Acute sleep deprivation reduces energy expenditure in healthy men. Benedict Christian,Hallschmid Manfred,Lassen Arne,Mahnke Christin,Schultes Bernd,Schiöth Helgi Birgir,Born Jan,Lange Tanja The American journal of clinical nutrition BACKGROUND:Epidemiologic evidence indicates that chronic sleep curtailment increases risk of developing obesity, but the mechanisms behind this relation are largely unknown. OBJECTIVE:We examined the influence of a single night of total sleep deprivation on morning energy expenditures and food intakes in healthy humans. DESIGN:According to a balanced crossover design, we examined 14 normal-weight male subjects on 2 occasions during a regular 24-h sleep-wake cycle (including 8 h of nocturnal sleep) and a 24-h period of continuous wakefulness. On the morning after regular sleep and total sleep deprivation, resting and postprandial energy expenditures were assessed by indirect calorimetry, and the free-choice food intake from an opulent buffet was tested in the late afternoon at the end of the experiment. Circulating concentrations of ghrelin, leptin, norepinephrine, cortisol, thyreotropin, glucose, and insulin were repeatedly measured over the entire 24-h session. RESULTS:In comparison with normal sleep, resting and postprandial energy expenditures assessed on the subsequent morning were significantly reduced after sleep deprivation by ≈5% and 20%, respectively (P < 0.05 and P < 0.0001). Nocturnal wakefulness increased morning plasma ghrelin concentrations (P < 0.02) and nocturnal and daytime circulating concentrations of thyreotropin, cortisol, and norepinephrine (P < 0.05) as well as morning postprandial plasma glucose concentrations (P < 0.05). Changes in food intakes were variable, and no differences between wake and sleep conditions were detected. CONCLUSION:Our findings show that one night of sleep deprivation acutely reduces energy expenditure in healthy men, which suggests that sleep contributes to the acute regulation of daytime energy expenditure in humans. 10.3945/ajcn.110.006460
    Poor sleep quality and sleep apnea are associated with higher resting energy expenditure in obese individuals with short sleep duration. de Jonge Lilian,Zhao Xiongce,Mattingly Megan S,Zuber Samuel M,Piaggi Paolo,Csako Gyorgy,Cizza Giovanni, The Journal of clinical endocrinology and metabolism CONTEXT:Epidemiological studies reported an inverse or U-shaped relationship between sleep duration and weight. The relationship between sleep and resting energy expenditure (REE) has not been well characterized. OBJECTIVE:The aim of the study was to determine the relationship between sleep, REE, and stress hormones. DESIGN AND SETTING:We conducted a cross-sectional evaluation of a prospective cohort study at a tertiary referral research clinical center. SUBJECTS:Subjects included 126 obese individuals (30 males, 96 females; age, 40.5 ± 6.9 yr; body mass index, 38.6 ± 6.5 kg/m(2); sleep duration, 360 ± 50 min/night; and sleep efficiency, 79.5 ± 7.5%). MAIN OUTCOME MEASURE(S):REE and respiratory quotient (RQ) were assessed by indirect calorimetry. Sleep duration and sleep efficiency were assessed by actigraphy. Sleep quality was estimated by questionnaires, and sleep apnea was evaluated by respiratory disturbance index (RDI). Morning plasma ACTH, serum cortisol, and 24-h urinary free cortisol and catecholamines were also measured. RESULTS:RDI was positively correlated with REE adjusted by fat-free mass (r = 0.307; P = 0.003) and RQ (r = 0.377; P < 0.001). Sleep efficiency was inversely correlated with RQ (r = -0.200; P = 0.033). The relationship of RDI score and REE was stronger in men than women (P = 0.03). In women, serum cortisol was positively correlated (r = 0.407; P < 0.001), and Epworth sleepiness score tended to be inversely (r = -0.190; P = 0.086) correlated with adjusted REE. The RQ was positively related to RDI in women, whereas subjective sleep time was related to RQ in men. In a multiple regression model, RDI, serum cortisol, and urinary norepinephrine were directly related to REE, whereas serum cortisol also directly related to adjusted REE. CONCLUSION:Poor sleep quality was associated with increased REE, a higher RQ indicating a shift from fat toward carbohydrate oxidation, and activation of the stress system. 10.1210/jc.2011-2858
    The influence of energy metabolism on postpartum weight retention. Pereira Leticia C R,Elliott Sarah A,McCargar Linda J,Bell Rhonda C,Vu Khanh,Bell Gordon,Robson Paula J,Prado Carla M, The American journal of clinical nutrition BACKGROUND:Profiling postpartum energy metabolism may assist in optimizing weight management following childbirth. OBJECTIVES:The aims of this study were to profile total energy expenditure (TEE), resting energy expenditure (REE), exercise energy expenditure, sleep energy expenditure, and respiratory quotient in women at 3 and 9 mo postpartum (3M-PP, 9M-PP, respectively), and to examine the association between energy metabolism and postpartum weight retention (PPWR). METHODS:In this cohort study, 1-h REE (measured in a whole body calorimetry unit, WBCU) and body composition (BC, measured by dual-energy X-ray absorptiometry) were measured at 3M-PP and 9M-PP (n = 49). Cardiorespiratory fitness [measured by the predicted maximal volume of oxygen consumption (p$\dot{V}$O2 max), n = 47] and 24-h TEE (WBCU, n = 43) were assessed only at 9M-PP. Women were stratified as high (>4.8 kg) or low (≤ 4.8 kg) weight retainers. Two-way mixed repeated-measures ANOVA and longitudinal regression models were applied. Linear regression was used to generate an equation at 3M-PP from the BC data, to predict the REE at 9M-PP. RESULTS:The fat mass at 3M-PP was positively associated with PPWR at 3M-PP (mean ± SE β: 0.09 ± 0.03; P = 0.005) and 9M-PP (β: 0.11 ± 0.04; P = 0.008), and negatively associated with REE at 3M-PP (β: -0.16 ± 0.02; P < 0.001) and TEE at 9M-PP (β: -0.15 ± 0.03; P < 0.001). REE was negatively associated with PPWR (β: -0.74; 95% CI: -1.29, -0.19; P = 0.0087). REE was 2 kcal/kg higher in low- vs. high-retainers at 3M-PP, and REE and TEE were both 4 kcal/kg higher in low- vs. high-retainers at 9M-PP. Low-retainers demonstrated an increase in REE greater than expected for changes in BC. PPWR was negatively associated with TEE (β: -0.08 ± 0.02; P = 0.0009) and p$\dot{V}$O2 max (β: -0.02 ± 0.01; P = 0.047); p$\dot{V}$O2 max was 7 mL · kg-1 · min-1 higher in low- vs. high-retainers (P = 0.047). CONCLUSIONS:Energy metabolism, BC, and cardiorespiratory fitness may be associated with weight regulation and its trajectory during the postpartum period. This provides the foundation for future strategies to promote appropriate postpartum weight management. 10.1093/ajcn/nqy389
    Pre-Sleep Casein Protein Ingestion Does Not Impact Next-Day Appetite, Energy Intake and Metabolism in Older Individuals. Morehen Stephen,Smeuninx Benoit,Perkins Molly,Morgan Paul,Breen Leigh Nutrients Maintaining adequate daily protein intake is important to maintain muscle mass throughout the lifespan. In this regard, the overnight period has been identified as a window of opportunity to increase protein intake in the elderly. However, it is unknown whether pre-sleep protein intake affects next-morning appetite and, consequently, protein intake. Therefore, the purpose of the current study was to investigate the effects of a pre-sleep protein drink on next-morning appetite, energy intake and metabolism. Twelve older individuals (eight males, four females; age: 71.3 ± 4.2 years) took part in a single-blind randomised cross-over study. After a standardised dinner, participants consumed either a 40-g protein drink, isocaloric maltodextrin drink, or placebo water control before bedtime. Next-morning appetite, energy intake, resting metabolic rate (RMR), respiratory exchange rate (RER), and plasma acylated ghrelin, leptin, glucose, and insulin concentrations were assessed. No between-group differences were observed for appetite and energy intake at breakfast. Furthermore, RMR, RER, and assessed blood markers were not significantly different between any of the treatment groups. Pre-sleep protein intake does not affect next-morning appetite and energy intake and is therefore a viable strategy to increase daily protein intake in an older population. 10.3390/nu12010090
    Applicability of predictive equations for resting energy expenditure in obese patients with obstructive sleep apnea. Del Re Mariana Pantaleão,Melo Camila Maria de,Santos Marcus Vinicius Dos,Tufik Sergio,Mello Marco Túlio de Archives of endocrinology and metabolism Objective:To investigate the applicability of predictive equations for resting energy expenditure (REE) in obese individuals with obstructive sleep apnea (OSA) and the effects of OSA severity on REE. Materials and methods:Twenty-nine obese men, 41.5 ± 7 years old, with moderate and severe OSA were recruited. All subjects were submitted to a clinical polysomnography, body composition, and indirect calorimetry measurements. REE was also predicted by three different equations: Harris and Benedict (1919), Cunningham (1990), and DRI (2002). Results:No effects of OSA severity on REE were found. The measured REE (2416.0 ± 447.1 kcal/day) and the REE predicted by equations were different from each other (F = 2713.88; p < 0.05): Harris and Benedict (2128.0 ± 245.8 kcal/day), Cunningham (1789.1 ± 167.8 kcal/day) and DRI (2011.1 ± 181.4 kcal/day). Pearson correlations showed a moderate positive correlation between the REE measured and predicted by all equations. Conclusion:Our findings suggest that predictive equations for REE underestimate the energy expenditure in obese patients with sleep apnea. Also, no effects of OSA severity on REE were found. 10.1590/2359-3997000000228
    State-dependent metabolic partitioning and energy conservation: A theoretical framework for understanding the function of sleep. Schmidt Markus H,Swang Theodore W,Hamilton Ian M,Best Janet A PloS one Metabolic rate reduction has been considered the mechanism by which sleep conserves energy, similar to torpor or hibernation. This mechanism of energy savings is in conflict with the known upregulation (compared to wake) of diverse functions during sleep and neglects a potential role in energy conservation for partitioning of biological operations by behavioral state. Indeed, energy savings as derived from state-dependent resource allocations have yet to be examined. A mathematical model is presented based on relative rates of energy deployment for biological processes upregulated during either wake or sleep. Using this model, energy savings from sleep-wake cycling over constant wakefulness is computed by comparing stable limit cycles for systems of differential equations. A primary objective is to compare potential energy savings derived from state-dependent metabolic partitioning versus metabolic rate reduction. Additionally, energy conservation from sleep quota and the circadian system are also quantified in relation to a continuous wake condition. As a function of metabolic partitioning, our calculations show that coupling of metabolic operations with behavioral state may provide comparatively greater energy savings than the measured decrease in metabolic rate, suggesting that actual energy savings derived from sleep may be more than 4-fold greater than previous estimates. A combination of state-dependent metabolic partitioning and modest metabolic rate reduction during sleep may enhance energy savings beyond what is achievable through metabolic partitioning alone; however, the relative contribution from metabolic partitioning diminishes as metabolic rate is decreased during the rest phase. Sleep quota and the circadian system further augment energy savings in the model. Finally, we propose that state-dependent resource allocation underpins both sleep homeostasis and the optimization of daily energy conservation across species. This new paradigm identifies an evolutionary selective advantage for the upregulation of central and peripheral biological processes during sleep, presenting a unifying construct to understand sleep function. 10.1371/journal.pone.0185746
    Relationship of evening meal with sleep quality in obese individuals with obstructive sleep apnea. de Melo Camila Maria,Del Re Mariana Pantaleão,Dos Santos Quaresma Marcus Vinicius Lucio,Moreira Antunes Hanna Karen,Togeiro Sonia Maria,Lima Ribeiro Sandra Maria,Tufik Sergio,de Mello Marco Tulio Clinical nutrition ESPEN PURPOSE:To determine the relationship between habitual food intake, resting energy expenditure and sleep pattern in obstructive sleep apnea (OSA) patients. METHODS:Forty-five OSA obese males were included in the study. All participants were submitted to nocturnal polysomnography, body composition measurements by plethysmography, resting energy expenditure (REE) analysis by indirect calorimetry and they filled in a 3-day food record. RESULTS:No differences in body composition, REE and food intake were found between the moderate and severe OSA groups. A trend towards higher energy intake in the severe OSA group was observed, compared to the moderate group (p = 0.08). Significant associations between apnea-hypopnea index (AHI) with body weight, body mass index (BMI) and resting energy expenditure (REE) were found. Higher food intake in the evening period was positively correlated with sleep stage NREM1, arousal index, and AHI and negatively correlated with sleep stage NREM3 and sleep efficiency. A multivariate linear regression showed energy intake at breakfast to be a significant negative predictor of AHI; protein intake (g/kg) showed a positive association, while energy intake at breakfast and at dinner were negative predictors of sleep efficiency; and energy intake at dinner was a negative predictor of stage NREM1 sleep. CONCLUSIONS:We conclude that higher amounts of food intake during the evening period may diminish sleep quality in moderate and severe sleep apnea patients. In addition, despite observing no differences between OSA severity groups, a moderate correlation between REE and sleep quality and OSA exists. 10.1016/j.clnesp.2018.09.077
