Total daily energy expenditure in anorexia nervosa13 Regina

C Casper,

ABSTRACT

Dale

A Schoeller,

Clinical

reports

physical activity for anorexia quantitative measurements. expenditure

(TDEE)

rate (BMR),

and thermic

in six female

outpatients and

weight)

subjects. physical 0.044

± 0.008

(997

BMR

labeled

ThM

nervosa

wt,

similar

L, respectively; roxine

(T4);

P

body

titative

values and

evidence

vosa

despite

were

fat-free

Nutr

There

normal.

mass.

for increased

profound

Am J Clin

groups.

physical

underweight

was

l99l;53:1

KEY

WORDS

Thyroid

composition,

mass

a reduction thyand

doubly

with

and

a decline

anorexia

level

(2-4)

intake

and

that overactivity extraordinary free-living systematic

olescents

ponents

tool

(5) despite

with a high

a restricted

proportions.

treated

and had

water

for measuring of total

basal metabolic (TEM) (9, 10).

199l;53:I

method

physical

energy rate The

accounts attempted

chart

for anorexia

provides

expenditure,

the

(BMR)

and

purpose

of this

143-50.

a unique

as one other

not

Printed

effect was

in USA.

for a diagnosis criteria

3 mo

restricting

duration.

type.

occasionally

be considered

17 to 32 y and

individual goal being

Two

Their

eating

patients

stated

although excessive.

the

mean

of an-

(1 1). All patients

the

The

described

patients’

duration

(12)

and

Patients could insurance

not be hospitalized and therefore re-

and group therapy weight maintenance.

and nutritional One premor-

Metropolitan

Life

height (within 5 cm). No subject a serum albumin concentration known

viewed

and

Review

to alter

approved

kg, from all the

energy by

the

Insurance

normal for ad-

tables

(13)

control subjects with normal from the staff of the university

as through acquaintances. with an anorexia nervosa

ication

illness

nervosa. The mean percent of based on the Iowa Growth Charts

the

ages

of their

Each patient

control by age

was pregnant, of 10% agreement

and was

in anorexia

nervosa

0. 185 ± 0.046 and 0.157 ± 0.044, respectively, and 0.08 1 ± 0.016 in control subjects. The

ratio

intakes published respiratory quotient

and

(Friends of Geology, were measured on a

precision (1 SD) ofthe carbon dioxide-proestimated from this comparison was 5.7%.

deuterium

patients

Bele-

vacuum

spectrometer.

the two estimates were repeated

The relative measurement and

was

spectrometer

were

1 .O4kH). compared

-

respectively);

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mass

method

and

of the

from

over

2 h of 1000

as ln(S)/t, where S is the enrichment is the rate offractionated water loss,

± 0.07,

meal.

Urine black.

(N/2.078Xl.Olko

to that

expressed

at the

production

al-

measurement,

patients

Results the

at liquid

amount equal to 0.47 the liquid meal under

nervosa meal.

ofthe

were

gas over Deutenium

Energy expenditure without correction the oral

samples

samples

HD

patients averaged vs 0. 105 ± 0.020

to 2% with

0700. within

isotope-ratio

dioxide

d. In three the isotope

from

was

weight

carbon dioxide at 25 #{176}C and the carbon dioxide isolated. 180 abundances were measured on

as 1 .05N(l .0lk were calculated

and

subject’s was cal-

ratio

3-60

calculated and rH

nervosa

administered Subjects

supervision

sum

equation

system

as the

except

The

the

were

the results

to allow for the Energy expenditure

expressed

a

Respiratory-gas

but only

Harris-Benedict

4 h after

direct

a percentage

also

flows humidity

and

where N is TBW and is calculated 1.01 ; k and kH are the oxygen and

meal

measured

rest integrated

mm,

Lusk

was

and

daily

water were 0.25 g H2180 and urine output was collected

and

urine

Triplicate

R02

(Schiller

ice trap;

( 1 7).

corrected

were averaged to the hood.

culated

an

with

analyzer

pressure,

for 45-60

measured

dioxide

using

Haldane

35-40 mm accustomed

to BMR

by

system

water

to the CRC.

day

measurement

reduced to hydrogen Bloomington, IN).

was measured Holland), ox-

a single-channel Apanalyzer (Sunnyvale, were

carbon

temperature,

was performed

the final becoming

with oxygen

concentrations

were

for ambient

canopy

Flow rate (Bilthofen,

Average

labeled

Total

the time ofanalysis. with dry carbon

3-60

Nuclide

was

weight.

dose

next

final

accurate

PA).

morning

BMR

of the h the

and

tubes until decolorized

the

constructed at the University ofChicago. with a Godhardt pneumotachograph

time 1000

initial

sample

CRC.

