Accuracy and Validity of Resting Energy Expenditure Predictive Equations in Middle-Aged Adults

The association between the basal metabolic rate and cardiovascular disease: A two-sample Mendelian randomization study

BACKGROUND

Mendelian randomization analysis was applied to elucidate the causal relationship between the basal metabolic rate (BMR) and common cardiovascular diseases.

METHOD

We choose BMR as exposure. BMR is the metabolic rate of the body when the basic physiological activities (blood circulation, breathing and constant body temperature) are maintained. The normal BMR is 1507 kcal/day for men and 1276 kcal/day for women. The dataset was drawn from the public GWAS dataset (GWAS ID: ukb-a-268), collected and analysed by UK biobank, containing 331,307 European males and females. SNPs independently and strongly associated with BMR were used as instrumental variables in the inverse variance weighted analysis. MR-Egger, weighted median, MR pleiotropy residual sum, and outlier methods were also performed, and the sensitivity was evaluated using horizontal pleiotropy and heterogeneity analyses to ensure the stability of the results.

RESULTS

An increased BMR is associated with a higher risk of cardiomyopathy (odds ratio [OR] = 2.00, 95% confidence interval [CI], 1.57-2.54, p = 1.87 × 10-8), heart failure (OR = 1.39, 95% CI, 1.27-2.51, p = 8.1 × 10-13), and valvular heart disease (OR = 1.18, 95% CI, 1.10-1.27, p = .00001). However, there was no clear association between BMR and the subtypes of other cardiovascular diseases, such as coronary disease (OR = .96, 95% CI, .85-1.08, p = .48651) and atrial fibrillation (AF) (OR = 1.85, 95% CI, 1.70-2.02, p = 6.28 × 10-44).

CONCLUSION

Our study reveals a possible causal effect of BMR on the risk of cardiomyopathy, heart failure and valvular disease, but not for coronary disease and AF.

Accuracy of equations for estimating resting energy expenditure in children and adolescents living with phenylketonuria

BACKGROUND

Measuring resting energy expenditure (REE) in individuals living with phenylketonuria (PKU) using indirect calorimetry (IC) is unusual in healthcare facilities because it requires specific protocols and expensive equipment. Considering that determining REE is crucial for devising nutritional strategies for the management of PKU, the aim of this study was to identify the predictive equations that provide the best estimates of REE in children and adolescents living with PKU and to propose a predictive equation for determining REE in this population.

METHODS

An REE concordance study was conducted with children and adolescents living with PKU. Anthropometric and body composition assessments using bioimpedance and REE assessment using IC were performed. The results were compared to 29 predictive equations.

RESULTS

Fifty-four children and adolescents were evaluated. The REE obtained using IC differed from all estimated REE, except Henry's equation for male children (p = 0.058). Only this equation showed good agreement (0.900) with IC. Eight variables were associated with the REE obtained using IC with emphasis on fat-free mass (kg) (r = 0.786), weight (r = 0.775), height (r = 0.759) and blood phenylalanine (r = 0.503). With these variables, three REE equations were suggested, with R2  = 0.660, 0.635 and 0.618, respectively, and the third equation, which involves weight and height, showed adequate sample size for a statistical power of 0.942.

CONCLUSION

Most equations, not specific for individuals living with PKU, overestimate the REE of this population. We propose a predictive equation for assessing REE for children and adolescents living with PKU to be used in settings where IC is not available.

Predictive Equation for Basal Metabolic Rate in Normal-Weight Chinese Adults

This study aimed to develop a predictive equation for basal metabolic rate (BMR) in normal-weight Chinese adults and provide a reference for establishing the national recommended dietary energy intake. A new equation for BMR was derived from a sample of 516 normal-weight Chinese adults (men = 253, women = 263), and this sample was collected from two previous studies. Furthermore, the accuracy of this new equation and eight other previous predictive equations was reviewed. The agreement and reliability were compared in terms of bias, accuracy, the intraclass correlation coefficient, and Bland-Altman plots between predictive equations. In addition, the newly developed equation was further verified using a small independent sample, which contained 41 healthy Chinese adults (men = 21, women = 20). The measured BMR (mBMR) of all participants, measured using indirect calorimetry, was 1346.2 ± 358.0 kcal/d. Thirty participants were excluded based on Cook's distance criteria (Cook's distance of ≥0.008). Previous equations developed by Henry, Schofield, Harris-Benedict (H-B), Yang, and Hong overestimated the BMR of healthy Chinese adults. The present equation displayed the smallest average bias (0.2 kcal/d) between the mBMR and predicted basal metabolic rate (pBMR). The limits of agreement of the present equation from Bland-Altman plots were -514.3 kcal/d and 513.9 kcal/d, which is the most narrow and balanced limit of agreement. Moreover, in the verification of the testing database, the pBMR of the new equation was not significantly different from the mBMR, and the accuracy was 75.6%. Compared with pre-existing equations, the present equation is more applicable to the prediction of BMR in healthy Chinese adults. However, further studies are required to verify the accuracy of this new equation.