    Short sleep duration and its association with energy metabolism. Klingenberg L,Sjödin A,Holmbäck U,Astrup A,Chaput J-P Obesity reviews : an official journal of the International Association for the Study of Obesity A growing body of observational evidence suggests that short sleep duration is a risk factor for the development of obesity. Although increased energy intake is the most prevailing causal explanation for this association, we should also consider possible effects on energy metabolism to understand fully the potential impact of short sleep duration on the regulation of energy balance. We performed a search of the literature from 1970 to 2011, including original papers, investigating the relation between short sleep and energy metabolism in animals and humans. Although the limited number of experimental studies in humans precludes any definitive conclusions about causality, short sleep duration does not seem to substantially affect total daily energy expenditure, nor is there sufficient evidence in support of any meaningful effect of restricted sleep on the specific components of energy metabolism (i.e. resting metabolic rate, intentional as well as unintentional physical activity, diet-induced thermogenesis, and substrate utilization). As studies on rats suggest that other factors that can potentially influence energy metabolism could be affected (i.e. hormonal systems and thermoregulation), we included these factors in our literature search and found some indications in support of an up-regulation of thyroid hormones and glucocorticoids as well as increased heat dissipation following total or severe sleep deficit. Although we found some evidence also in humans that suggests a possible effect on energy metabolism, the limitations of the studies make it difficult to draw conclusions on the effect of short sleep on energy metabolism under relevant free living conditions. To explore this area further, more studies using suitable methodology under relevant conditions to mimic real-life situations are needed. 10.1111/j.1467-789X.2012.00991.x
    Resting metabolic rate varies by race and by sleep duration. Spaeth Andrea M,Dinges David F,Goel Namni Obesity (Silver Spring, Md.) OBJECTIVE:Short sleep duration is a significant risk factor for weight gain, particularly in African Americans and men. Increased caloric intake underlies this relationship, but it remains unclear whether decreased energy expenditure is a contributory factor. The current study assessed the impact of sleep restriction and recovery sleep on energy expenditure in African American and Caucasian men and women. METHODS:Healthy adults participated in a controlled laboratory study. After two baseline sleep nights, subjects were randomized to an experimental (n = 36; 4 h sleep/night for five nights followed by one night with 12 h recovery sleep) or control condition (n = 11; 10 h sleep/night). Resting metabolic rate and respiratory quotient were measured using indirect calorimetry in the morning after overnight fasting. RESULTS:Resting metabolic rate-the largest component of energy expenditure-decreased after sleep restriction (-2.6%, P = 0.032) and returned to baseline levels after recovery sleep. No changes in resting metabolic rate were observed in control subjects. Relative to Caucasians (n = 14), African Americans (n = 22) exhibited comparable daily caloric intake but a lower resting metabolic rate (P = 0.043) and higher respiratory quotient (P = 0.013) regardless of sleep duration. CONCLUSIONS:Sleep restriction decreased morning resting metabolic rate in healthy adults, suggesting that sleep loss leads to metabolic changes aimed at conserving energy. 10.1002/oby.21198
    Hibernoma: a clinical model for exploring the role of brown adipose tissue in the regulation of body weight? Gadea Emilie,Thivat Emilie,Paulon Rodolphe,Mishellany Florence,Gimbergues Pierre,Capel Frédéric,Mosoni Laurent,Merlin Charles,Lombès Marc,Morio Béatrice,Durando Xavier The Journal of clinical endocrinology and metabolism CONTEXT:Hibernoma is a rare benign tumor histologically similar to brown adipose tissue. Some studies reported weight loss in patients with this tumor; however, the mechanisms have never been investigated. OBJECTIVE:The purpose of this study is to explore the impact of hibernoma resection on the whole-body metabolism. PATIENT AND METHODS:A 68-year-old woman was examined after a weight loss of 10 kg in 6 months. Body composition, food intake, physical activity, blood levels of thyroid hormones, and lipid profile were assessed before surgery and during 1 year after surgery. The patient's resting energy expenditure (REE) over time was compared to a control group of 18 matched healthy volunteers. RESULTS:Within 1 year after hibernoma resection, the patient gained 15 kg of body weight. This was associated with fat mass gain (+41%), mainly in the abdominal region (+48%). The patient also developed hepatic nonalcoholic steatosis, mild hypertriglyceridemia, and reduced levels of high-density lipoproteins. REE increased during the dynamic phase of weight gain, compared to the presurgery measurement, and returned to baseline after 1 year. Food intake was increased by 37.5% 6 weeks after resection of the hibernoma and returned to baseline values within 6 months. CONCLUSIONS:In our study conditions, hibernoma did not alter REE, but weight gain did. Specific physical activities and dietetic follow-ups are suggested for those patients to prevent excess fat mass gain and metabolic disorders after hibernoma resection. More studies should focus on hibernoma mechanisms inducing weight loss. 10.1210/jc.2013-2829
    Body composition and time course changes in regional distribution of fat and lean tissue in unselected cancer patients on palliative care--correlations with food intake, metabolism, exercise capacity, and hormones. Fouladiun Marita,Körner Ulla,Bosaeus Ingvar,Daneryd Peter,Hyltander Anders,Lundholm Kent G Cancer BACKGROUND:Several investigations that yielded different results in terms of net changes in body composition of weight-losing cancer patients have been reported that employed a variety of methods based on fundamentally different technology. Most of those reports were cross-sectional, whereas to the authors' knowledge there is sparse information available on longitudinal follow-up measurements in relation to other independent methods for the assessment of metabolism and performance. METHODS:For the current report, the authors evaluated time course changes in body composition (dual-energy X-ray absorptiometry) with measurements of whole body and regional distribution of fat and lean tissue in relation to food and dietary intake, host metabolism (indirect calorimetry), maximum exercise capacity (walking test), and circulating hormones in cancer patients who were receiving palliative care during 4-62 months of follow-up. The entire cohort comprised 311 patients, ages 68 years +/- 3 years who were diagnosed with solid gastrointestinal tumors (84 colorectal tumors, 74 pancreatic tumors, 73 upper gastrointestinal tumors, 51 liver-biliary tumors, 3 breast tumors, 5 melanomas, and 21 other tumor types). RESULTS:Decreased body weight was explained by loss of body fat, preferentially from the trunk, followed by leg tissue and arm tissue, respectively. Lean tissue (fat-free mass) was lost from arm tissue, whereas trunk and leg tissue compartments increased, all concomitant with declines in serum albumin, increased systemic inflammation (C-reactive protein, erythrocyte sedimentation rate), increased serum insulin, and elevated daily caloric intake; whereas serum insulin-like growth factor 1 (IGF-1), resting energy expenditure, and maximum exercise capacity remained unchanged in the same patients. Serum albumin levels (P < 0.001), whole body fat (P < 0.02), and caloric intake (P < 0.001) predicted survival, whereas lean tissue mass did not. Daily intake of fat and carbohydrate was more important for predicting survival than protein intake. Survival also was predicted by serum IGF-1, insulin, leptin, and ghrelin levels (P < 0.02 - P < 0.001). Serum insulin, leptin, and ghrelin (total) levels predicted body fat (P < 0.001), whereas IGF-1 and thyroid hormone levels (T3, free T3) predicted lean tissue mass (P < 0.01). Systemic inflammation primarily explained variation in lean tissue and secondarily explained loss in body fat. Depletion of lean arm tissue was related most to short survival compared with the depletion of lean leg and trunk tissue. CONCLUSIONS:The current results demonstrated that body fat was lost more rapidly than lean tissue in progressive cancer cachexia, a phenomenon that was related highly to alterations in the levels of circulating classic hormones and food intake, including both caloric amount and diet composition. The results showed importance in the planning of efficient palliative treatment for cancer patients. 10.1002/cncr.21013
    Resting energy expenditure and body composition in patients with head and neck cancer: An observational study leading to a new predictive equation. Souza Micheline Tereza Pires,Singer Pierre,Ozorio Gislaine Aparecida,Rosa Vitor Modesto,Alves Maria Manuela Ferreira,Mendoza López Rossana Verónica,Waitzberg Dan L Nutrition (Burbank, Los Angeles County, Calif.) OBJECTIVES:Patients with head and neck cancer have changes in body composition and resting energy expenditure (REE) related to significant inflammatory processes. We investigated REE and body composition in a population of patients with head and neck cancer, comparing the measured REE with predicted energy expenditure and deriving an equation of anthropometric values and body composition. METHODS:This retrospective, observational, descriptive study of a single center included patients with head and neck cancer. We evaluated nutritional status by body mass index (BMI) and Patient-Generated Subjective Global Assessment (PG-SGA), body composition by electric bioimpedance, and REE by indirect calorimetry (IC). RESULTS:We included 140 patients, most of whom were men (80.7%), 60 y or older (58.6%), and had advanced disease (77.9%). Most were malnourished by BMI standards (77.9%) and severely malnourished according to the PG-SGA (49.3%), with a fat-free mass below the ideal values (82.9%) associated with sarcopenia (92.1%). Hypermetabolism was 57%. When comparing REE with the Harris-Benedict formula, we found the agreement limits from -546 613 to 240 708, the mean difference was -152 953 (95% confidence interval [CI], -185 844 to -120 062) and Pitman's variance test was r = -0.294 (P = 0.001). When we included the activity factor and the thermogenesis factor in REE and compared with Harris-Benedict, we found the agreement limits from -764.423 to 337.087, a mean difference of -213.668 (95% CI -259.684 to -167.652), and the Pitman's variance text at r = -0.292 (P = 0.001). CONCLUSION:Predictive equations, generally recommended by guidelines, are imprecise when compared with IC measures. Therefore, we suggest a new predictive equation. 10.1016/j.nut.2017.12.006
    Modifications of Resting Energy Expenditure After Sleeve Gastrectomy. Bettini Silvia,Bordigato Emanuel,Fabris Roberto,Serra Roberto,Dal Pra' Chiara,Belligoli Anna,Sanna Marta,Compagnin Chiara,Foletto Mirto,Prevedello Luca,Fioretto Paola,Vettor Roberto,Busetto Luca Obesity surgery OBJECTIVES:Resting energy expenditure (REE) declines more than what is expected according to body composition changes after caloric restriction. This metabolic adaptation is considered one of the factors favoring weight regain. The aim of this study is to evaluate the changes of REE and calculate the degree of metabolic adaptation occurring after laparoscopic sleeve gastrectomy (LSG). METHODS:REE (by indirect calorimetry) and body composition (fat-free mass or FFM, fat mass or FM by bioelectrical impedance analysis) were determined before and after 12 months in 154 patients with obesity treated with laparoscopic sleeve gastrectomy (LSG). RESULTS:Weight loss was 29.8 ± 10.6%, with corresponding relative reductions in FM (44.5 ± 22.8%), FFM (13.7 ± 9.9%), and REE (27.3 ± 12.9%). A predictive equation for REE was computed by using the baseline FFM and FM values to account for body composition changes. A predicted post-weight loss REE was calculated by using this equation and entering post-weight loss body composition values. Observed post-surgery REE was significantly lower than predicted one (1410 ± 312 vs 1611 ± 340 kcal/day, P < 0.001) and metabolic adaptation, calculated as the difference between observed and predicted post-weight loss REE, was - 199 ± 238 kcal/day. The post-surgery level of metabolic adaptation was inversely related to postoperative percent weight loss (r = - 0.170; P < 0.05) and FM loss (r = - 0.245; P < 0.01). CONCLUSIONS:A significant reduction of resting energy expenditure and a significant degree of metabolic adaptation both occur after sleeve gastrectomy. A greater metabolic adaptation could be partly responsible for a lower weight loss after surgery. 10.1007/s11695-018-3190-3
