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Comparison of BEE Estimation Equations with Indirect Calorimetry in Goiânia Men, Exercises of Medicine

This study compares the basal energy expenditure (bee) estimated by the harris-benedict, food and agriculture organization and institute of medicine equations with indirect calorimetry in men living in goiânia, brazil. The results show that the food and agriculture organization and harris-benedict equations can overvalue the bee of healthy young men with characteristics similar to those recorded in the study.

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96
Rev Bras Med Esporte – Vol. 19, No 2 – March/April, 2013
Arícia Motta Arantes Lustosa1
Ana Paula Nunes Bento(1)
Fernando Policarpo Barbosa2
Eliane De Abreu Soares3
Estélio Henrique Martin Dantas4
José Fernandes Filho5
1. Nutrition – Goiânia, GO, Brazil.
2. Stricto Sensu Graduation Program in
Health Sciences of the Federal University
of Rio Grande do Norte – Natal, RN, Brazil.
3. State University of Rio de Janeiro –
Rio de Janeiro, RJ, Brazil.
4. Stricto Sensu Graduation Program
in Nursing and Biosciences of the
Federal University of Rio de Janeiro
State - Rio de Janeiro, RJ, Brazil
5. Federal University of Rio de Janeiro
– Rio de Janeiro, RJ, Brazil.
Mailing address:
Av. T-1 n. 2.620-A – S. Bueno
74215-022 – Goiânia, GO, Brasil
E-mail: arícia@terra.com.br
ABSTRACT
Introduction: The Basal Energy Expenditure (BEE) is the amount of energy necessary to the hu-
man body to keep the normal physiological processes and homeostasis. Currently, BEE is calculated
from equations based on the North American and/or European population. Objective: To compare
the Harris-Benedict, Food and Agriculture Organization and Institute of Medicine equations with
indirect calorimetry in men living in Goiânia. Methods: Forty-four male volunteers with average age
of 29.80, standard deviation – SD = 6.21 years; stature 1.79, SD = 0.06m; weight 77.79, SD = 8.49 kg;
BMI 24.30, SD = 1.96 kg/m2; body fat 15.84, SD = 4.49% and waist circumference 80.48, SD = 5.89 cm
were evaluated. BEE was determined by direct gas analyses; therefore, the VO2000 gas analyzer was
used. Results: There was significant difference (p < 0.05) for the BEE estimated by the Harris-Benedict
(1824.66 ± 138.25 kcal/day) and Food and Agriculture Organization (1821.77, SD = 115.39 kcal/day)
equations when compared to the BEE acquired by the indirect calorimetry (1709.81, SD = 329.75
kcal/day). BEE estimated by the IOM/2005 equation (1791.81, SD = 329.74) did not present significant
difference when compared to the measured BEE. Conclusion: The Food and Agriculture Organization
and Harris-Benedict equations can overvalue the BEE of healthy young men with characteristics
similar to those recorded on this work.
Keywords: BEE, indirect calorimetry, equations.
BASAL ENERGY EXPENDITURE IN MEN
LIVING IN GOIÂNIA
Original article
EXERCISE AND SPORTS
MEDICINE CLINIC
INTRODUCTION
The Basal Energy Expenditure (BEE) represents the greatest
part of the daily energetic cost in humans (50 to 70%) and it is
the amount of energy needed for the body to keep the normal
physiological processes and homeostasis. These processes include
the cardiovascular and respiratory at rest, gastrointestinal and
renal functions, the energy used by the central nervous system,
cellular homeostasis as well as the remaining biochemical reactions
involved in the maintenance of the basal metabolism-3.
It is directly influenced by fat-free mass, age, sex, body composi-
tion and genetic factors. Other processes such as the nervous system
activity, the thyroid hormones, the protein turnover and the sodium-po-
tassium pump also contribute to a BEE variation among individuals4-7.
The BEE may be measured by direct or indirect calorimetry,
which is the amount of the energetic cost from the respiratory
exchanges (oxygen consumption and carbon dioxide production),
associated with the oxidation of the main energetic substrates: car-
bohydrates, proteins, lipids and alcohol6.
Many mathematical equations using variables of easy measure-
ment and low cost, such as age, height and total body mass have
been developed for BEE estimation5. Among these equations, we
highlight the ones by Harris and Benedict3, FAO/858 and Institute
of Medicine (IOM)9, all of them widely spread and studied.
The BEE is usually measured in the morning, under ten to 12
hour-fasting, with six to eight hours of sleep, at supine position,
in environment with controlled temperature and humidity, after
15 to 30 minutes of rest. The measurement of the gas exchanges
is obtained in the 20 to 30 subsequent minutes, during which
the individual should remain at supine position, awake and com-
pletely relaxed. The Basal Energy Expenditure (BEE), on the other
hand, is measured in the afternoon, at sitting position, three to
four hours after the last meal, and provides an estimation of the
energetic consumption value (kcal/day) which is from 10% to
20% higher than the BEE5,9,10-12, mainly derived from the Thermal
Effect of the Food (TEF).
Studies conducted by different groups of researchers in many
parts of the world have found variations between the BEE estima-
tion obtained by mathematical equations and the ones determined
by indirect calorimetry. These differences contribute to the quality
loss of diet or physical exercise programs, which may be harmful
to the population’s health. The inadequation of the BEE estima-
tion equations for specific populations, such as the Brazilian and
Australian ones, ends up bringing dissatisfaction and discredit to
the given services besides disturbing their aims, as weight body
composition control9-15.
The aim of this study was to compare the results of the BEE es-
timated by mathematical equations proposed by Harris-Benedict3,
FAO/856 and IOM 20057, with the values determined by indirect calo-
rimetry in young male volunteers, residents of the city of Goiânia.
METHODS
This comparative research16 was approved by the Ethics Com-
mittee of the Castelo Branco University. 44 male volunteers selected
pf3

