L, Garrow. JS, Jorgensen. B, et al. Relation between energy expenditure and body composition in man: specific energy expenditure in vivo of fat and fat-free.
Resting Jane and
energy
R Allen, James Kevin J Gaskin
ABSTRACT
C McCauley,
Reports
nylketonuria We found with
expenditure
have
Donna
suggested
These
overweight
children
because
of
may an
have
in 65
y).
(23
There
REE
was
alteration
was
in
subjects
The
and
(5306
with
phe-
± 8.5%
of a reduced
REE
J C/in
Nutr
PKU
in
and female
and
PKU (males
±
102.1
±
This
or of increased
within
children 701
an REE
of predicted).
1 1 .2 ± each
The
mean
with
PKU
h, respectively)
5164
had
fat
10-34%).
kJ/24
h,
similar
7.8%
the
respec-
to that
of
study
weight
and
found
(10,
with
WORDS
Resting
energy
expenditure,
(9),
nesting
children
phenylketonu-
with
overweight lower body
intake
in those
on on
compared
with
control
PKU
have
a predisposition
because protein),
expenditure
energy
subjects
may
of an alteration in body comwhich may result in reduced
(REE)
and
hence
a lower
total
nitrogen
or body
protein
was
documented
in children
with
PKU
compared with control subjects of the same weight, age, or lean body mass. Because TEE in adults (16, 17) and in children (14) sition body
PKU.
in energy
or when
energy expenditure (TEE) because REE is the largest component of TEE in adults (12, 13) and in children (14, 15). In a previous study (unpublished observation), lower total body
to fat-free
of this protein
may
result
was
to
mass
(FFM),
tissue may affect content per unit lower
in
measure
comparison KEY
no increase
diet
to becoming position (eg,
is related
l995;62:797-801.
Roberts,
11).
and
no evidence
in children
demonstrated a special
pre-
predicted
CK
Alternatively,
which
(aged
body
group:
kJ/24
1024
969
data
children
the male
with
control
100.2
control
David
have off
to becoming
composition,
± ±
children
from
females
4703
body
range
1 1-34%;
between
757
tively). dicted
children
0 ‘Connor,
(REE). REE was measured with PKU (aged 9.6 ± 2.9
females)
a comparable
similar
±
42
group:
control
A,n
males,
(control
(5300
Janice
with
with
energy REE in a group
any
alteration
in the compo-
energy expenditure. of FFM in children
expenditure. a group of
The with
lower PKU
The aim of this study children with PKU in
of similar-aged,
healthy
control
sub-
jects.
children
na,
SUBJECTS
AND
METHODS
INTRODUCTION Subjects Since
the
introduction
for the treatment
of the
low-phenylalanine
of phenylketonunia
to balance
the intake
too much regimens
to impair neural development. there were reports of phe
over-restriction, some
cases
that
children
which
older
than
relation
between
4 y in children
with
for
the
children
overweight
for
dietary by an
(1-3)
have
PKU The
PKU,
and
been
were
in
reports
overweight
United
States
compared
with
(NCHS) reference was normal. There
energy
age
growth there
yet not
the first caused
intake
PKU
(5,
and
Col-
6), although
to consume
more.
National
standards (8). was no signif-
being
overweight
there
was
at a trend
Additionally,
in
these children, being overweight up to age 10 y was positively associated with serum phe concentrations, suggesting a possible increase in energy intake associated with an increased phe intake A,n
(7).
J C/in
Other Nutr
dietary
1995:62:797-801.
intake
studies Printed
of children
in USA.
© 1995
with American
Thirty from
Treated for Phenylketonunia (5-7) in body weight in prepubertal
3 y with
for Health Statistics growth in this group
icant
in poor
diet
difficult
for growth
With deficiency
children.
of Children an increase
it has been
enough
Recently,
treatment
nonaffected
labonative Study has documented Center Height
(4).
receiving with
to ensure
resulted
malnutrition
compared
children
of phe
(PKU)
(phe)
Sydney,
Clinic which
aged
4.6-17.0
y with
at the
Royal
Alexandra
is the
referral
center
dren with PKU detected the state of New South
for
by the neonatal Wales (18).
