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PubMed2005

Effect of pioglitazone on body composition and energy expenditure: a randomized controlled trial.

BACKGROUND: Several clinical studies have demonstrated that body weight increases after treatment with thiazolidinediones (TZDs). Prior studies have demonstrated an increase in insulin-stimulated lipid storage in adipose tissue. Some, but not all, studies demonstrate reductions in visceral adipose tissue. Changes in body weight are the result of changes in energy intake, energy expenditure, or both. OBJECTIVES: Based on these findings, the primary aim of this study was to evaluate the effect of TZDs on visceral, subcutaneous, and total body fat. Secondary aims were to determine the effects of pioglitazone on (a) energy expenditure, (b) hunger and satiety, (c) blood lipids, and (d) the role of insulinemia/sulfonylurea usage on weight gain in patients with type 2 diabetes. SUBJECTS AND METHODS: We performed a randomized, double-blind, placebo-controlled trial in 48 men and women with type 2 diabetes who had not previously received treatment with TZDs. Patients were treated for 24 weeks with 45 mg/d of pioglitazone or a matching placebo. Body composition was measured by dual-energy x-ray absorptiometry. Visceral and subcutaneous fat were measured by computed tomography. Resting metabolic rate and thermogenic response to a test meal were measured by indirect calorimetry before and after a standardized meal. Hunger and satiety were measured with visual analog scales before and after the same test meal. Blood was collected for the measurement of fasting glucose and insulin levels, hemoglobin A 1c levels, and lipid content. RESULTS: Pioglitazone treatment resulted in a decrease in hemoglobin A(1c) level by 0.96 +/- 1.1% vs 0.11 +/- 0.8% in the placebo group (P < .005). Body weight and fat increased steadily in the patients treated with pioglitazone during the 6 months of the study (+3.9 +/- 3.1 kg at 6 months in pioglitazone-treated patients vs -0.8 +/- 3.4 kg in the placebo-treated patients). Subcutaneous fat in the trunk, arms, and legs were all increased in the pioglitazone-treated group. Visceral fat did not change significantly in either group. Neither resting metabolic rate nor the thermogenic responses to a meal were altered by pioglitazone. Subjective measures of hunger (visual analog scale) did not change with pioglitazone treatment. Triglycerides fell in the pioglitazone-treated group (-58.5 +/- 124 mg/dL, P < .003). Neither the prior use of sulfonylureas nor the level of insulinemia before treatment was a predictor of weight or fat change. CONCLUSION: Pioglitazone increased subcutaneous body fat, but not visceral fat. There was no measurable effect on energy expenditure or hunger/satiety. In contrast to the placebo-treated patient with diabetes, weight gain occurs in the face of falling hemoglobin A(1c) and triglyceride levels.

Adult↗
PubMed2005

Effects of diacylglycerol on postprandial energy expenditure and respiratory quotient in healthy subjects.

OBJECTIVE: This study examined the effects of a diacylglycerol (DAG)-containing diet on postprandial energy expenditure and respiratory quotient. METHODS: A randomized, double-blind, crossover, placebo-controlled study with a washout period was performed in 13 healthy male subjects. A 4240-kJ diet containing 30 g of triacylglycerol (TAG) or DAG (TAG meal or DAG meal, containing 34.5% lipids, 52.1% carbohydrates, and 14.1% proteins) was administered after a fasting period of 15 to 16 h. Breath and serum were analyzed for up to 5 h after ingestion of the meal. RESULTS: The amount of change in energy expenditure 3 h after loading with the DAG meal tended to be higher than that after loading with the TAG meal (P < 0.1). Changes in respiratory quotient 2 and 5 h after loading with the DAG meal were significantly lower than those after loading with the TAG meal, suggesting high lipid oxidation activity after the meal. The serum insulin level 0.5 h after loading with the DAG meal was significantly lower than that after loading with the TAG meal. This result suggests that there is a smaller stimulus in the direction of fat storage after loading with the DAG meal. CONCLUSIONS: Compared with the TAG-containing meal, the DAG-containing meal tended to produce a higher postprandial energy expenditure and a significantly lower postprandial respiratory quotient. These results suggest that the DAG-containing meal has high postprandial lipid oxidation activity and a potential effect on high diet-induced thermogenesis.

Adult↗
PubMed2005

Metabolic efficiency and energy expenditure during short-term overfeeding.

