The Effect of Continuous Positive Airway Pressure on Basal Metabolism Rate in Patients with Severe Obstructive Sleep Apnoea Syndrome

ABSTRACT Objective: To assess the effect of the continuous positive airway pressure (CPAP) treatment on basal metabolism rate (BMR) in patients with severe obstructive sleep apnoea syndrome (OSAS). Methods: Demographic characteristics, body mass index (BMI), apnoea-hypopnoea index (AHI) and smoking history of the patients were recorded. Basal metabolism rate was measured via indirect calorimetry in the morning following nights of polysomnography and CPAP titration. Basal metabolism rate, oxygen consumption (VO2) and carbon dioxide output (VCO2) levels were compared before and after CPAP administration. Results: A total of 25 patients with a mean age of 51.4 ± 13.7 years were included in the study: 6 (24%) female and 19 (76%) male. A significant reduction in the BMR (p = 0.049), VO2 (p = 0.042) and VCO2 (p = 0.008) values were observed after a single night administration of CPAP as compared to before treatment. Furthermore, it was detected that this reduction provided by CPAP treatment was more significant in current smokers, patients with AHI > 60 and BMI ≥ 30. Conclusion: It is suggested that there is a correlation between BMR and the severity of OSAS, and it is possible to provide a significant reduction in BMR with single night administration of CPAP depending on the patient's smoking history, degree of obesity and disease severity.

Basal metabolic rate in Brazilian patients with type 2 diabetes: comparison between measured and estimated values

ABSTRACT Objectives: The aims of this study are to investigate which of the seven selected predictive equation for estimating basal metabolic rate (BMR) is the best alternative to indirect calorimetry (IC) and to evaluate the dietary energy intake in patients with type 2 diabetes. Subjects and methods: Twenty-one patients with type 2 diabetes participated in this diagnostic test study. Clinical and laboratorial variables were evaluated as well as body composition by absorptiometry dual X-ray emission (DXA) and BMR measured by IC and estimated by prediction equations. Dietary intake was evaluated by a quantitative food frequency questionnaire. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients. Results: Patients were 62 (48-70) years old, have had diabetes for 8 (2-36) yeas, and 52.4% were females. The mean body composition comprised a fat-free mass of 49.8 ± 9.4 kg and a fat mass of 28.3 ± 7.2 kg. The energy intake was 2134.3 ± 730.2 kcal/day and the BMR by IC was 1745 ± 315 kcal/day. There was a wide variation in the accuracy of BMR values predicted by equations when compared to IC BMR measurement. Harris-Benedict, Oxford, FAO/WHO/UNO equations produced the smallest differences to IC, with a general bias of < 8%. The FAO/WHO/UNO equation provided the best BMR prediction in comparison to measured BMR. Conclusion: In patients with type 2 diabetes, the equation of the FAO/WHO/UNO was the one closest to the BMR values as measured by IC.

Energy expenditure, growth, and nutritional therapy in appropriate and small for gestational age preterm infants / Gasto energético, crescimento e terapia nutricional em recém-nascidos pré-termo adequados e pequenos para idade gestacional

Abstract Objective: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. Methods: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500 g or gestational age < 32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. Results: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. Conclusion: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

Resumo Objetivo: Avaliar o gasto energético de repouso, o crescimento e a quantidade ofertada de energia e macronutrientes em um grupo de recém-nascidos pré-termo. Método: Foi feito estudo de coorte com recém-nascidos pré-termo adequados e pequenos para a idade gestacional (peso de nascimento inferior a 1.500 gramas ou idade gestacional < 32 semanas). O gasto energético foi avaliado com a calorimetria indireta nos dias 7°, 14°, 21°, 28° dias de vida e alta hospitalar. Medidas do comprimento, perímetro cefálico e peso corporal foram avaliadas semanalmente. A terapia nutricional foi calculada durante a internação do recém-nascido e as informações de cada tipo de alimentação foram registradas em um software que calcula a quantidade total de energia e macronutrientes. Resultados: Foram acompanhados 61 recém-nascidos, sendo 43 adequados e 18 pequenos para idade gestacional. O gasto energético de repouso não apresentou diferença estatística entre os grupos e aumentou entre a primeira e quarta semana de vida (adequados: 26,3% e pequenos: 21,8%). O aporte energético nas duas primeiras semanas de vida mostrou-se bem abaixo do requerimento energético mensurado pela calorimetria. Conclusão: Considerando os resultados que demonstram um gasto energético alto ao longo das primeiras semanas de vida, fica evidente a necessidade de fornecer ao recém-nascido pré-termo um melhor aporte energético já nas primeiras semanas de vida, para que os neonatos com ou sem restrição intrauterina possam atingir o seu potencial máximo de crescimento e desenvolvimento.

