Estimation of energy expenditure using prediction equations in overweight and obese adults: a systematic review

BackgroundEstimates of energy requirements are needed in weight management and are usually determined using prediction equations. The objective of these two systematic reviews was to identify which equations based on simple anthropometric and demographic variables provide the most accurate and precise estimates of (1) resting energy expenditure (REE) and (2) total energy expenditure (TEE) in healthy obese adults. MethodsSystematic searches for relevant studies in healthy adults with body mass index (BMI) 25kgm(-2) and published in English were undertaken using Cinahl, Cochrane Library, OpenGrey, PubMed and Web of Science (completed March 2014). Search terms included metabolism, calorimetry, obesity and prediction equations. Data extraction, study appraisal and synthesis followed guidelines from PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). ResultsFrom 243 REE papers and 254 TEE papers identified, 21 and four studies, respectively, met the inclusion criteria. (1) The most accurate REE predictions varied with BMI subgroup: WHO (weight and height) 25 and 30kgm(-2); Mifflin 30-39.9kgm(-2); Henry 40kgm(-2). The most precise REE predictions were obtained using Mifflin in BMI 30-39.9 and 40kgm(-2), where approximately 75% of predictions were within 10% ofmeasured REE. (2) No accurate or precise predictions of TEE were identified. ConclusionsNo single prediction equationprovides accurate and precise REE estimates in all obese adults. Mifflin equations are recommended in this population, although errors exceed 10% in 25% of those assessed. There is no evidence to support the use of prediction equations in estimating TEE in obesity.