimental protocol and subject control that reportedly affect measurements of resting energy expenditure, postprandial energy expenditure, and the calculation of TEF.     

Reciprocal Compensation to Changes in Dietary Intake and Energy Expenditure within the Concept of Energy Balance

An imbalance between energy intake and energy expenditure is the primary etiology for excess weight gain. Increased energy expenditure via exercise and energy restriction via diet are commonly used approaches to induce weight loss. Such behavioral interventions, however, have generally resulted in a smaller than expected weight loss, which in part has been attributed to compensatory adaptations in other components contributing to energy balance. Current research points to a loose coupling between energy intake and energy expenditure on a daily basis, and evidence for long-term adaptations has been inconsistent. The lack of conclusive evidence on compensatory adaptations in response to alterations in energy balance can be attributed to differences in intervention type and study population. Physical activity (PA) levels may be reduced in response to aerobic exercise but not in response to resistance exercise. Furthermore, athletic and lean adults have been shown to increase their energy intake in response to exercise, whereas no such response was observed in obese adults. There is also evidence that caloric restriction is associated with a decline in PA. Generally, humans seem to be better equipped to defend against weight loss than avoid weight gain, but results also show a large individual variability. Therefore, individual differences rather than group means should be explored to identify specific characteristics of “compensators” and “noncompensators.” This review emphasizes the need for more research with simultaneous measurements of all major components contributing to energy balance to enhance the understanding of the regulation of energy balance, which is crucial to address the current obesity epidemic.     

Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study

Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REE_IC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REE_IC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REE_IC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.     

Effect of Green Coffee Consumption on Resting Energy Expenditure,Blood Pressure,and Body Temperature in Healthy Women: A Pilot Study

ABSTRACT

Objective: This study was conducted to determine the effects of green coffee consumption on resting energy expenditures (REEs), blood pressure, and body temperature of individuals.

Method: The study was conducted with 24 women. The REE values of the individuals were measured with the COSMED Fitmate PRO. After the first REE measurements, individuals were given 1 cup of green coffee that was prepared to contain 6 mg caffeine per kg of lean body mass. After coffee consumption, REE measurements were made at 30, 60, 120, and 180 minutes. Blood pressure (mm Hg) and body temperature values (°C) were measured simultaneously with REE measurement.

Results: There was a positive correlation between the caffeine amounts given with green coffee and 30-minute (p < 0.05), 60-minute (p = 0.06), and 120-minute (p < 0.05) REE (kcal/d) values. There was also a positive correlation between the total chlorogenic acid taken with green coffee and 30-minute (p < 0.05), 60-minute (p = 0.06), and 120-minute (p < 0.05) REE (kcal/d) values. The intracellular and extracellular fluid amounts liter(l) before and after consumption of green coffee by individuals were 18.7 ± 1.57 versus 18.6 ± 1.44 (p < 0.05) and 11.4 ± 1.01 versus 11.2 ± 0.97 (p < 0.05), respectively. The body temperature (°C) changes observed in the individuals whose usual dietary caffeine intake was less than or equal to the 50th percentile after green coffee consumption were statistically significant (p < 0.05). Similarly, the diastolic blood pressure changes observed in the individuals whose usual dietary caffeine intake was less than or equal to the 50th percentile after green coffee consumption was almost statistically significant (p = 0.06).

Conclusions: The results of this study showed that 6 mg caffeine/kg (lean body mass) intake among women changed body temperature and blood pressure values and liquid balance depending on the usual dietary coffee intake. In addition, chlorogenic acid is also correlated with REE values besides green coffee caffeine.

Key teaching points

? There are several findings, and chlorogenic acid may have antihypertensive effects.

? There is a significant correlation between green coffee chlorogenic acid amount and REE.

? Intracellular and extracellular liquid amounts decrease following green coffee consumption (215–280 mg caffeine), and these changes are observed in individuals whose usual dietary caffeine intake is relatively both low and high.

? The body temperature values of individuals whose usual dietary caffeine intake was in the 50th percentile or greater (relatively high) increased after green coffee consumption.

Effect of Acute and Chronic Dietary Supplementation with Green Tea Catechins on Resting Metabolic Rate,Energy Expenditure and Respiratory Quotient: A Systematic Review

The consumption of green tea catechins (GTC) is associated with modulations of fat metabolism and consequent weight loss. The aim of this systematic review was to investigate the effect of GTC on resting metabolic rate (RMR), energy expenditure (EE), and respiratory quotient (RQ). Eligible studies considered both the chronic and acute intake of GTC-based supplements, with epigallocatechin gallate (EGCG) doses ranging between 100–800 mg. Findings from 15 studies (n = 499 participants) lasting 8–12 weeks (for chronic consumption) or 1–3 days (for acute intake) are summarized. This review reveals the positive effects of GTC supplementation on RQ values (272 subjects). Regarding the effects of acute and chronic GTC supplementation on RMR (244 subjects) and EE (255 subjects), the results did not allow for a definitive conclusion, even though they were promising, because some reported a positive improvement (two studies revealed an increase in RMR: one demonstrated an RMR increase of 43.82 kcal/day and another demonstrated an increase of 260.8 kcal/day, mainly when subjects were also engaged in resistance training exercise). Considering GTC daily dose supplementation, studies in which modifications of energetic parameters occurred, in particular RQ reduction, considered GTC low doses (100–300 mg). GTC may be useful for improving metabolic profiles. Further investigations are needed to better define adequate doses of supplementation.     

The Cross-Sectional Association of Energy Intake and Dietary Energy Density with Body Composition of Children in Southwest China

Objective: We examined whether dietary energy intake (EI) and dietary energy density (ED) were cross-sectionally associated with body composition of children living in Southwest China. Design and Methods: Multivariate regression analyses were performed on three day, 24 h dietary recall data and information on potential confounders from 1207 participants aged 8–14 years. EI was calculated from all foods and drinks and ED was classified into five categories. Body mass index (BMI) z-scores, percentage of body fat (%BF), fat mass index (FMI), fat-free mass index (FFMI) and ratio of waist to hip circumference (WHR) were used to describe body composition. Results: Boys with higher total EI had higher BMI z-scores, %BF, and FMI than boys with lower total EI both before and after measurements were adjusted for confounders (age, fiber intake, physical activity, the timing of adding complementary foods, paternal education level and maternal BMI) (p ≤ 0.04). However, EI was not associated with body composition in girls. Dietary ED, in any category, was not associated with body composition in either gender. Conclusions: Dietary ED was not associated with body composition of children in Southwest China, while dietary EI in boys, not girls, was positively associated with body composition. Reducing dietary energy intake may help to prevent obesity and related diseases in later life among boys living in Southwest China.