Total Energy Expenditure In Children Research Articles

Determining total energy expenditure in 3–6-year-old Japanese pre-school children using the doubly labeled water method

The doubly labeled water (DLW, 2H218O) method for calculating the total production of CO2 over several days is currently considered to be the most accurate technique for the measurement of total energy expenditure (TEE), and the results obtained using this method have been used to review energy requirements. Presently, there is limited data available on TEE in Japanese children. The objective of this study was to assess the TEE in pre-school Japanese children using the DLW method. We used a cross-sectional population of 140 children (69 boys and 71 girls) aged 3–6 years. TEE was measured using the DLW method over 8 days under free-living conditions. The average weights (kg) of the boys and girls were 15.6 ± 2.5 and 15.0 ± 2.1 for the 3–4 years old and 19.8 ± 3.8 and 19.6 ± 2.7 for the 5–6 years old, respectively. The corresponding TEE (kcal/day) was 1260.9 ± 357.8 and 1265.2 ± 408.0, and 1682.3 ± 489.0 and 1693.1 ± 473.3, respectively, showing a significant difference with respect to age. Furthermore, TEE per body weight (kcal/kg/day) was 83.2 ± 29.2 and 84.9 ± 26.6, and 85.4 ± 23.2 and 86.7 ± 22.6, respectively. However, when TEE was adjusted for body weight or fat-free mass, there were no age or sex differences. We conclude that in Japanese children, TEE in those aged 3–4 years was similar to the current Ministry of Health recommendations. However, TEE in children aged 5–6 years was slightly higher than the recommendations. Based on these findings, the present results obtained from a large number of participants will provide valuable reference data for Japanese children.

Total energy expenditure among children with motor, intellectual, visual, and hearing disabilities: a doubly labeled water method.

Few studies have evaluated the total energy expenditure (TEE) of children with disabilities using the doubly labeled water (DLW) method; however, none have compared it by disability type. Furthermore, no large-scale studies have focused on the severity of motor disability (MD). We aimed to compare TEE in children with disabilities by disability type. In a cross-sectional study design, TEE was measured using the DLW method, anthropometry, and weighted food records. The following comparisons were made: (1) TEEs among four disability types and (2) TEEs of three subgroups classified by MD based on the Gross Motor Function Classification System (GMFCS). In total, 256 children (138 boys; ages 6-15 years) were studied. The comparison between the four disability types for boys in all age categories revealed that TEE (kJ/d) was lowest in MD, followed by intellectual disability (ID), visual disability, and hearing disability (HD), in that order. TEE/fat-free mass (FFM) (kJ/FFMkg/d) was also lowest in MD and highest in HD. TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were also lowest in MD and highest in HD in girls. For both boys and girls, TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were higher in the MD subtype GMFCS I-II than in GMFCS III-IV and GMFCS V. TEE differed, depending on the disability type, and was the lowest in MD and highest in HD for both boys and girls. Analysis by GMFCS classification revealed that greater severity of motor dysfunction resulted in lower TEE.

Total and activity-induced energy expenditure measured during a year in children with inflammatory bowel disease in clinical remission remain lower than in healthy controls.

Pediatric inflammatory bowel disease (IBD) is often associated with growth retardation due to malnutrition. However, knowledge on total energy expenditure (TEE), active-induced energy expenditure (AEE) and physical activity remains limited in children with IBD. Assessment of TEE using the doubly labelled water (DLW) method, resting energy expenditure (REE) using indirect calorimetry, and physical activity level using the actigraph GT3X+ in children with IBD (in remission) and healthy controls. TEE, REE, AEE and physical activity were measured in 21 children with IBD and 24 healthy controls at baseline. IBD children parameters were monitored further after 6 and 12 months. Predicted REE and TEE values (using Schoefield and the actigraph GT3X+, for REE and TEE respectively) were compared to measured values. Mean ages at baseline were 14.8±1.5 and 13.2±2 years in children with IBD and in healthy control children, respectively. Measured TEEDLW was significantly lower (P<0.001) in children with IBD compared to the healthy control group. REE corrected by FFM0.5, REE and AEE were also significantly lower in children with IBD. Children with IBD had AEE of 17.5% of TEE and had a significantly higher sedentary behaviour as compared to healthy children. This study suggests that TEE and AEE are reduced in children with IBD in clinical remission which may result in a reduced moderate and vigorous physical activity level. Our result also highlights that the actigraph GT3X+might give good prediction of TEE in children with IBD at group level but it remains highly variable at individual level.

