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Dos Reis TO, de Magalhães Oliveira F, Kattah FM, Pena NF, Soares MMS, da Gama Torres HO. Body composition and energy expenditure in anorexia nervosa: preliminary data of outpatients with recovering and active disease. J Eat Disord 2022; 10:167. [PMID: 36384574 PMCID: PMC9667629 DOI: 10.1186/s40337-022-00702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Anorexia Nervosa (AN) recovery, body mass index (BMI) may not reflect body composition. To investigate recovery, bioelectrical impedance (BIA) parameters and energy expenditure were investigated in patients with active and recovering AN, with emphasis on phase angle (PA), a BIA parameter. METHODS BMI, PA, indirect BIA parameters (fat free mass, fat mass, total body water, fat free mass index, fat mass index) and resting metabolic rate (RMR) were obtained. Data from subjects distributed to active AN (ANact, n = 9), recovered AN (ANrec, n = 9) and healthy individuals (HI) (n = 16) were compared employing univariate methods and ordinal logistic regression. RESULTS In univariate comparison, the BMI would not distinguish recovered individuals; this distinction was observed for the PA (p = < 0,001). PA showed a good capacity to discriminate, between ANrec and HI (AUC = 0.792; CI = 0.564- 1.000; p = 0.017). In 2 models of ordinal logistic regression PA (OR = 0.123; 95% CI 0.030; 0.503 and OR = 0.091; 95% CI 0.016; 0.528) remained as a significant independent variable, indicating that increases in PA are related to higher probabilities of moving from ANact, to ANrec and to HI group. Bivariate regression indicated the presence of a relationship between PA and (R2 = 0.266, p = 0.002). CONCLUSIONS Changes in body composition and energy expenditure were observed in recovered anorexics with normal BMI. PA can play an important role in the assessment of recovering anorexic patients.
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Affiliation(s)
- Tâmara Oliveira Dos Reis
- Adult Health Post-Graduate Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,Núcleo de Investigação de Anorexia E Bulimia (NIAB), Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | | | - Fabiana Martins Kattah
- Nutrition Departament, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Natalia Fenner Pena
- Adult Health Post-Graduate Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Marta Sarquis Soares
- Adult Health Post-Graduate Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Internal Medicine Departament, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Oswaldo da Gama Torres
- Adult Health Post-Graduate Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Internal Medicine Departament, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Núcleo de Investigação de Anorexia E Bulimia (NIAB), Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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2
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Hoteit M, Mohsen H, Bookari K, Moussa G, Jurdi N, Yazbeck N. Prevalence, correlates, and gender disparities related to eating disordered behaviors among health science students and healthcare practitioners in Lebanon: Findings of a national cross sectional study. Front Nutr 2022; 9:956310. [PMID: 35928833 PMCID: PMC9345498 DOI: 10.3389/fnut.2022.956310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe raised prevalence of eating disorders (ED) amongst health science students and health professionals is of mounting concern. This study aims to determine the prevalence and correlates of eating disorders risk amongst a sample of Lebanese health science students and healthcare practitioners of both genders.MethodsThis cross-sectional study enrolled a convenient sample of 1,000 participants (mean age: 23 ± 5.4; females: 74.9%) from faculties of health sciences, clinics, pharmacies, and hospitals. The validated Eating Attitudes Test (EAT-26) was used to screen for eating disorders. Anthropometric data were self-reported by respondents to assess their nutritional status.ResultsThe risk of eating disorders was prevalent in 22.5% of participants. Females were at higher risk of ED compared to males p = 0.03. Eating disorders risk did not differ between students and practitioners (p = 0.3). The highest proportion of high-risk participants were students studying nutrition and practitioners (40.9%), outracing their counterparts in nursing (18.7%), medicine (17.8%), pharmacy (17.7%), and midwifery (4.9%) sciences (p = 0.02). Most high-risk participants had normal body weight (60.4%), and 28.9% were overweight (p = 0.001). Female gender, nutrition profession, and dieting were associated with increasing the odd of ED. Particularly, dieting increased the risk around five times. Further, each 3 participants over 10 were facing binge eating behavior.ConclusionThis study uncovers an undervalued profession-related-health-disorder in Lebanese health science students and healthcare practitioners. Specific attention should be given to EDs in professional educational programmes across healthcare disciplines.
