Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2005) / Chapter Skim
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5. Energy
5. Energy
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From page 107... ...
is defined as the average dietary energy intake that is predicted to maintain energy balance in a healthy, adult of a defined age, gender, weight, height, and level of physical activity consistent with good health. To calculate the EER, prediction equations for normal weight individuals were developed from data on total daily energy expenditure measured by the doubly labeled water technique.
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BACKGROUND INFORMATION Humans and other mammals constantly need to expend energy to perform physical work; to maintain body temperature and concentration gradients; and to transport, synthesize, degrade, and replace small and large molecules that make up body tissue. This energy is generated by the oxidation of various organic substances, primarily carbohydrates, fats, and amino acids.
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The phenomenon has been precisely measured by indirect calorimetry in human subjects, in whom ethanol consumption was found to primarily reduce fat oxidation (Suter et al., 1992)
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However, the biochemical and physiological evidence about the contribution made by ethanol to oxidative phosphorylation is so unambiguous that the apparent discrepancies between energy intake data and body weights must be attributed to inaccuracies in reported food intakes. In fact, in individuals consuming a healthy diet, the additional energy provided by alcoholic beverages can be a risk factor for weight gain (Suter et al., 1997)
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In underweight individuals, on the other hand, desirable energy intakes are greater than their current energy expenditure to permit weight gain and maintenance of a higher body weight. Thus, it seems logical to base estimated values for energy intake on the amounts of energy that need to be consumed to maintain energy balance in adult men and women who are maintaining desirable body weights, taking into account the increments in energy expenditure elicited by their habitual level of activity.
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From page 112... ...
This standardized metabolic state corresponds to the situation in which food and physical activity have minimal influence on metabolism. The BMR thus reflects the energy needed to sustain the metabolic activities of cells and tissues, plus the energy needed to maintain blood circulation, respiration, and gastrointestinal and renal processing (i.e., the basal cost of living)
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cal/24 (k RMR1,000 0 FFM (kg) FIGURE 5-2 Resting metabolic rates (RMR)
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. Because most people adjust their clothing and environment to maintain comfort, and thus thermoneutrality, the additional energy cost of thermoregulation rarely affects total energy expenditure to an appreciable extent.
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, while one-third is used for physical activity. In very active individuals, 24-hour total energy expenditure can rise to twice as much as basal energy expenditure (Grund et al., 2001)
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, or the Physical Activity Index. Describing physical activity habits in terms of PAL is not entirely satisfactory because the increments above basal needs in energy expenditure, brought about by most physical activities where body weight is supported against gravity (e.g., walking, but not cycling on a stationary cycle ergometer)
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Recommendations about energy intake vary accordingly, and are also subject to the criterion that an individual adult's body weight should remain stable and within the healthy range. SELECTION OF INDICATORS FOR ESTIMATING THE REQUIREMENT FOR ENERGY Reported Energy Intake The reported energy intakes of weight-stable subjects (i.e., those in energy balance)
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. Thus, mean expected energy requirements for different levels of physical activity were defined.
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. Measurement of Energy Expenditure by Doubly Labeled Water The DLW method is a relatively new technique that measures TEE in free-living individuals.
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A critical mass of DLW data has now accumulated on a wide range of age groups and body sizes, so that the estimated energy requirements provided in this report could be based on DLW measurements of TEE. The available DLW data (Appendix I)
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. Thus, although there may be some adaptive capacity to alter TEE in response to changes in dietary energy intake, the DLW-based evaluation of TEE at approximate weight maintenance provides an appropriate estimate of energy expenditure from which energy requirements for maintaining energy balance can be derived.
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122 DIETARY REFERENCE INTAKES TABLE 5-2 Comparison of Carbon Dioxide Production Rates Measured by the Doubly Labeled Water Method and Indirect Calorimetry in Humans Reference Subjects n Time (d) Coward et al., 1984 Adults, in energy balanced 4 12 Klein et al., 1984 Adults, in energy balance 1 5 Schoeller and Webb, 1984 Adults, in energy balance 5 5 Roberts et al., 1986 Preterm infants, growing 4 5 Schoeller et al., 1986 Adults, in energy balance "Low" dose 6 4 "High" dose 3 4 Jones et al., 1987 Infants, after surgery 9 56 Westerterp et al., 1988 Adults, in energy balance Sedentary 5 6 Active 4 3.5 Riumallo et al., 1989 Adults 6 7 Seale et al., 1990 Adults, in energy balance 4 13 Ravussin et al., 1991 Obese adults, in energy 12 7 balance Schulz et al., 1992 Adults, in energy balance 9 7 Seale and Rumpler, 1997 Adults, in energy balance 19 10 aCalculations for pool: I = 2-pool model using measured pool sizes as proposed by Coward et al.
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dEnergy balance indicates that induction of positive or negative energy balance was not part of study protocol.