Using an Allometric Equation to Accurately Predict the Energy Expenditure of Children and Adolescents With Nonalcoholic Fatty Liver Disease.

Pediatric patients with nonalcoholic fatty liver disease (NAFLD) require targeted nutrition therapy that relies on calculating energy needs. Common energy equations are inaccurate in predicting resting energy expenditure (REE), influencing total energy expenditure (TEE) estimates. Equations based on allometric scaling are simple, accurate, void of subjective activity and/or stress factor bias, and they estimate TEE. To investigate the predictive accuracy of an allometric energy equation (AEE) in predicting TEE of children and adolescents with NAFLD. Retrospective study performed in a single institution. The allometric equation was used to calculate AEE, and the results were compared with TEE calculated using indirect calorimetry data (measured REE) multiplied by an activity factor (AF) of 1.5 or 1.7. Fifty-six patients with a mean age of 13 years were included in this study. The agreement between TEE (using an AF of 1.5) and AEE was -96 kcal/d (confidence interval, -29 to 221). The predictive accuracy of the allometric equation was not different between obese and nonobese patients. Allometric equations allow for accurate estimation of TEE in children with NAFLD.

A pilot study to assess Total Energy Expenditure in Children with Severe Burns during acute hospitalization: Application of the Doubly Labelled Water Method

IntroductionSevere burn injury causes a prolonged hypermetabolic response leading to losses in weight and lean mass, whereas excessive feeding has been associated with increased morbidity and mortality. Several equations have been developed to assist nutritional management in pediatric burn patients, but there are no universally accepted guidelines. The doubly labelled water (DLW) technique is a validated method to calculate total energy expenditure (TEE), which has only been used in burn children during rehabilitation. The aim of this study is two‐fold; to assess the feasibility of employing the DLW method in critically injured children and to estimate total energy needs of these patients compared to healthy children.MethodsFor this prospective exploratory study we are recruiting children aged 4–18 years with at least 30% of Total Body Surface Area (TBSA) burned admitted to Shriners Hospital for Children, Galveston. TEE is measured during the acute phase of their injury, while being non‐ambulatory, using the DLW method over a 4–7 days period. Time of study initiation and termination are determined from their surgery schedule and overall health status. The average study starting time is 23 ± 5 days post burn. A second DLW dose is administered on the last study day on children who have more than 3% weight loss to determine changes in total body water. A group of healthy children are also being recruited and administered DLW over a 14‐day period. For both groups REE is measured by indirect calorimetry during the study period.ResultsTo date we have studied 6 burned and 2 healthy children. Because burn injury and subsequent skin grafting procedures result in high water turnover that can affect the precision of the method, we had to exclude from further analysis two patients that exhibited estimated water turnover rates of &gt; 40% daily. One more patient was excluded due to undergoing an unscheduled surgery during the study. Our preliminary results are based on the remaining 3 patients; mean burn size was 59% ± 20% (range, 34%–83%) of TBSA, mean age was 12.6 ± 0.4 years (range, 12–13) and mean weight was 50 ± 6.5 kg (range, 41–55.3). Daily TEE averaged 66 ± 16 kcal/kg (range, 48–87) and was 1.45 ± 0.25 times measured REE (range, 1.2–1.7). For healthy children mean age and weight were 8 ± 1 years (range, 7–9) and 28.5 ± 4 kg (range, 24.5–32.6) respectively. Average daily TEE was calculated to be 62 ± 7 kcal/kg (range, 55–69) and 1.6 ± 0.03 times measured REE (range, 1.58–1.64).ConclusionsBurn injury presents several challenges to the application of the DLW method. A significant percentage of recruited patients may have to be excluded from final analysis due to very high water turnover or unanticipated surgeries with associated fluid transfusion. However such an approach is feasible and can provide precise estimates of TEE. Energy requirements of bedridden children during acute burn injury are elevated to levels comparable or higher than healthy active individuals.Support or Funding InformationThis work was funded by NIH (P50 GM060338 and R01 GM056687) and SHC (84080 and 80490)

