a new predictive equation for resting energy expenditure in healthy individualsı

7/28/2019 A new predictive equation for resting energy expenditure in healthy individuals

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A m J C /in N u ir l99 0 ;5 1 :2 41-7 . P r in ted in U SA . 1990 Am erican Soc ie ty fo r C lin ica l N utrition 241

O rig in a l R es e a rch C o m m u n ic a tio n s -m eth o d s

A n e w p re d ic tiv e e q u a tio n fo r re s tin g e n e rg y e x p e n d itu rein h ea lth y in d iv id ua ls 3M a rk D M u ffin , Sa ch iko T S t Jeor, L isa A H ill, B arb ara J Sco tt,S and ra A D au gherty , an d Y oun g 0 K o h

ABSTRACT A pred ic tive equa tion fo r res ting en ergy ex-pend itu re (REE ) w as derived from data from 498 hea lth y sub-jec ts , in clud in g fem ales (n = 247) and m ales (n = 25 1), aged1 9-78 y (45 1 4 y , I SD ). N o rm al-w eigh t (n = 264) andobese (n = 234 ) ind iv idu a ls w ere stud ied and R EE w as m ea-su red b y in d irec t ca lo r im e try . M ultip le -reg res sion ana lysesw ere em plo yed to de rive re la tionsh ips b e tw een REE andw e igh t, he igh t, an d age fo r b o th m en and w om en (R 2 = 0 .71) :REE = 9 .99 x weigh t + 6 .25 X heig h t - 4 .92 X age + 166x sex (m a le s, 1 ; fem ale s, 0 ) - 161 . S im p lifica tion of th is fo r-m ula and separa tion by sex d id no t a ffec t its p red ic tive va lu e:REE (m a les ) = 10 X w eig h t (k g) + 6 .25 X heigh t (cm ) - 5x age(y ) + 5 ; REE (fem ales) = 10 X w eigh t(k g ) + 6 .25 X he igh t( cm ) - 5 X age (y ) - 161 . T he inc lusion ofre la tiv e bo dy w eigh tand body -w e igh t d istrib u tion d id no t sign if ican tly im pro ve thepred ic tive va lue of these eq ua tion s. T h e H arris-B ened ic tEqua tions de riv ed in 19 19 ove re stim a ted m easu red R EE by 5%(p < 0 .01) . Fa t-free m ass (FFM ) w as the best s in g le p red icto rof REE (R 2 = 0 .64) : REE = 19 .7 x FF M + 413 . W eigh t a lsow as c lose ly co rre lated w ith REE (R 2 0 .56): REE = 1 1x w eig h t + 371 . A m JC lin N u tr 1990 ;5 1 :24 1 -7 .

KEY W ORDS R es ting ene rg y expend itu re, ind irect cab -rim etry , 24-h energy req u irem en t, ob es ity , healthy adu lts

In troduct ionThe accu ra te p red ic tion o f ene rgy req u irem en ts fan hea lthy

ind iv idua ls has m any usefu l c lin ica l ap p lica tions . T h e m ost o h-v ious use is in w eigh t m anagem ent o fb o th norm al-w eigh t andob#{231} send iv idu als . T he obese po pu la tion , de fined as > 120% ofideal b ody w eigh t (IBW ), as estab lish ed by the 1959 M etrapo li-tan D esirab le W eig h t T ab le s (1 ), is e stim a ted to cons titu te2 3% ofthe wh ite , b lack , and h ispan ic adu lt po pu la tio n in theUn ited S ta tes (2 ). A dd itio na lly , d ie ting is a comm on prac ticein ind iv idu a ls o fa ll w e igh t ca tegories. It h as been repo rted tha t77% of a ll w om en (48% overw eig h t, 20% norm a l w e igh t, an d9% underw eigh t) and 42% of a ll m en (2 8% overw eig h t, 10%norm a l w e igh t, and 4% unde rw e igh t) a re d ie ting a t any tim e(2 ). U nfortun a te ly , m any of these ind iv idua ls a re no t aw are o fthe ir en ergy requ irem en ts and m ay attem p t to reg u la te the irenergy ba lance at an unknown leve l.

R ecen t em phasis on th e hea lth consequ ences o f o besity hasencou raged re sea rche rs to im p rov e the de fin ition and asse ss-m en t o f o besity an d h as fu rthe r p rom oted th e deve lopm en t o f

n ew w eigh t-m anag em en t stra teg ies (3 ) . A ssessm en t n ow oftenin clu des re ference to o ve ra ll body com positio n [pe rcen t bodyfat (% BF )] an d fa t d is tr ibu tio n p atte rns [w a ist-to -h ip ra tio(W HR )] (3 ). A dd itiona lly , ob esity w as iden tif ied as a risk fac to rfar card iov ascu lar d isea se , w ith in creasin g m ortality in ob esein d iv id ua ls w ith a bo dy m ass in dex (BM I) > 25 kg /m 2 (4 , 5) .T he risk o f ca rd io vascu la r d is ea se inc rea se s w ith w eig h t g ainan d decreases w ith w eigh t lass (5 ) , and e leva ted risk is a lso asso -c ia ted w ith in creased abdom in a l fa t, on a W HR > 0 .90 inw om en and > 1 .0 in m en (6) . T odays hea lth -conscio us so c ie typ rov ides b o th the ch alleng e and oppo rtu n ity to p rac tice p re -ven tive m ed ic ine by he lp ing th ese a t-risk pa tien ts to ach ievean d m ain tain a h ea lthy body w eig h t. Im portan t to th is p rac ticeis an accura te m ethod ofassessing ov erall en ergy requ irem en tsin bo th n orm al-w eigh t an d obese in d iv idua ls.

