To Total Energy Expenditure Research Articles

Doubly labelled water-calibration approach attenuates the underestimation of energy intake calculated from self-reported dietary assessment data in Japanese older adults.

Self-reported energy intake (EI) estimation may incur systematic errors that could be attenuated through biomarker calibration. We aimed to confirm whether calibrated EI was comparable to total energy expenditure (TEE) measured using the doubly labelled water (DLW) technique. Cross-sectional study. General older population from the Kyoto-Kameoka Study, Japan. This study included sub- and main cohorts of 72 and 8058 participants aged≥ 65 years, respectively. EI was evaluated using a validated FFQ, and calibrated EI was obtained using a previously developed equation based on the DLW method. TEE was considered representative of true EI and also measured using the DLW method. We used a Wilcoxon signed-rank test and correlation analysis to compare the uncalibrated and calibrated EI with TEE. In the sub-cohort, the median TEE, uncalibrated EI and calibrated EI were 8559 kJ, 7088 kJ and 9269 kJ, respectively. The uncalibrated EI was significantly lower than the TEE (median difference = -1847 kJ; interquartile range (IQR): -2785 to -1096), although the calibrated EI was not (median difference = 463 kJ; IQR: -330 to 1541). The uncalibrated (r = 0·275) and calibrated EI (r = 0·517) significantly correlated with TEE. The reproducibility was higher for calibrated EI (interclass correlation coefficient (ICC) = 0·982) than for uncalibrated EI (ICC = 0·637). Similar findings were observed when stratifying the sample by sex. For medians, uncalibrated EI was lower (about 17 %) than calibrated EI in the main cohort. Biomarker calibration may improve the accuracy of self-reported dietary intake estimation.

Erythroderma (exfoliative dermatitis). Part 2: energy homeostasis and dietetic management strategies.

Erythroderma (exfoliative dermatitis) is associated with important metabolic changes that include an enhancement in energy expenditure. The key components to total energy expenditure (TEE) include basal metabolic rate (~68% of TEE), physical activity (~22% of TEE) and thermic effect of food (~10% of TEE). In the erythrodermic state, there are likely multiple contributors to the increase in basal metabolic rate, such as 'caloric drain' resulting from increased evaporation of water from enhanced transepidermal water loss, increased activity of the cardiovascular system (including high-output cardiac failure), increased nonshivering thermogenesis and hormonal changes such as hypercortisolaemia. A change in the patient's level of physical activity and appetite as a result of ill health status may further impact on their TEE and energy consumption. In Part 2 of this two-part concise review, we explore the key constituents of energy homeostasis and the potential mechanisms influencing energy homeostasis in erythroderma, and suggest much-needed dietetic management strategies for this important condition.

Effect of Chronic Kidney Disease on Metabolic Rate: Studies Using Doubly Labelled Water

The causes of protein malnutrition and body composition changes in chronic kidney disease (CKD) are poorly understood. Alterations to metabolic rate caused by CKD may be a contributor. Using the doubly labeled water technique and indirect calorimetry, we set out to determine whether reduced glomerular filtration rate is associated with alterations to total energy expenditure (TEE) and resting energy expenditure (REE). We also aimed to determine whether TEE in patients with CKD can be easily predicted from a physical activity questionnaire. In a prospective, observational study we evaluated 80 patients (52 men; mean age 56.7±16.2years) with CKD ranging from stage 1 to stage 5 with estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). TEE was measured using doubly labeled water isotope excretion over 14days (TEEDLW), REE by indirect calorimetry (REEIndirectCal) and physical activity level using the Stanford 7-day recall questionnaire. eGFR did not correlate with TEEDLW and REEIndirectCal. Findings with weight-adjusted energy measures were similar. REEIndirectCal and TEEDLW were significantly lower in patients whose eGFR was <50mL/min/1.73m2 and those with higher levels. There were similar findings with respect to weight-adjusted energy measures. In multivariable analysis, age, sex, and weight were independent predictors of TEEDLW and REEIndirectCal. eGFR did not predict TEE or REE in either of these models. There was no direct relationship between reduced renal function and metabolic rate. Differences in energy metabolism at lower levels of glomerular filtration rate are more likely to be due to factors such as age, body composition, and physical activity.

