RESEARCH Resting energy expenditures in Asian women measured by indirect calorimetry are lower than expenditures calculated from prediction equations KEIKO ONO CASE, MS; C. JAY BRAHLER, M: LSS ‘ABSTRACT Objective Measured resting energy expenditure (REE) and REEs calculated using the Harris-Benedict equation, Food and Agriculture OrganizatiowWorld Health Organization! United Nations University (FAQWHO/UNU) equations (PAO equations), and the Liu equation were compared in Asian women, Design REEs were measured using indirect calorimetry in the morning ater an overnight fast and compared with RES calculated ising the Harris-Benedict equation, the FAQ and the Liu equation. Height, weight, and 3-day ained, Subjects Thirty-six healthy, free-living Asian women aged 19 to 52 years and living in the United States were recruited from Washington State University, Pullman, and completed the study, Statistical analyses Paired ¢ tests, stepwise regression, one-way analysis of variance, and Pearson correlation coefficients were used for the statistical analyses. Signif cance was set at Ps.0 Results A significant. correlation was found between measured REE and REE derived from the Harris-Benedict equation (F2=0.67, P<.0001), the PAO equations (R=0.70, P,0001), and the Liu equation (R=0.70, P<.0001). However, measured REE was significantly lower than REE calculated using the Harris-Benedict and PAO equations by 8.5% (P<.001) and 5.4% (P=.01), respectively. No significant difference was noted between measured REE and REE, derived from the Liu equation Applications Caution must be taken when predicting REE of Asian women using the Harris-Benedict equation or the FAO ‘equation. Indirect calorimetry or an equation specific to Asians, suct as the Liu equation, is recommended when an accurate estimate is necessary. J Am Diet Assoc. 1997; 97128-1292, 1288 / NOVEMBER 1997 VOLUME 97 NUMBER 11 ; CINDY HE PD, RD of encray expended by the body at rest ina fasted state ata thermoneutral temperature (1). This energy expen diture sustains life processes such as respiration, cellu lar metabolism, circulation, glandular a nance of body temperature. REE represents the majority (60% to 70%) of total energy expenditure in sedentary people (2); thus, knowledge of an accurate REE is valuable in several ways. The amount of food ired by a population, which can be estimated by using EE, activity, and thermogenic effect of foods, influences economic, agricultural, developmental, and political decision: muking processes related to food aid, farming systems, and national food security in many countries (3). Estimated total energy expenditure can be used in school menu planning, weight control, and nutrition management of hospitalized patients. Especially in the clinical setting, energy expenditure of patients mnust be estimated accurately because overteeding or underfeeding may have adverse effects, such as electrolyte imbalance and gastrointestinal problems (4) Many equations for estimating the REE of individuals have een formulated (5-7) and can be helpful when actual meta: bolic measurements are not available. ‘The Harris-Renedict equation and the Food and Agriculture Organization/World Health OrganizatiowUnited Nations University (FAQWWHO) UNU) equations (FAO equations) are formulas commonly used to estimate REE (5,8). The Harris-Benedict equation is based on data solely from white men and worten. The FAO equations were derived from data from different ethnic groups, although 38% of the data were from white men and women, Re heamount ivity, and the mainte KO. Case is with the Department of Food Science and. Human Nutrition and C, J. Brahler is with the Department of Interdisciplinary Studies, Washington ‘State University, Pullman. C, Heiss is with the Department of Food Science and Nutrition, California Polytechnical State University, San Luis Obispo; at the time of the study she was with the Department of Food Science and Human Nutrition, Washington State University. ‘Address correspondence to: Cindy Heiss, PRD, RD, Department of Food Science and Nutrition, California Polytechnical State University, San Luis Obispo, CA 93407,Expertsin energy metabolism have observed problems with equations used to predict energy expenditure, The Harts Benedict equation overestimates the REE of present-day North er Americans (9), and the FAO equations may not reflect racial variations (6). Itisunclear whether predictive equations derived from one population can be applied successively to 2 different population (10), and many studies have concluded that race has an influence on metabolic rate (11-18). For example, Indian subjects have lower REBs than Northern European and North American subjects (13). Asian and Sibe- rian subjects have lower REEs than North Americans (11,14) Liu et al (15) reported that most equations developed from data from whites overestimated measured REE in healthy Chinese. Henzy and Rees (16) suggested