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Arícia Motta Arantes Lustosa^1 Ana Paula Nunes Bento(1) Fernando Policarpo Barbosa^2 Eliane De Abreu Soares^3 Estélio Henrique Martin Dantas^4 José Fernandes Filho^5

  1. Nutrition – Goiânia, GO, Brazil.
  2. Stricto Sensu Graduation Program in Health Sciences of the Federal University of Rio Grande do Norte – Natal, RN, Brazil.
  3. State University of Rio de Janeiro – Rio de Janeiro, RJ, Brazil.
  4. Stricto Sensu Graduation Program in Nursing and Biosciences of the Federal University of Rio de Janeiro State - Rio de Janeiro, RJ, Brazil
  5. Federal University of Rio de Janeiro
  • Rio de Janeiro, RJ, Brazil.

Mailing address: Av. T-1 n. 2.620-A – S. Bueno 74215-022 – Goiânia, GO, Brasil E-mail: arícia@terra.com.br

ABSTRACT

Introduction: The Basal Energy Expenditure (BEE) is the amount of energy necessary to the hu- man body to keep the normal physiological processes and homeostasis. Currently, BEE is calculated from equations based on the North American and/or European population. Objective: To compare the Harris-Benedict, Food and Agriculture Organization and Institute of Medicine equations with indirect calorimetry in men living in Goiânia. Methods: Forty-four male volunteers with average age of 29.80, standard deviation – SD = 6.21 years; stature 1.79, SD = 0.06m; weight 77.79, SD = 8.49 kg; BMI 24.30, SD = 1.96 kg/m 2 ; body fat 15.84, SD = 4.49% and waist circumference 80.48, SD = 5.89 cm were evaluated. BEE was determined by direct gas analyses; therefore, the VO2000 gas analyzer was used. Results: There was significant difference (p < 0.05) for the BEE estimated by the Harris-Benedict (1824.66 ± 138.25 kcal/day) and Food and Agriculture Organization (1821.77, SD = 115.39 kcal/day) equations when compared to the BEE acquired by the indirect calorimetry (1709.81, SD = 329. kcal/day). BEE estimated by the IOM/2005 equation (1791.81, SD = 329.74) did not present significant difference when compared to the measured BEE. Conclusion: The Food and Agriculture Organization and Harris-Benedict equations can overvalue the BEE of healthy young men with characteristics similar to those recorded on this work.

Keywords: BEE, indirect calorimetry, equations.