Adults with early diagnosis of phenylketonuria have higher resting energy expenditure than adults with late diagnosis

INTRODUCTION

To date, there is a gap regarding resting energy expenditure (REE) in adults with phenylketonuria (PKU), whether PKU type and time of diagnosis interfere with REE, and whether the available predictive equations are valid in this population.

OBJECTIVE

To compare the REE of adult subjects with PKU with healthy subjects and secondarily, examine the REE of adults with PKU according to type and time of diagnosis, and check the agreement of commonly used predictive equations of REE.

METHODS

Concordance study with adults with PKU and a comparison group (CG) with healthy adults. Anthropometric and body composition assessments and REE assessment by indirect calorimetry (IC) were performed. The results obtained by IC were compared with predictive equations.

RESULTS

Sixty-nine adults were evaluated (PKU: 36; CG: 33). The REE of adults with mild and classic PKU is similar (p>.05) and similar to CG (p>.05). The REE of individuals with early diagnosis is higher (p < .05) than the REE of individuals with late diagnosis. The REE obtained by IC differed (p < .05) from all estimated REE.

CONCLUSION

Late diagnosis of PKU showed lower REE compared to individuals with early diagnosis. The REE of adults with PKU does not differ in relation to the type of PKU, nor does it differ from the CG. Predictive equations overestimate REE.

Change of obesity prevalence and lifestyle patterns before and during COVID-19 among Korean adolescents

PURPOSE

Lockdown measure for limiting coronavirus disease 2019 (COVID-19) spread cause an aggravation of the childhood obesity epidemic through lifestyle changes. The aim is to investigate how social restriction might have changed obesity prevalence and lifestyle patterns in Korean adolescents. We also evaluate the most fragile group and most influencing lifestyle parameters on obesity prevalence.

METHODS

To assess the change in weight status and lifestyle, we compared the Korea Youth Risk Behavior Web-based Survey data 2019 (pre-COVID-19, n=57,303) and 2020 (post-COVID-19, n=54,948). Participants from middle schools and high schools, aged 12 to 18 years, voluntarily reported their weight status and lifestyles.

RESULTS

The prevalence of obesity of the total subjects was 11.0% in 2019 and 12.1% in 2020. This prevalence difference varied by sex (males 1.8%, females 0.3%, p<0.001), age group (12-15 year 1.6%, 16-18 year 0.4%, p<0.001), and socioeconomic status. Male aged 12-15 years showed highest increase from 12.5% to 15.2%. Physical activities, fruit intake, consumption of sugar-sweetened beverages, and stress showed all decrease. Only, nonstudy sedentary time marked increased from 3.3±2.3 hr/day to 4.3±2.8 hr/day. Both moderate-intensity and vigorous-intensity physical activity marked decreased especially in male aged 12-15 years, while increased in female aged 16-18 years.

CONCLUSION

Korean adolescents showed increasing obesity prevalence after COVID-19 lockdown, with males aged 12-15 years mainly affected, mainly due to a reduced physical activity and increased sedentary time.

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.

Dietary habits, shopping behavior and weight gain during COVID-19 pandemic lockdown among students in a private university in Selangor, Malaysia

Background

Due to the global surge in COVID-19 cases, numerous countries have enforced lockdowns of varying stringency. Social isolation and stay-at-home orders have detrimental effects on one's lifestyle and dietary habits. This study aimed to assess the dietary patterns, food preferences, shopping behavior and weight gain during the lockdown among students in a private university in Malaysia.

Design and Methods

We conducted a cross-sectional study among 426 students using convenience sampling method one-month after initiating the Conditional Movement Control Order (November 15-30, 2020), using a validated self-administered web-based survey. Chi-square test with post-hoc and planned comparison procedures were performed.

Results

Of the 426 participants, more than half were females (55.9%). Over half of the surveyed students reported increased eating (51.2%), snacking (55.2%) and online food ordering (71.1%) during the lockdown. Meat products and sweet drinks (both >90%) were the most consumed food among individuals with higher BMI. 45.5% of the participants reported weight gain (mean 3.36, SD 1.61kg) one month after the lockdown. Female, youth (aged 19-24), working remotely, increased eating, snacking, cooking, and online food ordering were positively associated with weight gain.

Conclusions

Findings suggested that unintended consequences of lockdown have negative impacts on dietary habits and food preferences among university students. Advocacy and public health measures for nutritional support amidst the pandemic are crucial, especially for at-risk groups such as overweight and obese individuals.

Factors Associated with Body Weight Gain among Korean Adults during the COVID-19 Pandemic

Background

Obesity is of grave concern as a comorbidity of coronavirus disease 2019 (COVID-19). We examined the factors associated with weight gain among Korean adults during the COVID-19 pandemic.

Methods

We conducted an online survey of 1,000 adults (515 men and 485 women aged 20-59 years) in March 2021. Multivariable logistic regression analysis was performed to evaluate the factors associated with weight gain. The analysis was adjusted for sex, age, region, depressive mood, anxiety, eating out, late-night meals, alcohol consumption, exercise, sleep disturbance, meal pattern, subjective body image, comorbidities, marital status, living alone, and income.