Validation of a modified three-day weighed food record for measuring energy intake in preschool-aged children with cerebral palsy

Accurate energy intake (EI) determination in children with cerebral palsy (CP) is critical for nutritional management, however no valid measures exist. We aimed to validate a modified three-day weighed food record for measuring EI in preschool-aged children with CP. Thirty-one children with CP (61% male) of all functional abilities and 15 typically developing children (TDC) (63% male), median age 3.79 years participated. A three-day weighed food record was validated by comparing reported EI to measured total energy expenditure (TEE) via doubly labelled water, assuming a state of weight balance. Children with moderate-severe CP showed no difference between EI and TEE. Values for EI were less than TEE in children with mild CP and TDC (p<0.01, limits of agreement-2559 to 845kJ and-2524 to 350kJ respectively). The mean difference between EI and TEE as a percentage of measured TEE was 14.8% (mild CP), 4.3% (moderate-severe CP) and 16.8% (TDC), all less than data detailing typical within-subject variability in day-to-day EI. In contrast to previous literature, results demonstrated that a modified three-day weighed food record accurately measured EI in preschool-aged children with CP. This record can be used in clinical practice and future research to accurately determine EI in this population.

A Systematic Review of the Validity of Dietary Assessment Methods in Children when Compared with the Method of Doubly Labeled Water

Measuring dietary intake in children enables the assessment of nutritional adequacy of individuals and groups and can provide information about nutrients, including energy, food, and eating habits. The aim of this review was to determine which dietary assessment method(s) provide a valid and accurate estimate of energy intake by comparison with the gold standard measure, doubly labeled water (DLW). English-language articles published between 1973 and 2009 and available from common nutrition databases were retrieved. Studies were included if the subjects were children birth to age 18 years and used the DLW technique to validate reported energy intake by any other dietary assessment method. The review identified 15 cross-sectional studies, with a variety of comparative dietary assessment methods. These included a total of 664 children, with the majority having <30 participants. The majority of dietary assessment method validation studies indicated a degree of misreporting, with only eight studies identifying this to a significant level ( P<0.05) compared to DLW estimated energy intake. Under-reporting by food records varied from 19% to 41% (n=5 studies) with over-reporting most often associated with 24-hour recalls (7% to 11%, n=4), diet history (9% to 14%, n=3), and food frequency questionnaires (2% to 59%, n=2). This review suggested that the 24-hour multiple pass recall conducted over at least a 3-day period that includes weekdays and weekend days and uses parents as proxy reporters is the most accurate method to estimate total energy intake in children aged 4 to 11 years, compared to total energy expenditure measured by DLW. Weighed food records provided the best estimate for younger children aged 0.5 to 4 years, whereas the diet history provided better estimates for adolescents aged ≥16 years. Further research is needed in this area to substantiate findings and improve estimates of total energy expenditure in children and adolescents.

Energy expenditure and physical activity of ambulatory children with cerebral palsy and of typically developing children

Children with cerebral palsy (CP) expend more energy when walking than do their typically developing peers. The effect this has on physical activity levels (PALs) and on total energy expenditure (TEE) will have important implications when determining energy requirements. This study aimed to investigate the components of TEE in children with CP in comparison with typically developing children and to determine what effect the higher energy expenditure during walking has in ambulatory children with CP on PAL and on TEE. Sixteen children with mild CP and 16 typically developing children, aged 5-12 y, were recruited for the study. Resting energy expenditure (REE) and the energy expenditure during walking were measured by using indirect calorimetry. TEE was determined by using the doubly labeled water technique. PAL was calculated as the ratio of TEE to REE. Body composition was estimated by using oxygen-18. TEE was lower in children with CP (7012 +/- 1268 kJ/d) than in typically developing children (8309 +/- 2088 kJ/d) because of a lower PAL (1.57 +/- 0.23 compared with 1.79 +/- 0.26). The children with CP expended significantly more energy when walking than did the typically developing children (13.8 +/- 4.9 compared with 10.3 +/- 2.3 kJ/min) while walking at a lower velocity (61 +/- 10 compared with 72 +/- 8 m/min). Correlations between energy expenditure during walking and PAL were not statistically significant for either group. Children with CP expend more energy during walking and have a lower PAL and lower energy requirements than do typically developing children. This has important implications when estimating the energy requirements of children with CP.

