Body movement and physical activity energy expenditure in children and adolescents: how to adjust for differences in body size and age

BACKGROUND: Physical activity data in children and adolescents who differ in body size and age are influenced by whether physical activity is expressed in terms of body movement or energy expenditure. OBJECTIVE: We examined whether physical activity expressed as body movement (ie, accelerometer counts) differs from physical activity energy expenditure (PAEE) as a function of body size and age. DESIGN: This was a cross-sectional study in children [n = 26; (+/-SD) age: 9.6 +/- 0.3 y] and adolescents (n = 25; age: 17.6 +/- 1.5 y) in which body movement and total energy expenditure (TEE) were simultaneously measured with the use of accelerometry and the doubly labeled water method, respectively. PAEE was expressed as 1) unadjusted PAEE [TEE minus resting energy expenditure (REE); in MJ/d], 2) PAEE adjusted for body weight (BW) (PAEE. kg(-1). d(-1)), 3) PAEE adjusted for fat-free mass (FFM) (PAEE. kg FFM(-1). d(-1)), and 4) the physical activity level (PAL = TEE/REE). RESULTS: Body movement was significantly higher (P = 0.03) in children than in adolescents. Similarly, when PAEE was normalized for differences in BW or FFM, it was significantly higher in children than in adolescents (P = 0.03). In contrast, unadjusted PAEE and PAL were significantly higher in adolescents (P < 0.01). CONCLUSIONS: PAEE should be normalized for BW or FFM for comparison of physical activity between children and adolescents who differ in body size and age. Adjusting PAEE for FFM removes the confounding effect of sex, and therefore FFM may be the most appropriate body-composition variable for normalization of PAEE. Unadjusted PAEE and PAL depend on body size.     

加速度计对成人日常体力活动测量效度的研究

目的　对加速度计(CSA)测量成年人日常体力活动的效度进行验证并提出根据 CSA数据预测能量消耗的方程。方法　选取 72 名北京市居民,年龄(43.6±4.0)岁,男性 33 名,女性 39名,作为调查对象,佩带7天CSA,在同一期间采用双标水方法(DLW) 测量能量消耗,包括平均每天总能量消耗(TEE)、平均每天体力活动能量消耗(AEE)和体力活动水平(PAL)作为验证标准。结果通过CSA测量的平均每天活动计数(AC)与TEE、AEE和PAL之间均呈显著相关,偏相关系数 r 分别为0.31、0.30、0.26(P<0.05)。逐步多元回归分析表明,影响TEE的因素包括去脂体重或体重指数、AC(R2=0.52~0.70),影响AEE的因素包括AC、性别和去脂体重(R2=0.25~0.32)。结论　CSA能准确测量中国成年人日常体力活动模式,AC可以解释TEE和AEE的变异。     

Longitudinal changes in energy expenditure in girls from late childhood through midadolescence

BACKGROUND: Longitudinal data on energy expenditure in children and adolescents are scarce. OBJECTIVE: The purpose of this study was to examine changes in energy expenditure and physical activity in girls from late childhood through midadolescence. DESIGN: We measured total energy expenditure (TEE) by doubly labeled water, resting metabolic rate (RMR) by indirect calorimetry, body composition by 18O dilution, and time spent in activity by an activity diary in 28 initially nonobese girls at approximately 10, approximately 12, and approximately 15 y of age. Changes with age in TEE, RMR, and activity energy expenditure (AEE), both in absolute terms and in adjusted analyses, and in physical activity level (PAL) and time spent sleeping, being sedentary, and in moderate and vigorous activity were evaluated by mixed-model repeated-measures analyses. RESULTS: Absolute TEE and AEE increased significantly from age 10 to age 15 y (P < 0.0001 for both). Absolute RMR at ages 12 and 15 y did not differ significantly, despite significant increases in fat-free mass and fat mass between the visits. PAL was significantly higher (P < 0.0001) at age 15 y than at age 10 or 12 y, whereas time spent being sedentary increased significantly from age 10 to age 15 y (P < 0.001), and AEE adjusted for fat-free mass appeared to decrease over the same interval. CONCLUSION: Conclusions drawn regarding changes with age in physical activity depend on the measure of physical activity assessed.     