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Affiliation(s)
- Maha Hoteit
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut, Lebanon
- *Correspondence: Maha Hoteit
| | - Hala Mohsen
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut, Lebanon
| | - Khlood Bookari
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
- Executive Department of Monitoring and Risk Assessment, Food Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Taibah University, Madina, Saudi Arabia
| | - Ghadir Moussa
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Najwa Jurdi
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Nour Yazbeck
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut, Lebanon
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Bou Khalil R, Sultan A, Seneque M, Richa S, Lefebvre P, Renard E, Courtet P, Maimoun L, Guillaume S. Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study. Nutrients 2022; 14:2727. [PMID: 35807906 PMCID: PMC9269154 DOI: 10.3390/nu14132727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
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 (REEIC). 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 REEIC. 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 REEIC. 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.
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Affiliation(s)
- Rami Bou Khalil
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Ariane Sultan
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Maude Seneque
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Laurent Maimoun
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295 Montpellier, France
| | - Sebastien Guillaume
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
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Duriez P, Mastellari T, Viltart O, Gorwood P. Clinical meaning of body temperatures in anorexia nervosa and bulimia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:124-134. [PMID: 35037343 DOI: 10.1002/erv.2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Bradycardia is one of the common cardiac abnormalities in patients with eating disorders. It ensues from hypometabolism, which results from reduced caloric intake and consequential weight loss. Hypothermia is another consequence of hypometabolism. While at-rest metabolism and body mass index (BMI) are typically used to assess hypometabolism and estimate potential bradycardia, we hypothesised that body temperature, which is easy to measure, could also capture the presence of this threatening cardiovascular condition. METHOD We monitored heart rate continuously for 72 h, measured resting energy expenditure (REE) and assessed body temperature in 12 body parts for 58 patients with anorexia nervosa (AN) and 29 patients with bulimia nervosa (BN). RESULTS Palm temperature reflects bradycardia in both AN and BN, explaining 18% of its variance (p < 0.001), capturing this aspect even more efficiently than BMI. We also observe different correlations between palm temperature, abdominal temperature, BMI, REE and levels of physical activity. CONCLUSION Palm temperature could be used as a warning of bradycardia, a serious cardiovascular condition which can be difficult to detect in short visits with outpatients. Further studies are needed to determine how useful bradycardia and palm temperature could be to assess severity and prognosis of the disorder.
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Affiliation(s)
- Philibert Duriez
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Clinique des Maladies Mentales et de l'Encéphale, Paris, France
| | - Tomas Mastellari
- Faculté de Médecine Henri Warembourg, Université de Lille, Lille, France
| | - Odile Viltart
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Faculté des Sciences et Technologies, Université de Lille, SCALab UMR, Villeneuve d'Ascq, France
| | - Philip Gorwood
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Clinique des Maladies Mentales et de l'Encéphale, Paris, France
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5
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Zorrilla-Revilla G, Rodrigues D, Machado-Rodrigues AM, Mateos A, Rodríguez J, Padez C. Sex-specific differences in somatic investment and strategies of physical activity among Portuguese schoolchildren. Am J Hum Biol 2021; 34:e23626. [PMID: 34076323 DOI: 10.1002/ajhb.23626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Physical activity (PA) is required for healthy growth, development, and maturation and plays an important role in the prevention of overweight and obesity in childhood and adolescence. Sex-differences in PA levels are well documented, with boys spending more time in PA, especially in moderate-to-vigorous activities. Following the Life History Theory, our aim is to study if PA affects the fat tissues increases during childhood and juvenile phases in both sexes. METHODS Time spent in sedentary, light, and moderate-to-vigorous PA levels were measured in a sample of 415 Portuguese children and juveniles (207 females/208 males; aged 6-11 years), using an accelerometer for 7 days. Skinfolds related with body fat were objectively collected and socioeconomic status factors were reported using a parental questionnaire. RESULTS The outcomes show that girls' and boys' fat variables increased during the end of the childhood and the juvenile phase. However, these variables were differently affected by PA. Girls increased fat variables with the sedentary activity while boys decreased fat variables with moderate-to-vigorous PA. Alike, active boys but not girls reduced the fat increase tendency with age. CONCLUSIONS Although both sexes displayed a general fat increment with age, moderate-to-vigorous PA dampens the increase only in boys. In fact, active girls increased body fat in the same manner as non-active girls. From an evolutionary perspective, it could explain sex-specific somatic strategies related to future reproduction or, with future mating and intrasexual competition.