Results

After adjusting for confounding variables, the odds for weight gain increased in the group aged 20-34 years compared with the group aged 50-59 years (1.82; 95% confidence interval [CI], 1.01-3.32). Women were more associated with the risk of weight gain compared with men. The odds for weight gain increased in the lack of exercise group compared with the exercise group (4.89; 95% CI, 3.09-7.88). The odds for weight gain increased in the eating-out and late-night meal groups compared with that in the groups not eating out and not having late-night meals. Individuals watching a screen for 3-6 hr/day were more associated with the risk of weight gain compared with those who rarely watched a screen. The odds for weight gain increased in participants who considered themselves obese compared with those who did not consider themselves obese.

Conclusion

A healthy diet and regular physical activity tend to be the best approach to reduce obesity, a risk factor for COVID-19.

Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on clinical, quality of life, and mental health outcomes in women with migraine: A randomised controlled trial

The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and clinical, quality of life, and mental health outcomes in migraine is unknown. To address this knowledge gap, we conducted a parallel-group, randomised controlled trial to evaluate the effect of the DASH diet on these health outcomes in women with migraine. Of 102 eligible women (20-50 years), 51 randomised to the DASH and 51 to the usual dietary advice (control) groups completed a 12-week intervention. The DASH diet was designed using a 7-day menu cycle to provide 15-20% of total daily energy requirements from proteins, 25-30% from fats, and 55-60% from carbohydrates. Dietary records and serum vitamin C levels were used to assess women's compliance with the DASH diet. The clinical symptoms of migraine (i.e., frequency, duration, severity) and quality of life and mental health (i.e., depression, anxiety, stress) outcomes were assessed in groups pre-and post-intervention. We observed greater decreases in the frequency (-3.00 vs. -1.40, P=0.025) and severity (-1.76 vs. -0.59, P<0.001) of migraine in the DASH vs. control group post-intervention. Similarly, the DASH group exhibited a tendency toward greater decreases in migraine duration (-0.58 vs -0.33 days, P=0.053) and had lower scores of depression (-4.50 vs. -2.73, P=0.019) and stress (-5.84 vs -2.98, P=0.011) vs. controls. However, the quality of life and anxiety outcomes remained comparable in groups post-intervention. Together, evidence supports the benefits of the DASH diet on improving migraine health outcomes in reproductive-aged women. Further research is needed to confirm our findings.

COVID-19 Self-quarantine and Weight Gain Risk Factors in Adults

PURPOSE OF REVIEW

The COVID-19 pandemic is associated with weight gain in certain individuals. This review highlights the risk factors for weight gain during COVID-19 self-quarantine in adults.

RECENT FINDINGS

Among those who have gained weight during COVID-19 self-quarantine, self-reported body weight has increased between .5 and 1.8 kg (± 2.8 kg) after just 2 months of quarantine. Identified risk factors for weight gain during COVID-19 self-quarantine are the following: increased sedentary behaviors, decreased physical activity, increased snacking frequency (particularly after dinner), increased alcohol intake, decreased water intake, emotional eating, decreased sleep quality, and being overweight/obese. Having identified risk factors for weight gain during the COVID-19 pandemic, practitioners and researchers should devise plans to assist those who have gained weight to re-learn weight management/weight loss strategies.

The effects of the dietary approaches to stop hypertension (DASH) diet on oxidative stress and clinical indices of migraine patients: a randomized controlled trial

AIMS

The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and oxidative stress (OS) in patients diagnosed with migraine is unknown and remains to be examined. Hence, we conducted a parallel-group, randomized controlled trial to investigate this issue.

METHODS

Of the 102 women who met all the inclusion criteria, 51 individuals were randomized to the DASH diet group and 51 to the usual dietary advice group to receive allocated intervention for three months. In order to assess the compliance of participants to the DASH diet, dietary records, and serum vitamin C levels were examined. Parameters of OS status (e.g. nitric oxide (NO), total antioxidant capacity (TAC), total oxidative status (TOS), malondialdehyde (MDA), and oxidative stress index (OSI)) and clinical indices of migraine (e.g. migraine index (MI), headache dairy result (HDR), and migraine headache index score (MHIS)) were assessed at the beginning and the end of the study.

RESULTS

There was a significant reduction in NO (-5.75 vs. + 4.18, P = 0.025) and TOS (-1.55 vs. + 0.71, P = 0.034), and a marginally significant reduction in OSI (-0.10 vs. + 0.14, P = 0.060) in the DASH group compared with the control. Compliance with the DASH diet resulted in a significant decrease in the score of MI (-31.33 vs. - 15.09), HDR (-5.04 vs. -2.51), and MHIS (-44.21 vs. -26.74). Moreover, no significant change was observed in TAC, MDA, and total thiol content.

CONCLUSION

This type of dietary approach can be considered as a complementary treatment for migraine patients, also further investigations are needed to replicate our findings.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20121216011763N38.

