Energy requirements and physical activity in free-living older women and men: a doubly labeled water study.

Determinants of daily energy needs and physical activity are unknown in free-living elderly. This study examined determinants of daily total energy expenditure (TEE) and free-living physical activity in older women (n = 51; age = 67 +/- 6 yr) and men (n = 48; age = 70 +/- 7 yr) by using doubly labeled water and indirect calorimetry. Using multiple-regression analyses, we predicted TEE by using anthropometric, physiological, and physical activity indexes. Data were collected on resting metabolic rate (RMR), body composition, peak oxygen consumption (VO2 peak), leisure time activity, and plasma thyroid hormone. Data adjusted for body composition were not different between older women and men, respectively (in kcal/day): TEE, 2,306 +/- 647 vs. 2,456 +/- 666; RMR, 1,463 +/- 244 vs. 1,378 +/- 249; and physical activity energy expenditure, 612 +/- 570 vs. 832 +/- 581. In a subgroup of 70 women and men, RMR and VO2 peak explained approximately two-thirds of the variance in TEE (R2 = 0.62; standard error of the estimate = +/-348 kcal/day). Crossvalidation of this equation in the remaining 29 women and men was successful, with no difference between predicted and measured TEE (2,364 +/- 398 and 2,406 +/- 571 kcal/day, respectively). The strongest predictors of physical activity energy expenditure (P < 0.05) for women and men were VO2 peak (r = 0.43), fat-free mass (r = 0.39), and body mass (r = 0.34). In summary, RMR and VO2 peak are important independent predictors of energy requirements in the elderly. Furthermore, cardiovascular fitness and fat-free mass are moderate predictors of physical activity in free-living elderly.

Total daily energy expenditure in free-living older African-Americans and Caucasians.

Low rates of daily energy expenditure, increased energy intake, or a combination of both contribute to obesity in African-Americans. We examined whether African-Americans have lower rates of free-living daily energy expenditure than Caucasians. One hundred sixty-four (> 55 yr) volunteers (37 African-American women, 52 Caucasian women, 28 African-American men, and 47 Caucasian men) were characterized for total daily energy expenditure, resting metabolic rate, and physical activity energy expenditure from the doubly labeled water method and indirect calorimetry. Absolute total daily energy expenditure was lower in women than men but was not different between African-Americans and Caucasians. However, we found race and gender differences in total daily energy expenditure after controlling for differences in fat-free mass. Total daily energy expenditure was 10% lower (P < 0.01) in African-Americans compared with Caucasians due to a 5% lower resting metabolic rate (P < 0.01) and 19% lower physical activity energy expenditure (P = 0.08). Moreover, total daily energy expenditure was 16% lower (P < 0.01) in women compared with men due to a 6% lower resting metabolic rate (P = 0.09) and a 37% lower physical activity energy expenditure (P = 0.06). Low rates of energy expenditure may be a predisposing factor for obesity, particularly in African-American women.

Longitudinal changes in fatness in white children: no effect of childhood energy expenditure.

Reduced energy expenditure may predispose children to the development of obesity, but there are limited longitudinal studies to support this theory. We studied 75 white, preadolescent children over 4 y by taking annual measures of body composition and resting energy expenditure (by indirect calorimetry) and two annual measures of total energy expenditure and physical-activity-related energy expenditure (by doubly labeled water). Body composition of parents was assessed at the onset of the study with use of underwater weighing. The major outcome variable was the individual rate of change in fat mass (FM) adjusted for fat-free mass (FFM). The influence of sex, energy expenditure components, initial FM, and parental FM on the rate of change in FM was analyzed by hierarchical linear modeling and analysis of variance. The rate of change in absolute FM was 0.89 +/- 1.08 kg/y (range: -0.44 to 5.6 kg/y). The rate of change in FM adjusted for FFM was 0.08 +/- 0.64 kg/y (range: -1.45 to 2.22 kg/y) and was similar among children of two nonobese parents and children with one nonobese or one obese parent, but was significantly higher in children with two obese parents (0.61 +/- 0.87 kg/y). The major determinants of change in FM adjusted for FFM were sex (greater fat gain in girls), initial fatness, and parental fatness. None of the components of energy expenditure were inversely related to change in FM. The main predictors of change in FM relative to FFM during preadolescent growth are sex, initial fatness, and parental fatness, but not reduced energy expenditure.