that different ethnic ‘groups may have different metabolic responses to climate and, that differences may also be attributable othe varying degrees of muscular relaxation during rest. There is a need to reevaluate equations used to predict enerdy expenditure in Asians, because previously reported measurements of REE may not be accurate or appropriate when applied to a modern population (17). Comparative stud. jes of measured REE of Asian women and REE determined by existing predictive equations were done on the basis of data obtained at least 40 years ago (12,13,18). In addition, the size of the Asian population has increased rapidly in the United States; thus, there will be an increased demand toestimate energy expenditure of Asians inthe United States. In 1990, 7,458,000 Asians lived in the United States, and the projection for 2025 is 25,524,000 (19). ‘The goal of our study was (o reevaluate the REE of present- day healthy Asian women living in the United States and compare measured REE with REE calculated using three predictive equations, two of which are based on data mostly from whites (Harris-Benedict equation and FAO equations) and one on data from Chinese (Lit equation) (20), METHODS. Subjects Subjects were recruited from Washington State University in Pullman. Thirty-six healthy Asian women, aged 19 to 52 years and free-living in the United States, completed the study. Griteria to be a participant included (a) being able to under- stand and give written informed consent; (b) being an Asian ‘woman aged 18 years or older; (c) being raised in her native country; (@) having lived in the United States for at least 3 ‘months; and (¢) being free of medications, diseases, or trauma ‘that might affect REE, Approval of this study was granted by ‘the Institutional Review Board of Washington State University. Subjects completed a 3-day diet record (2 weekdays and 1 ‘weekend day) that included vitarnin and mineral supplements, Which wasanalyzed by computerusing Nutritionist IV software (version 2, 1994, N-Square Computing, Silverton, Ore). In addition, shbjects completed a questionnaire regarding their country of origin, duration of stay in the United States, medical history, and usual physical activity. Height was recorded to the nearest 0.5 em, and weight was recorded to the nearest 0.1 kg while the subject was wearing a swimsuit according to the technique deseribed by Lohman et al (21), Resting Energy Expenditure Measurements Subjects reported to the Human Performance Laboratory at. ‘Washington State University (elevation 2,350 feet) between 7 au and 12 Px, Subjects were atleast 12 hours postprandial and had. refrained from exercise forat least 24 hours. Room temperature was controlled between 21 and 22°C at all times. Subjects acclimated to mouthpieces and nose clips, then rested quietly in 4 supine position on a mattress for 30 minutes before the metabolic measurement. Heart rate was monitored by chest electrodes with a digital wrist receiver display (Polar USA, Stanford, Conn). Measurements were postponed nti the su= jects resting heart rates did not decrease for 5 minutes. Body temperature was taken to ensure normal body temperature. REB was determined using an open-circuit incroctcalorira- ler (Vista™ Desktop Motabotie Measurernent Systom, version 3.03, 1990, Vacumetries, Ventura, Calif). An experienced tech- nician calibrated the calorimeter wath 100% nitrogen, calibra- tion gas with known oxygen and carbon dioxide content, and room air before each measurement, and the same technician measured the REE of all subjects. Metabolic variables were .05) ‘There was a significant correlation between measured REE, andthe Harris-Benedict equation (R=.70;P<.0001), PAO equa: tions (R=.67; P<0001), and Liu equation (F=.70; P<.0001). Mean Gtstandard error) differences between measured REE and REE calculated using the Harris-Benedict equation, the FAO equations, and the Liu equation are shown in Table 2. ‘There was no significant difference between measured REE and the Liu equation, but the Hatris-Benedict eqnation and the FAO equations were significantiy higher than measured REE by 8.5% (P<.001) and 5.4% (P<.01), respectively. No signifi cant difference was noted between measured REE of Chinese and Japanese subjects ‘The correlations betweenmeasured REE and woight, height, BMI, and age were 0.71 (P<.001), 0.35 (P=.05), 0.64 (P<.001) and -0.07 (P>.05), respectively” The correlation coefficient, between body weight and measured REE was the strongest of the prodictive variables analyzed, and the correlation between ‘age and measured REE was not significant ‘Contrary tothe Pearson correlation, height and ago were not significant according tothe stepwise regression analysis, which, resulted in the following equation: Measured REE (keal/24 hours): R71 1536+ 12.00x( kg weight); DISCUSSION Sevoral investigators have reported racial differences in REE (711,12). Benedict (11) suggested that the REE of Asians is Tower than the American standard. Schofield (14) reported thal predicted REE may overestimate measured REE of differ- cent racial groups, especially Asian Indians and Italians. In our study, the Harris-Benedict equation, FAO equations and Liu cquational overestimated the measured REE of Asiatt, women, The magnitude of the difference between predicted and measured REE was largest for the Harris-Benedict equa- tion_(110.6415.5 keal) followed by the FAO equations (95.5411 8 kcal) and the Liu equation (90.611.8 keal). Statis- ically, both the FAO equations and the Harris-Benedict cqua- tion significantly overestimated the daily measured REE-of the Asian women by 8.5% (P<.001) and 5.4% (P=.01), respee- tively. FAO equations predicted REE of the subjects: more closely than Harris-Benedict equation. This was not surprising because the FAO equations were developed from data that included whites and other races, whereas the Harris-Benedict ‘equation was based solely on whites. We do not know why the Liu equation—derived froma data on Chinese wornen—overes- timated the measured REB of the subjects, even though the difference was not statistically significant. Nevertheless, pre- vious and current findings suggest Uhat a predictive equation, specific to the racial group can predict energy expenditure ‘more accurately than non-race-speeific equations. Many studies comparing measured REE with the Harris- Benedict and FAO equations have found percentage differ- ences comparable to those of our study (14,15,25-27). Unfor- tunately, most ofthe studies did nol report the race ofsubjects. Daly et al (26) reported that the Harris Benedict equation overestimated REE measured by indirect calorimetry by 18.5412.2% in women, Owen et al (26) confirmed that the Harris- Benedict equation overestimated REK ofhealthy women ‘by 249%. Ravussin et al (27) reported that the Harris-Benedict ‘equation overestimated REE of healthy women by 1.0%. The reported discrepancy of only 1.0%, compared with higher discrepancies reported in other studies, may be at least par-tially explained by the fact that 11 of 16 women were obese; in ‘other studies the subjects were, for the most part, lean. Mifflin et al (28) proposed a new predictive equation because the Harris-Benedict equation overestimated measured REE by 5% ina population of 247 healthy women, ‘The FAO equations have also been reevaluated, Ina study of people from tropics, Henry and Rees (16) reported that the Schofield equation (14), whichis similar to the FAO equations, overestimated REE of women aged 18 to 30 years by 2%; the equation overestimated the REE of women aged 30 t0 60 years, by 8.9%. Ina study conducted by Lawrence et al (29), REE of Gambian women aged 20 to 35 years was an average of 10% above that estimated by FAO equation, Reports about. racial difference in REE are conflicting. Lawrence et al (29) reported that the difference in REE ‘between Scottish and Gambian women was only 4%. In con trast, the difference between Asian Indians (n=332) and whites 390) was about 14% (14). Many studies, including meta- analyses designed to examine racial differences in REE, have consisted of data pooled froin several different studies. The report by WHO/FAO/UNU (8) suggested that one cannot con- clude that racial differences exist, because differences in methodology or conditions under which REE was measured nave not been standardized. Conditions that: varied in the studies include ambient tem peratures, inpatient vs outpatient subject status, and degree of familiarity of subjects with the procedure (30,31). REE is known to rise in below thermoncutral temperatures (30) Berke et al (31) reported an 8% increase in REE measured under outpatient. conditions, although Bullough and Melby (82) found no difference. For these reasons, the method of REE measurement in our study carefully followed the proce- dure used by Harris and Benedict (5). The only difference was that inour study the measurement was not repeated. Figucroa- Colon et al (88) reported that REE in young girls was highly reproducible and that single measurement was appropriate for ‘energy expenditure studies, ‘The possible effect of a tropical climate on REE has been suggested in the past (7,11), but reports are not conclusive. In four study, all the subjects had been in the United States for at Jeast 9 months at the time of the REE measurement; therefore, the effect of habitual climate can be excluded. Recent advances in technology may have resulted in more accurate measurement of oxygen and carbon dioxide in the present. study compared with earlier studies (25,34). For example, analysis of the concentration of oxygen and carbon dioxide was fully automated, and computer outputs—a tech- nology not available earlier this century—were provided every 30 seconds in the present study. ‘Another possible explanation for the difference between measured and calculated