    Predicted versus measured resting energy expenditure in patients requiring home parenteral nutrition. Ławiński Michał,Singer Pierre,Gradowski Łukasz,Gradowska Aleksandra,Bzikowska Agnieszka,Majewska Krystyna Nutrition (Burbank, Los Angeles County, Calif.) OBJECTIVES:Guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) recommend between 20 and 35 kcal/kg daily for patients requiring home parenteral nutrition (PN). Other guidelines use predictive equations. However, these equations have not been validated. Indirect calorimetry is recommended as the gold standard for determining resting energy expenditure (REE). The aim of this study was to compare the frequently used equations with measured REE. METHODS:Seventy-six hospitalized patients suffering from intestinal failure (ages 21-85 y) were enrolled between January 2012 and May 2014. They were eligible for implementation of home parenteral nutrition (HPN) due to short bowel syndrome (54%), intestinal fistulae (24%), cancer obstruction (16%), and radiation-induced intestinal injury (6%). REE measurements were compared with predictive equations by Harris and Benedict (HB), Owen, Ireton-Jones, and Mifflin, as well as recommendations from ESPEN. RESULTS:In all, 152 calorimetry measurements (two per patient) were performed in 76 patients, after total PN administrations. An average result of REE measurement by indirect calorimetry was 1181 ± 322 kcal/d. Variability in momentary energy expenditure (MEE) from one measurement to the other was 8% ± 7%. Bland-Altman analysis showed a mean bias of -192 ± 300 kcal/d between MEE and estimated energy expenditure using the HB equation, which means that the equation increased the score on average by 192 ± 300 kcal/d. Limits of agreement (LoA) between the two methods was -780 to +396 kcal/d. Estimation energy expenditure using the Ireton-Jones equation gave a mean bias of -359 ± 335 kcal/d. LoA between the two methods was -1015 to +297 kcal/d. For Owen equation, Bland-Altman analysis showed a mean bias of -208 ± 313 kcal/d and the LoA between the two methods was -822 to +406 kcal/d. Using the Mifflin equation, estimation energy expenditure gave a mean bias of -172 ± 312 kcal/d and the LoA between the two methods was -784 to +439 kcal/d. Using the ESPEN range (20-35 kcal/kg daily) analysis showed mean bias of -13 ± 326 kcal/d and the LoA was -652 to +626 kcal/d for 20 kcal/kg daily and mean bias of -909 ± 436 kcal/d with the LoA between the two methods -1764 to -54 kcal/d for 35 kcal/kg daily. CONCLUSION:If REE cannot be measured by indirect calorimetry in patients qualified for HPN, the Ireton-Jones equation and the 20 kcal/kg/d ESPEN recommendation seem to be the most appropriate ones as it provides results that constitute the best approximation of calorimetric examination results. 10.1016/j.nut.2015.05.002
    Acute oral sodium propionate supplementation raises resting energy expenditure and lipid oxidation in fasted humans. Chambers Edward S,Byrne Claire S,Aspey Karen,Chen Yanjie,Khan Saadiyah,Morrison Douglas J,Frost Gary Diabetes, obesity & metabolism Short-chain fatty acids (SCFAs), produced from fermentation of dietary fibre by the gut microbiota, have been suggested to modulate energy metabolism. Previous work using rodent models has demonstrated that oral supplementation of the SCFA propionate raises resting energy expenditure (REE) by promoting lipid oxidation. The objective of the present study was to investigate the effects of oral sodium propionate on REE and substrate metabolism in humans. Eighteen healthy volunteers (9 women and 9 men; age 25 ± 1 years; body mass index 24.1 ± 1.2 kg/m ) completed 2 study visits following an overnight fast. Tablets containing a total of 6845 mg sodium propionate or 4164 mg sodium chloride were provided over the 180-minute study period in random order. REE and substrate oxidation were assessed by indirect calorimetry. Oral sodium propionate administration increased REE (0.045 ± 0.020 kcal/min; P = .036); this was accompanied by elevated rates of whole-body lipid oxidation (0.012 ± 0.006 g/min; P = .048) and was independent of changes in glucose and insulin concentrations. Future studies are warranted to determine whether the acute effects of oral sodium propionate on REE translate into positive improvements in long-term energy balance in humans. 10.1111/dom.13159
    Effects of Inulin Propionate Ester Incorporated into Palatable Food Products on Appetite and Resting Energy Expenditure: A Randomised Crossover Study. Byrne Claire S,Chambers Edward S,Preston Tom,Tedford Catriona,Brignardello Jerusa,Garcia-Perez Isabel,Holmes Elaine,Wallis Gareth A,Morrison Douglas J,Frost Gary S Nutrients Supplementation with inulin-propionate ester (IPE), which delivers propionate to the colon, suppresses ad libitum energy intake and stimulates the release of satiety hormones acutely in humans, and prevents weight gain. In order to determine whether IPE remains effective when incorporated into food products (FP), IPE needs to be added to a widely accepted food system. A bread roll and fruit smoothie were produced. Twenty-one healthy overweight and obese humans participated. Participants attended an acclimatisation visit and a control visit where they consumed un-supplemented food products (FP). Participants then consumed supplemented-FP, containing 10 g/d inulin or IPE for six days followed by a post-supplementation visit in a randomised crossover design. On study visits, supplemented-FP were consumed for the seventh time and ad libitum energy intake was assessed 420 min later. Blood samples were collected to assess hormones and metabolites. Resting energy expenditure (REE) was measured using indirect calorimetry. Taste and appearance ratings were similar between FP. Ad libitum energy intake was significantly different between treatments, due to a decreased intake following IPE-FP. These observations were not related to changes in blood hormones and metabolites. There was an increase in REE following IPE-FP. However, this effect was lost after correcting for changes in fat free mass. Our results suggest that IPE suppresses appetite and may alter REE following its incorporation into palatable food products. 10.3390/nu11040861
    Does endogenous GLP-1 affect resting energy expenditure and fuel selection in overweight and obese adults? Poggiogalle E,Donini L M,Chiesa C,Pacifico L,Lenzi A,Perna S,Faliva M,Naso M,Rondanelli M Journal of endocrinological investigation PURPOSE:To investigate the association between fasting glucagon-like peptide 1 (GLP-1) levels and resting energy expenditure (REE), and respiratory quotient (RQ) in overweight and obese adults. METHOD:Study participants were enrolled at the Dietetic and Metabolic Unit, University of Pavia, Italy. Inclusion criteria were age ≥ 25 and ≤ 45 years, and body mass index (BMI) ≥ 25 and ≤ 35 kg/m. Diabetic subjects were excluded. Body composition was measured by dual-energy X-ray absorptiometry. REE was evaluated using indirect calorimetry, and RQ was calculated from respiratory gas exchanges. Fasting GLP-1, glucose, insulin and free fatty acid (FFA) levels, and 24-h norepinephrine urinary excretion were measured. Homeostasis model assessments of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β) were calculated. RESULTS:Thirty-seven participants were included (age 43.4 ± 1.6 years; BMI 30.6 ± 0.5 kg/m). REE was not associated with fasting GLP-1 levels (p = 0.98) after adjustment for age, sex, fat-free mass (FFM), and fat mass (FM). Similarly, no association was observed between RQ and GLP-1 levels (p = 0.95), after adjustment for age, sex, and body fat. CONCLUSION:In adults subjects with increased adiposity fasting, GLP-1 levels do not seem to play a role in the regulation of energy metabolism and in fuel selection. 10.1007/s40618-017-0764-1
    Comparison of equations of resting and total energy expenditure in peritoneal dialysis patients using body composition measurements determined by multi-frequency bioimpedance. El-Kateb Sally,Sridharan Sivakumar,Farrington Ken,Fan Stanley,Davenport Andrew Clinical nutrition (Edinburgh, Scotland) BACKGROUND & AIMS:Waste products of metabolism accumulate in patients with kidney failure and it has been proposed that the amount of dialysis treatment patients require be adjusted for energy expenditure. This requires validation of methods to estimate energy expenditure in dialysis patients. METHODS:We compared values of resting energy expenditure (REE) estimated in peritoneal dialysis (PD) patients using a selection of available equations with estimates derived using a novel equation recently validated in chronic kidney disease patients (CKD equation). We also determined the relationship of these estimates of REE and of total energy expenditure (TEE - which is REE plus physical activity associated energy expenditure (PAEE) estimated using the Recent Physical Activity Questionnaire) - to bioimpedance-derived parameters of body composition. RESULTS:We studied 118 adult PD patients; 75 male (63.6%), 33 diabetic (28.5%), Caucasoid (42.4%), mean age 59.3 ± 18.2 years and weight 73.1 ± 16.6 kg. REE with the CKD equation was 1532 ± 237 kcal/day, which was more than that for Mifflin-St. Joer 1425 ± 254, Harris-Benedict 1489 ± 267, Katch-McArdle 1492 ± 243, but less than Cunningham 1648 ± 248 kcal/day. Bland Altman mean bias ranged from -107 to 111 kcal/day. TEE was 1924 (1700-2262) kcal/day, and on multi-variate analysis was associated with appendicular muscle mass and nitrogen appearance rate (β 34.3, p < 0.001 and β 5.6, p = 0.002, respectively). CONCLUSION:With reference to the CKD equation, the majority of standard equations underestimate REE in PD patients. Whereas the Cunningham equation overestimates REE. TEE was associated with appendicular muscle mass and estimated dietary protein intake. 10.1016/j.clnu.2017.02.007
    Pre-sleep protein in casein supplement or whole-food form has no impact on resting energy expenditure or hunger in women. Leyh Samantha M,Willingham Brandon D,Baur Daniel A,Panton Lynn B,Ormsbee Michael J The British journal of nutrition The purpose of this study was to determine the effect of a whole-food protein (cottage cheese, CC) consumed before sleep on next-morning resting energy expenditure (REE), RER and appetite compared with an isoenergetic/isonitrogenous casein protein (CP) supplement and placebo (PL) in active women. In a beverage-blinded, randomised, cross-over design, ten active women (age, 23·1 (sd 1·9) years; body fat, 22·0 (sd 4·6) %) consumed pre-sleep CC (30 g of protein, 10 g of carbohydrate and 0 g of fat) or energy- and protein-matched liquid CP or PL (0 kJ). Participants arrived at 18.00 hours for an overnight stay in the laboratory. At 30-60 min before normal bed time (2 h post standard meal), participants consumed CC, CP or PL before measurement of REE. Upon waking (05.00-08.00 hours), REE was repeated and subjective appetite was recorded. Statistical analyses were conducted using repeated-measures ANOVA (SPSS). Significance was accepted at P≤0·05. There were no significant differences in acute REE (CC, 7217 (sd 1368); CP, 7188 (SD 895); PL, 7075 (sd 1108) kJ/d, P=0·95), acute RER (0·79 (sd 0·05), P=0·56), morning REE (CC, 5840 (sd 1225); CP, 5694 (sd 732); PL, 5991 (sd 903) kJ/d, P=0·79) or morning RER (0·77 (sd 0·03), P=0·52). Subjective measures of appetite were not different between groups. In active women, pre-sleep consumption of CC does not alter REE or RER more than a CP or PL beverage. These data suggest that the metabolic response from whole-food protein do not differ from the metabolic response of liquid protein. 10.1017/S0007114518002416
    Human Resting Energy Expenditure Varies with Circadian Phase. Zitting Kirsi-Marja,Vujovic Nina,Yuan Robin K,Isherwood Cheryl M,Medina Jacob E,Wang Wei,Buxton Orfeu M,Williams Jonathan S,Czeisler Charles A,Duffy Jeanne F Current biology : CB There is emerging evidence that circadian misalignment may alter energy expenditure, leading to obesity risk among those with irregular schedules [1-5]. It has been reported that energy expenditure is affected by the timing of sleep, exercise, and meals [6]. However, it is unclear whether the circadian system also modulates energy expenditure, independent of behavioral state and food intake. Here, we used a forced desynchrony protocol to examine whether fasted resting energy expenditure (REE) varies with circadian phase in seven participants. This protocol allowed us to uncouple sleep-wake and activity-related effects from the endogenous circadian rhythm, demonstrating that REE varies by circadian phase. REE is lowest at circadian phase ∼0°, corresponding to the endogenous core body temperature (CBT) nadir in the late biological night, and highest at circadian phase ∼180° in the biological afternoon and evening. Furthermore, we found that respiratory quotient (RQ), reflecting macronutrient utilization, also varies by circadian phase. RQ is lowest at circadian phase ∼240° and highest at circadian phase ∼60°, which corresponds to biological morning. This is the first characterization of a circadian profile in fasted resting energy expenditure and fasted respiratory quotient (with rhythmic profiles in both carbohydrate and lipid oxidation), decoupled from effects of activity, sleep-wake cycle, and diet in humans. The rhythm in energy expenditure and macronutrient metabolism may contribute to greater weight gain in shift workers and others with irregular schedules. 10.1016/j.cub.2018.10.005