Total energy expenditure and physical activity level in healthy young Swedish children 9 or 14 months of age

OBJECTIVES: To measure total energy expenditure (TEE) and total body water (TBW) in healthy Swedish children 9 or 14 months of age. To compare their TEE with current recommendations for energy intake. To define their body composition and relate this to energy expenditure. DESIGN:: Children were investigated at 9 or 14 months. The following variables were measured: TEE and TBW (by the doubly labelled water method), weight and length. Total body fat (TBF), sleeping metabolic rate, activity energy expenditure and physical activity level (PAL) were calculated. SUBJECTS: Thirty infants 9 months of age and 29 children 14 months of age. RESULTS:: TEE was 323+/-38, 322+/-29, 313+/-23 and 331+/-28 kJ/kg/day in 9-month-old girls, 9-month-old boys, 14-month-old girls and 14-month-old boys, respectively. At 9 months of age girls and boys contained 29.6+/-4.8 and 29.7+/-4.5% TBF, respectively. At 14 months the corresponding figures were 29.1+/-4.3 and 28.2+/-4.3%. There was a significant negative relationship between PAL and %TBF (r=-0.81, P<0.001, n=59). CONCLUSIONS: Measured TEE plus calculated energy cost of growth confirm previous estimates that the physiological energy requirements of children 9 and 14 months of age are 15-20% lower than current recommendations for energy intake. One possible interpretation of the relationship between PAL and %TBF is that children with a high TBF content are less physically active than children with less TBF. However, this relationship needs further studies.     

The energy expenditure of postmenopausal women classified as restrained or unrestrained eaters.

OBJECTIVE: Restrained eating is a common dietary practice among individuals who are attempting to prevent weight gain, but little is known about differences in energy physiology and regulation between restrained and unrestrained eaters. We investigated this issue in non-obese free-living postmenopausal women classified as long-term restrained (n=26) or unrestrained (n=34) eaters group matched for body mass index (BMI). MEASUREMENTS: Measurements were made of total energy expenditure (TEE), resting energy expenditure (REE), body composition, reported leisure time activity, maximal aerobic capacity (VO2max) and weight change during the study period. In addition, physical activity level (PAL) and nonexercise activity thermogenesis (NEAT) were calculated from measured variables. RESULTS: There were no significant differences between the groups in body composition, weight change, aerobic capacity or total leisure time activity. Relationships between fat-free mass (FFM) and both REE and TEE, and the relationship between work load and energy expenditure in the test of maximal oxygen consumption, were also not different between groups. However, restrained eaters had a significantly lower PAL (equal to TEE/REE, 1.72+/-0.04 vs 1.84+/-0.04, P<0.05). In addition, in multiple regression models predicting NEAT, NEAT was significantly lower in restrained eaters than unrestrained eaters and there was a positive relationship between NEAT and weight change in unrestrained eaters but no relationship in restrained eaters (P<0.05). CONCLUSIONS: In contrast to a previous report, we found no significant difference in TEE between restrained and unrestrained eaters. PAL was slightly lower in restrained eaters, apparently due to reduced NEAT, and restrained eaters also lacked the positive association between NEAT and body weight change seen in unrestrained eaters. This latter finding, if confirmed in future studies, could help explain an increased susceptibility of restrained eaters to weight gain. SPONSORSHIP: NIH grants AG12829, DK46124 and T32AG00209, and US Cooperative Agreement number 58-1950-9-001.     

