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Porter J, Ward LC, Nguo K, Ward A, Davidson Z, Gibson S, Prentice R, Neuhouser ML, Truby H. Development and validation of age-specific predictive equations for total energy expenditure and physical activity levels for older adults. Am J Clin Nutr 2024; 119:1111-1121. [PMID: 38503654 DOI: 10.1016/j.ajcnut.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Predicting energy requirements for older adults is compromised by the underpinning data being extrapolated from younger adults. OBJECTIVES To generate and validate new total energy expenditure (TEE) predictive equations specifically for older adults using readily available measures (age, weight, height) and to generate and test new physical activity level (PAL) values derived from 1) reference method of indirect calorimetry and 2) predictive equations in adults aged ≥65 y. METHODS TEE derived from "gold standard" methods from n = 1657 (n = 1019 females, age range 65-90 y), was used to generate PAL values. PAL ranged 1.28-2.05 for males and 1.26-2.06 for females. Physical activity (PA) coefficients were also estimated and categorized (inactive to very active) from population means. Nonlinear regression was used to develop prediction equations for estimating TEE. Double cross-validation in a randomized, sex-stratified, age-matched 50:50 split, and leave one out cross-validation were performed. Comparisons were made with existing equations. RESULTS Equations predicting TEE using the Institute of Medicine method are as follows: For males, TEE = -5680.17 - 17.50 × age (years) + PA coefficient × (6.96 × weight [kilograms] + 44.21 × height [centimeters]) + 1.13 × resting metabolic rate (RMR) (kilojoule/day). For females, TEE = -5290.72 - 8.38 × age (years) + PA coefficient × (9.77 × weight [kilograms] + 41.51 × height [centimeters]) + 1.05 × RMR (kilojoule/day), where PA coefficient values range from 1 (inactive) to 1.51 (highly active) in males and 1 to 1.44 in females respectively. Predictive performance for TEE from anthropometric variables and population mean PA was moderate with limits of agreement approximately ±30%. This improved to ±20% if PA was adjusted for activity category (inactive, low active, active, and very active). Where RMR was included as a predictor variable, the performance improved further to ±10% with a median absolute prediction error of approximately 4%. CONCLUSIONS These new TEE prediction equations require only simple anthropometric data and are accurate and reproducible at a group level while performing better than existing equations. Substantial individual variability in PAL in older adults is the major source of variation when applied at an individual level.
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Affiliation(s)
- Judi Porter
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia.
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, the University of Queensland, Brisbane, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia
| | | | - Zoe Davidson
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia
| | - Ross Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Marian L Neuhouser
- Fred Hutchinson Cancer Research Center and School of Public Health and Community Medicine, University of Washington, Seattle, WA, United States
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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Hanna L, Porter J, Bauer J, Nguo K. Energy Expenditure in Upper Gastrointestinal Cancers: a Scoping Review. Adv Nutr 2023; 14:1307-1325. [PMID: 37562709 PMCID: PMC10721480 DOI: 10.1016/j.advnut.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
Malnutrition is prevalent in people with upper gastrointestinal (GI) cancers and is associated with shorter survival and poor quality of life. In order to effectively prevent or treat malnutrition, nutrition interventions must ensure appropriate energy provision to meet daily metabolic demands. In practice, the energy needs of people with cancer are frequently estimated from predictive equations which are not cancer-specific and are demonstrated to be inaccurate in this population. The purpose of this scoping review was to synthesize the existing evidence regarding energy expenditure in people with upper GI cancer. Three databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus) were systematically searched to identify studies reporting on resting energy expenditure using indirect calorimetry and total energy expenditure using doubly labeled water (DLW) in adults with any stage of upper GI cancer at any point from diagnosis. A total of 57 original research studies involving 2,125 individuals with cancer of the esophagus, stomach, pancreas, biliary tract, or liver were eligible for inclusion. All studies used indirect calorimetry, and one study used DLW to measure energy expenditure, which was reported unadjusted in 42 studies, adjusted for body weight in 32 studies, and adjusted for fat-free mass in 13 studies. Energy expenditure in upper GI cancer was compared with noncancer controls in 19 studies and measured compared with predicted energy expenditure reported in 31 studies. There was heterogeneity in study design and in reporting of important clinical characteristics between studies. There was also substantial variation in energy expenditure between studies and within and between cancer types. Given this heterogeneity and known inaccuracies of predictive equations in patients with cancer, energy expenditure should be measured in practice wherever feasible. Additional research in cohorts defined by cancer type, stage, and treatment is needed to further characterize energy expenditure in upper GI cancer.