OBJECTIVE: To investigate whether efficiency of weight gain during a short period of overfeeding is related to adaptive differences in basal metabolic rate (BMR) and physical activity. SUBJECTS: Fourteen healthy females (age 25+/-4 years, BMI 22.1+/-2.3 kg/m2). DESIGN AND MEASUREMENTS: Subjects were overfed with a diet supplying 50% more energy than baseline energy requirements for 14 days. Overfeeding diets provided 7% of energy from protein, 40% from fat and 53% from carbohydrates. Body composition was determined using hydrodensitometry and isotope dilution, total energy expenditure (TEE) with doubly labeled water and basal metabolic rate (BMR) with indirect calorimetry. Physical activity (PA) was recorded with a tri-axial accelerometer. RESULTS: Body weight increased by 1.45+/-0.86 kg (mean+/-S.D.) (P<0.0001), fat mass increased by 1.05+/-0.75 kg. Energy storage was 57.0+/-17.9 MJ, which is the difference between energy intake (207.2 MJ) and energy expenditure (150.2 MJ) during overfeeding. There was no difference between metabolically efficient and metabolically inefficient subjects in changes in BMR and PA. CONCLUSION: These results indicate that the metabolic efficiency of weight gain was not related to adaptive changes in energy expenditure.

Adaptation, Physiological↗
PubMed1999

Body composition, dietary intake, and energy expenditure in nonobese, prepubertal children of obese and nonobese biological mothers.

OBJECTIVE: To determine differences in dietary intake, resting energy expenditure, activity level, fat-free mass, and percentage body and abdominal fat in nonobese children of obese mothers compared with nonobese children of nonobese mothers. DESIGN: Cross-sectional comparison study. Children's food diaries were analyzed to determine average energy and nutrient content. Resting energy expenditure of children was measured by means of indirect calorimetry. Children's activity levels were estimated through questionnaires administered during interviews. Dual-energy x-ray absorptiometry was used to estimate body composition of children. SUBJECTS: Mothers of subjects responded to advertisements and were recruited as nonobese (body mass index = 20 to 25) or obese (body mass index > or = 30). Offspring included in the study were prepubertal and nonobese (10th to 90th percentile of weight for height by gender). Twelve pairs of children could be matched for weight, gender, and age. STATISTICAL ANALYSIS PERFORMED: Wilcoxon signed rank tests were used to determine differences between the 2 groups of children. RESULTS: Percentage abdominal fat was greater (median difference = 3.15, P = .001) and fat-free mass was lower (median difference = 1.19, P = .04) in children of obese mothers compared with children of nonobese mothers. No statistically significant differences between the 2 groups of children were found for dietary intake, resting energy expenditure, activity level, or percentage body fat. APPLICATIONS/CONCLUSIONS: The significantly higher percentage of abdominal fat and lower fat-free mass in children of obese mothers may contribute to obesity onset. Use of dual-energy x-ray absorptiometry as a screening tool for nonobese, prepubertal children with an obese parent will help to identify those at risk. Education and lifestyle changes can then be implemented to help prevent the onset of obesity.

Absorptiometry, Photon↗
PubMed1993

Increased energy expenditure in a patient with diencephalic syndrome.

Total energy expenditure, measured in an infant with diencephalic syndrome with doubly labeled water, was 30% to 50% higher than that reported for other healthy infants whose energy expenditure was measured by the same technique and 13% higher than the patient's energy intake. This result suggests that the weight loss and cachexia of the diencephalic syndrome are the result of abnormally increased energy expenditure.

Astrocytoma↗
PubMed1987

Energy expenditure of patients with cystic fibrosis.

Resting energy expenditure was measured by open-circuit indirect calorimetry in 71 patients, aged 8.9 to 35.5 years, with cystic fibrosis who had no recent history of acute lung infection. Pulmonary function and nutritional status were studied simultaneously. In most patients, resting energy expenditure was above normal (range 95% to 153% of predicted values for age, sex, and weight as derived from the Harris Benedict equations), and was negatively correlated with pulmonary function (P less than 0.01) and nutritional status (P less than 0.01) when expressed as a percentage of body fat. Pulmonary status was positively correlated with nutritional status (P less than 0.01). We conclude that resting energy expenditure in patients with cystic fibrosis exceeds normal values and that the increase correlates with a deterioration in lung function and nutritional status.

Adolescent↗
PubMed1996

Energy expenditure and body composition in children with spastic quadriplegic cerebral palsy.