活动记录辅助加速度仪测量总能量消耗的初步研究

目的 用活动记录辅助加速度仪测量人体日常活动的能量消耗,为监测个体总能量消耗(TEE)提供简便易行的方法.方法 采用气体代谢法标定加速仪不同活动强度记录所对应的能量消耗;41名受试者连续佩戴加速度仪7 d,同时记录每日活动,间接估算每日总能量消耗.结果 加速仪测量TEE,男性(9761±866)kJ/d[(2332±207)kcal/d,休力活动水平(PAL)1.46±0.11],女性(7526±879)kJ/d[(1798±210)kcal/d,PAL 1.43±0.09];加速仪结合活动记录的测量结果为,男性(10573±804)kJ/d[(2526±192)kcal/d,PAL 1.58±0.10],女性(8191±737)kJ/d[(1957±176)kcal/d,PAL 1.56±0.08].结论 加速度仪配合活动记录所得TEE值在既往报道的范围之内,可以作为监测个体TEE和体力活动水平变化的简便方法.     

Relation between physical activity and energy expenditure in a representative sample of young children

BACKGROUND: Strategies for the prevention and treatment of childhood obesity require a better understanding of the relation between the pattern of free-living physical activity and total energy expenditure (TEE). OBJECTIVE: We assessed the relations between TEE and physical activity level (PAL) during engagement in different intensities of physical activity. DESIGN: We used a cross-sectional study of 104 children (median age: 5.4 y) in Scotland. TEE was measured with use of doubly labeled water (DLW), and resting energy expenditure was predicted to determine PAL. Time spent sedentary and in light-intensity activity and in moderate- and vigorous-intensity physical activity (MVPA) was assessed by accelerometry concurrent with DLW measurements. Correlation and regression were used to assess the relations between measures of sedentary behavior, intensities of activity, and PAL as the dependent variable. RESULTS: Time spent sedentary was negatively correlated with PAL (r = -0.33, P < 0.01), and time spent in light-intensity activity was positively correlated with PAL (r = 0.31, P < 0.01). In multiple regression analyses, both time spent sedentary and in light-intensity activities were significantly associated with PAL. Time spent in MVPA was not associated with PAL; engagement in MVPA was limited in this sample (median: 3% of waking hours; range: 0-14%). PAL was significantly higher in boys than in girls. CONCLUSION: In this sample and setting, PAL was not influenced by engagement in MVPA but was influenced by time spent sedentary and in light-intensity activities. This study suggests that in young children, MVPA could make only a minor contribution to free-living TEE and PAL.     

Energy requirements in the eighth decade of life

BACKGROUND: Knowledge of energy requirements among relatively healthy elderly is limited. OBJECTIVES: The objectives of the study were to measure total energy expenditure (TEE)-derived energy requirements in a biracial population of older adults without limitations to daily life and to test these empirical measures against national and international recommendations. DESIGN: TEE (measured by the doubly labeled water method), resting metabolic rate (RMR), activity-related energy expenditure (AEE), and body composition were measured in 288 persons aged 70-79 y selected from the Health, Aging, and Body Composition Study. RESULTS: TEE was lower in women (approximately 530 kcal/d; P < 0.0001) than in men because of the women's lower RMR and AEE. Fat-free mass explained the sex difference in RMR, but body weight failed to account for the women's lower AEE (approximately 1 kcal x kg(-1) x d(-1); P = 0.007). Blacks had lower TEE than did whites (approximately 100 kcal/d, P = 0.03), and that was explained by blacks' lower RMR. Physical activity level (TEE/RMR) did not differ significantly between sexes and races (1.70 +/- 0.23). The World Health Organization (WHO) recommendations overestimated TEE by 10 +/- 15% (P < 0.0001) in women but not in men, and the dietary reference intakes (DRIs) were accurate to 0 +/- 14% (P = 0.1). Both WHO and DRI recommendations are based on an underestimated physical activity level, and WHO recommendations are based on overestimated RMR. CONCLUSIONS: This study of well-functioning older adults confirms the racial difference in energy metabolism and supports the use of the 2002 DRIs. Because the DRIs and WHO recommendations underestimated PAL, new predictive equations of energy requirements are proposed.     

