Nutr Res Pract.  2018 Aug;12(4):336-341. 10.4162/nrp.2018.12.4.336.

Validation of Dietary Reference Intakes for predicting energy requirements in elementary school-age children

• Kim EK
• Ndahimana
• Ishikawa-Takata K
• Lee S
• Kim H
• Lim K
• Lee IS
• Tanaka S
• Kim YJ
• Choi YJ
• Ju MJ
• Park J

• KMID: 2420999
• DOI: http://doi.org/10.4162/nrp.2018.12.4.336

Abstract

BACKGROUND/OBJECTIVES
Dietary Reference Intakes (DRI) for energy are derived from total energy expenditure (TEE) measured using the doubly labelled water (DLW) method. The objective of this study was to assess the validity of DRI for predicting the energy requirements of elementary school-age children.
SUBJECTS/METHODS
The present study involved 25 elementary school-age children aged between 9 and 11 years. TEE was assessed by the DLW method, and the results were compared with the TEE predicted by the DRI equations in order to evaluate accuracy.
RESULTS
The subjects' TEE measured by the DLW method was 1,925.2 ± 380.9 kcal/day in boys and 1,930.0 ± 279.4 kcal/day in girls, whereas resting energy expenditure was 1,220.2 ± 176.9 kcal/day in boys and 1,245.9 ± 171.3 kcal/day for girls. The physical activity level was 1.58 ± 0.20 in boys and 1.55 ± 0.13 in girls. The mean bias between the predicted and measured TEE was 12.6% in boys and −1.6% in girls, and the percentage of accurate predictions was 28.6% and 63.6%, respectively. In boys, the equation resulted in underprediction of TEE among the subjects having low TEE values, whereas there was overprediction among subjects having high TEE values as shown by the Bland-Altman plot. On the contrary, this proportional bias was not observed in girls.
CONCLUSIONS
The findings of this study suggest that the DRI equation for energy could result in the overestimation of energy requirements in elementary school-age boys. In the case of girls, the equations could be accurate at the group level. However, the DRI appears to be invalid for individual girls, as more than one third of girls had their TEE inaccurately predicted. We recommend more studies for confirmation of these results.

Keyword

Child; nutrition requirements; energy expenditure

MeSH Terms

Bias (Epidemiology)
Child*
Energy Metabolism
Female
Humans
Methods
Motor Activity
Nutritional Requirements
Recommended Dietary Allowances*
Water
Water

Figure

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  Fig. 1 Correlation between TEEDRI and TEEDLW in boys (A) and girls (B). TEEDLW, total energy expenditure measured by the DLW method; TEEDRI, total energy expenditure calculated by the DRI predictive equation.

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  Fig. 2 Bland-Altman plot of differences between TEEDRI and TEEDLW in boys (A) and girls (B). SD, standard deviation; TEEDLW, total energy expenditure measured by the DLW method; TEEDRI, total energy expenditure calculated by the DRI predictive equation.

Reference

1. Santaliestra-Pasías AM, Rey-López JP, Moreno Aznar LA. Obesity and sedentarism in children and adolescents: what should be bone? Nutr Hosp. 2013; 28:Suppl 5. 99–104.

2. Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, Bleich SN, Cheskin LJ, Showell NN, Lau BD, Chiu DT, Zhang A, Segal J. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015; 16:547–565.

3. Brown CL, Halvorson EE, Cohen GM, Lazorick S, Skelton JA. Addressing childhood obesity: opportunities for prevention. Pediatr Clin North Am. 2015; 62:1241–1261.

4. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, James WP, Wang Y, McPherson K. Child and adolescent obesity: part of a bigger picture. Lancet. 2015; 385:2510–2520.

5. Institute of Medicine of the National Academies (US). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: National Academies Press;2002.

6. Torun B. Energy requirements of children and adolescents. Public Health Nutr. 2005; 8:968–993.

7. Park J, Kazuko IT, Kim E, Kim J, Yoon J. Estimating free-living human energy expenditure: practical aspects of the doubly labeled water method and its applications. Nutr Res Pract. 2014; 8:241–248.

8. Speakman JR. The history and theory of the doubly labeled water technique. Am J Clin Nutr. 1998; 68:932S–938S.

9. Wong WW, Roberts SB, Racette SB, Das SK, Redman LM, Rochon J, Bhapkar MV, Clarke LL, Kraus WE. The doubly labeled water method produces highly reproducible longitudinal results in nutrition studies. J Nutr. 2014; 144:777–783.

10. Silva AM, Santos DA, Matias CN, Minderico CS, Schoeller DA, Sardinha LB. Total energy expenditure assessment in elite junior basketball players: a validation study using doubly labeled water. J Strength Cond Res. 2013; 27:1920–1927.

11. Trabulsi J, Schoeller DA. Evaluation of dietary assessment instruments against doubly labeled water, a biomarker of habitual energy intake. Am J Physiol Endocrinol Metab. 2001; 281:E891–E899.

