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Chapter 6
analysis without the overweight group. We observed no apparent differences in percentage accurate prediction, bias, and RMSE.
Only a few validation studies were conducted in this specific population (5,10- 13), and they compared a different and very small set of equations (usually ≤ 4). Comparisons of the Schofield or FAO/WHO/UNU equations are based only on children aged of 3-10 and 10-18 years. The results are, therefore, difficult to compare. The Schofield and FAO/WHO/UNU equations based on weight and height were found to be the best REE predictive equation by Rodriguez et al. (10) and Dietz et al. (11). Derumeaux-Burel et al. (5) concluded ‘the FAO equation had no systematic bias’. From these studies (5,10-13) only the Dutch study by van Mil et al. (12) evaluated and found improved predictions by the FAO equations based on the older category (18-30 years).
Five equations (Derumeaux-Burel, Lazzer, Molnar, Schmelze and Tverskaya) were specifically developed for obese adolescents (5-9). The Molnar equation predicted well in our group. Also, Schmelze et al. (8) predicted well with 71% accurate predictions, but with a higher RMSE. Lazzer et al. (13) had 72% accurate predictions; however, with 26% overpredictions and a large bias of 5.6%.
The REE predictive equations of Derumeaux-Burel (2004) (5) and Tverskaya (1998) (6), both based on FFM, had 53% and 71% accurate predictions in our population. However, the equation of Derumeaux-Burel had 46% overpredictions and a bias of 10.8%. For FFM-based equations, we did not observe any improvement in predictions. In other studies, it is repeatedly shown that equations based on FFM have no added value over-prediction by age, height, and weight (18,26). Korth et al. (26) compared 6 body- composition methods, and the choice of method was not the explanation for the results. Most FFM- based equations used bioimpedance for body-composition assessment, except for Johnstone et al. (36), who used air-displacement plethysmography (Bodpod). According to Korth et al. (26), there must be another explanation, maybe in the rather large residual (unexplained) error. Also, but less clear, the inclusion of height did not improve the REE prediction. Because the height is usually available, this is not a practical limitation for use of REE prediction equations. On the basis of the present analysis, it remains unclear whether inclusion of height is better, but because the best-performing Molnar equation is also based on height, we consider height to be important enough for REE prediction in obese adolescents.
Our study showed differences between ethnic groups, but there were no systematic differences in the REE in kcal, kcal/kg, or kcal/kg FFM. A review of the relation between ethnicity and REE concluded that there are sufficient data to conclude that ethnicity has been a factor in the REE prediction in adults. In children, these data are inconsistent. Most of the studies reviewed involved an Afro-American population (37). However, the non-western population in our study was not of sub-Saharan African descent; for this reason, no comparison
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