Total energy expenditure, resting metabolic rate and physical activity level in free-living rural elderly men and women from Cuba, Chile and México

OBJECTIVE: The objective of this study was to assess total energy expenditure (TEE), resting metabolic rate (RMR) and physical activity level (PAL), and to estimate energy requirements (ERs) in free-living elderly subjects from Cuba, Chile and Mexico. DESIGN: Cross-sectional study designed to estimate ERs. SETTING: Rural regions of Cuba, Chile and Mexico. SUBJECTS: Forty subjects >60 years old were selected to participate in this study. INTERVENTIONS: A dose of doubly labeled water (DLW) was administered and urine samples were collected in the following 12-14 days. From the isotopic analysis, TEE was derived. RMR was measured by indirect calorimetry. RESULTS: TEE in Chilean (8.8+/-1.6 MJ/day) and Cuban (8.3+/-1.3 MJ/day) elderly was not different, and was higher for the Mexican group (9.5+/-1.5 MJ/day) (P < 0.0001). RMR was not different between countries. PAL and activity energy expenditure (AEE) were only different between Chile and Mexico (P < 0.002). For the three regions, overall PALs were 1.70+/-0.16 for male and 1.62+/-0.13 for female subjects (P < 0.02), and AEE was 3.05+/-0.66 and 2.27+/-0.66 MJ/day for male and female subjects, respectively (P < 0.001). Predictive equations (MJ/day) were RMR = 1.6447 + 0.05714 x weight (kg) + 0.449 sex (male = 1; female = 0) (R2 = 0.75; SEE = 0.479) and TEE = 3.414 + 0.0795 x weight (kg) + 1.227 x sex (male = 1; female = 0) (R2 = 0.75; SEE = 0.668). CONCLUSIONS: There were differences in TEE and PAL owing to sex and region. The average PAL in men was higher than the PAL reported either with factorial approach or with the DLW method in elderly. Predictive ER equations based on RMR and TEE gave very similar results to calculations from the 2004 FAO/WHO/UNU report.     

Physical activity level in healthy free-living Japanese estimated by doubly labelled water method and International Physical Activity Questionnaire

OBJECTIVE: To measure total energy expenditure (TEE) for normal healthy Japanese by the doubly labelled water (DLW), and to compare the physical activity level (PAL) among categories classified by the categories used in daily reference intake (DRI), Japan and the International Physical Activity Questionnaire (IPAQ). SUBJECTS AND METHODS: A total of 150 healthy Japanese men and women aged 20- to 59-year-old living in four districts of Japan. TEE was measured by the DLW method, and the PAL was calculated from TEE divided by basal metabolic rate. Simultaneously with TEE measurement, the PAL was assessed employing the categories used in DRI, Japan and IPAQ. RESULTS: The average TEE and PAL were 10.78+/-1.67 MJ/day and 1.72+/-0.22 for males and 8.37+/-1.30 MJ/day and 1.72+/-0.27 for females, respectively. The subjects in the highly active categories assessed by both DRI and IPAQ showed significantly higher PAL compared with less active categories. However, PALs among light and moderate categories by DRI, and insufficient and sufficiently active by IPAQ were not significantly different. CONCLUSIONS: In developed countries, highly active subjects could be assessed by a simple questionnaire. However, the questionnaire should be improved to clarify the sedentary to moderately active subjects by assessing carefully very light to moderate physical activity.     