BASAL ENERGY EXPENDITURE IN MEN

LIVING IN GOIÂNIA

Original article

EXERCISE AND SPORTS MEDICINE CLINIC

INTRODUCTION

The Basal Energy Expenditure (BEE) represents the greatest part of the daily energetic cost in humans (50 to 70%) and it is the amount of energy needed for the body to keep the normal physiological processes and homeostasis. These processes include the cardiovascular and respiratory at rest, gastrointestinal and renal functions, the energy used by the central nervous system, cellular homeostasis as well as the remaining biochemical reactions involved in the maintenance of the basal metabolism-3. It is directly influenced by fat-free mass, age, sex, body composi- tion and genetic factors. Other processes such as the nervous system activity, the thyroid hormones, the protein turnover and the sodium-po- tassium pump also contribute to a BEE variation among individuals4-7. The BEE may be measured by direct or indirect calorimetry, which is the amount of the energetic cost from the respiratory exchanges (oxygen consumption and carbon dioxide production), associated with the oxidation of the main energetic substrates: car- bohydrates, proteins, lipids and alcohol^6. Many mathematical equations using variables of easy measure- ment and low cost, such as age, height and total body mass have been developed for BEE estimation^5. Among these equations, we highlight the ones by Harris and Benedict 3 , FAO/85 8 and Institute of Medicine (IOM)^9 , all of them widely spread and studied. The BEE is usually measured in the morning, under ten to 12 hour-fasting, with six to eight hours of sleep, at supine position, in environment with controlled temperature and humidity, after

15 to 30 minutes of rest. The measurement of the gas exchanges is obtained in the 20 to 30 subsequent minutes, during which the individual should remain at supine position, awake and com- pletely relaxed. The Basal Energy Expenditure (BEE), on the other hand, is measured in the afternoon, at sitting position, three to four hours after the last meal, and provides an estimation of the energetic consumption value (kcal/day) which is from 10% to 20% higher than the BEE 5,9,10-12^ , mainly derived from the Thermal Effect of the Food (TEF). Studies conducted by different groups of researchers in many parts of the world have found variations between the BEE estima- tion obtained by mathematical equations and the ones determined by indirect calorimetry. These differences contribute to the quality loss of diet or physical exercise programs, which may be harmful to the population’s health. The inadequation of the BEE estima- tion equations for specific populations, such as the Brazilian and Australian ones, ends up bringing dissatisfaction and discredit to the given services besides disturbing their aims, as weight body composition control9-15. The aim of this study was to compare the results of the BEE es- timated by mathematical equations proposed by Harris-Benedict^3 , FAO/85^6 and IOM 2005^7 , with the values determined by indirect calo- rimetry in young male volunteers, residents of the city of Goiânia.

METHODS

This comparative research 16 was approved by the Ethics Com- mittee of the Castelo Branco University. 44 male volunteers selected

by simple convenience method in a universe of 900 men, members of a club in the city of Goiânia were evaluated. Inclusion criteria were: absence of chronic diseases; absence of smoking habit; ab- sence of loss or gain diet in the last six months and no use of pharmacological substances or ergogenic food supplements which are considered metabolism accelerators. The work was performed after consent given by the individu- als, who received information about all the procedures involved in the research. The evaluations were carried out in the Flex Center of Nutrition/ Qualitatis Vitae in Goiânia. Body composition was evaluated through data of body density and body fat percentage. Body density was calculated using the protocol of seven skinfolds, as described by Pollock and Wilmore^17. Body fat percentage was evaluated with application of reference values by Pollock and Wilmore^17. Basal Energy Expenditure (BEE) was obtained by indirect calo- rimetry and mathematical equations (FAO/85, Harris-Benedict and IOM/2005). The indirect calorimetry was measured with the VO metabolic gas analyzer (MEDGRAPH, USA), which was calibrated with gas with known composition (16% O 2 and 5% CO 2 ) before each measurement. BEE was calculated based on the mean of the O 2 consumption and CO 2 release, applying the formula [(3.9 x O 2 )

  • (1.1 x VCO 2 )] x 1.440^18. BEE measured by indirect calorimetry required the individuals to refrain from practicing intense physical activity for 24 hours and drinking alcohol. Additionally, they should remain 12 hours at fasting. After eight hours of sleep, the individuals went to the evaluation premises being still at fasting from liquid or solid food, without having engaged in any kind of activity, including having a bath. The volunteers were placed at rest for 30 minutes before the collection. Subsequently, during further 30 minutes, they remained connected to the gas analyzer through a mouth piece, with a nasal clip on to avoid they breathe through their noses11,19. The BEE values obtained by indirect calorimetry through the equations were expressed as mean and standard deviation (SD). Data normality was evaluated through application of the Kolmogorov- Smirnov test. The Boferrone treatment with repeated measures with correction was used to verify the possible differences between the BEE obtained by indirect calorimetry and by the studied estimation equations. Subsequently, analysis of the Bland and Altman residual scores for confidence level of 95% was performed (p < 0.05).

