Canadian recommendations underestimate energy needs of women over fifty years as determined by doubly-labelled water

Accurate estimations of energy requirements at the population level are crucial because of disease processes associated with energy imbalance. The present objective was to compare energy expenditure with existing Recommended Nutrient Intakes for Canadians (RNIC) and determine whether the RNIC provides a true index of energy requirement in middle-aged and elderly Canadian women. A second objective was to compare energy expenditure and the RNIC to Food and Agriculture Organization, World Health Organization, United Nations University (FAO/WHO/UNU) predictions. Seventy-six women were recruited for the study (67.3 ± 11.5 y, 63 ± 11.7 kg, BMI 24.8 ± 4.4 kg·m-2). The two-point doubly-labelled water (DLW) method was used over 13 days to assess energy expenditure while subjects carried out their routine activities. Subjects were stratified to enable age specific requirements for middle-aged and elderly women. At weight maintenance, energy needs were underestimated using the RNIC (7.1 ± 1.6 MJ·d-1, 1698 ± 391 kcal·d-1) compared to total energy expenditure (10.0 ± 3.2 MJ·d-1, 2395 ± 746 kcal·d-1) as determined by DLW as a whole and for each age group. The RNIC recommendations were lower than the FAO/WHO/UNU estimations even for light activity. Results indicate that mean energy expenditure was 29% greater than the RNIC recommendations created using formulas based on age and weight, whereas the FAO/WHO/ UNU estimations closely approximated energy expenditure based on heavy activity in women 49-79 y and light activity in women over 80 y old. These data suggest a systematic underestimation of Canadian energy recommendations for women.Key words: energy expenditure, doubly-labelled water, energy intake, dietary assessment, humans.

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Doubly labelled water assessment of energy expenditure: principle, practice, and promise

European Journal of Applied Physiology ◽

10.1007/s00421-017-3641-x ◽

2017 ◽

Vol 117 (7) ◽

pp. 1277-1285 ◽

Cited By ~ 39

Author(s):

Klaas R. Westerterp

Keyword(s):

Energy Expenditure ◽

Observation Interval ◽

Energy Requirement ◽

Dietary Assessment ◽

Body Water ◽

Assessment Methods ◽

The Body ◽

Turnover Rates ◽

Doubly Labelled Water ◽

The Difference

AbstractThe doubly labelled water method for the assessment of energy expenditure was first published in 1955, application in humans started in 1982, and it has become the gold standard for human energy requirement under daily living conditions. The method involves enriching the body water of a subject with heavy hydrogen (2H) and heavy oxygen (18O), and then determining the difference in washout kinetics between both isotopes, being a function of carbon dioxide production. In practice, subjects get a measured amount of doubly labelled water (2H 2 18 O) to increase background enrichment of body water for 18O of 2000 ppm with at least 180 ppm and background enrichment of body water for 2H of 150 ppm with 120 ppm. Subsequently, the difference between the apparent turnover rates of the hydrogen and oxygen of body water is assessed from blood-, saliva-, or urine samples, collected at the start and end of the observation interval of 1–3 weeks. Samples are analyzed for 18O and 2H with isotope ratio mass spectrometry. The doubly labelled water method is the indicated method to measure energy expenditure in any environment, especially with regard to activity energy expenditure, without interference with the behavior of the subjects. Applications include the assessment of energy requirement from total energy expenditure, validation of dietary assessment methods and validation of physical activity assessment methods with doubly labelled water measured energy expenditure as reference, and studies on body mass regulation with energy expenditure as a determinant of energy balance.

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A pilot study to determine whether using a lightweight, wearable micro-camera improves dietary assessment accuracy and offers information on macronutrients and eating rate

British Journal Of Nutrition ◽

10.1017/s0007114515004262 ◽

2015 ◽

Vol 115 (1) ◽

pp. 160-167 ◽

Cited By ~ 32

Author(s):

Claire Pettitt ◽

Jindong Liu ◽

Richard M. Kwasnicki ◽

Guang-Zhong Yang ◽

Thomas Preston ◽

...

