Volume 90, Issue 5, November (2003), pp. 961-968 © The Author 2003
doi:10.1079/BJN2003975

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*Comparison of commonly used procedures, including the doubly-labelled water technique, in the estimation of total energy expenditure of women with special reference to the significance of body fatness

Marie Lof¹, Ulf Hannestad², Elisabet Forsum^1
1Division of Nutrition and
²Division of Clinical Chemistry, Department of Biomedicine and Surgery, University of Linköping, SE-58185 Linköping, Sweden

 (Received 14 February 2003–Revised 16 June 2003–Accepted 7 July 2003) *Reprints will not be available.

According to the report of the World Health Organization (1985), total energy expenditure (TEE) in human subjects can be calculated as BMR×physical activity level (PAL). However, other reports have pointed out limitations in the suggested procedure related to the % body fat of the subjects. The purpose of the present study was to evaluate the World Health Organization (1985) procedure in thirty-four healthy women with BMI 18–39 kg/m². BMR and TEE were measured using indirect calorimetry (BMR_meas) and the doubly-labelled water method (TEE_ref) respectively. When assessed using the doubly-labelled water and skinfold-thickness methods, the women had 34 (sd 8) and 33 (sd 6) % body fat respectively. On the basis of guidelines provided by the World Health Organization (1985), 1·64 was selected to represent the average PAL of the women. Furthermore, PAL was also assessed by means of an accelerometer (PAL_acc), heart-rate recordings (PAL_HR) and a questionnaire (PAL_q). These estimates were: PAL_acc 1·71 (sd 0·17), PAL_HR 1·76 (sd 0·24), PAL_q 1·86 (sd 0·27). These values were lower than TEE_ref/BMR_ref, which was 1·98 (sd 0·21). BMR assessed using equations recommended by the World Health Organization (1985) (BMR_predicted) overestimated BMR by 594 (sd 431) kJ/24 h. However, when TEE was calculated as BMR_predicted×PAL_acc, BMR_predicted×PAL_HR and BMR_predicted×PAL_q respectively, average results were in agreement with TEE_ref. Furthermore, TEE values based on BMR_predicted and PAL_acc, PAL_HR, PAL_q as well as on PAL=1·64, minus TEE_ref, were significantly correlated with body fatness. When the same PAL value (1·64) was used for all subjects, this correlation was particularly strong. Thus, the World Health Organization (1985) procedure may give TEE results that are biased with respect to the body fatness of subjects.

Keywords:
Basal metabolic rate, Body fatness, Doubly-labelled water, Physical activity level, Total energy expenditure

Abbreviations:
acc, accelerometer, BF, body fat, BF_DLW, body fat calculated from estimates of total body water, BF_STF, body fat calculated from skinfold-thickness measurements, BMR_meas, BMR measured by indirect calorimetry, BMR_predicted, BMR predicted using World Health Organization (1985) equations, BW, body weight, DLW, doubly-labelled water, HR, heart rate, MET, metabolic equivalent, PAL, physical activity level, PAL_acc, physical activity level obtained using an accelerometer, PAL_HR, physical activity level obtained using heart-rate recording, PAL_ref, physical activity level obtained using a combination of doubly-labelled water and indirect calorimetry, PAL_q, physical activity level obtained using a questionnaire, TEE, total energy expenditure, TEE_acc, total energy expenditure obtained using an accelerometer, TEE_HR, total energy expenditure obtained using heart-rate recording, TEE_ref, total energy expenditure obtained using doubly-labelled water, TEE_q, total energy expenditure obtained using a questionnaire