    Validation of the Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition Recommendations for Caloric Provision to Critically Ill Obese Patients: A Pilot Study. Mogensen Kris M,Andrew Benjamin Y,Corona Jasmine C,Robinson Malcolm K JPEN. Journal of parenteral and enteral nutrition BACKGROUND:The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommend that obese, critically ill patients receive 11-14 kcal/kg/d using actual body weight (ABW) or 22-25 kcal/kg/d using ideal body weight (IBW), because feeding these patients 50%-70% maintenance needs while administering high protein may improve outcomes. It is unknown whether these equations achieve this target when validated against indirect calorimetry, perform equally across all degrees of obesity, or compare well with other equations. METHODS:Measured resting energy expenditure (MREE) was determined in obese (body mass index [BMI] ≥30 kg/m(2)), critically ill patients. Resting energy expenditure was predicted (PREE) using several equations: 12.5 kcal/kg ABW (ASPEN-Actual BW), 23.5 kcal/kg IBW (ASPEN-Ideal BW), Harris-Benedict (adjusted-weight and 1.5 stress-factor), and Ireton-Jones for obesity. Correlation of PREE to 65% MREE, predictive accuracy, precision, bias, and large error incidence were calculated. RESULTS:All equations were significantly correlated with 65% MREE but had poor predictive accuracy, had excessive large error incidence, were imprecise, and were biased in the entire cohort (N = 31). In the obesity cohort (n = 20, BMI 30-50 kg/m(2)), ASPEN-Actual BW had acceptable predictive accuracy and large error incidence, was unbiased, and was nearly precise. In super obesity (n = 11, BMI >50 kg/m(2)), ASPEN-Ideal BW had acceptable predictive accuracy and large error incidence and was precise and unbiased. CONCLUSIONS:SCCM/ASPEN-recommended body weight equations are reasonable predictors of 65% MREE depending on the equation and degree of obesity. Assuming that feeding 65% MREE is appropriate, this study suggests that patients with a BMI 30-50 kg/m(2) should receive 11-14 kcal/kg/d using ABW and those with a BMI >50 kg/m(2) should receive 22-25 kcal/kg/d using IBW. 10.1177/0148607115584001
    Can Vco-Based Estimates of Resting Energy Expenditure Replace the Need for Indirect Calorimetry in Critically Ill Children? Mouzaki Marialena,Schwartz Steven M,Mtaweh Haifa,La Rotta Gustavo,Mah Kandice,Herridge Joann,Van Arsdell Glen,Parshuram Christopher S,Floh Alejandro A JPEN. Journal of parenteral and enteral nutrition BACKGROUND:Optimal energy provision, guided by measured resting energy expenditure (REE), is fundamental in the care of critically ill children. REE should be determined by indirect calorimetry (IC), which has limited availability. Recently, a novel equation was developed for estimating REE derived from carbon dioxide production (Vco). The aim of this study was to validate the accuracy of this equation in a population of critically ill children following cardiopulmonary bypass (CPB). METHODS:This is an ancillary study to a larger trial of children undergoing CPB. Respiratory mass spectrometry was used measure oxygen consumption (Vo) and Vco. REE was then calculated according to the established Weir equation (REE) and the modified, Vco-based equation (REE). The agreement between the 2 measurements was assessed using Bland-Altman plots and mixed-model regressions accounting for repeated measures. RESULTS:Data from 104 patients, which included 575 paired measurements, were included. The agreement between REE and REE was biased during the 72-hour observation period post CPB, with a mean percentage error between measurements of 11% (±7%). The most important determinant of the bias with the Vco-based equation was the respiratory quotient (RQ). The percentage error between REE and REE dropped to 4.4% (±2.4%) in those with an RQ between 0.8 and 1. The within-subject variability for RQ in this cohort was wide (11%). CONCLUSIONS:IC remains the most accurate method to determine the REE of critically ill patients. Widespread availability of Vco data renders Vco-based approaches to measurement of REE attractive; however, further research is needed to ensure that REE is estimated accurately. 10.1177/0148607115627143
    Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Zusman Oren,Theilla Miriam,Cohen Jonathan,Kagan Ilya,Bendavid Itai,Singer Pierre Critical care (London, England) BACKGROUND:Intense debate exists regarding the optimal energy and protein intake for intensive care unit (ICU) patients. However, most studies use predictive equations, demonstrated to be inaccurate to target energy intake. We sought to examine the outcome of a large cohort of ICU patients in relation to the percent of administered calories divided by resting energy expenditure (% AdCal/REE) obtained by indirect calorimetry (IC) and to protein intake. METHODS:Included patients were hospitalized from 2003 to 2015 at a 16-bed ICU at a university affiliated, tertiary care hospital, and had IC measurement to assess caloric targets. Data were drawn from a computerized system and included the % AdCal/REE and protein intake and other variables. A Cox proportional hazards model for 60-day mortality was used, with the % AdCal/REE modeled to accommodate non-linearity. Length of stay (LOS) and length of ventilation (LOV) were also assessed. RESULTS:A total of 1171 patients were included. The % AdCal/REE had a significant non-linear (p < 0.01) association with mortality after adjusting for other variables (p < 0.01). Increasing the percentage from zero to 70 % resulted in a hazard ratio (HR) of 0.98 (CI 0.97-0.99) pointing to reduced mortality, while increases above 70 % suggested an increase in mortality with a HR of 1.01 (CI 1.01-1.02). Increasing protein intake was also associated with decreased mortality (HR 0.99, CI 0.98-0.99, p = 0.02). An AdCal/REE >70 % was associated with an increased LOS and LOV. CONCLUSIONS:The findings of this study suggest that both underfeeding and overfeeding appear to be harmful to critically ill patients, such that achieving an Adcal/REE of 70 % had a survival advantage. A higher caloric intake may also be associated with harm in the form of increased LOS and LOV. The optimal way to define caloric goals therefore requires an exact estimate, which is ideally performed using indirect calorimetry. These findings may provide a basis for future randomized controlled trials comparing specific nutritional regimens based on indirect calorimetry measurements. 10.1186/s13054-016-1538-4
    Validation of carbon dioxide production (VCO) as a tool to calculate resting energy expenditure (REE) in mechanically ventilated critically ill patients: a retrospective observational study. Kagan I,Zusman O,Bendavid I,Theilla M,Cohen J,Singer P Critical care (London, England) BACKGROUND:Indirect calorimetry (IC) measurement is considered the gold standard for the assessment of resting energy expenditure (REE). It is based on the measurement of oxygen and carbon dioxide consumption (VO and VCO, respectively). However, its use is limited by cost and technical issues. It has been proposed that, in critically ill patients, the analysis of VCO obtained from the ventilator alone may be used as an accurate method to assess REE in ventilated patients. This retrospective study aimed to assess the accuracy of VCO measurement alone in the determination of REE. METHODS:This was a retrospective study conducted at the general intensive care unit of a single university-affiliated tertiary medical center. Patients included were invasively ventilated and their REE was measured by using IC. The respiratory quotients (RQs) were set at 0.8, 0.85, and 0.89. Data were collected from computerized patient files. REE obtained from the ventilator by using VCO (REE-VCO) alone was compared with REE obtained from IC (REE-IC). RESULTS:Measurements were obtained for 80 patients, and 497 REE-IC measurements were compared with REE-VCO obtained at the same time. The mean REE-IC was 2059.5 ± 491.7 kcal/d. The mean REE-RQs corresponding to RQs of 0.80, 0.85, and 0.89 were 1936.8 ± 680.0, 2017.8 ± 708.8, and 2122.1 ± 745.4 kcal/d, respectively. REE-VCO derived from an RQ of 0.85 had the lowest mean difference from REE-IC. Whereas accuracy was higher using an RQ of 0.85, agreement (between 85% and 115%) was highest using an RQ of 0.89. CONCLUSIONS:The level of agreement of REE obtained from VCO readings with REE obtained from IC was generally low. IC continues to be the recommended method for REE assessment. 10.1186/s13054-018-2108-8
    Harris-Benedict Equation and Resting Energy Expenditure Estimates in Critically Ill Ventilator Patients. Picolo Michele Ferreira,Lago Alessandra Fabiane,Menegueti Mayra Gonçalves,Nicolini Edson Antonio,Basile-Filho Anibal,Nunes Altacílio Aparecido,Martins-Filho Olindo Assis,Auxiliadora-Martins Maria American journal of critical care : an official publication, American Association of Critical-Care Nurses BACKGROUND:In routine practice, assessment of the nutritional status of critically ill patients still relies on traditional methods such as anthropometric measurements, biochemical markers, and predictive equations. OBJECTIVE:To compare resting energy expenditure measured by indirect calorimetry (REEIC) with REE calculated by using the Harris-Benedict equation with 3 different sources of body weight (from bed scale, REEHB1; ideal body weight, REEHB2; and predicted body weight, REEHB3). METHODS:This study included 205 critically ill patients (115 men, 90 women) evaluated within the first 48 hours of admission and undergoing mechanical ventilation. REE was measured by indirect calorimetry for 30 minutes and calculated by using the Harris-Benedict equation with the 3 sources of body weight. Data were compared by the Bland-Altman method. RESULTS:The values based on ideal and predicted body weight (REEHB2 and REEHB3) did not agree with REEIC. Bland-Altman analysis showed that the limits of agreement varied from +796.1 kcal/d to -559.6 kcal/d for REEHB2 and from +809.2 kcal/d to -564.7 kcal/d for REEHB3. REEIC and REEHB1 (body weight determined by bed scale) agreed the best; the bias was -18.8 kcal/d. However, REEHB1 still overestimated REEIC by +555.3 kcal/d and underestimated it by -593.0 kcal/d. CONCLUSION:For measuring REE in critically ill patients undergoing mechanical ventilation, calculation via the Harris-Benedict equation, regardless of the source of body weight, cannot be substituted for indirect calorimetry. 10.4037/ajcc2016758
    Measured versus calculated resting energy expenditure in critically ill adult patients. Do mathematics match the gold standard? De Waele E,Opsomer T,Honoré P M,Diltoer M,Mattens S,Huyghens L,Spapen H Minerva anestesiologica BACKGROUND:Indirect calorimetry (IC) is considered to be the standard method for estimating energy requirements in intensive care unit (ICU) patients. Hence, most ICU clinicians still rely on various mathematical formulas to calculate caloric requirements in their patients. We assessed whether measurements obtained by IC reached agreement with the results of such commonly used equations. METHODS:Retrospective study in consecutively hospitalized patients in a mixed medico-surgical adult ICU. Resting energy expenditure (REE) was measured by IC in all patients as a standard procedure within our routine nutritional care planning and simultaneously calculated from 10 distinct predictive equations. IC was performed with the VmaxTM Encore 29n calorimeter (VIASYS Healthcare Inc, Yorba Linda, CA). Bland-Altman plots and regression analysis were used to assess agreement between measured and calculated REE. RESULTS:The study included 259 critically ill patients: 161 subjects (62%) met final analysis criteria (age 63 ± 16 years; 58% males). Measured REE was 1571 ± 423.5 kcal/24 h with VO2 0.23 ± 0.06 L/min and VCO2 0.18 ± 0.05 L/min. Calculated values correlated very weakly with IC-derived measurements. Only the Swinamer equation and the Penn State 2010 reached an R² > 0.5. Widely used formulas in daily ICU practice such as the adjusted Harris Benedict, Faisy-Fagon, and ESICM '98 statement equations, reached R² values of respectively only 0.44, 0.49, and 0.41. Calculation resulted in under- as well as overestimation of REE. Global formulas reached no acceptable correlation in elderly or obese critically ill patients. CONCLUSION:In critically ill adult patients, measured REE poorly correlated with calculated values, regardless what formula was used. Our findings underscore the important role of IC to adequately estimate energy requirements in this particularly frail population.
