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

Steemburgo, Thais; Lazzari, Camila; Farinha, Juliano Boufleur; Paula, Tatiana Pedroso de; Viana, Luciana Vercoza; Oliveira, Alvaro Reischak de; Azevedo, Mirela Jobim de

doi:10.20945/2359-3997000000103

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Original Article • Arch. Endocrinol. Metab. 63 (1) • Feb 2019 • https://doi.org/10.20945/2359-3997000000103 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords
Indirect calorimetry; basal metabolic rate; energy metabolism; type 2 diabetes

Reference	BMR predictive equations	Number of subjects	Sample characteristics	Weight/BMI
Harris-Benedict (³3. Harris J, Benedict FG. A biometric study of human basal metabolism. PNAS. 1918;4(12):370-3.)
Men	66 + [13.8 × W (kg)] + [5.0 × Ht (cm)] – [6.8 × (A)]
Women	655 [9.5 × W (kg)] + [1.9 × Ht (cm)] – [4.7 × (A)]	–	–	–
Schofield (⁴4. Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985;39(1):5-41.)
Men age < 60 years	[0.048 × W (kg) + 3.653] × 239	-	-	-
Men age > 60 years	[0.049 × W (kg) + 2.459] × 239
Women age < 60 years	[0.034 × W (kg) + 3.538] × 239
Women age > 60 years	[0.028 × W (kg) + 2.755] × 239
Mifflin-St. Jeor (⁵5. Mifflin MD, St Jeor ST. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51(2):241-7.)
Men	[W (kg) × 10] + [Ht (cm) × 6.25] – [(A) × 5] + 5	251 men	Healthy adults	–
Women	[W (kg) × 10] + [Ht (cm) × 6.25] – [(A) × 5] + 5 −166	247 women		–
FAO/WHO/UNO (⁶6. FAO. Energy and protein requirements: Report of a joint FAO/WHO/UNO expert consultation. Geneva: World Health Organization; 1985.)
Men age < 60 years	11.6 × W (kg) + 879	7173		–
Men age > 60 years	13.5 × W (kg) + 487	men/women	Healthy adults
Women < 60 years	8.7 × W (kg) + 829
Women > 60 years	10.5 × W (kg) + 596
Gougeon and cols. (²⁰20. Gougeon R, Lamarche M, Yale JF, Venuta T. The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia. Int J Obes Relat Metab Disord. 2002;26(12):1547-52.)		25 men	Patients with type 2 diabetes	100 ± 3 kg
Men and women	375 + (85 × W) – (48 × FM) + (63 × FPG)	40 women	Patients with type 2 diabetes	37 ± 1 kg/m²
Bernstein (²⁹29. Bernstein RS, Thornton JC, Yang MU, Wang J, Redmond AM, Pierson RN Jr, et al. Prediction of the resting metabolic rate in obese patients. Am J Clin Nutr. 1983;37(4):595-602.)
Men	(11.0 × W) + (10.2 × Ht) – (5.8 × A) – 1,032	48 men	Obese
Women	(7.48 × W) + (0.42 × Ht) - (3.0 × A) + 844	154 women
Oxford (³⁰30. Cole TJ, Henry CJ. The Oxford Brookes basal metabolic rate database-a reanalysis. Public Health Nutr. 2005;8(7A):1202-12.)		800 men
Men 30-60 years	14.2 × weight + 593	5,000 women	Healthy adults	–
Men > 60 years	13.5 × weight + 514
Women 30-60 years	9.74 × weight + 694
Women > 60 years	10.1 × weight + 569