Daily energy expenditure in free-living non-institutionalized Alzheimer's patients: a doubly labeled water study.

Weight loss is common in Alzheimer's disease (AD), but its pathogenesis is poorly understood. It is unclear whether an elevated daily energy expenditure contributes to the weight loss. We tested the hypothesis that daily energy expenditure is higher in AD patients compared to healthy elderly. Thirty AD (73 +/- 8 years; Mini-Mental State Examination score: 16 +/- 8) and 103 healthy elderly (69 +/- 7 years) were characterized for daily energy expenditure and its components (resting and free-living physical activity energy expenditure) from doubly labeled water and indirect calorimetry. Fat-free mass and fat mass were measured from dual energy X-ray absorptiometry. Fat-free mass tended to be lower in AD patients (45 +/- 9 kg) versus healthy elderly (49 +/- 10 kg; p = 0.07), whereas no differences were noted in fat mass between groups. Daily energy expenditure was 14% lower in AD (1901 +/- 517 kcal/d) compared to healthy elderly (2213 +/- 513 kcal/d; p < 0.001), due to lower resting (1287 +/- 227 versus 1418 +/- 246 kcal/d; p < 0.01) and physical activity energy expenditures (425 +/- 317 versus 574 +/- 342 kcal/d; p < 0.05). No differences in energy expenditure were noted between groups after controlling for differences in body composition. Daily energy expenditure was examined in a subgroup (n = 11) of AD patients who lost significant body weight (5.6 +/- 2.3 kg) within the past year. There was a lower daily energy expenditure in cachectic AD patients (1799 +/- 474 kcal/d) versus non-cachectic patients (1960 +/- 544 kcal/d) and healthy elderly (2213 +/- 513 kcal/d; p < 0.01). Similarly, no differences in energy expenditure were noted between groups after controlling for differences in body composition. We conclude that absolute levels of daily energy expenditure are lower in AD patients due to their lower body mass. However, after taking into account differences in body composition, daily energy expenditure in AD patients is appropriate for their metabolic size. The hypothesis that elevated daily energy expenditure contributes to weight loss in AD is not supported by these findings.

No evidence for a higher resting metabolic rate in noninstitutionalized Alzheimer's disease patients.

OBJECTIVE: It has previously been suggested that Alzheimer's disease patients have higher resting energy requirements than healthy individuals, which may contribute to their unexplained weight loss. We examined whether resting metabolic rate, the largest component of daily energy expenditure, is elevated in Alzheimer's patients compared with healthy older controls. DESIGN: Cross-sectional. SETTING: General Clinical Research Center and Baltimore VA Medical Center. PATIENTS: Twenty-five noninstitutionalized demented patients (74 +/- 8 years; mean +/- SD) with a wide range of Mini-Mental Examination scores (1 to 20) and 73 healthy older individuals (69 +/- 7 years). MEASUREMENTS: Resting metabolic rate was measured by indirect calorimetry, fat-free mass and fat mass by dual energy X-ray absorptiometry, and daily energy intake by food diaries. RESULTS: No differences in fat-free mass and fat mass were noted between Alzheimer's disease patients and healthy older controls. Resting metabolic rate was similar in Alzheimer's disease patients (5446 +/- 962 kJ/day) and healthy older individuals (5647 +/- 887 kJ/day). These results persisted when resting metabolic rate was statistically adjusted for differences in body composition and age. CONCLUSION: These results provide no evidence for an elevation in resting energy requirements in noninstitutionalized demented patients.

Energy expenditure in children of lean and obese parents.

We evaluated whether children of obese parents have defects in energy expenditure in a study of 73 children (5 +/- 0.9 yr of age) of lean and obese parents. Total energy expenditure (TEE) was measured over 14 days by use of doubly labeled water and physical activity energy expenditure (AEE) derived by subtracting resting energy expenditure (REE) under postprandial conditions. Fat and fat-free mass (FFM) were measured in children and parents with use of bioelectrical resistance. There were no significant correlations between TEE, REE, or AEE in children (after adjustment for FFM) and body fat in children or body fat in mothers or fathers. In three-way analysis of covariance (ANCOVA, with FFM as a covariate), there were no significant effects of gender in children, obesity in mothers, or obesity in fathers on TEE or AEE in children. There was a significant effect of gender and a significant interaction between obesity in mothers and obesity in fathers on REE; relative to children with two nonobese or two obese parents, REE was approximately 6% lower in children when mothers only or fathers only were obese. In conclusion, our data do not support the hypothesis that children of obese parents have major defects in energy expenditure.

