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Energy expenditure, energy intake and body composition in geriatric long-stay patients.

Energy expenditure, energy intake, body composition and selected biochemical analyses were studied in 14 males and 16 females with a mean age of 83 years (range 68-92) in geriatric long-stay wards. Energy expenditure was predicted from heart rate monitoring, and energy intake was assessed with a 4-day dietary record. Lean body mass (LBM), body fat (BF), and total body water (TBW) were estimated with a bioelectrical impedance method. The mean energy expenditure and energy intake were 1845 kcal/d (7719 kJ/d) and 1746 kcal/d (7305 kJ/d) in male, and 1550 kcal/d (6485 kJ/d) and 1489 kcal/d (6230 kJ/d) in female subjects. Thirty per cent of the patients were in a negative energy balance. Mean values (+/- SD) of LBM were 50.2 +/- 7.81 kg and 39.6 +/- 6.78 kg, of BF 14.4 +/- 4.98 kg and 19.6 +/- 6.26 kg, of TBW 38.2 +/- 4.67 kg and 29.2 +/- 4.16 kg, and of basal metabolic rate expressed per unit LBM 24 +/- 2.6 kcal/kg LBM and 27 +/- 4.5 kcal/kg LBM in male and female subjects, respectively. The males had a lower per cent body fat expressed per kg body weight, also supported by low triceps skinfold values. Twenty per cent of the patients had triceps skinfold values indicating severe malnutrition according to definitions in the literature. The values of serum sodium, potassium, triiodothyronine and thyroid-stimulating hormone were within reference limits.

Aged↗

Energy expenditure, energy balance, and composition of weight gain in low birth weight infants fed diets of different protein and energy content.

The effect of energy and protein intakes on energy expenditure, energy balance, and amount and relative rate of both protein and fat deposition in new tissue was investigated in 19 low birth weight infants whose mean protein and energy intakes, respectively, were 2.24 g/kg/d and 113 kcal/kg/d (formula A, n = 8), 3.6 g/kg/d and 115 kcal/kg/d (formula B, n = 5), and 3.5 g/kg/d and 149 kcal/kg/d (formula C, n = 6). The higher energy intake (formula C) but not the higher protein intake (formula B) resulted in greater energy expenditure. Both the higher protein (formula B vs formula A) and higher energy intakes (formula C vs formula B) resulted in greater weight gain secondary, in group B, to a greater absolute rate of protein deposition and, in group C, to a greater absolute rate of fat deposition. The relative composition of the new tissue deposited reflected the proportional intakes of protein and energy. The numerical value of the protein/fat ratio (g/g) of the new tissue deposited by infants fed formulas A and C, the protein contents of which were low relative to energy contents, were similar and significantly lower than the numerical value of the protein/fat ratio of the new tissue deposited by infants fed formula B, which had a higher protein content relative to energy content. These findings suggest that the composition of weight gain is related to both the absolute amounts and the proportions of dietary protein and energy; thus, both must be considered in formulation of nutritional regimens for LBW infants.

Body Weight↗

Energy expenditure, energy intake, and weight loss in Alzheimer disease.

Alzheimer disease is one of the leading causes of death among older individuals. Unexplained weight loss and cachexia are frequent clinical findings in patients with Alzheimer disease. Thus, it has been postulated that Alzheimer disease may be associated with dysfunction in body weight regulation. This brief review examines the interrelations among energy intake, energy expenditure, and body composition in Alzheimer disease. We explored whether abnormally high daily energy expenditures, low energy intakes, or both contribute to unexplained weight loss and a decline in nutritional status. Specifically, we considered studies that examined energy intake, body composition, and daily energy expenditure and its components. The application of doubly labeled water and indirect calorimetry to understand the etiology of wasting has increased our knowledge regarding the relation among energy expenditure, physical activity levels, and body composition in Alzheimer disease patients. Although the number of studies are limited, results do not support the notion that a hypermetabolic state contributes to unexplained weight loss in Alzheimer disease, even in cachectic patients. Recent findings are presented suggesting an association between abnormally elevated levels of physical activity energy expenditure and elevated appendicular skeletal muscle mass and energy intake in Alzheimer disease patients. Clinical strategies aimed at developing lifestyle and dietary interventions to maintain adequate energy intake, restore energy balance, and maintain skeletal muscle mass should be a future area of investigation in Alzheimer disease research.

