Skip to main content
Top
Published in: Obesity Surgery 8/2012

01-08-2012 | Clinical Research

Metabolic Profile of Clinically Severe Obese Patients

Authors: Silvia Leite Faria, Orlando Pereira Faria, Caroline Soares Menezes, Heloisa Rodrigues de Gouvêa, Mariane de Almeida Cardeal

Published in: Obesity Surgery | Issue 8/2012

Login to get access

Abstract

Background

Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition.

Methods

We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris–Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin–St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables.

Results

Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p < 0.0001). A positive correlation between fat-free mass and a negative correlation between body fat percentage and BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC.

Conclusions

The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.
Literature
1.
go back to reference Hurt RT, Kulisek C, Buchanan LA, et al. The obesity epidemic: challenges, health initiatives, and implications for gastroenterologists. Gastroenterol Hepatol. 2010;6(12):780–2. Hurt RT, Kulisek C, Buchanan LA, et al. The obesity epidemic: challenges, health initiatives, and implications for gastroenterologists. Gastroenterol Hepatol. 2010;6(12):780–2.
2.
go back to reference WHO. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO; 2003. WHO. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO; 2003.
3.
go back to reference Wandell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes. 2009;33:577–82.CrossRef Wandell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes. 2009;33:577–82.CrossRef
4.
go back to reference Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995;332:621–8.PubMedCrossRef Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995;332:621–8.PubMedCrossRef
5.
go back to reference Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16:1602–8.PubMedCrossRef Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16:1602–8.PubMedCrossRef
6.
go back to reference Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19:856–9.PubMedCrossRef Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19:856–9.PubMedCrossRef
7.
go back to reference Cunningham JJ. Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr. 1991;54:963–9.PubMed Cunningham JJ. Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr. 1991;54:963–9.PubMed
8.
go back to reference Feurer ID, Crosby LO, Mullen JL. Measured and predicted resting energy expenditure in clinically stable patients. Clin Nufr. 1984;3:27–34.CrossRef Feurer ID, Crosby LO, Mullen JL. Measured and predicted resting energy expenditure in clinically stable patients. Clin Nufr. 1984;3:27–34.CrossRef
10.
go back to reference Foreaux G, Pinto KMC, Dâmaso A. Efeito do consumo excessivo de oxigênio após exercício e da taxa metabólica de repouso no gasto energético. Rev Bras Med Esporte. 2006;12:393–8.CrossRef Foreaux G, Pinto KMC, Dâmaso A. Efeito do consumo excessivo de oxigênio após exercício e da taxa metabólica de repouso no gasto energético. Rev Bras Med Esporte. 2006;12:393–8.CrossRef
11.
go back to reference Javed F, He Q, Davidson LE, et al. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr. 2010;91:907–12.PubMedCrossRef Javed F, He Q, Davidson LE, et al. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr. 2010;91:907–12.PubMedCrossRef
12.
go back to reference Mifflin MD. St Jeor ST, Hill LA, et al. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:241–7.PubMed Mifflin MD. St Jeor ST, Hill LA, et al. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:241–7.PubMed
13.
go back to reference Johnstone AM, Murison SD, Duncan JS, et al. Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine1. Am J Clin Nut. 2005;82:941–8. Johnstone AM, Murison SD, Duncan JS, et al. Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine1. Am J Clin Nut. 2005;82:941–8.
14.
go back to reference Lazzer S, Boirie Y, Bitar A, et al. Assessment of energy expenditure associated with physical activities in free-living obese and nonobese adolescents. Am J Clin Nutr. 2003;78:471–9.PubMed Lazzer S, Boirie Y, Bitar A, et al. Assessment of energy expenditure associated with physical activities in free-living obese and nonobese adolescents. Am J Clin Nutr. 2003;78:471–9.PubMed
15.
go back to reference Nelson KM, Weinsier RL, Long CL, et al. Prediction of resting energy expenditure from fat-free mass and fat mass. Am J Clin Nutr. 1992;56:848–56.PubMed Nelson KM, Weinsier RL, Long CL, et al. Prediction of resting energy expenditure from fat-free mass and fat mass. Am J Clin Nutr. 1992;56:848–56.PubMed
16.