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and of percent body fat versus BMI and triceps skinfold (Appendix Table H-5) were used to construct Figures 5-3 and 5-4.
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, BMI is a better predictor of differences in percentage of body fat than in men (R2 = 0.55, Appendix Table H-3) , and in women, triceps skinfold data (R2 = 0.82, Appendix Table H-5)
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. TABLE 5-5 Body Weight Classification by Body Mass Index (BMI)
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vs. body mass index (BMI)
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Yet no correlation can be detected between height and percent body fat in men, whereas in women a negative correlation exists, but with a very small R2 value (0.0026) (Appendix Table H-6)
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and fat mass (FM) as a function of height in adult men and women with body mass indexes of 18.5, 25, 30, and 35 kg/ m2 (from Appendix H)
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. Childhood overweight is associated with several risk factors for later heart disease and other chronic diseases including hyperlipidemia, hyperinsulinemia, hypertension, and early arteriosclerosis (Must and Strauss, 1999)
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FACTORS AFFECTING ENERGY EXPENDITURE AND REQUIREMENTS Body Composition and Body Size While body size and body weight exert marked effects on energy expenditure, it is still disputed whether differences in body composition quantitatively affect energy expenditure. In adult men and women with moderate levels of body fat (20 to 35 percent)
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Obesity Another question relevant to the effect of body composition on energy requirements is whether obese individuals taken as a group have altered energy requirements, either prior to the development of obesity (in
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or following weight stabilization at a high level. The information relating to the former issue is conflicting, as cross-sectional studies consistently show that overweight and obese individuals have higher absolute values for TEE than nonobese adults, as the effect of high RMR values associated with increased body size generally outweighs the influence of low energy expenditure of physical activity (EEPA)
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. In those studies, there was no relationship between TEE and growth rate, further suggesting that TEE is within the normal range in individuals who are apparently susceptible to excess weight gain but maintain a normal weight.
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As such, these data are consistent with the general view that obesity is a multifactor problem. The question of whether obese individuals may have decreased energy requirements after weight loss, a factor that would help explain the common phenomenon of weight regain following weight loss, has also been investigated.
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. TABLE 5-9 Reference Heights and Weights for Girls 3 Through 18 Years of Age Based on Median Height and Median Weight for Age Height Range 3rd97th Age (y)
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51.697.1 (113.7213.9) Weight Range 3rd97th Median Weight (kg [lb]
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. Recent studies have focused on using doubly labeled water to quantify the effects of physical activity on TEE.
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. There may also be chronic changes in energy expenditure associated with regular physical activity as a result of changes in body composition and alterations in the metabolic rate of muscle tissue, neuroendocrine status, and changes in spontaneous physical activity associated with altered levels of fitness (van Baak, 1999; Webber and Macdonald, 2000)
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Similarly, Blaak and coworkers (1992) reported no measurable change in spontaneous physical activity in obese boys enrolled in an exercise-training program.
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used imprecise methods for assessing body composition. A separate longitudinal study (Goran et al., 1998a)
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The energy cost of growth as a percentage of total energy requirements decreases from around 35 percent at 1 month to 3 percent at 12 months of age, and remains low until the pubertal growth spurt, at which time it increases to about 4 percent (Butte, 2000)
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However, in individuals who gain significant amounts of weight as they get older, RMR may actually increase due to gains of FM and FFM. There is evidence suggesting that the RMR response to changes in energy balance may be attenuated in old versus young adults (Roberts and Dallal, 1998)
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Genetics Energy requirements vary substantially between individuals due to combinations of differences in body size and composition, differences in RMR independent of body composition, differences in TEF, and differences in physical activity and in EEPA. All of these determinants of energy requirements are potentially influenced by genetic inheritance, with transmissible and nontransmissible cultural factors contributing to variability as well.
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suggesting genetic influences on voluntary physical activity. Since EEPA is the major variable component of TEE, it is likely that genetic influences on EEPA may contribute substantially to intra-individual variability in TEE.
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. Similarly, physical activity levels were not different between Pima Indian and Caucasian children (Salbe et al., 1997)
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Potential effects of ambient temperature on energy requirements include the postprandial and postabsorptive metabolic rate (which would also include energy expenditure for shivering and nonshivering thermogenesis) , the amount and types of voluntary and required physical activity, and EEPA.
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In addition to the effects of normal variations in ambient temperature on sedentary TEE, there may also be season-related influences on the amount of voluntary physical activity and EEPA, but these potential effects are less well defined. Burstein and coworkers (1996)
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Changes in energy intake or in energy expenditure trigger metabolic and behavioral responses aimed at restoring energy balance in adults. These responses involve the endocrine system, the central nervous system, and the body energy stores.
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. Environmental conditions favoring high energy consumption and low physical activity can overwhelm these mechanisms and lead to positive energy balance, resulting in body fat accumulation and weight gain until another state of weight maintenance becomes established.
