Research ArticleAbility of the Harris-Benedict formula to predict energy requirements differs with weight history and ethnicity
Introduction
Research involving human metabolism requires that subjects be tested in a weight-stable state to obtain accurate measurements. Therefore, study subjects should be maintained in a eucaloric state before metabolic testing. To accomplish this aim, basal energy requirements, or resting energy expenditure (REE), often are estimated using prediction formulas such as the Harris-Benedict (HB) formula [1]. This prediction formula takes into account sex, body weight, height, and age. The calculated REE must then be modified by an activity factor to predict total, free-living energy requirements. Activity factor adjustments for healthy adults often range from 1.2 (sedentary lifestyle) to 1.5 (moderately active) and are even further increased for very active subjects. Unfortunately, neither the HB formula nor other common formulas, such as the Food and Agriculture Organization/World Health Organization [2] or the Mifflin equation [3], consider weight history status (ie, overweight, weight reduced) or ethnicity, factors that are known to affect REE. Therefore, we felt it was crucial to reevaluate the validity of the HB formula in predicting REE and in estimating energy needs within a female healthy population with differing weight histories and ethnicities. This information is critical to nutrition research in understanding limitations in the accuracy of the HB formula and other predictive equations that do not take weight history status or ethnicity into account.
Body composition influences energy expenditure and, subsequently, may affect the predictive ability of the HB formula. Fat-free mass (FFM) is the largest determinant of basal energy expenditure. However, obese individuals have a lower REE than would be predicted using a formula simply containing weight, height, age, and sex because of a greater proportion of fat mass versus metabolically active FFM. Conversely, weight loss may result in a disproportionate loss of FFM, thereby resulting in an overestimation of REE for weight-reduced individuals. Fat-free mass can be largely maintained during weight loss if physical activity is included in the weight loss program [4]. However, subjects undergoing weight loss without exercise experience a loss of FFM as well as fat mass [5]. Therefore, the HB formula may not possess equal predictive ability among normal-weight individuals as compared with overweight individuals or those with differing histories of weight loss.
Ethnicity also influences REE and therefore may affect the predictive ability of the HB formula. Resting energy expenditure has been shown to be lower among African American (AA) versus white (W) women [6], [7], in part because of a lower amount of highly metabolically active trunk lean tissue mass [3], [8]. However, REE among AA remained lower than among W by an average of 565 kJ/d even after adjusting for differences in lean body mass [9], suggesting that ethnicity is associated with an unidentified factor that affects REE. These findings suggest that the HB formula, which was validated in a study population largely composed of W individuals, may overestimate REE in AA.
The objective of this study was to assess the effects of weight history status and ethnicity on the ability of the HB formula to (1) predict measured REE and (2) accurately estimate energy needs over a 2-week test period among never-overweight, overweight, and weight-reduced healthy, adult W and AA women. We hypothesized that the HB formula would overestimate REE in overweight and weight-reduced subjects relative to normal-weight subjects; that the HB formula would overestimate REE in AA relative to W subjects; and that, over 2 weeks of controlled feeding based on the HB formula, overweight/weight-reduced subjects and AA subjects would gain more weight than normal-weight subjects and W subjects, respectively.
Section snippets
Subjects
Data were collected from 217 women who participated in 2 research studies at the University of Alabama at Birmingham (UAB). Enrollment criteria included AA or W ethnicity by self-report, premenopausal status, aged 20 to 47 years, and a body mass index (BMI) ranging from 21 to 25 or 27 to 30 kg/m2. Subjects were nonsmokers, were sedentary (defined as exercising <1 time per week for the past year), were not using any medications that affected fatty acid or glucose metabolism, and reported normal
Results
The characteristics of the study population according to weight status are displayed in Table 1. Never-overweight and weight-reduced women were similar with respect to weight, BMI, and total fat (percentage), and were significantly different from the overweight group (P < .05 for all). The never-overweight and overweight women were significantly different with respect to total lean mass and limb lean mass (P < .05 for both), but neither group was significantly different from the weight-reduced
Discussion
The results of this study indicated that the ability of the HB formula to estimate REE differed with weight history status and ethnicity, such that it was less accurate among overweight women and AA women. In addition, the accuracy of the HB formula to predict free-living dietary energy needs, as reflected in weight change over 2 weeks, was affected by weight history status, such that it was less accurate among previously overweight women, regardless of ethnicity. These results suggest that
Acknowledgment
We express our gratitude to the UAB GCRC metabolic kitchen staff who packaged the meals for the study participants. We acknowledge the late Roland L Weinsier who was largely responsible for the study design. We appreciate the assistance of Gary Hunter. This study was supported by NIH grants R01-DK49779 and R01-DK51684, GCRC grant M01-RR00032, and Clinical Nutrition Research Center grant P30-DK-56336. Nestlé Food Co (Solon, Ohio) generously supplied Stouffer's Lean Cuisine entrées. Weight
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