go back to reference Bosy-Westphal A. Grade of adiposity affects the impact of fat mass on resting energy expenditure in women. Br J Nutr. 2009;101:474–7.PubMedCrossRef Bosy-Westphal A. Grade of adiposity affects the impact of fat mass on resting energy expenditure in women. Br J Nutr. 2009;101:474–7.PubMedCrossRef
17.
go back to reference Armellini F, Robbi R, Zamboni M, et al. Resting metabolic rate, body-fat distribution, and visceral fat in obese women. Am J Ch Nutr. 1992;56:981–7. Armellini F, Robbi R, Zamboni M, et al. Resting metabolic rate, body-fat distribution, and visceral fat in obese women. Am J Ch Nutr. 1992;56:981–7.
18.
go back to reference Buffington CK, Cowan Jr GS, Scruggs D, et al. The effects of fat distribution on resting energy expenditure in premenopausal morbidly obese females. Obes Surg. 1995;5:11–7.PubMedCrossRef Buffington CK, Cowan Jr GS, Scruggs D, et al. The effects of fat distribution on resting energy expenditure in premenopausal morbidly obese females. Obes Surg. 1995;5:11–7.PubMedCrossRef
19.
go back to reference St-Onge MP, Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010;26(2):152–5.PubMedCrossRef St-Onge MP, Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010;26(2):152–5.PubMedCrossRef
20.
go back to reference Lazzer S, Bedogni G, Lafortuna CL, et al. Relationship between basal metabolic rate, gender, age, and body composition in 8780 white obese subjects. Obesity. 2010;18(1):71–8.PubMedCrossRef Lazzer S, Bedogni G, Lafortuna CL, et al. Relationship between basal metabolic rate, gender, age, and body composition in 8780 white obese subjects. Obesity. 2010;18(1):71–8.PubMedCrossRef
21.
go back to reference Dobratz JR, Sibley SD, Beckman TR, et al. Predicting energy expenditure in extremely obese women. J Parent Enteral Nutr. 2007;31(3):217–27.CrossRef Dobratz JR, Sibley SD, Beckman TR, et al. Predicting energy expenditure in extremely obese women. J Parent Enteral Nutr. 2007;31(3):217–27.CrossRef
22.
go back to reference Breen HB, Ireton-Jones CS. Predicting energy needs in obese patients. Nutr Clin Pract. 2004;19:284–9.PubMedCrossRef Breen HB, Ireton-Jones CS. Predicting energy needs in obese patients. Nutr Clin Pract. 2004;19:284–9.PubMedCrossRef
23.
go back to reference Hagedorn T, Savina C, Coletti C, et al. Calorimetry in obese women: comparison of two different operating indirect calorimeters together with the predictive equation of Harris and Benedict. Mediterr J Nutr Metab. 2010;4(2):117–25.CrossRef Hagedorn T, Savina C, Coletti C, et al. Calorimetry in obese women: comparison of two different operating indirect calorimeters together with the predictive equation of Harris and Benedict. Mediterr J Nutr Metab. 2010;4(2):117–25.CrossRef
24.
go back to reference Harris JA, Benedict FG. A biometric study of basal metabolism in men. Carnegie Inst. 1919;279(3):48–9. Harris JA, Benedict FG. A biometric study of basal metabolism in men. Carnegie Inst. 1919;279(3):48–9.
25.
go back to reference Cunninghan JJ. A reanalysis of the factors influencing basal metabolic rate in normal adults. Am J Clin Nutr. 1980;33:2372–4. Cunninghan JJ. A reanalysis of the factors influencing basal metabolic rate in normal adults. Am J Clin Nutr. 1980;33:2372–4.
26.
go back to reference Horie LM, Gonzalez MC, Torrinhas RS, et al. New specific equation to estimate resting energy expenditure in severely obese patients. Obesity. 2011;19(5):1090–4.PubMedCrossRef Horie LM, Gonzalez MC, Torrinhas RS, et al. New specific equation to estimate resting energy expenditure in severely obese patients. Obesity. 2011;19(5):1090–4.PubMedCrossRef
27.
go back to reference Bobbioni-Harsch E, Morel P, Huber O, et al. Energy economy hampers body weight loss after gastric bypass. J Clin Endocrinol Metab. 2000;85:4695–700.PubMedCrossRef Bobbioni-Harsch E, Morel P, Huber O, et al. Energy economy hampers body weight loss after gastric bypass. J Clin Endocrinol Metab. 2000;85:4695–700.PubMedCrossRef
28.
go back to reference Astrup A, Gøtzsche PC, Van WK, et al. Meta-analysis of resting metabolic rate in formerly obese subjects. Am J Clin Nutr. 1999;69:1117–22.PubMed Astrup A, Gøtzsche PC, Van WK, et al. Meta-analysis of resting metabolic rate in formerly obese subjects. Am J Clin Nutr. 1999;69:1117–22.PubMed
29.
go back to reference Ravussin E, Lillioja S, Knowler WC, et al. Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med. 1988;318:467–72.PubMedCrossRef Ravussin E, Lillioja S, Knowler WC, et al. Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med. 1988;318:467–72.PubMedCrossRef
30.