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By reducing growth rate, children are able to save energy and may subsist for prolonged periods of time on marginal energy intakes, though at the cost of eventually becoming stunted. Another common example of accommodation is a reduction in physical activity.
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Exclusion criteria included undernutrition, acute and chronic diseases, underfeeding and overfeeding protocols, and lifestyles involving uncommonly high levels of physical activity (e.g., elite athletes, astronauts, military trainees, and those with a physical activity level [PAL] greater than 2.5)
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The database for overweight and obese adults contains information on 360 individuals -- 165 men and 195 women (Appendix Table I-7)
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BEE and physical activity level were not used for infants. For children, BEE Data Analysis and Assumptions Made for the Total Energy Expenditure Equations For the normative DLW database, prediction equations of TEE from age, gender, height, and weight were developed.
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Because of the difficulty of estimating physical activity in the field, a four-level ordinal variable was generated, estimated from PAL data and used in the model to modify the total height and weight contribution to TEE. Various transformations of the data and the inclusion of multiplicative terms were explored, but none significantly improved how well the model described the data.
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1.58 (62) aSummary of data in Appendix Tables I-6 and I-7.
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All data were entered into and analyzed with SPSS, version 10.0. Physical Activity Level Categories The PAL categories were defined as sedentary (PAL 1.0 < 1.4)
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FIGURE 5-6 Total energy expenditure and age in all individuals (excluding infants and pregnant or lactating women) in the doubly labeled water database (Appendix I)
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basis. Regression of Total Energy Expenditure on Age, Height, Weight, and Physical Activity Level Category While stepwise multiple linear regressions were used to identify gender, age, height, and weight as the important variables for predicting TEE, physiological considerations determined that the form of the best predictive equation was nonlinear: TEE = A + B × age + PA × (D × weight + E × height)
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In the above equation the relative importance of height and weight is constant for different activity levels but the magnitude of their combined contribution changes for different PAL levels. Because of the mathematical interdependencies between the physical activity coefficients and the height and weight coefficients, the physical activity coefficient for the sedentary PAL category is set to 1.0.
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For each fit an R-squared was calculated as the ratio of the explained sum of squared error to the total sum of squared error, and asymptotic standard errors of the coefficients were calculated. TEE Equations for Normal-Weight Children Separate TEE predictive equations were developed for normal-weight boys and girls from age, height, weight, and PAL category using the same definitions as that for adults (see Table 5-12)
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, and Physical Activity Level (PAL) for each of the PAL Categories in Adults Included in the DLW Databasea BMI PAL (kg/m2)
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b (kg/m2) b Measuredb 1,567 ± 261 22.1 ± 1.7 1.23 ± 0.11 2,036 ± 252 22.1 ± 1.8 1.52 ± 0.05 2,303 ± 288 21.8 ± 1.7 1.74 ± 0.09 2,588 ± 348 21.2 ± 1.6 2.09 ± 0.16 2,229 ± 447 21.7 ± 1.7 1.73 ± 0.31 1,992 ± 263 23.0 ± 1.5 1.29 ± 0.10 2,500 ± 381 22.4 ± 1.5 1.51 ± 0.05 2,892 ± 402 22.5 ± 1.5 1.74 ± 0.08 3,338 ± 419 22.4 ± 1.6 2.06 ± 0.01 2,784 ± 561 22.5 ± 1.5 1.70 ± 0.25 1,788 ± 373 30.3 ± 5.0 1.25 ± 0.10 2,205 ± 344 30.2 ± 4.3 1.52 ± 0.06 2,594 ± 452 31.0 ± 6.6 1.74 ± 0.08 2,888 ± 347 28.9 ± 3.3 2.04 ± 0.11 2,400 ± 545 30.3 ± 5.3 1.65 ± 0.27 2,378 ± 546 30.3 ± 6.3 1.27 ± 0.09 2,719 ± 544 29.7 ± 6.5 1.50 ± 0.06 3,142 ± 425 29.4 ± 4.1 1.73 ± 0.09 3,821 ± 608 29.9 ± 4.2 2.10 ± 0.14 3,174 ± 727 29.7 ± 5.0 1.74 ± 0.30 Prediction equations of TEE for normal-weight boys and girls ages 3 through 18 years were then developed using age, height, weight, and PAL category as predicted from the above BEE equations.
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FINDINGS BY LIFE STAGE AND GENDER GROUP Infants and Children Ages 0 Through 2 Years Evidence Considered in Determining the Estimated Energy Requirement Energy Expenditure and Energy Deposition. The energy requirements of infants and young children should balance energy expenditure at a level of physical activity consistent with normal development and allow for deposition of tissues at a rate consistent with health.
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. Experimental conditions varied across studies in which indirect calorimetry was used to measure SMR or resting metabolic rate (RMR)
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Physical Activity. Physical activity represents an increasingly larger component of the total energy expenditure (TEE)
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. In practicality, the energy cost of growth is an issue only during the first half of infancy when energy deposition contributes significantly to energy requirements.