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Affiliation(s)
| | - Daniela Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Aristides M Machado-Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,High School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Ana Mateos
- National Research Center on Human Evolution, CENIEH, Burgos, Spain
| | - Jesús Rodríguez
- National Research Center on Human Evolution, CENIEH, Burgos, Spain
| | - Cristina Padez
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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Tannir H, Itani L, Kreidieh D, El Masri D, Traboulsi S, El Ghoch M. Body Composition in Adolescents and Young Adults with Anorexia Nervosa: A Clinical Review. Curr Rheumatol Rev 2021; 16:92-98. [PMID: 30806320 DOI: 10.2174/1573397115666190222200704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anorexia nervosa is a serious health condition characterized by a significant low body weight and alteration in body composition components. AIM In the current paper, we aim to summarize the available literature concerning changes in body fat, lean, and bone masses, during anorexia nervosa and after complete weight restoration. METHODS Data were summarized using a narrative approach based on clinical expertise in the interpretation of the available evidence base in the literature. RESULTS The available data revealed three main findings. Firstly, anorexia nervosa causes a significant reduction in body fat mass, however it is completely restored after short-term weight normalization but with a central adiposity phenotype that does not seem to negatively influence treatment outcomes and appears to normalize after 1 year of normal weight maintenance. Secondly, anorexia nervosa causes a significant reduction in bone mineral density, but weight restoration is associated first (≈12 months) with stabilization of bone mineral density, followed by improvements (after ≈16 months); and finally, with complete normalization (after ≈30 months) after normal-weight maintenance. Thirdly, during anorexia nervosa loss of lean and skeletal body mass occurring in particular from the extremities rather than the central regions has been consistently reported, especially in patients with a Body Mass Index (BMI) ≤ 16.5 Kg/m2 however short-term weight restoration is associated with complete normalization. CONCLUSION Anorexia nervosa adversely affects body composition, however this medical complication seems to be reversible through the main treatment strategy of body weight restoration followed by normal weight maintenance, and this should be openly discussed with patients.
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Affiliation(s)
- Hana Tannir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Dima Kreidieh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Dana El Masri
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Samira Traboulsi
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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Validation of predictive equations for resting energy expenditure in treatment-seeking adults with overweight and obesity: Measured versus estimated. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e32-e47. [PMID: 31971355 DOI: 10.15586/jptcp.v27i1.653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/31/2019] [Indexed: 01/04/2023]
Abstract
The quantification of resting energy expenditure (REE) in patients with obesity is an important measure. We aimed to evaluate the validity of predictive equations in estimating REE compared with indirect calorimetry (IC) in treatment-seeking Arab adults with overweight or obesity. Twenty-three predictive equations were compared with REE values measured by IC (Vmax Encore 229) in 89 adult participants with overweight or obesity (mean age = 40.62 ± 15.96 years and mean body mass index [BMI] = 35.02 ± 4.60 kg/m2) referred to the Department of Nutrition and Dietetics of Beirut Arab University (Lebanon). The accuracy of the predictive equations was evaluated on the basis of whether the percentage prediction was within 10% of the measured REE, and the mean difference between predicted and measured values (bias). The Bland-Altman method was used to assess the agreement between the predicted and measured values. The equations that demonstrated the closest agreement with IC were the De La Cruz equation in males (accurate predictions: 68.2%; bias: -19.52 kcal/day) and the Mifflin equation in females (accurate prediction: 61.2%; bias: -36.43 kcal/day). In conclusion, we suggest that these two equations produce the least biased estimations for REE in this population.
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8
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El Masri D, Itani L, Kreidieh D, Tannir H, El Ghoch M. Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity. Curr Diabetes Rev 2020; 16:381-386. [PMID: 31663845 DOI: 10.2174/1573399815666191030085915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/19/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM An accurate estimation of Resting Energy Expenditure (REE) in patients with obesity is crucial. Therefore, our aim was to assess the validity of REE predictive equations based on body composition variables in treatment-seeking Arab adults with obesity. METHODS Body composition and REE were measured by Tanita BC-418 bioimpedance and Vmax Encore 229 IC, respectively, and predictive equations based on fat mass and fat-free mass were used in REE estimations among 87 adults of both genders, in the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated REE values were calculated to assess the accuracy, and the Bland-Altman method was used to assess the level of agreement. RESULTS Ten predictive equations were included. In males, all the predictive equations gave significantly different estimates of REE when compared to that measured by IC. On the other hand, in females, the mean difference between the REE value estimated by Huang and Horie-Waitzberg equations and that measured using IC was not significant, and the agreement was confirmed using Bland-Altman plots. CONCLUSION Huang and Horie-Waitzberg equations are suggested for accurate REE estimation in females; however, new validated REE estimation equations for males in this population are still needed.