Impacto del Programa de manejo de la obesidad Bright Bodies aplicado a niños y adolescentes chilenos / Effects of the Bright Bodies Program in Chilean obese children

Background: Yale University’s Bright Bodies Program consists on a lifestyle intervention, in areas such as nutrition and exercise, while focusing on behavior modification and family support. Aim: To evaluate the impact of the Program in Chilean children and adolescents with obesity who participated in the Program during 8 months. Material and Methods: The weight management Program was carried out during 8 months and consisted in weekly sessions directed by dietitians or psychologists and exercise sessions twice per week in charge of physical education teachers. The family component was based on sessions for parents or caregivers to achieve the same goals of children activities. Results: Twenty eight obese children aged 9.5 ± 2 years completed the eight months of intervention. There was a significant 5% reduction of body mass index (BMI), a 15% reduction of BMI z score and a 2.9% reduction of waist circumference. Bioelectrical impedance showed a 9% reduction of percentage body fat and a 7% increase in lean body mass. Blood pressure, blood glucose, total and LDL cholesterol and triglycerides decreased significantly, without changes in HOMA-IR. The frequency of metabolic syndrome decreased from 36% at baseline to 18% at the end of the intervention. A 43% reduction in caloric intake and an improvement in physical condition was also observed. Conclusions: The Bright Bodies Program produced significant and positive changes on anthropometric and metabolic parameters in this group of children.

Different Location of Triaxial Accelerometer and Different Energy Expenditures

PURPOSE: We performed a study to determine the best appropriate wearing site of a triaxial accelerometer at different exercise speeds. MATERIALS AND METHODS: We conducted an observational study with 66 healthy Korean adults (26 men and 40 women). Resting metabolic rate (RMR) before exercise, physical activity-related energy expenditure (PAEE) by cardiorespiratory gas analyzer and Signal Vector Magnitude (SVM) were measured while wearing four triaxial accelerometers on four different sites (wrist, waist, upper arm, and ankle) at exercise speeds from 2-10 km/h. RESULTS: The mean RMR was 4.03 mL/kg/min and Actual METs (oxygen consumption at different exercise speeds divided by individual RMR) compared with the calculated METs (oxygen consumption divided by 3.5 mL/kg/min) showed relatively low value. The overall correlation between PAEE and SVM was highest when the accelerometer was worn on the wrist at low exercise speed (r=0.751, p<0.001), waist at a moderate speed (r=0.821, p<0.001), and ankle at a high speed (r=0.559, p<0.001). Using regression analysis, it was shown that the ankle at a low speed (R2=0.564, p<0.001), high speed (R2=0.559, p<0.001), and the waist at a moderate speed (R2=0.821, p<0.001) were the best appropriate sites. CONCLUSION: When measuring the PAEE and SVM at different exercise speeds, the ankle in low and high exercise speed, and waist in moderate speed are the most appropriate sites for an accelerometer.

Aspectos nutricionales en la enfermedad de Graves: comunicación de un caso / Nutritional aspects in Graves' disease: case report

Introduction: An increased basal metabolism rate and hyperphagia associated with weight loss are among the main clinical manifestations of hyperthyroidism. However, few literature reports are available regarding the adequacy of calorie consumption based on the energy expenditure of the patient. Case Report: A 24-year-old male patient (weight 61.5 kg, height 1.78 m) with a diagnosis of hyperthyroidism due to Graves' disease and initial hormone values consistent with this disease (free T3=17,6 pg/ml; free T4>6,0 ng/dl; TSH<0,004 IU/ml). Indirect calorimetry was performed in order to estimate real energy expenditure and adequacy of the nutritional conducts adopted during hospitalization. The patient had a resting energy expenditure of2574 kcal. Conclusion: The present study suggests that the measurement of energy expenditure by indirect calorimetry is an important tool for the evaluation of the energy requirements and diet adequacy of a patient with thyrotoxicosis due to Graves' disease.

Introducción: El aumento del metabolismo basal, hiperfagia asociada con pérdida de peso son algunas de las principales manifestaciones clínicas que ocurren en el hipertiroidismo. Sin embargo, hay pocos estudios disponibles acerca de la necessidad y del gasto energético del paciente. Caso clínico: Varón de 24 años de edad con 61,5 kg de peso y estatura de 1,78 m, con el diagnóstico de hipertiroidismo por enfermedad de Graves (T3 libre = 17,6 pg/ml; T4 livre >6,0 ng/dl; TSH <0,004 IU/ml) y con los siguientes síntomas: pérdida de peso, aumento de apetito y hiperactividad. La calorimetría indirecta se realizó para estimar el consumo energético real para definir la conduta nutricional durante la hospitalización. El gasto energético basal fue de 2574 kcal. Conclusión: El presente estudio sugiere que la medición del gasto energético por calorimetría indirecta es una herramienta importante para la evaluación de las necesidades de energía y la adecuación de la dieta de un paciente con tirotoxicosis por enfermedad de Graves. Se necesitan más estudios para determinar el impacto de esta conducta en la evaluación de la respuesta al tratamiento del hipertiroidismo.

Energy expenditure in critically ill surgical patients. Comparative analysis of predictive equation and indirect calorimetry / Gasto energético em pacientes cirúrgicos. Análise comparativa entre equação preditiva e calorimetria indireta

PURPOSE: The aim of this investigation was to compare the resting energy expenditure (REE) calculated by the Harris-Benedict equation (REE HB) with the REE measured by indirect calorimetry (REE IC) in critically ill surgical patients under mechanical ventilation. METHODS: Thirty patients were included in this work. REE was calculated by the Harris-Benedict equation (REE HB) using real body weight, and it was also measured by indirect calorimetry (REE IC), which was performed for 30 minutes. RESULTS: REE HB had significant (p < 0.0005) but low correlation (Spearman r = 0.57) with REE IC, with a mean bias of 12 kcal.d-1 and limits of agreement ranging from - 599.7 to 623.7 kcal.d-1 as detected by the Bland-Altman analysis. CONCLUSION: These findings suggest that REE IC seems to be more appropriate than REE HB for accurate measurement of REE in critically ill surgical patients under mechanical ventilation.

