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PubMed2001

Do critically ill surgical neonates have increased energy expenditure?

BACKGROUND/PURPOSE: Adult metabolic studies suggest that critically ill patients have increased energy expenditures and thus require higher caloric allotments. To assess whether this is true in surgical neonates the authors utilized a validated, gas leak-independent, nonradioactive, isotopic technique to measure the energy expenditures of a stable postoperative group and a severely stressed cohort. METHODS: Eight (3.46+/-1.0 kg), hemodynamically stable, total parenteral nutrition (TPN)-fed, nonventilated, surgical neonates (5 with gastroschisis, 2 with intestinal atresia, and 1 with intestinal volvulus) were studied on postoperative day 15.5+/-11.9. These were compared with 10 (BW = 3.20+/-0.2 kg), TPN-fed, extracorporeal life support (ECLS)-dependent neonates, studied on day of life 7.0+/- 2.8. Energy expenditure was obtained using a primed, 3-hour infusion of NaH(13)CO(3'), breath (13)CO(2) enrichment determination by isotope ratio mass spectroscopy, and the application of a standard regression equation. Interleukin (IL)-6 levels and C-reactive protein (CRP) concentrations were measured to assess metabolic stress. Comparisons between groups were made using 2 sample Student's t tests. RESULTS: The mean energy expenditure was 53+/-5.1 kcal/kg/d (range, 45.6 to 59.8 kcal/kg/d) for the stable cohort and 55+/-20 kcal/kg/d (range, 32 to 79 kcal/kg/d) for the ECLS group (not significant, P =.83). The IL-6 and CRP levels were significantly higher in the ECLS group (29 +/-11.5 v 0.7+/-0.6 pg/mL [P<.001], and 31+/-22 v 0.6+/-1.3 mg/L [P<.001], respectively). Mortality rate was 0% for the stable postoperative patients and 30% for the ECLS group. CONCLUSIONS: Severely stressed surgical neonates, compared with controls, generally do not show increased energy expenditures as assessed by isotopic dilution methods. These data suggest that the routine administration of excess calories may not be warranted in critically ill surgical neonates and support the hypothesis that neonates obligately redirect energy, normally used for growth, to fuel the stress response. This is a US government work. There are no restrictions on its use.

C-Reactive Protein↗
PubMed2002

Energy expenditure in ill premature neonates.

BACKGROUND/PURPOSE: The energy needs of critically ill premature neonates undergoing surgery remain to be defined. Results of studies in adults would suggest that these neonates should have markedly increased energy expenditures. To test this hypothesis, a recently validated stable isotopic technique was used to measure accurately the resting energy expenditure (REE) of critically ill premature neonates before and after patent ductus arteriosus (PDA) ligation. METHODS: Six ventilated, fully total parenteral nutrition (TPN)-fed, premature neonates (24.5 plus minus 0.5 weeks' gestational age) were studied at day of life 7.5 plus minus 0.7, immediately before and 16 plus minus 3.7 hours after standard PDA ligation. REE was measured with a primed continuous infusion of NaH(13)CO(3), and breath samples were analyzed by isotope ratio mass spectroscopy. Serum CRP and cortisol concentrations also were obtained. Statistical analyses were made by paired sample t tests and linear regression. RESULTS: The resting energy expenditures pre- and post-PDA ligation were 37.2 plus minus 9.6 and 34.8 plus minus 10.1 kcal/kg/d (not significant, P =.61). Only preoperative energy expenditure significantly (P <.01) predicted postoperative energy expenditure (R(2) = 88.0%). Pre- and postoperative determinations of CRP were 2.1 plus minus 1.5 and 7.1 plus minus 4.2 mg/dL (not significant, P =.34), and cortisol levels were 14.1 plus minus 2.3 and 14.9 plus minus 2.1 microgram/dL (not significant, P =.52). CONCLUSIONS: Thus, critically ill premature neonates do not have elevated REE, and, further, there is no increase in REE evident the first day after surgery. This suggests that routine allotments of excess calories are not necessary either pre-or postoperatively in critically ill premature neonates. Given the high interindividual variability in REE, actual measurement is prudent if protracted nutritional support is required.

Carbon Isotopes↗
PubMed2000

Day-night pattern of energy expenditure and body temperature in cachectic tumour-bearing rats.