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Gender was not a statistically significant predictor of TEE, once body weight was accounted for. Because of the small sample size and limited range of estimated physical activity, the physical activity level (PAL)
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for Boys 0 Through 2 Years of Age Reference Total Energy Energy Weight Expenditureb Depositionc EER (kcal/d)
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These estimates of total energy expenditures are approximately 80 percent of the 1985 FAO/WHO/UNU recommendations for energy intake of infants and toddlers (FAO/WHO/UNU, 1985) , which were based upon observed energy intakes of infants compiled by Whitehead and colleagues (1981)
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Physical Activity. Energy needs per unit body weight for maintenance and growth decrease in relation to the increased energy needed for physi
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172 DIETARY REFERENCE INTAKES TABLE 5-18 Human Milk Intake and Composition Energy Intake from Stage of Milk (As Reported in Study Country n Lactation Study) a Anderson et al., Canada 10 women 35 d Not reported 1981 811 d 1518 d 2629 d Anderson et al., United 9 women 3 d Not reported 1983 States 7 d 14 d Butte and United 23 1 mo Not reported Calloway, 1981 States Butte et al., United 37 infants 1 mo 520 ± 131 kcal/d 1984a, 1984b States 40 infants 2 mo 468 ± 115 kcal/d 37 infants 3 mo 458 ± 124 kcal/d 41 infants 4 mo 477 ± 111 kcal/d Dewey et al., United 12 women 720 mo 610 kcal/d at 7 mo 1984 States 735 kcal/d at 1116 mo Ferris et al., United 12 women 2 wk Not reported 1998 States 6 wk 12 wk 16 wk Lammi-Keefe United 6 women 8 wk Not reported et al., 1990 States Nommsen et al., United 58 infants 3 mo Not reported 1991 States 45 infants 6 mo 28 infants 9 mo 21 infants 12 mo Heinig et al., United 38 F, 33 M 3 mo 535.37 ± 81.26 kcal/d 1993 States 30 F, 26 M 6 mo 518.64 ± 114.72 kcal/d 22 F, 24 M 9 mo 439.77 ± 143.40 kcal/d 21 F, 19 M 12 mo 303.54 ± 172.08 kcal/d aMean ± SD, unless otherwise noted.
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ENERGY 173 Energy Content of Milka Maternal Intakea Comments 50 kcal/dL Not reported Full-term infants 60 kcal/dL Milk energy content was 60 kcal/dL approximated from 60 kcal/dL study figure 51 ± 9 kcal/dL Not reported Full-term pregnancies 63 ± 9 kcal/dL 67 ± 10 kcal/dL 66 ± 12 kcal/dL Not reported Navajo women 0.68 ± 0.08 kcal/g 2,334 ± 536 kcal/d Healthy term infants, 0.64 ± 0.08 kcal/g 2,125 ± 582 kcal/d exclusively breast-fed 0.62 ± 0.09 kcal/g 2,170 ± 629 kcal/d 0.64 ± 0.10 kcal/g 2,092 ± 498 kcal/d 65 kcal/dL Not reported Breast-feeding mothers 78.1 ± 12.5 kcal/dL 2,315 ± 658 kcal/d Full-term pregnancies, 75.3 ± 7.7 kcal/dL 2,439 ± 806 kcal/d healthy nonsmokers, 79.2 ± 9.3 kcal/dL 2,384 ± 845 kcal/d exclusively breast82.9 ± 12.2 kcal/dL 2,337 ± 724 kcal/d feeding Energy content measured by bomb calorimetry 66.5 kcal/dL ± 7.74 2,531 ± 442 kcal/d Exclusively breast(range 51.981.2 feeding kcal/dL) Full-term pregnancies 69.7 ± 6.7 kcal/dL 2,340 kcal/d Healthy, exclusively 70.7 ± 9.2 kcal/dL (range: 1,477 breast-feeding mothers 70.9 ± 7.4 kcal/dL 3,201 kcal/d)
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, but these variations are assumed to minimally impact total energy requirements of children, as only from 8 to 32 kcal/d are estimated to be required for tissue deposition. EER Summary, Ages 3 Through 8 Years Marked variability exists for boys and girls in the EER because of variations in growth rate and physical activity (Zlotkin, 1996)
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. Where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be 1.0 < 1.4 (sedentary)
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bBased on equations given in Appendix Table I-8. PAL = physical activity level.
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In adolescents, changes in occupational and recreational activities further alter energy requirements.
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bBased on equations given in Appendix Table I-8. PAL = physical activity level.
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Physical Activity. Physical activity reflects the energy expended in activities beyond basal processes for survival and for the attainment of physical, intellectual, and social well-being.