Aged↗

Resting energy expenditure, activity energy expenditure and total energy expenditure at age 91-96 years.

There is a limited knowledge concerning energy requirements of the elderly, especially the oldest old (> 80 years). Energy requirements should be estimated from measurements of energy expenditure. For this purpose twenty-one free-living individuals (eight males, thirteen females) aged 91-96 years living in Göteborg, Sweden were studied. Total body water (TBW) measured by the doubly-labelled-water (DLW) technique was 29.5 (sd 5.4) kg in females and 35.6 (sd 4.3) kg in males. TBW measured using bioelectric impedance (BIA) was 31.6 (sd 6.4) kg in females and 42.0 (sd 7.4) kg in males. The mean difference between TBW measured by BIA and that measured by DLW was 3.54 (sd 3.6) kg (P = 0.0002). Resting metabolic rate (RMR) was measured using a ventilated-hood system and averaged 5.36 (sd 0.71) MJ/d in females (n 12) and 6.09 (sd 0.91) MJ/d in males (n 8). Difference between measured RMR and predicted BMR (n 20) was 0.015 (sd 0.86) MJ/d (NS). Total energy expenditure (TEE) measured by DLW averaged 6.3 (sd 0.81) MJ/d in females and 8.1 (sd 0.73) MJ/d in males. Activity energy expenditure (TEE - RMR), thus including diet-induced thermogenesis (DIT), averaged 0.95 (sd 0.95) MJ/d in females (n 12) and 2.02 (sd 1.13) MJ/d in males. Physical activity level (TEE/BMR) averaged 1.19 (sd 0. 19) in females and 1.36 (sd 0.21) (P = 0.08) in males. If DIT is assumed to be 10 % of the TEE, energy spent on physical activity will be very low in this population.

Aged↗

Energy expenditure, energy intake and prevalence of obesity after therapy for acute lymphoblastic leukemia during childhood.

OBJECTIVES: To investigate the prevalence and potential risk factors of obesity after therapy for childhood acute lymphoblastic leukemia (ALL). STUDY DESIGN: 39 ALL patients (age 10.7-20.5 years) who were in first remission for 3.4-14.6 years after standardized treatment with chemotherapy plus cranial irradiation (n = 25) or with chemotherapy alone (n = 14) were examined. After fasting overnight, the following parameters were investigated: body mass index (BMI) of patients and their parents; patients' BMI before ALL therapy; serum free thyroxin, growth hormone-dependent factors, estradiol, testosterone, cortisol, leptin and c-peptide; fat-free mass (bioelectrical impedance); resting metabolic rate (RMR, indirect calorimetry); caloric intake (24-hour recall); and physical activity (questionnaire). RMR data were applied to the fat-free mass and compared with 83 controls. RESULTS: The prevalence of obesity (criterion: BMI > 2 SDS) was significantly (p < 0.05) higher after ALL therapy (38%; irradiated patients 48%, non-irradiated patients 21%) than before therapy (3%). Compared to non-irradiated patients, irradiated patients had significantly lower RMRs (-1.07 +/- 0.24 vs. -0.32 +/- 0.21 SDS; p < 0.05), reduced physical activity levels (1.41 +/- 0.03 vs. 1.52 +/- 0.03; p < 0.05), and lower concentrations of insulin-like growth factor-binding protein-3 (-0.65 +/- 0.17 vs. 0.25 +/- 0.33 SDS; p < 0.05) and of free thyroxin (1.17 +/- 0.06 vs. 1.38 +/- 0.08 ng/dl; p < 0.05). Caloric intake was adequate. CONCLUSIONS: After ALL during childhood, patients face a higher risk of obesity. In the cranially irradiated patients, the likely causes are low physical activity, RMRs and hormonal insufficiency.