PKU
were
recruited
Hospital
for
Children,
treatment
for
screening
program
all chilin
Seventy-six unselected control children aged were also recruited: 7 unaffected siblings of children
4.3-18.4 y with PKU
and
illness
69
children
with
no
first-degree health and
family relative. not taking any
ment.
The
study
mittee
and
was
written,
significant
history
All control medications
approved
by
informed
the
consent
of
in
a
children were in good at the time of measureHospital was
Ethics
obtained
Comfrom
the
From the James Fairfax Institute of Paediatric Clinical Nutrition, Royal Alexandra Hospital for Children, Camperdown, NSW, and the Department of Nutrition and Dietetics, The University of Newcastle, Newcastle, NSW, Australia. 2
Address
Paediatric
PKU Society
children
the
for
reprint Nutrition,
requests P0
Received
March
Accepted
for publication
Clinical
Nutrition
Box
to
KJ
Gaskin,
34, Camperdown,
James NSW,
Fairfax 2050,
Institute
of
Australia.
1, 1995. May
25,
1995. 797
Downloaded from www.ajcn.org by guest on July 13, 2011
3.1
that
a predisposition
may lower resting energy expenditure in 30 (15 males, 15 females) children
group
L Waters,
(PKU) weigh more compared with reference data. lower body protein and bone mineral density in children
PKU.
y) and
in children
ALLEN
798 parents. REE.
All
children
had
measurements
of anthropometry
and
El
AL diagnosis > 1000
of PKU tmolfL.
The Anthropometry All
measurements
were
ing standardized
techniques
cm)
with
were
made
Cnymmych, were made minimal
(19).
with
a Hanpenden
Height
the NCHS
nant
side
and
subscapula)
Ltd, with
St Albans, PKU who
the
and
weight
reference
in triplicate
of Rahaman
energy
hospital
by
After
in the
equipment,
morning
measurements
estimated
com-
The
measure-
urinary
dioxide
predicted
et al (25)
except
by
body
using and
age group.
FFM
of was
mass.
calorimetry that
was
with
built
fast,
children
and
after
for
were
an open-
use
in chil-
brought
to the
familiarization
taken
for
20
with
mm
Nitrogen
to the
and with
excretion.
produced
PKU
compared
the
while
the
excretion
was
estimated by using an equation derived from measurements made in pediatric burn patients (unpublished data) and accounted for a reduction of < 2% in the measured REE. The respiratory quotient (RQ) was calculated as the ratio of volume of carbon
of indirect
Indicators
children
volume
of oxygen
females.
wane
were
(version
test was tenistics
analyzed
8.0,
Minitab
used to compare and REE between
control
group).
by using Pearson
Adjustment
REE
for
State
size with
child
by
the
PA).
and
predicted
of Bland to detect significance
Student’s
childhood
(age
0.06
±
had
were derived In addition,
from
equations
the
(26).
a 15% difference level was set
started
0. 1 1 y),
after
dietary
weight
scones
on body
are shown
control REE
in Table
subjects
by sex,
showed
except
for predicted
was
no difference
in the
that
predicted
from
equations
the
female
the
PKU
2. The a similar
group
REE
measured
REE
of Schofield
who
had
a higher
P = 0.009). significantly correlated = 0.89, 0.86, 0.80, and subjects the REE analysis with
data
±
of predicted
based
females difference
on
(t =
measurements subjects males where male
weight
(males
102.1
100.2 ± 8.5% of predicted) between predicted and
kJ for males females (t
-0.58, P
=
-0.45,
P
between
0.57) and -50 The similarity
=
0.66).
=
7.8%
groups,
the children
respectively,
of the
control
and
with a nonsignificant measured REE of -65
with
fall
within
±
PKU
the
mean ± 434
438 kJ for in the REE
and
after adjustment of REE for weight and females in Figure 1 and Figure all but one and two data points for the
terval
the control
is shown for the 2, respectively, PKU female and
95%
prediction
in-
data.
DISCUSSION the REE
subjects
within
was each
in the REE
similar sex
for children
group.
between
with
Similarly,
the groups
PKU
there
after
and
was
no
adjustment
body weight. The children with PKU had a body similar to that of the control subjects with the FFM, which was lower in the female children
TABLE 1 Characteristics control
for
composition exception of with PKU,
of children
A sample
in the REE at P < 0.05.
treatment
confirmation
early of
with phenylketonuria
initial
in
(PKU)
PKU Males (n
Age (y) SD height score SD weight score Body
fat (%) ±
10.4
Significantly 13 children.