Energy expenditure measured by doubly labeled water,activity recall,and diet records in the rural elderly

OBJECTIVE: The purpose of this study was to determine whether energy expenditure estimated from physical activity and energy intake were equivalent to total daily energy expenditure in an elderly rural population. METHODS: Twenty-seven elderly male (n = 14) and female (n = 13) subjects (mean age, 74 y) were recruited from a rural Pennsylvania population. Over a 2-wk period, total daily energy expenditure was measured by doubly labeled water (TEE) and estimated from 7-d physical activity recall factors multiplied by weight (PA(WT)), estimated basal metabolic rate (PA(BMR)) and resting energy expenditure from indirect calorimetry (PA(REE)), and energy intake from 3-d self-reported diet records (EI). Analysis of variance was used to determine significant within-subject differences in physical activity, energy intake, and energy expenditure. RESULTS: PA(REE) (men: 13.69 +/- 3.23 MJ, women: 9.51 +/- 2.40 MJ) and PA(BMR) (men: 13.69 +/- 2.99 MJ, women: 10.15 +/- 2.21 MJ) were not significantly different from TEE (men: 12.43 +/- 1.63 MJ, women: 9.44 +/- 0.90 MJ). EI (men: 8.66 +/- 2.34 MJ, women: 7.12 +/- 0.93 MJ) was significantly less than TEE, and PA(WT) (men: 17.03 +/- 4.07 MJ, women: 12.86 +/- 3.41 MJ) was significantly greater than TEE. CONCLUSIONS: Whereas 7-d physical activity recall determined with an age- and gender-specific estimate of resting metabolic rate or measured using indirect calorimetry accurately estimated TEE for this group of rural elderly, self-reported diet records consistently underestimated and physical activity recall determined with weight alone consistently overestimated energy expenditure measured by doubly labeled water.     

Comparison of total energy expenditure between the farming season and off farming season and accuracy assessment of estimated energy requirement prediction equation of Korean farmers

BACKGROUND/OBJECTIVESThe purposes of this study were to compare total energy expenditure (including PAL and RMR) of Korean farmers between the farming season and off farming season and to assess the accuracy of estimated energy requirement (EER) prediction equation reported in KDRIs.SUBJECTS/METHODSSubjects were 72 Korean farmers (males 23, females 49) aged 30-64 years. Total energy expenditure was calculated by multiplying measured RMR by PAL. EER was calculated by using the prediction equation suggested in KDRIs 2010.RESULTSThe physical activity level (PAL) was significantly higher (P < 0.05) in the farming season (male 1.77 ± 0.22, female 1.69 ± 0.24) than the off farming season (male 1.53 ± 0.32, female 1.52 ± 0.19). But resting metabolic rate was significantly higher (P < 0.05) in the off farming season (male 1,890 ± 233 kcal/day, female 1,446 ± 140 kcal/day) compared to the farming season (male 1,727 ± 163 kcal/day, female 1,356 ± 164 kcal/day). TEE (2,304 ± 497 kcal/day) of females was significantly higher in the farming season than that (2,183 ± 389 kcal/day) of the off farming season, but in males, there was no significant difference between two seasons in TEE. On the other hand, EER of male and female (2,825 ± 354 kcal/day and 2,115 ± 293 kcal/day) of the farming season was significantly higher (P < 0.05) than those (2,562 ± 339 kcal/day and 1,994 ± 224 kcal/day) of the off farming season.CONCLUSIONSThis study indicates that there is a significant difference in PAL and TEE of farmers between farming and off farming seasons. And EER prediction equation proposed by KDRI 2010 underestimated TEE, thus EER prediction equation for farmers should be reviewed.     

Effects of familial predisposition to obesity on energy expenditure in multiethnic prepubertal girls