The Assessment of Daily Energy Expenditure of Commercial Saturation Divers Using Doubly Labelled Water

Commercial saturation divers are exposed to unique environmental conditions and are required to conduct work activity underwater. Consequently, divers' physiological status is shown to be perturbed and therefore, appropriate strategies and guidance are required to manage the stress and adaptive response. This study aimed to evaluate the daily energy expenditure (DEE) of commercial saturation divers during a 21-day diving operation in the North Sea. Ten saturation divers were recruited during a diving operation with a living depth of 72 metres seawater (msw) and a maximum working dive depth of 81 msw. Doubly labelled water (DLW) was used to calculate DEE during a 10-day measurement period. Energy intake was also recorded during this period by maintaining a dietary log. The mean DEE calculated was 3030.9 ± 513.0 kcal/day, which was significantly greater than the mean energy intake (1875.3 ± 487.4 kcal; p = 0.005). There was also a strong positive correction correlation between DEE and total time spent performing underwater work (r = 0.7, p = 0.026). The results suggested saturation divers were in a negative energy balance during the measurement period with an intraindividual variability in the energy cost present that may be influenced by time spent underwater.

The Effect of Dietary Intake and Nutritional Status on Anthropometric Development and Systemic Inflammation: An Observational Study

(1) Background: Daily caloric intake should aim to reduce the risk of obesity or poor anthropometric development. Our study objective was to analyze the association between food consumption, inflammatory status and anthropometric development; (2) Methods: We performed a prospective observational analytical research during September 2020 and April 2021 on a group of 160 healthy subjects, aged between 6 and 12 years old, by analyzing food ingestion, the basal metabolic rate, anthropometric development and the inflammatory status; (3) Results: IL-6 was significantly correlated to the sum of skinfolds, along with both serum proteins and triglycerides. The skin folds were significantly correlated with the caloric intake and with total fat intake, next to saturated and trans fats. Unlike the skin folds, the body weight was significantly correlated with the caloric intake along with some vitamins, such as Vitamin A and Vitamin B12. Inactive mass increased with excessive folic acid, Vitamin E, Vitamin K and saturated fat intake; (4) Conclusions: The inflammatory status was influenced by the ingestion of micronutrients, total serum lipids and proteins. The anthropometric development was associated with the ingestion of carbohydrates, energy balance and energy intake. We can conclude that daily menu and nutrition imbalances can influence both the risk of obesity and the inflammatory status.

Nutritional status and energy metabolism in elderly patients with nonalcoholic fatty liver disease

BACKGROUND

With the aging of global population and the increase in the incidence of NAFLD, the research of elderly NAFLD population is particularly important.

AIM

To study the nutritional status and energy metabolism in elderly patients with nonalcoholic fatty liver disease (NAFLD) to provide evidence for disease evaluation, clinical monitoring, and treatment intervention.

METHODS

One hundred and eighteen elderly patients (≥ 60 years) with NAFLD were enrolled at Department of Gastroenterology Tianjin Third Central Hospital from January 2017 to January 2019. A non-NAFLD group consisting of non-NAFLD volunteers ≥ 60 years was also included. Nutritional status and energy metabolism were evaluated with a body composition analyzer and metabolic cart ( anthropometric measurement, clinical biochemical examination, etc.).

RESULTS

Body composition analysis showed that the waist-to-hip fat ratio and body fat content of the NAFLD group were significantly higher (waist-to-hip fat ratio 0.95 vs 0.92, body fat 27.20 vs 19.60 kg, P < 0.05) compared with those of the non-NAFLD group. The results of metabolic vehicle showed that the resting energy expenditure (REE) of the NAFLD group was increased (1769.00 vs 1706.00 vs 1323.00). In elderly NAFLD patients, body fat, waist-to-hip fat ratio, basal metabolism, and REE in the mild fatty liver group were significantly lower than those in the moderate-severe fatty liver group.

CONCLUSION

In elderly patients with NAFLD, there are nutritional imbalance and energy metabolism disorder. The nutritional status and energy metabolism of elderly NAFLD patients can be comprehensively evaluated and monitored with a body composition analyzer and metabolic vehicle, so as to provide evidence for disease intervention.

Relationships between diet and basal fat oxidation and maximal fat oxidation during exercise in sedentary adults

BACKGROUND AND AIMS

To study the relationships between different dietary factors (i.e., energy, macronutrient and fatty acid intake, food group consumption, and dietary pattern) and basal fat oxidation (BFox) and maximal fat oxidation during exercise (MFO) in sedentary adults.

METHOD AND RESULTS

A total of 212 (n = 130 women; 32.4 ± 15.1 years) sedentary healthy adults took part in the present study. Information on the different dietary factors examined was gathered through a food frequency questionnaire and three nonconsecutive 24 h recalls. Energy and macronutrient intakes and food consumption were then estimated and dietary patterns calculated. BFox and MFO were measured by indirect calorimetry following standard procedures. Our study shows that dietary fiber intake was positively associated with BFox after taking into consideration the age, sex, and energy intake. A significant positive association between nut consumption and BFox was observed, which became nonsignificant after taking into consideration the age and energy intake. Fat intake and the dietary quality index (DQI), and the DQI for the Mediterranean diet were positively associated with MFO, which was attenuated after taking sex, age, and energy intake into consideration.