    Resting energy expenditure in critically ill patients: Evaluation methods and clinical applications. Sanches Ana Cláudia Soncini,Góes Cassiana Regina de,Bufarah Marina Nogueira Berbel,Balbi André Luiz,Ponce Daniela Revista da Associacao Medica Brasileira (1992) Patients on intensive care present systemic, metabolic, and hormonal alterations that may adversely affect their nutritional condition and lead to fast and important depletion of lean mass and malnutrition. Several factors and medical conditions can influence the energy expenditure (EE) of critically ill patients, such as age, gender, surgery, serious infections, medications, ventilation modality, and organ dysfunction. Clinical conditions that can present with EE change include acute kidney injury, a complex disorder commonly seen in critically ill patients with manifestations that can range from minimum elevations in serum creatinine to renal failure requiring dialysis. The nutritional needs of this population are therefore complex, and determining the resting energy expenditure is essential to adjust the nutritional supply and to plan a proper diet, ensuring that energy requirements are met and avoiding complications associated with overfeeding and underfeeding. Several evaluation methods of EE in this population have been described, but all of them have limitations. Such methods include direct calorimetry, doubly labeled water, indirect calorimetry (IC), various predictive equations, and, more recently, the rule of thumb (kcal/kg of body weight). Currently, IC is considered the gold standard. 10.1590/1806-9282.62.07.672
    Resting Energy Expenditure in Critically Ill Patients With Spontaneous Intracranial Hemorrhage. Koukiasa Pagona,Bitzani Militsa,Papaioannou Vasileios,Pnevmatikos Ioannis JPEN. Journal of parenteral and enteral nutrition BACKGROUND:Data on energy requirements of patients with spontaneous intracranial hemorrhage (SICH) are scarce. The objective of this study was to determine the resting energy expenditure (REE) in critically ill patients with SICH and to compare it with the predicted basal metabolic rate (BMR). METHODS:In 30 nonseptic patients with SICH, the REE was measured during the 10 first posthemorrhage days with the use of indirect calorimetry (IC). Predicted BMR was also evaluated by the Harris-Benedict (HB) equation. Bland-Altman analysis was used to evaluate the agreement between measured and predicted values. The possible effect of confounding factors (demographics, disease, and severity of illness score) on the evolution of continuous variables was also tested. RESULTS:mean predicted BMR, calculated by the HB equation, was 1580.3 ± 262 kcal/d, while measured REE was 1878.9 ± 478 kcal/d (117.5% BMR). Compared with BMR, measured REE values showed a statistically significant increase at all studied points (P < .005). Measured and predicted values showed a good correlation (r = 0.73, P < .001), but the test of agreement between the 2 methods with the Bland-Altman analysis showed a mean bias (294.6 ± 265.6 kcal/d) and limits of agreement (-226 to 815.29 kcal/d) that were beyond the clinically acceptable range. REE values presented a trend toward increase over time (P = .077), reaching significance (P < .005) after the seventh day. Significant correlation was found between REE and temperature (P = .002, r = 0.63), as well as between REE and cortisol level (P = .017, r = 0.62) on the 10th day. No correlation was identified between REE and depth of sedation, as well as Acute Physiology and Chronic Health Evaluation II, Glasgow Coma Scale, and Hunt and Hess scores. CONCLUSIONS:During the early posthemorrhagic stage, energy requirements of critically ill patients with SICH are increased, presenting a trend toward increase over time. Compared with IC, the HB equation underestimates energy requirements and is inefficient in detecting individual variability of REE in this group of patients. 10.1177/0148607114539352
    The relationship between resting energy expenditure and thyroid hormones in response to short-term weight loss in severe obesity. Marzullo Paolo,Minocci Alessandro,Mele Chiara,Fessehatsion Rezene,Tagliaferri Mariantonella,Pagano Loredana,Scacchi Massimo,Aimaretti Gianluca,Sartorio Alessandro PloS one BACKGROUND:Regulating thermogenesis is a major task of thyroid hormones (THs), and involves TH-responsive energetic processes at the central and peripheral level. In severe obesity, little is known on the relationship between THs and resting energy expenditure (REE) before and after weight loss. METHODS:We enrolled 100 euthyroid subjects with severe obesity who were equally distributed between genders. Each was examined before and after completion of a 4-wk inpatient multidisciplinary dieting program and subjected to measurement of thyroid function, REE, fat-free mass (FFM, kg) and percent fat mass (FM). RESULTS:Baseline REE was lower than predicted in 70 obese patients, and overall associated with BMI, FFM and FM but not thyroid-related parameters. By the study end, both BMI and REE decreased (5.5% and 4.1%, p<0.001 vs. baseline) and their percent changes were significantly associated (p<0.05), while no association related percent changes of REE and FFM or FM. Individually, REE decreased in 66 and increased in 34 patients irrespective of gender, BMI and body composition. Weight loss significantly impacted TSH (-6.3%), FT3 (-3.3%) and FT4 levels (3.9%; p<0.001 for all). By the study end, a significant correlation became evident between REE and FT4 (r = 0.42, p<0.001) as well as FT3 (r = 0.24, p<0.05). In stepwise multivariable regression analysis, however, neither THs nor body composition entered the regression equation for REE response to weight loss. CONCLUSIONS:In severe obesity, short-term weight loss discloses a positive relationship between REE and THs. 10.1371/journal.pone.0205293
    Normalizing resting energy expenditure across the life course in humans: challenges and hopes. Müller Manfred J,Geisler Corinna,Hübers Mark,Pourhassan Maryam,Braun Wiebke,Bosy-Westphal Anja European journal of clinical nutrition Whole-body daily energy expenditure is primarily due to resting energy expenditure (REE). Since there is a high inter-individual variance in REE, a quantitative and predictive framework is needed to normalize the data. Complementing the assessment of REE with data normalization makes individuals of different sizes, age, and sex comparable. REE is closely correlated with body mass suggesting its near constancy for a given mass and, thus, a linearity of this association. Since body mass and its metabolic active components are the major determinants of REE, they have been implemented into allometric modeling to normalize REE for quantitative differences in body weight and/or body composition. Up to now, various size and allometric scale laws are used to adjust REE for body mass. In addition, the impact of the anatomical and physical properties of individual body components on REE has been quantified in large populations and for different age groups. More than 80% of the inter-individual variance in REE is explained by FFM and its composition. There is evidence that the impact of individual organs on REE varies between age groups with a higher contribution of brain and visceral organs in children/adolescents compared with adults where skeletal muscle mass contribution is greater than in children/adolescents. However, explaining REE variations by FFM and its composition has its own limitations (inter-correlations of organs/tissues). In future, this could be overcome by re-describing the organ-to-organ variation using principal components analysis and then using the scores on the components as predictors in a multiple regression analysis. 10.1038/s41430-018-0151-9
    Performance of Predictive Equations Specifically Developed to Estimate Resting Energy Expenditure in Ventilated Critically Ill Children. Jotterand Chaparro Corinne,Taffé Patrick,Moullet Clémence,Laure Depeyre Jocelyne,Longchamp David,Perez Marie-Hélène,Cotting Jacques The Journal of pediatrics OBJECTIVE:To determine, based on indirect calorimetry measurements, the biases of predictive equations specifically developed recently for estimating resting energy expenditure (REE) in ventilated critically ill children, or developed for healthy populations but used in critically ill children. STUDY DESIGN:A secondary analysis study was performed using our data on REE measured in a previous prospective study on protein and energy needs in pediatric intensive care unit. We included 75 ventilated critically ill children (median age, 21 months) in whom 407 indirect calorimetry measurements were performed. Fifteen predictive equations were used to estimate REE: the equations of White, Meyer, Mehta, Schofield, Henry, the World Health Organization, Fleisch, and Harris-Benedict and the tables of Talbot. Their differential and proportional biases (with 95% CIs) were computed and the bias plotted in graphs. The Bland-Altman method was also used. RESULTS:Most equations underestimated and overestimated REE between 200 and 1000 kcal/day. The equations of Mehta, Schofield, and Henry and the tables of Talbot had a bias ≤10%, but the 95% CI was large and contained values by far beyond ±10% for low REE values. Other specific equations for critically ill children had even wider biases. CONCLUSIONS:In ventilated critically ill children, none of the predictive equations tested met the performance criteria for the entire range of REE between 200 and 1000 kcal/day. Even the equations with the smallest bias may entail a risk of underfeeding or overfeeding, especially in the youngest children. Indirect calorimetry measurement must be preferred. 10.1016/j.jpeds.2016.12.063
    Relationship between thyroid hormones, resting energy expenditure and cardiometabolic risk factors in euthyroid subjects. Spadafranca Angela,Cappelletti Chiara,Leone Alessandro,Vignati Laila,Battezzati Alberto,Bedogni Giorgio,Bertoli Simona Clinical nutrition (Edinburgh, Scotland) BACKGROUND & AIMS:Whereas hypothyroid subjects have a decreased resting energy expenditure (REE), it is unknown whether REE is associated with TSH in euthyroid subjects. It is also uncertain whether there is an association between cardiometabolic risk factors and TSH among euthyroid subjects. The primary aim was to test whether REE and TSH are associated in euthyroid subjects. The second aim was to evaluate the association between TSH and cholesterol, HDL-cholesterol, triglycerides, glucose and blood pressure. METHODS:885 Caucasian euthyroid subjects (75% women) aged 18-79 years and with a median body mass index of 28.6 kg/m(2) were consecutively studied at our Research Center. REE was measured using a canopy-equipped indirect calorimeter. Multivariable regression of 25(th), 50(th) and 75(th) percentiles was used to evaluate the association between the outcomes (REE, cholesterol, HDL-cholesterol, triglycerides, glucose and blood pressure) and the predictors (TSH, FT4 and FT3) controlling by gender, age and body mass index. RESULTS:REE was not associated with TSH, FT4 and FT3 at any percentile. On the contrary, a positive association between TSH and triglycerides was evident at all percentiles. A positive association between FT3 and HDL-cholesterol was also present but only at the 75(th) percentile. CONCLUSIONS:REE is not associated with TSH in euthyroid subjects. It is however positively associated with triglycerides confirming the findings of recent population studies. 10.1016/j.clnu.2014.07.014
