title: Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies.
abstract: BACKGROUND
  There is an assumption that people in developing countries have a higher total energy expenditure (TEE) and physical activity level (PAL) than do people in developed nations, but few objective data for this assertion exist.
  
  
  OBJECTIVE
  We conducted a meta-analysis of TEE and PAL by using data from countries that have a low or middle human development index (HDI) compared with those with a high HDI to better understand how energy-expenditure variables are associated with development status and population differences in body size.
  
  
  METHODS
  We performed a literature search for studies in which energy expenditure was measured by using doubly labeled water. Mean data on age, weight, body mass index (BMI; in kg/m(2)), TEE, and PAL were extracted, and HDI status was assessed. Pooled estimates of the mean effect by sex were obtained, and the extent to which age, weight, HDI status, and year of publication explained heterogeneity was assessed.
  
  
  RESULTS
  A total of 98 studies (14 studies from low- or middle-HDI countries) that represented 183 cohorts and 4972 individuals were included. Mean (±SE) BMI was lower in countries with a low or middle HDI than in those with a high HDI for both men and women (22.7 ± 1.0 compared with 26.0 ± 0.7, respectively, in men and 24.3 ± 0.7 compared with 26.6 ± 0.4, respectively, in women). In meta-regression models, there was an inverse association of age (P < 0.001) and a positive association of weight (P < 0.001) with TEE for both sexes; there was an association of age only in men with PAL (P < 0.001). There was no association of HDI status with either TEE or PAL.
  
  
  CONCLUSIONS
  TEE adjusted for weight and age or PAL did not differ significantly between developing and industrialized countries, which calls into question the role of energy expenditure in the cause of obesity at the population level.
authors.affiliation: Department of Preventive Medicine and Epidemiology, Loyola University Chicago, Maywood, IL 60153, USA. ldugas@lumc.edu
authors.forename: Lara R
authors.initials: LR
authors.lastname: Dugas
authors.forename: Regina
authors.initials: R
authors.lastname: Harders
authors.forename: Sarah
authors.initials: S
authors.lastname: Merrill
authors.forename: Kara
authors.initials: K
authors.lastname: Ebersole
authors.forename: David A
authors.initials: DA
authors.lastname: Shoham
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Rush
authors.forename: Felix K
authors.initials: FK
authors.lastname: Assah
authors.forename: Terrence
authors.initials: T
authors.lastname: Forrester
authors.forename: Ramon A
authors.initials: RA
authors.lastname: Durazo-Arvizu
authors.forename: Amy
authors.initials: A
authors.lastname: Luke
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D001834:Body Water; D001835:Body Weight; D019049:Developed Countries; D003906:Developing Countries; D004734:Energy Metabolism; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D012737:Sex Factors; D014867:Water
chemical_list: D014867:Water