Measuring energy expenditure in community-dwelling older adults: are portable methods valid and acceptable?

The objective of this study was to assess the validity and acceptability of a handheld indirect calorimeter for measurement of resting energy expenditure in a sample of community-dwelling older adults. It was a measurement study involving 48 healthy community-dwelling older adults. Assessment of resting energy expenditure was performed in 48 healthy older adults under fasting conditions using the Europa Gas Exchange Monitor (GEM; ventilated hood indirect calorimeter, NutrEn Technology Ltd, Cheshire, UK) and the MedGem (handheld indirect calorimeter, HealtheTech Inc, Golden, CO). An eight-item self-administered survey was used to determine the acceptability of the two measurement devices. Bias and limits of agreement were calculated to determine the level of agreement between the two measurements. The Wilcoxon signed-ranks test was used to test for significant differences across items of the self-administered survey. Participants mean age was 80 years and mean body mass index (calculated as kg/m(2)) was 23. Mean (95% confidence interval) resting energy expenditure was 1,149 kcal/day (1,086, 1,194) and 1,489 kcal/day (1,386, 1,592) for the traditional and handheld indirect calorimeter, respectively; paired t test P<0.001. Mean bias and limits of agreement were 349 kcal (-270, 969) or 5 kcal/kg/day (-3.6, 13.2) with least products regression resulting in a slope of b(1)=1.9 (95% confidence interval 1.2, 2.7, P<0.05). The handheld indirect calorimeter was less acceptable to participants than the ventilated hood indirect calorimeter. Measurement of resting energy expenditure from the handheld indirect calorimeter used in this study is not acceptable for use in healthy older adults given the magnitude of the overestimate, the wide limits of agreement, the significant slope of the bias, and the discomfort experienced by the participants.