OBJECTIVE: To determine the relationship between resting energy expenditure and body cell mass in a group of children with spastic quadriplegic cerebral palsy (SQCP) in comparison with a group of healthy volunteers. SUBJECTS AND METHODS: Children with SQCP (n = 13) and healthy control subjects (n = 21) participated in the study. Resting energy expenditure (REE) by indirect calorimetry, as well as body composition measurements were obtained. Those included skinfold measurements, isotope dilution methods for total body water and extracellular water (2H2O or H2(18)O and NaBr, respectively), and bioelectrical impedance analysis. Intracellular water was calculated as total body water minus extracellular water. RESULTS: Overall REE in children with SQCP was significantly less than in control subjects or from predicted World Health Organization equations. There was a poor correlation between REE and weight or height for children with SQCP and those for control subjects. Children with SQCP showed a higher variance and small improvement in the correlation between REE and lean body mass or intracellular water in comparison with control subjects. Nine of the thirteen children with SQCP had significantly reduced REE per unit of lean tissue or intracellular water. Furthermore, bioelectrical impedance analysis was validated against dilution methods as a suitable technique for measuring total body water (r2 = 0.90, r = 0.95) and extracellular water (r2 = 0.84, r = 0.92) in children with SQCP. CONCLUSION: REE in children with SQCP is poorly correlated with body cell mass. We postulate that the central nervous system plays a crucial role in energy regulation. In children with SQCP, individual energy expenditure should be measured so that optimal nutritional status can be achieved. Bioelectrical impedance analysis can be used in this population to measure body water spaces.

Adolescent↗
PubMed1996

Effect of exercise training on energy expenditure, muscle volume, and maximal oxygen uptake in female adolescents.

OBJECTIVES: American female adolescents are at high risk of a physically inactive lifestyle that likely leads to health problems later in life. We hypothesized that a brief program of endurance exercise training in female adolescents would result in increased energy expenditure and quantifiable structural and functional adaptations. STUDY DESIGN: Forty-four high school girls (aged 15 to 17 years, none were elite athletes) enrolled in a 5-day per week anatomy class for 5 weeks and were randomly assigned to control (n = 22) and training groups. All subjects participated in a 2-hour daily teaching program. During the remaining time (2 hours), the training group members underwent endurance-type training and control group subjects participated in a computer workshop. The intervention was assessed by (1) comparison of total energy expenditure between groups with the doubly labeled water technique, (2) determination of changes in thigh muscle volume by magnetic resonance imaging, and (3) determination of changes in maximal oxygen uptake by use of respiratory gas exchange responses. RESULTS: Total energy expenditure was significantly greater (15.3%) in the training group compared with the control subjects (p < 0.003). Five weeks of training led to a 4.3% +/- 1% increase in thigh muscle volume (p < 0.0002) and a 12.1% +/- 3.7% increase in maximal oxygen uptake (p < 0.004); there were no changes in the control group. The training effect was most pronounced in the least fit subjects. CONCLUSIONS: Exercise training programs for female adolescents can be successfully integrated into a high school summer curriculum. Quantifiable, substantial structural and functional responses occur with relatively short periods of training. Approximately 60% of the training response was related to factors independent of muscle size per se. These data may serve to better design physical activity programs for female adolescents.

Adolescent↗
PubMed1996

Determinants of resting energy expenditure in young black girls and young white girls.

OBJECTIVE: To identify determinants of resting energy expenditure (REE) in black girls and white girls and to evaluate racial differences in REE. STUDY DESIGN: Cross-sectional study of 98 girls (47 black and 51 white girls), ages 6 to 16 years. METHODS: Determinations of lean body mass, fat mass, and bone mass were made by dual-energy x-ray absorptiometry. Measurements of REE were made with the DeltaTrac metabolic monitor. Subjects fasted at least 3 hours before testing, had rested 30 minutes before the test, and had not engaged in strenuous activity for the previous 12 hours. Pubertal maturation was assessed with a three-stage scoring method: (1) prepubertal, (2) pubertal, but premenarcheal, and (3) postmenarcheal. RESULTS: There were no significant differences in height, weight, lean body mass, or fat mass between the black and white subjects. Racial differences in total REE were also not significant, but REE standardized by weight was significantly greater in white girls (40.3 kcal/day) compared with black girls (35.5 kcal/day) (p = 0.001). Resting energy expenditure was positively and significantly correlated with all measures of body composition. Multiple regression analysis identified lean body mass, sexual maturation, and race as significant main effects. After controlling for lean body mass and maturation, black girls had significantly lower REE. The race-maturation interaction was of borderline significance (p = 0.09); prepubertal black girls had significantly lower REE (1156 kcal/day) than prepubertal white girls (1399 kcal/day), but racial differences in stages 2 and 3 were not statistically significant. CONCLUSION: Lean body mass, maturation, and race are significant determinants of REE. Resting energy expenditure is significantly lower in black than white girls in the prepubertal stage. The cause of this racial difference in REE is not known; it is not explained by differences in anthropometric variables. Racial differences in REE could explain in part the earlier onset of puberty in black girls compared with white girls and could be a factor in the difference in obesity in black and white women.