BACKGROUND: The prevalence of childhood obesity is increasing and the causes of this are unknown. OBJECTIVE: The objective of this study was to determine whether energy expenditure (EE), measured by 24-h calorimetry and doubly labeled water, differed in normal-weight-for-height, multiethnic prepubertal girls with or without a familial predisposition to obesity. DESIGN: Normal-weight, prepubertal white (n = 52), African American (n = 30), and Hispanic (n = 19) girls with a mean (+/-SD) age of 8.5 +/- 0.4 y were studied according to parental leanness and overweight or obesity. The girls were grouped according to whether they had 2 lean parents (n = 30), 2 obese parents (n = 27), or 1 lean and 1 obese parent (n = 44). Basal metabolic rate (BMR), sleeping metabolic rate (SMR), 24-h EE, respiratory quotient, heart rate, and activity were measured by 24-h room calorimetry; free-living total EE (TEE), activity-related EE (AEE), and physical activity level were measured by doubly labeled water. EE was standardized by fat-free mass (FFM). RESULTS: There were no significant differences among familial groups in weight, height, fat mass, FFM, or percentage body fat. African American girls had a higher FFM than did white or Hispanic girls (P < 0.05). BMR, SMR, 24-h EE, respiratory quotient, heart rate, and activity levels were not significantly different among familial groups. Additionally, there were no significant familial group differences in TEE, AEE, or physical activity level. However, BMR, SMR, and TEE were lower in African American girls than in white girls (P < 0.05). CONCLUSION: There was no significant difference in EE between normal-weight, multiethnic prepubertal girls predisposed to obesity and those not predisposed to obesity.     

Energy expenditure is very high in extremely obese women

To test the hypothesis that total energy expenditure (TEE) and resting energy expenditure (REE) are low in extremely obese individuals, factors that could contribute to maintenance of excess weight, a cross-sectional study was conducted in 30 weight stable, extremely obese women [BMI (mean +/- SEM) 48.9 +/- 1.7 kg/m(2)]. TEE was measured over 14 d using the doubly labeled water method, REE and the thermic effect of feeding (TEF) were measured using indirect calorimetry, and activity energy expenditure (AEE) was calculated as TEE - (REE + TEF). Body composition was determined using a 3-compartment model. Subjects were divided into tertiles of BMI (37.5-45.0; 45.1-52.0; and 52.1-77.0 kg/m(2)) for data analysis. TEE and REE increased with increasing BMI tertile: TEE, 12.80 +/- 0.5, 14.67 +/- 0.5, and 16.10 +/- 0.9 MJ/d (P < 0.01); REE, 7.87 +/- 0.2, 8.78 +/- 0.3, and 9.94 +/- 0.6 MJ/d (P < 0.001), and these values were 29-38% higher than published means of measured TEE in nonobese individuals. No significant differences were observed among BMI tertiles for AEE, TEF, or physical activity level (PAL = TEE/REE, overall mean 1.64 +/- 0.16). The Harris-Benedict and WHO equations provided the closest estimates of REE (within 3%), whereas the obese-specific equations of Ireton-Jones overpredicted (40%) and Bernstein underpredicted (21%) REE. Extremely obese individuals have high absolute values for TEE and REE, indicating that excess energy intake contributes to the maintenance of excess weight. Standard equations developed for nonobese populations provided the most accurate estimates of REE for the obese individuals studied here. REE was not accurately predicted by equations developed in obese populations.     

Water loss as a function of energy intake, physical activity and season

Although water is an important nutrient, there are no recommended intake values. Here, water intake, energy intake, physical activity and water loss was measured over 1 week in summer and in winter. Subjects were healthy volunteers, forty-two women and ten men, mean age of 29 (SD 7) years and mean BMI 21.8 (SD 2.2) kg/m2. Water intake was measured with a 7 d food and water record. Physical activity level (PAL) was observed as the ratio of total energy expenditure, as measured with doubly labelled water, to resting energy expenditure as measured in a respiration chamber. Water loss was measured with the deuterium elimination method. Water loss was highly reproducible and ranged from 0.20 to 0.35 l/MJ, independent of season and activity level, with higher values in women. Water loss was related to water and energy intake in summer (r 0.96, P<0.0001 and r 0.68, P<0.001, respectively) as well as in winter (r 0.98, P<0.0001 and r 0.63, P<0.01, respectively). Water loss was, for men, higher in subjects with a higher physical activity in summer (r 0.94, P<0.0001) and in winter (r 0.70, P<0.05). Normalizing water loss for differences in energy expenditure by expressing water loss in litres per MJ resulted in the same value for men in summer and winter. For women, physical activity-adjusted values of water loss were higher, especially in summer. In men, water turnover was determined by energy intake and physical activity, while seasonal effects appeared through energy expenditure. Women showed a higher water turnover that was unrelated to physical activity.     