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Affiliation(s)
- Lauren Hanna
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
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Porter J, Ward LC, Nguo K, Davidson Z, Gibson S, Prentice R, Neuhouser ML, Truby H. Development and validation of new predictive equations for the resting metabolic rate of older adults aged ≥65 y. Am J Clin Nutr 2023; 117:1164-1173. [PMID: 37054885 PMCID: PMC10447471 DOI: 10.1016/j.ajcnut.2023.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The aging process alters the resting metabolic rate (RMR), but it still accounts for 50%-70% of the total energy needs. The rising proportion of older adults, especially those over 80 y of age, underpins the need for a simple, rapid method to estimate the energy needs of older adults. OBJECTIVES This research aimed to generate and validate new RMR equations specifically for older adults and to report their performance and accuracy. METHODS Data were sourced to form an international dataset of adults aged ≥65 y (n = 1686, 38.5% male) where RMR was measured using the reference method of indirect calorimetry. Multiple regression was used to predict RMR from age (y), sex, weight (kg), and height (cm). Double cross-validation in a randomized, sex-stratified, age-matched 50:50 split and leave one out cross-validation were performed. The newly generated prediction equations were compared with the existing commonly used equations. RESULTS The new prediction equation for males and females aged ≥65 y had an overall improved performance, albeit marginally, when compared with the existing equations. It is described as follows: RMR (kJ/d) = 31.524 × W (kg) + 25.851 × H (cm) - 24.432 × Age (y) + 486.268 × Sex (M = 1, F = 0) + 530.557. Equations stratified by age (65-79.9 y and >80 y) and sex are also provided. The newly created equation estimates RMR within a population mean prediction bias of ∼50 kJ/d (∼1%) for those aged ≥65 y. Accuracy was reduced in adults aged ≥80 y (∼100 kJ/d, ∼2%) but was still within the clinically acceptable range for both males and females. Limits of agreement indicated a poorer performance at an individual level with 1.96-SD limits of approximately ±25%. CONCLUSIONS The new equations, using simple measures of weight, height, and age, improved the accuracy in the prediction of RMR in populations in clinical practice. However, no equation performs optimally at the individual level.
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Affiliation(s)
- Judi Porter
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Burwood, Melbourne, Victoria, Australia.
| | - Leigh C Ward
- Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Melbourne, Victoria, Australia
| | - Zoe Davidson
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Melbourne, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Melbourne, Victoria, Australia
| | - Ross Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Marian L Neuhouser
- Fred Hutchinson Cancer Research Center and School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Nguo K, Truby H, Porter J. Total Energy Expenditure in Healthy Ambulatory Older Adults Aged ≥80 Years: A Doubly Labelled Water Study. ANNALS OF NUTRITION & METABOLISM 2023; 79:263-273. [PMID: 36592624 DOI: 10.1159/000528872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The life expectancy of older adults continues to increase; however, knowledge regarding their total energy requirements is lacking. This study aimed to compare the total energy expenditure (TEE) of older adults ≥80 years measured using doubly labelled water (DLW), with estimated TEE. The hypothesis was that the Mifflin, Ikeda, and Livingston equations will more closely estimate energy requirements than the commonly used Schofield equation. METHODS Resting metabolic rate (RMR) and TEE were measured using the reference methods of indirect calorimetry and DLW, respectively. Bland-Altman plots compared measured RMR and TEE with predicted RMR using equations (Mifflin, Ikeda, Livingston, Schofield) and predicted TEE (predicted RMR × physical activity level). RESULTS Twenty-one older adults (age range 80.7-90.1 years, BMI 26.1 ± 5.5 kg/m2) were included. The Schofield equation demonstrated the greatest bias from measured RMR, overestimating approximately up to double the mean difference (865 ± 662 kJ/day) compared with the three other equations. The Schofield equation exhibited the greatest bias (overestimation of 641 ± 1,066 kJ/day) compared with measured TEE. The other three equations underestimated TEE, with the least bias from Ikeda (37 ± 1,103 kJ/day), followed by Livingston (251 ± 1,108 kJ/day), and Mifflin (354 ± 1,140 kJ/day). Data are mean ± SD. CONCLUSIONS In older adults ≥80 years, the Ikeda, Mifflin, and Livingston equations provide closer estimates of TEE than the widely used Schofield equation. The development of nutrition guidelines therefore should consider the utilization of equations which more accurately reflect age-specific requirements.