Absorptiometry, Photon↗
PubMed1988

Measurement of body potassium with a whole-body counter: relationship between lean body mass and resting energy expenditure.

We conducted studies to determine whether the Mayo whole-body counter could be used to measure body potassium, and thus lean body mass (LBM), and whether moderate obesity alters resting energy expenditure when corrected for LBM. Twenty-four nonobese and 18 moderately obese adults underwent body potassium (40K) counting, as well as tritiated water space measurement and indirect calorimetry. LBM values predicted from 40K counting and tritiated water space measurements were highly correlated (P = 0.001; r = 0.88). Resting energy expenditure was closely related to LBM (P less than 0.0001; r = 0.78): kcal/day = 622 kcal + (LBM.20.0 kcal/kg LBM). In this relationship, the obese subjects did not differ from nonobese subjects. In summary, the Mayo whole-body counter can accurately measure LBM, and moderate obesity has no detectable effect on corrected resting energy expenditure.

Adult↗
PubMed1998

Plasma leptin in children: relationship to puberty, gender, body composition, insulin sensitivity, and energy expenditure.

Leptin has been demonstrated to reflect body fat mass (FM) in humans, but the regulation of leptin levels during childhood growth and development is poorly understood. We studied the relation between plasma leptin, fasting insulin, insulin sensitivity, and resting energy expenditure in 22 healthy prepubertal children and 27 adolescents. Body composition was assessed by the H2(18)O-dilution principle, insulin sensitivity by a hyperinsulinemic (40 mU/m2/min)-euglycemic clamp, and energy expenditure by indirect calorimetry. Plasma leptin in prepubertal children (9.3 +/- 2.0 ng/mL) was not different from that in pubertal adolescents (10.9 +/- 2.2 ng/mL). Plasma leptin correlated with FM (r = .77, P < .001). There were no gender differences in leptin after controlling for FM differences. In prepubertal and pubertal subjects, plasma leptin correlated with fasting insulin independently of FM (r = .60, P < .001), but did not correlate with insulin sensitivity independently of body fat content. Leptin showed no relationship to resting energy expenditure after adjusting for body composition. The present cross-sectional evaluation of normal children shows that (1) plasma leptin reflects body fat content, (2) leptin concentrations are similar between prepubertal children and pubertal adolescents, (3) there are no gender differences in leptin independent of adiposity, and (4) leptin correlates with fasting insulin but not with insulin sensitivity. Contrary to animal data, our cross-sectional results in healthy children do not suggest a role for leptin in puberty or a female-related leptin resistance as reported in adults. It remains to be determined at which stage of human development the sexual dimorphism in leptin becomes evident.

Adolescent↗
PubMed2000

Energy expenditure in the extremely low-birth weight infant.

Information about energy requirements of extremely low-birth weight infants is sparse, despite the rapidly improving survival rates of this population. Metabolizable energy intake can be estimated from energy balance studies and the percentage of caloric intake that is actually absorbed by these infants is approximately 87%. Data on energy expenditure in extremely premature infants is limited; however, energy expenditure has been shown to increase with postnatal age. Because both intake and expenditure are affected by multiple factors, there is significant variability in estimates of the energy requirements in extremely low-birth weight infants. At present, no valid recommendations can be made regarding optimal energy requirements for the extremely low-birth weight infant, except that their requirements probably exceed those of stable, growing very low-birth weight infants, currently estimated at 105 to 135 kcal.kg-1d-1.

Energy Intake↗
PubMed1988

Increased energy expenditure in young children with cystic fibrosis.