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. Regular physical activity is often associated with decreased body fat in both genders and, sometimes, increased FFM, at least in males (Parizkova, 1974; Sunnegardh et al., 1986; Deheeger et al., 1997)
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It is recognized that the energy deposited in newly synthesized tissues varies in childhood, particularly around the adolescent growth spurt, but these variations minimally impact total energy requirements. Longitudinal data on the body composition of normally growing adolescents are not available.
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Occupational and recreational activities also variably affect energy requirements. To derive the EER for children, the DLW data (Appendix Table I-2)
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Physical Activity. The physical activities carried out by free-living individuals vary greatly in intensity as well as duration, and assessment of physical activity-induced increments in TEE in individuals is fraught with considerable uncertainties.
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Whereas the energy cost of weight-bearing physical activities is approximately proportional to body weight, BEE is not proportional to body weight, as the contribution of FFM to basal metabolism is much greater than FM (resulting in a substantial intercept in the equations relating BEE to body weight)
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) Where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be 1.0 < 1.4 (sedentary)
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60.0 (132) Low active Active Very active 1.60 (63)
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ENERGY 187 EER, Men (kcal/d) c EER, Women (kcal/d)
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For each year above 30, subtract 7 kcal/d for women and 10 kcal/d for men. bPAL = physical activity level.
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) , where PA is the physical activity coefficient of 1.00 for sedentary PAL, 1.12 for low active PAL, 1.27 for active PAL, and 1.45 for very active PAL.
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Physical Activity. Until late gestation, the gross energy cost of standardized nonweight-bearing activity does not significantly change.
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For overweight women, the mean rate of weight gain is 0.9 kg in the first trimester and 0.30 kg/wk in the second and third trimesters. Fat gains associated with gestational weight gains within the IOM recommended ranges were measured in 200 women with varying prepregnancy BMIs using a four-component body composition model (Lederman et al., 1997)
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Mean total energy deposition was equal to 39,862 kcal or 180 kcal/d (Table 5-26)
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. Since TEE changes little and weight gain is minor during the first trimester, no increase in energy intake during the first trimester is recommended.
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1950 years EERpregnant = EERnonpregnant + additional energy expended during pregnancy + energy deposition 1st trimester = adult EER + 0 + 0 2nd trimester = adult EER + 160 kcal (8 kcal/wk × 20 wk) + 180 kcal 3rd trimester = adult EER + 272 kcal (8 kcal/wk × 34 wk)
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Lactation Evidence Considered in Determining the Estimated Energy Requirement Basal Metabolism. Increased RMRs and SMRs have been observed in lactating women on the order of 4 to 5 percent (Butte et al., 1999; Forsum et al., 1992; Sadurskis et al., 1988; Spaaij et al., 1994a)
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Gain (kg) Goldberg et al., 1991b 10 36 -- - Forsum et al., 1992 22 0 60.8 13.5 22 1618 22 30 19 36 Goldberg et al., 1993 12 0 61.7 11.91 6 12 18 24 30 36 Kopp-Hoolihan et al., 1999 10 0 -- 11.6 810 2426 3436 aPhysical activity level = total energy expenditure/basal energy expenditure.
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Physical Activity. Theoretically, the energy cost of lactation could be met by a reduction in the time spent in physical activity or an increase in the efficiency of performing routine tasks.
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and their physical activity had returned to prepregnancy levels. While a decrease in moderate and discretionary activities appears to occur in most lactating women in the early postpartum period, activity patterns beyond this period are highly variable.
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. In general, during the first 6 months postpartum, well-nourished lactating women experience a mild, gradual weight loss, averaging 0.8 kg/mo (Butte et al.,
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. In some women, the energy costs of lactation may be met by an increase in energy intake or a decrease in physical activity, with no change or even an increase in weight or FM.