The implication of an increase in energy expenditure in cancer cachexia, which seems to be related to the type of tumour, remains unclear. We therefore investigated the energy metabolism and body temperature in anorectic and cachectic rats bearing the Yoshida sarcoma (TB), in comparison with pair-fed (PF) and ad-libitum fed (AL) control rats. The resting energy expenditure was higher in the TB than in the two control groups when corrected for the modifications of body composition. However, the total energy expenditure did not differ between the TB and the AL, presumably because of the drop of activity in TB. There was a temporal distribution of differences in energy expenditure with higher energy expenditure in TB than in AL during the diurnal phase and a lack of difference during the nocturnal phase. The TB presented a fever, which was limited to the diurnal period. Moreover, the acrophase of the body temperature rhythm was delayed in the TB. These results highlight the circadian effects of tumour development on the energy metabolism of the host and hint to the possible implication of cytokines.

Adipose Tissue↗
PubMed2004

The effect of positioning on energy expenditure in preterm infants: a feasibility study.

The aim of this study was to determine the feasibility of a study of the effect of positioning on energy expenditure in preterm infants. We performed a prospective, randomized, clinical cross-over pilot study of eight healthy, appropriate weight for gestational age, gavage-fed, clinically stable preterm infants at the postmenstrual age of 30 weeks. Prior to the study and in accord with our feeding protocol, infants uniformly received either their own mother's milk or a preterm formula. Each infant was studied in four different positions after randomization to eight different sequences. Infants were studied asleep, 90 minutes after feeding, after 20 minutes of being nursed in a given position. They were cared for in a servo-controlled convective incubator during the metabolic measurements, which were performed by indirect calorimetry. Energy expenditure was not significantly affected by the body position in which the infant was studied. The difference between the highest and the lowest mean energy expenditure was 3.7% of the highest one. We conclude that attempts to minimize energy expenditure by modifying infant positioning are likely to be insignificant, from a practical standpoint, because of the nonsignificant or minimal differences in energy expenditure.

Calorimetry, Indirect↗
PubMed2006

Resistance training volume and post exercise energy expenditure.

The main purpose of this study was to determine if increasing the volume of a resistance training program, while keeping the intensity the same would significantly increase the recovery energy expenditure, as measured by the excess post-exercise energy expenditure (EPEE). Fifteen resistance-trained women completed two resistance training protocols. Both protocols consisted of nine exercises performed to volitional fatigue, at the previously determined eight RM. The only difference between the two protocols was the number of sets (1-set or 3-sets). All subjects completed both protocols in a randomized and counterbalanced fashion. Energy expenditure, as determined by oxygen consumption and respiratory exchange ratio (RER), was measured continuously prior to exercise, during the exercise session, and during the entire 120 min of recovery. Fingertip blood lactate concentration was determined at baseline, immediately post-exercise, and every 30 min in recovery. The net energy expenditure during exercise was significantly greater during the 3-set protocol (661.9 +/- 43.9 kj) than the 1-set protocol (234.7 +/- 13.4 kj). However, per minute of exercise, there was no significant difference between the two protocols. During the 120 min of recovery, the net EPEE was not significantly different between the two protocols (93.3 +/- 20.1 kj following the 1-set protocol, and 94.1 +/- 7.1 kj following the 3-set protocol). However, when comparing the EPEE to the number of minutes spent in the exercise session, the 1-set protocol led to a significantly greater energy expenditure in the recovery period (1.0 +/- 0.22 kj/min) than did the 3-set protocol (0.4 +/- 0.03 kj/min). These data indicate that in previously trained women, increasing the volume of resistance training, from 1-set to 3-sets, while keeping the intensity the same will not significantly increase EPEE above what is found in a lower volume of work.

Adaptation, Physiological↗
PubMed1996

Trends and patterns in research and development expenditures in the United States.

This paper is a review of recent trends in United States expenditures on research and development (R&D). Real expenditures by both the government and the private sector increased rapidly between the mid-1970s and the mid-1980s, and have since leveled off. This is true of both overall expenditures and expenditures on basic research, as well as funding of academic research. Preliminary estimates indicate that about $170 billion was spent on R&D in the United States in 1995, with approximately 60% of that funding coming from the private sector and about 35% from the federal government. In comparison to other countries, we have historically spent more on R&D relative to our economy than other advanced economies, but this advantage appears to be disappearing. If defense-related R&D is excluded, our expenditures relative to the size of the economy are considerably smaller than those of other similar economies.