    Use of both quantitative and qualitative methods to improve assessment of resting energy expenditure equation performance in hospitalized adults. Teigen Levi M,DiCecco Sara R,Vock David M,Vierow Kelsey L,Andrews Lindsay,Hammel Kris D,Sfeir Jad G,Miles John M,Hurley Daniel L Clinical nutrition ESPEN OBJECTIVE:To introduce the use of qualitative assessment in energy expenditure (EE) equation research to improve the understanding of performance of the equations in the clinical setting. PATIENTS AND METHODS:Hospitalized individuals who had an indirect calorimetry (IC) measurement during their hospital stay from 2010 to 2012 were included in the study (n = 59). An additional 1000 patients hospitalized during this time were used to limit the IC cohort to a more "clinically relevant" BMI range (n = 46). The following estimation equations were assessed: Harris-Benedict, 25 kcal/kg using actual body weight, Mifflin St. Jeor, Ireton-Jones, Penn State, and Owen. Bland-Altman plots with Loess curves were generated to compare estimated basal caloric needs between EE equations and IC values. RESULTS:This study found a large amount of variability with all EE equations. As the mean calorie level increased, the Harris Benedict, Mifflin St. Jeor, Penn State, and Owen equations all tended to increasingly under-predict caloric need. CONCLUSION:In a research setting a qualitative assessment of EE equations can provide a more comprehensive understanding of equation performance by complementing traditional quantitative methods. The addition of a Loess curve to the Bland-Altman plot further enhances qualitative assessment. 10.1016/j.clnesp.2018.01.001
    Association between uncoupling protein 2, adiponectin and resting energy expenditure in obese women with normal and low resting energy expenditure. Taghadomi Masoumi Zahra,Eshraghian Mohammad Reza,Hedayati Mahdi,Pishva Hamideh Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology Obesity is recognized as the most prevalent metabolic disease worldwide. Decreases in energy expenditure may increase risk of obesity. One of the key regulators of energy balance is uncoupling protein2 (UCP2), a transporter protein presents in mitochondrial inner membrane. Moreover, adiponectin is the most abundant adipocytokine, it may play a role in energy metabolism and gene expression of UCP2. The aim of this study was to investigate potential associations between the level of uncoupling protein 2 and adiponectin and their relationship with REE (Resting Energy Expenditure) in obese women with normal and low resting energy expenditure. A total of 49 subjects (women, 25-50 years old), were included in current study, 16 subjects with BMI > 30 and low resting energy expenditure, 17 subjects with BMI > 30 and normal resting energy expenditure and 16 non-obese subjects as a control group. Anthropometric, body composition parameters and resting energy expenditure were measured. Plasma adiponectin, UCP2 protein and total protein in PBMC were determined. Measured resting energy expenditure in obese subjects with low REE was significantly lower than other groups. Plasma adiponectin in the obese subjects with low REE was significantly lower compared to normal weight group. There was a significant relationship between 'UCP2 protein/Total protein' ratio and plasma adiponectin in obese group with low REE and in three groups when we pooled. There was a significant association between REE and plasma adiponectin in three groups when we pooled. There was a significant association between plasma adiponectin and REE. Moreover, there was a significant relationship between UCP2 and REE. 10.1080/09513590.2017.1379492
    Age-related changes in resting energy expenditure in normal weight, overweight and obese men and women. Siervo Mario,Oggioni Clio,Lara Jose,Celis-Morales Carlos,Mathers John C,Battezzati Alberto,Leone Alessandro,Tagliabue Anna,Spadafranca Angela,Bertoli Simona Maturitas OBJECTIVES:Aging is associated with changes in resting energy expenditure (REE) and body composition. We investigated the association between age and changes in REE in men and women stratified by body mass index (BMI) categories (normal weight, overweight and obesity). We also examined whether the age-related decline in REE was explained by concomitant changes in body composition and lifestyle factors. STUDY DESIGN:Cross-sectional. MAIN OUTCOME MEASURES:3442 adult participants (age range: 18-81 y; men/women: 977/2465) were included. The BMI range was 18.5-60.2 kg/m(2). REE was measured by indirect calorimetry in fasting conditions and body composition by bioelectrical impedance. Regression models were used to evaluate age-related changes in REE in subjects stratified by sex and BMI. Models were adjusted for body composition (fat mass, fat free mass), smoking, disease count and physical activity. RESULTS:In unadjusted models, the rate of decline in REE was highest in obese men (slope=-8.7±0.8 kcal/day/year) whereas the lowest rate of decline was observed in normal weight women (-2.9±0.3 kcal/day/year). Gender differences were observed for the age of onset of REE adaptive changes (i.e., not accounted by age related changes in body composition and lifestyle factors). In women, adaptive changes appeared to occur in middle-age (∼47 y) across all BMI groups whereas changes seemed to be delayed in obese men (∼54 y) compared to overweight (∼43 y) and normal weight (∼39 y) men. CONCLUSIONS:Sex and BMI influenced the rate and degree of the age-related decline in REE. Critical age windows have been identified for the onset of putative mechanisms of energy adaptation. These findings require confirmation in prospective studies. 10.1016/j.maturitas.2014.12.023
    Isometric thermogenesis at rest and during movement: a neglected variable in energy expenditure and obesity predisposition. Dulloo A G,Miles-Chan J L,Montani J-P,Schutz Y Obesity reviews : an official journal of the International Association for the Study of Obesity Isometric thermogenesis as applied to human energy expenditure refers to heat production resulting from increased muscle tension. While most physical activities consist of both dynamic and static (isometric) muscle actions, the isometric component is very often essential for the optimal performance of dynamic work given its role in coordinating posture during standing, walking and most physical activities of everyday life. Over the past 75 years, there has been sporadic interest into the relevance of isometric work to thermoregulatory thermogenesis and to adaptive thermogenesis pertaining to body-weight regulation. This has been in relation to (i) a role for skeletal muscle minor tremor or microvibration - nowadays referred to as 'resting muscle mechanical activity' - in maintaining body temperature in response to mild cooling; (ii) a role for slowed skeletal muscle isometric contraction-relaxation cycle as a mechanism for energy conservation in response to caloric restriction and weight loss and (iii) a role for spontaneous physical activity (which is contributed importantly by isometric work for posture maintenance and fidgeting behaviours) in adaptive thermogenesis pertaining to weight regulation. This paper reviews the evidence underlying these proposed roles for isometric work in adaptive thermogenesis and highlights the contention that variability in this neglected component of energy expenditure could contribute to human predisposition to obesity. 10.1111/obr.12505
    Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus. Buscemi Silvio,Donatelli Maria,Grosso Giuseppe,Vasto Sonya,Galvano Fabio,Costa Flavia,Rosafio Giuseppe,Verga Salvatore Diabetes research and clinical practice AIMS:Resting energy expenditure (REE) plays a critical role in the regulation of body weight, with important implications in type 2 diabetes (T2D). However, the relationships between REE and T2D have not been extensively evaluated. We compared REE in persons with diabetes and in persons without diabetes. We also investigated the acute effect of insulin on REE and venous lactate, the latter an indirect measure of neoglucogenetic activity. METHODS:REE was measured using indirect calorimetry in 14 newly diagnosed, untreated T2D adults and in 14 non-diabetic age-, gender- and body mass index-matched persons. The REE and lactate venous concentrations were also measured in a subgroup of 5 T2D patients in the hour following an IV insulin bolus. RESULTS:The REE normalized for fat-free mass (FFM) was significantly higher in T2D patients than in the group without diabetes (mean ± SD: 27.6 ± 1.9 vs. 25.8 ± 1.9 kcal/kg-FFM·24h; P=0.02). REE normalized for FFM was correlated with fasting plasma glucose concentration (r=0.51; P=0.005). Following the insulin venous bolus REE (0': 2,048 ± 242; 10': 1,804 ± 228; 20': 1,684 ± 230; 30': 1,634 ± 212; 45': 1,594 ± 179; 60': 1,625 ± 197 kcal/24h; P<0.001) and both glucose (P<0.001) and lactate (P<0.001) concentrations progressively declined in the ensuing hour. CONCLUSIONS:Patients with diabetes have a higher energy expenditure, likely a consequence of higher gluconeogenetic activity. This study may contribute to recognizing the nature of body weight reduction that occurs in concomitance with poorly controlled diabetes, and of body weight gain as commonly observed when hypoglycemic treatment is started. 10.1016/j.diabres.2014.09.016
    Assessment of resting energy expenditure and body composition in Japanese pregnant women with diabetes. Eto Eriko,Maki Jota,Tamada Shoko,Mitsui Takashi,Hayata Kei,Hiramatsu Yuji,Masuyama Hisashi Journal of diabetes investigation AIMS/INTRODUCTION:To measure longitudinal changes in resting energy expenditure and body composition of Japanese pregnant women with or without diabetes. MATERIALS AND METHODS:The study population consisted of women who had delivered a live singleton neonate after 22 weeks' gestation at Okayama University Hospital from July 2013 to June 2017. Resting energy expenditure and body composition were measured in the first trimester, second trimester, third trimester and postpartum. RESULTS:A total of 144 women participated in this study: 103 with normal glucose tolerance and 41 with diabetes. The resting energy expenditure (kcal/day) of pregnant women with normal glucose tolerance was significantly higher in the third trimester (1,644 ± 234) than in the first (1,461 ± 215) and second trimesters (1,491 ± 219), and postpartum (1,419 ± 254), whereas that of pregnant women with diabetes did not significantly change during all periods (1,568 ± 404, 1,710 ± 332, 1,716 ± 251, 1,567 ± 249). The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Fat-free mass was closely correlated with resting energy expenditure. CONCLUSIONS:The resting energy expenditure of Japanese pregnant women with normal glucose tolerance was significantly increased in the third trimester. The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Resting energy expenditure and fat-free mass are potential indexes for medical nutrition therapy in pregnant women with diabetes. 10.1111/jdi.12795
    Resting energy expenditure in OSAS: the impact of a single CPAP application. Fekete Katalin,Boutou Afroditi K,Pitsiou Georgia,Chavouzis Nikolaos,Pataka Athanasia,Athanasiou Ioanna,Ilonidis Georgios,Kontakiotis Theodoros,Argyropoulou Paraskevi,Kioumis Ioannis Sleep & breathing = Schlaf & Atmung PURPOSE:Data on the impact of obstructive sleep apnea syndrome (OSAS) and its treatment on resting energy expenditure (REE) are currently few and conflicting. The purpose of the present study was to investigate the impact of OSAS on REE, as measured before and after sleep, and the changes in REE after a single continuous positive airway pressure (CPAP) application, for the first time in literature. METHODS:This is a nested case-control study. From the initial study population, two groups were formed, based on the results of nocturnal polysomnography: a group of male OSAS patients and a group of male, age-matched non-OSAS controls. REE was measured in both groups before and after sleep by indirect calorimetry, while patients repeated REE measurements before and after a single nasal CPAP application. RESULTS:Ninety-two male OSAS patients (45.3 ± 12.8 years old) and 19 male non-OSAS controls (50.8 ± 11.7 years old) were studied. REE/lean body mass (LBM) was higher among patients compared to controls both pre- (29.6 ± 12 vs 22.9 ± 7.9 kcal/kg; p = 0.022, correspondingly) and post-sleep (26.4 ± 9.6 vs 21.6 ± 9 kcal/kg; p = 0.047 correspondingly). REE/LBM decreased significantly after sleep in OSAS patients (p = 0.002), but not in controls; this difference was most evident among patients with more severe disease and higher desaturation. A single nasal CPAP application diminished the pre-post REE/LBM difference (30.3 ± 8.2 vs 28.3 ± 10.3 kcal/kg; p = 0.265), but only among responders. CONCLUSIONS:In OSAS patients, REE values are high and vary significantly before and after sleep. A single nasal CPAP application diminishes this difference among responders, possibly through reversal of nocturnal desaturation. 10.1007/s11325-015-1194-y