Control Females
15)
(n
± 2.4
with
±
-0.17
± 0.97
Males 15)
subjects Females
(n
23)
(n
42) ± 3.3
10.0
± 2.2
11.8
0.91
0.32
± 0.87
0.27
± 0.93
0.07
± 0.92
0.13
± 0.85
0.05
± 0.89
8.9
0.98
-0.27
-0.15
± 3.22 ±
18.4
±
6.5
20.8
± 743
20.4
± 6.8
23.5
± 6.2
27.2
± 7.6
23.1
±
27.1
± 7.0
30.9
± 8.2
SD. FFM, fat-free
0.007. 3n
compared
subjects’
of
2.4
PKU
and
(P = was no
3). The children from the control
‘
with
female
(Table predicted
RESULTS children
However,
all P < 0.001). For control by least-squares-regression
FFM (kg)
The
the
comparisons As appropriate, calculated. Pre-
females regression.
Altman
height
calorimetry and
for
and height. Measured and by paired t test. AgreeREE measurements was and
and
weight as the independent variable with PKU had an REE similar to that
difference
Soft-
in physical characgroup compared with
for multiple
for males best-subsets was
method
of 30 is required 90% power. The
College,
made
Schofield et al (25) based on weight predicted REE values were compared ment between the actual and predicted assessed
Statistical
to reduce type 1 error. correlations (r) were
for REE by using
each
Inc,
MINITAB
mean differences groups (PKU was
the Scheff#{233}test product-moment
dictive equations from control data the
by using
subjects.
There
0.69, respectively; is best described
control
data
PKU
used.
analysis
The
with
than control subjects 0.007), but there
measured REE (105 ± 6% of predicted, The REE in the control subjects was with FFM, weight, height, and age (r
In this study Data
control
SD
concentration
1. There was no difference body fat, or FFM between
younger FFM (P
the
with
measured
to taped music in a nonclinical REE was calculated by using the from measured gas exchange and
nitrogen
results
children
(British
thicknesses
of children
and
between
caliper
prepubertal
were
child lay supine listening thenmoneutnal environment. Bnockway equation (24)
difference
in the
from
system
PKU
suprailiac,
indirect
an overnight
with
with PKU were and had a lower
phe
fat.
expenditure
measured
early
mass
males
children 0.006)
biceps,
skinfold
for
characteristics
plasma
subjects are shown in Table SD height and weight scores,
(triceps,
for the pubertal
fat
ventilated-hood (23).
were
(8). These
a fasting
different
mass.
from
control
females:
2
p
o.ooo,
‘
P
=
Downloaded from www.ajcn.org by guest on July 13, 2011
Resting
the
(21)
(22)
by subtracting
was
sites
from
Brook
derived
dren
the
Ltd,
expressed as SD scones (20). were taken on the nondomi-
a Harpenden
obtained
and
circuit,
(Holtain
Hertsfordshine, UK), except in two children refused to cooperate. An estimate of percentage
fat was
REE
(±
measurements
population
at four
with
equations
Durnin
us0.1
observers
measurements
stadiometen
ments were normalized by being Skinfold-thickness measurements
body
by trained Height
Dyded, Wales). Weight measurements (± 0.1 kg) with an electronic scale with subjects weaning
clothing.
pared
performed
physical
control in age,
with
REE TABLE 2 The resting energy expenditure (PKU) compared with control
IN
CHILDREN
WITH
PKU
799
8000
(REE)
of children
with phenylketonuria
subjects’
. 0
.
Control
PKU Males
REE
(kJ/24 h)
PREE (kJ/24 REE/PREE(%)
h)2
(n
15)
2
Schofield
(n
5300
± 757
4703
5205 ± 931 103±7
i ± SD. PREE, PREE, predicted
‘
Females
subjects
Males
7000
Females
(n
23)
± 1024
5306
± 969
5164
± 701
5285
± 876
5171
± 766
4453 ± 802 105±6
(n
0
15)
100±7
42)
et al (25),
using
Significantly
different
4
Significant
difference
weight
#{149}#{149}#{149}#{149}:00
100±7
00
predicted resting energy expenditure. resting energy expenditure based on the equation
3
6000
5000
of
0 0
and height.
from
0
P REE and PREE,
control
between
.