Influence of body composition and resting metabolic rate on variation in total energy expenditure: a meta-analysis.

The influence of body composition, resting metabolic rate (RMR), and sex on variation in total energy expenditure (TEE) was examined by using meta-analysis (13 published studies in a total of 162 adults). TEE (10.9 +/- 3.2 MJ/d) was significantly correlated with body mass (BM; weighted mean converted r = 0.68, P < 0.05) and resting metabolic rate (RMR; weighted mean converted r = 0.66, P < 0.05). The correlation coefficients, regression coefficients, and intercepts for the regression between TEE and RMR and between TEE and BM were highly variable between studies. When TEE was adjusted for RMR, there was no significant correlation with body fat, and females had a significantly lower TEE than males by 1.1 MJ/d (P = 0.005). We conclude that 1) the relationships between TEE and RMR and TEE and BM are highly variable between studies with nonzero intercepts, precluding use of the traditionally used ratios of TEE to RMR or TEE to BM for data comparison; 2) after adjustment of TEE for RMR, TEE is not associated with adiposity, and women have a significantly lower TEE than men; and, 3) there are insufficient published data to develop prediction models for TEE in adults.

Estimating body composition of young children by using bioelectrical resistance.

It is currently unclear whether age-specific equations should be used for assessing body composition from bioelectrical resistance. Kushner et al. (Am. J. Clin. Nutr. 56: 835-839, 1992) showed that the relationship between height2/resistance and total body water (TBW) is robust across a wide age range, although uncertainty remained over the relationship in preschool children. We therefore cross-validated the Kushner equation for predicting total body water in 4- to 6-yr-old children in two independent laboratories. TBW was measured from H2 18O dilution, and bioelectrical resistance and reactance were measured using an RJL 101A analyzer in 31 children (15 females, 16 males; 5 +/- 0.8 yr) studied in Burlington, Vermont, and 30 children (14 females, 16 males; 5 +/- 0.2 yr) studied in Phoenix, Arizona. There was no significant difference between TBW predicted from the Kushner equation and that measured in children in Burlington (11.76 +/- 2.00 vs. 11.91 +/- 2.46 kg; r = 0.94) or in Phoenix (11.53 +/- 1.64 vs. 11.66 +/- 1.90 kg; r = 0.94). The Kushner equation for TBW can be transformed into an equation for fat-free mass (FFM) by using published age- and gender-specific constants for the hydration of FFM: hydration of FFM = 76.9 - 0.25 age (yr) - 1.9 gender where female equals 0 and male equals 1. The intraclass reliability for estimates of fat mass and FFM with the use of bioelectrical resistance in an independent group of 26 children (5.0 +/- 0.8 yr, 20.2 +/- 3.0 kg) was > 0.99 for duplicate observations performed 2 wk apart.(ABSTRACT TRUNCATED AT 250 WORDS)

Total energy expenditure in 4- to 6-yr-old children.

There is a sparsity of data on energy expenditure in young children. We therefore examined the components of daily energy expenditure in a group of 30 children (16 boys, 14 girls; age 4-6 yr) characterized for body weight, height, heart rate, and body composition from bioelectrical resistance. Total energy expenditure (TEE) was measured over 14 days under free living conditions by doubly labeled water, resting energy expenditure (REE) from indirect calorimetry, and activity energy expenditure was estimated from the difference between TEE and REE. Mean TEE was 1,379 +/- 290 kcal/day, which was 475 +/- 202 kcal/day lower than energy intake recommendations for this age group. Activity-related energy expenditure was estimated to be 267 +/- 203 kcal/day. TEE was most significantly related to fat-free mass (FFM; r = 0.86; P < 0.001), body weight (r = 0.83; P < 0.001), and REE (r = 0.80; P < 0.001). When TEE was adjusted for FFM, a significant correlation with heart rate was observed (partial r = 0.54; P = 0.002). Collectively, 86% of interindividual variation in TEE was accounted for by FFM, heart rate, and REE. We conclude that, in young 4- to 6-yr-old children, 1) TEE is approximately 25% lower than current recommendations for energy intake and 2) combined measurement of FFM, heart rate, and REE explain 86% of interindividual variation in TEE, thus providing a possible alternative method to estimate TEE in young children.