The assessm en t o f 24 -h ene rgy ex pend itu re (2 4 -EE , in kca l/d ) is a requ irem en t fo r es tab lish ing ca lo ric p resc rip tio ns fo r pa-tien ts. T he b est p red ic to r o f 24-EE is the res tin g en ergy exp en-d itu re (R EE ), as d e te rm ined by ind irec t calo rim etr ic m easu re -m en t, w h ich accou n ts fo r 65 -70% ofto tab 24 -E E . Th e the rm iceffec t o ffood (TEF ) and phys ica l ac tiv ity (PA ) accoun t fo r therem a in ing 10 -1 5% and 20-30% , re sp ec tive ly , o f 24 -E E (7 , 8 ).B ecau se TE F and PA are h igh ly v ariab le from day to d ay an dd if ficu lt to q uan tify , REE is m o st o f ten u sed as an overa ll p re -d ic to r o f24 -EE . U sua lly , an in d iv idua ls REE is m u ltip lied b yan ac tiv ity fac to r to a rr ive a t th e 24 -E E . Forex am ple , in m ode r-a te ly active , hea lth y ad u lt in d iv idua ls, a fac to r o f 1 .6 fo rw om en and I .7 fo r m en has been used (9 ).

T he m os t w id ely u sed pred ic tive equa tions fo r REE w ere de-ve lop ed an 1 36 m en and 103 w om en by H arris an d B ened ic t-7 0 y ago (10). T hrough the 1 950s these im portan t equa tionsw ere va lida ted w ith in 5% by o th er re sea rche rs . M ore recen tly ,how eve r , inv estig ato rs h av e questio ned th eir con tinued app li-

I From th e N utri tio n Educatio n and R esearch P ro gram and th e D c-partm en t o f F am ily and Comm un ity M edic ine , U nivers ity o f N evad aS choo l o f M edic in e, and the G radu ate Schoo l, U n iv ersity o f N evada ,R eno , NV .

2 Supported by S tuden t in H ealth S c iences g ran t AM 07478 andg ran t H L 34589 from the N ationa l H eart, L ung and B lo od Ins titu te ,N atio nal Ins titu tes of H ealth .

3 Address rep rin t req uests to ST S t Jeo r, N u trition E duca tion andR esearch Pro gram , B rig ham Build ing , U nivers ity o fN evada S choo l o fMedic ine , Reno , N V 89557 .

R ece ived Jun e 30 , 1988 .A ccep ted fo r pub lica tion F ebruary 23 , 1 989 .


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2 4 2 MIFFL IN ET ALcab ility in o ur m odern popu la tio n , w ith its ob v ious d iffe rencesin body size and com positio n , lev els o f PA , and d iet and a lsoin ligh t o fth e av ailab ility o fim prav ed eq u ipm en t and tech no l-og y fo r m easu ring R EE (1 1). In 1980 C unn ing ham (12 ) con -f irm ed the h ypo thesis p ro posed o rig ina lly by B en ed ict tha tm etabo lica lly activ e body m ass, o r lean body m ass (L BM ), isth e best p red ic to r o f REE . O n the b as is o f tha t f ind ing , C un-n ingh am p ro posed a sim p lified fo rm u la fo r p red ic ting REEfrom LBM (12 ). S ubseq uen t stu d ie s have addre ssed sex -sp ec ificd iffe ren ces, w h ich can b e pred icted by LBM becau se w om enh ave a sm a lle r p ropo rtio n o f LBM and greaten fa t mas s whencom pared w ith m en (1 3) .

S tud ies repo rted by D a ly e t al in 19 85 (1 l)a lso in d icated th atthe H arr is-B en ed ict E qua tion s (H BE ) ove res tim a ted m easu redbasa l en ergy expen d itu re by 10-15% in the ir p op u la tion of 201hea lthy m en and w om en . M o re recen tly , Ow en e t ab ( 14) re-po rted stud ies confirm ing tha t th e H BE overp red icted the REEin h ea lthy w om en by 7-24% and m en und er the ag e o f 5 0 y by9 .2% (15). These s tud ie s a lso dem onstra ted tha t body weig h tand fa t-free m ass (FFM ) w ere h ig h ly co rrela ted w ith REE . Th epre sen t stu dy , w h ich inc luded bo th n orm al-w eig h t and obesem en and w om en rang ing in age from 19 to 78 y , dem onstra tedtha t th e H BE overe stim ated m easu red REE by 5% w hereas theC unn ingh am form ula o ve re stim ated m easu red REE by 14-1 5% . The Ow en fo rm ula s w ere m ost clo se ly assoc ia ted w ith ourm easu red REE , p red ictin g v alu es w ith in -4% in fem ale s and0 . 1% in m ales . T h e p o ten tia l fo r m etabo lic e fficiency as a resu lto fchn on ic d ietin g (16 , 17 ) and th e n eed fo r sepa ra te equ atio nsfo r obese p eo p le (18 ) rem a in o fs ig n if ican t in te rest.

W ith im proved techn o log y an d th e ava ilab ility o f sim p lifiedan d prac tical equ ipm en t, in d irec t calo rim etry has been ap p liedrecen tly in ou tpa tien t s ettin gs to m easu re in d iv id ua l en ergy ex-pend itu re . H ow eve r, becau se the equ ipm en t is exp en sive andtra ined p erson ne l and tim e are requ ired , it is no t ye t p rac tica lto ob tain REE on eve ry pa tien t. I t is also im portan t to rem em -ben tha t the co st is o f ten p ro h ib itiv e ($75-$l50) w ith ou t n eim -bursem en t b y th ird -party paym ent. A ssessm en ts o f LBM and% BF are m ore comm only m ad e on pa tien ts by va rio us tech -n iques. T he use o fsk in fo ld ca lipe rs at se lected s ites is the m os tpopu la r an d practica l m e thod fa r g en era l ou tpa tien t o ff ice se t-tings. How ev er , train ing pe rsonn el an d ob ta in in g reliab le m ea -su rem en ts (e specia lly in ob ese sub jec ts) s till p ose m ultip leprob lem s wh ich d iscourage the ro u tin e u se o f sk in fo ld m ea-su remen ts .

T he goa ls o f th is stud y w ere to 1) m athem atica lly derive apred ic tiv e equa tio n fo r R EE based on a sam ple of4 98 hea lthynorm a l-w e igh t and obese in d iv id ua ls , 2) as se ss the use fu lnessof the m o re recen t m easures o f body com po sition (% BF ) an dd is tr ib u tio n (W HR ) in pred ic ting REE , an d 3) asse ss the p re -d ic tive va lu e as w ell as the ov era ll p ractica lity o f the newequa tions com pared w ith th ose curren tly be ing app lied .