CONCLUSION

A higher dietary fiber intake and fat intake are associated with higher BFox and MFO, respectively, in sedentary adults.

CLINICAL TRIALS

ClinicalTrials.gov, ID: NCT02365129 (https://clinicaltrials.gov/ct2/show/study/NCT02365129) & ID: NCT03334357 (https://clinicaltrials.gov/ct2/show/NCT03334357).

Leading Factors for Weight Gain during COVID-19 Lockdown in a Spanish Population: A Cross-Sectional Study

The increase in sedentary behaviors during the COVID-19-induced lockdown may have led to a significant weight gain. To investigate this hypothesis, a representative sample of the Spanish adult population comprising 1000 subjects was enrolled in a cross-sectional study between 26 May and 10 June 2020. Computer-assisted telephone interviews were conducted consisting of 29 questions on the topic of lifestyle habits during the lockdown. The cohort comprised 51.5% women and 51% overweight or obese subjects and had a mean age of 50 ± 18 years. Of the respondents, 44.5% self-reported weight gain during the lockdown; of these, 58.0% were women, 69.9% had previous excess weight, 44.7% lived with a relative who also gained weight, and 73.5 experienced increased appetite. Further, an increased consumption of energy-dense products was found relative to respondents who did not gain weight (p ≤ 0.016 for all). Additionally, respondents were unaware that obesity is a poor prognostic factor for COVID-19 infection, lived in smaller flats, and had a lower level of education and lower monthly income. The factors independently associated with weight gain were female gender, previous overweight or obesity, lack of food care, increased appetite, and increased consumption of sugar-sweetened beverages, alcoholic beverages, and snacks (p ≤ 0.023 for all). Should another lockdown be mandated, extra caution is warranted to prevent weight gain.

Accuracy of the Resting Energy Expenditure Estimation Equations for Healthy Women

Background: There exist several prediction equations for the estimation of resting energy expenditure (REE). However, none of these equations have been validated in the Chilean female population yet. The aims of this study are (1) to determine the accuracy of existing equations for prediction of REE and (2) to develop new equations in a sample of healthy Chilean women. Methods: A cross-sectional descriptive study was carried out on 620 Chilean women. The sample showed an age range between 18 and 73 years, a body mass index average of 28.5 ± 5.2 kg/m², and a prevalence of overweight and obesity of 41% and 33.2%, respectively. REE was measured by indirect calorimetry (REE_IC), which was used as the gold standard to determine the accuracy of twelve available REE prediction equations and to calculate alternative formulas for estimation of REE. Paired t-tests and Bland–Altman plots were used to know the accuracy of the estimation equations with REE_IC. At the same time, multiple linear regressions were performed to propose possible alternative equations. The analyses were carried out by age groups and according to nutritional status. Results: All the equations showed a tendency to overestimate REE, regardless of age or nutritional status. Overall, the Ireton-Jones equation achieved the highest mean percentage difference from REE_IC at 67.1 ± 31%. The alternative new equations, containing variables of body composition, reached a higher percentage of classification within ±10% of REE_IC. Conclusions: The available equations do not adequately estimate REE in this sample of Chilean women. Although they must be validated, the new formulas proposed show better adaptation to this Chilean sample.

New predictive equations for estimating resting energy expenditure in subjects with normal weight and overweight

OBJECTIVE

The aim of this study was to develop and validate new predictive equations for estimating resting energy expenditure (REE) in subjects with normal weight and overweight, considering anthropometric parameters as well as raw variables from bioimpedance analysis (BIA).

METHODS

Adult participants with normal weight and overweight were recruited and randomly split into calibration and validation groups. Indirect calorimetry (IC) and BIA were performed in all subjects. New predictive equations were developed using the following models: model 1 with age, weight, stature, and body mass index (BMI) as predictors; and model 2: model 1 + raw BIA variables (bioimpedance index and phase angle). The accuracy of the new equations at both the group (bias) and individual (within ±10%) levels was tested in the validation group. Three published predictive equations were also compared, with the REE values measured by IC.

RESULTS

A total of 2483 adults were included for developing and validating the new equations. All selected formulas, including the new ones, showed a bias of <5% in estimating REE at the group level. Accuracy at the individual level was slightly higher for the new equations, especially for the equation based on raw BIA variables (men = 70.3%; women = 72.3%).

CONCLUSIONS

Compared to the equations in the literature, the new equations showed good accuracy at both the group and individual levels, with a slight improvement in individual accuracy for the formula including raw BIA variables. However, future research is required to verify the role of the raw BIA variables in predicting REE in subjects with normal weight and overweight.