Validity of Dietary Assessment Methods When Compared to the Method of Doubly Labeled Water: A Systematic Review in Adults

Accuracy in quantifying energy intake (EI) using common dietary assessment methods is crucial for interpreting the relationship between diet and chronic disease. The aim of this systematic review was to evaluate the validity of dietary assessment methods used to estimate the EI of adults in comparison to total energy expenditure (TEE) measured by doubly labeled water (DLW). Articles in English across nine electronic databases, published between 1973 and February 2019 were retrieved. Studies were included if participants were adults (≥18 years) and used the DLW technique to measure TEE compared to self-reported EI. A total of 59 studies were included, with a total of 6,298 free living adults and a mean of 107 participants per study. The majority of studies including 16 studies that included a technology based method reported significant (P < 0.05) under-reporting of EI when compared to TEE, with few over-reporting EI. Misreporting was more frequent among females compared to males within recall based dietary assessment methods. The degree of under-reporting was highly variable within studies using the same method, with 24 h recalls having less variation and degree of under-reporting compared to other methods.

Validation of an Online Food Frequency Questionnaire against Doubly Labelled Water and 24 h Dietary Recalls in Pre-School Children.

The development of easy-to-use and accurate methods to assess the intake of energy, foods and nutrients in pre-school children is needed. KidMeal-Q is an online food frequency questionnaire developed for the LifeGene prospective cohort study in Sweden. The aims of this study were to compare: (i) energy intake (EI) obtained using KidMeal-Q to total energy expenditure (TEE) measured via doubly labelled water and (ii) the intake of certain foods measured using KidMeal-Q to intakes acquired by means of 24 h dietary recalls in 38 children aged 5.5 years. The mean EI calculated using KidMeal-Q was statistically different (p < 0.001) from TEE (4670 ± 1430 kJ/24 h and 6070 ± 690 kJ/24 h, respectively). Significant correlations were observed for vegetables, fruit juice and candy between KidMeal-Q and 24 h dietary recalls. Only sweetened beverage consumption was significantly different in mean intake (p < 0.001), as measured by KidMeal-Q and 24 h dietary recalls. In conclusion, KidMeal-Q had a relatively short answering time and comparative validity to other food frequency questionnaires. However, its accuracy needs to be improved before it can be used in studies in pre-school children.

A comparison and validation of child versus parent reporting of children's energy intake using food frequency questionnaires versus food records: Who's an accurate reporter?

The aim of this study was to (i) to compare the accuracy of reporting for child's total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW. Healthy weight children (mean ± SD age 9.8 ± 1.3 years, n = 6 girls/3 boys) and their parents independently completed an FFQ about children's intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW. The mean difference (limits of agreement LOA, ± 2SD) when compared to DLW was; child 130 (-1518, 1258) kcal or (113 ± 35% of TEE); father 398 (0,796) kcal or (121 ± 13%); mother 807 (-213, 1824) kcal or (144 ± 26%) and for the WFR -153 (1089, -1395) kcal or 95 ± 32%. Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years.

Subjective Measures of Exercise Intensity to Gauge Substrate Partitioning in Persons With Paraplegia