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Affiliation(s)
- Kay Nguo
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Science, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Porter J, Thompson H, Tjahyo AS. Understanding total energy expenditure in people with dementia: A systematic review with directions for future research. Australas J Ageing 2021; 40:243-251. [PMID: 34192416 DOI: 10.1111/ajag.12977] [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: 01/03/2021] [Revised: 05/05/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Weight loss is a primary manifestation of dementia. This review aimed to systematically synthesise the literature on total energy expenditure (TEE) in people with dementia. METHODS The protocol, registered with PROSPERO, was reported against PRISMA guidelines. Eligible studies investigated TEE in people with dementia. Six electronic databases and a supplementary Internet search identified relevant publications. Results were synthesised narratively. RESULTS The final library considered the TEE of 358 participants. Two studies used the gold standard method of doubly labelled water (DLW); other studies used TEE measures validated against DLW. TEE varied considerably, from 6095 ± 1353 kJ to 9765 ± 2066 kJ. The TEE of community-dwelling people with dementia (range 8430 ± 2250 kJ-9765 ± 2066 kJ) was higher than in institutionalised groups (range 6095 ± 1353 kJ-7619 ± 1827 kJ). CONCLUSIONS New technologies will enable future research in this patient population to be less burdensome than those reliant on DLW measures. In planning future research, avoidance of selection bias and considering disease stage and movement are important considerations.
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Affiliation(s)
- Judi Porter
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Hannah Thompson
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Alvin Surya Tjahyo
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
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A new doubly labelled water anthropometry-based equation for prediction of total daily energy expenditure in older people from low- and middle-income countries. Eur J Clin Nutr 2021; 75:1618-1626. [PMID: 33790396 DOI: 10.1038/s41430-021-00886-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/24/2021] [Accepted: 02/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND For community-living older people, the ability to estimate total daily energy expenditure (TDEE) with validated predictive equations based on anthropometry is limited. To our knowledge no studies exist for non-Caucasian populations OBJECTIVE: To design and validate an anthropometry-based equation to estimate TDEE using doubly-labelled water (DLW) as the criterion measure, and to assess the performance of three other published equations in community-living older people from rural and urban areas of Brazil, Chile, Guatemala, Senegal, Cuba, and Mexico METHODS: This cross-sectional study measured anthropometry and TDEE using DLW in 69 men and 43 women aged 60-89 years. TDEE was also estimated with an anthropometry-based equation derived from the sub-sample of Mexico (n = 38) and with three other published equations. Predictive accuracy of the equations was tested by an external validation procedure RESULTS: TDEE by DLW in the six country sample was 2411 ± 41 kcal/day (mean ± SE) in men and 1939 ± 51 kcal/day in women. The best new Mexican equation was TDEE, kcal/d = [223.4 + (27.9 × weight, kg) + (239.7 × sex)]; where sex: Man = 1 and Woman = 0; having high precision; R2 = 0.89, lowest RMSE = 149.2, and Cp value of 2.0. This new Mexican equation estimated TDEE accurately in the five country sample and at country level after correction for Guatemalan older men, while the published equations performed poorly CONCLUSIONS: The Mexican equation performed better that other published equations and is recommended to accurately estimate energy requirements for community-living older people in five Latin American and one African country.
