title: World Health Organization equations have shortcomings for predicting resting energy expenditure in persons from a modern, affluent population: generation of a new reference standard from a retrospective analysis of a German database of resting energy expenditure.
abstract: BACKGROUND
  Reference standards for resting energy expenditure (REE) are widely used. Current standards are based on measurements made in the first part of the past century in various races and locations.
  
  
  OBJECTIVE
  The aim of the present study was to investigate the application of the World Health Organization (WHO) equations from 1985 in healthy subjects living in a modern, affluent society in Germany and to generate a new formula for predicting REE.
  
  
  METHODS
  The study was a cross-sectional and retrospective analysis of data on REE and body composition obtained from 2528 subjects aged 5-91 y in 7 different centers between 1985 and 2002.
  
  
  RESULTS
  Mean REE varied between 5.63 and 8.07 MJ/d in males and between 5.35 and 6.46 MJ/d in females. WHO prediction equations systematically overestimated REE at low REE values but underestimated REE at high REE values. There were significant and independent effects of sex, age, body mass or fat-free mass, and fat mass on REE. Multivariate regression analysis explained up to 75% of the variance in REE. Two prediction formulas including weight, sex, and age or fat-free mass, fat mass, sex, and age, respectively, were generated in a subpopulation and cross-validated in another subpopulation. Significant deviations were still observed for underweight and normal-weight subjects. REE prediction formulas for specific body mass index groups reduced the deviations. The normative data for REE from the Institute of Medicine underestimated our data by 0.3 MJ/d.
  
  
  CONCLUSIONS
  REE prediction by WHO formulas systematically over- and underestimates REE. REE prediction from a weight group-specific formula is recommended in underweight subjects.
authors.affiliation: Christian-Albrechts-Universität zu Kiel, Institut für Humanernährung und Lebensmittelkunde, Kiel, Germany. mmueller@nutrfoodc.uni-kiel.de
authors.forename: Manfred J
authors.initials: MJ
authors.lastname: Müller
authors.forename: Anja
authors.initials: A
authors.lastname: Bosy-Westphal
authors.forename: Susanne
authors.initials: S
authors.lastname: Klaus
authors.forename: Georg
authors.initials: G
authors.lastname: Kreymann
authors.forename: Petra M
authors.initials: PM
authors.lastname: Lührmann
authors.forename: Monika
authors.initials: M
authors.lastname: Neuhäuser-Berthold
authors.forename: Rudolf
authors.initials: R
authors.lastname: Noack
authors.forename: Karl M
authors.initials: KM
authors.lastname: Pirke
authors.forename: Petra
authors.initials: P
authors.lastname: Platte
authors.forename: Oliver
authors.initials: O
authors.lastname: Selberg
authors.forename: Jochen
authors.initials: J
authors.lastname: Steiniger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001481:Basal Metabolism; D001823:Body Composition; D001835:Body Weight; D002648:Child; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012015:Reference Standards; D012189:Retrospective Studies; D014944:World Health Organization