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Affiliation(s)
- Dana El Masri
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Dima Kreidieh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Hana Tannir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
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Gjoertz M, Wang J, Chatelet S, Monney Chaubert C, Lier F, Ambresin AE. Nutrition Approach for Inpatients With Anorexia Nervosa: Impact of a Clinical Refeeding Guideline. JPEN J Parenter Enteral Nutr 2019; 44:1124-1139. [PMID: 31742725 DOI: 10.1002/jpen.1723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/18/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study assesses the impact of a clinical refeeding guideline on weight restoration, length of stay, rate of refeeding complications, and rehospitalizations. METHOD This retrospective study included patient records of 107 participants aged 13-55 years with a diagnosis of AN, admitted for at least 7 days for renutrition before and after introduction of the refeeding guideline. Weight evolution graphs were rated by 2 clinical experts independently. Binary logistic regression models were erected to identify clinical outcomes associated independently with the guideline as well as to control for potential confounding by sociodemographic and clinical characteristics at admission. RESULTS The proportion of patients achieving optimal weight gain after the first 2 weeks increased significantly from 6.3% pre-guideline to 41.8% post guideline (adjusted odds ratio [AOR] = 37.6; 95% confidence interval [CI], 2.77-510.3; P = 0.006). Average length of hospitalization was reduced from 96.7 (SD 48.3) days pre-guideline to 62.2 (SD 45.5) days post guideline (AOR = 0.99; 95% CI, 0.97-1.01; P = 0.18). None of the patients developed a full refeeding syndrome. There was no significant change in the rate of rehospitalization: 48.5% pre-guideline to 43.2% post guideline (OR = 0.81; 95% CI, 0.36-1.84; P = 0.62). DISCUSSION The clinical guideline proved highly effective in bolstering weight gain via intensive refeeding procedures while also being safe. Harmonizing clinical practices improves quality of care for patients with anorexia and, interestingly, may decrease costs by cutting average length of stay by a third without increasing the rehospitalization rate.
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Affiliation(s)
- Mathea Gjoertz
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jen Wang
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Solène Chatelet
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Françoise Lier
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Vaudois Centre for Anorexia and Bulimia (abC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Anne-Emmanuelle Ambresin
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland
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IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META-ANALYSIS. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019; 26:e25-e37. [PMID: 31577083 DOI: 10.15586/jptcp.v26i2.601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/11/2019] [Indexed: 01/11/2023]
Abstract
The resumption of menses (ROM) is an important outcome in anorexia nervosa treatment and is considered as a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and exploratory meta-analysis of the association between total body fat percentage (%BF) and ROM after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, only seven studies comprising a total of 366 adolescent and young adult females with anorexia nervosa met the inclusion criteria and were reviewed, and preliminary results revealed three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.74, 95% CI: 2.26-5.22). Secondly, %BF was found to be an independent predictor of the ROM in this population and an increase of only one unit of %BF can increase the odds of menstruation by ≈15-20%. Thirdly, despite the paucity of data, a cut-off point of %BF≈21was suggested as the minimum needed for ROM. In conclusion, a higher %BF seems to be associated with the ROM in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration. The PROSPERO Registry - A systematic review and meta-analysis of the factors associated with the resumption of the menstrual cycle in females with anorexia nervosa after weight restoration (CRD42019111841).