Costs and Cost Analysis↗
PubMed1989

Energy expenditure in early infancy.

The measurement of energy expenditure has wide applications in clinical and scientific studies. Ethical and practical problems, however, have limited the acquisition of information on total energy expenditure in infancy. The doubly-labelled-water technique, recently validated for use in infants, has now been used to measure, non-invasively, total energy expenditure in a cohort of forty-one normal, full-term infants at or close to 1.5, 3 and 6 months of age. Mean total energy expenditure was 270, 280 and 330 kJ/kg per d at these ages. Centiles for total energy expenditure in early infancy are presented; it is suggested such data are most appropriately expressed as kJ/square root (kg body-weight per d). These findings will be of importance in the re-evaluation of energy requirements in infancy and in the study of lesions in energy metabolism in disease states at this age.

Aging↗
PubMed2002

Non-esterified fatty acid levels and physical inactivity: the relative importance of low habitual energy expenditure and cardio-respiratory fitness.

The fasting concentration of non-esterified fatty acids (NEFA) and the degree to which it declines during an oral glucose tolerance test are closely associated with insulin resistance and glucose intolerance. However, relatively few studies have described possible environmental determinants of NEFA concentrations. Physical activity is likely to be related to NEFA levels, but habitual activity level is difficult to quantify in epidemiological studies. In particular, it is unclear whether NEFA is more closely related to cardio-respiratory fitness or to habitual energy expenditure. In order to quantify these relationships, we analysed data from the Ely prospective population-based study in which 931 subjects underwent a glucose tolerance test with measurements of cardio-respiratory fitness and 4 d energy expenditure by heart-rate monitoring, a technique previously validated against whole-body calorimetry and doubly-labelled water. In order to estimate the latent variables of usual fitness and energy expenditure, a subset of 190 subjects underwent repeat testing on three further occasions over 1 year. In analyses adjusting only for age and sex, energy expenditure and cardio-respiratory fitness were both negatively correlated with the total area under the NEFA curve following the oral glucose load (standardised beta coefficients -0.030 and -0.039 respectively; both P<0.001) However, further adjustment for degree of obesity and bivariate measurement error suggested that the effect of energy expenditure was significantly greater than that for fitness (-0.047 and -0.005 respectively). These results suggest that the area under the NEFA curve in the oral glucose tolerance test, a measure of insulin sensitivity, is strongly associated with the habitual level of physical activity.

Adult↗
PubMed2003

Impacts of vigorous and non-vigorous activity on daily energy expenditure.

Activity intensity is a potential determinant of activity-induced energy expenditure. Tri-axial accelerometery is the most objective measurement technique for the assessment of activity intensity, in combination with doubly-labelled water for the measurement of energy expenditure under free-living conditions. Data on the effects of subject characteristics, including body size and age, and exercise training on the relationship between activity intensity and daily energy expenditure are reviewed. Average daily metabolic rate and non-basal energy expenditure are positively related to body size. The duration and intensity of physical activities do not need to be equivalent to the energy spent on activity. Obese subjects spend more energy on physical activity but can perform fewer activities, especially high-intensity (weight-bearing) activities, because of their higher body weight. Physical activity generally declines gradually from about 60 years of age onwards. Most subjects > 80 years have an activity level well below the level defined for sedentary middle-aged adults. Spending relatively more time on low-intensity activities has a negative effect on the mean physical activity level. To obtain a higher physical activity level does not necessarily imply high-intensity activities. In an average subject 25% of the activity-induced energy expenditure may be attributed to high-intensity activities. Exercise training, as a form of high-intensity activity, affects the physical activity level more in younger subjects than in elderly subjects.

Adult↗
PubMed2002

Measurement of total energy expenditure by the doubly labelled water method in professional soccer players.

