title: Assessing resting energy expenditure in overweight and obese adolescents in a clinical setting: validity of a handheld indirect calorimeter.
abstract: Accurately determining energy requirements is key for nutritional management of pediatric obesity. Recently, a portable handheld indirect calorimeter, MedGem (MG) has become available to measure resting energy expenditure (REE). Our work aims to determine the clinical validity and usefulness of MG to measure REE in overweight and obese adolescents.
  
  
  
  Thirty-nine overweight and obese adolescents (16 male (M): 23 female (F), 15.2 ± 1.9 y, BMI percentile: 98.6 ± 2.2%) and 15 normal weight adolescents (7M: 8F, age 15.2 ± 2.0 y, BMI percentile: 39.2 ± 20.9%) participated. REE was measured with both MG and standard indirect calorimeter (VMax) in random order.
  
  
  
  MG REE (1,600 ± 372 kcal/d) was lower than VMax REE (1,727 ± 327 kcal/) in the overweight and obese adolescents. Bland Altman analysis (MG -VMax) showed a mean bias of -127 kcal/d (95% CI = -72 to -182 kcal/d, P < 0.001), and a proportional bias existed such that lower measured REE by VMax was underestimated by MG, and higher measured REE by VMax were overestimated by MG.
  
  
  
  MG systematically underestimates REE in the overweight and adolescent population, thus the MG portable indirect calorimeter is not recommended for routine use. Considering that it is a systematic underestimation of REE, MG may be clinically acceptable, only if used with caution.
authors.affiliation: Division of Endocrinology, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Woo
authors.affiliation: Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.|Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gayathri
authors.initials: G
authors.lastname: Murthy
authors.affiliation: Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.|Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Wong
authors.affiliation: Division of Endocrinology, BC Children's Hospital, Vancouver, British Columbia, Canada.|Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Brenden
authors.initials: B
authors.lastname: Hursh
authors.affiliation: Division of Endocrinology, BC Children's Hospital, Vancouver, British Columbia, Canada.|Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Chanoine
authors.affiliation: Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.|Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Rajavel
authors.initials: R
authors.lastname: Elango
mesh_terms: D000293:Adolescent; D001481:Basal Metabolism; D015992:Body Mass Index; D002153:Calorimetry, Indirect / Q000295:instrumentation* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002648:Child; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000378:metabolism* / Q000473:pathology; D063766:Pediatric Obesity / Q000378:metabolism* / Q000473:pathology; D015203:Reproducibility of Results