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Because adaptations in basal metabolism and physical activity are not evident in wellnourished women, energy requirements of lactating women are met partially by mobilization of tissue stores, but primarily from the diet. In the first 6 months postpartum, well-nourished lactating women experience an average weight loss of 0.8 kg/mo, which is equivalent to 170 kcal/d (6,500 kcal/kg)
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Instead, weight maintenance TEE values are discussed, along with information on the relationship between reduction in energy intake and change in body composition. Equations to predict TEE for all adults from age, height, weight, gender, and activity level were generated from the combined DLW database of normal, overweight, and obese individuals (Appendix Tables I-3 and I-7)
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) Where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be 1.0 < 1.4 (sedentary)
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) Where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be 1.0 < 1.4 (sedentary)
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based on body weight and height and the observed BEE in the DLW database. These differences (averages ± standard deviation [SD]
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) for a Body Mass Index (kg/m2)
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ENERGY 207 TEEc (kcal/d) for a Body Mass Index (kg/m2)
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For each year above 30, subtract 4 kcal/d from BEE and 10 kcal/d from TEE. Equations determined from combined DLW databases (Appendix Table I-11)
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of: 18.5 22.5 24.99 25 30 35 40 1,596 1,747 1,841 1,820 1,984 2,148 2,312 2,301 2,507 2,635 2,628 2,858 3,088 3,318 2,513 2,742 2,884 2,875 3,132 3,390 3,648 2,782 3,040 3,200 3,183 3,475 3,767 4,059 3,225 3,530 3,720 3,738 4,092 4,447 4,801 1,658 1,818 1,917 1,889 2,062 2,236 2,409 2,382 2,600 2,735 2,718 2,961 3,204 3,447 2,602 2,844 2,995 2,975 3,248 3,520 3,792 2,883 3,155 3,325 3,297 3,606 3,915 4,223 3,344 3,667 3,867 3,877 4,251 4,625 4,999 1,721 1,889 1,995 1,959 2,142 2,325 2,507 2,464 2,694 2,837 2,810 3,066 3,322 3,579 2,694 2,949 3,107 3,078 3,365 3,652 3,939 2,986 3,273 3,452 3,414 3,739 4,065 4,390 3,466 3,806 4,018 4,018 4,412 4,807 5,202 1,785 1,963 2,073 2,031 2,223 2,416 2,608 2,548 2,790 2,940 2,903 3,173 3,443 3,713 2,786 3,055 3,222 3,183 3,485 3,788 4,090 3,090 3,393 3,581 3,532 3,875 4,218 4,561 3,590 3,948 4,171 4,162 4,578 4,993 5,409 bPAL = physical activity level, BEE = basal energy expenditure. Weight Reduction in Overweight and Obese Adults When obese individuals need to lose weight, the necessary negative energy balance can theoretically be achieved by either a reduction in energy intake or an increase in energy expenditure of physical activity (EEPA)
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) for a Body Mass Index (kg/m2)
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ENERGY 211 TEE (kcal/d) for a Body Mass Index (kg/m2)
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. Several studies indicate that energy expenditure decreases when energy intake is less than TEE, with the result that weight loss is less than anticipated based on the reduction in energy intake.
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of: 18.5 22.5 24.99 25 30 35 40 1,398 1,490 1,596 1,586 1,725 1,865 2,004 2,015 2,106 2,211 2,239 2,416 2,593 2,769 2,239 2,341 2,459 2,529 2,731 2,932 3,133 2,519 2,634 2,769 2,799 3,023 3,247 3,472 2,855 2,987 3,141 3,172 3,428 3,684 3,940 1,448 1,545 1,657 1,645 1,792 1,940 2,087 2,083 2,179 2,290 2,322 2,509 2,695 2,882 2,315 2,422 2,548 2,624 2,836 3,049 3,262 2,605 2,727 2,869 2,904 3,141 3,378 3,615 2,954 3,093 3,255 3,292 3,562 3,833 4,103 1,499 1,601 1,719 1,706 1,861 2,016 2,171 2,151 2,253 2,371 2,406 2,603 2,800 2,996 2,392 2,505 2,637 2,720 2,944 3,168 3,393 2,693 2,821 2,971 3,011 3,261 3,511 3,760 3,053 3,200 3,371 3,414 3,699 3,984 4,270 1,550 1,657 1,782 1,767 1,931 2,094 2,258 2,221 2,328 2,452 2,492 2,699 2,906 3,113 2,470 2,589 2,729 2,817 3,053 3,290 3,526 2,781 2,917 3,074 3,119 3,383 3,646 3,909 3,154 3,309 3,489 3,538 3,838 4,139 4,439 b PAL = Physical activity level, BEE = basal energy expenditure. Role of Decreased Food Intake with or Without Increased Physical Activity There are also four underfeeding studies that have examined changes in TEE with negative energy balance achieved by a reduction in energy intake.
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By correcting the changes in TEE that can be attributed to the decrease in body size in the four underfeeding studies described in Table 5-31, 8.4 percent of the reduction in TEE was unaccounted for by weight loss and appears therefore to be associated with a state of negative energy balance. This could be due to a reduction in energy expenditure per kg body weight or to a decrease in physical activity.
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The coefficient of 16.6 kcal/kg of weight loss calculated from the data in Table 5-31 could be utilized to anticipate the reduction in energy intake required for maintaining lower body weights. Further studies in this area are needed.
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FIGURE 5-10 Comparison of body mass index (BMI) definitions of overweight and obesity during childhood with percentiles for BMI (85th, 95th, 97th)
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of the girls and had observed BEEs. The following predictive equations for BEE were derived from the observed BEEs provided in the DLW database (Appendix Table I-6)
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) Where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be 1.0 < 1.4 (sedentary)
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This lack of data makes it impossible to describe the relationship between change in energy intake and change in body energy for children in whom weight loss is indicated. However, if the negative energy balance is achieved by a reduction in energy intake alone, at least a 108 kcal/d decrease in energy intake (i.e., equivalent to the indicated loss of body energy)
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In adults, an abnormally low BMI is associated with decreased work capacity and limited voluntary physical activity. Additional Energy Requirements to Restore Normal Weight In an adult with a low BMI (less than 18.5 kg/m2)
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Under the controlled conditions of a clinical setting, undernourished children can exhibit rates of growth of 10 to 15 g/kg body weight/d (Fjeld et al., 1989) , which are tenfold higher than normal rates of weight gain at 1 year of age.