Adolescent↗

Validity of reported energy expenditure and energy and protein intakes in Swedish adolescent vegans and omnivores.

BACKGROUND: It is difficult to obtain accurate reports of dietary intake; therefore, reported dietary intakes must be validated. Researchers need low-cost methods of estimating energy expenditure to validate reports of energy intake in groups with different lifestyles and eating habits. OBJECTIVE: We sought to validate the reported energy expenditure and energy and protein intakes of Swedish adolescent vegans and omnivores. DESIGN: We compared 16 vegans (7 females and 9 males; mean age: 17.4 +/- 0.8 y) with 16 omnivores matched for sex, age, and height. Energy expenditure as reported in a physical activity interview and energy and protein intakes as reported by diet history were validated by using the doubly labeled water method and by measuring urinary nitrogen excretion. RESULTS: The validity of reported energy expenditure and energy and protein intakes was not significantly different between vegans and omnivores. The physical activity interview had a bias toward underestimating energy expenditure by 1.4 +/- 2.6 MJ/d (95% CI: 2.4, 0.5 MJ/d). The diet-history interview had a bias toward underestimating energy intake by 1.9 +/- 2.7 MJ/d (95% CI: 2.9, 1.0 MJ/d) but showed good agreement with the validation method for nitrogen (protein) intake (underestimate of 0.40 +/- 1.90 g N/d; 95% CI: 1.10, 0.29 g N/d). CONCLUSIONS: The physical activity and diet-history interviews underestimated energy expenditure and energy intake, respectively. Energy intake and expenditure were underestimated to the same extent, and the degree of underestimation was not significantly different between vegans and omnivores. Valid protein intakes were obtained with the diet-history method for both vegans and omnivores.

4-Aminobenzoic Acid↗

The role of energy expenditure in energy regulation: findings from a decade of research.

The role of energy expenditure in energy regulation remains a subject of continuing controversy. New data have emerged from studies conducted over the last decade demonstrating that energy expenditure is a critical factor contributing to successful energy regulation in normal individuals, as well as to the disregulation of energy balance that characterizes obesity. Reduced energy expenditure appears to facilitate weight gain in individuals susceptible to obesity and also appears to reduce the extent of body energy loss during undereating in both lean and obese individuals. The magnitude of the reduction in energy expenditure during, and perhaps after, weight loss is greater than expected on the basis of the reduction in body weight and appears to occur in response to undefined underlying determinants of energy regulation. In addition, exercise intervention studies and cross-sectional investigations of the relationship between energy expenditure for physical activity and body composition demonstrate an apparent equilibration between physical activity and body fat content. This equilibration is suggestive of a direct influence of physical activity on the underlying metabolic determinants of energy balance.

Body Mass Index↗

Effect of posture and locomotion on energy expenditure.

Energy expenditure for human adults and infants and for dogs was measured in resting (supine or lateral) posture, in bipedal posture and locomotion, and in quadrupedal posture and locomotion. Variations in respiratory and heart rate and in body temperature were utilized in this comparative study. Oxygen consumption was also measured in human adults. In human adults, bipedal posture and locomotion were shown to be much less energy-consuming than corresponding quadrupedal posture and locomotion. The opposite was observed in adult dogs, where bipedalism was shown to be much more energy-consuming than quadrupedalism. In addition, this study demonstrated, for human adults in their natural erect posture, an energy expenditure barely higher than in supine or lateral resting posture, while the dogs in their natural quadrupedal stance, the energy expenditure is much higher than in their resting posture. With respect to energy, therefore, humans are more adapted to bipedalism than dogs to quadrupedalism. Human children, at the transitional stage between quadrupedalism and bipedalism, have high and almost equal requirements for all postures and locomotions. This demonstrates, in term of energy, their incomplete adaptation to erect behavior.

