The dietary energy needs of older adults: Comparison with predictive equations

摘要

Background: Accurate estimates of food energy requirements inform dietetic practice and nutritional guidelines. Aim: To determine the optimal method of predicting total energy expenditure (TEE) in adults aged >=65 years through 1) determining which resting metabolic rate (RMR) equations best reflect measured RMR and 2) using these equations to calculate TEE and determining the agreement with TEE measured by doubly labelled water (DLW). Methods: We established an international database comprising of 31 studies of healthy, ambulatory adults aged >=65 years (988 participant level RMR data and 1488 participant level TEE data) to enable comparison with 17 predictive equations. Bland-Altman plots assessed agreement between measured RMR and TEE with predicted RMR and TEE in adults aged >=65 years. Results: The Ikeda, Livingston and Mifflin equations showed closest agreement with measured RMR and TEE. In adults aged >=65 years, the Ikeda and Livingston equations overestimated TEE by a mean ± SD of 175 ± 1362 kJ/d and 86 ± 1344 kJ/d. The Mifflin equation underestimated TEE by 24 ± 1401 kJ/d. Proportional bias was present with increasing energy expenditure. Commonly cited equations (Schofield and Harris-Benedict) showed proportional bias and overestimated RMR. Conclusions: It is recommended that the Ikeda, Livingston and Mifflin equations are used to estimate energy requirements for older adults. Future research should focus on the development of equations to meet the energy requirements of older adults with considerations given to body composition and functional measures.