Comparison of Measured and Estimated Resting Energy Expenditure in Adolescents and Young Adults With Severe Obesity Before and 1 Year After Sleeve Gastrectomy

Frances A Rickard; Landy P Torre Flores; Sonali Malhotra; Alexander T Toth; Abeer Bader; Fatima Cody Stanford; Hang Lee; Miriam A Bredella; Madhusmita Misra; Vibha Singhal

doi:10.3389/fped.2019.00037

Comparison of Measured and Estimated Resting Energy Expenditure in Adolescents and Young Adults With Severe Obesity Before and 1 Year After Sleeve Gastrectomy

Front Pediatr. 2019 Feb 19:7:37. doi: 10.3389/fped.2019.00037. eCollection 2019.

Authors

Frances A Rickard^{1

2}, Landy P Torre Flores², Sonali Malhotra³, Alexander T Toth², Abeer Bader⁴, Fatima Cody Stanford^{2

4}, Hang Lee⁵, Miriam A Bredella⁶, Madhusmita Misra^{2

3}, Vibha Singhal^{2

3

4}

Affiliations

¹ Melbourne School of Medicine, University of Melbourne, Melbourne, VIC, Australia.
² Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
³ Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
⁴ MGH Weight Center and Harvard Medical School, Boston, MA, United States.
⁵ Biostatistics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
⁶ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

Abstract

Introduction: 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). Materials and Methods: Cross-sectional study (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. Longitudinal study: 12 subjects had repeat indirect calorimetry and DXA 1 year after SG. Longitudinal analysis was used to assess changes in REE and body composition. Results: CSS: Median BMI was 45.2 kg/m² 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. Longitudinal Study: In the subset that underwent SG, after 12-months, absolute REE decreased from 1709 (1567.7-2234) to 1580.5 (1326-1862.5) Calories (p = 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 (p = 0.043). When evaluating parameters affecting % total weight loss, we found that it correlated positively with REE/TBW at 12 months (R = 0.625; p = 0.03) and negatively with % fat mass at 12 months (R = -0.669; p = 0.024). Discussion: 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.

Keywords: adolescents; calorimetry; equation; obesity; resting energy expenditure; sleeve gastrectomy.

Abstract

Grants and funding