go back to reference Weyer C, Snitker S, Bogardus C, et al. Energy metabolism in African Americans: potential risk factors for obesity. Am J Clin Nutr. 1999;70:13–20.PubMed Weyer C, Snitker S, Bogardus C, et al. Energy metabolism in African Americans: potential risk factors for obesity. Am J Clin Nutr. 1999;70:13–20.PubMed
31.
go back to reference Das K, Saltzman E, McCrory MA, et al. Energy expenditure is very high in extremely obese women. J Nutr. 2004;134:1412–6.PubMed Das K, Saltzman E, McCrory MA, et al. Energy expenditure is very high in extremely obese women. J Nutr. 2004;134:1412–6.PubMed
32.
go back to reference Kaiyala KJ, Schwartz MW. Toward a more complete (and less controversial) understanding of energy expenditure and its role in obesity pathogenesis. Diabetes. 2011;60(1):17–23.PubMedCrossRef Kaiyala KJ, Schwartz MW. Toward a more complete (and less controversial) understanding of energy expenditure and its role in obesity pathogenesis. Diabetes. 2011;60(1):17–23.PubMedCrossRef
33.
go back to reference De Lorenzo A, Tagliabue A, Andreoli A, et al. Measured and predicted resting metabolic rate in Italian males and females, aged 18–59 y. Eur J Clin Nutr. 2001;55:208–14.PubMedCrossRef De Lorenzo A, Tagliabue A, Andreoli A, et al. Measured and predicted resting metabolic rate in Italian males and females, aged 18–59 y. Eur J Clin Nutr. 2001;55:208–14.PubMedCrossRef
34.
go back to reference Flatt JP. Body composition, respiratory quotient, and weight maintenance. Am J Clin Nutr. 1995;62(5 suppl):1107S–17S.PubMed Flatt JP. Body composition, respiratory quotient, and weight maintenance. Am J Clin Nutr. 1995;62(5 suppl):1107S–17S.PubMed
35.
go back to reference Carrasco F, Papapietro K, Csendes A, et al. Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass. Obes Surg. 2007;17:608–16.PubMedCrossRef Carrasco F, Papapietro K, Csendes A, et al. Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass. Obes Surg. 2007;17:608–16.PubMedCrossRef
36.
go back to reference Frankenfield D, Roth-Yousey L, Compher C. Comparison of predictive equations for resting metabolic rate in healthy nonobese and adults: a systematic review. J Am Diet Assoc. 2005;105:775–9.PubMedCrossRef Frankenfield D, Roth-Yousey L, Compher C. Comparison of predictive equations for resting metabolic rate in healthy nonobese and adults: a systematic review. J Am Diet Assoc. 2005;105:775–9.PubMedCrossRef
37.
go back to reference Carrasco F, Rojas P, Ruz M, et al. Agreement between measured and calculated by predictive formulas resting energy expenditure in severe and morbid obese women. Nutr Hosp. 2007;22(4):410–6.PubMed Carrasco F, Rojas P, Ruz M, et al. Agreement between measured and calculated by predictive formulas resting energy expenditure in severe and morbid obese women. Nutr Hosp. 2007;22(4):410–6.PubMed
38.
go back to reference Weijs PJ. Validity of predictive equations for resting energy expenditure in US and Dutch overweight and obese class I and II adults aged 18–65 y. Am J Clin Nutr. 2008;88:959–70.PubMed Weijs PJ. Validity of predictive equations for resting energy expenditure in US and Dutch overweight and obese class I and II adults aged 18–65 y. Am J Clin Nutr. 2008;88:959–70.PubMed
39.
go back to reference Feurer ID, Crosby LO, Buzby GP, et al. Resting energy expenditure in morbid obesity. Ann Surg. 1983;197:17–21.PubMed Feurer ID, Crosby LO, Buzby GP, et al. Resting energy expenditure in morbid obesity. Ann Surg. 1983;197:17–21.PubMed
40.
go back to reference Gougeon R, Lamarche M, Yale J-F, et al. The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia. Int J Obes. 2002;26:1547–55.CrossRef Gougeon R, Lamarche M, Yale J-F, et al. The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia. Int J Obes. 2002;26:1547–55.CrossRef
41.
go back to reference Frankenfield DC, Rowe WA, Smith JS, et al. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc. 2003;103:1152–9.PubMedCrossRef Frankenfield DC, Rowe WA, Smith JS, et al. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc. 2003;103:1152–9.PubMedCrossRef
42.
go back to reference Livingston HE, Kohlstadt I. Simplified resting metabolic rate—predicting formulas for normal-sized and obese individuals. Obes Res. 2005;13:1255–62.PubMedCrossRef Livingston HE, Kohlstadt I. Simplified resting metabolic rate—predicting formulas for normal-sized and obese individuals. Obes Res. 2005;13:1255–62.PubMedCrossRef
Metadata
Title
Metabolic Profile of Clinically Severe Obese Patients
Authors
Silvia Leite Faria
Orlando Pereira Faria
Caroline Soares Menezes
Heloisa Rodrigues de Gouvêa
Mariane de Almeida Cardeal
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 8/2012
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0651-y

Other articles of this Issue 8/2012

Obesity Surgery 8/2012 Go to the issue