To determine the daily energy requirements of professional soccer players during a competitive season, we measured total energy expenditure in seven players (age 22.1+/-1.9 years, height 1.75+/-0.05 m, mass 69.8+/-4.7 kg; mean +/- s) using the doubly labelled water method. Energy intake was simultaneously estimated from 7 day self-report dietary records. Mean total energy expenditure and energy intake were 14.8+/-1.7 MJ x day(-1) (3532+/-408 kcal x day(-1)) and 13.0+/-2.4 MJ x day(-1) (3113+/-581 kcal x day(-1)), respectively. Although there was a significant difference between total energy expenditure and energy intake (P < 0.01), there was a strong relationship between the two (r= 0.893, P< 0.01). Basal metabolic rate and recommended energy allowance calculated from the Recommended Dietary Allowances for the Japanese were 7.0+/-0.3 MJ x day(-1) (1683+/-81 kcal x day(-1)) and 15.6+/-0.8 MJ x day(-1) (3739+/-180 kcal x day(-1)), respectively. A physical activity level (total energy expenditure/ basal metabolic rate) of 2.11+/-0.30 indicated that, during the competitive season, professional soccer players undertake much routine physical activity, similar to that of competitive athletes during moderate training. Energy intake estimated using dietary records was under-reported, suggesting that its calculation from these data does not predict energy expenditure in soccer players.

Adult↗
PubMed1980

Energy expenditures and food intakes of lactating women in Guatemala.

Total energy expenditures and intakes were simultaneously assessed in 18 free-ranging lactating women (10 months postpartum) and compared to six similarly-sized, nonlactating, nonpregnant but multiparous women living in the same rural villages in the Guatemalan highlands. Energy intakes were estimated by the 24-hr recall method for each of 4 consecutive days. Energy expenditures were determined for 2 days by monitoring heart rate throughout the day and relating heart rate to oxygen consumption by individually-determined regression lines. The mean energy intake for the 4 consecutive days was estimated to be 1929 +/- 360 kcal/day (39.2 kcal/kg per day) for the lactating group; and 1876 +/- 404 kcal/day (38.3 kcal/kg per day) for the nonlactating group. The 2-day mean energy expenditures were estimated to be 2007 +/- 292 kcal/day for the lactating women (41.8 kcal/kg per day) and 1966 +/- 382 kcal/day for the lactating women (40.1 kcal/kg per day). The way of life of both groups was judged "moderately active" by 1973 FAO/WHO classifications. Most of the lactating women had been losing weight progressively during the past 6 months. Over the 10-week period prior to our measurnth) (P less than 0.01) than in the nonlactating group (-35 g/month) (ns). The high correlation (r = 0.87) between weight loss and the reduction in the sum of the three skinfolds suggested adipose tissue loss. There were no significant differences between the two groups in terms of daily energy intake, daily energy expenditure, the energy cost of specific activities throughout the day. The slope of the heart rate/oxygen consumption regressions suggest adequate cardiorespiratory fitness. This study suggests that the energy cost of lactation was met to a greater extent by fat loss than by either increased energy intake, reduced energy expenditure, or both.

Adolescent↗
PubMed1981

Energy expenditure in prepubescent children: influence of sex and age.

The purpose of this investigation was to examine the relationship between energy expenditure and speed for 6-and 7-yr-old children and to compare these data to published data for adults. Eight subjects (n = four boys, four girls) completed three treadmill tests at 67, 94, and 127.5 m . min-1 (k = 12 trials for the boys, 12 trials for the girls). Heart rate was monitored continuously and oxygen uptake (VO2) and carbon dioxide production (VCO2) were determined at each speed in order to estimate caloric expenditure. Sex differences were observed in the metabolic and heart rate responses to exercise. In comparison to the females, the energy expenditure (kcal . min-1) was 16 (p less than 0.05), 11 (p greater than 0.05) and 14 (p less than 0.05) percent higher for the males at the slow, medium, and fast speeds, respectively. Additionally, heart rate was 13 beats . min-1 lower (p less than 0.05) for the males at a speed of 94 m . min-1. Differences in kcal . kg . min-1 between children and adults were observed (children higher). In contrast to adults' linear increase in energy expenditure with increasing speed, a curvilinear pattern was observed for prepubescent children. It was concluded that these sex and age effects must be considered when attempting to quantify children's daily energy expenditure and caloric requirements.

Age Factors↗
PubMed1983

Energy expenditure of pregnant women at rest or walking self-paced.