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Batista LD, De França NAG, Pfrimer K, Fontanelli MDM, Ferriolli E, Fisberg RM. Estimating total daily energy requirements in community-dwelling older adults: validity of previous predictive equations and modeling of a new approach. Eur J Clin Nutr 2020; 75:133-140. [PMID: 32814851 DOI: 10.1038/s41430-020-00717-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Accurate estimation of energy requirements is crucial for health maintenance and prevention of malnutrition in older adults. This study aimed to assess the accuracy of predictive equations for estimating energy requirements in older adults and to test the validity of new predictive equations for this age group. SUBJECTS/METHODS This is a cross-sectional study including 38 Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). The energy expenditure was compared to the Institute of Medicine (Dietary Reference Intake (DRI)) and Vinken et al. previous predictive equations and three predictive models developed in a modeling sample. The agreement was assessed using intra-class correlation coefficient, Bland-Altman plots, and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured energy expenditure. RESULTS The mean (standard deviation) TEEDLW was 2656.7 (405.6) kcal/day for men and 2168.9 (376.9) for women. Vinken et al. and both DRI equations presented moderate to good degree of agreement, while the developed models vary from fair to very good agreement in comparison to DLW. The accuracy rate was the same for both DRI equations and Vinken et al. equation (60.53%). The new equations developed in this study had accuracy in predicting TEE for Brazilian older adults varying from 43.11% to 73.68%. CONCLUSIONS The results corroborate the use of previous predictive equations for estimating energy requirements in Brazilian older adults. Further studies have the potential to explore the use of the developed models to assess energy needs in this population.
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Affiliation(s)
- Lais Duarte Batista
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Natasha Aparecida Grande De França
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, Cerqueira Cesar, São Paulo, SP, Brazil.,Centro Universitário de Rio Preto (UNIRP), R. Ivete Gabriel Atique, 45-Vila Maria, São José do Rio Preto, SP, Brazil
| | - Karina Pfrimer
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Mariane de Mello Fontanelli
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Eduardo Ferriolli
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Regina Mara Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, Cerqueira Cesar, São Paulo, SP, Brazil.
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Bonnefoy M, Gilbert T, Normand S, Jauffret M, Roy P, Morio B, Cornu C, Roche S, Laville M. Energy Expenditure in Older People Hospitalized for an Acute Episode. Nutrients 2019; 11:nu11122946. [PMID: 31817061 PMCID: PMC6949974 DOI: 10.3390/nu11122946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 12/26/2022] Open
Abstract
Weight loss and worsening of nutritional state is a frequent downfall of acute hospitalization in older people. It is usually accepted that acute inflammation is responsible for hypercatabolism. However, several studies suggest, on the contrary, a reduction in resting energy expenditure (REE). This study aimed to obtain a reliable measure of REE and total energy expenditure (TEE) in older patients hospitalized for an acute episode in order to better assess patients’ energy requirements and help understand the mechanisms of weight loss in this situation. Nineteen hospitalized older patients (mean age 83 years) with C-reactive protein (CRP) level >20mg/L were recruited. REE and TEE were measured using gold standard methods of indirect calorimetry and doubly labeled water (DLW), respectively. REE was then compared to data from a previous study on aged volunteers from nursing homes who were free of an acute stressor event. Energy requirements measured by DLW were confirmed at 1.3 × REE. Energy intake covered the needs but did not prevent weight loss in these patients. TEE was not increased in hospitalized patients and was not influenced by inflammation, while the relationship between REE and inflammation was uncertain. Our results suggest that lean mass remains the major determinant of REE in hospitalized older people and that weight loss may not be explained solely by a state of hypercatabolism.
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Affiliation(s)
- Marc Bonnefoy
- Department of Geriatric Medicine, Groupement Hospitalier Sud, CHU de Lyon, 69495 Bénite-Pierre CEDEX, France; (T.G.); (M.J.)
- CarMeN, U1060 INSERM, 69921 Oullins CEDEX, France; (B.M.); (M.L.)
- Rhône-Alpes Center for Research in Human Nutrition, European Center for Nutrition and Health, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France;
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Correspondence: ; Tel.: +33-4788-615-80
| | - Thomas Gilbert
- Department of Geriatric Medicine, Groupement Hospitalier Sud, CHU de Lyon, 69495 Bénite-Pierre CEDEX, France; (T.G.); (M.J.)
