Dietary Reference Intakes for Energy (2023) / Chapter Skim
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5 Development of Prediction Equations for Estimated Energy Requirements
5 Development of Prediction Equations for Estimated Energy Requirements
Pages 65-110
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From page 65... ...
Further, the committee identified additional data from systematic reviews and the broader peer-reviewed published literature on evidence to determine the energy cost of growth across selected life stages (childhood, adolescence, pregnancy, and lactation)
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From page 66... ...
. The factorial method involves summing the energy costs of occupational activities, nonoccupational activities, and sleeping to equal total energy expenditure (WHO, 1985)
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From page 67... ...
The DLW method provides an objective measurement of TEE integrated over days, if not weeks, and in combination with basal metabolism measured using indirect calorimetry, it allows for the objective measurement of energy expended in physical activity. As illustrated in Chapter 4 (Figure 4-1)
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From page 68... ...
For a pregnant woman, particularly during the second and third trimesters, EER is the sum of TEE and the energy cost of tissue accretion during pregnancy in both the fetal and maternal tissues. For a lactating woman, EER is the sum of TEE and the energy cost of milk production.
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From page 69... ...
, height, weight at the beginning of the DLW study period, TEE, fat-free mass, fat mass, percent fat mass, BMR, method of BMR measurement, and international standard country codes were requested with no a priori exclusions. The majority of the observations included in the IAEA DLW Database came from studies in the United States (78.1 percent)
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From page 70... ...
As indicated above, the IAEA DLW Database began with 7,696 study participants; after excluding 707 from non-high-income countries, 239 with infectious and chronic diseases, 50 professional athletes and study participants who took part in strenuous physical activities during the measurement period, 673 institutionalized elders, 222 observations with no age or sex reported, and 88 study participants with PAL greater than 2.5, there were 5,717 observations available for DRI analysis. The ages of the study participants included in the final IAEA dataset ranged from 0 to 90 years and above.
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From page 71... ...
IOM DLW Database The IOM (2002/2005) report included DLW data that were available to the committee and published by the end of the year 2000; the data pertained to study participants with normal weight, overweight, and obesity, as well as pregnant and lactating women.
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From page 72... ...
. Approximately 50 percent of the measurements among lactating women were made between TABLE 5-1 Distribution of Observations by Life Stage and DLW Database IOM, Life Stages IAEA SOLNAS 2002/2005 CNRC Totals Infants, 0–11 months 378 0 177 0 555 Children, 1–8 years 432 0 689 0 1,121 Children, 9–18 years 425 0 279 0 704 Adults, 19+ years 4,309 380 767 0 5,456 Pregnant/lactating/ 173 0 371 220 764 NPNL women Totals 5717 380 2,283 220 8,600 NOTES: IAEA = International Atomic Energy Agency; SOLNAS = Study of Latinos: Nutrition and Physical Activity Assessment Study; IOM = Institute of Medicine; CNRC = Children's Nutrition Research Center at Baylor College of Medicine; NPNL = nonpregnant nonlactating women who were included in the studies of pregnant or lactating women.
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From page 73... ...
(225) 354 2,364 582 NOTE: BMR = basal metabolic rate; cm = centimeter; d = day; mo = months; kcal = kilocalorie; kg = kilogram; n = sample size; NPNL = nonpregnant nonlactating; SD = standard deviation; TEE = total energy expenditure; y = years.
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From page 74... ...
From the graphic display of the current data, however, it was apparent that the mean PAL value was age dependent in the first 2 decades of life, and the same PAL coefficients could not be used for all life stages. An approach was needed to incorporate the age dependency into PAL categories for the development of the TEE prediction equations.
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From page 75... ...
, and/or R2 values. The committee decided to use the sex- and age-specific Schofield equations based on weight and height to estimate BMR where the value was missing in the combined DLW database (Schofield, 1985)
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From page 76... ...
. STATISTICAL MODELING: DEVELOPMENT OF TEE PREDICTION EQUATIONS Prediction equations were developed fitting general linear models on TEE based on sex, age, weight, height, and PAL category, or, alternatively, based on sex, age, height, body composition variables (FFM and FM)
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From page 77... ...