Basal

the

expenditure

equilibrated with was cryogenically

admin-

returned

of

measured

at

sample

subjects

times

sample was obtained in the evening and doubly labeled was administered and allowed to equilibrate overnight.

urine the

amounts

Samples were prepared and analyzed (9, 20). Briefly, urine samples were kept

Body

water

meal

subjects.

energy was

urine

A final 7 when

after

control

to ensure

was suspended

labeled

single

calorie intake was assumed because subjects did not

on the morning

between

Columbus, and the TEM

anthropometric

doubly

a midpoint

the

to leave

after

this

The doses ofstable-isotope-labeled 0. 12 g 2H20/kg estimated TBW. again

immediately

after

urine water

Sub-

sample.

from

significant

daily

ginning

was measured.

urine

lose

TDEE

were

( 16).

impedance

Skinfold either

day

collected

day

collection

by bioelectnic

or on the seventh

and

disorders

permitted

then

for collection

measured

TEM

terminations

that

1 50 mm

was

Total

day.

psychological

or

wk for the

No food was

eating

of calories

changes over the 7-d metabolic period were +0.4 ± 0.4 kg/wk ( ± SD) for the anorexia nervosa patients and -0.4 ± 0.3 kg/

Attitudes Test (EAT) (14) and the (EDI) (1 5). The Beck Depression

for 4 h, except

composition

pletion

water

next

A liquid meal of Ensure Plus (Ross Laboratories, OH) was administered under direct supervision was

water

body

was used to measure depressive symptoms allowed to sleep from 2200 until 0700.

the bed to provide

gain

recorded.

labeled

(TDEE). of the

associated

(CRC)

gave informed

of total

midmorning

characteristics

assessed Eating

vital

percentage

calorie intake divided by 100. Daily to equal the daily energy expenditure

to the sub-

and doubly

determination

until

towards

behavioral

and

was collected

for

Center

was described

and total daily energy

permitted

Research

protocol

Weight,

urine

Clinical

The

consent

for minors.

A baseline

to the

1900.

and informed

jects

AL

the

reported

1800

ET

1.027

± 0.02

was calculated for protein (18)

1.032

anorexia

in respiratory

difference quotient

respiratory quotient from self-reported

nervosa patients (21, 22). The from control subjects was similar

nervosa the

in anorexia

subjects.

by using the Lusk equation and with the assumption that

quotient was 0.85. This food quotient calculated for anorexia obtained

± 0.01

in control

patients was were

the day, then we would be underestimating the anorexia nervosa patients.

(0.86 not

± 0.02 significant.

to continue TDEE

vs 0.83 If this

throughout by 3-5%

in

ENERGY Energy

expended

in

difference

between

TDEE

Physical where

physical

activity

and

the

all are expressed

calculated

was

sum

= TDEE

activity

EXPENDITURE

of BMR

(BMR

-

IN

TEM:

+ TEM)

as MJ/d.

phase Body

composition

Body

was

and water.

the

enrichment

ative

to the

dilution

The baseline

d is the of

dose

urine

retained

the molecular

weight

administered

dose

(N)

APE

body

dose water. sum

to equal

that

TBW

during

from

atom

(bw),

The

MWd

dose

urinary

latter

is

spent

from

estimated

was

101

impedance

up and

about

the dilution

Impedance

placements

The

was

Analyzer on the

hand,

deuterium-dilution

previously

space

Schoeller

with

The

RJL

tetrapolar and

(ND)

was calculated equation

0.382(Ht2/R)

model

dilution

foot

were

(FFM)

and weight

and

by using

+ 8.3 15

(FM)

were

FM

premorbid

calculated

Skinfold-thickness caliper

measurements

at the

measurement

triceps,

was repeated

calculated

was

according

from

to Jackson

from density Blood for state

(T3), reverse measured obtained and TSH

at 0700.

three the sum

et al (25).

according laboratory

and

made

ofthe Percent

averaged.

three

skinfold

body

Serum

total

thyroxine

by radioimmunoassay from Diagnostic by a sensitive

RIA

Body

den-

calculated

drawn

in the

(T4), triiodothyronine

concentrations were (T4 T3 and rT3 by kits ,

RIA

(29).

calculated

the

between

Pearson

Student’s variables

product-moment

t

was corre-

differences were computed patient 2, by virtue of her

overweight,

as mean

using two

± SEM

was

considered

an outlier.

(Systat,

Systat

BMI

Percent normal weight

Inc,

Evan-

and eating

attitudes

Weight

,

Corporation, Los Angeles, Serono Diagnostic, Norwell,

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Height

y

kg

m

30 17 17 30

41.6 60.9 38.0 35.2

1.73 1.70 1.57 1.56

Eating attitudes test

%

13.9 21.1 15.4 14.5

62.1 74.3 72.4 65.2

24 53 71 40 43

5

32

42.0

1.62

16.0

70.6

21

37.5

1.69

13.1

59.1

51

.

24.5

42.5

1.65

15.7

67.3

47.0

2.8

3.8

0.03

1.2

30 16 19 25

58.6 54.4 65.3 51.1

1.67 1.66 1.58 1.56

21.0 19.7 26.2 21.0

5

35

54.8

1.59

6 i SEM

24 24.8

54.5 56.5

1.64 1.62

2.8

2.0

Control subjects 1 2 3 4

thicknesses

fat was was

Each

(TSH) (RIA)

Products from

a Lange

areas.

and

to Siri (26). tests and hormones

T3 (rT3), and thyrotropin

with

upper-thigh

times

inter-

6

SEM

were

suprailiac,

and

1 characteristics

Anorexia nervosa patients I 2 3 4

from

FFM.

-

were

relationship

Between-group pair 2, because

pathological

Age

= N/0.73

= Wt

intra-

2.5%

by a double-antibody

groups The

by calculating

a

and

fasting

data.

lation coefficients. with and without

(23): FFM

sity

between

and

R is resistance in ohms, and was calculated from estimated

fat mass

measured

The

and 22%, respectively. did not cross react but fl-LPH Plasma human growth hormone