Increased television viewing is associated with elevated body fatness but not with lower total energy expenditure in children

Background: Television (TV) viewing in children is associated with a higher body mass index, but it is unknown whether this reflects body fatness, and, if it does, why.Objective: The objective was to investigate whether TV viewing is associated with body fatness, physical activity, and total energy expenditure in preschool children.Design: Eighty-nine children were recruited into a cross-sectional study. Total daily energy expenditure (TEE) was measured by doubly labeled water, body composition by dual-energy X-ray absorptiometry, and physical activity by accelerometry.Results: There was a significant positive association between fat mass (corrected for fat-free body mass) and TV viewing (F = 9.05, P = 0.004). Each extra hour of watching TV was associated with an extra 1 kg of body fat. Children who watched more TV were also significantly less physically active (F = 5.16, P = 0.026). Independent of body composition and sex, children with greater physical activity levels had higher TEE (F = 5.15, P = 0.029); however, physical activity did not mediate the relation between TV viewing and adiposity (P > 0.05).Conclusions: Preschool children who watch more TV are fatter and are less active, and activity influences TEE. However, despite TV viewing being linked to lower physical activity, the relation between TV viewing and fatness is not mediated by physical activity. The results suggest that a relation between TV viewing and fatness is more likely to be due to an effect on food intake.

Application of cross-sectional time series modeling for the prediction of energy expenditure from heart rate and accelerometry

Accurate estimation of energy expenditure (EE) in children and adolescents is required for a better understanding of physiological, behavioral, and environmental factors affecting energy balance. Cross-sectional time series (CSTS) models, which account for correlation structure of repeated observations on the same individual, may be advantageous for prediction of EE. CSTS models for prediction of minute-by-minute EE and, hence, total EE (TEE) from heart rate (HR), physical activity (PA) measured by accelerometry, and observable subject variables were developed in 109 children and adolescents by use of Actiheart and 24-h room respiration calorimetry. CSTS models based on HR, PA, time-invariant covariates, and interactions were developed. These dynamic models involve lagged and lead values of HR and lagged values of PA for better description of the series of minute-by-minute EE. CSTS models with random intercepts and random slopes were investigated. For comparison, likelihood ratio tests were used. Log likelihood increased substantially when random slopes for HR and PA were added. The population-specific model uses HR and 1- and 2-min lagged and lead values of HR, HR(2), and PA and 1- and 2-min lagged values of PA, PA(2), age, age(2), sex, weight, height, minimum HR, sitting HR, HR x height, HR x weight, HR x age, PA x weight, and PA x sex interactions (P < 0.001). Prediction error for TEE was 0.9 +/- 10.3% (mean +/- SD). Errors were not correlated with age, weight, height, or body mass index. CSTS modeling provides a useful predictive model for EE and, hence, TEE in children and adolescents on the basis of HR and PA and other observable explanatory subject characteristics of age, sex, weight, and height.

Total Energy Expenditure in Children Assessed by Doubly Labeled Water and Physical Activity Questionnaire

Accurate assessment of physical activity and energy expenditure in children is crucial for understanding physical activity status and guiding prevention efforts. PURPOSE: This study was to assess the total daily energy expenditure in children in Hong Kong using doubly labeled water (DLW) method and physical activity questionnaire. METHODS: Eight 7–9 years old non-obese boys (Mean ± SD, age: 8.1 ± 0.6 y; Body mass: 25.4 ± 3.0 kg; Body mass index: 16.0 ±2.1) recruited from local primary school participated in this study. Basal metabolic rate (BMR) was determined by indirect calorimetry. Total daily energy expenditure (TEE) was measured over a 10-day period by DLW method (TEEDLW) and a 3-day physical activity questionnaire (TEEQ). Energy intake (EI) was estimated by a 3-day weighed food diary. The physical activity level (PAL) was calculated from TEEDLW/BMR and the 3-day heart rate (HR) record. RESULTS: The TEE and DLW method showed similar results in assessing TEE in the schoolchildren (1900.7 ± 293.7 kcal and 1756.4 ± 296.5 kcal, NS), whereas the EI was 1705.8 ± 129.0 kcal. Reported physical activity energy expenditure and EI from food diary record during weekend (35.7 ± 3.5 METs·min, 1779.2 ± 326.2 kcal) was lower than that during weekday (39.3 ± 2.6 METs.min, 1961.6 ± 321.3 kcal, P<0.05). PAL of this group was 1.49 ± 0.26 on weekdays and 1.48 ± 0.14 at weekend. The HR record showed that these children spent only 1.3% of their time in moderate physical activity, i.e., HR 140–160 bpm, within the 3-day period. Only one child experienced a single 10-minute period with the HR above 140 bpm during the monitored weekdays. CONCLUSIONS: The results suggested that the physical activity level in these Hong Kong primary schoolchildren was alarmingly low. The 3-d physical activity questionnaire produced results similar to DLW method in estimating the total energy expenditure in these schoolchildren.