RESULTS

The evaluated individuals presented mean age of 29.8 years with range between 18 and 39 years. Mean weight, height and waist circumference were 77.79 kg (SD = 6.21); 1.79 m (SD = 0.06); 80.48 cm (SD = 5.89), respectively. Concerning body composition, mean BMI and fat percentage were 24.3 kg/m² (SD = 1.96) and 16% (SD = 5.5), respectively. The values concerning the BEE measurement by indirect calo- rimetry and the ones obtained by the mathematical equations are presented in table 1. Statistical analysis of the means presented significant difference: for Wilks’Lambda of F (19.295) = 41.000; p:0. with significance level of p < 0.05 between indirect calorimetry and the one estimated by the Harris-Benedict equation (p = 0.01) for standard error of 20.8 kcal, with the same behavior being observed

(p = 0.01) between indirect calorimetry and the FAO/85 equation, where standard error was of 17.4 kcal. The mean error estimated by the IOM 2005 equation did not present difference when compared with indirect calorimetry (p = 0.09), being observed the lowest stan- dard error of 16.7 kcal. The residual scores results represented by the difference be- tween indirect calorimetry and the studied equations enabled us detect that the FAO/85 equation overestimated mean of 11.66% of the BEE of the volunteers. The Harris-Benedict equation presented mean percentage difference of 10.07% for the BEE determined by indirect calorimetry, corroborating hence the tendency to overes- timate the reference values.

Table 1. Values of the Basal Energy Expenditure obtained by indirect calorimetry and estimated by the IOM/2005, FAO/85 and Harris-Benedict equations for 44 adult and young men from Goiânia, Goiás. Mean ± standard deviation (kcal)

Minimum (kcal)

Maximum (kcal) Indirect calorimetry 1.710 ± 330 1.067 2. IOM, 2005 1.791 ± 111 1.583 2. FAO, 85 1.822 ± 115 1.631 2. Harris-Benedict 1.825 ± 138 1.557 2. IOM 2005: Institute of Medicine (2005)^9 ; FAO 85: Food and Agriculture Organization (1985)^8 ; Harris-Benedict (1919)³.

DISCUSSION

It is possible to observe through the comparison of the anthro- pometric results of the present study and other studies that results similar to the ones reported by Piers et al.^12 and Wahrlich et al.^11 for Australian and Brazilian men, respectively were evidenced. The values concerning the BEE measurement by indirect calo- rimetry indicate that the Harris-Benedict and FAO/85 equations overestimated the basal energy expenditure in men residents of the city of Goiânia. These results are in agreement with the ones found by other authors5,10,11,13,20-22^ who also observed statistically significant differences of BEE obtained by indirect calorimetry and the one estimated by the referred equations. An interesting piece of information which should be mentioned is that the individuals evaluated by Cruz et al.^13 and Clark and Hoffer 22 , as well as the ones in the present study, lived in tropical regions. These sites present high temperatures, which can represent reduction of 2 to 5% in the total energy expenditure of sedentary individuals when compared with the ones who live in tropical climate (IOM, 2005)^9. Once the tendency to BEE overestimation was verified by the equations, the difference between the measured and estimated values was evaluated. It was observed that the difference between the measured and estimated BEE found in the present study was lower than the values obtained by Wahrlich and Anjos^10 (Harris- Benedict: 17%; FAO/85; 13.5%) and by Cruz et al.^13 (Harris-Benedict: 19%; FAO/85 12.5%), who researched the BEE in Brazilian women, indicating higher inadequation for the female population. It was observed that the FAO/85 and Harris-Benedict equations presented the same behavior for the male group evaluated. However, Valencia et al.^23 found lower values for the BEE in a study conducted with 32 Mexican men aged between 18 and 40 years, evidencing BEE overestimation of 8.2% by the FAO/85 equation^6. Other studies