Energy expenditure during rest and self-paced walking was determined from early to late pregnancy either longitudinally or in a cross-section of women. The cross-sectional study was done with 16 women confined to a metabolic unit: six nonpregnant (NP), six early pregnant (EP 10 to 20 wk gestation), and four late pregnant (LP 30 to 40 wk gestation). In the longitudinal study, five of the six EP subjects from the cross-sectional study were studied at 5-wk intervals until parturition. Basal metabolic rate, measured by open circuit, indirect calorimetry, and expressed as kcal/min, was 13% greater (p less than 0.05) in EP compared to NP and was 28% greater (p less than 0.05) in LP compared to EP. Resting metabolism increased during gestation in the EP group from a value of 1.01 kcal/min at 15 to 25 wk to 1.15 kcal/min at 35 to 40 wk. When energy expenditure during rest is expressed as kcal/kg body weight/h, there were no significant differences due to stage of pregnancy. The time required for the women to walk 400 m at their own pace was measured. The pace of the LP women was 20% slower (p less than 0.05) than the EP women. But when the EP women were studied at 35 and 40 wk gestation their pace was only 4.5% slower than that at 15 to 25 wk. These data suggest that individual behavioral differences have a greater effect on pace than stage of gestation. A decrease in pace reduced the rate of energy expenditure per kilogram body weight for walking 400 m. But, body weight, rather than pace, was the major determinant of total energy expenditure for the walk (p less than 0.05). It is apparent from these data that body weight is the major determinant of energy expenditure during rest and self-paced weight bearing activity in pregnancy.

Adult↗
PubMed1983

Energy expenditure and postprandial thermogenesis in obese women before and after weight loss.

In six young obese women (mean weight 85 +/- 3 kg) with a childhood history of obesity, and in six young nonobese women (mean weight 55 +/- 2 kg), the energy expenditure was measured during 24 h in a respiratory chamber with a maintenance energy intake. The next day, the thermogenic response to a mixed meal was investigated by using an open circuit indirect calorimetry hood system. In addition, five of the same obese women were similarly studied after a mean weight loss of 12.1 kg (14% of initial body weight) consecutive to an 11-wk hypocaloric diet (protein-supplemented modified fast). Expressed in absolute terms, the total 24 h and basal energy expenditures were found to be significantly greater in the obese (2208 +/- 105 and 1661 +/- 56 kcal/24 h, respectively) than in the controls (1746 +/- 61 and 1230 +/- 40 kcal/24 h, respectively). After weight loss, both the total 24-h and the basal energy expenditures were significantly reduced (2009 +/- 99 kcal/24 h and 1423 +/- 43 kcal/24 h respectively), but both values were still greater than that of the control subjects. The thermogenic response to the mixed meal (a liquid diet containing 17, 54, and 29% as protein, carbohydrate, and lipid calories, respectively, and an energy level determined to cover 60% of the basal energy expenditure computed for 24 h) was found to be significantly reduced in the obese as compared to controls (ie, 7.6 +/- 0.4% versus 9.5 +/- 0.4% of the energy content of the load, respectively, p less than 0.025). After weight loss, the postprandial thermogenesis of the obese was still markedly reduced (ie, 6.2 +/- 0.8%). Both before and after weight loss, the relative increase in diurnal urinary norepinephrine excretion was found to be lower in the obese than in controls, when compared to the nocturnal values. These results show that the greater 24 h energy expenditure of obese women is entirely due to their higher basal metabolic rate. The lower thermogenic response to the meal in the obese supports the concept of a thermogenic defect which can favor energy gain; furthermore, the unchanged response after weight loss in the obese suggests that the thermogenic defect may be a cause rather than a consequence of obesity.

Adipose Tissue↗
PubMed1984

Postprandial energy expenditure and respiratory quotient during early and late pregnancy.