The Borg Rating of Perceived Exertion (RPE) Scale and talk test (TT) are commonly recommended for persons to gauge exercise intensity. It is not known whether they are suitable to estimate substrate partitioning between carbohydrate and fat in persons with SCI. Investigate substrate partitioning/utilization patterns associated with RPE and TT. Twelve participants with chronic paraplegia underwent 2 arm crank exercise tests on nonconsecutive days within 2 weeks. Test 1 was a graded exercise test (GXT) to volitional exhaustion. Test 2 was a 15-minute self-selected steady state (SS) voluntary arm exercise bout simulating a brief, yet typical exercise session. For the GXT, very light intensity exercise (RPE < 9) and TT stage before last positive were associated with highest contribution of fat oxidation (~35%-50%) to total energy expenditure (TEE). Fat oxidation was low at all stages, with the highest rate (0.13 ± 0.07 g/min) occurring at stage 1 (10 W). Corresponding average RPE was 7 ± 2 and the TT was positive for all participants at this stage. For the SS, fuel partitioning throughout exercise was dominated by carbohydrate oxidation (1.47 ± 0.08 g/min), accounting for almost all (~94%) of TEE with only a minute contribution from fat oxidation (0.02 ± 0.004 g/min). A positive TT was associated with an average contribution of fat oxidation of ~10%. RPE but not the TT appears suitable to predict exercise intensities associated with the highest levels of fat oxidation. However, such intensities are below authoritative intensity thresholds for cardiorespiratory fitness promotion, and therefore the applicability of such a prediction for exercise prescriptions is likely limited to individuals with low exercise tolerance.

A feasibility study comparing two metabolic monitors in hospitalised patients following an ischaemic stroke

Background: Data on the energy requirements of patients following acute ischaemic stroke are scarce. A recent draft report highlighted the lack of data on physical activity levels during and following acute illness (SACN, 2009). The aims of this study were to establish if two metabolic monitors (CCM Express™ and the Sensewear™ armband) were feasible for use in hospitalised stroke patients and to determine the relative contributions of resting energy expenditure (REE) and physical activity to total energy expenditure (TEE). Methods: Eleven medically stable patients (seven male; four female) were recruited within 7 days of ischaemic stroke. Exclusion criteria: unable to give informed consent, receiving renal replacement therapy, body mass index (BMI) ≥ 50 kg m−2, known nickel allergy or receiving end-of-life care. All subjects were fasted from midnight and REE was measured early in the morning using the CCM Express™ for a period of up to 1 h (including establishment of steady-state (i.e. <10% difference in minute to minute VO2 and VCO2 measurements over 5 min). Concurrently, TEE was measured using the Sensewear™ armband for a period of 24 h. Assessments of patient acceptability and tolerance of both metabolic monitors were conducted by direct observation, completion of a checklist and, where clinically appropriate, a brief patient questionnaire. REE was compared with predicted basal metabolic rate (BMR) (Henry, 2005) and physical activity was estimated using the Metabolic Equivalent Task (MET) method, where 1.0 MET is equivalent to the energy expended at rest. Results: Mean age was 69.8 years (range 42–84 years) and mean (SD) BMI was 25.4 (5.2) kg m−2. All subjects were able to tolerate measurement of REE using the CCM Express™, although the facemask caused some discomfort to one subject with facial abrasions. Mean (SD) REE was 1257 (357) kcal day−1 and, perhaps unexpectedly, was lower than predicted BMR [1503 (226) kcal day−1; t-test, P = 0.07]. It was, however, difficult to achieve steady-state in four patients; thus, these REE measurements were unreliable. All subjects were able to tolerate measurement of TEE using the Sensewear™ armband. Mean (SD) TEE was 1663 (303) kcal day−1. Physical activity on the ward was very low, with subjects expending very little more energy than would be expected at rest [METS = 1.01 (SD 0.15)]. Discussion: Both metabolic monitors were well tolerated by the subjects; however, the unreliable REE measurements in some patients made it impossible to determine the relative contribution of REE to TEE. The results obtained regarding TEE and the low activity level in this study were comparable to results reported in other metabolic studies of patients who have had a stroke (Weekes & Elia, 1992; Finestone et al., 2003; Leone & Pencharz, 2010). Conclusions: Both metabolic monitors were feasible for use in patients following ischaemic stroke; however, some measurements of REE using the CCM Express™ were unreliable because of difficulties in establishing steady-state and the reasons for this merit further investigation. In this group of patients, physical activity on the ward was very low following a stroke.