Sub jects an d m e tho dsD a ta from sub jec ts ennob led in a 5 -y investiga tion a fth e n ela -

tionsh ips o fenergy nu tritio n and obes ity to card iovascu lar d is -ease risk (R ENO D ie t-H eart S tudy ) se rved as the bas is o f th isstud y . B ase line d ata w ere com ple ted on 508 sub jec ts, and the49 8 sub jec ts on wh ich REE s w ere su ccessfu lly com p le ted w ereinc luded in th is s tudy . In fo rm ed consen t to partic ipa te in th is

stud y w as ob ta in ed from each su b jec t a t the beg in n ing o f thestud y , w h ich w as co nduc ted in acco rd w ith e th ica l s tan dardsou tlined an d app roved by the U niversity o f N evada ins titu -tion al rev iew boa rd .Subjects

Sub jec ts w ere rec ru ited acco rd ing to a 2 X 2 X 5 fac to ria ldes ign where sex (m a le s vs fem ale s) an d w e igh t (no rm a l w e igh tvs ob ese) w ere s tra tified b y fiv e d iffe ren t ag e gro ups accord ingto d ecade (20 -2 9 , 30 -3 9 , 4 0 -49 , 50 -59 , and 60+ y). T he se lec -tio n o fsu b jects w as b iased tow ard th e w o rk ing c la ss , de f ined ase ithe r the sub jec t o r spo use b ein g em p loyed ha lf - t ime fo r thep ast yea r. A n add itio na l en try req u irem en t w as reported lygood hea lth with < 1 s ick day /m o for the p as t y ear and no m a-jo n cu rren t illne sse s o r psycho lo g ica l p rob lem s.

Descr ip tion s o f the sub jec ts an d the variab les se lec ted fo rstu dy are sum m arized in T ab le 1 . T he fin a l sam ple in clu ded247 fem ales , rang ing in age from 20 to 76 y (44 .6 14 .0 y I SD ), and 25 1 m a le s, ran g ing in ag e from 19 to 78 y (4 4 .4 14 .3 y) . O f th e w om en , 135 w ere c lass ified as n orm al w eigh t(8 0 -< 1 19% IBW ) and 1 12 w ere c la ssif ied as ob ese ( 120%IBW ) and ofthe m en , 129 w ere c las sified as norm a l w eig h t an d1 22 as obese . A n a ttem p t w as m ade to exc lud e those w ho w ereex trem e ly un de rw e igh t (< 80% IBW ) and tho se w ho w ere m ar-b id ly ob ese (> 180% IBW ). H ow ev er , in o ur fin al p opu latio none ind iv idu a l w as < 80% IBW and tw o were > 180% IBW .Indirect calorim etry

T he m ajo r d ep en den t va riab le fo r th is stu dy w as REE (kca l/d ) a s o b ta ined by in d irec t ca lo r im e try b y use o f a m etabo licm easu rem en t ca rt w ith a canopy hood (M etabo lic M easure-m ent C art H o rizon s Sy stem , S enso r M ed ics , A nahe im , CA ) .M easu rem en ts w ere taken on all su b jects b y tra ined an d ce rti-fled nu tr ition is ts usin g a standa rd ized pro toco l. S u b jec ts w erein struc ted to fas t and abs tain from exe rcise fo r 1 2 h be fo re thetest an d to refra in from sm ok ing 1 h be fo re te stin g bu t fo r 12h if p ossib le. S ub jec ts w ere p laced und er the can opy hood in arelaxed , su p ine po sition and a stan da rd ized re lax atio n tape w asp layed . M easu rem en ts w ere rep ea ted on a ll sub jects un til a 3 -mm steady sta te w as ach ieved . Th e en tire te st took -2 0 m mper sub jec t to com ple te. S tand ard com pute r p ro g ram s ( MMCH orizon System , S enso r M edics) con ve rted O 2-CO 2 gas ex -chang e in to REE .H eight and w eight

Body w e igh t to the nea re st 0 .55 k g w as d ete rm ined b efo reth e REE m easu rem en t o n a standa rd p hys ician s b eam scalewith th e sub jec t in s tree t c lo th es and w ith ou t shoes. H e igh t wa sm easu red to th e n ea rest 0 .63 cm on a stan da rd ized , w a ll-m oun ted h e igh t boa rd acco rd ing to estab lished pro toco l (w ith -o u t sh oes; heels toge th er; su b jects h eels , bu tto ck s, sho u lde rs ,an d head touch in g the ve rtica l w a ll su rface ; and w ith lin e o fs igh t a lign ed ho rizon tally ). P ercen t o fIBW w as d ete rm ined byuse of the 1959 M etropo litan H eigh t W eigh t Tab les (1 ), andBM I wa s ca lcu la ted w ith w eig h t (kg ) and he igh t (m ) m easu re -m en ts (k g/rn2 ) .Skinfold thicknesses and circumferences

Percen t B F w as as ses sed by us ing sk in fo ld and c ircum feren cem easu rem en ts taken a t selec ted site s by train ed techn ic ian s u s-


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PR ED IC IIN G R ES T IN G EN ER G Y EX PEN D IT U R E 24 3

and f em ales , a v alue o f 0 . R EE = 15 .1 x w eigh t + 371 (R 2 = 0 .56) (2 )

T A B L E IC harac te ristic s o fstu dy p opu latio n

Pe rce nt ide alb o d y we i g h t W e i gh t Heigh t A ge

Pe rce nt idealbo dy w eie j t

B od y m assindex

W a i st - t o -h ip s rati o

Percen tbo dy at R EE

kg cm y % % kca lW o m e n

< lOO%(n= 52 )100- I l9%(n = 83 )1 2 0 - 1 3 9% ( n= 6 1 ) 40%(n= 51 )A l lwom en ( n=24 7 )Ra n g e