Calculation of resting energy expenditure in obese children

For the calculation of resting energy expenditure, which is the main part of total energy expenditure in children with low physical activity, Fusch et al. have developed an equation. This equation might be useful for research but not in daily work with obese patients.

Total energy expenditure in children with obstructive sleep apnoea syndrome.

Childhood obstructive sleep apnoea syndrome (OSAS) acts as a check on growth and nutritional status. An increase in sleeping energy expenditure has been proposed as a possible mechanism, but to date, no studies have determined whether energy requirements (total energy expenditure; TEE) are raised in OSAS. The aim of this study was to test the hypothesis that OSAS is associated with increased TEE. Eleven children (mean+/-SD 5.8+/-2.2 yrs of age) with OSAS confirmed by nocturnal polysomnography were each matched with a pair of healthy controls (n=22) of the same age and sex. TEE was measured using the doubly-labelled water method in all subjects. In 10/11 patients TEE was also measured after adenotonsillectomy and changes in TEE assessed. There was no significant difference in TEE between patients (mean+/-SD 325+/-44 kJ x kg(-1) x day(-1)) and controls (339+/-48 kJ x kg(-1) x day(-1)), nor between patients and age- and sex-specific literature data on TEE, using the doubly-labelled water method. Differences in TEE within patients, before versus after surgery, were minor and not statistically significant. This study does not support the hypothesis that obstructive sleep apnoea syndrome in childhood is associated with increased energy requirements, and suggests that alternative explanations for the effect of this syndrome on growth and energy balance should be sought.

Influence of sex, seasonality, ethnicity, and geographic location on the components of total energy expenditure in young children: implications for energy requirements.

BackgroundThere are limited data on the influence of body composition, sex, seasonality, ethnicity, and geographic location on the components of energy expenditure in children. ObjectiveThe objective was to examine the determinants of total energy expenditure (TEE), resting energy expenditure (REE), and activity-related energy expenditure (AEE) in children. DesignCross-sectional data from 232 children (4-10 y of age) from 4 ethnic groups (white American, African American, Guatemalan Mestizo, and Native American Mohawk) were examined. ResultsIn 104 white children studied in Vermont and Alabama, TEE was significantly higher in spring than in fall, higher in boys than in girls, and higher in children in Vermont (all effects: approximately ≈ 0.42 MJ/d, P < 0.05). The significant effect of sex was explained through REE; the influences of season and location were explained through AEE. In all children, there was no effect of sex but a significant effect of ethnicity (P < 0.01) on TEE: a significant effect of sex (P < 0.01) and no effect of ethnicity (P = 0.16) on REE; and no effect of sex and a significant effect of ethnicity on AEE. The significant effects of ethnicity were due to lower values in Guatemalan children. TEE correlated most strongly with weight (r = 0.81) and fat-free mass (r = 0.79-0.81); REE with weight (r = 0.85) and fat-free mass (r = 0.80-0.87); and AEE with maximal oxygen consumption (r = 0.54), fat-free mass (r = 0.50), and fat mass (r = 0.49). Conclusions1) Season and location influenced TEE in children through their effects on AEE, 2) a higher REE in boys was consistent across all groups examined, 3) Guatemalan children had lower TEE due to a lower AEE, 4) body weight may be the best predictor of TEE, and 5) maximal oxygen consumption was the strongest marker of AEE. Am J Clin Nutr 1998; 68:675–82.