OBJETIVO: O objetivo deste estudo foi comparar o gasto energético de repouso (GER), calculado pela equação de Harris-Benedict (GER HB) com o GER medido pela calorimetria indireta (GER CI) em pacientes cirúrgicos gravemente enfermos em ventilação mecânica. MÉTODOS: Trinta pacientes foram incluídos nesta investigação. O gasto energético de repouso foi calculado pela equação de Harris-Benedict (GER HB) utilizando o peso corporal real e medido pela calorimetria indireta (GER CI). A calorimetria indireta foi realizada durante 30 minutos. RESULTADOS: O gasto energético de repouso calculado pela equação de Harris-Benedict mostrou uma correlação significativa (p < 0,0005), porém fraca (Spearman r = 0,57) com GER CI, com um viés médio de 12 kcal.d-1 e os limites de concordância variando de - 599,7 a -623,7 kcal.d-1 como detectados pela análise de Bland-Altman. CONCLUSÃO: Estes achados sugerem que a calorimetria indireta parece ser mais apropriada do que a equação de Harris Benedict para a medida exata do GER em pacientes cirúrgicos gravemente enfermos em ventilação mecânica.

Determinação da taxa metabólica basal em cutias, Dasyprocta azarae, por calorimetria indireta / Determination of the basal metabolic rate in agoutis, Dasyprocta azarae, by indirect calorimetry

A melhor ferramenta para comparação fisiológica entre organismos diferentes é a taxa metabólica basal, inter-relação fundamental que existe entre todos os seres vivos. Mensurações diretas das concentrações de oxigênio e dióxido de carbono, pela análise do ar inspirado e expirado, podem ser usadas para a mensuração de taxa metabólica. Este trabalho foi executado com o propósito de aferir as taxas metabólicas basal e específica, e reexaminar o escalonamento do metabolismo basal em cutias (Dasyprocta azarae). Foram utilizadas 34 cutias (D. azarae) adultas sadias, sendo 9 machos não castrados, 9 machos castrados e 16 fêmeas, pertencentes ao plantel do Criadouro Científico do Museu de História Natural Capão da Imbuia, Curitiba, PR. Os animais passaram por jejum prévio de 6 horas e foram acondicionados em caixas especiais, com temperatura ambiente controlada (22,0±1,0ºC), sendo então submetidos à aferição da taxa metabólica basal, por calorimetria indireta. Empregou-se o monitor metabólico Deltatrac®II, (Datex Ohmeda, Finlândia) usualmente indicado para a mensuração da produção de dióxido de carbono (VCO2) e do consumo de oxigênio (VO2) em seres humanos, por meio da mensuração das variações na concentração de VCO2 e de VO2, com uma precisão de 0,01 por cento. Após a aferição da taxa metabólica basal, foi calculada a taxa metabólica específica, e efetuada a análise dos dados por estatística indutiva. Os testes de hipóteses para comparação entre amostras indicaram que a taxa metabólica específica de machos não castrados é maior que a de fêmeas e machos castrados (5 por cento de significância), e que a taxa metabólica específica de fêmeas e machos castrados é equivalente (1 por cento de significância). Constatou-se ainda, com a análise da correlação de pontos experimentais, que outra variável que não o tamanho corporal afeta a taxa metabólica dos machos não castrados (1 por cento de significância), o que indica a necessidade de novos estudos sobre...

The best way to compare different organisms is the basal metabolic rate, a fundamental interrelation existent among all living beings. Direct measures of oxygen and carbon dioxide concentrations by evaluation of inspired and expired air can be used to measure metabolic rate. So, this research was done in order to measure basal and specific metabolic rates in agoutis (Dasyprocta azarae), and reexamine the scaling of basal metabolism in this species. There were used 34 adult healthy agoutis (9 non-castrated males, 9 castrated males, and 16 females), that belong to the wild animal scientific breeding facility of the Natural History Museum of the Curitiba city, State of Paraná, Brazil. After a six-hour fasting the animals were placed in special boxes under controlled temperature (22.0±1.0ºC), and submitted to measuring of the basal metabolic rate, by indirect calorimetry. It was used the Deltatrac®II metabolic monitor, usually indicated to measure carbon dioxide production (VCO2) and oxygen consumption (VO2) in human beings, by measuring variations in the concentration of VCO2 and of VO2, with a precision of 0.01 percent. The specific metabolic rate was calculated after determination of the basal metabolic rate and the obtained data were analyzed by inductive statistics. The hypotheses tests for comparison among samples indicated that the specific metabolic rate is higher in non-castrated males than in females and castrated males (significance of 5 percent), and that the specific metabolic rate of females and castrated males are equivalent (significance of 1 percent). In addition, analysis of the correlation of experimental points indicates that another variable beyond body size affects the metabolic rate of non-castrated males (significance of 1 percent), and therefore new studies on the metabolism of Dasyprocta azarae are required.