    Changes in Resting Energy Expenditure Following Orthotopic Liver Transplantation. Chen Yimin,Kintner Jennifer,Rifkin Sam K,Keim Kathryn S,Tangney Christy C JPEN. Journal of parenteral and enteral nutrition BACKGROUND:There is no consensus whether resting energy expenditure (REE) following orthotopic liver transplantation (OLT) is altered. METHODS:The objectives of this investigation were to describe changes in measured REE (mREE) using indirect calorimetry in 25 OLT patients on days 5, 10, and 15 after baseline (within 72 hours following OLT) and compare mREE changes with those calculated with 2 predicted equations for energy expenditure (pREE): the Harris-Benedict and Schofield equations. RESULTS:Patients were 57 ± 5.4 years of age, 44% were male, 36% were black, and 72% had liver disease of viral etiology. Measured REE (at baseline and days 5, 10, and 15, per kcal/d: 1832 ± 952, 1565 ± 383, 1538 ± 345, 1578 ± 418) and kcal per kilogram of body weight (22.7 ± 12.8, 18.4 ± 4, 18.7 ± 3.8, 21 ± 6.5) did not change over time. In contrast, changes in pREE based on either the Harris-Benedict (P < .001) or Schofield (P = .006) equation using measured weights at each corresponding time point and lowest body weight during the study to estimate dry weight were significant. CONCLUSIONS:Wide ranges in both mREE and mREE expressed per kilogram of body weight at each study time point were observed in contrast to pREE, which declined by day 15. The observed differences in mREE over time suggest indirect calorimetry is indicated if available following OLT. Additional research is warranted to determine the most appropriate predictive equation with suitable stress factors to use when indirect calorimetry is not available. 10.1177/0148607115586435
    No consistent evidence of a disproportionately low resting energy expenditure in long-term successful weight-loss maintainers. Ostendorf Danielle M,Melanson Edward L,Caldwell Ann E,Creasy Seth A,Pan Zhaoxing,MacLean Paul S,Wyatt Holly R,Hill James O,Catenacci Victoria A The American journal of clinical nutrition Background:Evidence in humans is equivocal in regards to whether resting energy expenditure (REE) decreases to a greater extent than predicted for the loss of body mass with weight loss, and whether this disproportionate decrease in REE persists with weight-loss maintenance. Objectives:We aimed to1) determine if a lower-than-predicted REE is present in a sample of successful weight-loss maintainers (WLMs) and 2) determine if amount of weight loss or duration of weight-loss maintenance are correlated with a lower-than-predicted REE in WLMs. Design:Participants (18-65 y old) were recruited in 3 groups: WLMs (maintaining ≥13.6 kg weight loss for ≥1 y, n = 34), normal-weight controls [NCs, body mass index (BMI; in kg/m2) similar to current BMI of WLMs, n = 35], and controls with overweight/obesity (OCs, BMI similar to pre-weight-loss maximum BMI of WLMs, n = 33). REE was measured (REEm) with indirect calorimetry. Predicted REE (REEp) was determined via 1) a best-fit linear regression developed with the use of REEm, age, sex, fat-free mass, and fat mass from our control groups and 2) three standard predictive equations. Results:REEm in WLMs was accurately predicted by equations developed from NCs and OCs (±1%) and by 3 standard predictive equations (±3%). In WLMs, individual differences between REEm and REEp ranged from -257 to +163 kcal/d. A lower REEm compared with REEp was correlated with amount of weight lost (r = 0.36, P < 0.05) but was not correlated with duration of weight-loss maintenance (r = 0.04, P = 0.81). Conclusions:We found no consistent evidence of a significantly lower REE than predicted in a sample of long-term WLMs based on predictive equations developed from NCs and OCs as well as 3 standard predictive equations. Results suggest that sustained weight loss may not always result in a substantial, disproportionately low REE. This trial was registered at clinicaltrials.gov as NCT03422380. 10.1093/ajcn/nqy179
    Evaluating the predictive factors of resting energy expenditure and validating predictive equations for Chinese obese children. Zhang Lin,Chen Ran,Li Rong,Chen Meng-Ying,Huang Rong,Li Xiao-Nan World journal of pediatrics : WJP BACKGROUND:To study the predictive factors of resting energy expenditure (REE) and evaluate the accuracy of predicted equations with indirect calorimeter (IC) in Chinese school-age children, particularly for the obese population. METHODS:Recruited children were from the department of child healthcare in Nanjing children's hospital during July 2014-September 2015. Anthropometric parameters and body composition were measured by bioelectrical impedance. Measured REE was assessed by IC. Predicted REE was estimated using ten published equations. RESULTS:248 children aged 7-13 years were recruited, including 148 obese [body mass index standard deviation score (BMISDS) = 2.48 ± 0.91] and 100 non-obese (BMISDS = - 0.96 ± 1.08). The unit mass of REE (REE/kg) in obese group (29.06 ± 5.74) was lower than that in non-obese group (37.51 ± 6.56). The stepwise regression showed that age, BMISDS and fat-free mass (FFM) had a major impact on REE/kg as the regression equation: Y = 54.41 - 1.36 × X - 2.25 × X - 0.16 × X (Y REE/kg, X age, X BMISDS, X FFM; R = 0.633, R = 0.401, P < 0.01). The accuracy of predicted REE in obese subjects was 62.16% by the new predictive equations. CONCLUSIONS:The REE/kg in obese children was lower and closely correlated with age, BMISDS and FFM. It is necessary to validate the new predictive equation in a larger sample to estimate energy requirements, particularly for children with obesity. 10.1007/s12519-017-0111-9
    Resting energy metabolism and anticancer treatments. Jouinot Anne,Vazeille Clara,Goldwasser François Current opinion in clinical nutrition and metabolic care PURPOSE OF REVIEW:Cachexia is a multifactorial syndrome associated with morbidity and mortality in cancer patients and represents a major challenge in cancer management. Elevated energy expenditure is supposed to contribute to cachexia. The current article presents the recent findings on the resting energy expenditure (REE) in cancer and the clinical implications for anticancer treatments. RECENT FINDINGS:Half of cancer patients present with hypermetabolism (measured REE >110% of predicted REE). Hypermetabolism is associated with clinical and biological features of cachexia. Hypermetabolic patients - even those with normal nutritional status - have a high risk of severe acute toxicity and a poor prognosis. SUMMARY:Recent discoveries have highlighted the REE as an essential component of nutritional assessment in cancer patients. Multimodal care for cachexia should include REE measurements and dedicated pharmacologic interventions such as adrenoreceptor blockade in case of hypermetabolism. 10.1097/MCO.0000000000000457
    Resting Energy Expenditure of Children and Adolescents With Nonalcoholic Fatty Liver Disease. Martincevic Inez,Mouzaki Marialena JPEN. Journal of parenteral and enteral nutrition BACKGROUND:The mainstay of treatment for pediatric nonalcoholic fatty liver disease (NAFLD) is lifestyle modification, which includes dietary changes that lead to slow but sustained weight loss or weight stabilization in growing children. Accurate estimation of energy requirements is necessary to achieve this goal. The objective of this study was to assess the accuracy of the most commonly used equations in predicting the resting energy expenditure (REE) of children with NAFLD. METHODS:This was a retrospective study performed in a single institution. The predictive accuracy of various equations was assessed by comparing their estimates against the measured REE obtained with indirect calorimetry. Accuracy was defined as an estimate within 10% of measured REE. RESULTS:Fifty-six children (70% male; 52% white and 36% Asian) with a median age of 13 years were included. The median measured REE was 1829 kcal/d. Of the equations studied, the Schofield had the smallest average bias (-32 kcal/d; confidence interval, -121 to 56). The Schofield and Molnar equations were the most accurate, providing REE estimates within 10% of measured in 59% of cases. The remaining equations had lower and variable predictive accuracy. The use of adjusted body weight in predictive equations did not improve the predictive accuracy. CONCLUSION:In a cohort of children and adolescents with NAFLD, the Schofield and Molnar equations performed best in predicting energy expenditure. However, predictive equations were often inaccurate, suggesting that clinicians should interpret their results with caution and consider using indirect calorimetry when available. 10.1177/0148607116658761
    The biology of appetite control: Do resting metabolic rate and fat-free mass drive energy intake? Blundell J E,Finlayson G,Gibbons C,Caudwell P,Hopkins M Physiology & behavior The prevailing model of homeostatic appetite control envisages two major inputs; signals from adipose tissue and from peptide hormones in the gastrointestinal tract. This model is based on the presumed major influence of adipose tissue on food intake. However, recent studies have indicated that in obese people fat-free mass (FFM) is strongly positively associated with daily energy intake and with meal size. This effect has been replicated in several independent groups varying in cultural and ethnic backgrounds, and appears to be a robust phenomenon. In contrast fat mass (FM) is weakly, or mildly negatively associated with food intake in obese people. In addition resting metabolic rate (RMR), a major component of total daily energy expenditure, is also associated with food intake. This effect has been replicated in different groups and is robust. This action is consistent with the proposal that energy requirements — reflected in RMR (and other aspects of energy expenditure) constitute a biological drive to eat. Consistent with its storage function, FM has a strong inhibitory effect on food intake in lean subjects, but this effect appears to weaken dramatically as adipose tissue increases. This formulation can account for several features of the development and maintenance of obesity and provides an alternative, and transparent, approach to the biology of appetite control. 10.1016/j.physbeh.2015.05.031
