Resting Energy Expenditure in Anorexia Nervosa: Measured versus Estimated

Body composition and energy expenditure in anorexia nervosa: preliminary data of outpatients with recovering and active disease

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.

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

Background

The 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.

Methods

This 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.

Results

The 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.

Conclusion

This 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.

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 (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.

Clinical meaning of body temperatures in anorexia nervosa and bulimia nervosa

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.

Sex-specific differences in somatic investment and strategies of physical activity among Portuguese schoolchildren

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.

Body Composition in Adolescents and Young Adults with Anorexia Nervosa: A Clinical Review

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.

Validation of predictive equations for resting energy expenditure in treatment-seeking adults with overweight and obesity: Measured versus estimated

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.

Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity

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.

Nutrition Approach for Inpatients With Anorexia Nervosa: Impact of a Clinical Refeeding Guideline

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.

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

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).

Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa

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.

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

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.

The use of metabolic balance studies in the objective discrimination between intestinal insufficiency and intestinal failure

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.

Near-fatal Anorexia Nervosa in a Middle-aged Woman

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.

Comparison of Indirect Calorimetry and Predictive Equations in Estimating Resting Metabolic Rate in Underweight Females

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.

Assessment of physical activity in anorexia nervosa and treatment outcome

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.

BMR in a Brazilian adult probability sample: the Nutrition, Physical Activity and Health Survey

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.

An approach to quantifying abnormalities in energy expenditure and lean mass in metabolic disease

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.

Comparison of five equations for estimating resting energy expenditure in Chinese young, normal weight healthy adults

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.