Validação das equações que estimam a taxa metabólica de repouso em adolescentes meninas / Validation of the equations that estimate the resting metabolic rate in adolescent girls

OBJETIVOS: O objetivo deste estudo é analisar a validade das equações de predição da taxa metabólica de repouso (TMR) propostas por Harris e Benedicti (1919), Schofield (1985), WHO/FAO/UNU (1985), Henry e Rees (1991), Molnár e cols. (1995), Tverskaya e cols. (1998) e Müller e cols. (2004) em adolescentes meninas. SUJEITOS E MÉTODOS: Para tanto, avaliaram-se 51 meninas entre 10 e 17 anos, sendo mensuradas as seguintes variáveis: massa corporal, estatura, massa gorda (absoluta e percentual) e massa magra (absoluta e percentual), bem como os valores do consumo de VO2 e produção de VCO2 que foram substituídos na equação de Weir (1949) considerada, neste estudo, como método padrão da TMR. Realizaram-se os seguintes procedimentos estatísticos: teste "t" pareado (p < 0,05); erro constante (EC) com diferença menor que 5 por cento e análise gráfica de Bland e Altman (1986). RESULTADOS: As equações propostas por Tverskaya e cols. (1998) e Müller e cols. (2004) foram as únicas que apresentaram diferenças significativas entre as médias. No entanto, somente as equações propostas por Henry e Rees (1991) e Molnár e cols. (1995) obtiveram erro constante inferior a 5 por cento. Porém, as análises gráficas de Bland e Altman (1986) revelaram que, independentemente da equação, não há concordância entre as equações e o método padrão. CONCLUSÕES: O estudo indicou que as equações não aprovaram nos critérios estipulados e que, portanto, não possuem validade no cálculo da TMR.

OBJECTIVES: The objective of the study is to analyze the validity of the prediction equations for the resting metabolic rate (RMR) proposed by Harris and Benedicti (1919), Schofield (1985), WHO/FAO/ UNU (1985), Henry and Rees (1991), Molnár and cols. (1995), Tverskaya and cols. (1998) and Müller and cols. (2004) in adolescent girls (51 girls between 10 and 17 years of age). SUBJECTS AND METHODs: The following anthropometric variables were measured: body weight, stature, body fat mass (absolute and percentage), body lean mass (absolute and percentage) as well as the consumption ofVO2 and production ofVCO2 that were substituted in Weir's (1949) equation which was considered the RMR standard method in this study. The following statistical procedures were carried out: paired t-test (p < 0.05); constant error (CE) with a less than 5 percent difference and Bland and Altman's (1986) graphical analysis. RESULTS: The equations proposed by Tverskaya and cols. (1998) and Müller and cols. (2004) were the only equations that presented significant differences between the averages. However, only the equations proposed by Henry and Rees (1991) and Molnár and cols. (1995) produced a constant error of less than 5 percent. However, Bland and Altman's (1986) graphical analysis showed that independently of the equation there is no agreement between the equations and the standard method. CONCLUSIONS: The study indicates that none of the equations meet all the stipulated criteria and that thus have no validity in the calculation of the RMR.

A suplementação de L-carnitina não promove alterações na taxa metabólica de repouso e na utilização dos substratos energéticos em indivíduos ativos / The supplementation of L-carnitine does not promote alterations in the resting metabolic rate and in the use of energetic substrates in physically active individuals

OBJETIVO: Avaliar o efeito da suplementação de L-carnitina, por 30 dias, sobre a taxa metabólica de repouso (TMR) e oxidação de ácidos graxos livres (AGL), em repouso e exercício. SUJEITOS E MÉTODOS: Vinte e um voluntários ativos (40 a 58 anos) com sobrepeso foram randomizados em dois grupos: suplementado (GS; N = 11; 1,8 g/dia de L-carnitina) e placebo (GP; N = 10; maltodextrina). Foi feita avaliação da ingestão calórica, antropometria, determinação da TMR, VO2máx, quociente respiratório e AGL plasmáticos. RESULTADOS: Não houve diferença significativa na ingestão (-244,66 vs. -126,00 kcal/dia), composição corporal (-0,07 vs. -0,17 kg/m²), TMR (0,06 vs. -0,02 kcal/ dia), quociente respiratório em repouso (3,69 vs. -1,01) e exercício (0,01 vs. -0,01) e VO2máx (0,50 vs. 1,25 mL/kg/min) para o grupo GS em relação ao GP. Houve aumento dos AGL em repouso no GP (0,27), porém sem diferenças no exercício para os grupos. CONCLUSÃO: Não houve efeito da L-carnitina em nenhuma das variáveis analisadas no estudo.

PURPOSE: To investigate the effects of L-carnitine supplementation, over thirty days, on the resting metabolic rate (RMR) and oxidation of free fatty acids (FFA) under rested or exercised conditions. SUBJECTS AND METHODS: Twenty-one overweight active volunteers (40 to 58 years old) were randomized into two groups: supplemented (GS; N = 11; 1,8 g/day of L-carnitine) or placebo (GP; N = 10; maltodextrin). Caloric intake, anthropometry, RMR, VO2max, respiratory exchange ratio and plasma FFA were measured. RESULTS: No significant changes were found in the caloric intake (-244,66 vs. -126,00 kcal/day), body composition (-0.07 vs. -0.17 kg/m²), RMR (0.06 vs. -0.02 kcal/day), respiratory exchange ratio at rest (3.69 vs. -1.01) and exercise (0.01 vs. -0.01) or VO2max (0.50 vs. 1.25 mL/kg/min) between GS and GP. Plasma FFA levels were increased under resting conditions only in the GP group (0.27), but no significant changes were observed before or after physical activity in any of the groups. CONCLUSION: Supplementation with L-carnitine caused no changes in the variables analyzed in this study.