Adolescent↗

Skeletal muscle metabolism is a major determinant of resting energy expenditure.

Energy expenditure varies among people, independent of body size and composition, and persons with a "low" metabolic rate seem to be at higher risk of gaining weight. To assess the importance of skeletal muscle metabolism as a determinant of metabolic rate, 24-h energy expenditure, basal metabolic rate (BMR), and sleeping metabolic rate (SMR) were measured by indirect calorimetry in 14 subjects (7 males, 7 females; 30 +/- 6 yr [mean +/- SD]; 79.1 +/- 17.3 kg; 22 +/- 7% body fat), and compared to forearm oxygen uptake. Values of energy expenditure were adjusted for individual differences in fat-free mass, fat mass, age, and sex. Adjusted BMR and SMR, expressed as deviations from predicted values, correlated with forearm resting oxygen uptake (ml O2/liter forearm) (r = 0.72, P less than 0.005 and r = 0.53, P = 0.05, respectively). These findings suggest that differences in resting muscle metabolism account for part of the variance in metabolic rate among individuals and may play a role in the pathogenesis of obesity.

Adult↗

The effect of protein intake on 24-h energy expenditure during energy restriction.

OBJECTIVE: To investigate whether protein intake influences the decline in energy expenditure during energy restriction. DESIGN: Cross-over study of three diets of 4.2 MJ/d for 7 days: one diet with 36% energy as protein and two with 15% energy as protein, one high in carbohydrate and the other high in fat. SUBJECTS: Two men and six women aged 31-57 y. BMI 27.B-34.1 kg/m2. MEASUREMENTS: 24-h energy expenditure (24-h EE), sleeping metabolic rate (SMR) and body weight on days 0 and 7 of each diet; 24-h urinary nitrogen excretion (24-h UN) on days 0-7 of each diet. RESULTS: 24-h EE and SMR declined on all three diets but the decrease was significantly less on the high protein diet than on the two low protein diets. Weight loss was similar on all three diets. 24-h UN was less than N intake on the high protein diet but greater than N intake on the two low protein diets. CONCLUSIONS: Maintaining protein intake reduces the decrease in energy expenditure during energy restriction.

Adult↗

Effect of sleep and circadian cycle on sleep period energy expenditure.

Energy expenditure is lower during sleep than relaxed wakefulness. However, there is disagreement as to the particular metabolic changes that produce the difference. The present study assessed the contribution of sleep, circadian cycle, and the specific dynamic action effect of the evening meal to the sleep period fall in metabolic rate. Five subjects were tested for a total of nine nights under three conditions in a repeated-measures design. Subjects were confined to bed throughout their usual sleep period but were instructed to go to sleep 0, 3, or 6 h after their usual time for lights out. O2 consumption was measured in all conditions for the 0.5 h before and after each of the times for lights out and then throughout the sleep period after lights out. The results demonstrated that changes in energy expenditure during the sleep period are a function of both sleep and circadian cycle. In this study, the contribution of the two components was approximately equal. However, the effect of sleep was rapid asymptoting within 15 min of sleep onset, whereas that of circadian cycle was constant over the assessment period.

Adult↗

Energy expenditure and energy intake during dexamethasone therapy for chronic lung disease.