To investigate the role of energy expenditure in the altered energy balance in cystic fibrosis (CF), total energy expenditure (TEE) was measured by the doubly-labelled water method in 9 clinically well CF infants (body weight 7.3-10.9 kg) without chronic lung disease. CF infants had 25% higher rates of energy expenditure when compared with data derived from measurements of TEE obtained by the same method in 16 healthy infants, matched for age and body weight. Mean TEE (SEM) for CF was 950 (38) kcal, vs 876 (72) kcal for controls matched for age and 758 (46) kcal for controls matched for weight. Although subclinical disease activity cannot be excluded as a determinant of the excess TEE, the possibility of an energy-requiring basic defect is suggested, because further analysis indicated that factors other than body weight, degree of underweight, presence of pancreatic insufficiency, or presence of lung disease were important. Increased TEE may contribute to undernutrition in CF, even in the absence of chronic lung disease.

Body Water↗
PubMed2001

A comparison of asthma-related expenditures for patients started on montelukast versus fluticasone propionate as monotherapy.

BACKGROUND: The prevalence of asthma is increasing, and this chronic condition imposes a substantial economic burden worldwide. It is not known whether newer therapies, such as leukotriene receptor antagonists (LTRAs), can ease this burden. OBJECTIVE: This analysis examined the association between choice of first-line asthma control therapy and health care resource utilization and expenditures in patients with mild asthma. METHODS: A retrospective cohort analysis of claims data for patients who started therapy with fluticasone propionate or montelukast between January 1, 1997, and February 28, 1999, was performed, adjusting for baseline differences. RESULTS: Data from 343 patients (229 fluticasone; 114 montelukast) were analyzed. Patients starting therapy with fluticasone were significantly older (33.3 vs 27.6 years; P = 0.015) and significantly less likely than patients starting therapy with montelukast to have been started on control therapy by an asthma specialist (52.0% vs 69.3%; P = 0.007). There were no significant differences in mean changes in total asthma-related health care expenditures, oral steroid and antibiotic prescriptions, hospitalizations, or emergent care visits. The mean increase in total asthma-related pharmacy expenses was significantly greater for patients who were prescribed montelukast than for those prescribed fluticasone (P < 0.001). Treatment adherence was better in patients prescribed montelukast versus fluticasone (5.1 vs 3.1 prescriptions filled per year, respectively; P < 0.001). Montelukast patients had a significantly lower increase in the number of beta-agonist prescriptions filled per year than fluticasone patients (0.19 vs 0.66; P = 0.03). In the subsequent year, 4% (10/229) of fluticasone patients added or switched to an LTRA. No montelukast patients added to or switched control therapy. CONCLUSION: The mean change in total asthma-related health care expenditures was not significantly different in patients started on fluticasone propionate versus montelukast. Montelukast patients had better adherence to their treatment regimen and required fewer beta-agonist prescriptions, which is an indicator of asthma control and possibly therapeutic effectiveness.

Acetates↗
PubMedDate not supplied

Energy intake and energy expenditure during the menstrual cycle in short-term smoking cessation.

The effect of short-term smoking abstinence on energy intake and expenditure parameters was investigated for women in different phases of the menstrual cycle (follicular or late luteal) in a rigorous inpatient laboratory setting. Twenty-one participants were randomized to a continued smoking (n = 5) or a smoking abstinence (n = 16) group and admitted for 2 7-day inpatient periods during alternate cycle phases. The smoking abstinence group experienced 2 days of baseline smoking and 5 days of smoking abstinence. Measurements included caloric intake (kcal/24 hours), energy expenditure (by indirect calorimetry), and weight. Results of within-subject analyses indicated no smoking abstinence effect on mean daily total kilocalorie intake, sweet kilocalorie intake, or resting metabolic rate. However, a significant cycle phase effect was observed, with increased kilocalorie intake and expenditure-as well as minor weight gain-occurring during the late luteal phase when premenstrual symptoms are highest. In light of this phase effect, women smokers might benefit by attempting to quit smoking during the follicular phase of their cycle.

Adult↗
PubMed1997

Leptin prevents posthibernation weight gain but does not reduce energy expenditure in arctic ground squirrels.