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. in the general population, the need to balance energy intake and expenditure over a wide range of body sizes, body compositions, and forms of exercise means that athletes will, in fact, require vastly different meal sizes and frequencies (e.g., female gymnasts compared to male American football linemen)
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ADVERSE EFFECTS OF OVERCONSUMPTION OF ENERGY Hazard Identification Adverse Effects Adaptation to High Levels of Energy Intake. The ability of healthy individuals to compensate for increases in energy intake by increasing energy expenditure (either for physical activity or resting metabolism)
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Summary Because of the direct impact of deviations from energy balance on body weight and of changes in body weight, body-weight data represent critical indicators of the adequacy of energy intake. Energy requirements are defined as the amounts of energy that need to be consumed by individuals to sustain stable body weights in the range desired for good health (BMI from 18.5 up to 25 kg/m2)
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· Factors affecting the energy intake required to satisfy nutrient requirements should be explored, including diet digestibility, viscosity, and energy and nutrient density. · Factors affecting the changes in TEE during pregnancy, as well as equations to predict the basal metabolic rate throughout pregnancy, are needed to better predict the energy requirements of nonobese, overweight, and obese pregnant women.
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226 DIETARY REFERENCE INTAKES TABLE 5-33 Body Mass Index (BMI) and Risk of Noninsulin-Dependent Diabetes Mellitus Length of Reference Country Study Population Follow-Up Westlund and Sweden 3,751 men, 4049 y 10 y Nicolaysen, 1972 Medalie et al., 1974 Israel 10,059 men, 40+ y 5 y Ohlson et al., 1985 Sweden 792 men, 54 y 13.5 y Despres et al., 1989 Canada 52 premenopausal Not obese women applicable Lundgren et al., 1989 Sweden 1,462 women, 3860 y 12 y Colditz et al., 1990 United States 113,861 women, 8 y 3055 y Haffner et al., 1991 United States 254 men and 8 y 366 women
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BMI, body fat mass BMI and body fat mass were significantly associated with plasma glucose and insulin BMI Significant correlation between initial BMI and incidence of diabetes during follow-up (p < 0.001)
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228 DIETARY REFERENCE INTAKES TABLE 5-33 Continued Length of Reference Country Study Population Follow-Up Chan et al., 1994 United States 27,983 men, 4075 y 5 y Ford et al., 1997 United States 8,545 adults 10 y aRR = relative risk, CI = confidence interval, OR = odds ratio, CVD = cardiovascular disease.
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35 42.1 (22.080.6) Weight gain since age 21 RR for diabetes (95% CI)
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230 DIETARY REFERENCE INTAKES TABLE 5-34 Body Mass Index (BMI) and Risk of Hypertension and Stroke Length of Reference Country Study Population Follow-Up Hypertension Ballantyne et al., UK 637 men and 835 women, Not 1978 mean 4549 y applicable Brennan et al., Australia 600 men and 400 women, Not 1980 2049 y applicable Criqui et al., 1982 United States 2,482 men and 2,298 Not women, 20+ y applicable MacMahon et al., Australia 5,550 men and women, Not 1984 2564 y applicable Brown et al., 2000 United States 16,681 adults, 20+ y Not applicable Stroke Walker et al., 1996 United States 28,643 men, 4075 y 5 y Rexrode et al., United States 116,759 women, 3055 y 16 y 1997 aRR = relative risk, OR = odds ratio.
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and women (p < 0.01) BMI BMI was significantly associated with diastolic and systolic blood pressure in both men and women BMI in men (kg/m2)
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232 DIETARY REFERENCE INTAKES TABLE 5-35 Body Mass Index (BMI) and Risk of Coronary Heart Disease Length of Reference Country Study Population Follow-Up Hubert et al., 1983 United States 2,252 men and 2,818 26 y women, 2862 y Willett et al., 1995 United States 115,818 women, 3055 y 14 y Rexrode et al., 2001 United States 16,164 men, 4084 y 9 y a RR = relative risk, CI = confidence interval.
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29 3.56 (2.964.29) Weight Gain from age 18 RR for coronary heart disease (95% CI)
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234 DIETARY REFERENCE INTAKES TABLE 5-36 Body Mass Index (BMI) and Risk of Gallbladder Disease Length of Reference Country Study Population Follow-Up Kato et al., 1992 United States 7,831 men, 45+ y 22 y Stampfer et al., 1992 United States 90,302 women, 3459 y 8 y Sahi et al., 1998 United States 16,785 men, 1524 y 61 y aRR = relative risk, CI = confidence interval.