For simplicity and ease of use, the TEE prediction equation is presented by redefining the parameters of the model above with slopes for height and weight separately for each PAL category in the following format: Predicted TEE = Intercept + A Age (years) + B Height (cm)
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From page 78... ...
This curvilinear pattern motivated the age strata used to develop the TEE prediction equations. Within the specific strata, TEE clearly increased across the BMI categories, as seen in adults in Figure 5-2.
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From page 79... ...
derived using data from the DLW database. NOTE: TEE = total energy expenditure.
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From page 80... ...
In general, the inactive category reflects a level of TEE covering basal metabolism, thermic effect of food, and a minimal level of physical activity required for independent living. The low active category reflects a level of physical activity beyond the minimal, involving more ambulation, and some occupational and recreational activities.
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From page 81... ...
category (normal BMI or overweight/obese BMI) by life stage.
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From page 82... ...
Categories Defined for Inactive, Low Active, Active, and Very Active Levels for Age Groups 3–8.99 Years, 9–13.99 Years, 14–18.99 Years, and 19 Years and Over Age Group (years) PAL Category PAL Range 3–8.99 Inactive 1.0 ≤ PAL <1.31 Low active 1.31 ≤ PAL < 1.44 Active 1.44 ≤ PAL < 1.59 Very active 1.59 ≤ PAL < 2.50 9–13.99 Inactive 1.00 ≤ PAL < 1.44 Low active 1.44 ≤ PAL < 1.59 Active 1.59 ≤ PAL < 1.77 Very active 1.77 ≤ PAL < 2.50 14–18.99 Inactive 1.00 ≤ PAL < 1.56 Low active 1.56 ≤ PAL < 1.73 Active 1.73 ≤ PAL < 1.92 Very active 1.92 ≤ PAL < 2.50 19 and over Inactive 1.00 ≤ PAL < 1.53 Low active 1.53 ≤ PAL < 1.68 Active 1.68 ≤ PAL < 1.85 Very active 1.85 ≤ PAL < 2.50
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From page 83... ...
Because of the limited range of physical activity in this youngest age group, TEE is not partitioned by PAL category. Sex-specific TEE prediction equations using age, height, and weight for each PAL category are also shown by life-stage group in Table 5-5.
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From page 84... ...
Low active TEE = 575.77 – (7.01 × age) + (6.60 × height)
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From page 85... ...
R2 = R squared; R2 adj = adjusted R squared; R2 shr = shrunken R squared; RMSE = root mean squared error; MAPE = mean absolute percentage error; MAE = mean absolute error. RMSE is the same as standard error of the estimate (SEE)
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From page 86... ...
. The summary statistics, including sample sizes, R2, adjusted R2, shrunken R2, MSE, Pearson correlation r for predicted TEE versus observed TEE, MAPE, and MAE, are shown in Table 5-6 for the general TEE prediction equation based on weight and height/length and including all data within each strata.
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From page 87... ...
Model Comparisons: Normal BMI Compared to Overweight/Obese BMI A major question for the committee was whether the general TEE prediction equation differed by BMI group, specifically for the normal weight versus overweight/obese BMI categories. In addition to the evaluations performed above, two-way and three-way interaction terms with BMI group were incorporated into the TEE prediction models.
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From page 88... ...
88 DIETARY REFERENCE INTAKES FOR ENERGY FIGURE 5-5 Bland-Altman plots of predicted TEE versus observed TEE (kcal/d) for the general TEE prediction equations.
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From page 89... ...
, BMI range, and PAL category. Their observed TEE data are shown in Panel 1, and their predicted TEE values from each of the five models are shown in the other panels.
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From page 90... ...
. ENERGY COSTS OF GROWTH, PREGNANCY, AND LACTATION Growth of Infants, Children, and Adolescents The energy requirements of infants, children, and adolescents includes the energy required for deposition of tissues consistent with health.
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From page 91... ...