Padronização do gasto metabólico de repouso e proposta de nova equação para uma população feminina brasileira / Characterization of metabolic resting rate and proposal of a new equation for a female Brazilian population

OBJETIVOS: Os objetivos do estudo foram normatizar o gasto metabólico de repouso (GMR) de mulheres brasileiras, avaliar a adequação da fórmula de Harris Benedict (HB), a relação entre suas variáveis e propor novas equações para estimativa do GMR. SUJEITOS E MÉTODOS: Para tanto, foram utilizados 760 exames de calorimetria indireta (CI) de mulheres com idade entre 18 e 65 anos. Os resultados foram tabulados, a população foi dividida de acordo com quintis de peso e, então, realizaram-se as análises estatísticas. RESULTADOS: A média de GMR variou entre 1.226 calorias/dia a 1.775 calorias/dia. A fórmula de HB superestimou o GMR em torno de 7 por cento.Concluímos, a partir da correlação entre as variáveis, que o peso possui correlação positiva com o GMR, e a idade, uma correlação negativa. CONCLUSÃO: GMR assim como coeficiente respiratório (QR) podem ser utilizados como preditores de obesidade. Nosso estudo trouxe duas novas propostas de equações, uma para a população com índice de massa corpórea (IMC) > 35 kg/m² e outra para a população com IMC < 35 kg/m².

OBJETIVES: The goals of this study were to standardize resting metabolic rate (RMR) in the Brazilian female population and evaluate the suitability of the HB equation. SUBJECTS AND METHODS: In order to do so, 760 indirect calorimetry (CI) measurements performed in Brazilian female patients between 18 and 65 years old, were used. The results were tabulated, the population distributed according to the quintiles of weight, and the statistical analyses applied. RESULTS: The average RMR varied from 1,226 to 1,775 calories/day. The HB equation overestimated the RMR by about 7 percent. From the correlation between the variables, we conclude that weight has a positive correlation with RMR and age a negative correlation. CONCLUSION: The RMR and respiratory quotient (QR) can be used as obesity predictors. Two new equations were proposed in our study, one for the population with body mass index (BMI) > 35 kg/m² and another for the population with BMI < 35 kg/m².

Symmorphosis in the proximal pathway for oxygen in the leaf-eared mouse Phyllotis darwini

In this report, we explore the matching of structures to functional needs by comparing previously reported data of maximal oxygen consumption and the development of the lung in the leaf-eared mouse Phyllotis darwini in warm and cold environments. We discuss whether the state of structural design is commensurate with functional needs from regulated morphogenesis as predicted by the hypothesis of symmorphosis. We found a close match between respiratory structures and functional needs during postnatal development, expressed as safety factors close to unity. However, in the adult stage the safety factors were greater than two, which suggests that adult animals acquired a structure greater than that required considering their maximum capacities. A high safety factor in the respiratory system of adult mice may be a consequence of the symmorphosis that operates during ontogeny and does not necessarily support a rejection of this hypothesis.

Taxa metabólica de repouso e composição corporal em mulheres na pós-menopausa / Resting metabolic rate and body composition in postmenopausal women

OBJETIVO: A presente pesquisa avaliou a relação entre a taxa metabólica de repouso (TMR) e a composição corporal de mulheres na pós-menopausa. MÉTODOS: Participaram 30 mulheres inativas fisicamente, com média de idade 54,33 ± 5,20 anos. O consumo de oxigênio foi avaliado por meio de calorimetria indireta após 12 horas em jejum e os valores obtidos foram calculados segundo a equação de Weir. A composição corporal foi obtida pelo método de dobras cutâneas e a medida da circunferência de cintura (CC) foi utilizada para avaliar a gordura abdominal. Utilizou-se a correlação linear de Pearson para estabelecer as correlações entre as variáveis. RESULTADOS: Foram encontradas correlações significantes da TMR com a CC (r = 0,42) e com a massa magra (MM) (r = 0,48). CONCLUSÕES: As variáveis da composição corporal que podem estar envolvidas na determinação da TMR são a MM e a CC.

OBJECTIVE: The present study evaluated the relationship between resting metabolic rate (RMR) and body composition of postmenopausal women. METHODS: Thirty physically inactive women participated in the study, and their age average was 54,33 ± 5,20 years old. Oxygen consumption was measured by indirect calorimetry after 12 hours of fasting and the values were calculated according to the equation of Weir. Body composition was obtained by the method of skinfolds and the measurement of waist circumference (WC) was used to assess abdominal fat. The linear correlation of Pearson was used to establish correlations between the variables. RESULTS: We found significant correlations of TMR with the CC (0.42) and the lean mass (LM) (r = 0.48). CONCLUSIONS: The variables of body composition that can be involved in the determination of the RMR are LM and WC.

