Agreement between the total energy expenditure calculated with accelerometry data and the BMR yielded by predictive equations v. the total energy expenditure obtained with doubly labelled water in low-income women with excess weight

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Abstract
Low-income women are the group with the highest levels of obesity worldwide. In low-income settings, the use of predictive equations, which yield a measure of the individuals’ BMR, is a feasible approach to estimate the individuals’ total energy expenditure (TEE), using the factorial method (calculated-TEE = BMR × physical activity level), an important step of the obesity nutritional care. The present study aimed to identify the predictive equation that, in conjunction with metabolic equivalents of tasks (MET) data from accelerometers, yields the calculated-TEE with better agreement compared with the TEE measured by doubly labelled water (TEE-DLW). Forty-five women aged 19–45 years, with excess weight and mothers of undernourished children, were included. They received DLW to determine TEE (14 d); at the same time, they used triaxial accelerometers (7 d) to estimate their MET. The Bland–Altman method, paired-sample t tests, concordance correlation coefficient and root-mean-square error were used to assess the agreement. Maximum allowed differences were defined as 24 %, based on the within-variance coefficient of the energy intake of the sample. Eleven equations were studied. The calculated-TEE obtained by five equations showed non-significant bias: Dietary Reference Intake (Institute of Medicine (2005) Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids), FAO/WHO/UNU ((2001) Food and Nutrition Technical Report Series), Harris & Benedict ((1919) Proc Natl Acad Sci USA4, 370–373), Henry & Rees ((1991) Eur J Clin Nutr45, 177–185) and Schofield ((1985) Hum Nutr Clin Nutr39, 5–41). The mean percentage differences were –1·5, –0·8, 2·2, –2·2 and 2·0 %, respectively. Considering all parameters, FAO/WHO/UNU ((2001) Food and Nutrition Technical Report Series) equation performed slightly better than the others; nevertheless, no equation in conjunction with the estimated-MET showed a calculated-TEE with its CI for the Bland–Altman limits of agreement inside the pre-defined acceptable range.

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