5 4 . 9 4. 563 .7 5. 57 6 . 2 6. 689 .4 11 .07 0 .2 1 4 .146-120

164.85 .2163 .9 58164 . 76. 4163 .77 .7164 .26 .3146-186

38 .5 12 .748 .8 13.645 . 114. 543 .3 1 3 .444 .6 14.0

20-76

92 .8 4.4108 .8 5.9129 . 5 6. 4153 .1 11 .3119.722.478-193

20 .3 1. 02 3 . 1 .328 . 41. 533.52.526.24.917-42

0.730.050 . 76 0 .060.800.070.820.070.780.070.63-0 .98

30.04.528 .7 5. 536 . 14. 541.55.531.78.612-51

12 45 1 611253 15 3139016515612311349214927-2216

Me n< l0 0%(n=26 )lOO -lI9% (n= 103)120 . - 139%(n=82)140%(n=40)AlImen(n=251)Ran g e

68.5 5 .880 .2 7. 592 .2 7. 3108.713.187.5 14.458-143

178.96.3178 . 57. 1178 . 06. 3178.37.3178.36.8160-201

37.414.)45 .5 14.446 . 0 13.642.614.344 .4 14.319-76

94 .8 4.0110 .9 5.2128 .5 5.4151.910.8121 .5 18 .0

84-186

21.50.925 . 2 1. 129.1 1 .234.42.427.54.1

19-42

0.860.040.900.050.930.050.960.060.920.06

0.8-1.1

10.75.317.64.921.95.128.46.019.86.9

5-39

162725116872771837240197634517762971030-2849

TotalA ll wom en and m en(n=498)

Ran g e78 .9 16.746-143

171.39.6146-201

44 .5 14.119-78

120.620.378-193

26.94.617-42

0.850.100 .63 -1 .1

25.89.84 .7-51

1564336927-2849

* 1 S D , e x ce p t range s. R EE , resting energy expend i ture .

in g H arpenden calipers and s tan dard iz ed tech n iqu es . T h eJack son -Po llock m e thod , w h ich sum s th ree sk in f o ld th ick -nesse s , the th igh , tricep s, and suprailium f or w om en (1 9) andth e th igh , ches t, and abdom en fo r m en (20), w as u sed . A l-though th e D u rn in -W om ers ley m e thod , w h ich uses the sum off ou r sk in f old m easu rem en ts (b iceps , tric ep s, sub scapu lar, an dsuprailium f o r bo th m ales and f em ales ), and bioelectrical im -pedance w ere also perf orm ed on ou r popu lation , th e Jack son -Pob lock m etho d an d f o rm u las w ere se lec ted f o r u se in our stu dybecause its use w ith large , h ete rogeneou s popu latio ns w as rec -om m en ded (2 1 ). FFM w as calculated b y w e igh t (k g ) - f at (k g)w here f at (k g ) is w e igh t (k g ) X %BF .

T h e w aist w as m easured at th e obv ious inden tation o r sm all-e,s t circum f erence on th e m id torso (at --2 .5 cm abov e th e um -b ilicu s). T h e h ip m easurem en t w as then tak en at th e w idestcircum f eren ce on the to rso (- I 5 - 1 8 cm below the um bilicu s).B ecause the se are o f ten d if f icu lt m easurem en ts, th e ju dgm ento f the in v estigator w as o f ten necessary to d ete rm ine th e p ro perm easu rem en t po in ts . T he W HR w as then calcu lated .

D ata a na lysisR e lation sh ip s be tw een m easured R EE and w e igh t, he igh t,

ag e, sex , FFM , % IB W , B M I, and W HR w ere assessed by u se o fth e SPSS-X p rogram (S PS S Inc , C h icago) to arriv e at Pearsonco rre latio n co ef f ic ien ts and sim p le and s tepw ise m u ltip le -re-gression analy ses o f th e d ata. Pred ictiv e eq uations w ere d ev e l-o _ and com pared w ith com m on ly u sed equation s . D ataanaly s is w as lim ited in certain circum stan ces because o f m iss-ing valu es for %B F and W HR m easurem en ts. T h e stepw isem ultip le reg ression s, w h ich inc luded estim ates o f FFM , w erelim ited to 4 82 o f th e 4 98 sub jec ts . In the analy s is sex w as en-tered as a dum m y v ariab le w ith m ales as signed a v alu e o f 1 .0

Re su l t sT h e analy s is o f m easured bod y com po sition v ariab le s and

th eir re sp ectiv e in f lu ences on R EE poses a com p lex prob lem .W ith Pearson co rrelation analy sis (T ab le 2) , % FFM w as show nt o c orre lat e m os t h ig h ly w ith R EE (r = 0 . 8 0 ) f o r the en tiregrou p o fm ale s and f em ales. T h is f ind ing su ppo rts the concep tth at th e am ount o fac tiv e p ro to p lasm ic tissue (FFM ) is h igh lyrelated to R EE , as show n in o th er stud ie s(l2 -15 ). T he re latio n -sh ip b e twe e n R EE and FFM in bo th sex es p rom pted th e f urth eras ses sm en t o fm en and w om en as a sing le group . S tepw ise m ul-tip le -reg ress io n analy s is inc lud ing all v ariab le s y ie lded a pre-d ic tiv e equation fo r R EE in w hich FFM alone y ield ed an R2v alue o f 0 .64 .

REE=19.7XFFM+4l3 (R2=0 .6 4 ) (1)T he stepw ise add ition o f w e igh t, ag e, h e ig h t, an d W HR in -

creased th e R2 va lue to 0 .70; the rem ain ing v ariab le s (sex ,% IB W , and B M I) d id no t con tribu te f urth er to th e pred ictiv ev alue o f the equation . A ltho ugh FFM w as m ost h igh ly co rre -b ated w ith R EE , w e igh t and h eig h t also d em on strated h igh rv alues (0 .73 and 0 .69 . re spectiv e ly ). N o t surprising ly , w e igh tand he igh t w ere h ig h ly co rre lated w ith FFM (r = 0 .79 and 0 .81 ,respec tiv e ly ) and in th is sam p le sex w as also h igh ly correlated(r = 0 .8 3 )w i thFFM.