Gasto energético y composición corporal en mujeres con obesidad severa y mórbida sometidas a bypass gástrico / Energy expenditure and body composition in severe and morbid obese women after gastric bypass

The effects of gastric bypass (GBP) on resting energy expenditure (REE) are not well known. Aim: To evaluate the changes in REE and its relationship with body composition in severe and morbid obese women before and six and twelve months after GBP. Patients and methods: Twenty three women aged 37±10 years, with a body mass index of 44±4 kg/m², were evaluated before, six and twelve months after GBP. REE was measured in a Deltatrac indirect calorimeter and expressed as kcal/day Fat mass (EM), and fat free mass (EEM) were determined by double beam Xray densitometry (DEXA). Results: Body weight reduction six and twelve months after GBP was 29.0±4.3 and 35.8±6.9 percent, respectively. The best predictor of weight reduction was initial weight (p <0.01). At six and twelve months, REE decreased by 291.7±260.0 and 353.8±378.4 kcal/day, respectively. In the same periods REE/kg body weight increased by 3.3 and 4.8 kcal/kg respectively, compared to baseline. REE/kg EEM was unchanged. Conclusions: GBP was associated with significant changes in body composition after six and twelve months. However, despite weight reduction, resting energy expenditure per fat free mass unit did not change significantly.

Análise da taxa metabólica de repouso avaliada por calorimetria indireta em mulheres obesas com baixa e alta ingestão calórica / Analysis of resting metabolic rate evaluated by indirect calorimetry in obese women with low and high caloric intake

Este trabalho analisou se mulheres obesas com baixa ingestão calórica (IC), aferidas por questionário alimentar, apresentam valores diminuídos de taxa metabólica de repouso (TMR), o que favoreceria um desequilíbrio no balanço energético (BE) e conseqüente ganho de peso. Foram avaliados o índice de atividade física (AF) e sua relação com a IC em 77 mulheres obesas, com índice de massa corporal (IMC) acima de 30 kg/m², entre 20 e 45 anos. A partir dos valores da IC, as mulheres foram divididas em três grupos: baixa (G1), média (G2) e alta (G3) IC e submetidas a exame de calorimetria indireta de repouso. Foram avaliados: peso, altura, superfície de área corpórea (SAC), composição corporal por bioimpedância. O G1 apresentou maior valor de peso, SAC, peso de gordura corpórea e também valores abaixo de 1,2 na razão IC:TMR, o que indica provável subestimação da IC. Os maiores valores de AF e de TMR (por quilo de massa magra) foram verificados no G3. O G1 apresentou o BE mais negativo. O G3 apresentou valores positivos. Em suma, este estudo mostrou que existe tendência à subestimação da IC de algumas mulheres obesas e que a manutenção do peso corporal em algumas pacientes se deve ao baixo nível de AF.

The aim of this study was to evaluate if obese women with the lowest values of caloric intake (CI) determined by food questionnaire also present the lowest values of resting metabolic rate (RMR), which could lead to excessive weight gain, caused by changes in energy balance. With this porpouse, 77 obese women, with IMC > 30kg/m², aged 20 to 45 years, had their physical activity level and CI evaluated. According to the values of CI obtained from food intake reports, the participants were divided in 3 groups: low (G1), medium (G2), high (G3) CI and were submitted to indirect calorimetry. Height, weight, body surface area (BSA), fat free mass and fat mass measured by bioimpedance were evaluated. The highest values of weight, BSA an fat mass were obtained in G1, as well as values above 1.2 for the CI:RMR ratio, which indicates a probable underestimation of CI. The highest values of physical activity and RMR were observed in the G3 (with high caloric intake). In conclusion, this paper shows that a tendency towards underestimation of self-reported caloric intake exists among obese women and that the maintenance of weight in some patients can be due to their low level of physical activity.

An easy way to estimate energy expenditure from hemodynamic data in septic patients / Um modo simples de estimar o consumo de energia a partir de dados hemodinâmicos em pacientes sépticos

PURPOSE: The purpose of this study is to compare the resting energy expenditure (REE) obtained by indirect calorimetry (IC) to the REE calculated by predictive equations (Brandi and Liggett) using the oxygen consumption (VO2) obtained by Fick's method in septic patients. METHODS: Prospective study in septic patients admitted in an intensive care unit of a university hospital. Fifteen adult patients (11 men and four women) were studied. VO2 measurements were made using a portable metabolic cart connected to a respirator and a pulmonary artery catheter. RESULTS: The APACHE II at admission was 22.6±7.2 with a mortality risk of 46.1±27.7 percent. The mean REE obtained by IC and by the Brandi and Liggett equations were 1699±271, 1815±355 and 1361±277 kcal.day-1 respectively. There were no statistically significant differences between the two methods, with the two means showing a difference of 8.7 percent. REE values were close for IC x BRANDI (r=0.80), but the IC x LIGGETT correlation was only 0.58. CONCLUSIONS: The results suggest that REE can be easily calculated by obtaining VO2 with the Swan-Ganz catheter and using the Brandi equation even for septic patients under mechanical ventilation.