Sedenatry Occupation, Its Validity and Risk for Colon Cancer

Although sedentary occupation has become more common, it is still uncertain how much physical activity spent at work contributes to total energy expenditure (TEE) and health outcomes. PURPOSE: The primary objective of this study is to examine the relationship between posture at work and TEE by the DLW method as a gold standard. The secondary objective is to investigate the relationship between posture at work and cancer incidence. METHODS: 1) Study participants were 226 Japanese men and women aged 20 to 83 years. TEE and TEE per unit weight (TEE/BW) were estimated over one or two weeks depending on the two half-lives of the isotopes using the DLW method. The posture at work, which is a component of our physical activity questionnaire (JALPAQ), was surveyed for every participant before DLW dosing. 2) We asked similar questions about physical activity of 7,796 urban male workers aged 35-59 who participated in periodic health check-up between 1988 and 1990. Subjects were followed till the end of December, 1994, and a total of 123 cancers (and 36 colon cancers) were identified during the period by Osaka Cancer Registry. Cox proportional hazards models were used to estimate age-adjusted relative risks (RR) and 95% confidence intervals (CI). RESULTS: The posture at work was most closely related with TEE/BW, and there was the dose-response relationship between the posture and TEE/BW. The relation of the posture at work with all-cause cancer appeared to be U-shaped. Compared to those who were almost sitting, those who were standing more frequently had a significantly lower risk (RR = 0.46, CI = 0.22-0.98). There seemed to be dose-response relationships between the posture and colon cancer. Compared to those who were almost sitting, RRs (CI) for those who were sitting more frequently, sitting for half of work time, standing more frequently, and almost standing were 0.50(0.20-1.28), 0.59(0.24-1.44), 0.45(0.13-1.54), and 0.27(0.09-0.83), respectively. CONCLUSIONS: These data suggest that the posture at work is a simple and useful question item to estimate a TEE, and the sedentary lifestyle may be one of strong risk factors for colon cancer among Japanese male workers.

Energy Intake of Swedish Overweight and Obese Children Is Underestimated Using a Diet History Interview

Estimating energy intake (EI) of a child by using a diet history interview (DHI) method may be a challenge because of difficulty for the child to remember what has been eaten as well as to report portion sizes. The aim of this research was to validate reported EI from a DHI in children classified as overweight or obese by comparing the reported EI to total energy expenditure (TEE) measured by 2 objective measures. Eighty-five 10.5- ± 1.1-y-old overweight and obese children, with help from 1 or 2 parents, reported their EI 2 wk retrospectively in a DHI. Reported EI was compared with TEE, as measured by SenseWear armband (n = 85) and the doubly-labeled water (DLW) method (n = 21), during the same period as the DHI. Reported EI was underestimated by 14% when validated against both the armband and DLW method. Underestimation did not differ between boys and girls. However, the EI of obese children was underestimated by 22%, which is twice the rate as for the overweight children (95% CI: 0.55, 3.08). Underestimated EI was negatively correlated with BMI (r = −0.38; P = <0.01) as well as age (r = −0.21; P = 0.05). EI is underestimated to a higher extent among children with higher BMI and higher age when using a DHI method. The findings show the importance of validating dietary intake of children in general and in overweight and obese children in particular.

Le mouvement secondaire, l’activité intégrée aux habitudes de vie et le sommeil : les nouvelles frontières de l’évaluation de l’activité physiqueCet article est tiré d’un supplément intitulé Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines (Favoriser les lignes directrices et la mesure de l’activité physique au

Canadian public health messages relating to physical activity have historically focused on the prescription of purposeful exercise, most often assessing leisure-time physical activity (LTPA). Although LTPA contributes to total energy expenditure (TEE), a large part of the day remains neglected unless one also considers the energy expended outside of purposeful exercise. This paper reviews the potential impact of incidental (non-exercise or non-purposeful) physical activity and lifestyle-embedded activities (chores and incidental walking) upon TEE and indicators of health. Given that incidental movement occurs sporadically throughout the day, this form of energy expenditure is perhaps most vulnerable to increasingly ubiquitous mechanization and automation. The paper also explores the relationship of physical inactivity, including sleep, to physical activity, TEE, and health outcomes. Suggestions are provided for a more comprehensive physical activity recommendation that includes all components of TEE. Objective physical activity monitors with time stamps are considered as a better means to capture and examine human movements over the entire day.