. NOTE: A = active; LA = low active; I = inactive; VA = very active; TEE = total energy expenditure; PALCAT = physical activity level category.
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From page 92... ...
. NOTES: A = active; LA = low active; I = inactive; VA = very active; TEE = total energy expenditure; PALCAT = physical activity level category.
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From page 93... ...
. Consistent with this premise, the committee determined that the energy cost of tissue accretion during the second and third trimesters of pregnancy should be based on body composition changes in women who gained within the IOM weight gain guidelines for their prepregnancy BMI category (IOM and NRC, 2009)
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From page 94... ...
. b Body composition increments used to estimate energy costs of tissue deposition (kcal/g)
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From page 95... ...
. b Body composition increments used to estimate energy cost of tissue deposition (Fomon et al., 1982; Haschke, 1989)
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From page 96... ...
. In this report, the energy cost of milk production was based on rates of human milk production in exclusively breastfeeding women in the first 6 months postpartum (Allen et al., 1991; Butte et al., 1984a; Reilly et al., 2005)
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From page 97... ...
. From 0 to 6 months postpartum, the net energy cost of milk production averages 404 kcal/d to support an average milk volume of 808 g/d in exclusively breastfeeding women experiencing gradual weight loss (0.64 kg/month)
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From page 98... ...
Men and Women, 19 Years and Above The EER for adults, 19 years and above, is based on sex-specific TEE prediction equations using age, height, and weight for each PAL category (Table 5-16)
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From page 99... ...
+ 20 Low active EER = 19.12 + (3.68 × age) + (8.62 × height)
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From page 100... ...
c Energy cost of growth for girls: 3 y: 15 kcal/d; 4 to 8 y: 15 kcal/d; 9 to 13 y: 30 kcal/d. TABLE 5-16 Summary Table of EER Equations Based on the TEE Prediction by Age, Sex, and Physical Activity: Adults Age Group Sex PAL Category EER Equation (kcal/d)
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From page 101... ...
The EER for pregnant women is thus calculated as the sum of TEE and energy deposition/mobilization. TABLE 5-17 Summary Table of EER Equations for Pregnant Women During the Second and Third Trimesters of Pregnancy Life Stage PAL Category EER Equation (kcal/day)
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From page 102... ...
Energy mobilization estimated for women and girls exclusively breastfeeding 0 to 6 months postpartum: 140 kcal/d. EERs are in kilocalories/day, age is in years, height is in centimeters, weight is in kilograms, energy cost of milk production is in kilocalories/day, and energy mobilization is in kilocalories/day.
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From page 103... ...
EERs are in kilocalories/day, age is in years, height is in centimeters, weight is in kilograms, and energy cost of milk production is in kilocalories/day. FINDINGS AND CONCLUSIONS Findings ased on its analysis of the assembled DLW database of 8,600 values B representing infants, children, adolescents, adults, and reproductive age women, the committee finds that TEE and PAL changed in a curvilinear fashion across the life span, which influenced development of the TEE prediction equations.
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From page 104... ...
weight gain guidelines, and with the TEE plus the energy cost of milk production during lactation. he committee finds that alternative TEE prediction equations T developed based on height and body composition (FFM and FM)
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From page 105... ...
verall, the committee concludes that its calculated EER equations were O based upon TEE in weight stable adults, and on TEE plus the energy cost of growth in children, on TEE plus the energy cost of tissue accretion during the second and third trimesters of pregnancy consistent with the IOM and NRC (2009) weight gain guidelines, and TEE plus the energy cost of milk production during lactation.
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From page 106... ...
2004. Energy requirements during pregnancy based on total energy expenditure and energy deposition.
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From page 107... ...
1988. Energy metabolism, body composition, and milk production in healthy Swedish women during lactation.
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From page 108... ...
1991. Energy cost of lactation, and energy balances of well-nourished Dutch lactating women: Reappraisal of the extra energy requirements of lactation.
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From page 109... ...
2004. Lactation, weaning, and calcium supplementation: Effects on body composition in postpartum women.
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