U pon assessing th e in terrelation sh ips o f th e v ariab le s and ne -aliz lng -thatthe m easurem en t o f e ithe r R EE o r FFM in the ou t-p atien t se tting is generally im prac tical an d d if f icu lt w ithou ttrained personne l and equ ipm en t, w e f ocused our atten tio n ondev e lop ing a s im ple and p rac ticatequation f or p red ic ting R EE .T he ex clu sion o f FFM from the stepw ise m ultip le -regressionan aly s is re su lted in a new pred ic tiv e equation w ith w eigh t alon econ trib u ting to an R2 of 0 .56 .


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24 4 MI F F L I N ET A LT A B L E 2Pearson correlation coe f f ic ien ts f o r re sting en ergy ex pend itu re (R EE ) and o th er pred ic t ive variables*P re dic tiv e v ariab le R EE W eigh t H e igh t A ge Percen t IB W B M I W HR S exW o m e n (n = 244 )

We i g h t 0 . 7 1 0 8 3Heigh t 0 .402 7 1 0 .34 905A ge -0 .35181 -0 .0 6073 -0 .1 7486% IB W 0.57979 0 .9 1331 -0 .0 4760 0 .01133B M 1 0.57489 0 .90 743 -0 .0627 6 0 .0109 5 0 .99910W HR 0.24627 0 .4 5641 -0 .0 3809 0 .31701 0 .5 0423 0 .5 0575%FFM 0 .5 9470 0 .76 208 0 .4 9363 -0 .176 97 0 .59 925 0 .59 137 0 .254 54

Me n ( n = 238)We i g h t 0 . 5 2 8 7 0H eigh t 0 .4 3560 0 .41604A ge -0 .33944 -0 .0656 5 -0 .2 15 75% IB W 0.33732 0 .86245 -0 .0 805 1 0 .0509 7B M I 0 .33 1 34 0 .8 56 40 -0 .09 24 3 0 .0 55 03 0 .99 984W HR 0.06555 0 .38897 -0 .09398 0 .47639 0 .4 7976 0 .48101%FFM 0 .6 6389 0 .80618 0 .575 49 -0 .36 844 0 .56 547 0 .55710 0 .11 261

To ta l (n = 482)W eigh t 0 .72607He igh t 0 .68669 0 .59922A ge -0 .2 6104 -0 .0 5172 -0 .12933% IB W 0.35497 0 .77152 -0 .02699 0 .0 2799 0 .01964B M I 0 .41390 0 .81459 0 .039 56 0 .03 014 0 .993 93 0 .12260WHR 0 . 5 4 5 9 9 0 . 6 2 5 7 9 0 . 5 1 2 2 3 0 . 2 6 6 6 9 0 . 3 4 7 8 0 0 . 4 2 2 4 0 0 . 7 3 7 16%F FM 0 . 8 0 2 3 1 0 . 7 9 4 8 0 0 . 8 1 3 7 1 - 0 . 1 5 2 8 5 0 . 3 2 4 9 4 0 . 4 0 5 4 1 0 . 6 7 9 4 9 0 . 8 3 3 33S IB W , id eal bod y w e ig h t; B M I, b ody m ass in dex ; and W H R, w aist- to -h ip ratio .

T he add ition o f % IB W , age , and sex increased the corre latio nto R2 = 0 .7 1 . H ow ev er, w e f elt th at loo k ing up % IB W in a tab lerequ ired an add itio nal step th at p hy sicians m igh t n o t ro u tine lyd o . A lso , because % IB W is d ependen t o n w e ig h t, he igh t, andage w e f e lt that a m o re accu rate estim ate o f R EE w ould resu lti f th e se v ariab les w ere m easured d irec tly . A n equatio n that ex -clu ded % IB W w as deriv ed and its pred ictiv e v alue equalled thato f equatio ns con tain ing FFM and % IB W . T h is new equatio ncou ld b e easie r to use because on ly v ariab le s th at are ro u tine lym easured in the ph y sic ian s o f f ic e are inc lud ed .

Eq uatio n 3 pred ic ts R EE f or bo th m en and w om en in ourpo pu latio n , w ith the inc luded v ariab le s accoun ting f o r 7 1% ofthe o bserv ed v ariab ility in R EE (ie, R2 = 0 .71 ) .R EE = 9 .99 x we ig h t + 6 .25 X h e ig h t - 4 .92 X ag e

+ 1 66 X sex (m ale s , 1 ; f em ales , 0 ) - 1 6 1 (3)A ddition o f quad ratic and /or in teractiv e -v ariab le com bin a-tion s d id no t im prov e the R2 o f th is equation . In f act, th e R2v alu e o f -P0 .70 seem ed to be a barrie r abov e w hich w e cou ldno t m are accurately pred ict R EE , regard le ss o f th e com bina-tion o f the selected v ariab le s or the sub se t o f th e p opu latio nanaly z ed . T h is w ou ld lead one to conc lud e that there is a v an -ab ilit y o f 30% in R EE that canno t b e ex p lained on th e basiso f th e v ariab le s assessed in th is stud y . T h is m ay b e due to m d i-v idu al d if f e rences in gene tically de te rm ined or acqu ired m e ta-bo lic ef f ic iency , w hich m erit f u rther in v estigation .

T he e f f ec ts o f sex and obesity on R EE w ere ex ten siv e ly cx -p laned b y analy z ing m en and w om en , and norm al w e ig h t(< 120% IB W ) and ov erw eig h t ( l20% IB W ) ind iv idu als sepa-

rate ly . T he relation sh ip (sim ple regres sions ) and form u las be -tw e e n R EE and FFM are show n in Fig ure 1 and th e relation -sh ip b etw een R EE and w eig h t is show n in Figure 2 . N o s ign if i-can t d if f e ren ces w ere ob serv ed be tw een the s im ple regressionlines f or FFM in m en and w om en w ith in the range o f v aluesstud ied .