Keyword(s):

Pilot Study ◽

Energy Expenditure ◽

Energy Intake ◽

Dietary Assessment ◽

Reporting Rate ◽

Eating Rate ◽

Food Diary ◽

Doubly Labelled Water ◽

Food Diaries ◽

Dietary Intake Assessment

AbstractA major limitation in nutritional science is the lack of understanding of the nutritional intake of free-living people. There is an inverse relationship between accuracy of reporting of energy intake by all current nutritional methodologies and body weight. In this pilot study we aim to explore whether using a novel lightweight, wearable micro-camera improves the accuracy of dietary intake assessment. Doubly labelled water (DLW) was used to estimate energy expenditure and intake over a 14-d period, over which time participants (n 6) completed a food diary and wore a micro-camera on 2 of the days. Comparisons were made between the estimated energy intake from the reported food diary alone and together with the images from the micro-camera recordings. There was an average daily deficit of 3912 kJ using food diaries to estimate energy intake compared with estimated energy expenditure from DLW (P=0·0118), representing an under-reporting rate of 34 %. Analysis of food diaries alone showed a significant deficit in estimated daily energy intake compared with estimated intake from food diary analysis with images from the micro-camera recordings (405 kJ). Use of the micro-camera images in conjunction with food diaries improves the accuracy of dietary assessment and provides valuable information on macronutrient intake and eating rate. There is a need to develop this recording technique to remove user and assessor bias.

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The conceptual framework for estimating food energy requirement

Public Health Nutrition ◽

10.1079/phn2005789 ◽

2005 ◽

Vol 8 (7a) ◽

pp. 940-952 ◽

Cited By ~ 5

Author(s):

Anna Ferro-Luzzi

Keyword(s):

Physical Activity ◽

Energy Expenditure ◽

Energy Requirement ◽

Historical Review ◽

Activity Level ◽

World Health ◽

Future Research ◽

Expert Consultation ◽

Protein Requirements ◽

Health Organization

AbstractObjectiveIn anticipation of the revision of the 1985 Food and Agricultural Organization/World Health Organization/United Nations University (FAO/ WHO/UNU) Expert Consultation Report on ‘Energy and Protein Requirements’, recent scientific knowledge on the principles underlying the estimation of energy requirement is reviewed.DesignThis paper carries out a historical review of the scientific rationale adopted by previous FAO/WHO technical reports on energy requirement, discusses the concepts used in assessing basal metabolic rate (BMR), energy expenditure, physical activity level (PAL), and examines current controversial areas. Recommendations and areas of future research are presented.ConclusionsThe database of the BMR predictive equations developed by the 1985 FAO/WHO/UNU Expert Consultation Report on Energy and Protein Requirements needs updating and expansion, applying strict and transparent selection criteria. The existence of an ethnic/tropical factor capable of affecting BMR is not supported by the available evidence. The factorial approach for the calculation of energy requirement, as set out in the 1985 report, should be retained. The estimate should have a normative rather than a prescriptive nature, except for the allowance provided for extra physical activity for sedentary populations, and for the prevention of non-communicable chronic diseases. The estimate of energy requirement of children below the age of 10 years should be made on the basis of energy expenditure rather than energy intake. The evidence of the existence of an ethnic/tropical factor is conflicting and no plausible mechanism has as yet been put forward.

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Quantifying the free living energy exchanges of Arctic ungulates with stable isotopes

Rangifer ◽

10.7557/2.20.2-3.1480 ◽

2000 ◽

Vol 20 (2-3) ◽

pp. 59 ◽

Cited By ~ 2

Author(s):

Paul Haggarty

Keyword(s):

Physical Activity ◽

Energy Expenditure ◽

Energy Requirement ◽

Ecological Impact ◽

The Arctic ◽

Unknown Parameters ◽

Free Living ◽

Doubly Labelled Water ◽

Energy Exchanges ◽

Free Ranging

When natural diets meet an animal's requirement for energy, other essential nutrients will usually be supplied in amounts at least sufficient for survival. Knowledge of the energy requirements of free ranging species under typical conditions are important in assessing both their nutritional needs and their ecological impact. The doubly labelled water (DLW) method is currently the most promising objective field methodology for estimating free living energy expenditure but expenditure is only equal to the energy requirement when an animal is in energy balance. Reproduction and seasonal cycles of fat deposition and utilization represent significant components of the energy budget of arctic ungulates but the information gained in the course of a typical DLW study may be used to estimate processes such as milk output and fat storage and mobilization in order to predict requirements from expenditure. The DLW method has been exhaustively validated under highly controlled conditions and the introduction of innovations such as faecal sampling for the estimation of body water isotopic enrichment, the availability of appropriate correction factors and stoichiometrics for known sources of error, and iterative calculation of unknown parameters, have produced a methodology suitable for use in truly free ranging species. The few studies carried out so far in arctic ungulates indicate that previous predictions have generally underestimated the true level of expenditure, that there is considerable between animal variation in the level of expenditure and that this is largely determined by physical activity. The disadvantages of the DLW methodology are that it remains expensive and the isotope analysis is technically demanding. Furthermore, although DLW can provide an accurate value for free living energy expenditure, it is often important to have information on the individual components of expenditure, for example the relative contribution of physical activity and thermoregulatory thermogenesis, in order to interpret the values for overall expenditure. For these reasons the most valuable use of the DLW method in the field may be to validate factorial models and other approaches so that they may be used with confidence. Additional important information on the energy exchanges of free ranging animals may be obtained from other stable isotope methodologies. In addition to the use of the isotopes 2H and lsO in the DLW method, natural variations in the abundance of "C and 15N in the arctic environment may be exploited to study diet selection in truly free living arctic ungulates.