OBJETIVO: O objetivo desse estudo foi o de comparar o consumo de oxigênio em repouso (COR) obtido por calorimetria indireta (CI) com valores do COR calculados por equações preditivas (Brandi e Ligget) que utilizam o consumo de oxigênio (VO2) obtido pelo método de Fick em pacientes sépticos. MÉTODOS. Estudo prospectivo em pacientes sépticos internados em unidade de terapia intensiva de um hospital universitário. Quinze pacientes adultos (onze homens e quatro mulheres). As medidas de VO2 foram realizadas usando um aparelho metabólico portátil conectado ao respirador e por cateter em artéria pulmonar. RESULTADOS: O índice APACHE II na admissão foi 22.6±7.2 com risco de mortalidade de 46.1±27.7 por cento. As médias do COR obtidas por CI e pelas equações de Brandi and Liggett foram, respectivamente, 1699±271, 1815±355 e 1361±277 kcal.day-1 Não se observaram diferenças estatisticamente significantes entre os dois métodos com as duas médias mostrando uma diferenças de 8.7 por cento. Os valores de COR Também foram próximo dos valores de CI x BRANDI (r=0.80), mas a correlação com CI x LIGGETT apenas 0.58. CONCLUSÕES: Os resultados sugerem que o COR pode ser facilmente calculado para obter-se o VO2 com o cateter de Swan-Ganz e pelo uso da equação de Brandi para pacientes sépticos em ventilação mecânica.

Avaliação do estado nutricional e do balanço energético de um grupo de atletas de ginástica artística / Evaluation of nutritional status and energetic balance of artistic gymnasts

O presente estudo teve por objetivo avaliar o estado nutricional de um grupo de atletas de ginástica artística. Participaram do estudo 14 atletas, com idade entre 11 e 15 anos, classificadas, de acordo com os critérios estabelecidos pela OMS (1995), como pré-puberes. Foram avaliados: massa corporal, estatura, e calculado o IMC (índice de massa corporal). A composição corporal foi avaliada a partir de bioimpedância elétrica (Biodynamics, 450e). O gasto energético de repouso (GER) e o gasto energético diário foram analisados por calorimetria indireta (VO2000- Inbrasport) adicionada do fator atividade (diário de atividade física). A partir de três diários alimentares foi calculada a ingestão de: energia (Kcal), macronutrientes (g), fibras (g), ferro (mg), cálcio (mg) e vitamina C. Algumas variáveis foram correlacionadas a partir do coeficiente de Pearson (p<0,05). Principais resultados: IMC = 15,85 ± 1,39Kg/m2; gordura corporal= 11,64 ± 3,16 e massa magra corporal= 27,06 ± 5,14Kg. Os valores obtidos por calorimetria ndireta não apresentaram correlação significativa com as fórmulas preditivas. O balanço energético foi negativo para o grupo (-1143,08Kcal). As alterações no balanço energético e a baixa gordura corporal observadas no presente estudo apontam para a necessidade de trabalhos educativos junto às atletas e seus técnicos no que diz respeito à alimentação, ao controle da massa corporal e à saúde.

The nutritional status of artistic gymnasts (14 girls, 11 to 15 years old, without menarche and pubertal signals) was evaluated. Body mass, stature, and body mass index (BMI) have been measured together with body composition, evaluated by bioelectrical impedance. Daily energetic expenditure was calculated from resting metabolic rate (RMR) including the activity factor, obtained from daily physical activity. Three food diary were filled by the evaluated group, from which the ingested energy (Kcal), macronutrients (g), dietetic fiber (g), iron (mg), calcium (mg) and vitamin C (mg) were obtained. Correlations among variables were calculated from Pearson´s coefficient, adopting p<0,05. The main results were: BMI = 15,85 ± 1,39Kg/m2; body fat= 11,64 ± 3,16 and 3,59 ± 1,32Kg; lean mass= 27,06 ± 5,14Kg. Energetic balance presented negative values (-1143, 08Kcal). The energetic balance alterations and low body fat found in the present study pointed the need of education programs with the athletes and technical staff, regarding feeding schedule, body weight control and health.

Gasto energético de repouso medido vs. estimado e relação com a composição corporal de mulheres / Resting energy expenditure measured vs. estimated and this relationship with body composition in women / Resting energy expenditure measured vs. estimated and this relationship with body composition in women

OBJETIVOS: Medir o gasto energético de repouso (GER, kcal/d), comparar as equações de predição disponíveis na literatura e associar a composição corporal. MÉTODOS: Vinte e oito sedentárias foram voluntárias [peso: 79 ± 12 kg; estatura: 164 ± 5 cm; idade: 36 ± 11 anos; índice de massa corporal (IMC): 29 ± 4 kg/m²]. A composição corporal foi estimada por antropometria, o GER foi medido por calorimetria indireta e estimado pelas principais equações da literatura. Foram desenvolvidas equações para estimativa do GER sendo a melhor a GER-Nosso. RESULTADOS: Diferentes tempos de coleta produziram resultados similares para o GER medido. O GER estimado pelas fórmulas de Harris & Benedict, FAO/WHO/UNO somente peso e peso mais altura, Schofield e GER-Nosso foram estatisticamente iguais ao GER medido. As equações do Siervo & Falconi, Schofield e Henry & Rees não foram correlacionadas ao GER medido. O melhor preditor isolado do GER foi a massa corporal e a melhor associação quando ajustado por unidade (kg) foi a massa magra. A equação desenvolvida no presente trabalho foi: GER(kcal/d)= 21837 - 14,448 * Peso(kg) + 54,963 * Massa Magra(kg) - 9,341 * Estatura(cm) - 4,349 * Idade(anos) - 19753 * Densidade Corporal(g/ml). CONCLUSÃO: As equações de predição do GER podem induzir a erros de predição e parecem ser população-específicas. O melhor resultado de predição foi para fórmula desenvolvida com os dados antropométricos das voluntárias (medido= 1617 ± 237 kcal/d; GER-Nosso= 1616 ± 167 kcal/d).