REE in this study may be dietary intake and the nutritional status of the subjects, Subjects inthe study of Harris and Benedict’s and those in out study were 12 hours postprandial, at which point the thermic effect of foods isthought to be minimal. However, Dauncey (35) reported that the thermic effect of foods could last longer than 12 hours. A 12% increase in REE of subjects with elevated energy intake was observed 14 hours after the last meal. Dietary intake of the previous day was not controlled in the Harris and Benedict study or in our study, and large day-to-day variations in energy, balance are known io occur (36). Therefore, the amount of food in the meal before the measurements could have influ- ‘enced REE. It is known that REE decreases during semi starvation and starvation (3,8); however, subjects in our study did not restrict their energy intake (according to 3-day diet records), and body weight of subjects was within the normal range for a given height. The mean energy intake of the subjects was slightly below the recommendation of the Japa- nese standard however, some of subjects might have underes- timated their food intake as the dietary record is known to underreport consumption (37,38). One limitation of our study is that we did not determine the body composition of subjects to analyze REE relative to lean Bod as ec mae tins ecm os ince lity that Une diserepancy of measured REE from Harris Benedict equation and FAO equation may be du to cifer- fences in the body composition of the sample populations. Generally, REE per kilogram body weight tends to be lower in a person with higher percentage body fat compared with a person with the same weight but witha lesser percentage body fat, partially because adipose tissue is less metabolically active than organ and muscle tissues (13). Correlations between measured REE and body weight and BMI were both significant (R=.70 and 68, respectively) in the present study, which agrees with other studies (26,27,84). This suggests that the heavier the person, the higher Ute REE. —— We recommend that equations specific to Asians, such as the Liu equation, be used when estimating resting energy expenditure of healthy Asian women ‘Tho mean weight in the fernale population of the Harris and Benedict study was similar (56.5411.6 kg) to the mean weight of our subjects (54.(448.17 kg), but the subjects in the Harris and Benedict study were slightly taller (162£5.2 cm) than those in our study (1595.3 cm); therefore, a similar body composition cannot be assumed. According to Wang et al (39), ‘Asian women have a higher percentage body fat than their Western counterparts. Conway et al (40) reported that there was a racial difference in visceral adipose tissue in black and white women; further comparisons that include Asians are heeded. The difference in the body composition between the subjects in our study and those in the study of Harris and Benedict may have resulted in a variation in REE. Lean body muss or faire mass is unknown, so possible discrepancies due to different body compositions between Asian and white women cannot be explored. ‘Owen et al (26) noted that precise prediction of REE for an individual is impossible because of large variations in actual REE among individuals. They observed that the difference in measured REE of nonathletic women and Harris-Benedict equation predictions was 7% to 35%. Schofield (14) reported 24% to 7% discrepancy between measured REE and the PAO ‘equations, which was supported by our study. The Harris- JOURNAL OF THE AMERICAN DIBTETIC ASSOCIATION /1291,Benedict equation has been cross-validated by several investi- gators. The percentage difference between measured REE and, the Harris-Benedict equation was comparable but somewhat smaller than that in somve of the reported studies (25,26), The reason for sinaller differences observed in our study is un known. This study indieates, however, that an equation devel- ‘oped using an Asian population, such as the Liu equation, is better for estimating REE in Asian women than the FAO ‘equations or the Harris-Benediet equation, APPLICATIONS Indirect calorimetry can accurately measure the energy ex- penditure of a person, but may not always be practical ina field study or in measuring the energy expenditure of ill persons. Use of predictive equations to estimate the energy need is, more practical; however, the FAO equations and the Harris- Benedict equation tend to overestimate the energy exvendi- ture of Asian women, We recommend that equations specificto| Asians, suchas the Liu equation, be used when estimating REE of healtiy Asian women. i This research was supported by Margaret Nicholson Schafer Graduate Fellowship junds and Etta Losee Reilly Home Bconomica Scholarship, Washington State University. Appreciation is e:ttended to the subjects ‘who participated in the study. References 1. 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