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Protein and energy requirements in health and illness

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0060 ◽

2017 ◽

pp. 455-462

Author(s):

Jürgen M. Bauer ◽

Rebecca Diekmann

Keyword(s):

Protein Intake ◽

Energy Requirement ◽

Large Degree ◽

Activity Level ◽

World Health ◽

Older Individuals ◽

Energy Needs ◽

The World ◽

Health And Illness ◽

Health Organization

The preservation of functionality in elders is closely associated with their nutritional status. In this context it is pivotal for them to meet their nutritional requirements, which vary according to their individual needs. The latter are influenced to a large degree by activity level and comorbidity. Most older individuals will cover their energy needs in the range 25–30 kcal/kg body weight (BW) per day, but in extreme states like hyperkinetic dementia, the daily energy requirement may amount to 40 kcal/kg BW per day. To achieve optimal protein intake, older persons will need more protein per kg BW than the World Health Organization (WHO) recommendation of 0.8 g/kg BW per day, which was not varied according to age. For slowing the associated decline in muscle mass and bone quality, 1.0–1.2 g protein/kg BW per day is recommended. In older individuals with relevant comorbidity, even higher protein intake is advisable.

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

British Journal Of Nutrition ◽

10.1079/bjn19940005 ◽

1994 ◽

Vol 72 (1) ◽

pp. 13-20 ◽

Cited By ~ 88

Author(s):

Peter S. W. Davies ◽

W. A. Coward ◽

J. Gregory ◽

A. White ◽

A. Mills

Keyword(s):

Energy Expenditure ◽

Total Energy ◽

Energy Intake ◽

Population Level ◽

Total Energy Expenditure ◽

Relative Bias ◽

Healthy Children ◽

Older Children ◽

Doubly Labelled Water ◽

The Mean

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

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Validation of energy requirement references for exclusively breast-fed infants

British Journal Of Nutrition ◽

10.1017/s000711451200428x ◽

2012 ◽

Vol 109 (11) ◽

pp. 2036-2043 ◽

Cited By ~ 2

Author(s):

Susan B. Nielsen ◽

Jonathan C. K. Wells ◽

Mary S. Fewtrell ◽

Simon Eaton ◽

James Grinham ◽

...

Keyword(s):

Body Weight ◽

Energy Requirement ◽

Population Level ◽

Prediction Equation ◽

Total Energy Expenditure ◽

Energy Requirements ◽

Doubly Labelled Water ◽

Factorial Approach ◽

Paediatric Practice ◽

Breast Fed

In paediatric practice, mean reference energy requirements for groups are often used to predict individual infant energy requirements. References from the FAO/WHO/United Nations University are based on infants not fed according to the current infant feeding recommendations. The objective of the present study was to measure total energy expenditure (TEE) and determine energy requirements using criterion methods, and validate the use of TEE prediction equation and mean energy requirement references for predicting individual TEE and energy requirements, respectively, in infants who were exclusively breast-fed (EBF) to 6 months of age. EBF infants were included from Greater Glasgow for measurements at 3·5 (n 36) and 6 (n 33) months of age. TEE was measured using doubly labelled water and energy requirements were determined using the factorial approach. TEE and energy requirements were also predicted using equations based on body weight. Relationships between criterion methods and predictions were assessed using correlations. Paired t tests and Bland–Altman plots were used to assess agreement. At the population level, predicted and measured TEE were similar. The energy requirement reference significantly underestimated energy requirements by 7·2 % at 3·5 months at the population level, but there was no bias at 6 months. Errors at individual levels were large and energy requirements were underestimated to a larger extent for infants with higher energy requirements. This indicates that references presently used in clinical practice to estimate energy requirements may not fully account for the different growth pattern of EBF infants. More studies in infants EBF to 6 months of age are needed to understand how growth of EBF infants influences energy requirements.