0
females,
0
0.006. P
0
0.009
=
(paired
t
4000
test). #{149}.#{149}#{149}#{149}
..0
probably
because
subtle
differences
total
body
the
There
the (15)
predicting
in the current is
related weight
study
in REE over that not of biological
one
than
of
the
weight
in
78%
of adolescent
and
73%
Regression
line
(
intervals
50
70
60
resting group
energy (0,
for the control
(-)
n
=
expenditure
(REE) and group (#{149}, n with 95% prediction
42);
PKU
children
).
and
adolescents
lower
REE
(30, in the
reliable
in obese
estimate
skinfold-thickness
may
be
establishment
31)
obese
onstnated a significant basal metabolic rate
due
to
have groups an
of obesity.
adult
Pima
15
20
not after
alteration However,
been
able
to demonstrate
adjustment
for body
in
positive correlation (BMR) (or REE) and Indians.
the
REE
Ravussin
Additionally,
before
et al (34)
between TEE and
a both weight
Roberts
a size. the demlow gain
et al (35)
and
measured for females
values of Schofield, with PKU, who had
predicted. This significant importance because it is
subjects
and predicted aged 1 1-13
(32)
REE from y whose
good
Schofield REE was
Dietz et al (33) did not find any difference measured values in their combined group
males
and
females,
although
REE
is not
always
of the
REE
in obese
the REE
8000.
equations
reported
was
103%
7000. .c
w w
6000
of
predicted.
5000.
A reduced studies
between Control
0.86) and to body weight as the preferred measure
and the predictive
of healthy
107% of that predicted. between predicted and
enal
15).
2. Relation for females.
This
with the predictive in female children
study
between except
40
in explaining In
is a more
of the instrument
Another
agreement equations,
that
have In this
(Wt)
Also, Goran et al (14) in children found that TEE
from
30
9000
agreed being
the precision 25).
weight
is derived
a 5% mean increase difference is probably (23,
=
FIGURE weight
measurements.
Measured REE the only difference
within
REE
explaining
to FFM (r was chosen
I
20
wt (kg)
range
children 27-31).
better
children,
I
10
of
10-34%).
subjects.
marginally
because
which
a similar
group:
predicted control
only
in 5-y-old
FFM,
body-weight
the
3000
in
of the children
having PKU
been
at the time
no evidence
in REE, respectively. of TEE in 4-6-y-old
significantly 0.83). Body
measured
both
equally
was
REE
of the variance the measurement
was
have
as differences
the REE in normal predictor of REE (15,
in
FFM
may
such
1 1-34%;
FFM
variance
There
not
group,
group:
and
age.
associated and
with
nonobese
obesity.
5ev-
children
(27)
4000 TABLE 3 Regression of resting control
energy
(REE)
expenditure
on weight
(Wt)
3000 Males
Equation
REEC
2433
Females +
82.6
Wt
REEC
3213
(kJ/24 h) R2 (%)
SD ‘
in
subjects’
REEC,
resting
energy
87.0
76.5
349.6
344.2
expenditure
for control
subjects.
+ 74.5
Wt
25
30
35
40
45
50
55
60
wt (kg) FIGURE 1. Relation between resting energy expenditure (REE) and weight (Wt) for males. Control group (0, n 23); PKU group (#{149}, n 15). Regression line (-) for the control children with 95% prediction intervals ( ).
Downloaded from www.ajcn.org by guest on July 13, 2011
studies
these
measuring is the best
weight of
than
were
fat (control
study,
was (r
but
in either
Other studies found that FFM 77%
composition,
calorimetry.
overweight
of body
younger
in body
nitrogen,
indirect
being
of their
ALLEN
800 found
a greater
mothers ens, and
weight
gain
in infants
were obese compared Gniffiths and Payne
with
a lower
with infants (36) documented
children found
no association
Because
with
a reduced
children
with
parental
REE
PKU,
fatness
appears
an alternative
weight
in the American
dietary There
intake. does
to
REE
be
(5-7)
Child 4.
in
PKU
may
children
with
reliable
method
appear
PKU
to be an excessive
but
dietary
intake
in assessment
energy
all
studies
of energy
are
not
intake,
always
a
from (36%
diet were
consuming
in fat (