Incidental movement, lifestyle-embedded activity and sleep: new frontiers in physical activity assessmentThis article is part of a supplement entitled Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines co-published by Applied Physiology, Nutrition, and Metabolism and the Canadian Journal of Public Health. It may be cited as

Canadian public health messages relating to physical activity have historically focused on the prescription of purposeful exercise, most often assessing leisure-time physical activity (LTPA). Although LTPA contributes to total energy expenditure (TEE), a large part of the day remains neglected unless one also considers the energy expended outside of purposeful exercise. This paper reviews the potential impact of incidental (non-exercise or non-purposeful) physical activity and lifestyle-embedded activities (chores and incidental walking) upon TEE and indicators of health. Given that incidental movement occurs sporadically throughout the day, this form of energy expenditure is perhaps most vulnerable to increasingly ubiquitous mechanization and automation. The paper also explores the relationship of physical inactivity, including sleep, to physical activity, TEE, and health outcomes. Suggestions are provided for a more comprehensive physical activity recommendation that includes all components of TEE. Objective physical activity monitors with time stamps are considered as a better means to capture and examine human movements over the entire day.

Energy requirements of adults

To describe issues related to energy requirements of free living adults and discuss the importance of basal metabolic rate (BMR) and their relationships to total energy expenditure (TEE ) and physical activity level (PAL, derived as TEE/BMR) and to determine the influence of body weight, height, age and sex. Based on a review of the literature, this paper examines the variability in BMR due to methodology, ethnicity, migration and adaptation (both metabolic and behavioural) due to changes in nutritional status. Collates and compiles data on measurements of TEE in free living healthy adults, to arrive at limits and to compare TEE of populations with different life-styles. The constancy of BMR and its validity as a reliable predictor of TEE in adults as well as the validity of PAL as an index of TEE adjusted for BMR and thus its use to categorise the physical activity pattern and lifestyle of an individual was confirmed. The limits of human daily energy expenditure at around 1.2 x BMR and 4.5 x BMR based on measurements made in free living adults have been reported in the literature. A large and robust database now exists of energy expenditure measurements obtained by the doubly labelled water method in the scientific literature and the data shows that, in general, levels of energy expenditure are similar to the recommendations for energy requirements adopted by FAO/WHO/UNU (1985). The review also confirms that metabolic adaptation to energy restriction is not an important factor that needs to be considered when recommending energy requirements for adults in developing countries.

An easy-to-use semiquantitative food record validated for energy intake by using doubly labelled water technique

Estimating dietary intake is important for both epidemiological and clinical studies, but often lacks accuracy. To investigate the accuracy and validity of energy intake estimated by an easy-to-use semiquantitative food record (EI(SQFR)) compared to total energy expenditure (TEE) estimated by doubly labelled water technique (EE(DLW)). TEE was measured in 29 nonobese subjects using the doubly labelled water method over a period of 14 days. Within this period, subjects reported their food consumption by a newly developed semiquantitative food record for 4 consecutive days. Energy intake was calculated using the German Food Code and Nutrition Data Base BLS II.3. A good correlation was observed between EI(SQFR) and EE(DLW) (r = 0.685, P < 0.001). The mean difference between EI(SQFR) and EE(DLW) was -1.7+/-2.6 MJ/day (-14+/-21%, P = 0.002). An underestimation of EI(SQFR) <10% was observed in nine subjects (31%), of 10-20% in six subjects (21%), and of >20% in nine subjects (31%). In five subjects (17%), an overestimation of EI(SQFR) was observed. The easy-to-use semiquantitative food record provided good estimates of EI in free-living and nonobese adults without prior detailed verbal instructions. The presented food record has limitations regarding accuracy at the individual level.