For m ales, R EE = 2 2 .5 X FFM + 20 9 (R 2 = 0 .44)Fo r f em ales, R EE = 20 .8 X FFM + 369 (R 2 = 0 .36)

S ign if ican t d if f e rences w ere observ ed b etw een the s lopes o f thesim p le regression lines fo r R EE and w eig h t in each w e igh t cate -gory altho ugh th is m ay b e partially ex p lained by th e se lectio no f l20% IB W as an arb itrary re f e rence po in t. T he slo pe o f theregression line s f or all m ales v s all f em ales w as no t sign if ican tlyd if f e ren t f o r R EE v s w eig h t.

Fo r m ales, R EE = 12 .3 X w e igh t + 70 4 (R 2 = 0 .36)Fo r f em ales, R EE = 10 .9 X w e igh t + 586 (R 2 = 0.50)

W ith these b as ic re latio nsh ips in m ind , w e proceeded wi ths tepwise m ultip le -reg ressio n analy ses o f subsets o f th e p opu la-tio n based on sex and % IB W . T h is ex tens iv e pro cess d id n o trev eal any re lationsh ips o r equatio ns surpassing the pred ictiv ev alue o f equatio n 3 , w h ich w as deriv ed f rom the en tire p opu la-tio n . For ex am ple , equation s 4 and 5 , be low , d eriv ed fo r m enand w om en separate ly do no t im prov e the R2 o f O.71 ob tain edin equation 1 . For th at m atte r, th e R2 o f 0 .68 ob tained w henth e v ariab le sex is om itted (E q 6) is also a v ery good pred icto ro f R EE .


5/7

PR ED ICT IN G R ES T IN G EN ER G Y EX PEN D IT UR E 2452850 .00

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1 5 0 2 . 5 0 S S S 5 5 2 S S *S *2 SS * .: ,3 ._ v _ # { 2 4 8 }: l . # { 1 4 9 } # {1 4 9 } 2 *5 55 5 2 5 *5

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S 5 5 59 2 5 .0 0 # { 1 4 9 } I I l1 1 1 1 1 1 1 I i i I

3 5 . 0 0 4 1 . 0 0 4 7 . 0 0 5 3 .0 0 5 9 .0 0 6 5 .0 0 7 1 .0 0 7 7 . 0 0 8 3 . 0 0 8 9 .0 0 9 5 .0 0

FIG 1 . C o rre la t io n b e tw e e n R EE a n d FFM fo r m e n (n = 2 3 8 ; d a s h e d lin e ) a n d w o m e n (n = 2 4 5 ; s o lid lin e ). Fo rm e n , R EE = 2 2 .5 X FFM + 2 0 9 ; fo r w o m e n , R EE = 2 0 .8 X FFM +3 6 0 .

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FIG 2 . C orre lation be tw een R EE and w e ig h t f o r m en (n = 25 1 ; dashed lin e) an d w om en (n = 2 47; so lid l ine ). Form en , R EE = 12 .3 x w eigh t + 704 ; f or w om en , R EE = 10 .0 X w eigh t + 586 . N um erals in g raph ind icate num ber o fv alu es at that p o in t.


6/7

24 6 MIFFL IN ET A LT A B L E 3Compar isons o fm easured R EE an d R EE estim ated by d if feren t p red ic tiv e equa t ion s , wi th an d wi th ou t lean bo dy m ass (L B M ), in sub jects o f th eR E N O D ie t-H eart S tudy

M easured M S JE t O w en( l4 , 15 ) HB E(I0 ) C unn in gham (l2 )kca l /d

R EE w itho u t L B MMaIes(n=251) 1 7 7 6 2 9 7 1 7 7 5 1 9 2 1 7 7 1 1 4 7 l 8 6 I 2 4 9 -Fc ma l c s ( n= 2 4 7 ) 1 3 4 9 2 1 4 1 3 4 8 1 7 9 l 2 9 9 l Ol f 1 4 b 7 l 5 8 t -

R EE w ith L B MMa l e s ( n = 2 3 8 ) 1 7 5 7 2 8 0 - - - 2 0 1 5 b 8 2 fFem ales(n=245 ) 1347214 - - - l534135 t5SD .t M uf f in -S t Jeor E quation s , th is study .:1 S ig nif ic an tly d if fe re nt from measured R EE , p < 0 .01 .

For m ales separate ly , R EE = 9 .98 X w e igh t- 5 .41 X age + 7 .94 x he igh t - 27 3 (R 2 = 0 .4 7) (4 )

For f em ales separate ly , R EE = 9 .9 1 X w eig h t- 4 .38 x age + 4 .2 6 x he igh t + 149 (F? 0 .62 ) (5 )

For all w ithou t sex , R EE = 10 .5 2 X w eig h t- l2 .b 8X he ig h t-4 .32X age - 116 0 (R 2=O .6 8 ) (6 )

In th e in te rest o f practicality , o ne equatio n m ay be b ette rth an tw o and , in ligh t o f th e fav o rab le streng th -o f -f it com pari-so n abo v e , equatio n 6 m ay be p re f e rab le to the separateequatio ns f or m ales and f em ales. If th e m ost accurate p red ic -tio n o f R EE is requ ired , s ep arate eq uations f or males and f e -m ales shou ld be u sed . T he sex (ma le s , 1; f em ales, 0 ) and con-stan t term s m ay be com bin ed in equation I to sim plif y it f u r-th er and y ield d if f e ren t co nstan ts f or m ales and f em ales .