Dexamethasone is commonly administered to ventilator-dependent preterm infants with chronic lung disease. Infants receiving dexamethasone therapy frequently exhibit decreased rates of weight gain. The purpose of this investigation was to determine whether decreased growth in infants receiving dexamethasone therapy is caused by increased energy expenditure. Twelve infants were studied: 6 received dexamethasone treatment at 2 wk of age and crossed over to receive placebo treatment at 4 wk; the treatment order was reversed in the other 6 infants. The doubly labeled water method was used to determine energy expenditure for a 1-wk period during each treatment phase. The rate of weight gain during dexamethasone treatment was 6.5+/-10.6 and 20.0+/-5.7 g/kg/d during placebo treatment. Energy expenditure was 93.1+/-34.6 kcal/kg/d during dexamethasone treatment and 88.3+/-37.1 kcal/kg/d during placebo treatment. Energy intake was 119.2+/-29.0 kcal/kg/d during dexamethasone treatment and 113.8+/-23.7 kcal/kg/d during placebo treatment. The difference between intake and expenditure, or the energy available for growth, was 26.2+/-36.8 kcal/kg/d during dexamethasone treatment and 25.5+/-37.4 kcal/kg/d during placebo treatment. No significant differences were found in energy expenditure or energy intake between the treatment phases. The reduced growth seen in infants receiving dexamethasone treatment cannot be explained by increased energy expenditure or decreased energy intake, but may be due to differences in the composition of newly accreted tissue.

Anti-Inflammatory Agents↗

Total energy expenditure and energy intake in the pre-school child: a comparison.

In a cohort (n 81) of healthy children aged 1.5-4.5 years, measurements of energy intake and energy expenditure were compared. Energy intake was calculated following a 4 d weighed record completed by the mother or guardian of the child. Total energy expenditure was measured using the doubly-labelled water technique. Mean energy intake and expenditure in the cohort were 4773 kJ/d and 4928 kJ/d respectively. The mean relative bias between the techniques was 154 kJ/d. In the older children (3.5-4.5 years) the mean relative bias was only 37 kJ/d. At the population level the measurements of energy intake and energy expenditure were extremely close, and the study has provided sufficient confidence in weighed intake methodology for it to be used in a major nationwide study of dietary intake and nutritional status of children aged 1.5-4.5 years.

Age Factors↗

Effects of recombinant human leptin treatment as an adjunct of moderate energy restriction on body weight, resting energy expenditure and energy intake in obese humans.

We explored the effects of recombinant human leptin (rL) as an adjunct of mild energy restriction (2092 kJ/day less than needed) in the treatment of obese humans as part of a larger multicentre trial. In a double blind, randomised, placebo (P)-controlled design, the effects of 10 mg of rL once daily vs twice daily (rL OD/BID, by s.c. injection) upon body weight, resting energy expenditure (REE) and energy intake were compared. The study groups comprised 9 (P), 15 (rL OD) and 6 (rL BID) healthy subjects (body mass index 27.5-35 kg/m2). We observed in both groups treated with rL a decline of body weight. [2.8+/-1.1 kg (P), 5.2+/-0.9 kg (rL OD), 7.9+/-1.4 kg (rL BID), p < 0.035]. No significant effects of rL treatment upon energy intake or REE were observed. However, rL tended to reduce the decline of energy expenditure associated with energy restriction, whereas the tendency of energy intake to increase back to baseline levels in placebo-treated subjects was largely prevented in subjects treated with rL. Thus, rL appears to enhance the loss of body weight in obese humans in a dose-dependent fashion if prescribed as an adjunct of energy restriction. This effect might be mediated by rL ability to counteract the behavioural and metabolic adaptations that accompany weight loss attempts.

Adaptation, Physiological↗

Interaction of acute changes in exercise energy expenditure and energy intake on resting metabolic rate.

The effects on resting metabolic rate (RMR) of energy intake and exercise energy expenditure were examined in eight trained men under four conditions: 1) high energy flux (HF), 90 min of exercise at 75% VO2max on 3 d while in energy balance; 2) low energy flux (LF), no exercise for 3 d while in energy balance; 3) negative energy balance (NEB), exercise on 3 d while consuming low-flux meals; and 4) positive energy balance (PEB), no exercise for 2 d while consuming high-flux meals. Eight untrained men were studied in LF. There were effects of exercise energy expenditure and energy intake on RMR, and an exercise x diet interaction (P < 0.05). RMR was greater in trained than in untrained subjects only when trained subjects were in HF. These data indicate that RMR is influenced by exercise, energy intake, and their interaction and suggest that higher RMR in trained vs untrained individuals results from acute effects of HF rather than from a chronic adaptation to exercise training.

