Comparison of predictive equations and measured resting energy expenditure among obese youth attending a pediatric healthy weight clinic: one size does not fit all.
BACKGROUND
The Academy of Nutrition and Dietetics recommends the use of indirect calorimetry for calculating caloric targets for weight loss in obese youth. Practitioners typically use predictive equations since indirect calorimetry is often not available. The objective of this study was to compare measured resting energy expenditure (MREE) with that estimated using published predictive equations in obese pediatric patients.


METHODS
Youth aged 7 to 18 years (n = 80) who were referred to a university-based healthy weight clinic and who were greater than the 95th percentile BMI for age and gender participated. MREE was measured via a portable indirect calorimeter. Predicted energy expenditure (pEE) was estimated using published equations including those commonly used in children. pEE was compared to the MREE for each subject. Absolute mean difference between MREE and pEE, mean percentage accuracy, and mean error were determined.


RESULTS
Mean percentage accuracy of pEE compared with MREE varied widely, with the Harris-Benedict, Lazzer, and Molnar equations providing the greatest accuracy (65%, 61%, and 60%, respectively). Mean differences between MREE and equation-estimated caloric targets varied from 197.9 kcal/day to 307.7 kcal/day.


CONCLUSIONS
The potential to either overestimate or underestimate calorie needs in the clinical setting is significant when comparing EE derived from predictive equations with that measured using portable indirect calorimetry. While our findings suggest that the Harris-Benedict equation has improved accuracy relative to other equations in severely obese youth, the potential for error remains sufficiently great to suggest that indirect calorimetry is preferred.
Sarah T. Henes, The Division of Nutrition, Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, PO Box 3995, Atlanta, GA 30302, USA. Email: shenes@gsu.edu.
Sarah T
ST
Henes
Doyle M
DM
Cummings
Robert C
RC
Hickner
Joseph A
JA
Houmard
Kathryn M
KM
Kolasa
Suzanne
S
Lazorick
David N
DN
Collier
D000293:Adolescent; D001481:Basal Metabolism / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight; D002153:Calorimetry, Indirect; D002648:Child; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009752:Nutritional Status; D063766:Pediatric Obesity / Q000378:metabolism*; D011237:Predictive Value of Tests; D015431:Weight Loss
childhood obesity; energy expenditure; indirect calorimeter; pediatric clinic; portable indirect calorimetry