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Estimating energy expenditure from wrist and thigh accelerometry in free-living adults: a doubly labelled water study

10.1101/370247 ◽

2018 ◽

Cited By ~ 2

Author(s):

Tom White ◽

Kate Westgate ◽

Stefanie Hollidge ◽

Michelle Venables ◽

Patrick Olivier ◽

...

Keyword(s):

Energy Expenditure ◽

Mean Squared Error ◽

Pearson Correlation ◽

Population Level ◽

Living Conditions ◽

Estimation Model ◽

Free Living ◽

Doubly Labelled Water ◽

Highly Correlated ◽

Free Living Conditions

AbstractBackgroundMany large studies have implemented wrist or thigh accelerometry to capture physical activity, but the accuracy of these measurements to infer Activity Energy Expenditure (AEE) and consequently Total Energy Expenditure (TEE) has not been demonstrated. The purpose of this study was to assess the validity of acceleration intensity at wrist and thigh sites as estimates of AEE and TEE under free-living conditions using a gold-standard criterion.MethodsMeasurements for 193 UK adults (105 men, 88 women, aged 40-66 years, BMI 20.4-36.6 kg·m-2) were collected with triaxial accelerometers worn on the dominant wrist, non-dominant wrist and thigh in free-living conditions for 9-14 days. In a subsample (50 men, 50 women) TEE was simultaneously assessed with doubly labelled water (DLW). AEE was estimated from non-dominant wrist using an established estimation model, and novel models were derived for dominant wrist and thigh in the non-DLW subsample. Agreement with both AEE and TEE from DLW was evaluated by mean bias, Root Mean Squared Error (RMSE) and Pearson correlation.ResultsMean TEE and AEE derived from DLW was 11.6 (2.3) MJ·day-1 and 49.8 (16.3) kJ·day-1·kg-1. Dominant and non-dominant wrist acceleration were highly correlated in free-living (r=0.93), but less so with thigh (r=0.73 and 0.66, respectively). Estimates of AEE were 48.6 (11.8) kJ·day-1·kg-1 from dominant wrist, 48.6 (12.3) from non-dominant wrist, and 46.0 (10.1) from thigh; these agreed strongly with AEE (RMSE ~12.2 kJ·day-1·kg-1, r ~0.71) with small mean biases at the population level (~6%). Only the thigh estimate bias was statistically significantly different from the criterion. When combining these AEE estimates with estimated REE, agreement was stronger with the criterion (RMSE ~1.0 MJ·day-1, r ~0.90). Conclusions: In UK adults, acceleration measured at either wrist or thigh can be used to estimate population levels of AEE and TEE in free-living conditions with high precision.

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Energy Expenditure and Physical Activity in Clozapine use: Implications for Weight Management

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2006.01888.x ◽

2006 ◽

Vol 40 (9) ◽

pp. 810-814 ◽

Cited By ~ 47

Author(s):

Jenny-Kay Sharpe ◽

Terry J. Stedman ◽

Nuala M. Byrne ◽

Connie Wishart ◽

Andrew P. Hills

Keyword(s):

Physical Activity ◽

Energy Expenditure ◽

Weight Management ◽

Atypical Antipsychotic ◽

Management Strategies ◽

Reference Method ◽

Resting Energy Expenditure ◽

Activity Level ◽

World Health ◽

Doubly Labelled Water

Objective: The management of atypical antipsychotic-induced weight gain is a significant challenge for people with mental illness. Fundamental research into energy metabolism in people taking atypical antipsychotic medication has been neglected. The current study of men with schizophrenia taking clozapine aimed to measure total energy expenditure (TEE) and energy expended on physical activity – activity energy expenditure (AEE) and to consider the clinical implications of the findings. Method: The well-established reference method of doubly labelled water (DLW) was used to measure TEE and AEE in men with schizophrenia who had been taking clozapine for more than 6 months. Resting energy expenditure was determined using indirect calorimetry. Results: The TEE was 2511 ± 606 kcal day−1 which was signifcantly different to World Health Organization recommendations (more than 20% lower). The Physical activity level (PAL) was 1.39 ± 0.27 confirming the sedentary nature of people with schizophrenia who take clozapine. Conclusions: The findings support the need for weight management strategies for people with schizophrenia who take clozapine to focus on the enhancement of energy expenditure by increasing physical activity and reducing inactivity or sedentary behaviours, rather than relying primarily on strategies to reduce energy intake.

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