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Cuerda C, Vasiloglou MF, Arhip L. Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa. J Clin Med 2019; 8:E1042. [PMID: 31319585 PMCID: PMC6679071 DOI: 10.3390/jcm8071042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a psychiatric disorder characterised by a physical and psychosocial deterioration due to an altered pattern on the intake and weight control. The severity of the disease is based on the degree of malnutrition. The objective of this article is to review the scientific evidence of the refeeding process of malnourished inpatients with AN; focusing on the clinical outcome. METHODS We conducted an extensive search in Medline and Cochrane; on April 22; 2019; using different search terms. After screening all abstracts; we identified 19 papers that corresponded to our inclusion criteria. RESULTS The article focuses on evidence on the characteristics of malnutrition and changes in body composition; energy and protein requirements; nutritional treatment; physical activity programmes; models of organisation of the nutritional treatment and nutritional support related outcomes in AN patients. CONCLUSION Evidence-based standards for clinical practice with clear outcomes are needed to improve the management of these patients and standardise the healthcare process.
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Affiliation(s)
- Cristina Cuerda
- Nutrition Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain.
| | - Maria F Vasiloglou
- Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland
| | - Loredana Arhip
- Nutrition Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
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Pavlidou E, Petridis D, Tolia M, Tsoukalas N, Poultsidi A, Fasoulas A, Kyrgias G, Giaginis C. Estimating the agreement between the metabolic rate calculated from prediction equations and from a portable indirect calorimetry device: an effort to develop a new equation for predicting resting metabolic rate. Nutr Metab (Lond) 2018; 15:41. [PMID: 29983723 PMCID: PMC6003108 DOI: 10.1186/s12986-018-0278-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Many studies have been performed over time in order to determine the reliability of metabolic rate prediction equations. PURPOSE To evaluate the agreement, in terms of bias, absolute bias and accuracy between metabolic rate prediction equations and measured metabolic rate using indirect calorimetry system (IC), investigating also the factors affecting this agreement. METHODS The anthropometric features of 383 Caucasian participants of all Body Mass Index (BMI) classes were recorded and Resting Metabolic Rate (RMR) was measured by using the IC Fitmate portable device. The resulting values were compared with the predictive values of Harris & Benedict, Schofield, Owen, FAO-WHO-UNU, Mifflin and Harrington equations. RESULTS A closer approximation in agreement was obtained using the Harrington equation (based on BMI, age and gender). The equations using variables, such as weight, height, age and gender demonstrated higher agreement than the equations using merely weight and gender. Higher educational level was associated with normal weight, while higher calorific ratio was found in the class of normal-weighted individuals. An inverse relationship between ΒΜΙ and RMR was also observed and a logarithmic equation for calculating RMR was created, which was differentiated in relation to BMI classes, using the weight and gender variables. CONCLUSION A better measurement agreement between RMR prediction equations and IC may be achieved due to BMI consideration. The present findings contributed to a better understanding of the measured parameters, confirming the inverse relationship between BMI and RMR. Age group and gender variables may also exert significant role on the bias response of some RMR equations.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, University of Aegean, Mitropoliti Ioakim 2, Myrina, Lemnos, 81440 Athens, Greece
| | - Dimitris Petridis
- Department of Food Technology, Technological Educational Institute, 57400 Thessaloniki, Greece
| | - Maria Tolia
- Department of Radiotherapy, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Larissa, Greece
| | - Nikolaos Tsoukalas
- Department of Oncology, Veterans Hospital (NIMTS), 10 Monis Petraki, 11521 Athens, Greece
| | - Antigoni Poultsidi
- Surgery Clinic, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Aristeidis Fasoulas
- Department of Food Science and Nutrition, University of Aegean, Mitropoliti Ioakim 2, Myrina, Lemnos, 81440 Athens, Greece
| | - George Kyrgias
- Department of Radiotherapy, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Larissa, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of Aegean, Mitropoliti Ioakim 2, Myrina, Lemnos, 81440 Athens, Greece
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Prahm AP, Brandt CF, Askov-Hansen C, Mortensen PB, Jeppesen PB. The use of metabolic balance studies in the objective discrimination between intestinal insufficiency and intestinal failure. Am J Clin Nutr 2017; 106:831-838. [PMID: 28768655 DOI: 10.3945/ajcn.117.158386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background: In research settings that use metabolic balance studies (MBSs) of stable adult patients with short bowel syndrome, intestinal failure (IF) and dependence on parenteral support (PS) have been defined objectively as energy absorption <84% of calculated basal metabolic rate (BMR), wet weight (WW) absorption <23 g · kg body weight-1 · d-1, or both. Objective: This study aimed to explore and validate these borderlines in the clinical setting.Design: Intestinal absorption was measured from April 2003 to March 2015 in 175 consecutive patients with intestinal insufficiency (INS) in 96-h MBSs. They had not received PS 3 mo before referral.Results: To avoid the need for PS, the minimum absorptive requirements were energy absorption of ≥81% of BMR and WW absorption of ≥21 g · kg body weight-1 · d-1, which were equivalent to findings in research settings (differences of 3.6% and 8.7%; P = 0.65 and 0.60, respectively). Oral failure defined as energy intake <130% of calculated BMR or WW intake <40 g · kg body weight-1 · d-1 was seen in 71% and 82% of the 10% of patients with the lowest energy absorption and WW absorption, respectively.Conclusions: In clinical settings, the borderlines between INS and IF were not significantly different from those in research settings, even in an unselected patient population in which oral failure was also a predominant cause of nutritional dyshomeostasis. MBSs may be recommended to identify the individual patient in the spectrum from INS to IF, to objectivize the cause of nutritional dyshomeostasis (oral failure, malabsorption, or both), and to quantify the effects of treatment.