- HESPER, EA 7425 Université Claude Bernard lyon 1, 69373 Lyon 8 CEDEX, France
| | - Sylvie Normand
- Rhône-Alpes Center for Research in Human Nutrition, European Center for Nutrition and Health, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France;
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Marc Jauffret
- Department of Geriatric Medicine, Groupement Hospitalier Sud, CHU de Lyon, 69495 Bénite-Pierre CEDEX, France; (T.G.); (M.J.)
| | - Pascal Roy
- Department of Biostatistics, Health sciences department, Hospices Civils de Lyon, 69003 Lyon, France; (P.R.); (S.R.)
- CNRS UMR 5558, Laboratory of Biometry and evolutive Biology, Biostatistics and health, 69100 Villeurbanne, France
| | - Béatrice Morio
- CarMeN, U1060 INSERM, 69921 Oullins CEDEX, France; (B.M.); (M.L.)
| | - Catherine Cornu
- Center of clinical investigations, Hôpital Louis Pradel, 69500 Bron, France;
| | - Sylvain Roche
- Department of Biostatistics, Health sciences department, Hospices Civils de Lyon, 69003 Lyon, France; (P.R.); (S.R.)
- CNRS UMR 5558, Laboratory of Biometry and evolutive Biology, Biostatistics and health, 69100 Villeurbanne, France
| | - Martine Laville
- CarMeN, U1060 INSERM, 69921 Oullins CEDEX, France; (B.M.); (M.L.)
- Rhône-Alpes Center for Research in Human Nutrition, European Center for Nutrition and Health, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France;
- Department of endocrinology and Nutrition, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France
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Porter J, Nguo K, Collins J, Kellow N, Huggins CE, Gibson S, Davidson Z, Schoeller D, Prentice R, Neuhouser ML, Snetselaar L, Truby H. Total energy expenditure measured using doubly labeled water compared with estimated energy requirements in older adults (≥65 y): analysis of primary data. Am J Clin Nutr 2019; 110:1353-1361. [PMID: 31504100 PMCID: PMC6885473 DOI: 10.1093/ajcn/nqz200] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Contemporary energy expenditure data are crucial to inform and guide nutrition policy in older adults to optimize nutrition and health. OBJECTIVE The aim was to determine the optimal method of estimating total energy expenditure (TEE) in adults (aged ≥65 y) through 1) establishing which published predictive equations have the closest agreement between measured resting metabolic rate (RMR) and predicted RMR and 2) utilizing the RMR equations with the best agreement to predict TEE against the reference method of doubly labeled water (DLW). METHODS A database consisting of international participant-level TEE data from DLW studies was developed to enable comparison with energy requirements estimated by 17 commonly used predictive equations. This database included 31 studies comprising 988 participant-level RMR data and 1488 participant-level TEE data. Mean physical activity level (PAL) was determined for men (PAL = 1.69, n = 320) and women (PAL = 1.66, n = 668). Bland-Altman plots assessed agreement of measured RMR and TEE with predicted RMR and TEE in adults aged ≥65 y, and subgroups of 65-79 y and ≥80 y. Linear regression assessed proportional bias. RESULTS The Ikeda, Livingston, and Mifflin equations most closely agreed with measured RMR and TEE in all adults aged ≥65 y and in the 65-79 y and ≥80 y subgroups. In adults aged ≥65 y, the Ikeda and Livingston equations overestimated TEE by a mean ± SD of 175 ± 1362 kJ/d and 86 ± 1344 kJ/d, respectively. The Mifflin equation underestimated TEE by a mean ± SD of 24 ± 1401 kJ/d. Proportional bias was present as energy expenditure increased. CONCLUSIONS The Ikeda, Livingston, or Mifflin equations are recommended for estimating energy requirements of older adults. Future research should focus on developing predictive equations to meet the requirements of the older population with consideration given to body composition and functional measures.
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Affiliation(s)
- Judi Porter
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
| | - Nicole Kellow
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
| | - Zoe Davidson
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
| | - Dale Schoeller
- Nutritional Sciences and Biotechnology Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Ross Prentice
- Fred Hutchinson Cancer Research Center and School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Linda Snetselaar
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Helen Truby
- Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Victoria, Australia
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