12. Plasqui G, Westerterp KR. Physical activity assessment with accelerometers: an evaluation against doubly labeled water. Obesity (Silver Spring). 2007; 15:2371–2379.

13. St-Onge M, Mignault D, Allison DB, Rabasa-Lhoret R. Evaluation of a portable device to measure daily energy expenditure in free-living adults. Am J Clin Nutr. 2007; 85:742–749.

14. Butte NF, Wong WW, Wilson TA, Adolph AL, Puyau MR, Zakeri IF. Revision of Dietary Reference Intakes for energy in preschool-age children. Am J Clin Nutr. 2014; 100:161–167.

15. Harrell JS, McMurray RG, Baggett CD, Pennell ML, Pearce PF, Bangdiwala SI. Energy costs of physical activities in children and adolescents. Med Sci Sports Exerc. 2005; 37:329–336.

16. Bandini LG, Lividini K, Phillips SM, Must A. Accuracy of dietary reference intakes for determining energy requirements in girls. Am J Clin Nutr. 2013; 98:700–704.

17. Park JH, Ishikawa-Takata K, Lee SJ, Kim EK, Lim KW, Kim HR, Lee IS, Tanaka S. Association between daily step counts and physical activity level among Korean elementary schoolchildren. J Exerc Nutrition Biochem. 2016; 20:51–55.

18. Crouter SE, Antczak A, Hudak JR, DellaValle DM, Haas JD. Accuracy and reliability of the ParvoMedics TrueOne 2400 and MedGraphics VO2000 metabolic systems. Eur J Appl Physiol. 2006; 98:139–151.

19. Kim MH, Kim JH, Kim EK. Accuracy of predictive equations for resting energy expenditure (REE) in non-obese and obese Korean children and adolescents. Nutr Res Pract. 2012; 6:51–60.

20. Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949; 109:1–9.

21. Black AE, Prentice AM, Coward WA. Use of food quotients to predict respiratory quotients for the doubly-labelled water method of measuring energy expenditure. Hum Nutr Clin Nutr. 1986; 40:381–391.

22. Ministry of Health and Welfare (KR). The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2015. Sejong: Ministry of Health and Welfare;2016.

23. Kaneko K, Ito C, Koizumi K, Watanabe S, Umeda Y, Ishikawa-Takata K. Resting energy expenditure (REE) in six- to seventeen-year-old Japanese children and adolescents. J Nutr Sci Vitaminol (Tokyo). 2013; 59:299–309.

24. Hoffman DJ, Sawaya AL, Coward WA, Wright A, Martins PA, de Nascimento C, Tucker KL, Roberts SB. Energy expenditure of stunted and nonstunted boys and girls living in the shantytowns of São Paulo, Brazil. Am J Clin Nutr. 2000; 72:1025–1031.

25. Yoon JS, Kim GJ, Kim JH, Park YS, Gu JO. A Study to Determine the Recommended Dietary Allowance of Energy and to Develop Practical Dietary Education Program for Korean Adults. Seoul: Ministry of Health and Welfare;2002.

26. Kim Y, Na HJ. The estimation of the daily energy expenditure of Korean adolescents. Korean J Community Nutr. 2003; 8:270–279.

27. Choi HJ, Song JM, Kim EK. Assessment of daily steps, activity coefficient, body composition, resting energy expenditure and daily energy expenditure in female university students. J Korean Diet Assoc. 2005; 11:159–169.

28. Lee HM, Kim EK. Assessment of daily steps, physical activity and activity coefficient of the elementary school children in the rural area. Korean J Community Nutr. 2007; 12:361–371.

29. Lee JS, Lee GH, Kim EK. Assessment of daily steps, activity coefficient and daily energy expenditures of dieticians in Youngdong area. J Korean Diet Assoc. 2006; 12:277–288.

30. Lee SH, Park JS, Kim EK. Assessment of daily steps, physical activities and activity coefficient of policemen who do shift-work. Korean J Nutr. 2007; 40:576–583.

31. Ha KH, Kim DJ. Epidemiology of childhood obesity in Korea. Endocrinol Metab. 2016; 31:510–518.

32. Lee G, Ham OK. Factors affecting underweight and obesity among elementary school children in South Korea. Asian Nurs Res. 2015; 9:298–304.

33. Tooze JA, Schoeller DA, Subar AF, Kipnis V, Schatzkin A, Troiano RP. Total daily energy expenditure among middle-aged men and women: the OPEN Study. Am J Clin Nutr. 2007; 86:382–387.

34. Kim EK, Kim JH, Kim MH, Ndahimana D, Yean SE, Yoon JS, Kim JH, Park J, Ishikawa-Takata K. Validation of dietary reference intake equations for estimating energy requirements in Korean adults by using the doubly labeled water method. Nutr Res Pract. 2017; 11:300–306.