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Affiliation(s)
- August P Prahm
- Department of Medical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Per B Mortensen
- Department of Medical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Palle B Jeppesen
- Department of Medical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
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Foppiani L, Massobrio B, Cascio C, Antonucci G. Near-fatal Anorexia Nervosa in a Middle-aged Woman. Intern Med 2017; 56:327-334. [PMID: 28154278 PMCID: PMC5348458 DOI: 10.2169/internalmedicine.56.7370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anorexia nervosa (AN) is a serious psychiatric disorder which typically occurs in young women; however, more and more cases in middle-aged women are being reported. The management of this complex disease requires a team approach, and full recovery occurs only in 50% of patients. Endocrine and metabolic complications are commonly observed, the latter of which may even be life-threatening, and require prompt and proper management. Infections, albeit reported, are not usually a major clinical problem in these patients. We herein report the case of a severely malnourished middle-aged woman with long-standing AN who was hospitalized with marked hypokalaemia (1.5 mEq/L) and rhabdomyolysis; during hospitalization she developed septic shock and acute respiratory distress syndrome, which required urgent admission to the intensive care unit. She underwent sedation and tracheal intubation for mechanical ventilation and was managed with combined therapies, which eventually led to a successful outcome. Life-threatening medical complications can occur not only in young women but in middle-aged women with AN as well and require a combined multidisciplinary approach.
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Elbelt U, Haas V, Hofmann T, Stengel A, Berger H, Jeran S, Klapp BF. Evaluation of a Portable Armband Device to Assess Resting Energy Expenditure in Patients With Anorexia Nervosa. Nutr Clin Pract 2015; 31:362-7. [DOI: 10.1177/0884533615618900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ulf Elbelt
- Department of Endocrinology, Diabetes and Nutrition, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Haas
- Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of Child and Adolescent Psychiatry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Stengel
- Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Heike Berger
- Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Experimental & Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Jeran
- Experimental & Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Burghard F. Klapp
- Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
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ALIASGHARZADEH S, MAHDAVI R, ASGHARI JAFARABADI M, NAMAZI N. Comparison of Indirect Calorimetry and Predictive Equations in Estimating Resting Metabolic Rate in Underweight Females. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:822-9. [PMID: 26258095 PMCID: PMC4524307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Underweight as a public health problem in young women is associated with nutritional deficiencies, menstrual irregularity, eating disorders, reduced fertility, etc. Since resting metabolic rate (RMR) is a necessary component in the development of nutrition support therapy, therefore we determined the accuracy of commonly used predictive equations against RMR measured by indirect calorimetry among healthy young underweight females. METHODS This cross-sectional study was conducted on 104 underweight females aged 18-30 years old with body mass index (BMI) <18.5 kg/m(2) in 2013. After collecting anthropometric data, body composition was measured by bioelectric impedance analysis (BIA). RMR was measured by using indirect calorimetry (FitMate™) and was estimated by 10 commonly used predictive equations. Comparisons were conducted using paired t-test. The accuracy of the RMR equations was evaluated on the basis of the percentage of subjects' predicted RMR within 10% of measured RMR. RESULTS The mean BMI of subjects was 17.3±1.3 kg/m(2). The measured RMR ranged 736-1490 kcal/day (mean 1084.7±175 kcal/day). Findings indicated that except Muller and Abbreviation, other equations significantly over estimated RMR, compared to measured value (P<0.05). As an individual prediction accuracy, these predictive equations showed poor performance with the highest accuracy rate of 54.8% for Muller equation (22.1% under and 23.1% over-prediction) and 43.3% for Abbreviation equation (31.7% under and 25% over-prediction), the percentage bias was 1.8% and 0.63% and RMSE was 162 and 173 kcal/d, respectively. CONCLUSION Although Muller equation gave fairly acceptable prediction, more suitable new equations are needed to be developed to help better management of nutritional plans in young underweight people.