    Impact of metabolic syndrome on resting energy expenditure in patients with chronic kidney disease. Rodrigues Carolina Q D,Santos Jacqueline A P,Quinto Beata M R,Marrocos Mauro S M,Teixeira Andrei A,Rodrigues Cássio J O,Batista Marcelo C Clinical nutrition ESPEN BACKGROUND & AIMS:Resting energy expenditure (REE) changes in patients with chronic kidney disease (CKD) may contribute to mortality increase. The obesity and inflammation is associated with high REE and when not compensated by adequate intake, may determine an unfavorable clinical outcome in this population. We aimed to evaluate the influence of metabolic syndrome (MetS) on REE in CKD patients. METHODS:One hundred eighty-three patients were stratified according to glomerular filtration rate (GFR) and divided in groups: without CKD (GFR > 60 ml/min/1.73 m) and CKD (GFR < 60 ml/min/1.73 m) and according to the presence or absence of MetS. REE was measured by indirect calorimetry; body composition was assessed by bioelectrical impedance analysis and blood and urine were collected for biochemical tests. RESULTS:REE was lower in the group with CKD compared with those without CKD (1293 ± 364 vs 1430 ± 370 kcal/d, P = 0.01). The group with CKD without MetS showed decrease in REE compared to the groups without CKD, regardless the presence of Mets, and those with CKD and MetS (1173 ± 315 vs 1392 ± 324 vs 1460 ± 410 vs 1424 ± 376 kcal/d, P < 0.05, respectively). Multivariate analysis showed an independent association of CKD in determining REE when adjusted for lean body mass. The inclusion of MetS as an independent variable in the same analysis model neutralized the impact of CKD on the REE (P = 0.19). Patients without MetS, REE correlated with estimated GFR and the protein equivalent (r = 0.33, P < 0.01, r = 0.21, P = 0.04, respectively), whereas in MetS patients, these correlations were not observed. CONCLUSION:The presence of CKD is independently associated with reduced REE. The observed decrease in REE is reversed in patients with MetS independent of renal function. 10.1016/j.clnesp.2016.07.001
    Smoking is associated with increased resting energy expenditure in the general population: The NEO study. Blauw Lisanne L,Boon Mariëtte R,Rosendaal Frits R,de Mutsert Renée,Gast Karin B,van Dijk Ko Willems,Rensen Patrick C N,Dekkers Olaf M, Metabolism: clinical and experimental OBJECTIVE:Animal studies and human studies in small selected populations have shown a positive association between nicotine smoking and resting energy expenditure (REE), but data in large cohorts are lacking. We aimed to investigate the association between smoking behavior and REE in a large, population-based study. DESIGN:Population-based cross-sectional study. METHODS:In this cross-sectional analysis of baseline measurements from the Netherlands Epidemiology of Obesity (NEO) study (n=6673), we included participants with REE measurement by indirect calorimetry who were not using lipid or glucose lowering drugs (n=1189). We used linear regression analysis to examine the association of smoking status (never, former, occasional, current smoker) and smoking quantity (pack years) with REE per kilogram (kg) fat free mass (FFM) and with REE adjusted for FFM. Models were adjusted for age, sex, ethnicity, educational level, physical activity, energy intake and body mass index (BMI). RESULTS:Mean (standard deviation, SD) age was 55.2 (5.9) years and BMI was 26.3 (4.4) kg/m(2). 60% of the participants were women. Mean (SD) REE/FFM (kcal/day/kg FFM) was for male never smokers 25.1 (2.0), male current smokers 26.4 (2.8), female never smokers 28.9 (2.5) and female current smokers 30.1 (3.7). After adjustment, only current smokers had a higher REE/FFM (mean difference 1.28, 95% CI 0.64, 1.92), and a higher REE adjusted for FFM (mean difference 60.3 kcal/day, 95% CI 29.1, 91.5), compared with never smokers. There was no association between pack years and REE/FFM (mean difference -0.01, 95% CI -0.06, 0.04) or REE adjusted for FFM (mean difference 0.2, 95% CI -2.4, 2.8) in current smokers. CONCLUSION:Current smoking is associated with a higher resting energy expenditure compared with never smoking in a large population-based cohort. 10.1016/j.metabol.2015.08.008
    New equations to estimate resting energy expenditure in obese adults from body composition. De Lorenzo Antonino,Di Renzo Laura,Morini Pietro,de Miranda Renata Costa,Romano Lorenzo,Colica Carmela Acta diabetologica AIMS:The aims of this study were: to develop new equations for predicting resting energy expenditure (REE) in obese Italian subjects according to body composition parameters; to compare them with predicted values estimated by other REE prediction equations; and to cross-validate our equations using a validation set cohort. METHODS:Four hundred patients were enrolled and divided into three groups. Besides anthropometry and REE (indirect calorimetry), total body fat and lean were evaluated by dual X-ray absorptiometry, and fat mass and fat-free mass by bioelectrical impedance analysis. RESULTS:The subjects eligible to participate were 330. Group 1 (n = 174) was used to develop (R  = 0.79) and (R  = 0.77). Group 2 (n = 115) was used to generate (R  = 0.85) and (R  = 0.81). Group 3 (n = 41) was used to cross-validate the equations. CONCLUSION:Equations 1 and 3 are reliable to measure REE from calorimetry and better than other equations that use anthropometric variables as predictors of REE. Further analysis in different populations is required before it can be applied in clinical practice. 10.1007/s00592-017-1061-3
    Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest - a prospective observational cohort study. Holzinger Ulrike,Brunner Richard,Losert Heidrun,Fuhrmann Valentin,Herkner Harald,Madl Christian,Sterz Fritz,Schneeweiß Bruno Critical care (London, England) INTRODUCTION:Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest. METHODS:This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed five times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis. RESULTS:In 25 patients resting energy expenditure decreased 20 (18 to 27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21 to 26) vs. 21 (16 to 26); P = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11 to 68) g/day vs. 39 (7 to 75) g/day, P = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104 to 171) g/day vs. 117 (70 to 139) g/day, P <0.05) and a significantly lower glucose oxidation rate (30 (-34 to 88) g/day vs. 77 (19 to 138) g/day; P < 0.05) as compared to patients with unfavourable neurological outcome. CONCLUSIONS:Targeted temperature management at 33°C after cardiac arrest reduces resting energy expenditure by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome. TRIAL REGISTRATION:Clinicaltrials.gov NCT00500825. Registered 11 July 2007. 10.1186/s13054-015-0856-2
    Low validity of predictive equations for calculating resting energy expenditure in overweight and obese women with polycystic ovary syndrome. Rodrigues A M Dos S,Costa A B P,Campos D L,Silva M P S,Cândido A L,Santos L C Dos,Ferreira A V M Journal of human nutrition and dietetics : the official journal of the British Dietetic Association BACKGROUND:Predictive equations are the main clinical tools for determining resting energy expenditure (REE). However, their adequate use in overweight and obese individuals is unclear. Thus, we investigated the best predictive equations for estimating REE in overweight and obese women with polycystic ovary syndrome (PCOS). METHODS:Eleven analyses were performed with prediction equations (pREE) based on anthropometric parameters in 30 overweight or obese women with PCOS without other chronic diseases. The measured REE (mREE) was calculated by indirect calorimetry. The validity of the equations was investigated by comparison, accuracy and agreement tests between pREE and mREE at both the individual and group level. RESULTS:Four analyses were similar to those of mREE, and smallest mean differences were observed for the World Health Organization/Food and Agriculture Organization of the United Nations/United Nations University (WHO/FAO/UNU) considering weight (W) [0.07 (1.13) MJ (16 [270] kcal)]. Individual accuracy was greater than 50% for Harris and Benedict, Müller and Lazzer equations. The percentage of REE underestimation ranged between 16.7% and 73.3%, whereas higher rates of overestimation were observed in the De Luis (66.7%) and Ireton-Jones (43.3%) equations. Mean bias at the group level was lowest in the WHO/FAO/UNU W and WHO/FAO/UNU considering weight and height (WH), Müller and Lazzer equations (-2.8 to 0.5). The WHO/FAO/UNU W and WHO/FAO/UNU WH formulas were optimal in individual agreement (33.3%). CONCLUSIONS:FAO/WHO/UNU W equations may estimate the REE in overweight and obese women with PCOS. However, the low individual accuracy and agreement in relation to mREE suggest caution regarding when to use the formula to perform an individual nutritional plan. 10.1111/jhn.12498
    Resting energy expenditure after Roux-en Y gastric bypass surgery. Wilms Britta,Ernst Barbara,Thurnheer Martin,Schmid Sebastian M,Spengler Christina M,Schultes Bernd Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery BACKGROUND:The mechanisms by which Roux-en Y gastric bypass surgery (RYGB) provokes weight loss are incompletely understood. Enhanced energy expenditure may be one contributing mechanism. Previous results on changes in resting energy expenditure (REE) after RYGB are inconsistent. OBJECTIVES:The aim of the present study was to assess changes in REE after RYGB and whether REE predicts weight loss (percentage weight loss). SETTING:Obesity Clinic. METHODS:REE was measured by indirect calorimetry (mREE) before and 1 year after RYGB in 233 patients with severe obesity (175 women; all body mass index ≥35.0 kg·m) and mREE was compared with predicted REE (pREE) and expressed as percentage of pREE (%pREE). For calculation of pREE, 2 new equations were developed from an independent reference group of overweight and obese patients (852 patients; body mass index range: 27.4-73.0 kg·m) that were examined in exactly the same setting as the bariatric patients that were followed-up after RYGB. The new equations were based on either anthropometric (pREE-BM, %pREE-BM) or body composition (pREE-BC; %pREE-BC) parameters. RESULTS:After RYGB, absolute mREE was reduced by 20.4 ± 11.0% (-458 ± 277 kcal·d; P<.001). Compared with pREE-BM (post-%REE-BM) and pREE-BC (post-%REE-BC), mREE was 2.3 ± 9.4% and 1.6 ± 9.5%, respectively, higher (both P ≤ .03). Post-%pREE-BM and post- %pREE-BC after RYGB were positively correlated with percentage weight loss (r = .206 and r = .231; both P ≤ .003). CONCLUSIONS:Data indicate a slightly higher mREE than pREE after RYGB. Although the underlying mechanisms of this observation remain to be elucidated our finding may play a role for weight loss outcomes after the surgery. 10.1016/j.soard.2017.10.014
    Resting metabolic rate prediction equations and the validity to assess energy deficiency in the athlete population. Schofield K L,Thorpe H,Sims S T Experimental physiology NEW FINDINGS:What is the topic of this review? We review the issues with using predicted resting metabolic rate equations in athletic populations. What advances does it highlight? The use of dated predicted resting metabolic rate equations is not appropriate for athletic populations until more studies have been conducted among these unique populations. ABSTRACT:Resting metabolic rate (RMR) is the amount of energy the body uses at rest. A suppressed RMR has been correlated with low energy availability and therefore used as an indicator of an individual's energy state. Furthermore, confounding identification of low energy availability within an athletic population are the physiological measures required, which can be time consuming and require professional expertise. To negate the demands of laboratory protocols in measuring RMR, predicted RMR ( RMR) equations were developed. Caution should be exercised when applying the RMR equations for determining low energy availability in athletes owing to the population used to develop the equations and the higher metabolic cost of fat-free mass, thus elevated RMR, associated with athletes. Moreover, a low ratio of measured RMR to RMR is often used as an alternative marker for energy deficiency. Predictive equations should implement fat-free mass within the algorithm when estimating RMR in athletic populations. The purpose of this paper is to describe RMR equation development and the issues associated with use of RMR equations for athletic populations. As professional sport increases, validation of RMR equations in the modern athlete population is needed to monitor energy availability for athletic health and performance. 10.1113/EP087512