Boys Girls

ENERGY 217

Rapid weight loss is undesirable in children due to the risks of stunting and micronutrient deficiencies. In addition, children under 2 years of age should not be placed on energy-restricted diets out of concern that brain development may inadvertently be compromised by inadequate dietary intake of fatty acids and micronutrients. A recent expert pediatric committee recommended that weight maintenance be the goal for most children over 2 years of age in the 85th to 95th percentiles for BMI (Barlow and Dietz, 1998). In addition, the committee recommended that weight loss be at a rate of 1 lb/mo for children over 7 years of age at or greater than the 95th percentile BMI and for children between the 85th and 95th percentiles who have comorbidities that would be anticipated to be improved by weight loss.

Separate TEE predictive equations were developed from the DLW data for 3- through 18-year-old overweight and obese boys and girls (Appendix Table I-6) from age, height, weight, and PAL categories using nonlinear regression techniques. In order to utilize all the TEE data, PAL categorization was determined using predicted BEE rather than observed BEE, since only 67 percent (85/127) of the boys and 64 percent (123/192) of the girls and had observed BEEs. The following predictive equations for BEE were derived from the observed BEEs provided in the DLW database (Appendix Table I-6).

For overweight and obese boys: BEE (kcal/d) = 420 - 33.5 age (y) + 418.9 x height (m) + 16.7 weight (kg)

For overweight and obese girls: BEE (kcal/d) = 516 - (26.8 x age [y]) + 347 height (m) + 12.4 weight (kg)

For normal-weight, overweight, and obese boys: BEE (kcal/d) = 79 - 934.2 x age [y]) + 730 x height (m) + 15.3 weight (kg)

For normal-weight, overweight, and obese girls: BEE (kcal/d) = 322 - 926.0 x age [y]) + 504 x height (m) + 11.6 weight (kg)

218 DIETARY REFERENCE INTAKES

Prediction equations of TEE for overweight and obese girls and boys were developed using age, height, weight, and PAL category as predicted from the above BEE equations. Data were not used in the derivation of the TEE equations if the PAL value was less than 1.0 or greater than 2.5. In addition, TEE predictive equations were developed combining normal-weight, overweight, and obese children. The coefficients and SE for boys and girls in the overweight and obese database (Appendix Table I-6) are provided in Appendix Table I-12. Mean of the residuals did not differ from zero, and the standard deviation of the residuals ranged from 74 to 213. The coefficients and SE for boys and girls in the combined normal-weight, overweight, and obese database are described in Appendix Table I-13. The mean of the residuals did not differ from zero and the standard deviation of the residuals ranged from 73 to 208.

The children's predictive equations for TEE were subjected to statistical testing of their estimated coefficients and asymptotic standard deviations using a chi-square distribution (Hotelling T-squared test). The specific equation for the overweight and obese boys was statistically different from the equation derived solely from normal-weight boys (P > 0.032), and tended to differ from the combined equation derived from normal, overweight, and obese boys (P = 0.086). The specific equation for the overweight and obese girls was statistically different from the equation derived solely from normal-weight girls (P > 0.001), but not from the combined equation derived from normal, overweight, and obese girls (P = 0.99). The equations for the normal-weight boys and girls differed from the combined equation (P = 0.001).

Despite the suggestion of differences in the predictive equations for the TEE of boys, and because of the larger sample size, reduced SEs of the coefficients and increased stability, and consistency between the genders, the prediction equations for TEE based on the combined database are recommended for use in overweight and obese children for weight maintenance—they do not include growth. (See Table I-13 for coefficients used in the equations.)

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