In mammals, leptin reduces energy intake and may increase energy expenditure as a means to maintain body weight and/or adiposity at an appropriate level. Hibernating mammals seasonally alter body mass, food intake, and body composition and, therefore, represent an attractive model for investigating the physiological regulation of changing body mass and adiposity. Previous experiments in our laboratory demonstrated that administration of mouse recombinant leptin reduces food intake and body weight in arctic ground squirrels during prehibernation fattening. In addition, leptin appeared to reduce metabolic efficiency (weight gain per unit of energy intake). This result suggests that reduced food intake alone may not account for the observed weight loss. Here, we describe the effect of a 3-week constant infusion of leptin given to posthibernation arctic ground squirrels on food consumption and energy expenditure. Mouse recombinant leptin (1 mg/ml) was administered through subcutaneously implanted mini-osmotic pumps (10 microliters/hr flow rate). Resting metabolic rate was monitored before and during the 3-week leptin administration period by indirect calorimetry. Body temperature and locomotory activity were monitored continuously by abdominal radiotransmitters. At the end of the leptin administration period, thermogenic capacity was evaluated by measuring brown fat uncoupling protein-1 mRNA and protein levels. Leptin administration resulted in reduced food intake and prevented posthibernation weight gain, but it did not alter any of the measured parameters of energy expenditure.

Adipose Tissue↗
PubMed2002

Estimating energy expenditure from the Minnesota Leisure Time Physical Activity and Tecumseh Occupational Activity questionnaires - a doubly labeled water validation.

An accurate, simple method for assessing energy expenditure in individuals and in free-living populations continues to be elusive. To compare estimates of energy expenditure (EE) from a combination of two previously validated physical activity questionnaires: Tecumseh Occupational (EE(TEC)) and a 4-wk history version of the Minnesota Leisure Time Physical Activity that included household activities (EE(MNLTPA)) and EE from sleep (EE(SLEEP)), to EE obtained from doubly labeled water (EE(DLW)). We studied free-living males (n = 24) eating a controlled diet designed to maintain body weight and determined EE from doubly labeled water (DLW) during 14 days and EE from physical activity instruments used in epidemiological studies (EE(TEC) and EE(MNLTPA)). There was excellent agreement between EE(DLW) (mean +/- SEM, 13.55 +/- 0.38 MJ/d) and EE(TEC) + EE(MNLTPA) + EE(SLEEP) (EE(TOTAL1)) (13.79 +/- 0.89 MJ/d) with a difference of only 1.0% +/- 5.4%. When the EE from watching TV, reading, and childcare activities was added the total EE (EE(TOTAL2)) (14.87 +/- 0.90 MJ/D) overestimated EE(DLW) by 8.9% +/- 5.4%. Both of these estimates of EE had significant regressions against EE(DLW) (EE(TEC) + EE(MNLTPA) + EE(SLEEP), R(2) = 0.38, P < 0.001; EE(TOTAL2), R(2) = 0.39, P < 0.001). Men whose occupations involved significant intermittent moderate activity had the largest disagreement between EE(DLW) and estimates from the questionnaires. This investigation demonstrates that a combination of previously validated physical activity questionnaires can be used to accurately determine the mean energy expenditure of a population of employed males.

Adult↗
PubMed1999

An evaluation of resting energy expenditure in hospitalized, severely underweight patients.

A prospective trial was conducted with 14 hospitalized patients who were severely underweight with a mean weight of 40.9+/-5.1 kg and 70.7+/-7.8% of ideal body weight, to compare estimates of resting energy expenditure (REE) with measured values. The 9 women and 3 men, whose mean age was 66.5+/-13.9 y, underwent nutritional assessment and measurement of their REE by indirect calorimetry using the Sensormedics Deltatrac MBM100 indirect calorimeter. Their REE was also estimated by the Harris-Benedict formula (mean 1032+/-66 kcal/d) as well as a previously established empirical formula where REE = 25 x body weight in kg (mean 1023+/-129 kcal/d). Results by both estimates were significantly lower than the measured resting energy expenditure (MREE) in this group of patients (P<0.0001). The percentage difference between MREE and estimated REE by the Harris-Benedict formula was 18.4+/-9.4% and 20.9+/-7.5% by the empirical formula. The MREE exceeded the estimated REE in each individual. The correlation between MREE and body weight (r2 = 0.558, r = 0.005) was better than that between MREE and estimated REE by Harris-Benedict formula (r2 = 0.275, P = 0.08) suggesting that weight was the principal determinant rather than the other components (height, age, sex) of the Harris-Benedict formula. Our data shows that commonly employed formulae routinely underestimate the energy needs of severely underweight patients below 50 kg in body weight. The Harris-Benedict equation had limited predictive value for the individual, explaining approximately 25% of the variance in energy expenditure. Given the particular importance of matching energy intake to needs in this group of patients with limited reserves, many of whom are critically ill, we suggest an empirical equation using 30-32 kcal/kg be used to estimate the energy requirements of severely underweight patients when direct measurements are unavailable or clinically less imperative.

Adult↗