Rates of energy expenditure after a 750-kcal meal were determined by open circuit, indirect calorimetry for four women in late pregnancy (30 to 40 wk gestation), six women in early pregnancy (10 to 20 wk gestation), and six nonpregnant women. Preprandial resting metabolic rates, expressed in kcal min-1, were 22.5% higher (p less than 0.05) in the late pregnancy group compared to the early pregnancy, and 15.9% higher (p less than 0.05) in the early pregnancy compared to the nonpregnant women. No differences in preprandial energy expenditure rates were seen between groups when expressed as kcal kg-1 h-1. Rates of energy expenditure increased above preprandial levels in all groups by 15 min postprandially and remained significantly elevated for the next 175 min. The total increase in postprandial energy expenditure above preprandial levels did not differ significantly due to stage of gestation. Respiratory quotient, the ratio of VCO2:VO2, increased significantly in all groups (p less than 0.05) above preprandial levels by 15 min after the meal. Respiratory quotient values began decreasing after 95 min and returned, in all groups, to preprandial levels by 175 min. The results from this study demonstrate that the increase in the rates of energy expenditure after a mixed meal was not altered by gestation.

Adult↗
PubMed1986

Validation of a field technique for the measurement of energy expenditure: factorial method versus continuous respirometry.

The field technique for measuring daily energy expenditure, using activity diary plus short-term indirect calorimetry, was validated with a room respirometer. Eleven male and 14 female subjects spent 24-h periods in the respirometer and kept an activity diary to the nearest minute. Subsequently, the energy cost of the recorded activities was measured in duplicate, and 24-h expenditure was calculated. Over the 42 24-h measurements the mean value by the factorial field method was within 1% of that from continuous indirect calorimetry. However, the error in individual daily expenditure ranged from -17% to +25%. Correction of the error involved in using calculated BMR for the cost of sleeping resulted in a 5% mean underestimation of the daily value. The factorial method is, therefore, too inaccurate for the estimation of individual daily expenditures but provides a close estimate of the true energy expenditure for population groups.

Adult↗
PubMed1995

Comparison of the heart rate-monitoring and factorial methods: assessment of energy expenditure in highland and coastal Ecuadoreans.

Accurate estimates of total daily energy expenditure (TDEE) are critical to studies of the nutritional adaptation of human populations. This study compared the standard factorial method with the recently developed flex-HR technique in a sample of 32 adults (16 males, 16 females) from rural, agricultural communities of highland and coastal Ecuador. Although energy expenditures obtained from the two methods were highly correlated (r = 0.759, P < 0.0001), the 1985 FAO/WHO/UNU factorial method significantly underestimated TDEE relative to the heart rate-monitoring technique (10.27 +/- 2.54 compared with 11.91 +/- 3.96 MJ/d, P < 0.001). The degree of underestimation was greater in males, who had higher energy expenditures. Similarly, underestimation was greater in the highland farmers, who were studied during a period of heavy agricultural work. The differences in energy expenditure estimates translated into a 10% difference in estimated energy adequacy. Additional research is needed to identify the potential sources of bias in the factorial method and to further develop other techniques for accurately estimating energy expenditure under field conditions.

Adolescent↗
PubMed1996

Energy expenditure of children and adolescents with severe disabilities: a cerebral palsy model.

Spastic quadriplegic cerebral palsy (SQCP) is a severe disability that is associated with abnormal physical activity, body composition, and food intake and with frequent malnutrition. This study examined the pattern of dietary intake, anthropometry, and energy expenditure in a group of subjects with SQCP aged 2-18 y and a normal control group. The energy expenditure pattern was determined from resting energy expenditure (REE, n = 61 SQCP; n = 37 control group) by using indirect calorimetry and from total energy expenditure (TEE, n = 32 SQCP; n = 32 control group) by using the doubly labeled water method. Physical activity, including the chronic spasticity of SQCP, was estimated from the ratio of TEE to REE. Abnormal growth and body composition were common and dietary intake was markedly overreported in the children with SQCP. Children with SQCP were divided according to body fat stores determined by triceps-skinfold-thickness measurements. The children with low fat stores had a lower REE adjusted for fat-free mass compared with the SQCP and control groups with adequate fat stores. TEE was significantly lower for the SQCP group than for the control group. The ratio of TEE to REE, indicating energy for nonbasal needs, was significantly lower in the SQCP children than in the control group, with the adequately nourished SQCP children having lower ratios than the more poorly nourished SQCP group. The nonbasal energy expenditure, such as for physical activity and spasticity, of children with SQCP was low. The nutrition-related growth failure and abnormal pattern of REE are likely related to inadequate energy intake.

Adolescent↗