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Introduction
The prevalence of overweight and obesity in adolescents is high and increasing (1-4). The ability to predict resting energy expenditure (REE) accurately in overweight and obese adolescents is important to establish reachable goals for dietary intake and weight-loss programs. Energy requirement can be measured by indirect calorimetry but is hardly feasible in most dietetic settings. To predict REE without measuring energy expenditure, several REE predictive equations were developed. Only a few REE predictive equations have been specifically designed for overweight or obese adolescents (5-9). Several studies have validated REE predictive equations in healthy children; however, only a few studies, however, have validated REE predictive equations in obese adolescents (5,10-13). Rodriguez et al. (10) found that the Schofield weight and height equation for 10-18 years was the most accurate equation in a mixed population of obese and nonobese children and adolescents. Dietz et al. (11) concluded in a small group of obese adolescents (n=28) that the FAO/WHO/UNU weight and height (10-18y) equation was the most accurate. Derumeaux-Burel et al. (5) had similar conclusions, although it is unclear whether this equation included both weight and height. The only Dutch study among obese adolescents, by Van Mil et al. (12), recommends the FAO/WHO/UNU weight equation for ages 18-30 y. Therefore, there is no consensus on which REE predictive equation to use in obese adolescents. Although the level of obesity is increasing especially in specific ethnic groups, no information about accurate REE predictive equations for obese persons was found (4). Currently, the FAO/WHO/UNU weight equation for age 10-18 years is the most widely used predictive equation in the Netherlands. As part of evidence-based practice, we sought the most accurate and precise REE predictive equation for overweight and obese adolescents using a comparison with indirect calorimetry.
Subjects and methods
Subjects
The subjects were recruited from the Paediatric Obesity Outpatient Clinic of the VU University Medical Center Amsterdam. The inclusion criteria were 1) age between 12 and 18 years and 2) overweight or obese (from now on called ‘obese’) according to the definition of Cole et al. (14). Exclusion criteria for the study were as follows: not speaking the Dutch language, overweight/obesity as a result of a known syndrome or organic cause (hypothyroidism), mental retardation, physical limitations that would not allow participation in a physical activity program, and diagnosis of type 2 diabetes mellitus. Data on ethnicity were collected during the first visit to the paediatrician at the paediatric outpatient clinic. We asked for the country of birth of both parents. According to the Netherlands Bureau of Statistics (15), an adolescent is considered to be of Dutch ethnicity when both parents are born in the Netherlands (western
Resting energy expenditure
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