Adolescent↗

The decrease in body fat in mice fed conjugated linoleic acid is due to increases in energy expenditure and energy loss in the excreta.

We carried out energy balance studies in four groups of young, growing, 5-wk-old Balb-C mice (n = 12/group) that were either food restricted or nonrestricted and fed high fat diets (38 energy%) with or without 0.93 g/100 g conjugated linoleic acid (CLA) for 39 d. The energy in carcasses, excreta and food was measured in a bomb calorimeter. CLA lowered the percentage of the energy intake that was stored in the body from 1.9 +/- 0.8 to -2.3 +/- 0.7% (mean +/- SD, P < 0.05) in the nonrestricted mice and from 1.4 +/- 1.3 to -2.9 +/- 0.7% (P < 0.05) in the restricted mice. Thus, the CLA-treated mice had a net loss of body energy. The percentage of the energy intake eliminated in the excreta increased from 7.6 +/- 0.9% in controls to 8.7 +/- 1.0% (P < 0.05) in the CLA-treated mice that were nonrestricted and from 7.3 +/- 0.8 to 8.4 +/- 0.6 (P < 0.05) in the restricted mice. The amount of energy ingested minus the amount retained in carcasses and excreta equals the energy expenditure. The percentage of the energy intake that was expended as heat increased from 90.5 +/- 1.2 in controls to 93.6 +/- 1.5% (P < 0.05) in the CLA-treated nonrestricted mice and from 91.3 +/- 1.5 to 94.5 +/- 1.0% (P < 0.05) in the restricted mice. The lower energy storage in the CLA-fed mice was accounted for by an increase in the energy expenditure (74%) and by an increase in energy lost in the excreta (26%). Feeding CLA also increased liver weight, which may warrant further studies on the safety of CLA.

Adipose Tissue↗

Energy requirements during pregnancy based on total energy expenditure and energy deposition.

BACKGROUND: Energy requirements during pregnancy remain controversial because of uncertainties regarding maternal fat deposition and reductions in physical activity. OBJECTIVE: This study was designed to estimate the energy requirements of healthy underweight, normal-weight, and overweight pregnant women and to explore energetic adaptations to pregnancy. DESIGN: The energy requirements of 63 women [17 with a low body mass index (BMI; in kg/m(2)), 34 with a normal BMI, and 12 with a high BMI] were estimated at 0, 9, 22, and 36 wk of pregnancy and at 27 wk postpartum. Basal metabolic rate (BMR) was measured by calorimetry, total energy expenditure (TEE) by doubly labeled water, and activity energy expenditure (AEE) as TEE - BMR. Energy deposition was calculated from changes in body protein and fat. Energy requirements equaled the sum of TEE and energy deposition. RESULTS: BMR increased gradually throughout pregnancy at a mean (+/-SD) rate of 10.7 +/- 5.4 kcal/gestational week, whereas TEE increased by 5.2 +/- 12.8 kcal/gestational week, which indicated a slight decrease in AEE. Energy costs of pregnancy depended on BMI group. Although total protein deposition did not differ significantly by BMI group (mean for the 3 groups: 611 g protein), FM deposition did (5.3, 4.6, and 8.4 kg FM in the low-, normal-, and high-BMI groups; P = 0.02). Thus, energy costs differed significantly by BMI group (P = 0.02). In the normal-BMI group, energy requirements increased negligibly in the first trimester, by 350 kcal/d in the second trimester, and by 500 kcal/d in the third trimester. CONCLUSION: Extra energy intake is required by healthy pregnant women to support adequate gestational weight gain and increases in BMR, which are not totally offset by reductions in AEE.

Adult↗