Energy requirements of urban Chinese adults with manual or sedentary occupations,determined using the doubly labeled water method

OBJECTIVE: To examine total energy expenditure (TEE) in relation to occupation and reported leisure time activities in free-living Chinese adults, and to determine whether measured TEE values differ from current international dietary energy recommendations. SETTING AND SUBJECTS: Seventy three weight-maintaining adults aged 35-49 y, leading unrestricted lives in urban Beijing, with a wide variety of occupations. DESIGN AND METHODS: A cross-sectional study in which TEE was determined by doubly labeled water, body composition by deuterium oxide ((2)H(2)O) dilution, resting energy expenditure (pREE) by prediction equations, and occupational and leisure time activities by questionnaire. RESULTS: For men and women respectively, TEE averaged 12.10+/-0.32 and 9.53+/-0.23 MJ/day (P<0.001), and physical activity level (PAL=TEE/pREE) was 1.77+/-0.04 and 1.66+/-0.02 (P<0.05). Fat-free mass (FFM) was the single best predictor of TEE (adjusted r(2)=0.71, P<0.001). Occupational category (light, moderate and heavy) further predicted TEE, independent of FFM (adjusted multiple r(2)=0.82, P<0.001). Both TEE adjusted for weight and PAL increased with occupational category. Measured TEE was slightly but significantly higher than the 1985 FAO/WHO/UNU estimates for women with light occupations, but did not differ from estimates for men with light occupations, or for adults with moderate or heavy occupations. CONCLUSION: Level of occupational activity, but not duration or type of leisure activity, significantly predicted TEE in free-living urban Chinese adults. Current energy requirement recommendations slightly underestimated the energy needs of women with light occupations but were accurate for men and women with moderate and heavy occupations. SPONSORSHIP: NIH grants DK53404 and F32-DK09747.     

Physical activity levels are low in free-living adults with chronic paraplegia

OBJECTIVES: To compare physical activity levels (PALs) of free-living adults with chronic paraplegia with World Health Organization recommendations and to compare energy expenditure between persons with complete vs. incomplete paraplegia. RESEARCH METHODS AND PROCEDURES: Twenty-seven euthyroid adults (17 men and 10 women) with paraplegia (12.5 +/- 9.5 years since onset; 17 with complete lesions and 10 with incomplete lesions) participated in this cross-sectional study. Resting metabolic rate was measured by indirect calorimetry and total daily energy expenditure (TDEE) by heart rate monitoring. PAL was calculated as TDEE/resting metabolic rate. Total body water was measured by deuterium dilution and fat-free mass (FFM) and fat mass (FM) by calculation (FFM = total body water/0.732; FM = weight - FFM). Obesity was defined using the following percentage FM cutoffs: men 18 to 40 years >22% and 41 to 60 years >25%; and women 18 to 40 years >35% and 41 to 60 years >38%. RESULTS: Nineteen subjects (70.4%; 13 men and six women) were obese. Fifteen subjects (56%) engaged in structured physical activity 1.46 +/- 0.85 times during the observation period for a mean of 49.4 +/- 31.0 minutes per session. Despite this, mean PAL of the group was 1.56 +/- 0.34, indicative of limited physical activity. TDEE was 24.6% lower in subjects with complete paraplegia (2072 +/- 505 vs. 2582 +/- 852 kcal/d, p = 0.0372). DISCUSSION: PAL of the group was low, indicating that persons with paraplegia need to engage in increased frequency, intensity, and/or duration of structured physical activity to achieve a PAL >/=1.75 and, thereby, to offset sedentary activities of daily living.     

Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery

BACKGROUND: Little is known about the determinants of individual variability in body weight and fat loss after gastric bypass surgery or about the effects of massive weight loss induced by this surgery on energy requirements. OBJECTIVES: The objectives were to determine changes in energy expenditure and body composition with weight loss induced by gastric bypass surgery and to identify presurgery predictors of weight loss. DESIGN: Thirty extremely obese women and men with a mean (+/- SD) age of 39.0 +/- 9.6 y and a body mass index (BMI; in kg/m(2)) of 50.1 +/- 9.3 were tested longitudinally under weight-stable conditions before surgery and after weight loss and stabilization (14 +/- 2 mo). Total energy expenditure (TEE), resting energy expenditure (REE), body composition, and fasting leptin were measured. RESULTS: Subjects lost 53.2 +/- 22.2 kg body weight and had significant decreases in REE (-2.4 +/- 1.0 MJ/d; P < 0.001) and TEE (-3.6 +/- 2.5 MJ/d; P < 0.001). Changes in REE were predicted by changes in fat-free mass and fat mass. The average physical activity level (TEE/REE) was 1.61 at both baseline and follow-up (P = 0.98). Weight loss was predicted by baseline fat mass and BMI but not by any energy expenditure variable or leptin. Measured REE at follow-up was not significantly different from predicted REE. CONCLUSIONS: TEE and REE decreased by 25% on average after massive weight loss induced by gastric bypass surgery. REE changes were predicted by loss of body tissue; thus, there was no significant long-term change in energy efficiency that would independently promote weight regain.     

Physical activity and total energy expenditure of child-bearing Gambian village women

In a longitudinal study of pregnancy and lactation levels of physical activity and total energy expenditure (TEE) were measured in 32 rural Gambian women using an activity diary technique. TEE, which was higher than previously measured food intake in this community, ranged from a minimum of 9.6 MJ (2300 kcal)/d (1.7 X BMR) in the months January-March to a maximum of 11.3 MJ (2700 kcal)/d (2 X BMR) during the agricultural season (July-October). During pregnancy and early lactation women went less often to the fields and also reduced the amount of time spent walking and performing household tasks. Standardizing for season and for changes in BMR and the energy cost of activity, reductions in physical activity reduced TEE by 0.59 +/- 0.08 MJ (140 +/- 18 kcal)/d between the 28th week of gestation and 4 weeks post-partum (P less than 0.001). While reduced physical activity may have had an adverse effect on agricultural productivity, energy was spared for other processes including fetal growth and milk output immediately post-partum. Dietary supplementation was without effect on activity pattern.     

Total daily energy expenditure among middle-aged men and women: the OPEN Study

BACKGROUND: Few large doubly labeled water (DLW) studies have provided an objective measure of total energy expenditure (TEE) in free-living men and women. The committee that developed the 2002 Dietary Reference Intake (DRI) estimated energy requirements (EER) noted that DLW studies in adults aged 40 to 60 y were limited. OBJECTIVE: We aimed to describe TEE and physical activity energy expenditure in middle-aged men and women by sex, age, menopausal status, and level of obesity, and to compare TEE to the DRI EER. DESIGN: TEE was measured by the DLW method in 450 men and women aged 40-69 y from the Observing Protein and Energy Nutrition Study. Resting metabolic rate was estimated by use of the Mifflin equation. RESULTS: Unadjusted TEE was lower in women than in men (591 kcal/d); however, when the analysis was adjusted for fat-free mass, women had significantly higher TEE than did men (182 kcal/d). This difference appeared to be due to higher physical activity levels in women (physical activity energy expenditure adjusted for FFM was 188 kcal/d greater in women than in men). Mean TEE was lowest in the seventh decade. TEE from DLW was highly correlated (r = 0.93) with EER from the DRI equations. CONCLUSION: In this population, TEE was higher in women than in men when adjusted for FFM, apparently because of higher physical activity levels in women. There were no significant differences in TEE, FFM, or physical activity levels in women by menopausal status. TEE was inversely associated with age and increased linearly with body mass index. This study corroborates the use of the DRI equations for EER.