Resting metabolic rate in old-old women with and without frailty: variability and estimation of energy requirements.

OBJECTIVES

To measure resting metabolic rate (RMR) in old-old adults living in the community and examine the association between measured RMR and frailty status and compare it with expected RMR generated by a predictive equation.

DESIGN

Physiological substudy conducted as a home visit within an observational cohort study.

SETTING

Baltimore City and County, Maryland.

PARTICIPANTS

Seventy-seven women aged 83 to 93 enrolled in the Women's Health and Aging Study II.

MEASUREMENTS

Resting metabolic rate with indirect calorimetry, frailty status, fat-free mass, ambient and body temperature, expected RMR according to the Mifflin-St. Jeor equation.

RESULTS

Average RMR was 1,119 ± 205 kcal/d (range 595-1,560 kcal/d). Agreement between observed and expected RMR was biased and poor (between-subject coefficient of variation 38.0%, 95% confidence interval = 35.1-40.8). Variability of RMR was greater in frail individuals (heteroscedasticity F-test P = .02). Low and high RMR were associated with being frail (odds ratio 5.4, P = .04) and slower self-selected walking speed (P < .001) after adjustment for covariates.

CONCLUSION

Equations to predict RMR that are not validated in old-old adults appear to correlate poorly with measured RMR. RMR is highly variable in old-old women, with deviations from the mean predicting clinical frailty. These exploratory findings suggest a pathway to clinical frailty through high or low RMR.