W e propose the fo llow ing M uf f in -S t ico n Equations(MS JEs ) f o r f em ales and m ales:Fo r f em ales, R EE = 9 .99 X we ig h t

Fo r males , R EE = 9 .99 X we ig h t+ 6 .25 X he igh t - 4 .9 2 x ag e - 16 1

+6.25Xhe igh t-4 .92X age+5Fu rther sim p lif ication w ith round ing o f f o f num bers d id n o taf fec t th e ov erall p red ic tab ility (r = 1 .0 ) and the fo llow ing f or-mu la s m ay encourage the u se o f th e f orm ulas.Fan f em ales, R EE = 10 X w eigh t (k g )

+6.25X he igh t(cm )-S X age(y )- 161 (7 )Fo r m ales, R EE = 10 X we i g h t ( k g )

Discussion

+ 6 .25 x he igh t (cm ) - 5 X age (y ) + 5 (8)

T ab le 3 ou tlines com parisons o f R EE as measured in ou rpopu la t ion (n = 498), w ith estim ates f rom the M S JE S , the on ig i-nab H B E dev e loped in 1919 , (10 ) th e new er equation s dev e l-o ped m are recen tly by O w en e t al (1 4 , 15) , an d th e 1980

equ ation s that u se L B M , dev e loped by C unn ingham (12). A sexpec ted , our equations are the best predictors o f R EE in oursub jec t s , w ith th ose m os t recently d eriv ed by O w en e t al h av ingthe nex t least m ean d if f e rence f rom m easured R EE (-4% inf ema l e s an d 0 .1% in mates) . A l t ho u g h th e O w en equatio ns th atu se on ly w eigh t are sim p le r th an the sim p lif ied M S JE (7 and8), w h ich use w eigh t, he igh t, and age , they m ay be le ss accuratein pred ic ting v alues f o r in d iv id uals at th e ex trem es in age (2 0and 60+ y ) and d if f e ring body com position (L B M , p ercen t f at)and w e igh t (% IB W , B M I). Fu rth er stu d ie s are b ein g conduc tedto assess th ese d if f erences in o ur popu lation by use o f M S JE sth at also just use w eigh t (2 ) o r FFM (1 ), re spec tiv e ly . B o th theH B E ( +5%) and C unn ingham equations (14-15% ) s ign i f i -can tly ov erp red ic ted R EE in o ur popu lation (by paired t testson ind iv idual m eans, p < 0 .01) , w ith the C unn ingham equa-t ion based on L B M y ie ld in g th e greate st d if f erences f rom m ea-sured R EE in bo th m ales and f em ales.

T he HB E has b ee n re po nte d(l l- l5 ) to ov erpred ict m easu redR EE by an av erage o f 15 % in modern popu latio ns. T h is oh -servation m ay be ex p lained b y a com parison o f th e orig in alHarr is -Bened ic t (HB)samp le w ith our ow n su bje ct p op ulatio n.T here are m ark ed d if f e rences be tw een m eans f o r w e igh ts andages. T he m ean w e igh ts in the HB group (m ales , 64 .1 10 .3k g and f em ales, 56 .5 1 1.5 k g) w ere m uch low er than theywere in ou r study (m ales , 8 7 .5 14 .4 k g and f em ales, 70 .2 14 .1 k g) . A dd itionally , th e m ean ag es f or th e HB group w eresignificantly bow er(2 7 9 and 31 14 y f or m ales and f em ales,re spec t iv e ly ) than the av erag e age o f 4 4 14 y f ar m ales andf em ales in ou r study . T h is m ay also partially ex p lain d if f e rencesin the o v erall equation s. O ur popu latio n inc lud ed m en andw o m e n w ith w e igh ts rang ing across a fu l l spectrum f rom lowto h igh and w ith ag es rang in g f rom th e 20 to 60+ y . O n th eo ther h and , th e H B popu lation w as ob v iou sly qu ite lean andd id no t rep resen t the f u ll age sp ec trum o f th e U S adu lt po pu la-tion , w h ich ren ders it som ew hat lim ited f or use tod ay .

In sum m ary , th e re latio nsh ips be tw een R EE and sev eralvariables we re s tud ied to deriv e p red ic tiv e equations f or practi-cal, c lin ical u se in w e igh t m anagem en t to day . T he resu lt o f th isprocess w as to con f irm that R EE is de term in ed large ly by FFM(E q 1) b u t is h ig h ly corre lated w ith to tal body w eigh t as w ell(E q 2). T he add ition o f o ther rou tin ely av ailab le v alues (h e igh t,ag e, and sex ) bu ilds on the pred ictiv e v alue o f w e ig h t in d ete r-


7/7

PRED1C f l NG R ES T IN G EN ER G Y EX PEN D IT U R E 24 7m in ing R EE . T h e add ition o fo ther measures o f bod y com posi-tion ( B M I and % IB W ) and bod y -w eig h t d is trib u tio n ( W H R )do no t con trib u te sig n if ican tly to th e de term in atio n o f R EE .W e be liev e that the M S JE S m ore accurate ly p red ic t R EE inh ealthy norm al-w e igh t and m oderate ly ov erw e igh t m en andw om en th an do o ther eq uations. A dd ition ally , th e p rac ticalityo f the M S JES in an o f f ice se tting is en hanced b ecause they u secom m on ly av ailab le in f o rm atio n . Eq uatio n s 7 and 8 m ay ap -pear som ew hat b urdensom e bu t the ir sim plic ity and use o fcom m on, round ed -o f f f acto rs (w ith on ly th e cons tan t f o r f e-males and m ales chang ing) m ay enhan ce th eir app lication .Furtherm ore , th ey are m ore app licab le to today s U S popu la-tio n than the w ide ly u sed H B E , d eriv ed in 1919 . Further s tud-ie s are needed to m ore accu rate ly predict the en ergy requ ire -m en ts o f the obese popu la t ion .

O u r equation s are lim ited to the ir deriv ation f rom ou r stud ypopu latio n . A lth ough th eir p red ic tiv e v alue com pares fav o r-ab ly w ith o ther equation s app lied to ou r data set, the ir c lin icalu tility can on ly b e assessed b y testin g in o ther popu lation s.T he ir streng th and s ign if ican ce lie in 1) the ir deriv atio n f rom alarger, m odern -d ay popu lation (s tratif ied f o r ag e, w e igh t, an dse x ) , 2) the use o f adv an ced equ ipm en t and techno log y fo r th em easurem en t o f ac tu al R EE , and 3) a reasonab ly h igh co rrela-tio n be tw een R EE and w e igh t, h eig h t, an d age (R 2 = 0 .71) .A l s o , because th e m ean % IB W o four sam p le w as n ear 120%(m ean B M I o f 26 fo r w om en and 27 f o r m en ), an equatio nw e igh ted tow ard th is m ean m ay b e v ery use fu l in assessing cab -ric needs in a larg e subset o f the U S po pu latio n w here b o thw eigh t and he igh t hav e b een con tinu ing to ris e [m ean B M I 22-27 f o r w om en and 24 -26 f o r m en as repo rted by sev en popu la-tio n stu d ie s (2 2)1 . T ho se w ho respond best to d ietary and ex er-c isc m od if icatio n s (5 , 2 3 ) are in th is m ild ly -m oderately -obesecateg ory (ie, < 8 0% IBW ) .