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Affiliation(s)
- Soghra ALIASGHARZADEH
- Student Research Committee, Faculty of Nutrition, Tabriz University of Medical Science, Tabriz, Iran
| | - Reza MAHDAVI
- Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad ASGHARI JAFARABADI
- Traffic Injury Prevention Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazli NAMAZI
- Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Science, Tabriz, Iran
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Alberti M, Galvani C, El Ghoch M, Capelli C, Lanza M, Calugi S, Dalle Grave R. Assessment of physical activity in anorexia nervosa and treatment outcome. Med Sci Sports Exerc 2014; 45:1643-8. [PMID: 23475165 DOI: 10.1249/mss.0b013e31828e8f07] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to compare objective and subjective assessments of physical activity (PA) in patients with anorexia nervosa and its effect on treatment outcome. METHODS Both Actiheart (AH) and International Physical Activity Questionnaire (IPAQ) were used to assess PA in 52 female patients with anorexia nervosa during the first week of inpatient treatment. RESULTS No correspondence between PA estimated by IPAQ, which had a tendency to underestimate PA, and that measured using AH emerged. However, a significant association was found between the change in Eating Disorder Examination global score at the end of the treatment and light PA measured by AH (beta = -0.12, t = -2.44, P = 0.019), but not that estimated by IPAQ. CONCLUSIONS PA in patients with anorexia nervosa is underestimated by subjective assessment when compared with objective measurement. Only time spent in light PA, assessed objectively with AH, showed a negative association with improvement in eating disorder psychopathology.
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Affiliation(s)
- Marta Alberti
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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18
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Anjos LA, Wahrlich V, Vasconcellos MTL. BMR in a Brazilian adult probability sample: the Nutrition, Physical Activity and Health Survey. Public Health Nutr 2014; 17:853-60. [PMID: 23286824 PMCID: PMC10282275 DOI: 10.1017/s1368980012005381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 10/03/2012] [Accepted: 11/22/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To measure BMR in a probability sample of adults from an urban city of Brazil and to compare indirectly measured BMR (BMRi) with BMR predicted from different equations. DESIGN BMR data were obtained by indirect calorimetry and estimated by different predictive equations (Schofield; Harris and Benedict; Henry and Rees). Anthropometric and body composition measures were also obtained. SETTING The Nutrition, Physical Activity and Health Survey (PNAFS), a household survey conducted in Niterói, Rio de Janeiro state, Brazil. SUBJECTS Representative sample of 529 adults (aged ≥20 years; 339 females) living in Niterói, Rio de Janeiro state, Brazil. RESULTS Mean BMRi values were 5839.7 (se 73.9) kJ/d and 4758.1 (se 39.5) kJ/d for men and women, respectively. Predicted BMR by all equations was significantly higher (difference between means and 95% CI did not include zero) than BMRi in both men and women of all ages. Overall bias in BMR (predicted BMR minus BMRi) using the Schofield equations (overestimation of about 20%) was higher than when using the Henry and Rees equations (13% and 16% overestimation for males and females, respectively). The percentage of individuals whose BMR predicted by the Schofield equations fell within 10% of BMRi was very low (7.8% and 14.1% of males nd females, respectively). CONCLUSIONS Current available predictive equations of BMR are not adequate to estimate BMR in Brazilians living in Niterói, Rio de Janeiro, Brazil.
