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Total energy expenditure in adults with cerebral palsy as assessed by doubly labeled water
R K Johnson1, H G Hildreth, S H Contompasis
1Department of Nutritional Sciences, University of Vermont, Burlington 05405, USA.
Objectives:
To characterize total energy expenditure (TEE) in free-living adults with cerebral palsy (CP) using the doubly labeled water technique, and to determine those physiologic variables and characteristics of CP that were markers of TEE in adults with CP.
Design:
TEE was measured using the doubly labeled water technique in 30 free-living adults with CP (12 women, 18 men). To determine the best markers of TEE, the following factors were examined: CP status, resting metabolic rate (RMR), anthropometric characteristics and body composition by means of dual-energy x-ray absorptiometry (DXA) and skinfold thickness measurements, energy cost of leisure-time activities, and oral-motor impairment.
Statistical Analysis:
Means +/- standard deviations, t tests, Pearson product-moment correlation coefficients, Spearman rank correlation coefficients, chi 2, stepwise multiple-correlation regression analysis, and analysis of covariance were used to examine the relationships among variables of interest.
Results:
TEE was highly variable in the sample (mean = 2,455 +/- 622 kcal/day for men and 1,986 +/- 363 kcal/day for women). Stepwise regression analysis showed that TEE was best predicted in the sample by RMR, percentage body fat determined by DXA, ambulation status, and sex (multiple R = .68, P = .003). When practical, easily measured variables were used, TEE was best predicted by height, ambulation status, percentage body fat by skinfold thickness measurements, and sex (multiple R = .61, P. = 018). The contribution of energy expended in physical activity to TEE was significantly higher in the ambulatory subjects than the nonambulatory subjects (25% vs 16%, respectively; P = .009).
Applications:
The high degree of variability in TEE, largely attributable to high interindividual variation in energy expended in physical activity, makes it difficult to provide general guidelines for energy requirements for adults with CP. Because ambulation status was an important predictor of TEE, it must be accounted for in estimating energy requirements in this population.