Steinberg Alissa, Manlhiot Cedric, Cordeiro Kristina, Chapman Karen, Pencharz Paul B, McCrindle Brian W, Hamilton Jill K
Division of Endocrinology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Division of Cardiology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Clin Nutr. 2017 Aug;36(4):1158-1164. doi: 10.1016/j.clnu.2016.08.006. Epub 2016 Aug 13.
BACKGROUND & AIMS: Severe obesity in children and adolescents is now a serious global health concern. Accurate measurements of resting energy expenditure (REE) is a key foundation for successful obesity treatment. Clinical dietitians rely heavily on measured or calculated REE to tailor dietary interventions. Indirect calorimetry (IC) is the gold standard for measuring REE. However, predictive resting energy expenditure (PREE) equations are commonly used when IC is unavailable due to cost or practicality. PREE equations differ based on variables such as age, gender, weight, and height and selecting the most accurate PREE for an individual is crucial to avoid over or underestimation of energy requirements. Published studies investigating the accuracy of PREE equations in obese children and adolescents have reported inconsistent findings, which likely result from heterogeneity in the patient populations studied. Accordingly, this study aimed to (a) assess the accuracy of the published PREE equations in a group of severely obese (SO) adolescents using IC measurement, and (b) determine if there is a BMI threshold at which the PREE equations become less accurate.
SO adolescents were studied using IC. REE was calculated using nine commonly used PREE equations. Generalized linear regression equations were used to compare absolute and relative differences between calculated and measured REE (MREE) for each PREE equation. Accuracy was calculated as the percentage of subjects with PREE values within 10 percent of MREE.
226 SO adolescents (mean ± SD age: 15.9 ± 1.9 years; weight: 126.9 ± 24.5 kg; BMI: 44.9 ± 8.1 kg/m) participated. Mean MREE was 2163 ± 443 kcal/d. PREE calculated by the Mifflin equation was the only equation without a statistically significant bias compared to MREE (mean bias of -23 ± 307 kcal/d; p = 0.26). Mifflin was also the most accurate with 61% of individuals within ±10% of MREE. PREE equations accuracy was not associated with degree of BMI elevation (31-69 kg/m).
In adolescents with severe obesity, the Mifflin equation best predicts REE. This should be the equation applied when using PREE to optimize nutritional care in this population.
儿童和青少年的重度肥胖现已成为一个严重的全球健康问题。准确测量静息能量消耗（REE）是成功治疗肥胖症的关键基础。临床营养师在很大程度上依赖测量或计算得出的REE来制定饮食干预措施。间接测热法（IC）是测量REE的金标准。然而，当由于成本或实用性原因无法使用IC时，通常会使用预测静息能量消耗（PREE）方程。PREE方程因年龄、性别、体重和身高变量而异，为个体选择最准确的PREE对于避免能量需求的高估或低估至关重要。已发表的关于肥胖儿童和青少年中PREE方程准确性的研究报告结果不一致，这可能是由于所研究患者群体的异质性所致。因此，本研究旨在（a）使用IC测量评估一组重度肥胖（SO）青少年中已发表的PREE方程的准确性，以及（b）确定是否存在一个BMI阈值，超过该阈值PREE方程的准确性会降低。
对SO青少年使用IC进行研究。使用九个常用的PREE方程计算REE。使用广义线性回归方程比较每个PREE方程计算得出的REE与测量的REE（MREE）之间的绝对差异和相对差异。准确性计算为PREE值在MREE的10%以内的受试者百分比。
226名SO青少年（平均±标准差年龄：15.9±1.9岁；体重：126.9±24.5千克；BMI：44.9±8.1千克/平方米）参与了研究。平均MREE为2163±443千卡/天。与MREE相比，由米夫林方程计算得出的PREE是唯一没有统计学显著偏差的方程（平均偏差为-23±307千卡/天；p = 0.26）。米夫林方程也是最准确的，61%的个体PREE值在MREE的±10%以内。PREE方程的准确性与BMI升高程度（31 - 69千克/平方米）无关。
在重度肥胖青少年中，米夫林方程能最好地预测REE。在该人群中使用PREE优化营养护理时应应用此方程。
