Rickard Frances A, Torre Flores Landy P, Malhotra Sonali, Toth Alexander T, Bader Abeer, Stanford Fatima Cody, Lee Hang, Bredella Miriam A, Misra Madhusmita, Singhal Vibha
Melbourne School of Medicine, University of Melbourne, Melbourne, VIC, Australia.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Front Pediatr. 2019 Feb 19;7:37. doi: 10.3389/fped.2019.00037. eCollection 2019.
Resting energy expenditure (REE) is often evaluated in adults and adolescents with obesity to estimate caloric requirements when advising dietary changes. However, data are lacking regarding the accuracy of methods used to clinically assess REE in adolescents with severe obesity. Moreover, there are no data regarding the effects of sleeve gastrectomy (SG) on REE in adolescents. We evaluated the accuracy and error rate between estimated and measured REE in adolescents with severe obesity and changes in REE following (SG). (CSS): 64 adolescents and young adults, 14-22 years old, with moderate to severe obesity were enrolled. We measured REE (mREE) by indirect calorimetry and estimated REE (eREE) using Derumeaux (Deru), Mifflin-St Jeor (MS), Harris Benedict (HB), and World Health Organization (WHO) equations. DXA was used to determine body composition. Bland Altman analysis evaluated agreement between eREE and mREE. : 12 subjects had repeat indirect calorimetry and DXA 1 year after SG. Longitudinal analysis was used to assess changes in REE and body composition. : Median BMI was 45.2 kg/m and median age was 18.0 (16.3-19.9) years. mREE correlated strongly with eREE . Bland Altman analysis demonstrated that only a few points were beyond the 1.96 SD limit of disagreement. However, there was considerable overestimation of mREE by most equations. : In the subset that underwent SG, after 12-months, absolute REE decreased from 1709 (1567.7-2234) to 1580.5 (1326-1862.5) Calories ( = 0.002); however, the ratio of REE/Total Body Weight (TBW) increased from 13.5 ± 2.3 at baseline to 15.5 ± 2.2 at 1 year ( = 0.043). When evaluating parameters affecting % total weight loss, we found that it correlated positively with REE/TBW at 12 months ( = 0.625; = 0.03) and negatively with % fat mass at 12 months ( = -0.669; = 0.024). In adolescents with moderate-severe obesity, despite a correlation between mREE using indirect calorimetry and eREE using the Deru, MS, HB, and WHO equations, there is significant over-estimation of REE at the individual level, challenging their clinical utility. One year after SG, REE/TBW increased and strongly correlated with % total weight loss in adolescents.
静息能量消耗（REE）常用于评估肥胖的成年人和青少年，以便在建议饮食改变时估算热量需求。然而，缺乏关于临床评估重度肥胖青少年REE方法准确性的数据。此外，也没有关于袖状胃切除术（SG）对青少年REE影响的数据。我们评估了重度肥胖青少年估算REE与测量REE之间的准确性和误差率，以及SG后REE的变化情况。（CSS）：纳入了64名14 - 22岁的中度至重度肥胖青少年和青年成人。我们通过间接测热法测量REE（mREE），并使用德鲁莫（Deru）、米夫林 - 圣乔尔（MS）、哈里斯 - 本尼迪克特（HB）和世界卫生组织（WHO）方程估算REE（eREE）。采用双能X线吸收法（DXA）测定身体成分。布兰德 - 奥特曼分析评估eREE与mREE之间的一致性。：12名受试者在SG后1年进行了重复间接测热法和DXA检测。采用纵向分析评估REE和身体成分的变化。：BMI中位数为45.2 kg/m²，年龄中位数为18.0（16.3 - 19.9）岁。mREE与eREE高度相关。布兰德 - 奥特曼分析表明，只有少数点超出了1.96标准差的不一致界限。然而，大多数方程对mREE存在相当程度的高估。：在接受SG的亚组中，12个月后，绝对REE从1709（1567.7 - 2234）千卡降至1580.5（1326 - 1862.5）千卡（P = 0.002）；然而，REE/总体重（TBW）的比值从基线时的13.5±2.3增加到1年后 的15.5±2.2（P = 0.043）。在评估影响总体重减轻百分比的参数时，我们发现它与12个月时的REE/TBW呈正相关（r = 0.625；P = 0.03），与12个月时的脂肪量百分比呈负相关（r = -0.669；P = 0.024）。在中度至重度肥胖的青少年中，尽管间接测热法测得的mREE与使用Deru、MS、HB和WHO方程估算的eREE之间存在相关性，但在个体水平上REE存在显著高估，这对其临床实用性提出了挑战。SG后1年时，青少年的REE/TBW增加，且与总体重减轻百分比密切相关。