Accuracy of resting metabolic rate prediction equations among healthy adults in Trinidad and Tobago

BACKGROUND

Over 50% of adults in Latin America and the Caribbean have a body mass index (BMI) ≥ 25 suggesting excess energy intakes relative to energy expenditure. Accurate estimation of resting metabolic rate (RMR), the largest component of total energy requirements, is crucial to strategies aimed at reducing the prevalence and incidence of overweight and obesity.

AIM

We evaluated the accuracies of established and locally developed RMR prediction equations (RMR_P) among adults.

METHODS

Four hundred adult volunteers ages 20 to 65 years had RMR measured (RMR_M) with a MedGem® indirect calorimeter according to recommended procedures. RMR_P were compared to RMR_M with values ± 10% of RMR_M deemed accurate. Anthropometry was measured using standard procedure. Linear regression with bootstrap analyses was used to develop local RMR_P equations based on anthropometric and demographic variables. The University of the West Indies Ethics Committee approved the study.

RESULTS

Males had higher mean absolute RMR (p < 0.001) but similar mean age-adjusted measured RMR per kg of body (20.9 vs. 21.5 kcals/day; p = 0.1) to females. The top performing established anthropometry-based RMR_P among participants by sex, physical activity (PA) level and BMI status subgroups were Mifflin-St Jeor, Owen, Korth, Harris-Benedict, and Livingston, while Johnstone, Cunningham, Müller (body composition (BC)), Katch and McArdle, Mifflin-St Jeor (BC) were the most accurate BC-based RMR_P. Locally developed RMR_P had accuracies comparable to their top-ranked established RMR_P counterparts.

CONCLUSIONS

Accuracies of established RMR_P depended on habitual PA level, BMI status, BC and sex. Furthermore, locally developed RMR_P provide useful alternatives to established RMR_P.

Resting Energy Expenditure during Breastfeeding: Body Composition Analysis vs. Predictive Equations Based on Anthropometric Parameters

Accurate estimation of energy expenditure in a breastfeeding woman is crucial for maintaining the proper nutritional status of the woman and healthy development of the infant. The current literature does not contain data regarding resting energy expenditure (REE) in breastfeeding women. Using mathematical equations is the most common method of REE assessment. However, due to changes in metabolism and body composition during pregnancy and lactation, the mathematical equations used among the general population may not apply. The aim of this study was to evaluate the resting energy expenditure of exclusively breastfeeding women by using body composition analysis–estimated REE (eREE) and to provide the most appropriate predictive equations–predicted REE (pREE) based on anthropometric parameters to estimate it. This was a pilot study with 40 exclusively breastfeeding women. Height and weight were measured and body composition analysis was performed. We predicted REE using fourteen self-selected equations, based on anthropometric parameters and/or age, and/or sex. The median eREE was 1515.0 ± 68.4 kcal (95% Cl, 1477–1582 kcal) and the pREE ranged from 1149.7 kcal (95% Cl, 1088.7–1215.0) by Bernstein et al., to 1576.8 kcal (95% Cl, 1479.9–1683.4), by Müller et al. Significant differences between eREE and all pREE were observed (p < 0.001, except Korth et al. equations). The Müller et al. equation was the most accurate with the smallest individual variation. All predictive equations showed low agreement, and in most cases, the results were underestimated. These findings indicate the need for further studies to propose more suitable methods to determine the energy requirements for breastfeeding women.

Association of Basal Metabolic Rate and Nutrients Oxidation with Cardiometabolic Risk Factors and Insulin Sensitivity in Sedentary Middle-Aged Adults

This cross-sectional study aimed to examine the association of basal metabolic rate (BMR) and basal fat and carbohydrate oxidation (BFox and BCHox, respectively) with cardiometabolic risk factors and insulin sensitivity in sedentary middle-aged adults. A total of 71 healthy sedentary adults (37 women) aged 40–65 years participated in the current study. Data were collected during the baseline assessments of the FIT-AGEING randomized controlled trial. BMR was measured via indirect calorimetry, and BFox and BCHox estimated by stoichiometric equations. Blood pressure, glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides plasma levels were selected as cardiometabolic risk factors and assessed following standard procedures. We observed positive associations of BMR with plasma insulin and the homeostatic model assessment of insulin resistance index (HOMA; all p < 0.05) which were attenuated or disappeared after controlling by sex, age, and/or lean mass. There were positive associations between BFox and the quantitative insulin sensitivity check index (QUICKI; p < 0.015), while negative associations were noted between BFox and plasma insulin and HOMA (p < 0.015). There was a significant negative association between BCHox with QUICKI (p < 0.01), whereas significant positive relationships were obtained when BCHox was associated with plasma insulin and HOMA (p < 0.01). These associations persisted in almost all cases when controlling by sex, age and/or lean mass. No further relationships were found when BMR, BFox, and BCHox were associated with other cardiometabolic risk factors. In conclusion, our study findings support that greater BFox and lower BCHox are related to improved insulin sensitivity, whereas BMR seems to be not associated with neither cardiometabolic risk nor insulin sensitivity in sedentary middle-aged adults. Further intervention studies are necessary to well-understand the physiological mechanism implied in this relationship.