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Rate ratio for gallbladder disease < 20.0 1.00 20.021.9 1.05 22.023.9 1.12 24.0 1.43 BMI change from baseline (kg/m2) Rate ratio for gallbladder disease 0.9 1.00 1.02.9 1.01 3.05.9 1.74 6.0 2.16 NOTE: BMI = kg/m2 unless noted otherwise.
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236 DIETARY REFERENCE INTAKES TABLE 5-37 Body Mass Index (BMI) and Risk of Osteoarthritis Length of Reference Country Study Population Follow-Up Felson et al., 1988 United States 1,420 adults, 6394 ~ 36 y at follow-up Hart and Spector, United 985 women, 4564 y Not 1993 Kingdom applicable Carman et al., 1994 United States 588 men and 688 23 y women, 5074 y at follow-up Hochberg et al., 1995 United States 465 men and 275 Not women, 40+ y applicable Cicuttini et al., 1996 United 658 women, Not Kingdom twins, 4869 y applicable aOR = odds ratio.
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ENERGY 237 Obesity Index Outcomea Metropolitan relative weight at Cumulative incidence rate of knee baseline osteoarthritis (n/n [%]
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From page 238... ...
238 DIETARY REFERENCE INTAKES TABLE 5-38 Body Mass Index (BMI) and Risk of Cancer Length of Reference Country Study Population Follow-Up Helmrich et al., United States, 1,185 women breast cancer ~ 3 y 1983 Canada, cases, median 52 y Israel 3,227 women controls, median 47 y Rosenberg et al., Canada 607 women breast cancer 4 yr 1990 cases, < 70 y 1,214 women controls Chu et al., 1991 United States 4,323 cases and Not 4,358 controls, applicable women, 2054 y Giovannucci et al., United States 47,723 men, 4075 y 6 y 1995 Giovannucci et al., United States 13,057 women, 4065 y 6 y 1996 Huang et al., 1997 United States 95,256 women, 3055 y 16 y aRR = relative risk, CI = confidence interval.
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29 1.50 (1.022.21) RR for breast cancer in postmenopausal women Weight gain from age 18 (95% CI)
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1990. Bone tissue and physical activity.
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From page 241... ...
1993. Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake.
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1997. Daily energy expendi ture and physical activity assessed by an activity diary in 374 randomly selected 15-year-old adolescents.
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2001. Energy requirements of lactating women derived from doubly labeled water and milk energy output.
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From page 244... ...
In: Van Es AJ, ed. Human Energy Metabolism: Physical Activity and Energy Expenditure Measurements in Epidemiological Research Based upon Direct and Indirect Calorimetry.
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1997. Physical activity and body composition in 10 year old French children: linkages with nutritional intake?
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1990. Effect of age on body composition and resting metabolic rate.
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1994a. Effects of increased energy intake and/or physical activity on energy expendi ture in young healthy men.
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1998b. Influence of sex, seasonality, ethnicity, and geographic location on the components of total energy expenditure in young children: Implications for energy requirements.
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1997. Are genetic determinants of weight gain modified by leisure-time physical activity?
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From page 250... ...
1998. Literacy and body fatness are associated with underreporting of energy intake in U.S.
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From page 251... ...
1992. Prospective study of clini cal gallbladder disease and its association with obesity, physical activity, and other factors.
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From page 252... ...
1997. Body fat and water changes during pregnancy in women with different body weight and weight gain.
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From page 253... ...
In: Bouchard C, Shephard RJ, Stephens T, eds. Physical Activity, Fitness, and Health.
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1995. Preschool physical activity level and change in body fatness in young children.
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From page 255... ...
1995. Energy expenditure, physical activity and basal metabolic rate of elderly subjects.
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1995. Physical activity, total energy expenditure, and food intake in grossly obese and normal weight women.
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From page 257... ...
1994. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults.
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1991. Dietary energy requirements of young adult men, determined by using the doubly labeled water method.
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From page 259... ...
1995. Dietary energy requirements of young and older women determined by using the doubly labeled water method.
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From page 260... ...
1994. Body mass index: Its relationship to basal metabolic rates and energy requirements.
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From page 261... ...
1986. Physical activity in relation to energy intake and body fat in 8- and 13-year-old children in Sweden.
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1986. Sea sonal variation in food intake, pattern of physical activity and change in body weight in a group of young adult Dutch women consuming self-selected diets.
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1995. Resting metabolic rate and diet-induced thermogenesis in young and elderly subjects: Relation ship with body composition, fat distribution, and physical activity level.
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1992. Spon taneous physical activity and obesity: Cross-sectional and longitudinal studies in Pima Indians.
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Key Terms
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