Variable		n (21)
Age (years)		62 (48-70)
Duration of diabetes (years)		8 (2-36)
Sex (female)		11 (52.4%)
Psysical activity – level 1 (sedentarism) (%)		14 (66.7%)
Weight (kg)		85.2 ± 18.0
Height (cm)		168.3 ± 10.2
BMI (kg/m²)		29.4 (20.2-37.4)
Fat-free mass (kg)		49.8 ± 9.4
Fat mass (kg)		28.3 ± 7.2
Total energy intake (kcal/day)		2134.3 ± 730.2
Hypertension (%)		21 (100%)
Fasting plasma glucose (mg/dL)		155.6 ± 58.4
A1C test (%)		7.6 (6.1-10.0)
Total cholesterol (mg/dL)		166.4 ± 36.1
LDL cholesterol (mg/dL)		88.7 ± 32.8
HDL cholesterol (mg/dL)		47.2 ± 14.2
Triglycerides (mg/dL)		145 (49-342)
Medications
	Oral antihyperglycemic	21 (100%)
	Antihypertensive agents	21 (100%)
	Hypolipidemic agents	8 (38.1%)

Variable		Mean	SD	95% Limits of Agreement¹ 1 Mean difference ± 1.96 SD of the difference.	p value
Measured BMR by IC (kcal/day)		1745	315
Estimated BMR (kcal/day)
Harris-Benedict (⁵5. Mifflin MD, St Jeor ST. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51(2):241-7.)		1607.8	340.0		0.002^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	-137.4		(-486.0; 211.1)
	Percentage %³ 3 Difference/measured) × 100 (%).	-7.8
Schofield (⁶6. FAO. Energy and protein requirements: Report of a joint FAO/WHO/UNO expert consultation. Geneva: World Health Organization; 1985.)		1552.2	387.2		< 0.001^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	-193.1		(-534.0; 147.8)
	Percentage %³ 3 Difference/measured) × 100 (%).	-11.7
Mifflin-St.Jeor (⁷7. Hagedorn T, Poggiogalle E, Savina C, Coletti C, Paolini M, Scavone L, et al. Indirect calorimetry in obese female subjects: factors influencing the resting metabolic rate. World J Exp Med. 2012;2(3):58-64.)		1508.4	319.0		< 0.001^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	-236.9		(-540.0; 66.2)
	Percentage %³ 3 Difference/measured) × 100 (%).	-13.6
FAO/WHO/UNO (⁸8. Krüger RL, Lopes AL, Gross JS, Macedo RC, Teixeira BC, Oliveira AR. Validation of predictive equations for basal metabolic rate in eutrophic and obese subjects. Rev Bras Cineantropom Desempenho Hum. 2015;17(1):73-81.)		1647.1	331.1		0.012^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	-98.2		(-416.1; 219.8)
	Percentage %³ 3 Difference/measured) × 100 (%).	-5.6
Gougeon (²⁰20. Gougeon R, Lamarche M, Yale JF, Venuta T. The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia. Int J Obes Relat Metab Disord. 2002;26(12):1547-52.)		1593.55	285.4		< 0.001^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	151.8		(-206.5; 510.0)
	Percentage %³ 3 Difference/measured) × 100 (%).	8.7
Bernstein (²⁹29. Bernstein RS, Thornton JC, Yang MU, Wang J, Redmond AM, Pierson RN Jr, et al. Prediction of the resting metabolic rate in obese patients. Am J Clin Nutr. 1983;37(4):595-602.)		1376.7	224.3	(-801.2; 64.0)	< 0.001^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	-368.6
	Percentage %³ 3 Difference/measured) × 100 (%).	-21.1
Oxford (³⁰30. Cole TJ, Henry CJ. The Oxford Brookes basal metabolic rate database-a reanalysis. Public Health Nutr. 2005;8(7A):1202-12.)		1615.1	353.6		0.002^† † Paired Student's t-test: to compared estimated and measured BMR
	Bias² 2 Estimated − measured (kcal in 24h. (kcal/day)	-130.2		(-459.5; 199.2)
	Percentage %³ 3 Difference/measured) × 100 (%).	-7.5

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[1] Correspondence to: Thais Steemburgo Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Universidade Federal do Rio Grande do Sul (UFRGS) Rua Ramiro Barcelos, 2400, 2º andar 90035-003 – Porto Alegre, RS, Brasil tsteemburgo@gmail.com