T h e lim itatio ns o fany pred ic tiv e eq uation f or R EE m ust alsob e cons idered . D irec t m etabo lic m easu rem en ts are preferablein ind iv id uals w he re a p rec ise de te rm ination o f R EE is m di-cated. In add ition , th e o ther com pon en ts o f 24 -E E (PA andT EF) sh ou ld be s tud ied to assess m ore accurate ly the ind iv id -ual to tal d aily caloric requ irem en ts. Finally , the 30 % un e x -p lained v ariab ility in R EE ob serv ed in o ur study shou ld bestu d ied fu rther to de te rm in e th e e f f ect o n R EE of such f acto rsas PA , w eig h t-g ain and w e igh t-f luc tuation patterns, eatin g pat-terns, and d ietary com po sition , as w e ll as the in d iv id uals d e-gree o fo besity or w e igh t s tatu s.

W e w ish to ack now ledge the support an d sp irit o f the en tire researchp ro ject team , w itho u t w hose coop eration th is study w ou ld hav e b eenim po ss ib le . S pec ial thanks are ex tend ed to Jo an B u nk e tt, w ho se handw ork and inno v ativ e com pu te r sk ills hav e m ad e it po ss ib le to trans f o rmdata in to research reports . S tep hen French w as k ey to o ur successf u lm easurem en t by h is train ing o f ou r staf f and h is com m itm en t to h igh -quality re search in m e th odo log y and data an aly s is. T he w ork o f K n isM cD on ald , a n u trition stud en t, is also ack now ledged in the ted iousrev is ion o f the m anuscrip t. Finally , g ratitude is ex tended to A lan D y er,N orthw este rn U niv ers ity M ed ical S choo l, f o r h is statis tical exper t i s eand gu id an ce fo r the en tire R EN O D ie t-H eart S tudy and h is inpu t in toth is stu dy .

Re fe rencesI. M etropo litan L if e Foun dation . N ew w eigh t S tan dards f o r m en an d

w om en . S tat B ull M etrop o l L if e In su rC o l959;40:l-4.2 . Form an M R, T row brid ge FL , G en try EM , e t aL O verw eigh t adu lts

in the U nited S tate s : the b ehav io ral risk f ac ton surv ey s. A m J C linN u tr b 98 6;4 4:4 10 -6 .

3 . C on sen sus D ev e lopm en t Pane l, N ational In stitu te s o f H ealth .H e al th im p li cat io ns o f ob esity . B eth esda, M D: U S D epartm en t o fHealth and H um an S erv ice s, 198 5 .

4 . L ew EA , G arf ink e l L V aria t ions in m o rtality b y we i g h t among75 0 ,0 00 m en and w om en . JC hron ic D is 1 9 7 9; 3 2 :5 6 3 -7 6 .

5 . B ray G A . O besity and the heart. M od Concep ts Cand iov asc D is1 98 7; 5 6: 6 7- 7 I .

6 . L ap idus L , Beng ts son C , L arsso n B , C t al. Distribution o f ad ip os etis sue and risk o f card io v ascu lard isease and death : a 12 year fo l lowup o f participants in th e popu la t ion study o f w om en in G oth en -b ur g , S we d e n. Br Me dJ l 9 84 ; 28 9 : l 2 5 7- 6 b .

7 . R av u ssin E , B urnan d B , S chu tz Y , Jequ ie r E . T w en ty -f ou r ho urenergyexpend i tune a nd n e st in g m e t ab o li c rate in o be se , m o de rate lyo bese and con tro l sub jec ts. A m J G in N utr l9 82;3 5:566-73 .

8 . Jequ ie r E , S chu tz Y . L ong -term measuremen ts o fenergy ex pend i-tu ne in hum ans usin g a resp iration cham ber. A m J C lm N utr1983;38:989-98 .

9 . C om m ittee on Dietary A l l owa n c e s , Food an d N u trition B oard ,Na t iona l Research C ouncil . R ecom mended d ie tary alb ow an ce &9 th ed . W ash ing ton , D C : N atio nal A cadem y Press, 19 80 .

1 0. H arris JA , B en ed ict FG . A b iom et r ic s tudy o fbasa l m etabo lism inm an . W ash ing to n , D C : C arneg ie In stitu tion o fW ash in gton , 1919 .(Carneg ie Ins titu te o fW ash ing ton p ub lication 279 .)

1 1. D aly JM , H ey m sf ie ld S B , Head CA , C t ab. H um an ener gy r equir e-men t s : overest ima tion by w idely used pr ediction equation. A m JClin N utr l985 ;4 2 :l 170 -4 .

1 2 . C unn ing ham JJ. A reanaly s is o f the factors inf luencing basal m ets-b o lic rate in n orm al adu lts. A m J C lin N u tn 1980 ; 33:2372-4 .

1 3 . C u nn ingh am JJ. B o dy com pos ition and res ting m e tabo lic rate : them y th o f f em in ine m e tabo lism . A m J Cm N utr 1 982 ; 36 :721 -6 .14 . O w en O E , K av le E , O w en R S . A reappraisal o f calo ric requ ire -m en ts in health y w om en . A m J C lin N uts 1 986 ;44 :l-l9 .

1 5 . O w en OE , H o lup JL , D A les sio , D A . A reappraisal o f the calo ricrequ irem en ts o fm en . A m J C lin N utr 1987 ;4 6 :875 -8 5 .

1 6 . d e B oerJO , v an E s A JH , R oov ers L CA , e t al. A dap tation o f en ergyme tabo l i sm o f ov erw e ig h t w om en to low -energ y in tak e, stud iedw ith w ho le body calorimeters. A m J (In N u t r l 98 6;4 4 :5 8 5- 95 .

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a new predictive equation for resting energy expenditure in healthy individualsı

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