Association between sleep quality and time with energy metabolism in sedentary adults

The aim of the present study was to investigate the relationship of sleep quality and time with basal metabolic rate (BMR) and fuel oxidation in basal conditions and during exercise in sedentary middle-aged adults. We also studied the mediation role of dietary intake and adherence to the traditional Mediterranean Diet in the relationship between sleep parameters and energy metabolism parameters.A secondary analysis of the FIT-AGEING study was undertaken. 70 middle-aged sedentary adults (40-65 years old) participated in the present study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and wrist accelerometers (ActiSleep, Actigraph, Pensacola, Florida, USA) for 7 consecutive days. BMR was measured with indirect calorimetry and fuel oxidation was estimated through stoichiometric equations. Maximal fat oxidation was determined by a walking graded exercise test and dietary intake with 24 h recalls. Adherence to the traditional Mediterranean diet was assessed through the PREDIMED questionnaire. PSQI global score (poor sleep quality) was associated with lower basal fat oxidation (BFox), both expressed in g/min and as a percentage of BMR, independently of confounders. We did not find any association between other sleep and energy metabolism parameters. No mediating role of the dietary intake or PREDIMED global score was observed in the association of PSQI and BFox. In conclusion, our study showed that a subjective poor sleep quality was associated with lower BFox, which is not mediated by dietary intake in sedentary adults.

Metabolic rate in sedentary adults, following different exercise training interventions: The FIT-AGEING randomized controlled trial

BACKGROUND & AIMS

This study compares the influence of different exercise training programs on basal metabolic rate (BMR) and fat oxidation, in basal conditions (BFox) and during exercise (MFO), in sedentary, middle-aged adults.

METHODS

The study subjects of this 12 week-long, randomised controlled trial, were 71 middle-aged adults (age 53.5 ± 4.9 years; 52% women). Subjects were randomly assigned to one of the following groups: (1) no exercise, (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT group), and (4) high intensity interval training plus whole-body electromyostimulation (HIIT + EMS group). Subject BMR, BFox and MFO were determined by indirect calorimetry before and after the intervention.

RESULTS

The HIIT + EMS subjects showed significant increases in BFox following the intervention compared with the control group (all P = 0.043); no such differences were seen in the PAR and HIIT compared with the control group (all P ≥ 0.1). A significant increase in post-intervention MFO was noted for the HIIT and HIIT + EMS group compared to the non-exercise control group (P < 0.05); no such difference was seen in the PAR group compared to the control group (all P ≥ 0.05).

CONCLUSIONS

Twelve weeks of high intensity interval training plus whole-body electromyostimulation may increase the BFox and MFO of middle-aged sedentary adults. These findings have important clinical implications; a well-designed high-intensity interval training program plus whole-body electromyostimulation might be followed to help combat the appearance of chronic metabolic diseases characterized by metabolic inflexibility in middle-aged sedentary adults, though it will be necessary to determine how long the effects last.

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.

Are predictive equations a valid method of assessing the resting metabolic rate of overweight or obese former athletes?

Athletes retiring from their sports career, an understudied population, are susceptible to become overweight/obese because of decreased energy expenditure not followed by a reduction in energy intake. Therefore, their energy requirements, through resting metabolic rate (RMR), should be accurately addressed for weight management purposes. This study aimed to determine the validity of predictive equations (PEq) for RMR estimation using indirect calorimetry as the reference method in a sample of overweight/obese former athletes. The study uses cross-sectional data collected during baseline measurements of a lifestyle intervention (NCT03031951). The RMR of 56 overweight/obese (31.5 (4.0 kg/m²)) individuals (78.6% male, 37.5% obese, 95.8 (14.8 kg), 174.2 (8.7 cm)) was measured by indirect calorimetry and predicted using seven PEq: Harris-Benedict, Cunningham, Schofield, FAO/WHO/UNU, Owen, Mifflin-St. Jeor, and Katch-McArdle. Dual-energy X-ray absorptiometry was used to assess body composition. The PEq overestimated the RMR measured by the indirect calorimetry, 70-300 kcal/day (4.3-14.9%). The linear regression between the reference and each of the PEq did not differ from the identity line with estimated values explaining around 50% of the variability of the measured values. The agreement between the methods was weak for all the PEq showing wide limits of agreement. The Harris-Benedict equation was the only one in which the difference between the methods was not related to the magnitude of the measured RMR. Given the weak performance of the various RMR models in overweight/obese former athletes, an effective weight management intervention based on estimated resting energy requirements may be compromised.

Predicting Equations and Resting Energy Expenditure Changes in Overweight Adults

Introduction

The aim of the study is to show the differences between the measured and estimated values of resting energy expenditure and any changes occurring after the 6-month weight loss intervention program.