THE CSA ACTIVITY MONITOR VALIDATED BY DOUBLY LABELED WATER IN ACTIVE ADOLESCENTS: A REPEATED TRIAL

1108 The purpose of this study was evaluate the suitability of the CSA activity monitor for assessment of physical activity. Activity data have been compared to total energy expenditure (TEE) and its derivatives measured by the doubly water (DLW) method. Seven young athletes (speed skaters)(mean age 18.5±1.0 y) were monitored by the CSA activity monitor for 8 consecutive days. Mean activity counts (cnts/min) were correlated against TEE, TEE-Resting Metabolic Rate (RMR), TEE-RMR/kilogram of body mass and Physical Activity Level (PAL=TEE/RMR). All measurements were performed twice during two different training periods. During the first period the main exercise performed was running whereas the second period mainly involved technique training. Activity counts were significantly correlated to all energy estimates (r=.90-.93, P<0.01) during the first period. When information about non-registered time was added to activity counts in a multiple regression analysis, the explained variance for TEE was 78%. No significant correlations were observed during the second period. The results indicate that the CSA activity monitor accurately assesses TEE and its derivatives during training periods which involves running. Activity counts is not related to energy estimates during a period of specific training (eg. inline skating, slideboard training).

EFFECT OF DIET AND EXERCISE VERSUS DIET ALONE ON LBM CHANGES IN ADULT OBESE MALES 666

This was a ten week long study to investigate the effect of lean body mass(LBM) preservation during diet and exercise (DE) versus diet alone (D) for adult obese males. Since LBM is one of the largest contributors to total energy expenditure (TEE), the preservation of LBM is an important factor when designing weight loss programs. This study involved fourteen participants(Mean ± SD): age 42 (±11) & 49 (±7), weight 290(±54) & 294 (±60), body mass index (BMI) 39 (±6)& 37 (±7), percent body fat (%BF) 45 (±4) & 41(±4), lean body mass 159 (±27) & 174 (±27), diet group (D) and diet and exercise group (DE) respectively. The subjects were assigned to either a diet and exercise group (n=7) or a diet alone group(n=7). All of the subjects were placed on a 1200 calorie per day diet. All subject were involved in weekly behavior modification classes. The exercise performed by the DE group consisted of one hour of walking five times per week. Measurement of the subjects% BF and LBM were determined using hydrostatic weighing. Table There occured a significant weight loss for both groups pretest versus posttest. There were no significance in the amount of LBM that was preserved between the groups. The changes that occured between groups for BMI and% body fat were also not significant. This data suggest there is no a difference in LBM preservation with the addition of exercise to a weight loss regimen in an obese population. This may be due to the large amount of work encountered with everyday activities due to their large body mass.

Calculation versus measurement of total energy expenditure.

In acutely ill patients both hypo- and hyperalimentation must be avoided by adjusting caloric intake to total energy expenditure (TEE). We determined the discrepancy between basal energy expenditure (BEE) calculated from the basic Harris-Benedict formula and TEE measured by continuous indirect calorimetry in a heterogeneous group of mechanically ventilated surgical patients. We also compared the accuracy of TEE calculated from the corrected Harris-Benedict formula or estimated by intermittent indirect calorimetry to that of TEE measured by continuous indirect calorimetry. The poor correlation between calculated BEE and measured TEE was significantly (p less than .05) improved by a correction factor based on each patient's clinical condition. The mean absolute difference between calculated TEE and measured TEE was 8.9 +/- 9.6 (SD) %. Calculations were significantly (p less than .05) improved by estimating TEE from two 5-min recording periods, which suggests that continuous indirect calorimetry may not always be necessary to guide caloric replacement.