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Affiliation(s)
- Luiz A Anjos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Laboratório de Avaliação Nutricional e Funcional, Departamento de Nutrição Social, Universidade Federal Flumimense, Caixa Postal 100231, 21041-970 Niterói, RJ, Brasil
| | - Vivian Wahrlich
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Laboratório de Avaliação Nutricional e Funcional, Departamento de Nutrição Social, Universidade Federal Flumimense, Caixa Postal 100231, 21041-970 Niterói, RJ, Brasil
| | - Mauricio TL Vasconcellos
- Escola Nacional de Ciências Estatísticas, Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro, RJ, Brasil
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Watson LPE, Raymond-Barker P, Moran C, Schoenmakers N, Mitchell C, Bluck L, Chatterjee VK, Savage DB, Murgatroyd PR. An approach to quantifying abnormalities in energy expenditure and lean mass in metabolic disease. Eur J Clin Nutr 2013; 68:234-40. [PMID: 24281313 PMCID: PMC3916834 DOI: 10.1038/ejcn.2013.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 01/09/2023]
Abstract
Background/objectives: The objective of this study was to develop approaches to expressing resting energy expenditure (REE) and lean body mass (LM) phenotypes of metabolic disorders in terms of Z-scores relative to their predicted healthy values. Subjects/methods: Body composition and REE were measured in 135 healthy participants. Prediction equations for LM and REE were obtained from linear regression and the range of normality by the standard deviation of residuals. Application is demonstrated in patients from three metabolic disorder groups (lipodystrophy, n=7; thyrotoxicosis, n=16; and resistance to thyroid hormone (RTH), n=46) in which altered REE and/or LM were characterised by departure from the predicted healthy values, expressed as a Z-score. Results: REE (kJ/min)=−0.010 × age (years)+0.016 × FM (kg)+0.054 × fat-free mass (kg)+1.736 (R2=0.732, RSD=0.36 kJ/min). LM (kg)=5.30 × bone mineral content (kg)+10.66 × height2 (m)+6.40 (male). LM (kg)=0.20 × fat (kg)+14.08 × height2 (m)−2.93 (female). (male R2=0.55, RSD=3.90 kg; female R2=0.59, RSD=3.85 kg). We found average Z-scores for REE and LM of 1.77 kJ/min and −0.17 kg in the RTH group, 5.82 kJ/min and −1.23 kg in the thyrotoxic group and 2.97 kJ/min and 4.20 kg in the LD group. Conclusion: This approach enables comparison of data from individuals with metabolic disorders with those of healthy individuals, describing their departure from the healthy mean by a Z-score.
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Affiliation(s)
- L P E Watson
- NIHR/Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK
| | - P Raymond-Barker
- NIHR/Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK
| | - C Moran
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - N Schoenmakers
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - C Mitchell
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - L Bluck
- 1] NIHR/Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK [2] MRC-Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - V K Chatterjee
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - D B Savage
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - P R Murgatroyd
- 1] NIHR/Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK [2] University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
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Rao ZY, Wu XT, Liang BM, Wang MY, Hu W. Comparison of five equations for estimating resting energy expenditure in Chinese young, normal weight healthy adults. Eur J Med Res 2012; 17:26. [PMID: 22937737 PMCID: PMC3477055 DOI: 10.1186/2047-783x-17-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/25/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Most resting energy expenditure (REE) predictive equations for adults were derived from research conducted in western populations; whether they can also be used in Chinese young people is still unclear. Therefore, we conducted this study to determine the best REE predictive equation in Chinese normal weight young adults. METHODS Forty-three (21 male, 22 female) healthy college students between the age of 18 and 25 years were recruited. REE was measured by the indirect calorimetry (IC) method. Harris-Benedict, World Health Organization (WHO), Owen, Mifflin and Liu's equations were used to predictREE (REEe). REEe that was within 10% of measured REE (REEm) was defined as accurate. Student's t test, Wilcoxon Signed Ranks Test, McNemar Test and the Bland-Altman method were used for data analysis. RESULTS REEm was significantly lower (P < 0.05 or P < 0.01) than REEe from equations, except for Liu's, Liu's-s, Owen, Owen-s and Mifflin in men and Liu's and Owen in women. REEe calculated by ideal body weight was significantly higher than REEe calculated by current body weight ( P < 0.01), the only exception being Harris-Benedict equation in men. Bland-Altman analysis showed that the Owen equation with current body weight generated the least bias. The biases of REEe from Owen with ideal body weight and Mifflin with both current and ideal weights were also lower. CONCLUSIONS Liu's, Owen, and Mifflin equations are appropriate for the prediction of REE in young Chinese adults. However, the use of ideal body weight did not increase the accuracy of REEe.
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Affiliation(s)
- Zhi-yong Rao
- Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, China
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