Methods

We included 33 healthy adults aged 25–49 years with an average body mass index 29.1±2.7 kg/m 2 for female and 29.8±2.8 kg/m² for male. The measured resting energy expenditure was obtained by indirect calorimeter MedGem® Microlife and estimated resting energy expenditure by the Harris–Benedict equation, the Mifflin–St Jeor equation, the Owen equation, the Wright equation, and by the Tanita body composition analyser. All measurements and calculations were carried out before and after the 6-month intervention. Results were compared using paired t-tests. P value less than 0.05 was considered statistically significant.

Results

A comparison of the measured resting energy expenditure of female subjects with the estimated resting energy expenditure using the Harris–Benedict equation, the Mifflin–St Jeor equation and the Wright equation showed a statistically significant difference. A comparison of the measured resting energy expenditure of male subjects with the estimated resting energy expenditure using the Harris–Benedict equation and the Wright equation showed a statistically significant difference. There was a significant difference in the measured resting energy expenditure and estimated resting energy expenditure using Tanita.

Conclusions

We concluded that the most comparable equation for our sample was the Owen’s equation. After losing weight, the measured resting energy expenditure has decreased, which must be taken into account in further diet therapy.

Association of basal metabolic rate and fuel oxidation in basal conditions and during exercise, with plasma S-klotho: the FIT-AGEING study

S-klotho, the shed form of α-klotho, is thought to be an ageing suppressor with functions related to the physiology of energy metabolism. However, it remains unknown whether ageing biomarkers such as S-klotho and/or chronological ageing are associated in any way with basal metabolic rate (BMR) and fuel oxidation in basal conditions and during exercise. The present work investigates the association of BMR and fuel oxidation in basal conditions and during exercise, with plasma S-klotho in middle-aged, sedentary adults. BMR was measured by indirect calorimetry in 74 such subjects (53% women; age 53.7±5.1 years) following standard procedures, and their fuel oxidation estimated via stoichiometric equations. The maximal fat oxidation during exercise (MFO) and the intensity of exercise that elicits MFO (Fat_max) were determined using a walking graded exercise test. No relationship was seen between BMR and plasma S-klotho (P>0.1), although both basal fat oxidation and MFO showed positive associations with this protein (both P<0.001); these relationships persisted after controlling for age, sex and fat mass. However, no significant associations were seen between BMR, basal fat oxidation or MFO and chronological age (all P>0.1). The present findings suggest that basal fat oxidation and MFO are strongly associated with plasma S-klotho in middle-aged sedentary adults. These results support the idea that metabolic flexibility is a powerful predictor of biological ageing.

Ruiz J. Energy expenditure differences across lying, sitting, and standing positions in young healthy adults

The time spent in sedentary behaviour represents an important public health burden. To reduce sedentary time in the general population, the simplest, most effective, and most accessible method is to decrease lying and sitting time. We aimed to compare differences on energy expenditure (EE) across lying, sitting, and standing positions; and to analyse the associations between the change on EE of changing from one position to another and anthropometric and body composition parameters in young healthy adults. A total of 55 (69% women) young healthy adults aged 21.7 ± 2.2 participated in the study. We measured EE by indirect calorimetry across lying, sitting, and standing positions following the standard procedures. The EE was significantly higher in standing than in both lying and sitting positions (mean difference: 0.121±0.292 and 0.125±0.241 kcal/min, respectively; all P<0.001), and no differences were observed between lying and sitting positions (P = 1.000). There was a negative association between the EE differences in sitting vs. standing position and lean body mass (P = 0.048), yet no associations between EE differences with the rest of the anthropometric and body composition parameters were observed in each position pair studied (all P>0.321). Our findings support the fact that increasing the time spent standing could be a simple strategy to slightly increase EE. Therefore, our results have important clinical implications including a better monitoring, characterizing, and promoting countermeasures to sedentariness through low-level physical activities.

Congruent Validity of Resting Energy Expenditure Predictive Equations in Young Adults

Having valid and reliable resting energy expenditure (REE) estimations is crucial to establish reachable goals for dietary and exercise interventions. However, most of the REE predictive equations were developed some time ago and, as the body composition of the current population has changed, it is highly relevant to assess the validity of REE predictive equations in contemporary young adults. In addition, little is known about the role of sex and weight status on the validity of these predictive equations. Therefore, this study aimed to investigate the role of sex and weight status in congruent validity of REE predictive equations in young adults. A total of 132 young healthy adults (67.4% women, 18⁻26 years old) participated in the study. We measured REE by indirect calorimetry strictly following the standard procedures, and we compared it to 45 predictive equations. The most accurate equations were the following: (i) the Schofield and the "Food and Agriculture Organization of the United Nations/World Health Organization/United Nations" (FAO/WHO/UNU) equations in normal weight men; (ii) the Mifflin and FAO/WHO/UNU equations in normal weight women; (iii) the Livingston and Korth equations in overweight men; (iv) the Johnstone and Frankenfield equations in overweight women; (v) the Owen and Bernstein equations in obese men; and (vi) the Owen equation in obese women. In conclusion, the results of this study show that the best equation to estimate REE depends on sex and weight status in young healthy adults.