OBJECTIVES: To compare the resting energy expenditure (REE, kcal/d) measured to the disposable equation of literature and to associate this to body composition. METHODS: Twenty-eight sedentary women were volunteers [weight: 79 ± 12 kg; stature: 164 ± 5 cm; age: 36 ± 11 years; body mass index (BMI, kg/m²): 29 ± 4]. The body composition was estimated with anthropometry methods; REE was measured by indirect calorimetry and was estimated by the main equations of the literature. Equations were developed to estimate REE and the best of them was REE-Our. RESULTS: The different time of harvest produced a similar result to REE measured. The Harris & Benedict, FAO/WHO/UNO only weight, and weight plus height, Schofield and REE-Our equations results were statistically similar to REE measured. The Siervo & Falconi, Schofield and Henry & Rees equations did not have correlation with the measured calorimetry. The best-isolated predictor of the REE was the body mass and the best association when adjusted to unit (kg) was lean body mass. The equation developed in the present work was: REE(kcal/d)= 21837 - 14,448 * Weight(kg) + 54,963 * Lean Mass(kg) - 9,341 * Stature(cm) - 4,349 * Age(years) - 19753 * Body Density(g/ml). CONCLUSION: The REE prediction equations can prompt to errors and seem to be population specific. The best prediction result was with the equation developed with anthropometrics variables of the volunteers (measured= 1617 ± 237 kcal/d; REE-Our= 1616 ± 167 kcal/d).

Medición del gasto energético basal o en reposo / Basal or rest energy expenditure determination

Las funciones vitales del organismos requieren un determinado gasto energético, que debe ser compensado por los alimentos y bebidas de la dieta. Así. Las necesidades energéticas se definen como la cantidad de energía necesaria para mantener la salud, el crecimiento y un nivel apropiado de actividad física. En situaciones de equilibrio, el ajuste entre la energía ingerida y el consumo energético diario se alcanza a través de diferentes mecanismos, que regulan el apetito y el gusto energético, evitando grandes variaciones en el peso a lo largo del tiempo y, por tanto, la destrucción calórica y obesidad. La medición del gasto energético aporta un dato objetivo en el manejo nutricional de pacientes hospitalizados y ambulatorios. Una de las metodologías utilizadas para realizar la medición es la calorimetría directa o indirecta. La base teórica de la calorimetría asegura exactitud y confiabilidad cuando la medición se realiza bajo condiciones adecuadas. La calorimetría indirecta constituye el método de aplicación más frecuente en clínica, adaptándose para ser usado en todo tipo de pacientes mientras que la calorimetría directa es reservada para estudios de investigación y desarrollo.

Métodos e equações de predição para avaliação do metabolismo energético / Methods and prediction equations for assessment of energy metabolism / Los métodos y ecuaciones de predicción para la evaluación del metabolismo energético

Introdução: A energia é necessária para a manutenção de diversas funções orgânicas, incluindo respiração, circulação, atividade física e manutenção da temperatura corporal. Ao consumir alimentos, a energia é liberada no organismo para a oxidação, produzindo energia química para manter o metabolismo e homeostase corpóreos. Muitos métodos têm sido empregados para estimar a necessidade energética de indivíduos e populações, incluindo a calorimetria indireta, água duplamente marcada e equações. objetivo: O presente artigo descreve e discute a importância e os aspectos mais relevantes dos métodos e equações que avaliam os componentes do gasto energético, colocando suas vantagens e limitações para uso individual e populacional. Também aponta a necessidade de se desenvolver equações mais específicas, principalmente para a população brasileira, para que melhores estimativas possam ser produzidas tanto para uso clínico quanto epidemiológico.

Introduction: It is required for maintenance of various physiological functions, including respiration, circulation, physical activity and maintenance of body temperature. When consuming food, energy is released in the body for the oxidation, producing chemical energy to maintain metabolic homeostasis and tangible. Many methods have been used to estimate the energy needs of individuals and populations, including indirect calorimetry, doubly labeled water and equations. Objective: This article describes and discusses the importance and the most relevant aspects of the methods and equations that evaluate the components of energy expenditure, putting their advantages and limitations for individual use and population. It also points out the need to develop more specific equations, especially for the Brazilian population, so that better estimates can be produced both for clinicians and epidemiologists.

Introducción: Se necesita para el mantenimiento de diversas funciones fisiológicas, incluyendo la respiración, la circulación, la actividad física y el mantenimiento de la temperatura corporal. Cuando el consumo de alimentos, la energía se libera en el cuerpo por la oxidación, produciendo energía química para mantener la homeostasis metabólica y tangibles. Muchos métodos han sido utilizados para estimar las necesidades energéticas de los individuos y poblaciones, inclusive la calorimetría indirecta, del agua doblemente marcada y ecuaciones. Objetivo: El presente artículo describe y analiza la importancia y los aspectos más relevantes de los métodos y ecuaciones que evaluar los componentes del gasto energético, poniendo sus ventajas y limitaciones para el uso individual y la población. También señala la necesidad de desarrollar ecuaciones más específicas, especialmente para la población brasileña, de modo que la mejora de las estimaciones pueden ser producidos tanto para los clínicos y epidemiólogos.