Tamini Sofia, Cicolini Sabrina, Caroli Diana, Sartorio Alessandro
Istituto Auxologico Italiano, Experimental Laboratory for Auxo-Endocrinological Research, Verbania and Milan, Italy.
Istituto Auxologico Italiano, Division of Auxology and Metabolic Diseases, Verbania, Italy.
Front Nutr. 2021 May 12;8:678788. doi: 10.3389/fnut.2021.678788. eCollection 2021.
In the obese population, the prescription of a proper diet plan is essential to ensure an appropriate and gradual weight loss, reduce the risk of weight cycling and favor an overall improvement of health conditions. Energy needs are commonly estimated using predictive equations, even if their accuracy is still debated, especially in severely obese subjects. In the present study, 850 severely obese females admitted to our hospital for a multidisciplinary body weight reduction program (BWRP) were divided into three subgroups, "hypo-," "normo-," and "hyper-metabolic," based on the comparison between estimated resting energy expenditure (eREE, using the Mifflin equation) and measured REE (mREE, using indirect calorimetry). The majority of this study population was considered normo-metabolic (59.4%, mREE between 90 and 110% of eREE), 32.6% was hyper-metabolic (mREE > 110% of eREE) and only 8% was hypo-metabolic (mREE < 90% of eREE). The three subgroups were evaluated before and after a 3-week BWRP, entailing energy restricted diet, adapted physical activity, psychological counseling and nutritional education. Since the diet plan during the BWRP consisted of a 30% reduction of total energy expenditure (obtained by multiplying mREE by the physical activity level), each subgroup responded positively to the BWRP independently from the difference between mREE and eREE, the extent of BMI reduction and clinical, metabolic and physical amelioration being comparable among the three subgroups. By contrast, the restriction of the energy intake based on eREE during the BWRP would have determined a slighter caloric restriction in the hypo-metabolic subgroup, thus determining a smaller body weight reduction, and, by contrast, a more marked caloric restriction in the hyper-metabolic subgroup, probably difficult to be tolerated and maintained for prolonged period. In conclusion, the percentage of subjects with "slow metabolism" in a Caucasian female obese population seeking hospitalization for a BWRP is actually lower than expected, finding controverting the common notion that obesity is mostly due to reduced REE. The high percentage (40%) of inadequate eREE in these female obese populations further underlines the absolute need to include the measurement of REE in the clinical practice for the correct prescription of energy intake in severely obese populations.
在肥胖人群中，制定合理的饮食计划对于确保适度且逐步的体重减轻、降低体重波动风险以及促进健康状况的整体改善至关重要。能量需求通常使用预测方程来估算，即便其准确性仍存在争议，尤其是在重度肥胖个体中。在本研究中，850名因多学科体重减轻计划（BWRP）入住我院的重度肥胖女性被分为三个亚组，即“低代谢”“正常代谢”和“高代谢”亚组，分组依据是估算静息能量消耗（eREE，使用米夫林方程）与实测静息能量消耗（mREE，使用间接测热法）的比较。该研究人群中的大多数被认为是正常代谢（59.4%，mREE在eREE的90%至110%之间），32.6%是高代谢（mREE > eREE的110%），只有8%是低代谢（mREE < eREE的90%）。这三个亚组在为期3周的BWRP前后接受了评估，该计划包括能量限制饮食、适应性体育活动、心理咨询和营养教育。由于BWRP期间的饮食计划包括将总能量消耗降低30%（通过将mREE乘以身体活动水平得出），每个亚组对BWRP均有积极反应，与mREE和eREE之间的差异无关，三个亚组在体重指数降低程度以及临床、代谢和身体改善方面具有可比性。相比之下，BWRP期间基于eREE的能量摄入限制会导致低代谢亚组的热量限制更轻微，从而导致体重减轻幅度更小，而相比之下，高代谢亚组的热量限制更显著，可能难以长期耐受和维持。总之，因BWRP寻求住院治疗的白种女性肥胖人群中“代谢缓慢”的受试者比例实际上低于预期，这一发现与肥胖主要归因于静息能量消耗降低这一普遍观念相矛盾。这些女性肥胖人群中40%的eREE不充足这一高比例进一步凸显了在临床实践中绝对有必要测量静息能量消耗，以便为重度肥胖人群正确开具能量摄入处方。
