肥胖儿童静息能量消耗的初步研究

Resting energy expenditure of obese children： a preliminary study

目的应用能量代谢仪测定肥胖儿童的静息能量消耗情况，以探讨安静状态下代谢水平与儿童肥胖的关系，同时比较各预测公式的准确性。方法选取2014年7月至2015年9月在本院儿童保健科就诊的年龄在7—14周岁的儿童。应用间接测热法测静息能量消耗，应用生物电阻抗法测体脂、去脂体质量等体成分。以预测公式值与实测值误差在±10％之内为可以接受的“准确”，超过10％为“高估”，低于10％为“低估”。结果共纳入研究对象72例，其中超重／肥胖组42例，平均年龄（10．4±1．7）岁，体质量指数（24．76±3．16）kg／m。；对照组共30例，平均年龄（10．4±2．0）岁，体质量指数（15．07±2．11）kg／m。。静息能量消耗以kJ／（kg·d）表示，校正性别、年龄的影响因素后肥胖组儿童每天静息能量消耗[（116．45±20．46）kJ／（kg·d）]明显低于对照组[（138．49±38．77）kJ／（kg·d）]（P=0．000）。各预测公式准确性尚无一致性定论，研究对象实测值与Harris-Benedict、Schofield、WHO、Mifflin、Cunningham、Liu、Jia公式完全符合的准确率分别为50％、47．6％、42．9％、47．6％、33．3％、42．9％、40．5％。结论肥胖儿童静息能量消耗低于正常儿童，与间接测热法比较，各预测公式准确性均较差。

Objective To study the relationship between metabolic rate at rest and obesity in children by measuring resting energy expenditure （REE） in obese children using metabolic cart, and to evaluate the accuracy of different equations in predicting resting energy expenditure. Methods Children aged 7 - 14 years visiting De- partment of Children Health Care in Nanjing Children＇s Hospital between July 2014 and September 2015 were di- vided into obese and nonobese （control） group according to their body mass index （BMI） for age and gender. REE was measured using indirect calorimeter （IC）, and body fat, fat-free mass were measured using bioelectrical impedance analysis. Predicted energy expenditure （pEE） estimated using the commonly published predictive equations were compared with the measured REE for each subject and evaluated as ＂acceptably accurate＂ if the error was within ＋ 10%, ＂over-estimated＂ if more than 10% higher, and ＂under-estimated＂ if more than 10% lower. Results A total of 72 children were recruited, including 42 in the obese group [ BMI （24. 76±3. 16） kg/m2, age （10.4±1.7） years] and 30 in the control group [BMI （15.07±2. 11） kg/m2, age （10.4 ± 2. 0） years ]. After controlling for gender and age, the REE in the obese group [ （ 116. 45± 20. 46） kJ/（ kg · d） ] was lower than that in the control group [ （ 138.49±38. 77） k J/（ kg · d） ] （P = 0. 000）. The mean accuracy of pEE compared to measured REE varied aeross the different predictive equations. The accuracy of Harris-Bene- dict, Sehofield, WHO, Mifflin, Cunningham, Liu, and Jia equations were 50%, 47.6%, 42.9%, 47.6%, 33. 3%, 42. 9%, and 40. 5%, respeetively. Conclusions Obese ehildren have a lower resting energy expenditure compared with non-obese children. The aceuracy of predictive equations is generally poor compared to IC.