Ravelli Michele Novaes, Schoeller Dale A, Crisp Alex Harley, Racine Natalie M, Pfrimer Karina, Rasera Junior Irineu, Oliveira Maria Rita Marques de
School of Pharmaceutical Sciences, São Paulo State University (Unesp), Rodovia Araraquara Jaú, Km 01, s/n. Bairro: Campos Ville, CEP: 14800-903, Araraquara, SP, Brazil.
Biotechnology Center, University of Wisconsin-Madison, USA, 425 Henry Mall Street, Madison, WI 53706, United State of America.
Clin Nutr ESPEN. 2018 Aug;26:57-65. doi: 10.1016/j.clnesp.2018.04.013. Epub 2018 May 3.
Predictive equations remain the clinical tool of choice to estimate the energy expenditure, however, poor accuracy has been found when applied in patients with severe obesity. The aim of this study was to test the accuracy of the total energy expenditure (TEE) those obtained by predictive equations of resting energy expenditure (REE) times individual estimates of metabolic equivalents (MET), taking as reference the TEE measured by doubly labeled water (DLW), before, six and twelve months after bariatric surgery.
Twenty class III obese women (age: 29.4 ± 5.1 years; BMI: 44.9 ± 2.5 kg/m), approved for Roux-en-Y gastric bypass participated in this study. TEE and body composition was measured after administration of a fixed dose of DLW. Predictive equations of REE were selected: Dietary Reference Intake (DRI), World Health Organization, Oxford, Harris-Benedict, Mifflin, De Lorenzo, Lazzer and Muller and their collaborators. The MET values were obtained individually by triaxial accelerometer.
The patients showed 65% of excess weight loss. The body fat mass decreased 17% after 1 year of surgery. TEE (2930 ± 525 kcal.day) decreased by 20% (p < 0.05) by the sixth postoperative month (2319 ± 430 kcal.day), increasing 10% by the twelfth month (2538 ± 336 kcal.day). The Harris and Benedict (accuracy: 65%) and DRI equations (accuracy: 60%) yielded better results in the prediction of TEE values at pre-surgery. In the sixth month after surgery, only the equation of Harris and Benedict kept accuracy above 50%. At twelve months post-surgery, only the equation of Lazzer et al. considering body composition showed better prediction (accuracy: 50%) in this period.
None of the prediction equations tested was accurate for estimating TEE for the 3 periods evaluated; however, while there are no reports of specific equations for class III obese women, the Harris and Benedict x MET and DRI equations, can describe the TEE with acceptable accuracy. After surgery, the best equation to be used will depend if the patient has been treated for weight loss and in which post-treatment period it is used. Registration of clinical trial as an observational study in Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.
预测方程仍是估算能量消耗的首选临床工具，然而，在重度肥胖患者中应用时发现其准确性较差。本研究的目的是，以双标记水（DLW）测量的总能量消耗（TEE）为参照，测试通过静息能量消耗（REE）预测方程乘以个体代谢当量（MET）估算值所得出的TEE在减肥手术前、术后6个月和12个月时的准确性。
20名经批准接受Roux-en-Y胃旁路手术的III级肥胖女性（年龄：29.4±5.1岁；体重指数：44.9±2.5kg/m²）参与了本研究。在给予固定剂量的DLW后测量TEE和身体成分。选择了REE的预测方程：膳食参考摄入量（DRI）、世界卫生组织、牛津方程、哈里斯-本尼迪克特方程、米夫林方程、德洛伦佐方程、拉泽尔方程以及穆勒及其合作者的方程。MET值通过三轴加速度计单独获取。
患者体重减轻了65%。术后1年身体脂肪量减少了17%。TEE（2930±525千卡/天）在术后第6个月降至2319±430千卡/天，下降了20%（p<0.05），到第12个月增加了10%（2538±336千卡/天）。哈里斯和本尼迪克特方程（准确性：65%）以及DRI方程（准确性：60%）在术前预测TEE值时效果较好。术后第6个月，只有哈里斯和本尼迪克特方程的准确性保持在50%以上。术后12个月，在此期间只有考虑身体成分的拉泽尔等人的方程显示出较好的预测效果（准确性：50%）。
在所测试的预测方程中，没有一个能准确估算所评估的3个时间段的TEE；然而，虽然没有针对III级肥胖女性的特定方程的报告，但哈里斯和本尼迪克特×MET方程以及DRI方程能够以可接受的准确性描述TEE。手术后，要使用的最佳方程将取决于患者是否接受了减肥治疗以及处于治疗后的哪个阶段。作为观察性研究在巴西临床试验注册中心注册的临床试验：RBR-8k5jsj。通用试验编号：U1111-1206-0858。
